, Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 82, No. 4, Supplement 5 8 doi:10.1093/jurban/jti137 . . . ""The Author 2005. Published by Oxford University Pres~ o.n behalf of t~e New York Academy of Medicine. All nghts reserved. for permissions, please e-mail: journals.perm1ss1ons@oxford1ournals.org

SECTION 11: POSTER SESSIONS

CONCEPTUALIZING AND MEASURING SOCIAL JUSTICE

Pl-0 t (A) A Critical Race Theory Perspective of Tobacco-Related Health Inequalities for African Americans

Pamela Jones

African Americans experience the greatest amount of tobacco related health disparities. Recent tobacco control programs have not closed the gap in disparities for African Americans. This poster see~s to pr~vide a theoretical framework for addressing the health inequities in tobacco among African Americans usmg the work of critical race theorists Richard Delgado and Kimberlie Crenshaw. Critical race theory has been used predominately in the legal and education arenas, but has broad implications for addressing health inequities that exist among African Americans. Applying critical race theory to tobacco use, the author will argue that: I) public health interventions should not exist in class bound areas; 2) that colorblind approaches to public health increase health disparities; and 3) public health interventions should be developed for specific commu­nities of color. This poster will provide an overview of critical race theory, apply the theory to health, and provide implications for public health practitioners and clinicians within the tobacco control arena.

Pt-02 (A) Using Perinatal Periods of Risk to Measure Social Justice Magda Peck, Jennifer Skala, and Amy Johnson

Introduction: Infant mortality rates (IMR) increased in 2000 for the first time in nearly 50 years. Urban public health agencies and community-driven prevention initiatives rely on traditional data meth· ods for assessment and program/policy development to address this disproportionately urban challenge. Disparities commonly are defined by race; success is when black infant survival equals whites. With increasing IMR including among whites, urban communities are asking: Is eliminating the Black-White gaps" ufficient? What new approaches are available?

Methods: Dedicated to urban women and children's health, CityMatCH has worked with the CDC and other partners since 1997 to validate, apply and evaluate the Perinatal Periods of Risk Approach (PPOR) as a community-based means for measuring perinatal health. PPOR's six steps integrate commu· nity participation with fresh data methods and translation strategies. Phase I analyses examine feto-infant mortality (FIM) by age at death and birthweight; communities sort their FIM problem into four "periods of risk." Local FIM rates overall and in each domain are compared with a reference group - selected in part· nership with the community - of infants with current optimal outcomes to yield rate differences and esti· mate excess deaths based on the justice question: why can't all our babies experience best outcomes like some already are? This 'opportunity gap' is the driver of targeted community-based inquiry using a mix of Phase II analytic methods (e.g. cause of death, fetal-infant mortality review, Kitagawa analyses, health systems review). Community-driven solutions are based on new understanding of perinatal data.

Results: PPOR was piloted in 14 U.S. cities (2000-2002) through a practice collaborative; community action teams from I 0 cities (2002-2004) further translated PPOR findings into targeted interventions to

improve women and infants' health. All cities found widest opportunity gaps and greatest excess deaths in the Maternal Health/Prematurity (1500g >28days). Very low birthweight (VLBW) accounted for 23-74% of overall estimated excess deaths. IMR in all cities and nationwide FIM rates and excess deaths were high· est among African Americans, driven by birthweight distribution and later non-VLBW infant deaths. Understanding the distribution of excess deaths and underlying causes empowered several urban communi· ties to shift focus to preconception health and target SIDS prevention to communities of color.

Conclusion: Reframing IMR and its disparities in terms of social justice through PPOR is empower· ing cities to better understand local complexities, target subsequent investigations, and shift emphasis to women's health prior to pregnancy.

Pt-03 (A) Measurement of Socioeconomic Status of Immigrants to Canada Farah Mawani

l1ftrod11ctiolf: There are a number of important reasons for focusing on the measurement of socio· economic status among immigrants to Canada. First, Canada accepts proportionately more immigrants

Y50

POSTER SESSIONS v51

and refugees than any other country. Second, immigrants experience the well-documented 'healthy immi­

grant effect', whereby due to stringent selection criteria, immigrants are healthier than Canadian-born

individuals when they arrive in Canada. Their health status declines over their time living in Canada to

match that of the Canadian-born, indicating the influence of changes in their social environment. Third,

there has been a dramatic decline in the economic status of immigrants and refugees in Canada over the

past twenty years. Rates of unemployment, underemployment and poverty have increased for immigrant

individuals and families during that time period at the same time that immigrant education levels have

increased. Methods: This paper provides an overview of the socioeconomic profile of immigrants to Canada

and examines the utility of current SES measures for immigrants in an attempt to elucidate more relevant

merhods of measuring SES of immigrants.

Results: Given chat there are no longer positive correlations between recent immigrants' levels of

education and their occupation and income levels, measuring SES either using an aggregate measure or

via single indicators poses problems. It is inaccurate to use an aggregate measure if the occupation and

income levels of immigrants do not correspond to their education levels. It would also be inaccurate,

however, to use a single indicator that does not reflect the entirety or the complexity of the situation.

Three main elements need to be considered in measuring the SES of Canadian immigrants. First, the

potential negative correlations between immigrant education level and occupation and income should be

incorporated. Second, change in immigrant SES upon migration to Canada and over time in Canada

should be measured. Third, SES should be studied in the context of other components of the complex

pathway by which SES affects immigrant health. Conclusions: With the changing demographic profile of immigrants to Canada, there is a great need

for more comprehensive and representative ways of thinking about, measuring and researching socioeco­

nomic determinants of the health of Canadian immigrants. A commitment to improvements in measure­

ment of SES for immigrants to Canada is essential as a first step in improving their health and is long

overdue. This will both require more research into the socioeconomic determinants of immigrant health

and facilitate such research in the future.

Pl-04 (A) Justice as a Determinant of Community Well-Being: Illustrations from the Lives of People with

Disabilities Isaac Prilleltensky and Ora Prilleltensky

Objective: The objective of this paper is to clarity the concept of social justice as it pertains to

health and well-being in general, and to the lives of people with disabilities in parricular. Research

Problem Due to fear, confusion, ideology, or ignorance, justice is often missing as a determinant of

health and well-being. And it is missing on two accounts. First, justice is missing from discussions of

determinants of well-being; and second, it is missing from well-being itself. More people than we wish

ro acknowledge suffer because of injustice, in North America and around the world. At first, the

absence of justice from discussions may be explained by the rather elusive character of the construct.

After all, it is an ambiguous concept over which there is much disagreement-- not a good variable for

scientists who strive for precision and consensus. Though plausible, this explanation does nor exhaust

the reasons for the inconspicuous nature of justice in the well-being literature. The wall between facts

and values erected by positivism still plays a big role. Politics, of course, contributes its share. It is infi­

nitely more convenient to blame deficient families and individuals for social ills than to face injustice

and inequality. Method: Our case proceeds along five steps. First, we define justice. We go beyond the original

conception to each his or her due and elaborate on what each and due mean. Furthermore, to the tra­

ditional to each his or her due, we elaborate on from each his or her due. Second, we define well-being.

Our formulation of well-being is based on sites (where does well-being reside?), signs (what docs it

look like?), sources (where does it come from?), and strategics (how can it be promoted?). The main

innovation inheres in a definition that contains multiple sites, as opposed to the traditional and singu­

lar focus on the individual. Relationships and communities are also sites of well-heing, as are families.

Third, we discuss justice as a determinant of well-being for people with disabilities. Fourth, we tackle

justice as a determinant of community well-being in general. The final point argues for the rights of

people with disabilities. Results: Our conceptualization and its application to the lives of people with disabilities

results in a viable framework for the development of policy and practices in health and community

development.

v52 POSTER SESSIONS

Pt-05 (A) Can Social Responsibility Be Taught? Exploring the Impact of a Service Lea~ng Strategy on

Attitudes of Health Sciences Students Towards Poverty, Homelessness and Future Practice .

Dyanne Scmogas, Kristin Cleverley, Catherine Ford Thomas, Mary Allen, Wendy Azzopardi, and Anna

Cleverley

Purpose and Background: The study (in progress) examines attitudes of nursing an~ ~achelor of health

s.:iences srudents toward individuals experiencing poverty and/or homelessness. In addmon the study will

determine what potential impact the course Poverty and Homelessness has on furure practice prior to and

after participating in a combined theory and practice course with a service learning component (where stu­

dents spend 24 hours in a community agency serving marginalized populations in a non-professional role).

Methodology: Approximately 50 srudents that were enrolled in the course participated in the study

that was conducted on the internet. In Time One a questionnaire is administered including: demograph­

ics, information sources about poverty and health; beliefs about poverty and health; exposure to poverty;

attitudes toward poverty and an open ended question asking what poverty means to them. In Time Two

rhe beliefs and attitudes section of the questionnaire are repeated with additional questions relating to

the course components, attitude change and how the course might influence future practice. Pre and Post

course test items will be compared using paired t-tests. Findings: To dare pre and post course questionnaires have been collected on one class of students.

Of rhe 56 questions asked, 23 of the items (40%) showed a positive significant change in attitude (p).

Pl-06 (C) Domestic Violence In Nigeria-Addressing the Issues in The Niger Delta Context

Ifode Ajari

Background: This study explores how proffesionals in the Warri City Judiciary interprete issues of

Domestic violence and violence against women.The study was designed to unveil details about the abri­

trary perceptions of the participants on the causes of violence in their community,what intervention

strategies are necesarry and what challenges they encounter in working with victims of violence.

Methods: Interviews were done in Warri between August 29 and September 2004 as part of a larger

work involving 31 participants.Participants for this analysis were selected based on their positions within

the judiciary and considering their involvement with issues of family/domestic violenceand violence

against women.The study included 9 participants,6females and 3 males,of which 7 were Lawyersand 2

.Judges.All interviews were conducted in English by one male researcher.lntreviews ranged from 40 min­

utes to 2hours 30 minutes.All interviews were recorded in tape and transcribed by the same researcher

and the data afterwards analysed. Results: the work was acorrelation between the participants\'perceptions of what causes violence in

their communities and the situations they face within the Judiciary system.The underlying reality was the

perpetual cycle of violence within the system-both in contexts and through even the laws and legal practises.

They assessed the roots of violence as (a) historic (b)socio-cultural and (c)systemic.Salient interventions dis­

cussed were adding legal sanctions tolaws on family or domestic violence,greater adherence to the law and

education education. The most common challenges encountered were lack of resources and alternative living

circumstances for victims,machismo,lack of information dissemination,lack of consistent registry,and statis­

tics,rcsistance to acknowledgement of womne\'s rights and inadequate implementation of the laws.

Pt-07 (C) Indoor Air Quality as an Issue of Social justice Maria Miller and Ann Phillips

Many people living in urban settings spend a significant amount of their time indoors. On average,

Canadians spend 80% of their time indoors, so the quality of the indoor air we breathe is an important fac­

tor in determining our health. There are many factors that can contribute to poor indoor air quality, building

materials and furnishings that off gas, cleaning chemicals containing volatile organic compounds and other

solvents, poor ventilation and air circulation. Children are one of the vulnerable groups in urban settings

that are more affected by poor indoor air quality and by exposure to other environmental contaminants.

Children's bodies are still growing and their organs developing so exposure to contaminants can affect them

in ways that do not affect adults. Young children breathe faster than adults and have a higher metabolic rate

- so per kilo body weight they have higher exposures. As well, children, especially infants and young chil­

dren exhibit _different behaviour that adults - they crawl on the floor, play with things adults do not and put

their hands m their mouth repeatedly-these behaviours increase their risk of exposure of environmental

contaminants. The standards regarding building design and indoor air quality were not designed for chil­

dren. There is no legislanon to protect children in indoor settings the way there are regulations to protect

worker's health and safety. Schools are places where children spend a considerable amount time - schools

POSTER SESSIONS v53

are like children's workplaces. It is important to ensure that school environments have the best possible

indoor air quality. The Blake/EAST Indoor Air Quality projen in collaboration with South Riverdale Com­

munity Health Centre has been involved in a successful project to improve the quality of life and health of

children, staff and teachers at a inner city Toronto school and an alternative school. This was done by rais­

ing awareness among parents, teachers, school administrators, school board staff and policy makers of the

significant influence that indoor air quality can have on health and well being, by utilizing simple strategies

for identifying indoor air problems, by finding effective methods for working together to improve indoor air

quality; and by mobilizing the school communities to take action.

Pl-08 (C) Ensuring Fair and Accountable Government: Ombudsman Ontario

Judith Klie

In Ontario the Office of the Ombudsman may be able to help you or your clients, if you feel a pro­

vincial government organization has treated you in a way that is unfair, illegal, unreasonable, mistaken,

or just plain wrong, you should bring your matter forward to the Ombudsman's office. You may succeed

in gening the problem solved and you might help make systemic changes so others are treated more

fairly. As an advocate for fairness, the Ombudsman is responsible for the investigation and resolution of

complaints about public administration by governmental organizations The Ombudsman is independent

of government and employs an impartial point of view. Some examples of organizations that may he

investigated include: the Family Responsibility Office which administers court ordered spousal or child

suppon, the Register General s (birth certificates), Ontario Health Insurance Program, Ontario Disabil­

iry Support Program, and any of the over 540 provincial government organizations, agencies or minis­

tries. Generally we are an office of the last resort and do not investigate matters if people still have a right

to use a statutory appeal process. We expect people to try to resolve an issue prior to complaining to the

Ombudsman. Often the Ombudsman is able to resolve problems informally with a phone call to the gov­

ernment organization involved. During the 2004-2005 fiscal year, on average 79 per cent of all com­

plaints were resolved within 28 days. Our new Ombudsman Andre Marin started his term on April 1,

2005 and is determined to put Ombudsman Ontario, often considered a "hidden treasure," on the map.

Remarkably, within his first two months in Office, he released his first public report "Between A Rock

and a Hard Place"(available at www.ombudsman.on.ca) chronicling a systemic investigation concerning

parents of children with severe disabilities who had to chose between giving up their parental rights or

obtaining necessary residential care for their children. He provided a detailed account of "acute govern­

ment maladministration." Following the release of his report, the government committed to moving

immediately to restore custody rights of parents in these circumstances. Call Ombudsman Ontario at 1-

800-263-1830,TTY 1-866-411-4211 or visit our website at htpp://www.ombudsman.on.ca to make a

complaint about provincial government services. Ombudsman Ontario's Community Education Pro­

gram offers staff information sessions and a workshop "How to Complain Effectively" The promotion

of awareness of Ombudsman Ontario services among community leaders and service providers helps us

reach those more disadvantaged and vulnerable communities. Call 416-586-3357.

MODELS OF COMMUNITY-BASED PARTICIPATORY RESEARCH

Pl-01 (C) An Academic-Community Partnership to Build Capacity for Community Based Research in

Immigrant Health Kim Chow, Kamran Khan, Miriam Cho, Vicky Fong, Jun Wang, and Meh Rashid

Introduction: Every year approximately 250,000 new immigrants arrive in Canada with more than

one half senling in Ontario. Despite the fact that the foreign-born represent nearly one-fifth of the Canadian

population, little is known about the health status of immigrants and refugees. Access Alliance Multi­

cultural Community Health Centre (AAMCHC) in collaboration with the Centre for Research on Inner

City Health (CRICH) at St. Michael's Hospital (SMH) partnered to examine health needs of new immi­

grants and refugees seen at this community health centre. Since there were numerous sensitive issues per­

taining to client privacy, data ownership, and the publication of research studies that could_have harmful

consequences to specific immigrant groups, SMH and AAMCHC developed an academ1e-commumty

partnership model to address these concerns. Methods: Staff from AAMCHC and CRICH-SMH came together to discuss questions of mutual

interest pertaining to the health of immigrants and refugees in Toronto. Both organizations were present

as equal partners in defining priority areas for research and in identifying specific research questions and

v54 POSTER SESSIONS

hypotheses. Ethics approval was requested from the research ethics bo~rd (REB) or research committee

from each institution. Once ethics approval was obtained, a partnership agreement was developed that

clearly addressed topics such as consensual decision-making (with t~e best im:rests of immigrant and

refugee communities), data storage and accessibility, and collaboration regarding the research design,

study implementation, data analysis, and interpretation. . . . RLsults: Study results were disseminated equally between both orgamzat10ns through presentat10ns,

informal gatherings, and e-mail that promoted an open discussion of research findings. A conceptual

model was designed to describe the research- partner collaboration process and how an academic

research centre and community health centre intersect with respect to goals and client care outcomes.

Conclusions: A successful relationship was developed between the two organizations and was

exhibited through equal involvement in research. The research was also utilized to guide clinical decision

making to improve client care outcomes. Another valuable process lesson learned was that sensitive and

questionable issues were discussed and addressed in the early research development stages providing a

non-threatening and trusting environment for all who participated.

P2-02 (A) Who Benefits from Community Based Participatory Research: A Case Study of the Positive

Youth Project Sarah Flicker

Background: Community-Based Participatory Research (CBPR) has evolved as a popular new para­

digm in health research. While this shift is exciting, there is still much to be discovered about how vari­

ous stakeholders are affected. Methods: A critical social science perspective was adopted to explore who benefits from these

changes through an analysis of a CBPR case study (The Positive Youth Project). In-depth semi-structured

interviews with 14 key stakeholders were undertaken. Interviews were audio-taped and transcribed. A

modified grounded theory approach guided analysis. Data were coded using Nud*ist Qualitative Soft­

ware. Member checks were used to enhance trustworthiness. Results: Four major categories of beneficiaries emerged: the research itself, the youth, the community­

based organizations and the academics. The benefits, however, were not gained without substantial human

resource investment; nor were they necessarily equitably spread. Youth found the project to be an empower·

ing experience that built their self-esteem, provided capacity building opportunities and enhanced their dis­

posable income. Several youth found the project transformative, and many of them secured tangible benefits

throughout the life of the project (e.g., finding housing, securing employment and/or income security, social

support). Nevertheless, questions remain as to the sustainability of these and other impacrs. By contrast, the

benefits secured by community-based organizations (partnerships, grant sources, service delivery models) and

academic researchers (grants, research partners, publications, career advancement) might be seen as more

sustainable. Costs associated with participation included heavy demands of time, an added burden of work,

frustration with the process, missing other opportunities, risking loss of anonymity and "loss of control."

Conclusion: Care needs to be taken to ensure that concrete benefits accrue for all project partners,

and costs arc minimized. Another way of framing benefits is to look at the community capacities built to address future health and social issues.

P2-0.1 (A) The Baltimore Health and Nutritional Exam Survey (BHANES) Chris Gibbons and Glenn Ross

Background: The National Health and Nutrition Examination Survey (NHANES) is conducted

periodic.:ally by the CDC on a nationwide probability sample of US citizens. The survey is designed to

obtain nationally representative information on the health and nutritional status of the population of the

United States through interviews and direct physical examinations. Approximately 30 topics are investi­

gated including high blood pressure, high blood cholesterol, obesity, passive smoking, lung disease,

osteoporosis, HIV, hepatitis, helicobacter pylori, immunization status, diabetes, allergies, growth and

development, blood lead, anemia, food sufficiency, dietary intake-including fats, antioxidants, and nutri·

tional blood measures. In part because of the paucity of high quality local level epidemiologic data, sev·

eral states ha.ve explored the notion of conducting state or city-level HANES type surveys. To date only

New York Cny has completed a sub national survey modeled after NHANES. Baltimore will become the

secon~ city to conduct a local survey modeled after NHANES. This presentation describes the concepru· alization and planning of the Baltimore HANES (BHANES) project .

. . Methods: Fro~ its.inception an ite_rative CBPR approach has been employed to complete all activities. lnmally a partnership with the East Balumore community was formed and an MOU was agreed upon. Over

the next year, several planning and organizational meetings were held including a one day planning retreat

POSTER SESSIONS vSS

where goals and outcomes of the project were developed, geographic boundaries finalized, project organiza­

rional and decision making methodology established and the preliminary study foci determined. Next Steps

Currently the partnership is actively engaged in fundraising, instrument and protocol development. This will

soon be followed by an intense volunteer recruitment and training period to prepare faculty, staff, students

and community members to participate in the implementation phase of the study. Upon completion of the

study all partners will remain engaged in the analysis, interpretation and active reporting of data to both the

scientific community and local East Baltimore community. The data obtained from this study will be used ro

improve access and utilization of healtcare services by community members.

Conclusions: Even at the relatively early stage we are demonstrating the value and potential of uti­

lizing a CBPR approach to conceptualize, plan and ultimately implement a successful population based

survey. All partners remain engaged and committed to the process which will ultimately lead to

improved access to health services and improve health outcomes among an urban inner city population,

while enhancing community-academic relations at the same time.

P2-04 (A) African American Community-Based Tobacco Control Organizations

Pamela Jones

Eliminating tobacco-related health disparities is a goal of Healthy People 2010 and the Centers for

Disease Control and Prevention's (CDC) tobacco control framework. A key component of this frame­

work is forming partnerships with community organizations to disseminate tobacco control messages.

African American organizations have been conducting tobacco control efforts within their communities

for at least ten years. However, to date, these efforts have not been systematically documented. The aim

of this ethnographic pilot study was to examine how African American organizations conduct tobacco

control activities in African American communities from the perspectives of the leaders of the organiza­

tions. Semi-structured interviews were conducted and the constant comparative grounded theory tech­

nique was used to analyze the interviews. Study findings illustrate the critical characteristics of

organizations and their leaders chat lead co effective tobacco control within African American communi­

ties. The results from this study will inform the development of a novel tobacco control framework that

engages the collective action of African American community-based tobacco control organizations

toward advocating for improving health, and ultimately, achieving the goal to eliminate tobacco-related

health disparities for African Americans.

P2-05 (A) The San Francisco Collaborative Food Systems Assessment

Fernando Ona, Paula Jones, and Leah Rimkus

Food and nutrition programs in large urban areas have not traditionally followed a systems

approach towards mitigating food related health issues, and instead have relied upon specific issue inter­

ventions char deal with downstream indicators of illness and disease. In June of 2004, the San Francisco

Food Alliance, a group of city agencies, community based organizations and residents, initiated a collah­

orarive indicator project called rhe San Francisco Food and Agriculture Assessment. In order to attend to

root causes of food related illnesses and diseases, the purpose of the Assessment is to provide a holistic,

systemic view of San Francisco\\'s food system with a focus on three main areas that have a profound

affect on urban public health: food assistance, urban agriculture, and food retailing. Using participatory,

consensus methods, the San Francisco Food Alliance jointly developed a sec of indicators to assess the

state of the local food system and co set benchmarks for future analysis. Members collected data from

various city and stare departments as well as community based organizations. Through the use of Geo­

graphic Information Systems software, a series of maps were created to illustrate the assets and limita­

tions within the food system in different neighborhoods and throughout the City as a whole. This

participatory assessment process illustrates how to more effectively attend to structural food systems

issues in large urban areas by ( t) focusing on prevention rather than crisis management, (2) emphasizing

collaboration to ensure institutional and structural changes, and (3) aptly translating data into meaning­

ful community driven prevention activities.

P2-06 (A) Underground Community Participatory Research: Cannabis Compassion Clubs as Ourlaw

Social Justice Andrew Hathaway and Kate Rossiter

Marijuana's use as medicine is now legal in Canada for patients who meet strict compassionate use

guidelines. Most who self-medicate, however, still do so on their own terms, without government

approval or the guidance of physicians. In this unregulated climate, "compassion clubs" outside the law

v56 POSTER SESSIONS

play a vital role in the provision of safe access and ~herapeutic knowle~ge abo~t medicinal ~rijuana. Operating on the margins of society these outlets fulf1ll another purpos~ in creating a comm.unity among

persons who are often highly marginalized themselves. The a~thor outlines key .m~thodolog1cal concerns

pursuing ethnographic research in this underground community. He also offer~ ms1~hts on the role of the

compassion clubs in the lives of individuals who choose to self-manage their pain and suffermg With

cannabis.

Pl-07 (A) Mobilizing for Food Security and Health Research Charles Levkoe, Laurie Green, Jennifer Reynolds, Donald Cole, Sarah Wakefield, and Fiona Yeudall

Introduction: Community food security (CFS) is "a strategy for ensuring secure access to adequate

amounts of safe, nutritious, culturally appropriate food for everyone, produced in an environmentally

sustainable way, and provided in a manner that promotes human dignity" (OPHA 2002). CFS research

is committed to participation of community members, and emphasizes the need to build coalitions and

co-ordinate actions (Cohen 2002). Several organizations including Foodshare, Toronto Board of Health,

Centre for Studies in Food Security (Ryerson University) and the Centre for Urban Health Initiatives

(Universiry of Toronto) have initiated a community based research process to identify research opportu·

nities related to food security and health (broadly defined) in Toronto. Methods: Key informants were interviewed to identify successes and barriers to food security policy

implementation, and gaps in knowledge that limit food sepolicy implementation and innovation. Resuhs

of key informant interviews will be summarized as an interactive board game and policy paper. Research

findings will form a starting point for consultative workshops with Toronto parmers to identify research

partnerships and priorities in late 2005. Results: Twenty five key informants representing civil society (community leaders, activists, farm·

ing and non governmental organizations) and public sector organizations (government, public health,

academics) from across Canada were interviewed by our community based research assistant. Results

clustered around the broad categories of successful strategies, barriers, potential research projects and

issues and controversies. Successful initiatives were characterized by community engagement, media cov·

erage, framing in relation to health outcomes and/or economics, coalition building, relationships with

government and private sector and champions. Commodification of food, the power of the food indus·

try, narrow views of health, patriarchy, departmentalization, lack of understanding and a short term

focus were identified as barriers to policy implementation. Suggested projects included an inventory of

best practices, 'number crunching', demystification of information and studying the sociology of change.

Issues and controversies included definitions of food security, departmentalization versus contextualiza·

tion, role of health, scale and views of policies. Conclusions: Results of the first phase regarding the identification of successes and barriers to food

policy implementation and knowledge gaps are consistent with a similar study in Eastern Canada. Next

steps include development of a research map and consultative workshops. After identifying research

partners, external support will be sought for identified research priorities. Funded by the Centre for

Urban Health Initiatives, a CIHR funded research development centre based at the University of Toronto

and supported by the Wellesley Central Health Corporation.

Pl-08 (C) Strategies to Overcome Barriers to Population Sampling: Experience from the Rapid Surveys in Los Angeles County (LAC) Magda Shaheen

To ~xplore the strategies to overcome barriers to population sample, we examined the data from

three rapid surveys conducted at Los Angeles County (LAC). The surveys were community-based partic·

1patory surveys utilizing a modified two-stage cluster survey method. The field modifications of the

method resulted in better design effect than conventional cluster sample survey (design effect dose to

that if the survey was done as simple random sample survey of the same size). The surveys were con·

ducte~ among parents of Hispanic and African American children in LAC. Geographic area was selected

and d1.v1ded int.o small c~usters. In the first stage, 30 clusters were selected with probability proportionate

to estimated size of children from the census data. These clusters were enumerated to identify and

develop a list of households with eligible children from where a random sample was withdrawn. Data

collectmn for consented respondents involved 10-15 minutes in-home interview and abstraction of infor·

ma~ion from vaccine record card. The survey staff had implemented community outreach activities

designed to fost~r an~ maintain community trust and cooperation. The successful strategies included:

developing re.lat1on .w.1th local community organizations; recruitment of community personnel and pro·

vide them with training to conduct the enumeration and interview; teaming the trained community

POSTER SESSIONS v57

personnel with the survey staff; developing relation with property managers to gain access to multiunit

addresses; enlisting the cooperation of community partners; and broad based public relations effort (fly­

ers and print adds) to increase public awareness of the survey and reinforcing its legitimacy. This is

essencial given the potential confusion of the survey staff with telemarketers or door-to-door solicitors,

and the understandable reluctance to allow strangers into the home. The participation range for the sur-

1·eys was 81 % to 92% of eligible at home children and 80% to 84% of all selected sampled children.

~issing data in the surveys was 1-3%.

Pl-09 (C) Seeding Research, Sprouting Change: A Funder's Perspective

Sarah Flicker, Radha Nayar, and Natalie Gierman

Introduction: Wellesley Central Health Corporation's mission is to promote urban health. As part

of our mission we support Community Based Research (CBR) initiatives in the area of social exclusion,

income distribution and housing and homelessness. Our Enabling Grant Program is a comprehensive

approach to seeding innovative urban health CBR. We provide up to $10,000 in start-up funding to

assist groups in assessing research priorities, building research partnerships and developing research pro­

posals. In addition, we offer one-on-one technical assistance and an innovative certificate program in

CBR. Methods: In February/2005, Wellesley Central commissioned an evaluation of the Enabling

Research Awards Program. The goals of the evaluation were to identify what is working well in the

grancing process, and what could be done differently; to begin to explore impact of grant activities on the

community and stakeholders and to use evaluation results to inform future planning for the Program.

Data was collected through 30-minute telephone interviews with a sample of successful grant recipients.

ln total, 25 recipients were interviewed, representing at least one Principal Investigator or Project Lead

from every grant disbursed in the first three calls of the Program. Data was analyzed based on a frame­

work analysis model. Results: Grantees see the Enabling Program as an innovation on the urban health landscape. They

highly valued individual consultations and many took advantage of the certificate program. Anticipated

outcomes of grants include completed literature reviews, developing research questions and applying for

research funding. Many grantees were successful in leveraging new research and program dollars. Unan­

ticipated outcomes were also prevalent. These included: finding new and unexpected research and pro­

gram partners and developing new advocacy networks. Grantees also reported that the enabling process

encouraged them to become engaged on a new level with policy makers.

Conclusions: Providing community and academic groups with the resources to build effective part­

nerships is key to the long term success of CBPR initiatives. Relatively modest investments can be lever­

aged into substantial research, policy and program outcomes.

Pl-10 (C) Community-Oriented Environmental Undergraduate Research Projects

Chad Rower and Venera Jouraeva

Most communities facing environmental problems do not have adequate means to assess these

problems. The research model developed at Capital University involves undergraduate science students

in designing a study plan to collect, analyze, and interpret relevant chemical data about the environmen­

tal issue. Dissemination of this knowledge and working within the political structures (e.g. Ohio EPA

and Departments of Health) in the community is completed by Political Science and Communications

majors. All students involved in the projects benefit from this community involvement. They obtain

experience working with standard analytical techniques and designing/implementing of scientific

research projects. Students gain valuable experience in understanding and working within government

and related organizations while exploring the interdisciplinary nature of complex environmental prob­

lems. This practice can open doors for internships and employment within the community after gradua­

tion. The university increases its visibility within the local community and the community benefits by

better understanding its environmental concerns from the basis of sciem:e. An example of one of such

projects will be presented.

Pl-11 (C) Realities and Complexities of Community Involvement: Experiences from Impoverished

Urban Neighborhoods in Lebanon Alamia Kaddour and Rima Nakkash

Background: The urban health research group (UHRG), a multi-disciplinary research team at the

Center for Research on Population and Health (CRPH) at the Faculty of Health Sciences (FHS), in the

v58 POSTER SESSIONS

American Universitv oi Beirut (AUB), is developing a series of intervention studies to improve health out­comes of older aduits ever-married women and youths in three disadvantaged urban neighborhoods on the outskirts of Bciru;, Lebanon. In order to ensure that the needs and viewpoints of the concerned pop­ulation are addressed and guarantee sustainability and scaling-up, the UHRG opted at involving the

communities concerned. Approach: There is a widespread consensus that community involvement is an essential element in

ensuring success and sustainability of intervention studies (Morga.n, 2001). T~e presence of unique aspects, complexities, and challenges within variable settings requires commumty mvolvemem to be operationalized differently. This depends on several factors such as; the type and content of the interven­tion, the target group, the varying views of the multidisciplinary research team, inclination of funders, the availability of human resources, institutions, and time constraints. It is also very much influenced by the structural forces within the neighborhood including, the socio-cultural, political-legal-economic and the organizational dimensions (Boyce, 2001 ). Lessons learned Although the three neighborhoods, Nabaa, Hay el Sellom, and Buri Barajneh Palestinian refugee camp, share characteristics of impoverish­ment, poor infrastrucrure, social heterogeneity, and having war displaced populations, they also differ with regard to their historical growth, social composition and networks, social structures and organiz­ing, political structures and power dynamics. The uniqueness of each context dictates defining the com­munity differently in each neighborhood. It also requires a hybrid of approaches to involve the community and hence drives the community involvement process differently in the different settings, especially with regard to partnership building. The degree of community involvement is affected by the context, but it is also influenced by factors related to the particularities of the intervention study, and the

research team. References: I. Boyce WF. 2001. "Disadvantaged persons\' participation in health promotion

projects: some strucrural dimensions." Social Sciences and Medicine 52(10):1551-64. 2. Morgan L. 200 I. "Community participation in health: perpertual allure, persistant challenge." Health Policy and Planning 16(3):221-230.

P2-12 (C) Paws for Thought Paula Tookey, Fiona Husband, Enza Trentadue, Mike Gould, Wayne O'Connor-Trelford, Kathyrn Fowles, and Sonia Lowton

Introduction: Though much research has been done on the health and social benefits of pet owner­ship for many groups, there have been no explorations of what pet ownership can mean to adults who are marginalized, living on fixed incomes or on the street in Canada. We are a community group of researchers from downtown Toronto. Made up of front line staff and community members, we believe that community research is important so that our concerns, visions, views and values are presented by us. We also believe that research can and should lead to social change.

Method: Using qualitative and exploratory methods, we have investigated how pet ownership enriched and challenged the lives of homeless and transitionally housed people. Our research team photographed and conducted one-on-one interviews with 11 pet owners who have experienced home· lessncss and live on fixed incomes. We had community participation in the research through a partner­ship with the Fred Vicror Centre Camera Club. Many of the Fred Victor Centre Camera Club members have experienced homelessness and being marginalized because of poverty. The members of the dub took the photos and assisted in developing the photos. They also participated in the presenta· tion of our project.

Results: We found that pet ownership brings important health and social benefits to our partici· pants. In one of the most poignant statements, one participant said that pet ownership " ... stops you from being invisible." Another commented that "Well, he taught me to slow down, cut down the heavy drugs .. " We also found that pet ownership brings challenges that can at times be difficult when one is liv· ing on a fixed income. We found that the most difficult thing for most of the pet owners was finding affordable vet care for their animals.

Conclusion: As a group, we decided that research should only be done if we try to make some cha.nges about what we have learned. We continue the project through exploring means of affecting social change--for example, ~eti.tions and informing others about the result of our project. We would like to present our ~mdmgs and experience with community-based participatory action resea.rch m an oral. presentarton at yo~r conference in October. Our presentation will include com· mumty representation ~f. both front-hne staff and people with lived experience of marginalization and homdessness. If this is not accepted as an oral presentation, we are willing to present the project m poster format.

POSTER SESSIONS

P2-t3 (C) Beyond Panicipatory Research: Promoting Recovery-Oriented Praxis Based on the

lndigineous Knowledge of Consumer/Survivors

Joan Nandlal and Lana Frado

v59

Introduction: Sound Times Support Services is a community mental health agency funded by the

Ontario Ministry of Health and Long Term Care to operate as a peer initiative. Peer initiatives function

as alternative supports within the broader mental health system and are staffed and governed by individ­

uals who are using, or who have used the mental health system, that is, consumers of mental health ser­

vices and/or psychiatric survivors. As an alternative support service, Sound Times is geared to a recovery­

orienred praxis rather than a clinical or traditional social service orientation. Sound Times received fund­

ing, in conjunction with three traditional community mental health agencies, to implement a Precharge

Diversion project to reduce contact of mental health consumers and psychiatric survivors with the crimi­

nal justice system. Method: In anticipation of this partnership with organizations whose culture, structure and policies

are based on clinical and traditional social service paradigms, Sound Times identified the need for and

undertook a qualitative research study to articulate and formalize our unique methods of defining and

measuring of a recovery-oriented praxis based on the indigenous knowledge of the consumer/survivor

community. There has been little recognition of peer initiatives compared to traditional mental health

services or resources for peer initiatives to conduct our own research based on our own values. In the

present paper we describe the process whereby Sound Times undertook its study led and conducted by

the first author and members of Sound Times using the second author (a member of the Community

Support and Research Unit at the Centre for Addiction and Mental Health) as a resource to provide

training and guidance as determined by Sound Times members.

Results/Conclusion: Drawing on Arnstein 's ( 1969) ladder of citizen participation we argue that the

working relationship between Sound Times and the second author climbed to the highest rung (i.e., citi­

zen control) on Arnstein's ladder thereby promoting rigorous research within a recovery-oriented con­

text. Moreover, the working relationship was characterized by "knowledge exchange" rather than

"knowledge transfer" as the second author expected to learn from Sound Times members. In discussing

the process of conducting the research project and our working relationship, we highlight the benefits of

such a working relationship model for all parties. Reference Arnstein, S ( 1969). A ladder of citizenship

participation. Journal of the American Institute of Planners, 35(4), 216-224.

Pl-14 (C) Building a Healthy City: Community Engagement in Neighbourhood Environmental Planning

Paul Young

Building a Health City: Community Engagement in Neighbourhood Environmental Planning

Introduction The concept of a Healthy City was adopted by The World Health Organization some time

ago and it includes strong support for local involvement in problem solving and implementation of solu­

tions. While aimed at improving social, economic or environmental conditions in a given community,

more significantly the process is considered to be a building block for poliq reform and larger scale

'hange, i.e. "acting locally while thinking globally." Neighbourhood planning can he the entry point for

citizens to hegin engaging with neighbours on issues of the greater common good.

Methods: This presentation will outline how two community driven projects have unfolded to

address air pollution. The first was an uphill push to create bike lanes where car lanes previously existed

and the second is an ongoing, multi-sectoral round table focused on pollution and planning. Both dt•m­

onstrate the importance of having support with the process and a health focus. Borrowing from tradi­

tions of "Technical Aid"• and community development the health promoter /planner has incorporated a

range of "determinants of health" into neighbourhood planning discussions. As in most urban condi­

tions the physical environment is linked to a range of health stressors such as social isolation, crowding,

noise, lack of open space /recreation, mobility and safety. However typical planning processes do not

hring in a health perspective. Health as a focus for neighbourhood planning is a powerful starti_ng point

when discussing transportation planning or changing land-uses. By raising awareness on determmants of

health, citizens can begin to better understand how to engage in a process and affect change. Often local

level politics are involved and citizens witness policy change in action. Results and Conclusion: The environmental Liaison Committee and the Dundas East hike lanes

project resulted from local level initiatives aimed at finding solutions to air pollution - a priority identi­

fied hy the community. SRCHC supported the process with facilitation and technical aid. _The processs

had tangible results that ultimately improve living conditions and health. •tn the United Kmgdom plan­

nm in the 60's established "technical aid" offices much like our present day Legal Aid system to provide

professional support and advocacy for communities undergoing change.

POSTER SESSIONS v60

P2-15 (C) Integrating Community Based Research: The Experience of Street Health, a Community

Service Agency I.aura Cowan and Jacqueline Wood

Street Health began offering services to homeless men and women in east downtown ~oronto in 1986. Nursing stations at drop-in centres and shelters were fo~lowed by HIV/AIDS prevent10~, harm reduction and mental health outreach, Hepatitis C support, sleeping bag exchange, and personal tdennfi­cation replacement and storage programs. As Street Health's progi;ams expanded, so to~ did the agency:s recognition that more nee~ed t~ be done to. address the underl~ing causes of, th~ soct~l and economic exclusion experienced by its clients. Knowing t.h~t. a~voca~y ts. helped by . evtd~nce , Street He.alt~ embarked on a community-based research (CBR) initiative to 1dent1fy commumty-dnven research priori-ties within the homeless and underhoused population.

Methods: Five focus groups were conducted with 46 homeless people, asking participants to iden-tify positive and negative forces in their lives, and which topics were important to take action on and learn more about. Findings were validated through a validation meeting with participants.

Results: Participants identified several important positive and negative forces in their lives. Key posi­tive forces included caring and respectful service delivery, hopefulness and peer networks. Key negative forces included lack of access to adequate housing and income security, poor service delivery and negative perceptions of homeless people. Five topics for future research emerged from the process, focusing on fund­ing to address homelessness and housing; use of community services for homeless people; the daily survival needs of homeless people and barriers to transitioning out of homelessness; new approaches to service delivery that foster empowerment; and policy makers' understanding of poverty and homelessness.

Conclusions: Although participants expressed numerous issues and provided much valuable insight, definitive research ideas and action areas were not clearly identified by participants. However, engagement in a CBR process led to some important lessons and benefits for Street Health. We learned that the community involvement of homeless people and front-line staff is critical to ensuring relevance and validity for a research project; that existing strong relationships with community parmers are essen­tial to the successful implementation of a project involving marginalized groups; and that an action approach focusing on positive change can make research relevant to directly affected people and commu­nity agency staff. Street Health benefited from using a CBR approach, as the research process facilitated capacity building among staff and within the organization as a whole.

P2-16 (C) A Collaborative Process to Achieve Access to Primary Health Care for Black Women and Women of Colour: A Model of Community Based Participartory Research Notisha Massaquoi, Charmaine Williams, Amoaba Gooden, and Tulika Agerwal

In the current healthcare environment, a significant number of Black women and women of color face barriers to accessing effective, high quality services. Research has identified several issues that con­tribute to decreased access to primary health care for this population however racism has emerged as an overarching determinant of health and healthcare access. This is further amplified by simultaneous mem­bership in multiple groups that experience discrimination and barriers to healthcare for example those affected by sexism, homelessness, poverty, homophobia and heterosexism, disability and HIV infection. The Collaborative Process to Achieve Access to Primary Health Care for Black Women and Women of Colour Project was developed with The University of Toronto Faculty of Social Work and five commu­nity partners using a collaborative methodology to address a pressing need within the community ro increase access to primary health care for Black Women and Women of Colour. Women's Health in Women's Hands Community Health Centre, Sistering, Parkdale Community Health Centre, Rexdale Community Health Centre and Planed Parenthood of Toronto developed this community-based partici­patory-action research project to collaboratively barriers affecting these women, and to develop a model of care that will increase their access to health services. This framework was developed using a process which ensured that community members from the target population and service providers working in multiculrural clinical settings, were a part of the research process. They were given the opportunity to shape the course of action, from the design of the project to the evaluation and dissemination phase. Empowerment is a goal of the participatory action process, therefore, the research process has deliber­ately prioritized _ro enabling women to increase control over their health and well-being. In this session, the presenters will explore community-based participatory research and how such a model can be useful for understanding and contextualizing the experiences of Black Women and Women of Colour. They will address. the development and use of community parmerships, design and implementation of the research prorect, challenges encountered, lessons learnt and action outcomes. They will examine how the results from a collaborative community-based research project can be used as an action strategy to

POSTER SESSIONS v61

address che social determinants of women health. Finally the session will provide tools for service provid­

ers and researchers to explore ways to increase partnerships and to integrate strategies to meet the needs

of che target population who face multiple barriers to accessing services.

P2-17 (C) Program and Policy Directions: Including Low Income Women with Children

Lynn Scruby and Rachel Rapaport Beck

The purpose of this project was ro bring traditionally disenfranchised Winnipeg and surrounding

area women into decision-making roles. The researchers have built upon the relationships and informa­

tion gachered from a pilot project and enhanced the role of input from participants on their policy prior­

iries. The project is guided by an advisory committee consisting of program providers and community

representatives, as well as the researchers. Participants included program users at four Family Resource

Cencres, two in Winnipeg and two located rurally, where they participated in focus groups. The partici­

pants answered a series of questions relating to their contact with government services and then provided

inpuc as to their perceptions for needed changes within government policy. Following data analysis, the

researchers will return to the four centres to share the information and continue che discussion on meth­

ods for advocating for change. Recommendations for program planning and policy development and

implementation will be discussed and have relevance to all participants in the research program.

P2-18 (C) Using Feminist Action Research to Examine the Relationship Between Employability and

Women's Health Vera LeFranc, Louise Hara, Denise Darrell, Sonya Boyce, and Colleen Reid

Women's experiences with paid and unpaid work, and with the formal and informal economies, have

shifted over the last 20 years. In British Columbia, women's employability is affected by government legis­

lation, federal and provincial policy changes, and local practices. Two years ago we formed the Coalition

ior Women's Economic Advancement to explore ways of dealing with women's worsening economic situa­

tions. Since the formation of the Coalition we have discussed the need for research into women's employ­

abilicy and how women were coping and surviving. We also identified how the need to document the

nature of women's employability and reliance on the informal economy bore significanc mechodological

and ethical challenges. Inherent in our approach is a social model of women's health that recognizes health

as containing social, economic, and environmental determinants. We aim to examine the social contexc of

women's healch by exploring and legitimizing women's own experiences, challenging medical dominance in

understandings of health, and explaining women's health in terms of their subordination and marginaliza­

cion. Through using a feminist action research (FAR) methodology we will explore the relationship

between women's employability and health in 4 communities that represent Bricish Columbia's social, eco­

nomic, cultural/ethnic, and geographic diversities: Skidegate, Fort St . .John, Lumhy, and Surrey. Over the

course of our 2 year project, in each community we will establish and work with Advisory Committees,

hire and train local researchers, conduct FAR (including a range of qualitative methods), and support

action and advocacy. Since the selected communities are diverse, the ways that the research unfolds will

1·ary between communities. Expected outcomes, such as the provision of a written report and resources, the

establishment of a website for networking among the communities, and a video do.:umentary, are aimed at

supporting the research participants, Coalition members, and Advisory Conuniuces in their action efforts.

P2- t 9 (C) Health & Housing: Assessing the Impact of Transitional Housing for People Living with HIV I AIDS

Sue Ferrier and Ligaya Byrch

Currently, there is a dearth of available literature which examines supporrive housing for PHAs in

the Canadian context. Using qualitative, one-on-one interviews we investigace the impact of transitional

housing for PHAswho have lived in the up to nine month long Hastings Program. Our post<'r pr<·senta­

t1on will highlight research findings, as well as an examination of transitional housing and th<· imp;Kt it

has on the everyday lives of PHAs in Canada. This research is one of two ground breaking undertakings

within the province of Ontario in which fife House is involved.

P2-20 (C) Eating Our Way to justice: Widening Grassroots Approaches to Food Security, The Stop

Community Food Centre as a Working Model Charles l.evkoe

Food hanks in North America have come co play a central role as the widespread response to grow­

ing rates of hunger. Originally thought to be a short term-solution, over the last 25 years, they have

v62 POSTER SESSIONS

be · · · 1· d wi'thi'n society by filling the gaps in the social safety net while relieving govem-come mst1tut1ona 1ze . . .

t f their responsibilities. Dependent on corporate donations and sngmauzmg to users, food banks men so Th' . ·11 I I . are incapable of addressing the structural cause~ of ~u~ger. 1s pres~ntation w1 e~~ ore a ternanve

approaches to addressing urban food security while bmldmg more sustamabl.e c~mmumt1es. i:nrough the

f th St p Community Food Centre, a Toronto-based grassroots orgamzanon, a model is presented case 0 e 0 h'l k' b 'Id · b that both responds to the emergency food needs of communities w 1 e wor mg to. u1 ~ sustama le

and just food system. Termed, the Community Food Centre model. (CFC), ~he S~op is worki?g to widen

its approach to issues of food insecurity by combining respectful ~1rect service wit~ com~~mty ~evelop­ment, social justice and environmental sustainability. Through this approach, various critical discourses

around hunger converge with different strategic and varied implications for a~ion. As a plac~-based orga­

nization, The Stop is rooted within a geographical space and connected directly to a neighbourhood.

Through working to increase access to healthy food, it is active in maintaining people's dignity, building a

strong and democratic community and educating for social change. Connected to coalitions and alliances,

The Stop is also active in organizing across scales in connection with the global food justice movement.

P2-21 (C) The Evaluation of an Inter-Agency Collaborative Care Team Serving Homeless Men at an

Inner City Shelter Vicky Stergiopoulos, Carolyn Dewa, Katherine Rouleau, Shawn Yoder, and Lorne Tugg

Introduction: In the city of Toronto there are more than 32,000 hostel users each year, many with

mental health and addiction issues. Although shelters have responded in various ways to the health needs

of their clients, evidence on the effectiveness of programs delivering mental health services to the home·

less in Canada has been scant. The objective of this community based research was to provide a forma·

tive evaluation of a multi-agency collaborative care team providing comprehensive care for high needs

clients at Toronto's largest shelter for homeless men. Methods: A logic model provided the framework for analysis. A chart review of 56 clients referred

over a nine month period was completed. Demographic data were collected, and process and outcome

indicators were identified for which data was obtained and analyzed. The two main outcome measures

were mental status and housing status 6 months after referral to the program. Improvement or lack of

improvement in mental status was established by chart review and team consensus. Housing outcomes

were determined by chart review and the hostel databases. Results: Of the clients referred 75% were single and 98% were unemployed. Forty four percent had

a psychiatric hospitalization within the previous two years. The prevalence of severe and persistent men·

tal illness, alcohol and substance use disorders were 60%, 26% and 37% respectively. Six months after

referral to the program 37% of clients had improved mental status and 41 % were housed. Logistic

regression controlling for the number of General Practitioner and Psychiatrist visits, presence of person·

ality or substance use disorder and treatment non adherence identified two variables significantly associ·

ated mental status improvement: the number of psychiatric visits (OR, 1.92; 95% CI, 1.29-2.84) and

treatment non adherence (OR, 0.086; 95% CI, 0.01-0.78). The same two variables were associated with

housing outcomes. History of forensic involvement, the presence of a personality or substance use disorder

and the number of visits with a family physician were not significantly associated with either outcome.

Conclusions: Despite the limitations in sample sire and study design, this study can yield useful informa·

tion to program planners. Our results suggest that strategies to improve treatment adherence and access to

mental health specialists can improve outcomes for this population. Although within primary care teams the appropriate collaborative care model for this population remains to be established, access to psychiatric follow

up, in addition to psychiatric assessment services, may be an important component of a successful program.

P2-22 (C) Enhancing and Supponing Local Capacity Through Community Integration Susan Owen

Mount Sinai Hospital (MSH) has become one of the pre-eminent hospitals in the world by contrib­

uting to the development of innovative approaches to effective health care and disease prevention.

Recently, the hospital has dedicated resources towards the development of a strategy aimed at enhancing

the hospital's integration with its community partners. This approach will better serve the hospital in the

current health care environment where Local Health Integration Networks have been struck to enhance

and support local capacity to plan, coordinate and integrate service delivery. MSH has had early success

with developing partnerships. These alliances have been linked to programs serving key target populations

with _estabhshe~. points of access to MSH. Recognizing the need to build upon these achievements to

remain compe~mve, the hospital has developed a Community Integration Strategy. At the forefront of

this strategy is C.A.R.E (Community Advisory Reference Engine): the hospital's compendium of

POSTER SESSIONS v63

Community Partners. As a single point of access to community partner information, C.A.R.E. is more

than a database. C.A.R.E. serves as the foundation for community-focused forecasting and a vehicle for

inter and intra-organizational knowledge transfer. Information gleaned from the catalog of community

parmers can be used to prepare strategic, long-term partnership plans aimed at ensuring that a compre­

hensive array of services can be provided to the hospital community. C.A.R.E. also houses a permanent

record of the hospital's alliances. This prevents administrative duplication and facilitates the formation

of new alliances that best serve both the patient and the hospital. C.A.R.E. is not a stand-alone tool and

is most powerful when combined with other aspects of the hospital's Community Integration Strategy. It

iscxpected that data from the hospital's community advisory committees and performance measurement

department will also be stored alongside stakeholder details. This information can then be used to drive

discussions at Senior Management and the Board, ensuring congruence between stakeholder, patient and

hospital objectives. The patient stands to benefit from this strategy. The unique, distinct point of refer­

ence to a wide array of community services provides case managers and discharge planners with the

information they need to connect patients with appropriate community services. Creating these linkages

enhances the patient's capacity to convalesce in their homes or places of residence and fosters long-term

connections to neighborhood supports. These connections can be used to assist with identifying patients'

ongoing health care needs and potentially prevent readmission to hospital.

Pl-23 (A) It All Comes Out in the Wash: Utilizing Existing Community Congregation Sites to Facilitate

HIV-Prevention Research Recruitment and Retention with Hard to Reach Populations

Jennifer Freeman and Alexine Fleck

Introduction: Recruiting high-risk drug users and sex workers for HIV-prevention research has

often been hampered by limited access to hard to reach, socially stigmatized individuals. Our recruitment

effom have deployed ethnographic methodology to identify and target risk pockets. In particular, eth­

nographers have modeled their research on a street-outreach model, walking around with HIV-prevention

materials and engaging in informal and structured conversations with local residents, and service provid­

ers, as well as self- identified drug users and sex workers. While such a methodology identifies people

who feel comfortable engaging with outreach workers, it risks missing key connections with those who

occupy the margins of even this marginal culture. Methods: Ethnographers formed a women's laundry group at a laundromat that had a central role

as community switchboard and had previously functioned as a party location for the target population.

The new manager helped the ethnographers invite women at high risk for HIV back into the space, this

time as customers. During weekly laundry sessions, women initiated discussions about HIV-prevention,

sexual health, and eventually, the vaccine research for which the Center would be recruiting women.

Ra.Its: The benefits of the group included reintroducing women to a familiar locale, this time as cus­

tomers rather than unwelcome intruders; creating a span of time (wash and dry) to discuss issues important to

me women and to gather data for future recruitment efforts; creating a location to meet women encountered

during more traditional outreach research; establishing the site as a place for potential retention efforts; and

supporting a local business. Women who participated in the group completed a necessary household task

while learning information that they could then bring back to the community, empowering them to be experts

on HIV-prevention and vaccine research. Some of these women now assist recruitment efforts. The challenges

included keeping the group women-only, especially after lunch was provided, keeping the membership of the

group focused on women at risk for HIV, and keeping the women in the group while they did their laundry.

Conclusion: Public health educators and researchers can benefit from identifying alternate congre­

gation sites within risk pockets to provide a comfortable space to discuss HIV prevention issues with

high-risk community members. In our presentation, we will describe the context necessary for similar

research, document the method's pitfalls and successes, and argue that the laundry group constitutes an

ethical, respectful, community-based method for recruitment in an HIV- prevention vaccine trial.

ENVIRONMENTAL JUSTICE

P3-0t (C) Upgrading Inner City Infrastructure and Services for Improved Environmental Hygiene

and Health: A Case of Mirzapur in U.P. India Madhusree Mazumdar

In urgency for agricultural and industrial progress to promote economic d.evelopment follo_wing

Independence, the Government of India had neglected health promotion and given less emphasis on

POSTER SESSIONS

b ·1d· h ·tal As a result as per the global Human Development Report of 2003, India trails u1 mg uman cap• · • . b"d" d I k

beh. d · h H n Development Index with a rank of 127, with poverty, mor 1 1ty an ac ofcduca-m mt e uma 1. . h "f · · "d

tion as the three major concerns of modern day planning. Rea mng t at. 1 attent10~ ~s n~t pat to the afore-mentioned problems that are retarding growth, t~e co~try's Pla~mng Comrms~1on 1s now focus­

ing on preventive healthcare and social development, .mcludmg e~bu1cat1on as th~ ma1or thru.st areas of

d I Pment. The Government of India is now adopting all poss1 e means to improve env1ronmental eve o d . . Al . h "d . fr

infrastructure to promote public health for enhanced human pro uct1v_ity. ong wit r~p1 m astruc-

rure development, which has become essential if citie~ are to. act ~s harbmger.s of econ~nuc ~owth, espe­cially after the adoption of the economic liberalization policy, importance _is a_lso ~emg g1ve.n to foster

environmental hygiene for preventive healthcare. The World Health Orga~1sat10~ IS also trJ:'1!1g to help the government to build a lobby at the local level for the purpose by off~rmg to mrroduce_ its Heal.thy City concept to improve public health conditions, so as to reduce th_e disease burden. This pape~ 1s a

report of the efforts being made towards such a goal: The paper descr~bes ~ c~se study ?f ~ small city of India called Mirzapur, located on the banks of the nver Ganga, a ma1or lifeline of India, m the eastern

part of the State of Uttar Pradesh, where action for improvement began by building better sanitation and

environmental infrastructure as per the Ganga Action Plan, but continued with an effort to promote pre· ventive healthcare for overall social development through community participation in and around the

city.

P3-02 (A) A Time Series Analysis of the Relationship Between Social Disadvantage, Air Pollution, and

Asthma Physician Visits in Toronto, Canada Tara Burra, Rahim Moineddin, Mohammad Agha, and Richard Glazier

Introduction: Air pollution and socio-economic status are both known to be associated with

asthma in concentrated urban settings but little is known about the relationship between these factors.

This study investigates socio-economic variation in ambulatory physician consultations for asthma and

assesses possible effect modification of socio-economic status on the association between physician visits

and ambient air pollution levels for children aged 1 to 17 and adults aged 18 to 64 in Toronto, Canada

between 1992 and 2001. Methods: Generalized additive models were used to estimate the adjusted relative risk of asthma

physician visits associated with an interquartile range increase in sulphur dioxide, nitrogen dioxide, PM2.5, and ozone, respectively.

Results: A consistent socio-economic gradient in the number of physician visits was observed

among children and adults and both sexes. Positive associations between ambient concentrations of sul·

phur dioxide, nitrogen dioxide and PM2.5 and physician visits were observed across age and sex strata, whereas the associations with ozone were negative. The relative risk estimates for the low socio-«o­

nomic group were not significantly greater than those for the high socio-economic group. Conclusions: These findings suggest that increased ambulatory physician visits represent another

component of the public health impact of exposure to urban air pollution. Further, these results did not

identify an age, sex, or socio-economic subgroup in which the association between physician visits and air pollution was significantly stronger than in any other population subgroup.

P3-03 (A) The Environmental Justice in the Metropolis of Tirana Luan Balliu

Eco-Life-Center (ELA) in Albania supports a holistic approach to justice, recognizing the environ· mental justice, social justice and economic justice depend upon and support each other. Low income cit·

izens and minorities suffer disproportionately from environmental hazards in the workplace, at home, and in their communities. Inadequate laws, lax enforcement of existing environmental regulations, and

~ea.k penalties for infractions undermine environmental protection. In the last decade, the environmental 1ust1ce m~ve~ent in Tirana metropolis has provided a framework for identifying and exposing the links

~tween irrational development practices, disproportionate siting of toxic facilities, economic depres· s1on, and a diminished quality of life in low-income communities and communities of color. The envi·

~onmental justice agenda has always been rooted in economic, racial, and social justice. Tirana and the

issues su.rroun~ing brow~fields redevelopment are crucial points of advocacy and activism for creating

~ubstantia~ social chan~~ m low-income communities and communities of color. We engaging intensively m prevcnnng co'.'1mumnes, especially low income or minority communities, from being coerced by gov·

ernmenta~ age_nc1es or companies into siting hazardous materials, or accepting environmentally hazard· ous_ practices m order to create jobs. Although environmental regulations do now exist to address the

environmental, health, and social impacts of undesirable land uses, these regulations are difficult to

POSTER SESSIONS v65

enforce because many of these sites have been toxic-ridden for many years and investigation and cleanup

of these sites can be expensive. Removing health risks must be the main priority of all brown fields action

plans. Environmental health hazards are disproportionately concentrated in low-income communities of

color. Policy requirements and enforcement mechanisms to safeguard environmental health should be strengthened for all brownfields projects located in these communities. If sites are potentially endanger­

ing the health of the community, all efforts should be made for site remediation to be carried out to the

highest cleanup standards possible towards the removal of this risk. The assurance of the health of the

community should take precedence over any other benefits, economic or otherwise, expected to result

from brownfields redevelopment. It's important to require from companies to observe a "good neigh­

bor" policy that includes on-site visitations by a community watchdog committee, and the appointment

of a neighborhood environmentalist to their board of directors in accordance with the environmental

principles.

P3-04 (A) A Neighbourhood Cohort for Population and Environmental Health: Air Pollution in

Vancouver 1976-2001 Michael Buzzelli, Jason Su, and Nhu Le

This is the second paper of research programme concerned with the geographical patterning of

environmental and population health at the urban neighbourhood scale. Based on the Vancouver met­

ropolitan region, the aim is to better understand the role of neighbourhoods as epidemiological spaces

where environmental and social characteristics combine as health processes and outcomes at the com­

munity and individual levels. This paper builds a cohort of commensurate neighbourhoods across all

six censuses periods from 1976 to 2001, assembles neighbourhood air pollution data (several crite­

rion/health effects pollutants), and providing an analysis to demonstrate how air pollution systemati­

cally and consistently maps onto neighbourhood socioeconomic markers, in this case low education

and lone-parent families. We conclude with a discussion of how the neighbourhood cohort can be fur­

ther developed to address emergent priorities in the population and environmental health literatures,

namely the need for temporally matched data, a lifecourse approach, and analyses that control for spa­

tial scale effects.

P3-05 (A) Solid Waste and Environment in Mumbai (India) Bairam Paswan and Uttam Sonkamble

Solid Waste Management and Environment in Mumbai (India) by Uttam Jakoji Sonkamble and

Bairam Paswan Abstract: Mumbi is the individual financial capital of India. The population of Greater

Mumbai is 3,326,837 and 437 Sq. Km. area. The density of population 21, 190 per Sq. Km. The day­

to-day administration and rendering of public services within Gr. Mumbai is provided by the Brihan

Mumbai Mahanagar palika (Mumbai Corporation of Gr. Mumbai) that is a body of 221 elected coun­

cilors on a 5-year team. Mumcial corporation provides varies conservancy services such as street

sweeping, collection of solid waste, removal and transportation, disposal of solid waste, disposal of

dead bodies of animals, construction, maintance and cleaning of urinals and public sanitary conve­

niences. The solid waste becoming complicated due to increase in unplanned urbanization and indus­

trialization, the environment has deteriorated significantly due to inter, intra and international

migration stream to Mumbai. The volume of inter state migration to Mumbai is considerably high i.e.

20.89 lakh and international migrant 0.77 lakh have migrated to Mumbai. Present paper gives the

view on solid waste management and its implications to environment and health. Pollution from a

wide varity of emission, such as from automobiles and industrial activities, has reached critical level in

Mumbai, causing respiratory, ocular, water born diseases and other health problems. Sources of gen­

eration of waste are - Household waste, commercial waste, Institutional waste, street sweeping, silt

removed from drain/nallah/cleanings. Disposal of solid waste in Gr. Mumbai done under 1 incinera­

tion 2. Processing to produce organic manure. 3. Vermi- composting 4. Landfill The study shows that

the quantity of waste disposal of through processing and conversion to organic ~anure is about 200-

240 M.T. per day. The processing is done by a private agency M/S excel Industries Ltd. Who had set

up a plant at the Chincholi dumping ground in western Mumbai for this purpose. The corporation is

also disposal a plant of its waste mainly market waste through the environment friendly, natural pro­

ces~ known as Vermi-composing about 100 M.T. of market waste is disposed of in this manner at the

various sites. There are four land fill sites are available and 95 percent of the waste matter generated m

Mumbai is disposed of through landfill. Continuous flow of migrant and increa~e in slum population

is a complex barrier in the solid waste management whenever community pamc1pat1on work strongly

than only we can achieved eco-friendly environment in Mumbai.

v66 POSTER SESSIONS

PJ-06 (A) Traffic Intensity, Lodging Value and Hospital Admissions for Respiratory Disease Among the

Elderly in Montreal (Canada): A Case-Control Analysis Audrey Smargiassi and Tom Kosatsky

Persons exposed to residential craffic have elevated races of respiratory morbidity an~ ~ortality. Since poverty is an important determinant of ill-health, some h~ve argued that t~es~ assoc1at1ons may

relate to che lower socioeconomic status of those living along ma1or roads. Our ob1ect1ve was to evaluate

the association between traffic intensity at home and hospital admissions for respiratory diagnoses

among Montreal residents older than 60 years. Morning peak traffic estimates from the EMMEJ2 Mont­

real traffic model (MOTREM98) were used as an indicator of exposure to road traffic outside the homes

of those hospitalised. The influence of socioeconomic status on the relationship between traffic intensity

and hospital admissions for respiratory diagnoses was explored through assessment of confounding by

lodging value, expressed as the dollar average over road segments. This indicator of socioeconomic sta­

tus, as calculated from the Montreal property assessment database, is available at a finer geographic

scale than socioeconomic information accessible from the Canadian Census. There was an inverse rela­

tionship between traffic intensity estimates and lodging values for those hospitalised (rho -0.23, p 3160

vehicles during che 3 hour morning peak), even after adjustment for lodging value (crude OR 1.35,

Cl95% 1.22-1.49; adjusted OR 1.13, Cl95% 1.02-1.25). In Montreal, elderly persons living along

major roads are at higher risk of being hospitalised for respiratory illnesses, which appears not simply to

reflect the fact that those living along major roads are at relative economic disadvantage.

PJ-07 (C) Planning Healthy and Sustainable Cities in Africa Geoffrey Nwaka

The paper argues that human beings ought to be at the centre of the concern for sustainable devel­

opment. While acknowledging the importance of protecting natural resources and the ecosystem in order

to secure long term global sustainability, the paper maintain that the proper starting point in the quest

for urban sustainability in Africa is the 'brown agenda' to improve che living and working environment

of che people, especially che urban poor who face a more immediate environmental threat to their health

and well-being. As the UN-Habitat has rightly observed, it is absolutely essential "to ensure that all peo­

ple have a sufficient stake in the present to motivate them to take part in the struggle to secure the future

for humanity.~ The human development approach calls for rethinking and broadening the narrow tech­

nical focus of conventional town planning and urban management in order to incorporate the emerging

new ideas and principles of urban health and sustainability. I will examine how cities in Sub-Saharan

Africa have developed over the last fifty years; the extent to which government policies and programmes

have facilitated or constrained urban growth, and the strategies needed to achieve better functioning,

safer and more inclusive cities. In this regard I will explore insights from the United Nations Conferences

of the 1990s, especially Local Agenda 21 of the Rio Summit, and the Istanbul Declaration/Habitat

Agenda, paying particular attention to the principles of enablement, decentralization and partnership

canvassed by these movements. Also, I will consider the contributions of the various global initiatives

especially the Cities Alliance for Cities Without Slums sponsored by the World Bank and other Partners;

che Sustainable Cities Programme, the Global Campaigns for Good Governance and for Secure Tenure

canvassed by UNHABIT AT, the Healthy Cities Programme promoted by WHO, and so on. The conclud­

ing section will reflect on the future of the African city; what form it will take, and how to bring about

the changes needed to make the cities healthier, more productive and equitable, and better able to meet people's needs.

PJ-08 (A) Exposure and Potential Health Risks to Toronto Residents Posed by Two Chemical Contaminants Heather jones-Otazo, john Clarke, Donald Cole, and Miriam Diamond

Urban areas, as centers of population and resource consumption, have elevated emissions and con­

centrations of a wide range of chemical contaminants. We have developed a modeling framework in

which we first ~stimate the emissions and transport of contaminants in a city and second, use these esti­

mates along with measured contaminant concentrations in food, to estimate the potential health risk

posed by these che.micals. The latter is accomplished using risk assessment. We applied our modeling

framework to consider two groups of chemical contaminants, polycyclic aromatic hydrocarbons (PAH)

a.nd the flame re~ardants polybrominated diphenyl ethers (PBDE). PAH originate from vehicles and sta­

tionary combustion sources. ~veral PAH are potent carcinogens and some compounds also cause non­

cancer effects. PBDEs are additive flame retardants used in polyurethane foams (e.g., car seats, furniture)

105fER SESSIONS v67

and cl~ equipm~nt (e.g., compute~~· televisio~s). Two out of three PBDEs formulations are being

voluntarily phased by mdustry due to rmng levels m human tissues and their world-wide distribution.

PBDEs have been .related to adv.erse neurological, developmental and reproductive effects in laboratory

IJlimals. We apphed our modelmg framework to the City of Toronto where we considered the south­

cattral area of 21 by 21 km that has a population of 1.3 million. For PAH, local vehicle traffic and area

sources contribute at least half of total PAH in Toronto. Local contributions to PBDEs range from 57-

85%, depending on the assumptions made. Air concentrations of both compounds are about 10 times

higher downtown than 80 km north of Toronto. Although measured PAH concentrations in food date to

the 1980s, we estimate that the greatest exposure and contribution to lifetime cancer risk comes from

ingestion of infant formula, which is consistent with toxicological evidence. The next greatest exposure

and cancer risk are attributable to eating animal products (e.g. milk, eggs, fish). Breathing downtown air

contributes an additional 10 percent to one's lifetime cancer risk. Eating vegetables from a home garden

localed downtown contributes negligibly to exposure and risk. For PBDEs, the greatest lifetime exposure

comes through breast milk (we did not have data for infant formula), followed by ingestion of dust by

the toddler and infant. These results suggest strategies to mitigate exposure and health risk.

HWTHCARE AVAILABILITY AND ACCESS

P4-01 (A) Immigration and Socioeconomic Inequalities in Cervical Cancer Screening in Toronto, Canada

Aisha Lofters, Rahim Moineddin, Maria Creatore, Mohammad Agha, and Richard Glazier

llltroduction: Pap smears are recommended for cervical cancer screening from the onset of sexual

activity to age 69. Socioeconomic and ethnoracial gradients in self-reported cervical cancer screening

have been documented in North America but there have been few direct measures of Pap smear use

among immigrants or other socially disadvantaged groups. Our purpose was to investigate whether

immigration and socioeconomic factors are related to cervical cancer screening in Toronto, Canada.

Methods: Pap smears were identified using fee codes and laboratory codes in Ontario physician ser­

vice claims (OHIP) for three years starting in 1999 for women age 18-41 and 42-66. All women with any

health system contact during the three years were used as the denominator. Social and economic factors

were derived from the 2001 Canadian census for census tracts and divided into quintiles of roughly equal

population. Recent registrants, over 80% of whom are expected to be recent immigrants to Canada,

were identified as women who first registered for health coverage in Ontario after January 1, 1993.

Results: Among 397,967 women age 18-41 and 328,885 women age 42-66, 55.3% and 55.5%,

rtSpcctively, had Pap smears within three years. Low income, low education, recent immigration, visible

minority and non-English language were all associated with lower rates (least advantaged quintile:most

advantaged quintile rate ratios were 0.84, 0.90, 0.81, 0.85, 0.83, respectively, p < 0.05 for all). Similar

gradients were found in both age groups. Recent registrants comprised 22.5% of women and had mm;h

lower Pap smear rates than non-recent registrants (37.2 % versus 63. 7% for women age 18-41 and

35.9% versus 58.2% for women age 42-66). ConclNSions: Pap smear rates in Toronto fall well below those dictated by evidence-based practice.

At the area level, immigration, visible minority, language and socioeconomic characteristics are associ­

ated with Pap smear rates. Recent registrants, representing a largely immigrant group, have particularly

low rates. Efforts to improve coverage of cervical cancer screening need to be directed to all ~omen, their providers and the health system but with special emphasis on women who recently arrived m

Ontario and those with social and economic disadvantage.

P4-02 (A) How HIV/AIDS have Affected Health Care Services in Urban Centres of Botswana

Josiah Muritu

Introduction: The vision of Botswana at independence was to end hunger, alleviate poverty, ensure

peace and justice, equal access education and health. Unfortunately these gains are .being revened. by

HIV/AIDs epidemic.Companing this epidemic with other country challenges such a btolog1cal d1vers1ty,

unrmployment and poverty HIV/A!Ds remain the single most important develop~ent. c.hallenge fac1~g Botswana today. HIV/AIDS has devastating and far reaching im~lications. for md1vtduals, fa'!:1hes

and communities living in urban areas. Due to climatic and econom1cal condmons ~ore than 65 Yo of

Batswana live in urban areas. This population requires the following to maintain their ~ea.Ith • Pro~r Housing • Good health care • Bener education • Clean water But due HID/AIDS this is not bemg

achieved.

v68 POSTER SESSIONS

Challeges Faced: a) Most of the resources are now being ~pent in ~reventing the sprea.d of HIV/ AIDS and maintaining the lives of those already affected. b) Skilled medical ~rs~nal are dymg under· mining the capacity to provide the required health care services. ~) Th.e comphcat1o~s of HIV/AIDs has complicated the treatment of other diseases e.g. TBs d) The ep1dem1c has led. to mcrease number of

h n requiring care and support. This has further stretched the resources available for health care. orp a s d db . . I

Methods used on our Research: 1. A simple community survey con ucte y our orgamzat1on vo · unteers in three urban centres members of the community, workers and health care prov~ders were inter-viewed ... 2. Meeting/Discussions were organized in Hospitals, commun.ity centre a~d with Government officials ... 3. Written questionnaires to health workers, doctors and pohcy makers m th.e health sectors.

Lessors Learning: • The biggest-health bigger-go towards HIV/AIDs prevention • AIDS are spreading faster in those families which are poor and without education. •Women are the most affected. •All health facilities are usually overcrowded with HIV/AIDs patients.

Actions Needed:• Community education oh how to prevent the spread of HIV/AIDS • HIV/AIDS testing need to be encouraged to detect early infections for proper medical cover. • People to eat healthy

• People should avoid drugs. Implications of our Research: Community Members and Civic Society-introduction of home based

care programs to take care of the sick who cannot get a space in the overcrowded public hospitals. PRl­V A TE SECTOR Private sector has established programs to support and care for the staff already affected. GOVERNMENT Provision of support to care-givers, in terms of resources and finances. Train­ing more health workers.

P4-03 (A) Prisoner Health Care in Australia - Opportunities for Addressing Health Deficits Michael Levy

Introduction: Australian prisons contain in excess of 23,000 prisoners. As in most other western coun­tries, reliance on 'deprivation of liberty' is increasing. Prisoner numbers are increasing at 7% per annum; incarceration of women has doubled in the last ten years. The impacts on the community are great - 4% of children have a parent in custody before their 16th birthday. For Aboriginal communities, the harm is greater - Aboriginal and/or Torres Strait Islanders are incarcerated at a rate ten times higher than other Australians. 25% of their children have a parent in custody before their 16th birthday. Australian prisons operate under state and territory jurisdictions, there being no federal prison system. Eight independent health systems, supporting the eight custodial systems, have evolved. This variability provides an unique opportunity to assess the capacity of these health providers in addressing the very high service needs of prisoners.

Results: Five models of health service provision are identified - four of which operate in one form or another in Australia: • provided by the custodial authority (Queensland and Western Australia)• pro· vided by the health ministry through a secondary agent (South Australia, the Australian Capital Terri­tory and Tasmania) • provided through tendered contract by a private organization (Victoria and Northern Territory) • provided by an independent health authority (New South Wales) • (provided by medics as an integral component of the custodial enterprise) Since 1991 the model of the independent health authority has developed in New South Wales. The health needs of the prisoner population have been quantified, and attempts are being made to quantify specific health risks /benefits of incarceration. Specific enquiry has been conducted into prisoner attitudes to their health care, including issues such as client information confidentiality and access to health services. Specific reference will be made to: • two inmate health surveys • two inmate access surveys, and • two service demand studies.

Conclusions: The model of care provision, with legislative, ethical, funding and operational inde­pendence would seem provide the best opportunity to define and then respond to the health needs of prisoners. This model is being adopted in the United Kingdom. Better health outcomes in this high-risk group, could translate into healthier families and their communities.

P4-04 (A) lnregrated Ethnic-Specific Health Care Systems: Their Development and Role in Increasing Access to and Quality of Care for Marginalized Ethnic Minorities Joshua Yang

Introduction: Changing demographics in urban areas globally have resulted in urban health systems that are racially and ethnically homogenous relative to the patient populations they aim to serve. The resultant disparities in access to and quality of health care experienced by ethnic minority groups have been addressed by short-term, instirutional level strategies. Noticeably absent, however, have been struc­tural approaches to reducing culturally-rooted disparities in health care. The development of ethnic-specific h~alth car~ systems i~ a structural, long-term approach to reducing barriers to quality health care for eth· me mmonty populations.

POSTER SESSIONS v69

Methods: This work is based on a qualitative study on the health care experiences of San Francisco

Chinatown in the United States, an ethnic community with a model ethnic-specific health care infrastruc­

rure. Using snowball sampling, interviews were conducted with key stakeholders and archival research

was conducted to trace and model the developmental process that led to the current ethnic-specific

health care system available to the Chinese in San Francisco. Grounded theory was the methodology

IJltd to analysis of qualitative data. Rmtlts: The result of the study is four-stage developmental model of ethnic-specific health infra­

strueture development that emerged from the data. The first stage of development is the creation of the

human capital resources needed for an ethnic-specific health infrastructure, with emphasis on a bilingual

and bicultural health care workforce. The second stage is the effective organization of health care

resources for maximal access by constituents. The third is the strengthening and stability of those institu­

tional forms through increased organizational capacity. Integration of the ethnic-specific health care sys­

tem into the mainstream health care infrastructure is the final stage of development for an ethnic-specific

infrastructure. Conclusion: Integrated ethnic-specific health care systems are an effective, long-term strategy to

address the linguistic and cultural barriers that are being faced by the spectrum of ethnic populations in

urban areas, acting as culturally appropriate points of access to the mainstream health care system. The

model presented is a roadmap to empower ethnic communities to act on the constraints of their health

and political environments to improve their health care experiences. At a policy level, ethnic-specific

health care organizations are an effective long-term strategy to increase access to care and improve qual­

iiy of care for marginalized ethnic groups. Each stage of the model serves as a target area for policy inter­

ventions to address the access and care issues faced by culturally and linguistically diverse populations.

P4-05 (A) Longitudinal Patterns of Health Care Utilization Among Community-Based Injection Drug

Users in Baltimore MD: 1989-2004 Noya Galai, Gregory Lucas, Peter O'Driscoll, David Celentano, David Vlahov, Gregory Kirk,

and Shruti Mehta

Introduction: Frequent use of emergency rooms (ER) and hospitalizations among injection drug

users (IDUs) has been reported and has often been attributed to lack of access to primary health care.

However, there is little longitudinal data which examine health care utilization over individual drug use

careers. We examined factors associated with hospitalizations, ER and outpatient (OP) visits among

IDUs over 14 years of follow-up. Methods: IDUs were recruited through community outreach into the AIDS Link to lntraVenous

Experience (ALIVE) study and followed semi-annually. 2,551 who had at least 2 follow-up visits were

included in this analysis. Outcomes were self-reported episodes of hospitalizations and ER/OP visits in

the prior six months. Poisson regression was used accounting for intra-person correlation with general­

ized estimation equations. hits: At enrollment, 73% were male, 95% were African-American, 33% were HIV positive,

median age was 35 years, and median duration of drug use was 15 years. Over a total of 37,512 visits,

mean individual rates of utilization were 11 per 100 person years (PY) for hospitalizations and 123 per

100 PY for ER/OP visits. Adjusting for age and duration of drug use, factors significantly associated with

higher rates of hospitalization included HIV infection (relative incidence [RI(, 1.4), female gender (RI,

1.2), homelessness (RI, 1.6), as well as not being employed, injecting at least daily, snorting heroin, hav­

mg a regular source of health care, having health insurance and being in methadone mainte.nance treat­

ment (MMT). Similar associations were observed for ER/OP visits except for MMT which was not

associated with ER/OP visits. Additional factors associated with lower ER/OP visits were use of alcohol,

crack, injecting at least daily and trading sex for drugs. 10% of the cohort accounted for 45% of total

ER/OP visits, while 11 % of the cohort never reported an OP visit during follow-up. . . .

Condusion: Within this marginalized, inner-city population, overall rates of health care ut1hzatmn,

and in particular hospitalizations, were high and increased over time indicating poor health. _However,

access indicators such as lack of insurance, active drug use and trading sex fo~ drugs, were important

suggesting the need to focus efforts on improving the health care of this population.

P4-06 (C) Advanced Access Scheduling: Decreasing Barriers to Health in Marginalized Inner City

Populations

Yuriy Tatuch, James Read, Mary Grondin, and Vinita Shah

. Introduction: Increasingly, health care providers are experimenting with more efficient ways to

deliver services, and to enhance both patient care and satisfaction. Advanced or open access scheduling 15

v70 POSTER SESSIONS

built on the premise ~to do today's work today". It is particularly i~portant in high-risk populations, with multiple medical and social needs, who ha~e barriers ~o ac~essmg care. The S~erbourne He~lth c t provides primary health care to an inner city community with a goal of decreasmg such bamm. T~: ;:ntre has a priority focus on Homeless/under-housed, N~~comer, ~nd Lesbian, Ga~, Bise~ua~ and Transgender (LGBT) populations. We hypothesized that prov1dmg .appomtments .for p~t1~nts w1thm 24 hours would ensure timely care, increase patient satisfaction, and improve practice eff1c1ency. Further, we anticipated that the greatest change would occur amongst our homeless patients.. .

Methods: We tested an experimental introduction of advanced access scheduling (usmg a 24 hour rule) in the primary care medical clinic. We tracked variables inclu~ing waiting ti~e fo~ next available appointment; number of patients seen; and no-show rates, for an eight week penod pnor to and post introduction of the new scheduling system. Both patient and provider satisfaction were assessed using a

brief survey (2 questions rated on a 5-pt scale). Results and Conclusion: Preliminary analyses demonstrated shorter waiting times for appointments

across the clinic, decreased no-show rates, and increased clinic capacity. Introduction of the advanced access scheduling also increased both patient and provider satisfaction. The new scheduling was initiated in July 2005. Quantitative analyses to measure initial and sustained changes, and to look at differential responses across populations within our clinic, are currently underway.

P4-07 (A) Assessing the Relationship Between Community Resources and Neighborhood Health and Well-Being in London, Ontario Sorina Vlaicu and Sean Mcintyre

Introduction: There are three recognized approaches to linking socio-economic factors and health: use of census data, GIS-based measures of accessibility/availability, and resident self-reported opinion on neighborhood conditions. This research project is primarily concerned with residents' views about their neighborhoods, identifying problems, and proposing policy changes to address them. The other two

techniques will be used in future research to build a more comprehensive image of neighborhood depri· vation and health.

Methods: A telephone survey of 658 London, Ontario residents is currently being conducted to

assess: a) community resource availability, quality, access and use, b) participation in neighborhood activities, c) perceived quality of neighborhood, d) neighborhood problems, and e) neighborhood cohe­sion. The survey instrument is composed of indices and scales previously validated and adapted to reflect London specifically. Thirty city planning districts are used to define neighborhoods. The sample size for each neighborhood reflects the size of the planning district. Responses will be compared within and across neighborhoods. Data will be linked with census information to study variation across socio-eco· nomic and demographic groups. Linear and GIS-based methods will be used for analysis.

Preliminary Results: The survey follows a qualitative study providing a first look at how experts involved in community resource planning and administration and city residents perceive the availability, accessibility, and quality of community resources linked to neighborhood health and wellbeing, and what are the most immediate needs that should be addressed. Key-informant interviews and focus groups were used. The survey was pre-tested to ensure that the language and content reflects real experiences of city residents. The qualitative research confirmed our hypothesis that planning districts are an acceptable surrogate for neighborhood, and that the language and content of the survey is appropriate for imple· mentation in London. Scales and indices showed good to excellent reliability and validity during the pre· test (Cronbach's alpha from 0.57-0.96). Preliminary results of the survey will be detailed at the conference.

Conclusions: This study will help assess where community resources are lacking or need improve· ment, thus contributing to a more effective allocation of public funds. It is also hypothesized that engaged neighborhoods with a well-developed sense of community are more likely to respond to health programs and interventions. It is hoped that this study will allow London residents to better understand the needs and problems of their neighborhoods and provide a research foundation to support local understandmg of community improvement with the goal of promoting healthy neighborhoods.

P4-08 (A) HIV Positive in New York City and No Outpatient Care: Who and Why? Hannah Wolfe and Victoria Sharp

Introduction: There are approximately 1 million HIV positive individuals living in the United Sta!es. About. 50% of these know their HIY status and are enrolled in outpatient care. Of the remaining 50 Yo, approx~mately half do not know their status; the other group frequently know their status but are not enrolled m any .sys~em of outpatient care. This group primarily accesses care through emergency departments. When md1cated, they are admitted to hospitals, receive acute care services and then, upon

POSTER SESSIONS v71

di5'harge, disappear from the health care system until a new crisis occurs, when they return to the emer­

gency department. As a large urban HIV Center, caring for over 3000 individuals with HIV we have an

active inpatient service ".'ith appr~xi~.ately 1800 discharges annually. We decided to survey our inpa­

tients to better charactenze those md1v1duals who were not enrolled in any system of outpatient care.

Methods: We conducted our study from August 2003 through November 2003 on the inpatient

units at St.Luke\'s and Roosevelt Hospitals. Surveys were conducted by the HIV Center social workers

on all HIV positive patients admitted to the medicine service. During this period of time there were 244

admissions, with 91 at St. Luke\'s and 153 at Roosevelt.

Results: 18% of inpatients were not enrolled in regular outpatient care: 2% at Roosevelt Hospital

and 35% at St.Luke\'s Hospital. Substance abuse and homelessness were highly prevalent in the cohort

of patients not enrolled in regular outpatient care. 84% of patients not in care (vs. 33% of those in care)

were deemed in need of substance use treatment by the inpatient social worker. 74% of those not in care

were homeless (vs. 15% of those in care.) Patients not in care did NOT differ significantly from those in

me in terms of age, race, or gender. Patients not in care were asked "why not:" the two most frequent

responses were: "I haven't really been sick before" and "I'd rather not think about my health.

Conclusions: This study suggests that there is an opportunity to engage these patients during their

stay on the inpatient units and attempt to enroll them in outpatient care. Simple referral to an HIV clinic

is insufficient, particularly given the burden of homelessness and substance use in this population. Efforts

are currently underway to design an intervention to focus efforts on this group of patients.

P4.Q9 (A) Healthcare Availability and Accessibility in an Urban Area: The Case of Ibadan city, Nigeria

Femi Agholor

In oder to cater for the healthcare need of the populace, for many years after Nigeria's politicl inde­

pendence, empphasis was laid on the construction of teaching, general, and specialist hospital all of

which were located in the urban centres. The realisation of the inadequacies of this approach in ade­

quately meeting the healthcare needs of the people made the country to change and adopt the Primary

Health Care (PHC) system in 1986. The Primary Health Care system which is in line with the Alma Ata

declaration of of 1978, wsa aimed at making health care available to as many people as possible on the

basis of of equity and social justice. Thus, close to two decades, Nigeria has operated Primary Health

Care system as a strategy for providing health care for rural and urban dwellers. This study focusing on

urban area, examimes the availabilty and accessibility of health care in one of Nigeria's urban centre,

Ibadan city to be specific. This is done within the contest of the country's National Heath Policy

of which Pimary Health Care is the main thrust. The study also offers necessary suggestion for policy

consideration.

P4-IO (A) Racial and Ethnic Differences in Unmet Need for Vision Care Among Children with Special

Healthcare Needs in the United States Kevin Heslin, Richard Casey, Magda Shaheen, Fernando Cardenas, and Richard Baker

Introduction: Studies indicate that children with vision deficits often suffer from multiple disabling

conditions. Because children with special healthcare needs (CSHCN) are often unable to report verbally

what they can see during conventional eye examinations, they may require more individually tailored

evaluation and treatment of their vision problems than children without special needs. Unfortunately,

some CSHCN do not receive needed eyeglasses or other types of vision care, which pla.:es them at great

risk of long-term delays in their educational and social development. .

Objective: We examined racial/ethnic differences in unmet need for vision <:are among .:ommumty-

dwelling CSHCN using data from the National Survey of CSHCN. . . .

Methods: This cross-sectional analysis was restricted to 14,070 CSHCN who needed v1s10n care. m

the previous year. Children who did not receive all the eyeglasses or vision .:are they needed were .:ons1d­

ered to have unmet need for vision care. We estimated the prevalence of unmet need m the populauon

overall and in each racial/ethnic group. A multivariate logistic regression model was fi~cd to test the

hypothesis that minority CSHCN were more likely than whites to have unmet need for v1s1on care, and

odds ratios (ORs) and 95% confidence intervals (Cls) were calculated. .

&suits: The subjects of the 14,070 interviews represent approximately 3,310,400 c.SHCN needing

vision care in the U.S. The majority of this population was white (70% ), followed by Afncaon Americans

114%), Latinos ( 11 %), multiracial CSHCN (3% ), and CSHCN of "other" b~ckgrounds (2 Yo). Children

of Asian, Native Hawaiian and other Pacific Islander (ANHOPI) and American Indian/Alaskan Native

IAIAN) backgrounds were 'both less than one percent of CSHCN needing vision care ,(0. 7% and o .. 5%,

respectively). Six percent of the sample, representing approximately 198,600 CSHCN needing v1s1on

v72 POSTER SESSIONS

h d d Rates of unmet need across the seven racial/ethnic groups ranged from 3% care, a unmet nee . . . d ·

15 01 R I · t whi"tes increased risks of unmet need for v1s10n care were foun among Afncan to 10. e at1ve o , 0 d ·

A · (OR 1 98 9501 CI-1 37 2 87) Latinos (OR= 1.94; 95 Yo CI= 1.13,3.33), an children of mer1cans = . ; /o - • , • ,

multiracial backgrounds (OR= 2.69; 95% CI= 1.43,5.08). Conversely, CSHCN of AIAN backgr~unds

had lower adjusted risk compared with whites (OR"". 0.23; 95~ CI=?.07,0.77). Healthc~re providers,

schools, and insurance coverage also contributed to differences m the nsk of unmet need, mdependendy

of child race/ethnicity. . . . Conclusion: Further research is needed to explain and address the causes of rac1al/ethmc differences

in unmet need for vision care among CSHCN.

P4-11 (A) Accessibility does not Necessarily Mean Using the Health Facilities

Ezzat Mazloomi, M. Rahim Kadivar, Mohammad Fararouei, and Jalil Masoomi

In spite of the accessibility to services provided by educated and trained midwifes in many parts of

Fars province (Iran) there are still some deliveries conducted by untrained traditional birth attendants in

rural parts of the province. As a result, a considerable proportion of deliveries are conducted under a

higher risk due to unauthorised and uneducated attendants. This study has conducted to reveal the pro·

portion of deliveries with un-authorized attendants and some spatial and social factors affecting the

selection of delivery attendants. Method: This study using a case control design compared some potentially effective parameters indud·

ing: spatial, social and educational factors of mothers with deliveries attended by traditional midwifes

(n=244) with those assisted by educated and trained midwifes (n=258). The mothers interviewed in our

study were selected from rural areas using a cluster sampling method considering each village as a cluster.

Results: more than 11 % of deliveries in the rural area were assisted by traditional midwifes. There

are significant direct relationship between asking a traditional birth attendant for delivery and mother

age, the number of previous deliveries and distance to a health facility provided for delivery. Significant

inverse relationships were found between mother's education and ability to use a vehicle to get to the

facilities. Conclusion: Despite the accessibility of mothers to educated birth attendants and health facilities

(according to the government health standards), some mothers still tend to ask traditional birth atten­

dants for help. This is partly because of unrealistic definition of accessibility. The other considerable

point is the preference of the traditional attendants for older and less educated mothers showing the

necessity of changing theirs knowledge and attitude to understand the risks of deliveries attended by tra­

ditional and un-educated midwifes.

P4-12 (A) Identification and Optimization of Service Patterns Provided by Assertive Community

Treatment Teams in a Major Urban Setting: Preliminary Findings &om Toronto, Canada

Jonathan Weyman, Peter Gozdyra, Margaret Gehrs, Daniela Sota, and Richard Glazier

Objective: Assertive Community Treatment (ACT) teams are financed by the Ontario Ministry of

Health and Long-Term Care (MOHLTC) and are mandated to provide treatment, rehabilitation and

support services in the community to people with severe and persistent mental illness. There are 13 such

teams located in various regions across the city of Toronto conducting home visits 1-5 times per week to

each of their approximately 80 respective clients. Each team consists of multidisciplinary health profes­

sionals who assist clients to identify their needs, establish goals and work toward them. Due to complex

referral patterns, the need for service continuity and the locations of supportive housing, clients of any

one team are often found scattered across the city which increases home visit travel times and decreases

efficiency of service provision. This project examines the locations of clients in relation to the home bases

of all 13 ACT teams and identifies options for overcoming the geographical challenges which arise in a large urban setting.

Methods: Using Geographic Information Systems (GIS) we geocoded all client and ACT agency

addresses and depicted them on location maps. At a later stage using spatial methods of network analysis

we plan to calculate average travel rimes for each ACT team, propose optimization of catchment areas and assess potential travel time savings.

ResNlts: Initial results show a substantial scattering of clients from several ACT teams and substan· rial overlap of visit travel routes for most teams.

Conclusions: Reallocation of catchment areas and optimization of ACT teams' travel patterns

should lead to substantial savings in travel times, increased service efficiency and better utilization of

resourc_~· ~e l'<!tenri~I modifications to catchment areas must be conducted with appropriate attention

to specific clients servtce needs, service continuity and applicable regulations by the MOHL TC.

POSTER SESSIONS

P4-13 (C) The Transfonnation of an Old and Dismissed Hospital into a Multi-Functions Center. A Project for the Seaside Hospital in Venice Lido, Italy

Raniera Barbisan

v73

Venice Lido is a popular island within and outside Italy because it hosts the International Cinema

Festival yearly. Only few people remember the island for its hospital, which, in the fifties, was one of the

most important hospitals in Italy and in Europe, being a modern center for wind-, sun- and thermal-ther­

apy. Since the sixties, its fame became to drop away, since its structure was no longer adequate for the

evolving medicine science. At the end of the seventies all the wards were moved into a new big building

in the same area. At present the hospital is made up by about forty 'pavilions' (mostly partially used or

empty) and a big building, disseminated in a 10 hectares area, on the sea front, on the 500 m long beach.

The aim of my research is to suggest a realistic solution, sustainable on the functional use of the area

according to basic local needs and economically realizable. I used a philological and multi-disciplinary

method, more in detail: - from historical documents, I found what was the very first call of the property

and how it adapted to the needs of the demographic development and the sanitary supply over time; - by

contacting some operators from different fields, I realized which functions were suitable to the buildings

in existence, to the population's needs and to the present sanitary supply. Moreover the planning idea

considers: - the debate going on between local people who strongly want to preserve the property, and

die ones who want to renew it by different new opportunities; and - the regional sanitary politics, aiming

at rationalizing the regional hospitals dislocation, and the budget needs. This plan analyzes and proposes

some new alternative solutions to satisfy different needs. The different activities will be dealt out and the

environmental fall will be limited as much as possible. After having analyzed its basic call, considered its

environmental peculiarities and its position, verified the emerging needs of the local population, the plan

proposes 5 different activities: the Hospital; the Social-Rehabilitation Center; the Elderly House; the

Thermal Center; the Residential Center; and other activities. Such a plan wants to share in the solution

of a basic problem by giving architectonic and functional dignity to an historical completely degraded

area and by starting again a social-economical broken off process, by bringing in Venice Lido some fresh

necessary elements for its so wished new throw.

P4-14 (C) Dilemma of Free Health Care in Spokane, WA David Bunting

Introduction: The paper reports on the activities of Project Access Spokane [PAS], a physician spon­

sored initiative to provide uncompensated health care to low income, uninsured residents of Spokane

County WA. Program providers included all county hospitals, over 600 physicians, other medical profes­

sionals, and specialized clinics. Each prescription requires only a $4 co-payment. Sponsored and admin­

istered by the county medical society, PAS is funded by local and national foundations, private

corporations, municipalities, civic organizations and individuals. Method: The paper is based on a first year assessment report funded by PAS, using HCFA [Health

Care Financing Administration] insurance claim data documenting utilization rates, disease categories

and donated charge information and patient CARES [Centralized Applications, Referrals and Enroll­

ment Status) data. Results: While essentially free for enrollees, the program involved real costs. An administrative

organization to refer over 700 patients to any of over 800 providers had to be developed and staffed,

using both paid and unpaid personnel. Methods to identify potential patients and veri.fy eligibility. had to

~devised. Patient appointments and transportation had to be scheduled and monitored. Pu~hc rela­

nons, provider solicitations and fundraising activities were continuous. Information requirements

regarding program operation were also significant. Data reporting the volume. ~nd value of dona~ed medical services were necessary to demonstrate accomplishments and attr~ct addmon~l support. Provid­

ers required assurances their contributions were both significant and eqmtable. Funding sources sought

evidence that their support had important consequences. However, generating this ~~ta proved difficult.

Many providers failed to submit appropriate insurance claims forms because .of a~dmonal donated effort

and administrative cost, thereby not only reducing their own apparent conmbut1ons but also the overall

Significance of the program. Conclusions: During its initial year, the estimated cost to deliver free health care was ~bout 5500

per enrollee. The lesson is that without an elaborate administrative structure and record keeping s.yst~~· efforts to provide free health care probably will fail. Eligible enrollees c~n not be ~parated from in~hgi­ble ones, care will not be accessed or delivered in an efficient manner, neither fundmg nor ~upport "".111 be

offered without evidence of tangible benefits, and providers will withdraw if they perceive mequ1table

tteannent.

v74

P4-1S (C) Mobility in Prostitution and the Impact of Health Therese Van der Helm and Henk Sulman

POSTER SESSIONS

Introduction: Many of the estimated 8.000 commer~ial ~ex wor~ers (C~W)in A'.'1~terdam ~~me from developing countries and Eastern Europe. To gain ins~ght mto their workmg and_ hvmg condinons the Intermediary Project (IP) at the Municipal Health Serv1~e _contacts these women via ?utreach work on regular basis. Since the new brothel law in October 2000 1s 1~troduc~d, ~SW ~rom outside the EU and who have no Dutch residence permit are not allowed to work m prost1tut10n. Smee then, many of these CSW therefore have gone "underground." The consequences of the new law in the Netherlands will be discussed with regard to the accessibility of CSW and their risk for STl/HIV acquisition and unplanned

pregnancies. Methods: Topics during outreach work are the interventions to increase the knowledge of safe

sex and birth control for CSW. Written information is handed out in relevant languages and with addresses of health and social services. In conversations with the women, it appeared that many are not aware of these services. To provide easier access to health care for women, staff of the IP carries out free STI control CSW working places, in windows brothels and sex houses. Also, women are offered vaccination against hepatitis B (HBV).

Results: From January 2004 till July 2005 we approached 900 CSW for first contact. One third was Dutch; others were from developing countries, other EU countries and Eastern Europe. 350 STI consul· rations were done among non-IV drug using sex workers, of whom 50 % was Dutch. Of these, 2 % was diagnosed with syphilis, 1 % with gonorrhea, and 9% with Chlamydia. Of 234 women tested for HIV, none were infected. Due to the high turnover of CSW in .brothels, most wnmen were tested only once. Among 845 CSW tested for HBV - of whom one third is Dutch - 22 % had antibodies for HBV, 12 were carrier of HBV, most of whom came from HBV endemic areas.

Conclusions: STI control and HBV vaccination in brothels is an important support in health care. Our findings suggest that CSW do not play an important role in the transmission of STI. Many CSW are highly mobile and often not aware of the existing health and social services. Continuous outreach is important to remain in contact with this mobile population. Regulations in the new brothel law should not hamper contacts with (illegal) CSW.

P4-16 (C) Bringing Health Care Outreach to the Workplace: Strategies for NYC's South Asian Taxi Drivers Saqib Sheikh, David Rubinstein, William Bateman, LaRay Brown, and Mitchell Rubin

Introduction: Cardiovascular diseases have become a worldwide health burden; by 2020, Coronary Heart Disease (CHO) is projected to become the leading cause of death. Studies conducted in Europe and the United States have proven a higher rate of CHO in South Asians who have migrated from South Asia, most notably India, Pakistan and Bangladesh. Approximately 50% of all heart attacks among South Asian men occur under the age of 55; 25% of them occur under the age of 40- unheard of in any other population. Associated risk factors such as diabetes, high blood pressure and cholesterol are also com· mon in this group. The population of South Asians residing in NYC has more than doubled over the past decade to over 300,000, the majority being young, working-class and with limited health care access. Many South Asian men are employed as taxi drivers (4 out of 10 NYC taxi drivers are from South Asial, working daily12 hour plus shifts.

Methods: Acknowledging that this vulnerable, at-risk group was unavailable for outreach through conventional venues, three of the hospitals of the New York City Health and Hospital Corporation, (Elmhurst, Queens and Bellevue) conducted a one day outreach effort at NYC's JFK International Air· ~rt's taxi holdin~ ar~a, ~here over one thousand taxis regularly assemble. Bringing an outreach event directly to the taxi dnvers workplace, a tent was set up where cardiovascular-related health screenings, in~luding bl~ pressure, sugar, cholesterol, body mass index (BMI), were provided. Results were shared with and explamed to the drivers and each participant received a South Asian health education brochure. A total of 84 taxi drivers who identified as South Asian were involved.

Rau/ts: Participants were all male, ranging from 20 to 61 years; mean age, 41.5. Screenings revealed 57% hypertensive; 46% had cholesterols over 200; 26% blood glucose over 160; 91 % had a BMI greater than 25.

Conc~on: A unique outreach activity, adapting to logistical, occupational limitations, is pre· se~ted. On-site f~back and explanation of results, reiterating and reinforcing the concern that South Asia~. men are at mcreased danger for early coronary heart disease, and the dissemination of a culturally sensmve and r~levant brochure, may heighten awareness of prevailing cardiac risk factors in this immi· grant community.

POSTER SESSIONS

P4-17 (C) The Community-Hospital Integration Program Framework: Community-Hospital

panoenhips to Improve the Population's Health

John Stevenson, Richard Blickstead, Ann-Marie Marcolin, and Sandi Kendal

v75

Introduction: St. Josephs Health Centre is a Catholic community teaching hospital located in the

heart of Southwest Toronto. St. Joseph\\'s was founded from a community-expressed need for hospital

services, and since then has stayed committed to fostering a healthy community through collaboration

and parmership. St. Joseph's has developed an innovative model, the Community-Hospital Integration

Program (CHIP), to strengthen St. Joseph's partnerships with community stakeholders, and facilitates

the building of links between community needs, service provision, and public policy outcomes to

improve the health and wellness of the diverse neighbourhoods they together serve.

Methods: Development of the CHIP Framework St. Joseph's Health Centre developed the CHIP

framework through a multidisciplinary approach that included extensive international literature reviews,

consultations, and key informant interviews with community service agencies and academics. To ensure

active community voice, St. Joseph's has hosted a number of community consultations including a Com­

munity Outreach Forum attended by over ninety representatives from 68 community partners.

Results: The CHIP Framework The CHIP framework aims to improve the health and wellness of

the urban communities served by St. Josephs Health Centre through four intersecting pillars: • Raising

Community Voices provides an infrastructure and process that supports community stakeholder input

into health care service planning, decision-making, and delivery by the hospital and across the contin­

uum of care; • Sharing Reciprocal Capacity promotes healthy communities through the sharing of our

intellectual and physical capacity with our community partners; • Cultivating Integration Initiatives facil­

itates vertical, horizontal, and intersectoral integration initiatives in support of community-identified

needs and gaps; and • Facilitating Healthy Exchange develops best practices in community integration

through community-based research, and facilitates community voice in informing public policy.

Conclusion: The CHIP framework drives the complex inter-relationships between community-hospi­

tal engagement, reciprocal capacity-building, integration initiatives, and community-based research and

evaluation, to create an interconnected network of health care services. The fluidity and simplicity of this

framework, and its dedication to balancing community needs and hospital mandate, posits the St. Josephs

Health Centre's CHIP model as an integral component in building healthy and thriving communities.

P4-18 (C) Home Based Care Promotion: Improving Acess to Quality Services and Livelihood in the

Face of AIDS Joseph Kamoga

Home Based care is a service provided to persons affected/living with HIV/AIDS, a menu of care/sup­

port services at home/community. It is a prominent alternative approach. In Uganda, hospital bed ocupacny

is high, patient health care worker ratio deteriorating. Empowering communities offers solutions to the

problems; adressing cost, effectiveness of care. HIV/AIDS demands changes in attitudes, behaviour,

approaches which is enhanced in home/community settings. For example ART requires high levels of

adherecnce, which medical workers have vety little opportunity to enforce. It also demands other support

mechanisims in terms of Nutrition, personal displine, etc which work best in stigma free environments.

Hence the relevance of home based care. This paper highlights the gaps that call for increased action in terms

of home based care, examples of whre it has worked key challenges and recommendations for the future.

P4-19 (C) Health Care For One ... Health Care For Alli

Katharina Kovacs Burns

Introduction: At the surface, it appears that every person in Canada _has. ~ccess to a publicly funded

health care system. Those living in urban centers should have the best ava1l~b1hty, chmce, and access to a

variety of health care services because of the distribution of health care services, fac1lmes, and health pro­

fessionals in concentrated in urban centers. This is not true for everyone - people with low income or who

are homeless experience the challenges of social exclusion and being marginalized: There are many factors

at play making it difficult for the latter group of people to access health care. service they need,.when they

need them. Health care is not as accessible or inclusive as intended. The quesuon to be explore.cl 1~: If health

care is available and accessible to one person, what makes it not available to all people? The ~1gmfic~nce of

having marginalized people accessing health care and other services includes e~hanced quality of hfe and

decreased risks associated with being homeless, and cost savings in Ion~ ter~ w1rh acute health care.

Methodology: Community-based Participatory Research is applied m a case study on health care

access and challenges experienced by low income and homeless people in one urban centre, Edmonton,

v76 POSTER SESSIONS

Albe d I ped In the initial phase of the study surveys were distributed to people with low income rta, was eve o . . . . .

d h re homeless health and other service providers, and program deos1on makers. Quesnons an w 0 a ' d b h d · d" 'd focused on their perceptions of the health care and other services accesse . y t e. ta~ete m 1v1 uals in Edmonton, and their challenges. The data is being gathered and ana_lyzed usmg basic m1x~d methods.

Results: The results will focus on how services can be more mtegrated and accessible to all people

with low income and who are homeless. There will also be discussion about specific perceptions of not

only the service providers but also of people with low income an~ who are homeless~ and vario~s deci­

sion makers. The results will be compared to the literature regardmg health care services access mother

urban centers in Canada and elsewhere. Conclusions: Recommendations will need to address social exclusion and other factors which can

make health care and other services more available to all people in the community. The implications for

health care will also be discussed. Additional information will be gathered in the next phases of the study

to develop a Community Services Access Model.

P4-20 (C) Availability and Access Exemplified: A Case Study Beth Hayhoe and Ruth Ewert

Introduction: Access to health care in Canada requires either the correct documentation or money.

Street youth have neither. In addition, health services in Canada are designed by adults for adults. Youth in

general are often wary of having trust in adults with respect to their health concerns and frequently feel

misunderstood. Street Youth are even more mistrustful of adults and public organizations, making their

contact with health care professionals minimal. This combined with their risky behaviours and dangerous

environment creates a population at risk for numerous health issues but with no place to have them investi·

gated. At our non-government, not for profit health service designed specifically to provide a broad range

of health care to street youth, professional services are provided almost entirely by volunteers.

Methods: Using a retrospective analysis of the 11 years of data gathered from this organization and

reviewing the initial reasons gathered from youth about their needs, the success of the Health Centre was

examined. Results: All the things youth had listed as being important in a Health Centre have been imple­

mented, and even more things have been added to improve the breadth and quality of services offered.

The use of the health centre has increased by more than six times since its opening in 1994. In addition,

tens of thousands of visits have been paid to the Health Centre, costing the government and taxpayers

nothing. As far as we know there is nothing else in Canada that offers so many diverse and innovative

services to youth in need. Conclusion: It is clear from this case, that health care targeted at the needs of specific disadvan·

taged populations can successfully provide them with appropriate health care. A model of accessible

health care for marginalized populations can easily be developed for high impact and low cost from this successful case.

P4-21 (C) Meeting the Needs of a Very Diverse Community Yasmin Vali

Toronto is one of the most ethno-racially diverse cities in the world Of the estimated 2,529,280

Toronto residents, 24% (597,218) live in Scarborough Population growth in Scarborough is faster

than Toronto. Scarborough's population increased by 6% from 1996 to 2001 while Toronto increased

only by 4%. Toronto's population is projected to increase by 10% (252 000) in 2011 while Scarbor·

ough's will increase by 12%. (Census Canada 2001) Low income, pove;ty, seniors, hidden homeless,

new~omers to Canada, the uninsured, are just a few of the issues concerning health care in our com­

munity. Health care needs in Scarborough are greatly impacted by diversity of ethnic and racial

groups, poverty and settlement issues. This paper will share how The Scarborough Hospital (TSH) an

Urb~n Communir_y Hospital cares f~~ it~ community. TSH recognizes: •The changing community•

B_arriers t~ accessing care • lnequalmes m health care The hospital in caring for its community pro·

v1~es services that '!'e~e cu~turally, racially, and linguistically sensitive to our community. The paper

will share the hospitals unique program on access and equity. The paper will share the needs in Scar·

borough and TSH's response to these needs: working in partnership with the Local Health Committee,

i:ne Scarborough Homeless Co.mminee, The Scarborough Network of Immigrant Services Organiza·

nons a~d others. 1:'1e paper will also share the many initiatives this urban community hospital has

taken viz. community and home programs in service areas such as mental health, haemodialysis day

care, t~~ home oxyg~n program, the palliative at-home program, and above all support for the volun­teer clinic for the uninsured.

POSTER SESSIONS

1'4-22 (C) Is Canada's Univenal Health Care System Universal? A Description of Undocumented

bllnigralllS at an Inner City Community Health Centre in Toronto

Meb Rashid, Kamran Khan, Miriam Cho, Vicky Fong, Jun Wang, and Kim Chow

v77

J"'"1tllu:lion: In Canada's universal health care system it is generally assumed that everyone has

equal access to health care. However, some immigrant groups in Canada have historically been unin­

swed. These groups include failed refugee claimants, those overstaying their visas, and new immigrants

in tranSition who are waiting to become eligible for health insurance. Some estimates have suggested that

at the present time there may be as many as one hundred thousand undocumented and thus uninsured

immigrants in Toronto alone. Understandably, information on the characteristics of this marginalized

population is very limited, since undocumented immigrants tend to have little contact with formal insti­

tutions. Knowledge of the demographic characteristics of this population may aid in the development

of health and social programs to better identify and meet the needs of undocumented immigrants in

Toronto. Metbods: We conducted a review of all undocumented, uninsured patients, 15 years of age or older

at Access Alliance Multicultural Community Health Centre (AAMCHC) between 1994 and 2004.

Demographic information such as age, gender, preferred language, length of time living in Canada, self­

reported education level and household income were recorded.

Rmdts: 72% of all adult patients at Access Alliance were undocumented and uninsured. 80% were

under40years of age (with a median age of 30 years), 72% were women and only 19% spoke English.

This group lived in Canada for an average period of 2.2 years before they were first seen at AAMCHC.

74% of undocumented clients reported having completed at least a secondary or post-secondary educa­

tion. 81% had self-reported household incomes of less than 20,000$/year, while 97% of households

reported earning less than $30,000/year. The mean income per person in an average household was

425$/month. Conchuions: Uninsured individuals at AAMCHC were predominantly young females with limited

knowledge of the English language. Despite having attained a high level of education most were living

well below the poverty line. Recognition of these characteristics may assist in the development of health

and social programs that are better adapted to meet the needs of undocumented immigrants.

P4-23 (C) Sharing Expertise: A Role for the Hospital Lactation Consultant in the Community.

Dina McGovern

Badrgrmuul: St. Michael's Hospital is a tertiary care hospital that serves a large inner city popula­

tion in downtown Toronto. In order to provide care to this population, the hospital has developed a

number of unique outreach roles. One such role was developed to work with pregnant and breastfeeding

women living in Regent Park, a social housing complex located near the hospital. The population of

Regent Park includes new immigrants, refugees and the socially disadvantaged.

Approach: The Outreach Lactation Consultant provides care, as part of the Canada Prenatal Nutri­

tion Program, in the community prenatally, in the hospital during their inpatient stay and postnatally

when they return to the community. The continuity of care enhances the probability of long term suc­

cessful breastfeeding. Aside from the health benefits of breastmilk, breastfeeding is especially important

for women who are financially needy and must depend on food banks for formula. . .

Lason Learned: Aher two years of partnership, the relationship between the an-hospital ~stpar­

tum experience for breastfeeding mothers and the community postpartum support, the breastfeeding rate

~thin this community is high. The professional support and visibility of the 1:8ctation Consultant, both

m the hospital and in the community, contributes to the support of breastfee~m~.. .

Chalknges!Opportunity: In light of ongoing funding constraints, this ha1son between hospital

and community could be at risk and discontinued. In light of the benefits to the mother/baby dyad, the

lactation consultant as a community partner in the Canada Prenatal Nutrition Program should be

safeguarded.

P4-24 (A) Folic Acid Knowledge and Use in a Large Multi-Ethnic Pregnancy Cohort: The Role of

language Proficiency Manon van Eijsden, Marcel van der Wal, and Gouke Bonsel

. lldPodiu:tion: Although the importance of adequate health care in pregna~cy is well recognised,

ethnic disparities in utilization of prenatal care still exist in many Western coun~~es. A fun~amental fac­

tor in these disparities may be language proficiency, as it influences women's ab1hty. to ob~m and under­

stand health information, to find the way in the health care system and to communicate with health care

v78 POSTER SESSIONS

providers. We investigated the role of language proficiency in use and knowledge of folic acid as aspect

of prenatal care in an urban multi-ethnic pregnancy c?hort. . . Methods: Design: Prospective cohort study. Setting and parnc1pants: Amsterdam ~regnant women

attending obstetric care providers for their first antenatal visit (N= 8050). Country of birth defined eth­nicity: the Netherlands, Surinam, Antilles, Turkey, Morocco, Ghana, other non-~est~m (NW) and other Western (W) country. Main outcome measures: Knowledge about and use of.fohc a~d (FA) supplements in pregnancy, and determinants of these in diffe~~t ethnic ~~ups. Deterrrunants mcl~ded age, ed~­tion, parity, pregnancy intention and Dutch prof1c1ency. Stansncs: ~2 to co~p~re e~c groups, stran­fied logistic regression (forward stepwise method) to explore determmants "'.'thm ethmc groups ..

Resfllts: Use of FA supplements was significantly lower among Ghanaian, Moroccan, Turkish and other NW women (21%to41 %) than among Dutch (86%) or other W women (78%). Use amongSuri­names and Antillean women was intermediate (51%and60%). Ethnic differences in FA knowledge were similar. Knowledge was the strongest determinant of use in all ethnic groups, with odds ratios (ORs) ranging from 10.9 to 42.0. Language proficiency was the strongest determi~a~t of kno~ledge in ethnic groups with a mother tongue different from Dutch (ORs good vs. low proficiency ranging from 3.2 ro 16.0). Educational level had a modifying role, as shown by an interaction effect between education and language proficiency in the NW group. Here, the odds of having FA knowledge given a high education and good Dutch proficiency was 20 times the odds given a good proficiency but low education.

Conclusions: Appropriate periconceptional use of folic acid supplements in non-Western ethnic groups is low, reflecting an absence of knowledge that is largely determined by the inability to speak and understand the language of the habitual country. Tailored interventions using communication channels most likely to address (pregnant) women from ethnic minority groups are necessary. Apan from specific interventions, our results are in support of strong incentives on language education

despite current political debate.

P4-25 (A) Variation in the Spatial Accessibility of Low- and No-Cost Mammography Facilities by Neighborhood Socioeconomic and Racial Characteristics in Chicago Shannon Zenk and Elizabeth T arlov

Introduction: Recent research suggests living in an economically disadvantaged neighborhood is asso· ciated with decreased likelihood of undergoing mammography and increased risk of late-stage breast can· cer diagnosis. Long distances and travel times to facilities offering low- or no-cost mammography may be imponant barriers to adherence to mammography screening recommendations for residents of economi­cally disadvantaged neighborhoods. The purpose of this study was to examine whether facilities providing low- and no-cost screening mammography were less spatially accessible in low-income neighborhoods in Chicago, and the extent to which the relationship between neighborhood income and the spatial accessibil­ity of facilities varied by the proponion of African-American residents in the neighborhood.

Methods: The sample consisted of 343 Chicago neighborhoods. For each neighborhood, we con· structed three measures of the spatial accessibility of facilities: street network distance to the nearest facility, public transportation travel time to the nearest facility, and shortest automobile travel time to a facility. Using 2000 decennial census data, we characterized the neighborhoods according to proportion of residents with incomes below the poverty line, proportion of residents in each of four raciaVethnic groups (African-American, Latino, White, and Other), and population density. We used ordinary least squares (OLS) and spatial exogenous lag regression to examine relationships. Model 1 estimated the rela­tionship between neighborhood poverty and the spatial accessibility of facilities, adjusting for raciaVeth· nic composition and population density. Model 2 added a multiplicative interaction term between neighborhood poverty and African-American.

Restllts: We identified deven facilities that provided low- or no-cost screening mammography to Chicago residents in 2004. We found that the distance and travel times via automobile and public trans· portation to facilities generally decreased as neighborhood poveny increased. However, we also found that the ~egative associations between neighborhood poverty and two of the spatial accessibility mea· sures - distance and public transportation travel time - were less strong in neighborhoods with the high­est proponions of African-American residents. Among neighborhoods in the highest tertile for poveny, th~ mean distance and mean public transportation travel time to facilities were over twice as long in neighborhoods in the highest tertile than in those in the lowest tenile of African-American residents.

. ~ Persistent socioeconomic and racial/ethnic disparities in breast cancer stage at diagno-s11 ~nd su~1val suggest that ensuring an equitable distribution of affordable mammography is a worth­

w~e policy .goal. The ~~dy sugges~ that ~ture investigations should consider both neighborhood soc1oecono1D1c charactensbes and rac1aVethmc composition when examining the spatial distribution of health resources.

POSTER SESSIONS v79

P+26 (A) Understanding Homosexuality in the Context of HIV I AIDS: Illness Experiences of Men Who

have Sex with Men in China Yanqiu Rachel Zhou

I11trotl#ction: By the end of 2003, the estimated cumulative number of HIV cases in China was

840,000, 11.1% of which are men who have sex with men (MSM) (SCAWCO & UNTG, 2004). Epide­

miological data suggest tha~ HIV prevalence among MSM is over 1 % in some metropolitan cities, such

.as Beijing (ibid.). Due to widespread homophobia in Chinese society, however, this population remains

invisible within current health/social services. Lack of research on sexuality, specifically homosexuality,

has impaired our understanding of health and health practices of Chinese MSM. Focusing on the illness

experiences of Chinese MSM with HIV/AIDS, this paper explores the socio-cultural impacts of HIV/

AIDS on this group. Mttbods: The data used for this paper were collected through semi-constructed in-depth face-to­

iace interviews with 21 adult PLWHAs (including 11 MSM) in Beijing, China. With the permission of

the participants, the interviews were audio-taped or recorded in notes. The transcribed interviews and

interview notes were analyzed by using N-vivo, a software program for qualitative data analysis. This

phenomenological study aimed to understand the experiences Chinese PLWHAs (including MSM) from

their own perspectives. Results: It is found that the illness experiences of Chinese MSM with HIV/AIDS are profoundly

shaped by the socio-cultural meanings of homosexuality, which are further complicated by the dominant

discourses on HIV/AIDS in China. At a macro level, homophobia in the larger society has decreased the

capability of this group to respond to this epidemic in a more efficient way. At a meso level, AIDS-pho­

bia within the Chinese MSM circuits has prevented this group from openly confronting this disease and

offering support to those who are already affected by it. At a micro level, however, these HIV-infected/

affected MSM have tried their best to locate spaces to live and to construct hope for their future lives

despite various barriers within family, community, and the larger society.

Conclusion: This study suggests that facilitating Chinese MSM's response to the AIDS crisis

urgently requires bridging awareness, commitment, knowledge and resources both within and without

this group. It also illustrates the importance of understanding homosexuality in the local context of HIV I

AIDS, which will be helpful for developing culturally sensitive HIV/AIDS programs for this population

on the community, national and international levels.

P4-27 (A) Having or Not a Regular Family Doctor: Social Determinants in 2 Underprivileged

Neighbourhoods in Paris, France Pierre Chauvin, Isabelle Parizot, Sylvain Terroni

Introduction: Having a regular family doctor (RFD) is known to be positively correlated with a

good medical follow up, including access to preventive and/or chronic care. Inversely, a lack of primary

care may lead to high rates of avoidable hospitalizations, especially among poor people and/or in under­

served neighbourhoods. In such a matter, a recent comparative study showed that Paris was better

ranged than other cities, such as NYC, Tokyo or London. Nevertheless, despite a quasi universal health

insurance and a high density of general practitioners, a noticeable fraction of the Paris population does

not have any regular physician and we aimed to understand who they are and for what reasons rhey

don't have any RFD. Mdbods: Cross sectional population survey among a random sample of households in 2 ~nderpriv­

ileged neighbourhoods in Paris inner city, performed in 2003, using a face-to-face quest10nna1re collecr-

1ng more than 400 social and health characteristics. Ruults: A quarter (26.3 %) of rhe study popularion did not have any RFD. This proporrion was

iignificantly higher among male (OR= 2.00, 95%CI = [ 1.41-2.781), younger (e.g. OR 18 -29/> .S l _= 4._oo,

95"1.CI = (2.13-7.69)), and/or unemployed (OR =2.01, 95%CI = IJ .21-3.3411_ people. In multtvanate

analysis, after a full adjustment on gender, age, health status, health insura~ce, income, occupat10n and

tducation level, we observed significant associations between having no RFD and: ~arrtal and_ pare~t­

hood status (e.g. OR single no kids/in couple+kids = 2.12, 95%CI = ( 1.26-3.59()~ quality of relattonsh1ps

with neighbours (OR bad/good= 3.82, 95%CI = [ 1.84-7.94)), and length of residence m the neighbour-

hood (with a dose/effect statistical relationship). .

Co11clusion: Gender, age, employment status, mariral and parenthood stat~s as well as ~e1gh­bourhood anchorage seem to be major predictors of having a RFD, even when um.versa! health i~sur­

ance has reduced most of financial barriers. In urban contexts, where residential migrattons and single

lift (or family ruptures) are frequent, specific information may be conducted to encourage people to

Ket RFD.

v80 POSTER SESSIONS

p4_28 (A) Radiation Induced Pollution in Kerala in South India: Health Care Availability and Access to

the Local Poor Subodh Kandamuthan and Murukan Kandamuthan

Obiectives: Certain parts of Coastal Kerala in South India are1 abundhantdin rhadio~~ve mmf· eral

sands and there are two government factories located in the coasta area t at o t e ~mmg o rhese

d The benefits accrued by the profitable factories do not reach the poor local fishmg community san s. f d" . II Th

h bear the brunt of radiation induced pollution in terms o 1seases espec1a Y cancer. e current

:tu~y tries to assess the health effects and costs and also analyse the availability and accessibility to

health care for poor. .

Methods: Data for this study was collected by a survey on 300 households of the local community

living near the factories and 100 households where radiation hazard w~s n?~ present. ~~art from mor·

bidity status and health expenditure, data was collected ~n access, a~ail~b1.hty and eff1c1ency of healrh

care. A discriminant analysis was done to identify the vanables that d1scnmmate between the study and

control group households in terms of health care pattern. A contingent valuation survey was also under­

taken among the study group to find out the factors affecting their willingness to pay for health insur­

ance and was analysed using logit model. Results: The health costs and indebtedness in families of the study group was high as compared to

control group households and this was mainly due to high health expenditure. The discriminant analysis

showed that expenditure incurred by Private hospital inpatient and outpatient expenditure were signifi­

cant variables, which discriminated between the two types of households. The logit analysis showed !hat

variables like indebtedness of households, better health care and presence of radiation induced illnesses

were significant factors influencing willingness to pay for health insurance. The study showed that study

group households were dependent on private sector to get better health care and there were problems

with access and availability at the public sector.

Conclusion: The study found out that the quality of life of the local community is poor due to

health effects of radiation and the burden of radiation induced illnesses are so high for them. There is an

urgent need for government intervention in this matter. There is also a need for the public sector to be

efficient to cater to the needs of the poor. A health insurance or other forms of support to these house­

holds will improve the quality for health care services, better and fast access to health care facilities and

reduces the financial burden of the local fishing community.

P4-29 (A) The Relationship Between Social Capital and Substance Abuse Treatment Utilization Among

Drug Using Puerto Rican Women Humberto Reynoso-Vallejo

The prevalence of substance abuse is an increasing problem among low-income urban women in

Puerto Rico. Latina access to treatment may play an important role in remission from substance abuse.

Little is known, however, about Latinas' access to drug treatment. Further, the role of social capital in

substance abuse treatment utilization is unknown. This study examines the relative roles of social capital

and other factors in obtaining substance abuse treatment, in a three-wave longitudinal study of women

ages 18-35 living in high-risk urban areas of Puerto Rico, the Inner City Latina Drug Using Study

(ICLDUS). Social capital is measured at the individual level and includes variables from social support

and networks, familism, physical environment, and religion instruments of the ICDUS. The study also

elucidates the role of treatment received during the study in bringing about changes in social capital. The

theoretical framework used in exploring the utilization of substance abuse treatment is the social sup­

port approach to social capital. The research addresses three main questions: ( t) does social capital pre­

dict parti~ipating in treatment programs? (2) does participation in drug treatment programs increase

social capital?, and (3) is there a significant difference among treatment modalities in affecting change in

~ial capital? The findings revealed no significant association between levels of social capital and get­

tmg treatment. Also, women who received drug treatment did not increase their levels of social capital.

The findings, however, revealed a number of significant predictors of social capital and receiving drug

~buse treatment. Predictors of social capital at Wave III include employment status, total monthly

mcoi:rie, and baseline social capital. Predictors of receiving drug abuse treatment include perception of

physical health and total amount of money spent on drugs. Other different variables were associated to

treatment receipt prior to the ICLDUS study. No significant difference in changes of social capital was

found among users of different treatment modalities. This research represents an initial attempt to eluci­

date the two-way relationship between social capital and substance abuse treatment. More work is nec­

essary to unden~nd. ~e role of political forces that promote social inequalities in creating drug abuse

problems and ava1lab1hty of treatment; the relationship between the benefits provided by current treatment

POSTER SESSIONS v81

sctrings and treatment-seeking behaviors; the paths of recovery; and the efficacy and effectiveness of the

trtaanent.

1'4-30 (A) Levelling the Playing Field - Bridging Services for Underserved Cancer Patients

JoanneHohenadel,John Laidlaw, Elizabeth Kaegi, Galina Kovacik, Andrea Cortinois, Rita Kang,

and Alejandro Jadad

Health professionals in urban centres must meet the challenge of providing equitable care to a

population with diverse needs and abilities to access and use available services. Within the Canadian

health care system, providers are time-pressured and ill-equipped to deal with patients who face barri­

ers of poverty, literacy, language, culture and social isolation. Directing patients to needed supportive

care services is even more difficult than providing them with appropriate technical care. A large pro­

portion of the population do not have equitable access to services and face major problems navigating

complex systems. New approaches are needed to bridge across diverse populations and reach out to

underserved patients most in need. The objective of this project was to develop an innovative program

to help underserved cancer patients access, understand and use needed health and social services. It

implemented and evaluated, a pilot intervention employing trained 'personal health coaches' to assist

underserved patients from a variety of ethno-linguistic, socio economic and educational backgrounds

to meet their supportive cancer care needs. The intervention was tested with a group of 46 underserved

cancer patients at the Princess Margaret Hospital, Toronto. Personal coaches helped patients identify

needs, access information, and use supportive care services. Triangulation was used to compare and

contrast multiple sources of quantitative and qualitative evaluation data provided by patients, per­

sonal health coaches, and health care providers to assess needs, barriers and the effectiveness of the

coach program. Many patients faced multiple barriers and had complex unmet needs. Barriers of pov­

erty and language were the easiest to detect. A formal, systematic method to identify and meet sup­

portive care needs was not in place at the hospital. However, when patients were referred to the

program, an overwhelming majority of participants were highly satisfied with the intervention. The

service also appeared to have important implications for improved technical health care by ensuring

attendance at appointments, arranging transportation and translation services, encouraging adherence

to therapy and mitigating financial hardship - using existing community services. This intervention

identified a new approach that was effective in helping very needy patients navigate health and social

services systems. Such programs hold potential to improve both emotional and physical health out·

comes. Since assistance from a coach at the right time can prevent crises, it can create efficiencies in the

health system. The successful use of individuals who were not licensed health professionals for this

purpose has implications for health manpower planning.

P4-31 (A) From Resistance to Celebration: The Anatomy of a Dynamic and Cost Effective User-Run

Needle Exchange/Harm Reduction Program in Toronto Raffi Balian

Needle Exchange Programs (NEPs) have been distributing harm reduction materials in Toronto

since 1990. COUNTERfit Harm Reduction Program is a small project operated out of a Community

Health Centre in south-east Toronto. The project is operated by a single full-time coordinator, one

pan-rime mobile outreach worker and two peers who work a few hours each week. All of COUNTER­

fit's staff, peers, and volunteers identify themselves as active illicit drug users. Yet the program dis~rib­

utes more needles and safer crack using kits and serves more illicit drug u~rs t~an the comb1~e~

number of all NEPs in Toronto. This presentation will discuss the reasons behind this success, .s~1f1-

cally the extended hours of operation, delivery models, and the inclusion of an. extremely marg1~ahzed

community in all aspects of program design, implementation and eva.luat1?n. ~OUNTERfit was

recently evaluated by Drs. Peggy Milson and Carol Strike, two leading ep1dem1olog1st and researchers

in the HIV and NEP fields in Toronto and below are some of their findings: "The Program has expe­

rienced considerable success in delivering a high quality, accessible and well-used program .... The pro·

gram has allowed (service users) to become active participants in providing. services to others and has

resulted in true community development in the best sense. " ... COUNTERf1t has ~~n verr succe~sful

attracting and retaining clients, developing an effective peer-based model an.d assisting chen~s ~1th a

vast range of issues .... The program has become a model for harm red~ctmn progr~ms withm the

province of Ontario and beyond." In June 2004, the Association of ?ntano Co~mumty Heal~~ <:en·

Ires recognized COUNTERfit's acheivements with the Excellence m Community Health Initiatives

Award.

v82 POSTER SESSIONS

P4-32 (A) Health Sector Reforms in Kenya and its Implications on Healthcare Access and Availability

Chrispus Kiliko

In Kenya, health outcomes and the performance of government health service~ have det~riorated

since the late 1980s, trends which coincide with a period of severe resource constramts necessitated by

macro-economic stabilization measures after the extreme neo-liberalism of the 1980s. When the govern·

ment withdrew from direct service provision as reform trends and donor advocacy suggested, how does it

perform its new indirect role of managing relations with new direct health services providers in terms of

regulating, enabling, and managing relations with these health services providers? In this paper therefore,

we seek to investigate how healthcare access and availability in the slums of Nairobi has been impacted

upon by the government's withdrawal from direct health care provision. The methodology involved col·

leering primary data by conducting field visits to 8 health institutions located in the slum areas of Kibera

and Korogocho in Nairobi. Purposive random sampling was utilized in this study because this sampling

technique allowed the researcher(s) to select those health care seekers and providers who had the required

information with respect to the objectives of the study. In-depth Interviews using a semi-structured ques·

tionnaire were administered ro key informants in health care institutions. This sought to explore ways in

which the government and the private sector had responded and addressed in practical terms to new

demands of health care provision following the structural adjustment programmes of the 1990s. This was

complemented by secondary literature review of publications and records of key governmental, bilateral

and multilateral development partners in Nairobi. The study notes a number of weaknesses especially of

Kenya's Ministry of Health to perform its expected roles such as managing user fee revenue and financial

sustainability of health insurance systems. This changing face of health services provision in Kenya there·

fore creates a complex situation, which demands greater understanding of the roles of competition and

choice, regulatory structures and models of financing in shaving the evolution of health services. We rec·

ommend that the introduction of user fees, decentralization of service provision and contracting-out of

non-clinical to private and voluntary agencies require a new management culture, and new and clear insri·

tutional relationships. Experience with private sector involvement in health projects underlines the need

not only for innovative financial structures to deal with a multitude of contractual, political, market and

risks, but also building credible structures to ensure that health services projects are environmentally

responsive, socially sensitive, economically viable, and politically feasible.

P4-33 (A) Utilization of Mammography Screening and Predictors of Utilization Among Muslim Women

in Southern California Magda Shaheen

Purpose: The purpose of this study is to examine the status of mammography screening utilization

and its predictors among Muslim women living in Southern California.

Methods: We conducted a cross-sectional study that included 202 women aged ::!: 40 years. We col·

leered data using a questionnaire in the primary language of the subjects. The questionnaire included

questions on demography; practices of breast self-examination (BSE) and clinical breast examination

(CBE); utilization of mammography; and family history of breast cancer. Bivariate and multiple logistic

regression analyses were performed to estimate the odds ratios of mammography use as a function of

demographic and other predictor variables.

. Results: Among the 202 women, 78% were married, 68% were 40-50 years old, and 20% had family

h1Story of breast cancer. Thirty-two percent of the participating women never practiced BSE and 32% had

not undergone CBE during the past two years. The data indicated that 46% of the women did not have

mammography in the last two years. Logistic regression analysis showed that age (0R=5.1, 95% Confi·

dcnc~ Interval (Cl)=l.8-14.2), having clinical breast examination (0R=24.9, 95% Cl=8.4-73.7), and

practtce of self-breast examination (0R=2.6, 95% Cl= 1.1-6.2), were strong predictors of mammography use .

. Conclusions: The data point to the need for intervention targeting Muslim women to inform and

motivate th.cm a~ut practices for early detection of breast cancer and screening. Further studies are

needed to investigate the factors associated with low utilization of mammography among Muslim women population in California.

P4-34 (A) International Cooperation in Health Care Between Low-Middle Income Countries· The Case of Venezuela's "Barrio Adentro" •

Sergio Rueda, Carles Muntaner, Francisco Armada, and Rene Guerra Salazar

J,,trodlu:tion: Venezuela has 25 million inhabitants with 85% of the population living in urban

areas. In 2000, more than half of Venezuelans were considered poor and 22 % extremely poor. Venezuela

iosmtSESSIONS v83

~boih afflicted by the diseases of industrialized countries (cardiovascular disease, cancer, injuries) and

oidtveloping countries (communicable diseases, violence, natural disasters). There is a clear need to

idorm the public health care system.

Methods: We conducted a review of the scientific literature and° government documents to describe

ditnational health care program "Barrio Adentro" (inside the neighborhood). We also conducted quali­

urivt interviews with members of the local health committees in urban settings to descrihe the comm u­

nity participation component of the program.

RtsMlts: Until recently, the Venezuelan public health system was characterized by a lack or limited

access w health care (70% of the population) and long waiting lists that amounted to denial of service.

MOit than half of the MDs worked in the five wealthiest metropolitan areas of the country. Jn the spring

oi2003, a pilot program hired 50 Cuban MDs to live in the slums of Caracas to provide health care to

piople who had previously been marginalized from social programs. The program underwent a massive

expansion and in only two years 20,000 Cuban and 6,500 Venezuelan health care providers were work­

ing acmss the country. They provide a daily average of 20-40 medical consultations and home visits,

C1llY out neighborhood rounds, and deliver health prevention initiatives, including immunization pro­

grams. They also provide generic medicines at no cost to patients, which treat 80% of presenting ill­

IJ!M, Barrio Adentro aims to build 8,000 clinics (primary care), 1,200 diagnostic and rehabilitation

ctnrres (secondary care), and upgrade the current hospital infrastructure (tertiary care). Local Health

Committees survey the community to identify needs and organize a variety of lobby groups to improve

dit material conditions of the community. Last year, Barrio Adentro conducted 3.5 times the medical

visits conducted by the Ministry of Health. The philosophy of care follows an integrated approach where

btalrh is related to housing, education, employment, sports, environment, and food security.

Conclusions: Barrio Adentro is a unique collaboration between low-middle income countries to

provide health care to people who have been traditionally excluded from social programs. This program

shows that it is possible to develop an effective international collaboration based on participatory

democracy.

P4-35 (C) Friends in Good Places: A Mixed-Methods Evaluation of the Neighborhood Health Initiative

in Des Moines, Iowa Disa Lubker, Anne Wallis, Lance Till, Mary Martin, and Rachel Lewis

Low-income Americans are at the greatest risk of being uninsured and often face multiple health

concerns. This evaluation of the Neighborhood Health Initiative (NH!), an organization which uses mul­

tiple programmatic approaches to meet the multiple health needs of clients, reflected the program's many

activities and the clients' many service needs. NH! serves low-income, underserved, and hard-to-reach

residents in the Des Moines Enterprise Community. Multiple approaches (fourth-generation evaluation,

grounded theory, strengths- and needs-based) and methods (staff and client interviews, concept mapping,

observations, qualitative and quantitative analysis) were used to achieve that reflection. Results indicate

good targeting of residents in the 50314 ZIP Code and positive findings in the way of health insurance

coverage and reported unmet health needs of clients. Program activities were found to match client

nttds, validating the organization\'s assessment of clients. Important components of NHI were the staff

composition and that the organization had become part of both the formal and informal networks. NHI

11 positioned as a link between the target population and local health and social sc:rvice agencies, work­

ing to connect residents with services and information as well as aid local agencies in reaching this under­

served population.

P4-36 (C) Welfare: Definition by New York City Maribeth Gregory

For an individual who resides in New York City, to obtain health insurance under the Medicaid

policy one must fall under certain criteria .. (New York City's Welfare Programs 2003) If the individual _is

on SSI or earns equal to or less than $934 per month, he is entitled to receive no more than $5,600 m

resources. A family the size of two would need to earn less than $942 per month to qualify for no greater

than SS,650 worth of Medicaid benefits. A family of three would qualify for $5,650 is they earned less

than $942 per month and so on. (New York City's Welfare Programs 2003) The family would need to

~~rn Sl42 a month more per person over the number eight to qualify for an add1t1onal $850 m _M~dicard hmtfits. (New York City's Welfare Programs 2003) Figure 1. Medicaid Sou_rce: (New York Ctty 5 ~el­tare Programs 2003) Food Stamps One will not be disqualified from obtami?g food stamps for owmng

~n automobile or real estate. However, the recipients cannot exceed $2000 m stocks, bonds or savings

acconnts. (Ohis 1995) It is possible for legal immigrants to receive food stamps after they have proven to

v84 POSTER SESSIONS

have been a US resident for a minimum of five years. (Fix & Zimmerman 1995) (N~·York City's Wel­

fare Programs 2003) In addition, to be eligible to qualify for food stamps, the fa1D1ly must fall benearb

130% of the poverty level. The food stamp program is the onl~ guaranteed program ~o~ l.~w income

families. (Ohis 1995) (New York City's Welfare Programs 2003) figure 2. Food Stamps ehgibtlitysourcc:

(New York City's Welfare Programs 2003)

P4-37 (C) Investigating Barriers to Accessing Sexual Health Services for Vancouver Asian Men Who

have Sex with Men: A Community Based Participatory Approach

Shimpei Chihara

Introduction: The Vancouver gay communiry has a significant number of Asian descendan!l.

Because of their double minority status of being gay and Asian, many Asian men who have sex with men

(MSM) are struggling with unique issues. Dealing with racism in both mainstream society and the gay

communiry, cultural differences, traditional family relations, and language challenges can be some of

their everyday srruggles. However, culturally, sexually, and linguistically specific services for Asian MSM

are very limited. A lack of availability and accessibiliry of culturally appropriate sexual health services

isolates Asian MSM from mainstream society, the gay community, and their own cultural communities,

deprives them of self-esteem, and endangers their sexual well-being. This research focuses on the qualita·

tive narrative voices of Asian MSM who express their issues related to their sexualiry and the challenges

of asking for help. By listening to their voices, practitioners can get ideas of what we are missing and

how we need to intervene in order to reach Asian MSM and ensure their sexual health.

Methods: Since many Asian MSM are very discreet, it is crucial to build up trust relationships

between the researcher and Asian MSM in order to collect qualitative data. For this reason, a community

based participatory research model was adopted by forming a six week discussion group for Asian

MSM. In each group session, the researcher tape recorded the discussion, observed interactions among

the participants, and analyzed the data by focusing on participants' personal thoughts, experiences, and

emotions for given discussion topics.

Ra11lts: Many Asian MSM share challenges such as coping with a language barrier, cultural differ·

ences for interpreting issues and problems, and Westerncentrism when they approach existing sexual

health services. Moreover, because of their fear of being disclosed in their small ethnic communities, a lot

of Asian MSM feel insecure about seeking sexual health services when their issues are related to their

sexual orientation.

ConclflSion: Sexual health services should contain multilingual and multicultural capacities to meet

minority clients' needs. For Asian MSM, outreach may be a more effective way to provide them with

accessible sexual health services since many Asian MSM are closeted and are therefore reluctant to

approach the services. Building a communiry for Asian MSM is also a significant step toward including

them in healthcare services. A communiry-based panicipatory approach can help to build a community

for Asian MSM since it creates a rrust relationship between a worker and clients.

P4-38 (C) Identifying Key Techniques to Sustain Interpretation Services for Assisting Newcomers

Isolated by Linguistic and Cultural Barriers from Accessing Health Services

S. Gopi Krishna

lntrodaetion: The Greater Toronto Area (GTA) is home to many newcomer immigrants and other

vulnerable groups who can't access health resources due to linguistic, cultural and systemic barriers.

Linguistic and cultural issues are of special concern to suburbs like Scarborough, which is home to

thousands of newcomer immigrants and refugees lacking fluency in English. Multilingual Community

~nterpreter. Service~ (MCIS) is a non-profit social service organization mandated to provide high quality

mterpretanon services. To help newcomers access health services, MCIS partnered with the Scarborough

Network of Immigrant Serving Organizations (SNISO) to recruit and train volunteer interpreters to

accompany clienrs lacking fluency in English and interpret for them to access health services at various

locati?ns, incl~~ing communiry ~C:-lth centres/social service agencies and hospitals. The model envisioned

agencies recruin~ and MCIS ~.mm.g and creating an online database of pooled interpreter resources. This

da.tabase, acces&1bl~ to all pama~~g ?rganization is to be maintained through administrative/member·

ship fees to. be ~1d by each parnapanng organization. This paper analyzes the results of the project,

defines and identifies suc:cases before providing a detailed analysis for the reasons for the success .

. Methods:. This ~per~ q~ntitative (i.e. client numben) and qualitative analysis (i.e. results of

key •~ormant m~rv1ews with semce ~sers and interpreters) to analyze the project development, training

and 1mplementanon phases of the proJect. It then identifies the successes and failures through the afore·

mentioned analysis.

POSTER SESSIONS vss

ReslJts: The results of the analysis can be summarized as: • The program saw modest success both

ia l?llllS of numbers of clients served as well as sustainability at various locations, except in the hospital

iririog. o The success of the program rests strongly on the commitment of not just the volunteer inter­

prmr, but on service users acknowledgments through providing transponation allowance, small hono­

roria, letter of reference etc. • The hospital sustained the program better at the hospital due to the

iolume and nature of the need, as well as innate capacity for managing and acknowledging volunceers.

Collc/llsion: It is possible to facilitate and sustain vulnerable newcomer immigrants access to health

!Ul'ices through the training and commitment of an interpreter volunteer core. Acknowledging volunteer

commitment is key to the sustenance of the project. This finding is important to immigration and health

policy given the significant numbers of newcomer immigrants arriving in Canada's urban communities.

P4-39 (C) The Casey House Approach: An Innovative Case Management Model

Lisa Shishis, Colleen Kearney, Karina Wulf, and Philip Weaver

The Casey House Approach: An Innovative Case Management Model. The Casey House Commu­

nity Program was established in 1993 to provide support to people dying at home, especially those who

were waiting for admission to the resi<lential hospice. With the advent of HAART and corresponding

challenges for people living with HIV/AIDS in the community, the Community Program has developed a

unique case management approach. This model features an interdisciplinary team providing a client­

drivcn service. The Case Manager provides continuity of care to clients in a variety of settings both

within and outside of the health care system. A case study is used to demonstrate how formal and infor­

mal netWorks of support facilitate efficient and appropriate resource utilization to promote client health.

This case study demonstrates the value of consistent coordination with a client who has complex physi­

cal, spiritual, substance use and mental health needs. The authors will show how they liaised with the

housing authority, police, social services as well as the family physician, clinic staff and a hospital emer­

gtncy room to ensure this client did not fall between the cracks.

P4-40 (C) From 'Working for' Towards 'Working with' Community

Tarek Hussain

Recognition of the importance of community involvement and sectoral cooperation in health and

!OCial services, formalized in Alma-Ata Declaration in 1978, was reinforced at Riga meeting held at the

mid·point between Alma-Ata and the year 2000. Then at the 20th Anniversary of Alma-Ata Declaration,

ir was declared that 'Primary Health Care is Everybody's Business'. Health does not exist in isolation.

Health cannot be defined only as an outcome of 'medical care' but also as one of 'social action'; the

responsibility of disease prevention and health promotion rests not only on governments, but also with

DOn·govemmentorganizations, the community, and individuals. The major accomplishment to date may

be that rhere is growing realization in the health sector that community involvement is more than a polit­

ical right-it is absolute necessary. Lessons have learned during the implementation of disease-specific

l'Cltical programmes, such as CDD, ARI, and EPI; first, integrated and holistic approaches to childcare

art needed, and second, the need for community involvement has become evident. IMC! is a broad inte­

gra1ed strategy with an overall objective contributing to reducing child morbidity and mortality in devel­

oping countries. And one of the IMCI components, 'Community !MCI', which is now broadening ~s an

entry point for child-focused community development initiatives. Community JMCl/c~1ld health is ~n

mtcgrated approach to the promotion of key family and community practices that have impact on: child

growth and development, disease prevention, home care for sick, malnourished child~en, a.nd care-seek­

mg behavior and compliance with advice and treatment. The presentation addres~es, m brief, the ~evel­

opinent of community !MCI, operational aspect of community/IM Cl, key strategies and tools ava1la~le

for implementation of C/IMCI. The paper draws some successful programme examples on working

logether for IMC! with the community in various countries which had substantial benefns on pro­

gramme outcomes.

P4-4 t (C) Healthy Child Screening: An Innovative Service Initiative

Ann-Marie Marcolin and Joyce Allen

. Introduction: With mounting attention for creative and integrated models of c~re .that are popula­

llon and community focused, the Healthy Child Screening initiative achiev.es t~ese pnncipl~s and more!

. Healthy Child Screenin Service Method: The Healthy Child Screenmg 1s an innovative co.llabora­

llle se · g .. d I · · hearing speech phystcal and . rvice. An array of preventive screenings - nutrmon, enta , v1si~n, . • . ' Th

IOQo-cmotional are provided through a multisectoral and interdisciplinary service delivery model. e

POSTER SESSIONS

service recipients are newcomer children - prenatal to age six .. :'1e model.is d~igned from c~mmu~~ty­based principles, addressing issues of service access an~ av~ilab1h~ for _at-nsk children and their fam1h~s. Collaborating and partnering agencies that contribute m-kmd services include: • Early Years Il~ Four Vil­lages Community Health Centre • Parkdale Beach Child Care Centre • Parkdale_ Commumty Health

Centre • Queen Victoria Public School (Toronto District Sch~ol Board) • St.Chn~topher House• St.

Joseph's Health Centre, Toronto• The Child Development Inst1~te ~Toronto Pubhc Health• ~depen­dent Ophthalmologist Practitioner Support Agencies: • OISE ~mvers1ty_ of ~oronto •Ryerson Uruvers1ty

• Parkdale High Park Rotary (sponsorship) The Heal~h ~h1ld Scree?1?g is a ~opl~-centred model of

care. Agency and professional sector-specific silos are ehmmated, ~rov1dmg f~~1hes wit~ one-sto~ access

to primary prevention services in a local school gym! Children at nsk are rece1vmg early mtervent10n and

appropriate referrals to the right care provider, at the right time a~d in t~e right place. Further, with a

complimentary focus on prevention, the program serves to keep at nsk children healthy. Healthy Child Screening Results: The service model is developed around four distinct phases:

1) planned outreach; 2) coordinated intake and registration; 3) interdisciplinary screening; and 4) targeted

referral. Since the fall 2003 and through six collaborative Healthy Child Screenings 158 children ranging

in age from 2 to 6 have benefited from this unique service model of care. Conclusion: The presentation will provide practical information on the development and imple­

mentation of the model. There will also be a focus on lessons learned in building community service pro­

vider-hospital relationships.

P4-42 (C) The Mobile Health Unit: An Urban Reproductive Health Model for Immigrant and Refugee

Women JoAnne Hunter, Sepali Guruge, Mary Jane McNally, and Keegan Barker

According to Statistics Canada (2001) 49% of the Toronto population was born outside of Canada

and 21 % were new immigrants. Immigrants often arrive in Canada in superior health compared to the

Canadian born population, but they lose this health advantage over time. Changes in immigrant health

status over time may be attributed to a variety of factors including barriers to accessing and receiving

care as well as limitations in the mainstream health service organizations and their approaches to health

care delivery (Hyman, 2001 ). For example, immigrant women are less likely to receive pap tests, which

places them at a greater risk for developing cervical cancer. Similarly, immigrant women receive less

mammography screening than their Canadian counterparts. The Immigrant Women's Health Centre

Mobile Health Unit (MHU) was created as an alternative care delivery model to address the need for

increased accessibility as well as culturally and linguistically appropriate reproductive health care. Tor­

onto Western Hospital and the Immigrant Women's Health Centre have formed a collaborative partner­

ship which incorporates a primary care nurse practitioner and lay ethnocultural counselors providing

care on the MHU. Currently, a qualitative ethnonursing study is underway to understand the unique

experiences of women using the MHU for their reproductive health care as well as the perspectives of the

MHU health care providers. Based on a literature review and preliminary findings from provider and

participant interviews, the proposed presentation will address the themes of health status for immigrant

and refugee women, accessibility issues as well strategies to improve their reproductive health care. We

will discuss benefits as well as limitations to health care provision using this alternative service delivery model.

P4-43 (C) Care and TreabDent for Hepatitis C in Active Substance Users Michael Carden, Brian Edlin, Andrew Talal, Elizabeth Getter, and Marla Shu

lntrod.ction: To date most active drug users have not had access to treatment for hepatitis C virus

(HCV) infection and substantial barriers continue to exist that interfere with treatment availability for this population.

Methods: Active illicit drug users interested in pursuing HCV care and treatment were recruited in

partnership w~th co~munity-based organizations (CBO's) in New York City. Baseline data were col­

lected on quahty of hfe, substance use patterns, depression, health care utilization, HCV health beliefs

and other relev.ant variables. Medical evaluations were conducted, including liver biopsy when indicated,

an~ treatment ts ~ffered when no contraindications are present. Participants also receive psychiatric eval­uahons to determme the appropriateness of interferon treatment.

Renlts: Fifteen individuals have been recruited to date and received an initial medical evaluation.

The mean age was 40 years and _the average age of initial heroin or cocaine use was 16.8. Eight (53%)

ha~ been homeless at least once m the last 6 months and S (33%) were homeless for most or all of this

penod. Fourteen (93%) had a history of injection drug use with the mean age at first injection being 21

111S1fRSEWONS v87

,an. Elrven persc.!ns (79%) reported inje~~ng .heroin or cocaine within the last 30 days while the

.Wing four (21 l'o) reported regular non-m1ect1on use of cocaine and street-obtained benzodiazepines.

SiJIY seven percent of the sample (n= 10) reported ever being referred to HCV treatment while 2 ( t 3 % )

ftPOneddiattreann~nt had been offered by~ ~e.dical provider. None had ever received a liver biopsy or

araanent. Most believed that HCV was a s1gmf1cant threat to their health (80%) and that there was a

pM)dchance they would eventually die if their hepatitis C was not treated (67%). Though 7 individuals

147%1 believed that there was no cure for HCV, 13 (87%) reported that they would initiate treatment if

i was recommended by their doctor. Thirteen (87%) had a current psychiatric diagnosis including

«pmsion, anxiety disorder, schizophrenia, schizoaffective disorder, and borderline and antisocial per­

sooaliry disorders. Among eight individuals who had the Beck Depression Inventory administered, the

mean score was 29.75. Attendance rates were 83% (83/100) at scheduled medical and psychiatric

1pPOintments and 50% (2/4) at liver biopsy.

<Andtuions: Active drug users, despite experiencing multiple psycho-social problems, can be

mgaged in HCV care using a multidisciplinary approach, but require intensive follow-up support. HCV

aunnent of active drug users should not be dismissed.

N-44 (C) Antiretroviral Therapy in mv Infected Infants: When to Initiate Therapy an African Experience

Kingsley Okonkwo, Ademola Adeyemo, Israel Sokeye, and Nwaife Umeike

/""°""ction: As technology for early diagnosis of human immunodeficiency virus [HIV] improves,

m to commence highly active antiretroviral therapy [HAARn is yet to be fully evaluated. This pro­

spective study describes our initial experience with early HAART in HIV infected Nigerian infants and

rqions the outcome. We also analyzed the socioeconomic implications of early HAART therapy in

infants in the African setting. Method: HIV infected Infants were started on HAART before 6 months and followed up at 4

mkly intervals.We monitored baseline and 3 monthly CD4 counts and viral load [VL]; we measured

l.cngth for age Z scores [LAZ] and Weight for age Z scores (WAZ]. We evaluated the development of

wlyonset AIDS associated events and adherence to therapy biweekly. We analyzed the risk and benefits

of early versus deferred HAART in Infants.

hits: 50 HIV infected infants were registered for the early HAART program between July 2002

and August 2003,we monitored 44 infants who were on deferred or no therapy.SO infants received

HAART before 6 months mean age was 4 months.56% [N= 28] had significant symptomatic (CDC] clin­

ical categories A, B or C at initiation of therapy. The response of infants on HAART for > or = 1 year

[N=45( was evaluated. There was significant reduction in VL (P=.001 (, 13 had undetectable VL and

marginal increase in CD4%, median CD4% was 23.7% after 1 year of therapy. Mean gain in length was

ltcm, no significant change in LAZ(P=0.29) and WAZ(P=0.16] mean weight gain was t.8kg. We

rrponed adherence to therapy> or= 89% in most children. By August 2003 42 children 84% were din­

iallywell, 3 [6%) had died from non-HIV related causes 2 (4%] were lost to follow Up and 3(6%] with­

draw from the study.9 were treated a total 21 times for infections. No severe drug reaction was recorded.

None of the infants developed early onset AIDS events. In the deferred group 8 developed Aids assod­

ared events [P= 0.01 ] . . Conclusion: Initial results suggest early HAART before 6 months resulted. in improv~d out~ome in

African children. Treatment appears to be as effective as in developed counmes. In. A~nca as. m most

developing countries with limited resources it is possible and effective to use HAART m 1~~ants if p~oper

lllOniroring facilities are available. However the occurrence of long-term drug related tox1c1ty and mk of

emergence of resistant viral strains create need for further evaluation of HAART in infants.

P4-4s (C) Title Mobile Behaviour Change Communication as a Tool for HIV I AIDS Prevention Strategy

laltAlabi

Information education and communication have been employed universally as vechicles through

which interventi~ns on health problems have been provided. However, in ~igeria info~matio.n •. educa­

llOI!, and communication on sexual health issues including HIV has many hmdrances hke rchgion and

ailture which make the war against HIV more difficult. There is an assumption on the part of parents

di.at their adolescent children have sexual health information may be, from schools. Teach~rs, themselves

however, do not have the information and skills to provide the information a~d e.ducanon .adolescent

!!quired on HIV. PROJECT: The concept of mobile behaviour change commumcanon a~ a viable strat­

egy of reaching the people of Lagos state with appropriate information on Reproductive Heal~h and

oditr health related issues especially HIV/AIDS Was conceived by the IEC work. group a~d w~ im~le­lllented through various NGOs. Considering the unique nature of this strategy mformanon, e ucanon

POSTER SESSIONS v88

and communication material was developed for the project. A two day workshop was orga~ for 40 volunteers from over 1 o selected NGOs and 20 Local gover~men~ were targeted for the campaign. LES­SON LEARNED: The campaign was able to address the bias attitude of the people towards PLWHA. Interaction with the people revealed that some lacked information and education on Reproductive health

and HIV/AIDS.

P4-46 (A) Health Care Access and Healthy Lifestyle Measures Among New York City Adults with Multiple Cardiovascular Disease Risk Factors Dejana Selenic, Chitra Ramaswamy, Sonia Angell, Bonnie Kerker, and Thomas Matte

Background: Most risk factors for cardiovascular disease (CVD) can be mitigated through ~th clinical interventions and lifestyle change. We used data from a telephone survey of New York City (NYC) adults to characterize health care access and healthy behavior among those with three or more

CVD risk factors. Methods: The study population included respondents to the NYC Community Health Survey 2002

(N= 9,674) self-reporting~ 3 of the following: smoking, diabetes, high cholesterol level, high blood pres· sure, body mass index >25, and age >45 (males) or >55 (females) (n=2,439).

Results: Based on self-report, an estimated 1.447,000 (24%) of NYC adults have~ 3 or more CVD risk factors. This population is 51 % male, 47% white, 25% black, and 53% with S 12 years of education. Most report good access to health care, indicated by having health insurance (95%), regular doctor (89%), their blood pressure checked within last 6 months (91 %), and their choles· terol checked within the past year (90% ). Only 29% reported getting at least 20 minutes of exercise ~ 4 times per week and only 9% eating ~ 5 servings of fruits and vegetables the previous day. Among current smokers, 59% attempted to quit in past 12 months, but only 32% used medication or counseling.

Implications: These data suggest that most NYC adults known to be at high risk for CVD have access to regular health care, but most do not engage in healthy lifestyle or, if they smoke, attempt effec­tive quit strategies. More clinic- based and population-level interventions are needed to support lifestyle change among those at high risk of CVD.

P4-47 (A) Geographical Accessibility and Health Promotion - Filling an Urban Research Gap? Eric Hemphill, Kim Raine, john Spence, Karen Smoyer-Tomic, and Carl Amrhein

Introduction: Recently, much interest has been directed at "obesogenic" (obesity-promoting) (Swinburn, Egger & Raza, 1998) built environments, and at Geographic Information Systems (GIS) as a tool for their exploration. A major geographical concept is accessibility, or the ease of moving from an origin to a destination point, which has been recently explored in several health promotion-related stud· ies. There are several methods of calculating accessibility to an urban feature, each with its own strengths, drawbacks and level of precision that can be applied to various health promotion research issues. The purpose of this paper is to describe, compare and contrast four common methods of calculat­ing accessibility to urban amenities in terms of their utility to obesity-related health promotion research. Practical and conceptual issues surrounding these methods are introduced and discussed with the intent of providing health promotion researchers with information useful for selecting the most appropria1e accessibility method for their research goal~

~ethod: This paper describes methodological insights from two studies, both of which assessed the neighbourhood-level accessibility of fast-food establishments in Edmonton, Canada - one which used a relatively simple coverage method and one which used a more complex minimum cos1 method.

Res.Its: Both methods of calculating accessibility revealed similar patterns of high and low access to fast-food outlets. However, a major drawback of both methods is that they assume the characteristics of the a~e~ities and of the populations using them are all the same, and are static. The gravity potential method is introduced as an alternative, since it is ·capable of factoring in measures of quality and choice. A n~mber of conceptual and pr~ctical iss~es, illustrated by the example of situational influences on food choice, make the use of the gravity potential model unwieldy for health promotion research into socially­determined conditions such as obesity.

Co.nclusions: I~ ~ommended that geographical approaches be used in partnership with, or as a foun~ation for, ~admonal exploratory methodologies such as group interviews or other forms of com­mumty consultation that are more inclusive and representative of the populations of interest.

N-48 (Al Validity of Retinomax Autore&actor to Comprehensive Eye Examinations in School-Aged

Qilhl in Los Angeles County ,,..ia Shaheen, Richard Casey, Fernando Cardenas, Holman Arthurs, and Richard Baker

~The Retinomax autorefractor has been used for vision screening of preschool age chil­

dien. Ir bas been suggested to be used and test school age children but not been validated in this age

poup. Ob;taiw: To compare the results of Retinomax autorefractor with findings from a comprehensive

I!' examination using wet retinoscopy for refractive error.

Mllhods: Children 5-12 years old recruited from elementary schools at Los Angeles County were

iaml with Snellen's chart and the Retinomax autorefractor and bad comprehensive eye examination

with dilation. Miiin Outcome Mun.res: The proportion of children with abnormal eye examination as well as

diesensitiviry and specificity of the screening tools using Retinomax autorefractor alone and in combina­

lion wirh snellen's chart. Results Of the 258 children enrolled in the study (Average age= 8.5± 2.1 years;

age range, 5-12 years), 6?% had abnormal eye examination using retinoscopy with dilation. For the

lerinomax, the sensitivity was 85% (95% confidence interval [CI] 78%-90%), and the specificity was

31% (95% CI, 22%-41 o/o). Simultaneous testing using Snellen's chart and Retinomax resulted in gain in

111Sitiviry (94%, 95% Cl= 89, 97), and loss in specificity (28%, 95% Cl= 19%-38%).

°""'1lsions: The study showed that screening school age children with Retinomax autorefractor

could identify most cases with abnormal vision but would be associated with many false-positive results.

Simuhaneous resting using Snellen's chart and Retinomax maximize the case finding but with very low

specificiry.

N-49 (A) Hepatitis C Virus Infection Saeening and Care Behaviours of Canadian Family Physicians

Lisa Graves, Joseph Cox, Anita Lambert-Lanning, Marc Steben, and Randolph Stephenson

IlllJotlMction: In Canada, approximately 37% of hepatitis C virus (HCV) infected people are

11111ware of their infection. Understanding HCV screening practices of Canadian family physicians is

important to limir HCV transmission and morbidity associated with chronic HCV infection.

MdhotJs: A language-stratified, random sample of 2366 members of the College of Family Physi­

cians of Canada received a confidential survey. The questionnaire collected data on socio-demographic

characteristics, medical training, practice type, setting and HCV-related care practices. The self-adminis­

ratd questionnaire was also made available to participants for completion on the Internet.

Batdti: Response proportion was 33%. Median age was 41 years (47% female) and the propor­

lionoffrench questionnaires was 26%. Approximately 88% had completed family medicine residency

lllining in Canada; median year of training completion was 1995. Sixty-seven percent, 38% and 29%

work in private offices/clinics, community hospitals and emergency departments, respectively. Regarding

~practices, 94% had ever requested a HCV test and 87% of physicians had screened for HCV

iafrction in rhe past 12 months· median number of tests was 10. While 17% reported having no HCV­

Uaed patients in their practic~, 44% had 1-5 HCV-infected patients. Regarding the level of HCV care

provided, 4.3% provide ongoing advanced HCV care including treatment and dose monitoring for

camplications and 41 o/o do basic HCV care comprised of HCV testing, counselling, basic evaluation and

fallow.up. Ctmduions: In this sample of Canadian family physicians, most had pro~ided HCV screening. to

•least one patient in the past year. Less than half had 1-5 HCV-infected patients and 41 % provide

~:relared care The role of socio-demographic factors, medical training as wel_I as HCV ca~e percep­

llDas 10 rhe provision of appropriate HCV screening will be examined and described at the time of the

canference.

'4-50 (C) Healthcare Services: The Context of Nepal Meen Poudyal Chhetri

"""1tl.ction Healthcare service is related with the human rights and fundamental righ~ of the ci~ ciaaiuntry. However, the growing demand foi health care services, quality heal~care service, accessib1b~ ID die mass population and paucity of funds are the different but interrelated issues to .be ~ddressed. m

Nepat.1n view of this context, public health sector in Nepal is among other sectors, which IS struggling

-.i for scarce resources. . . .

~:In Nepal, the problems in the field of healthcare servic~s do not bnut ~o the. paucity of

faads and resources only, but there are other problems like: rural - urban imbalance, regional unbalance,

POSTER SESSIO~

f the ll·m1·ted resources poor healthcare services, inequity and inaccessibility of the poor management o , . poor people of the rural, remote and hilly areas for the healthcare services and so on.. . . .

S I ,; • It ·s very necessary to determine what should be done for ~he maxim1zat1on of pubhc 0 u .. ons. i · · h f · d' 'd I' ·1

h I h · . I f ct the best resource allocation is the one that max1m1zes t e sum o m ivi ua s u11 · ea t services. n a , · h d' ·b ·

· · H . ·t effi.ciency and efficient management are correlated. It might be t e re istn utmn of mes. ence, equi y, . . . . 1. income or redistribution of services. Moreover, maximizanon of available resources, qua tty healthcare

services and efficient management of them are the very important and necessary tools and techmques to

meet the growing demand and quality healthcare services in Nepal.

P4-51 (A) An Jn-Depth Analysis of Medical Detox Clients to Assist in Evidence Based Decision Making

Xin Li, Huiying Sun, Ajay Puri, David Marsh, and Aslam Anis

Introduction: Problematic substance use represents an ever-increasing public health challenge. In

the Vancouver Coastal Health (VCH) region, there are more than 100,000 individuals having some

probability of drug or alcohol dependence. To accommodate this potential demand for addiction related

services, VCH provides various services and treatment, including four levels of Withdrawal Management

Services (WMS). Clients seeking WMS are screened and referred to appropriate services through a cen­

tral telephone intake service (ACCESS I). The present study seeks to rigorously evaluate one of the ser­

vices, Vancouver Detox, a medically monitored 24-bed residential detox facility, and its clients. Doing so

will allow decision makers to utilize evidence based decision-making in order to improve the accessibility

and efficiency of WMS, and therefore, the health of these clients. Methods: We extract one-year data (October 1, 2003-September 30, 2004) from an efficient and

comprehensive database. The occupancy rate of the detox centre along with the clients' wait time for ser­

vice and length of stay (LOS) are calculated. In addition, the effect of seasonality on these variables and

the impact of the once per month welfare check issuance on the occupancy rate are also evaluated.

Results: Among the 2411 clients (median age 40, 65% male) who were referred by ACCESS! to

Vancouver Detox over the one-year period, 1448 were admitted. The majority (81 %) of those who are

not admitted are either lost to follow up (i.e., clients not having a fixed address or telephone) or

declined service at time of callback. The median wait time was 1 day [Q3-Ql: 3-1], the median LOS

was 5 days IQ3-Qt: 6-3], and the average bed occupancy rate was 83%. However, during the three­

day welfare check issue period the occupancy rate was lower compared to the other days of the year

175% vs. 84%, p Conclusion: Our analysis indicates that there was a relatively short wait time at Vancouver Detox,

however 40% of the potential clients were not served. In addition, the occupancy rate declined during

the welfare check issuance period and during the summer. This suggests that accessibility and efficiency

at Vancouver Detox could be improved by specifically addressing these factors.

P4-S2 (A) Perceptions of and Responses to Intimate Partner Violence Among Canadian Born and Immigrant Young Women Robin Mason, Ilene Hyman, and Michelle Coghlan

Background: Intimate partner violence (IPV) is associated with acute and chronic physical and men·

tal health outcomes for women resulting in greater use of health services. Yet, a vast literature attests to

cultural variations in perceptions of health and help-seeking behaviour. Fewer studies have examined dif­

ferences in perceptions of IPV among women from ethnocultural communities. The recognition, defini­

tion, and understanding of IPV, as well as the language used to describe these experiences, may be

different in these communities. As such, a woman's response, including whether or not to disclose or

seek help, may vary according to her understanding of the problem.

Methods: This pilot study explores the influence of cultural factors on perceptions of and responses

to IPV among Canadian born and immigrant young women. In-depth focus group interviews were con·

ducted with women, aged 18 to 24 years, living in Toronto. Open-ended and semi-structured interview

questions were designed to elicit information regarding how young women socially construct JPV and

where they would go to receive help. Interviews were transcribed, then read and independently coded by

the research team. Codes were compared and disagreements resolved. Qualitative software QSR N6 was used to assist with data management.

. Ruu~ts_: Res~nses_abo~t what constitutes IPV were similar across the study groups. When consid­

ering specific ab.us1ve ~1tuanons and types of relationships, participants held fairly relativistic views

about IPV, especially with regard to help-seeking behaviour. Cultural differences in beliefs about norma­

~ive m;ile/femal~ relations. familial.roles, and customs governing acceptable behaviours influenced partic­

tpants perceptions about what 1n1ght be helpful to abused women. Interview data highlight the social

l05TER srnfONS v91

11111 suucrural _impact these factors ha:e on you?g women and provide details regarding the dynamics of

cibnocUltur~ m~uences on help-~eekmg behav10ur: T~e ro~e of such factors such as gender inequality

within rtlaoo?sh1ps and t_he ~erce1ved degree of ~oc1al 1solat1on and support nerworks are highlighted.

COllC~ The~ findmgs unde~score the _1mporta_nc_e of understanding cultural variations in per­

crprions of IPV ~ relanon to ~elp-seekmg beha~1':'ur. Th1s_mformation is critical for health professionals

iodiey may connnue developmg culturally sensmve practices, including screening guidelines and proto­

rols. ln addition, _this study demonstr~tes that focus group interviews are valuable for engaging young

romen in discussions about IPV, helpmg them to 'name' their experiences, and consider sources of help

when warranted.

P4-S3 (A) Health Problems and Health Care Use of Young Drug Users in Amsterdam

.Wieke Krol, Evelien van Geffen, Angela Buchholz, Esther Welp, Erik van Ameijden, and Maria Prins

/11trod11ction: Recent advances in health care and drug treatment have improved the health of pop­

ulations with special social and health care needs, such as drug users. However, still a substantial number

dots not have access to the type of services required to improve their health status. In The Netherlands,

tspccially young adult drug users (YAD) whose primary drug is cocaine might have limited access to

drugrreatment services. In this study we examined the history and current use of (drug associated) treat­

mmt services, the determinants for loss of contact, and the current health care needs in the Young drug

mm Amsterdam Study (YODAM). Methods: YODAM started in 2000 and is embedded in the Amsterdam Cohort Study among drug

mm. Data were derived from Y AD aged < 30 years who had used cocaine, heroin, ampheramines and I

or methadone at least 3 days a week during the 2 months prior to enrolment.

Res11lts:Of 195 YAO, median age was 27 years (range: 18-30 years), 72% was male and 83% had

1Dutch nationality at enrolment. Nearly all participants (97%) reported a history of contact with drug

llt.lnnent services (methadone maintenance, rehabilitation clinics and judicial treatment), mental health

car? (ambulant mental care and psychiatric hospital) or general treatment services (day-care, night-care,

hdp for living arrangements, work and finance). However, only 61 % reported contact in the past six

l!Xlllths. This figure was similar in the first and second follow-up visit. Among Y AD who reported no

current contact with the health care system, 87% would like to have contact with general treatment ser­

l'icts. Among participants who have never had contact with drug treatment services, 67% used primarily

cocaine compared with 22% and 8% among those who reported past or current contact, respectively.

Saied on the Addiction Severity Index, 70% reported at least one mental health problem in the past 30

days, but only 11 % had current contact with mental health services.

Concl11Sion: Results from this study among young adult drug users show that despite a high contact

rm with health care providers, the health care system seems to lose contact with YAO. Since 87% indi­

catt the need of general treatment services, especially for arranging house and living conditions, health

M services that effectively integrate general health care with drug treatment services and mental health

care might be more successful to keep contact with young cocaine users.

P4-S4 {A) Unraveling Socioeconomic Disparities in Mental Health Service Use in Canada: Finding the

Appropriate Targets for Policy Intervention Leah Steele, Carolyn Dewa, Elizabeth Lin, and Kenneth Lee

Introduction: Research on the relationship berween socioeconomic status _and !11ental health ser­

""' use in Canada has shown conflicting results. Using data from the Canadian Commun~ty Health

Survey 1.2, a population-based survey, this study sought to determine the inde~ndent and mteracnve

rdinonships between income education and the likelihood of mental health service use among mdividu-

als With either depressive or a~xiety disorder. . · · ·

Mtthods: Respondents included adults aged 18 and over who met DSM-IV diagn?snc criteria for

an anxiety or depressive disorder in the past 12 months. We performed two sets of logisnc regressmns.

Thtdichotomous dependent variables for each of the regressions indicated whether rhe respondenr_vis­

Ud a psychiatrist, psychologist, family physician or social worker in the _past_ 12 months. All regressions

aiatrolled for age, sex, employment, marital status, type of distress, and immigrant st~tus. d Tut firs · · d · · d pendent vanables. The secon . t set simultaneously examined educatmn an income as m e . . 1

!Iamined the relationship berween education and service use, stratifying the analysis by mcome leve ·

Rts,,/ts O f' · 'f" I · h" between education and service use, bar : ur irst set of analyses found a s1gm 1cant re anons •P . d . Th

no relationship for income. There was no significant interaction between educatmn an mco~:· r: ::or respondents with at least a high school education to seek help ~rom any of the four servic P

were almost twice that for respondents who had not completed high school.

v92 POSTER SESSIONS

Th . d ec of analyses found che associacion becween educacion and use of MD-provided care e secon s · · be d ·

· ·f· ly 1·n che low income group For non-MD care, the assoc1anon cween e ucatlon and was s1gm icant on - · . . . . use of social workers was significant in both income groups, but significant only for use of psychologists

in che high-income group. . . . Conclusion: We found differences in healch service use by education level. Ind1v1duals who have nor

compleced high school appeared co use less mental he~lt~ servi~es provided ~y psyc~iatrists, psycholo·

gists, family physicians and social workers. We found limited e.v1dence _suggesting the influence of educa·

tion on service use varies according to income and type of service provider.

Results suggesc there may be a need to develop and evaluate progr~ms.designe~ to deliver targeted

services to consumers who have noc completed high school. Further quahtanve studies about the expen·

ence of individuals with low education are needed to clarify whether education's relationship with ser·

vice use is provider or consumer driven, and to disentangle the interrelated influences of income and

education.

P4-55 (A) Does Racial Concordance Between Patients and Providers Influence Trust in the Health Care

System for Homeless, HIV-infected Patients in NYC? Nancy Sahler, Chinazo Cunningham, and Kathryn Anastos

Introduction: Racial/ethnic disparities in access to health care have been consistently documented.

One potential reason for disparities is that the cultural distance between minority patients and their pro­

viders discourage chese patients from seeking and continuing care. Many institucions have incorporated

cultural compecency craining and culturally sensicive models of health care delivery, hoping co encourage

better relacionships becween patients and providers, more posicive views about the health care system,

and, ulcimacely, improved health outcomes for minority patients. The current scudy tests whether cul­

tural distance between physicians and patients, measured by racial discordance, predicts poorer patient

attitudes about their providers and the health care system in a severely disadvantaged HIV-infected pop­

ulation in New York City that typically reports inconsistent patterns of health care.

Methods: We collected data from 396 unscably housed black and Latino/a people with HIV who

reported having a regular health care provider. We asked them to report on their attitudes about their

provider and the health care system using validated instruments. Subjects were categorized as being

racially "concordant" or "discordant" with their providers, and attitudes of these two groups were

compared. Results: The sample consisted of 256 (65%) black and 140 (35%) Latino/a people, who reported

having 80 (20%) black physicians, 49 (12%) Latino/a physicians, 167 (42%) white physicians, and 100

(25%) physicians of another/unknown race/ethnicity. Overall, 260 (75%) subjects had physicians of a

different race/ethnicity than their own. Racial discordance did not predict negative attitudes about rela·

tionship with providers: the mean rating of a I-item trust in provider scale (lO=high and O=low) was 8.0

for both concordant and discordant groups, and the mean score in 13-icem relationship with provider

scale (4=high and !=low) was 3.5 for both groups. However discordance was significantly associated

with distrust in che health care syscem: che mean score on a 7-icem scale (5=high discrust and l=low dis­

trust) was 3.4 for discordant group and 3.0 for che concordant group (t= 2.66, p= 0.008). We further

explored these patterns separacely in black and Lacino/a subgroups, and using different strategies ro con­ceptualize racial/ethic discordance.

Conclusions: In this sample of unscably housed black and Latino/a people who receive HIV care in

New York City, having a physician from the same racial/ethnic background may be less important for

developing a positive doctor-patient relationship than for helping the patients to dispel fear and distrust

about the health care system as a whole. We discuss the policy implications of these findings.

P4-56 (A) Mental Healthcare Utilization Patterns of Ethiopian Immigrants in Toronto Ilene Hyman and Samuel Noh

. .Abstract Objectiw: This study examines patterns of mental healthcare utilization among Ethiopian 1mm1grants living in Toronto.

Methods: A probability sample of 342 Ethiopian adults ( 18 years and older) completed struc­

tured face-to-face interviews. Variables ... define, especially who are non-health care providers. Plan of analysis.

Results: Approximately 5% of respondents received memal health services from mainstream

healthcare providers and 8% consulted non-healthcare professionals. Of those who sought mental health

services from mainstream healthcare providers, 3.1 % saw family physicians, 2.1 % visited a psychiatrist.

and 0.6% consulted other healthcare providers. Compared with males, a significantly higher proportion

1GSfER SESSIONS v93

ri ftlnales consulted non-healthcare_ professionals for emotional or mental health problems (p< 0.01 ).

tlbile Ethiopian's overall use of mamstream healthcare services for emotional problems (5%) did not

prlydiffer from the rate (6%) of the general population of Ontario, only a small proportion ( 12.5%)

rJErhiopians with mental health needs used services from mainstream healthcare providers. Of these,

!OJ% received family physicians' services, 4.3 % visited a psychiatrist, and 2.2% consulted other health­

ll/C providers. Our data also suggested that Ethiopian immigrants were more likely to consult tradi­

oooal healers than health professionals for emotional or mental health problems ( 18.8% vs. 12.5% ).

Our bivariate analyses found the number of somatic symptoms and stressful life events to be associated

with an increased use of medical services and the presence of a mental disorder to be associated with a

dfcreased use of medical services for emotional problems. However, using multivariate methods, only

die number of somatic symptoms remained significantly associated with use of medical services for emo­

oonal problems. Diu#ssion: Study findings suggest that there is a need for ethnic-specific and culturally-appropriate

mrcrvention programs to help Ethiopian immigrants and refugees with mental health needs. Since there

~a strong association between somatic symptoms and the use family physicians' services, there appears

robe a critical role for community-based family physicians to detect potential mental health problems

among their Ethiopian patients, and to provide appropriate treatment and/or referral.

Acknowledgement: The authors acknowledge the Centre of Excellence for Research in Immigration

and Settlement (CERIS) in Toronto and Canadian Heritage who provided funding for the study. We also

acknowledge Linn Clark whose editorial work has improved significantly the quality of this manuscript.

We want to thank all the participants of the study, and the Ethiopian community leaders without whose

honest contributions the present study would have not been possible.

P4-S7 (A) The Impact of Rationality on Clinical Decision-Making in Emergency Medicine

Alison Dunwoody

This paper addresses the impact of the rationalization of health-care services on the clinical deci­

sion-making of emergency physicians in two urban hospital emergency departments in Atlantic Canada.

Using the combined strategies of observational analysis and in-depth interviewing, this study provides a

qualitative understanding of how physicians and, by extension, patients are impacred by the increasing

ancmpts to make health-care both more efficient and cost-effective. Such attempts have resulted in sig­

nificantly compromised access to primary care within the community. As a consequence, patients are,

out of necessity, inappropriately relying upon emergency departments for primary care services as well as

access to specialty services. Within the hospital, rationalization has resulted in bed closures and severely

rmricted access to in-patient services. Emergency physicians and their patients are in a tenuous position

having many needs but few resources. Furthermore, in response to demands for greater accountability,

physicians have also adopted rationality in the form of evidence-based medicine. Ultimately, ho~ever,

rationality whether imposed upon, or adopted by, the profession significantly undermines physu.:1ans'

ability to make decisions in the best interests of their patients.

P4-S8 (A) Hispanic Males and Healthcare Access: A Snapshot of New York City

JohnJasek, Gretchen Van Wye, and Bonnie Kerker

Introduction: Hispanics comprise an increasing proportion of th.e New York City (NYC) popula­

non !currently about 25%). Like males in the general population, H1spamc males (HM) have a lower

prrval,nce of healthcare utilization than females. However, they face additional access barriers such as

bnguage differences and high rates of uninsurance. They also bear a heavy burden of health problems

lllehasobesity and HIV/AIDS. This paper examines patterns of healthcare access and ut1hzat1on by HM

compared to other NYC adults and identifies key areas for intervention. . .

. Mtthods: Data were drawn from the 2004 NYC Community Health Survey, an annual cross-sc"f

Ilona) survey of approximately 10 000 NYC adults. Bivariate analyses were used to examine measures 11

bralthc ' · · ·d r (PCP) regular source of are access (health insurance coverage, having a primary care prov• e ' . d

C!rt, provider quality ratings) and utilization (routine checkup, HIV and colon cancer screenings, flu an

Jllltumonia immunizations) by ethnicity and preferred home language (PHL). . . . .

IVsults: Preliminary analyses show that HM are more likely to be uninsured than either Hispam"

lanalt1 (HF) or Non-Hispanic males (NHM) (35.3% vs. 22.0% vs.15.4'Yo, P < O.OO.l for all) HM are

iho more likely than these groups to lack a PCP ( 40.5% vs. 28.4 % vs. 16. 7%, respecnvely' p< O.OO 1 for

all!. HM are more likely than HF (16.8 vs. 11.4%, p<.01) and NHM (5.9%'. p<.OOl) to useh emerge.ndq dcpartm h I ss likely to rate t ear prov1 er ~ ..... ents as their regular care sources. Compared to NHM, t ey are e . 60 60/c 68 90;. "'5'lly in terms of explaining (75.8% vs. 81.5%, p<.001) and spending adequate time ( · 0 vs. · 0'

001) · h lower ratings among PHL-Spanish as compared to PHL-English HM (73.3% I\ p<. ' wdit 57ev7e:, 69 zo1 p< o 01 for both). HM are less likely than HF to have b.ad a rouh.. 82 5% an . 10 vs. · 10 • • • • ...

h . k' . h t 6 months (55.1% vs. 66.3%, p<.001). Lifetime colonoscopyratesamongHMso c ec up m t e pas 1 . 148 901 58 901

and older are significantly lower than the NHM popu anon . 10 v. . 10, p<.05), though HI\'

screening and immunizations are comparable between the two groups. Conclusion: Findings suggest that HM have less access t? healthcare than HF or NHM. Hown1r,

HM ble to obtain certain discrete medical services as easily as other groups, perhapsdueto!Rtor are a HM. I I .

subsidized programs. For other services, utilization among 1s ower. mprovmg acc~tocareinthis

group will help ensure routine, quality care, which can lead to a greater use of prevennve services Iii!

thus bener health outcomes.

P4-S9 (A) Diagnostic Access Bias in Cancer Research Mohammad Fararouei and Esfandiar Afshoon

Introduction: Cancer registry is considered as one of the most important issues in cancer epidemiol­

ogy and prevention. Bias or under-reporting of cancer cases can affect the accuracy of the results of epi­

demiological studies and control programs. The aim of this study was to assess the reliability of the

regional cancer report in a relatively small province (Yasuj) with almost all facilities needed for C3llCll

diagnosis and treatment. Methods: Finding the total number of cancer cases we reviewed records of all patients diagnoicd

with cancer (ICD 140-239) and registered in any hospital or pathology centre from1999 until 2001 in

Yasuj and all (5) surrounding provinces. Results: Of 504 patients who were originally residents of Yasui province, 43.7% wereaccoulll!d

for Yasuj province. The proportion varies according to the type of cancer, for exarnplecancetsofdigls­

tive system, skin and breast were more frequently reported by Yasuj's health facilities whereas cancmoi

blood, brain and bone were mostly reported by neighbouring provinces. The remaining cases (56.3%1

were diagnosed, treated and recorded by neighbouring provinces as their incident cases. This is partly

because of the fact that patients seek medical services from other provinces as they believed that the facil.

ities are offered by more experienced and higher quality stuffs and their relative's or temporary acOOIII'

modation addresses were reported as their place of residence. Conclusion: Measuring the spatial incidence of cancer according to the location of report ortht

current address affected the spatial statistics of cancer. To correct this problem recording the permanm!

address of diagnosed cases is important.

P4-60 (C). Providing Primary HealthCare to a Disadvantaged Population at a University-Run Commumty Healthcare Facility Tracey Rickards

The. C:ommuni~y .H~alth ~linic (CHC) is a university sponsored nurse-managed primary bealthwt

(P~C:l clime. The clm1c is an innovative model of healthcare delivery in Canada that has integrated tht principles of PHC ser · · h' . vices wit ma community development framework. It serves to provide access to

PHC services for members of th · · illi · dru is II be. . e community, particularly the poor and those who use or gs,

we mg a service-learning facil'ty f d · · · · · · d rionll h . . 1 or stu ents across d1sc1plmes. Serv1ce-learrung IS an e uca

met od combmmg commun'ty · · h I · de Prof& · 1 II bo . 1 service wit c ear learning objectives in academic coursewo ·

s1ona s co a rate with other er I d bk . h oss-sectora partners to provide accessible appropriate an accepra

services t at are affordable to l' d . . ' ' .,m.:. · t · . meet c ient nee s. Chmc nursing and social work staff and srudents r·--· ipa em various PHC activities and h .L.hont" less I . f . outreac services in the local shelters and on the streelS to'""

popu auon o Fredericton As well th CHC · model Iii fosterin an on oi : . • e promotes and supports a harm reduction . · local d!or an~ h ng ~art:ersh1p with AIDS New Brunswick and their Needle Exchange program, w1tha

ing condoms and :xu:t h:~~~e e~aint~nance Therapy clients, and with the clie~ts themselves ~_r; benefits of receiving health f ucation, a place to shower, and a small clothing and food oai~·

care rom a Nurse p · · d d · --""~'I"· are evidenced in th r ract1t1oner an at a nurse manage center m !'''"~;.

et al, 2003; Seifer ~ 1~;~~re ~;~on, Ba~amee, Sowers & Robertson, 2003; Clendon, 2003; Mc~ of acute and chronic illn!s~~ d )h ~h•!e h~alth promotion, prevention, risk reduction,~ of di! CHC., research plays an eq U ~n ° istic client-centered care are vitally important funco~s sion, is community based ua J .imp~rtant role. Research conducted at the clinic informs seine;.!'.:

research that involved needsaans mvo ves clients, staff, and students. To date the CHC has unacn-1 · sessment/enviro I . d ; •• '""""1ll

eva uanon. The clinic has also e . d nmenta scan, cost-benefit analysis, an on-go...,,1"".'I'~

facility and compassionate lea x~mme the model of care delivery' focusing on nursing roles wi~ cJ

rmng among students. Finally, the clinic strives to share the resU•P

v95

.-arch with the community in which it provides service by distributing a bi-monthly newsletter, and

plllicipating in in-services and educational sessions in a variety of situations. The plan for the future is

coolinued research and the use of evidence-based practice in order to guide the staff in choosing how

much n~ primary healthcare services to marginalized populations will be provided.

N-61 (C) Tuming Up the Volume: Marginalized Women's Health Concerns

Tckla Hendrickson and Betty Jane Richmond

bdrotbu:tion: The marginalization of urban women due to socio-economic status and other deter­

minants negatively affects their health and that of their families. This undermines the overall vitaliry of

urban communities. For example, regarding access to primary health care, women of lower economic

surus and education levels are less likely to be screened for breast and cervical cancer. What is not as

widely reported is how marginalized urban women in Ontario understand and articulate their lack of

access to health care, how they attribute this, and the solutions that they offer. This paper reports on the

rnults of the Ontario Women's Health Network (OWHN) focus group project highlighting urban

women's concerns and suggestions regarding access to health care. It also raises larger issues about urban

health, dual-purpose focus group design, community-based research and health planning processes.

Mdhods: Focus group methodology was used to facilitate a total of 30 discussions with 55 urban

and 54 rural women across Ontario from 2003 to 2005. The women were invited to participate by local

women's and health agencies and represented a range of ages, incomes, and access issues. Discussions

focussed on women's current health concerns, access to health care, and information needs. Results were

analyzed using grounded theory. The focus groups departed from traditional focus group research goals

and had two purposes: 1) data collection and dissemination (representation of women's voices), and 2)

fostering closer social ties between women, local agencies, and OWHN. The paper provides a discussion

and rationale for a dual approach. Rax/ts: The results confirm current research on women's health access in women's own voices:

urban women report difficulty finding responsive doctors, accessing helpful information such as visual

aids in doctors' offices, and prohibitive prescription costs, in contrast with rural women's key concern of

finding a family doctor. The research suggests that women's health focus groups can address access

issues by helping women to network and initiate collective solutions.

Condiuion: The study shows that marginalized urban women are articulate about their health con­

ctrns and those of their families, often understanding them in larger socio-economic frameworks; how­

tver, women need greater access to primary care and women-friendly information in more languages and

in places that they go for other purposes. It is crucial that urban health planning processes consult

directly with women as key health care managers, and turn up the volume on marginalized women's

voices.

P4-62 (C) Voluntary Counseling and Testing for Human Immunodeficiency Virus in Pregnant Nigerian

Women: An Evaluation of Awareness, Attitudes and Beliefs Kingsley Okonkwo

Introduction: Nigeria has one of the highest rates of human immunodeficiency virus IHIVI sero­

prrvalence in the world. As in most developing countries vertical transmission from mother to child

account for most HIV infection in Nigerian children. The purpose of this study was ro. determine the

awareness, attitudes and beliefs of pregnant Nigerian women towards voluntary counseling and testing

IVCT! for HIV. Mnbod: A pre-tested questionnaire was used to survey a cross section '.>f.240 pregnant women ~t 2

(lrlleral antenatal clinics in Awka, Nigeria. Data was reviewed based on willingness to ~c~ept or re1ect

VCT and the reasons for disapproval. Knowledge of HIV infection, routes of HIV transm1ssmn and ant1-

rnroviral therapy IART) was evaluated. hsults: 72% of the women had good knowledge of HIV, I 5% had fair knowledge while 1.1%

had poor knowledge of HIV infection.48% of the women were not aware of the association of hreast

milk feeding and transmission of HIV to their babies. Majority of the women 87% approved V~T

while 13% disapproved VCT, 93% of those who approved said it was because VCT could ~educe risk

of rransmission of HIV to their babies. All respondents, 100% who accepted VC.I ~ere willing to be

tnted if results are kept confidential only 23% accepted to be tested if VC.T results w.111 be s~ared w1.th

Pinner and relatives 31 % attributed their refusal to the effect it may have on their marriage whale

69'- gave the social 'and cultural stigmatization associated with HIV infection for their r~fusal.S9% wall accept VCT if they will be tested at the same time with their partners.81 ~0 of ~omen wall pref~r to

breast feed even if they tested positive to HIV. Women with a Higher education diploma were 3 times

v96

more likely to accept VCT. Knowledge of ART for HIV infected pregnant women as a means of pre.

vention of maternal to child transmission [PMTCT) was generally poor, 37% of respondents wm

aware of ART in pregnancy. Conclusion: The acceptance of VCT by pregnant women seems to depend on their understanding

that VCT has proven benefits for their unborn child. Socio-cultural factors such as stigmatizationofHIV

positive individuals appears to be the maj_or impedi~ent towards widespread acceptanee of ycr in

Nigeria. Involvement of male partners may 1mpro~e attitudes t~wa~ds VCT:The developmentofmnova­

tive health education strategies is essential to provide women with mformanon as regards the benefits of

VCT and other means of PMTCT.

P4-63 (C) Ethnic Health Care Advisors in Information Centers on Health Care and Welfare in Four

Districts of Amsterdam Arlette Hesselink, Karien Stronks, and Arnoud Verhoeff

Introduction: In Amsterdam, migrants report a "worse actual health and a lower use of health care

services than the native Dutch population. This difference might be partly caused by problems migrants

have with the Dutch language and health care and welfare system. To support migrants finding their way

through this system, in four districts in Amsterdam Information Centers on Health Care and Welfare

were developed in which ethnic health care advisors were employed. Their main task is to provide infor·

mation to individuals or groups in order to bridge the gap between migrants and health care providers.

Methods: The implementation of the centers is evaluated using a process evaluation in order to give

inside in the factors hampering and promoting the implementation. Information is gathered using

reports, attending meetings of local steering groups, and by semi-structured interviews with persons

(in)directly involved in the implementation of the centers. In addition, all individual and groupcontaetS

of the health care advisors are registered extensively.

Results: Since 2003 four Information Centers, employing 12 ethnic health care advisors, are imple­

mented. The ethnicity of the health care advisors corresponds to the main migrant groups in the different

districts (e.g. Moroccan, Turkeys, Surinamese and African). Depending on the local steering groups, the

focus of the activities of the health care advisors in the centers varies. In total, around 2000 individual

and 225 group educational sessions have been registered since the start. Most participants were positive

about the individual and group sessions. The number of clients and type of questions asked depend

highly on the location of the centers (e.g. as part of a welfare centre or as part of a housing corporation).

In all districts implementation was hampered by lack of ongoing commitment of parties involved (e.g.

health care providers, migrant organizations) and lack of integration with existing health care and wel­

fare facilities.

Discussion: The migrant health advisors seem to have an important role in providing information

on health and welfare to migrant clients, and therefore contribute in bridging the gap between migrants

and professionals in health care and welfare. However, the lack of integration of the centers with the

existing health care and welfare facilities in the different districts hampers further implementation.

Therefore, in most districts the Information Centres will be closed down as independent facilicities in the

near future, and efforts are made to better connect the position of migrant health advisor in existing

facilities.

P4-64 (C) Community Palliative Care in an Urban Setting: Building a Model

Joe Bornstein, Dipti Purbhoo, and Drew Baillie

Palliative Care is receiving increased attention as a necessary component of a comprehensive

heal~h care syste~. As palliative care moves to the community setting there are complex challenges to

pro~de appropnate supports and services within the urban environment. Palliative Care in the home

requires a collaborative effort across a wide range of both formal and informal providers. The devel­

opment of Local_ Hea~th lntegrati~n Networks in Ontario has provided an opportunity for supporting

more collaboranons m community palliative care. The five Toronto area Community Care Access

C:Cntres suppo~ted a participatory process focused on the development of a Comprehensive Commu­

m~ Partnei:ship Model for Palliative Care. The approach combined evidence based decision making

with extensive stakeholder involvement in reviewing and developing an urban health palliative care

model. The model recognizes the importance of partnerships as well as the vital role of case manage-

ment ands te . . I b I · .

. . ys m navigation. t a ances a client centred focus with the structural needs of accountabil-

ity This prese · ·u d" h ·u lso . ntanon wt tsCUss t e ongoing developmental process and engagement of partners. It

!'_ • .1 °b~l~line the key components of the model and the particular relevance for Urban Health and

we ava1 a 1 tty and access to services.

POSTER SESSIONS v97

P4-65 (C) Empowering School Clinics of Urban Communities as Partners in TB Treatment:

The Philippine Experience Loyd Brendan Norella, Elmer Soriano, and Marilou Costello

The 2005 WHO Report ranks the Philippines as ninth among 22 countries with a high TB preva­

lence. About a fourth of the country's population is infected, with majority of cases coming from the

lower socioeconomic segments of the community. Metro Manila is not only the economic and political

capital of the Philippines but also the site of major universities and educational institutions. Initial inter­

views with the school's clinicians have established the need to come up with treatment guidelines and

protocols for students and personnel when TB is diagnosed. These cases are often identified during

annual physical examinations as part of the school's requirements. In many instances, students and per­

sonnel diagnosed with TB are referred to private physicians where they are often lost to follow-up and may

have failure of treatment due to un monitored self-administered therapy. This practice ignores the school

clinic's great potential as a TB treatment partner. Through its Single Practice Network (SPN) Initiative, the

Philippine Tuberculosis Initiatives for the Private Sector (Philippine TIPS), has established a model wherein

school clinics serve as satellite treatment partners of larger clinics in the delivery of the Directly Observed

Treatment, Short Course (DOTS) protocol. This "treatment at the source" allows school-based patients to

get their free government-supplied TB medicines from the clinic each day. It also cancels out the difficulty

in accessing medicines through the old model where the patient has to go to the larger clinic outside his/her

school to get treatment. The model also enables the clinic to monitor the treatment progress of the student

and assumes more responsibility over their health. This experience illustrates how social justice in health

could be achieved from means other than fund generation. The harnessing of existing health service provid­

ers in urban communities through standardized models of treatment delivery increases the probability of

treatment success, not only for TB but for other conditions as well.

P4-66 (C) Voices for Vulnerable Populations: Communalities Across CBPR Using Qualitative Methods

Martha Ann Carey, Aja Lesh, Jo-Ellen Asbury, and Mickey Smith

Introduction: Providing an opportunity to include, in all stages of health studies, the perspectives and

experiences of vulnerable and marginalized populations is increasingly being recognized as a necessary com­

ponent in uncovering new solutions to issues in health care. Qualitative methods, especially focus groups,

have been used to understand the perspectives and needs of community members and clinical staff in the

development of program theory, process evaluation and refinement of interventions, and for understanding

and interpreting results. However, little guidance is available for the optimal use of such information.

Methods: This presentation will draw on diverse experiences with children and their families in an

asthma program in California, a preschool Latino population in southern California, a small city after­

school prevention program for children in Ohio, HIV/AIDS military personnel across all branches of the

service in the United States, and methadone clinic clients in the South Bronx in New York City. Focus

groups were used to elicit information from community members who would not usually have input into

problem definitions and solutions. Using a fairly common approach, thematic analysis as adapted from

grounded theory, was used to identify concerns in each study. Next we looked across these studies, in a

meta-synthesis approach, to examine communalities in what was learned and in how information was

used in program development and refinement.

Results: While the purposes and populations were diverse, and the type of concerns and the report­

ing of results varied, the conceptual framework that guided the planning and implementation of each

study was similar, which led to a similar data analysis approach. We will briefly present the results of

each study, and in more depth we will describe the communalities and how they were generated.

Conclusions: While some useful guidance for planning future studies of community based research

was gained by looking across these diverse studies, it would be useful to pursue a broader examination of

the range of populations and purposes to more fully develop guidance.

HEALTH STATUS OF DISADVANTAGED POPULATIONS

PS-01 (A) Measuring Specific Features of Neighborhood Environments

Ana Diez Roux and Mahasin Mujahid

Background: The majority of studies examining the relationship between residential environments

and cardiovascular disease have used census derived measures of neighborhood SES. There is a need to

identify specific features of neighborhoods relevant to cardiovascular disease risk. We aim to 1) develop

POSTER SESSIONS

'ghbo h d les that represent features of the neighborhood important for CVD risk, 2) to assess the ne1 r oo sea . . be ighbo h od SES psychometric properties of such scales, and 3) to test for assoc1ahons tween ne r o and

our newly developed neighborhood scales. .

Methods· Data on neighborhood conditions were collected from a telephone survey of S,988 feSI·

dents in Balth:.ore, MD; Forsyth County, NC; and New York, NY. A sample of 120 of the i.ni~~l l'elpon­

dents was re-interviewed 2-3 weeks after the initial interview t~ measure the tes~-~etest rebab1~1ty of ~e

neighborhood scales. Information was collected across seven ~e1ghborho~ cond1~ons (aesth~~ ~uah~,

walking environment, availability of healthy foods, safety, violence, social cohesion, and acnvmes with

neighbors). Neighborhoods were defined as census tracts or homogen~us census tra~ clusters. ~sycho­

metric properties.of the neighborhood scales were accessed by ca~cu~~.ng Chronba~h s alpha~ (mtemal

consistency) and intraclass correlation coefficients (test-r~test reliabilmes) .. Pear~n s .corre~anons were

calculated to test for associations between indicators of neighborhood SES (tncludmg d1mens1ons of race/

ethnic composition, family structure, housing, area crowding, residential stability, education, employ-

ment, occupation, and income/wealth) and our seven neighborhood scales. .

Raulta: Chronbach's alphas ranged from .73 (walking environment) to .83 (Violence). Intraclass

correlations ranged from .60 (waling environment) to .88 (safety) and wer~ high~~~ .7~ for ~urout

of the seven neighborhood dimensions. Our neighborhood scales (excluding aChv1hes with neighbors)

were consistently correlated with commonly used census derived indicators of neighborhood SES.

Conclusion: The results suggest that neighborhood attributes can be reliably measured. Further

development of such scales will improve our understanding of neighborhood conditions and their impor­

tance to health.

P5-02 (A) Associations of Maternal Depressive Symptoms with Offspring Substance Use &om

Childhood to Young Adulthood in a National U.S. Sample

Jen Jen Chang

lntrodfldion: Prior studies indicate higher risk of substance use in children of depressed mothers, but

no prior studies have followed up the offspring from childhood into adulthood to obtain more precise esti­

mates of risk. This study aimed to examine the association between early exposure to maternal depl'elsive

symptoms (MDS) and offspring substance use across time in childhood, adolescence, and young adulthood.

Methods: Data were obtained from the National Longitudinal Survey of Youth. The study sample

includes 4,898 mother-child/young adult dyads interviewed biennially between 1992 and 2002 with chil­

dren aged 4 to 16 years old at baseline. Data were gathered using a computer-assisted personal interview

method. MDS were measured in 1992 using the Center for Epidemiologic Studies Depression Scale. Off­

spring substance use was assessed biennially between 1994 and 2002. Logistic and passion regression

models with Generalized Estimation Equation approach was used for parameter estimates to account for

possible correlations among repeated measures in a longitudinal study.

Rnlllta: Most mothers in the study sample were Whites (42%), urban residents (79%), had a mean

age of 31 years with at least a high school degree (82%). The mean child age at baseline was 9 years old.

Offspring cigarette and alcohol use increased monotonically across childhood, adolescence, and young

adulthood. Differential risk of substance use by gender was observed. Early exposure to MDS was asso­

ciated with increased risk of cigarette (adjusted odds ratio (aOR) = 1.52, 95% confidence interval (0):

1.12, 2.08) and marijuana use (aOR = 1.46, 95% CI: 1.02, 2.08), but not with alcohol use across child­

hood, adolescence, and young adulthood, controlling for a child's characteristics, socioeconomic statuS,

~ligiosity, maternal drug use, and father's involvement. Among the covariates, higher levels of father's

mvolvement (cigarette: aOR =0.84, 95% CI: 0.75, 0.93; marijuana: aOR =0.82, 95% CI: 0.72, 0.93),

older maternal age at child birth (aOR =0.94, 95% CI: 0.90, 0.98; marijuana: aOR =0.94, 95% Cl:

0.90, 1.0), and urban residency (cigarette: aOR = 1.34, 95% CI: 1.04, 1.73; marijuana: aOR =2.10,

95% Cl: 1.48, 2.96) were significant predictors of offspring cigarette and marijuana use over rime.

Condluion: Results from this study confirm previous suggestions that maternal depressive symp­

toms are associated with adverse child development. Findings from the present study on early life experi­

e~ce have the potential to inform valuable prevention programs for problem substance use before

disturbances become severe and therefore, typically, much more difficult to ameliorate effectively.

P5~3 (A) A Sc.le to Evaluate the Urban Neighborhood and Social Physic:al Environment

Danielle Ompad, Sandro Galea, Linda Weiss, and David Vlahov

. The ~ACT (~r-City Men~ Health Study Predicting filV/AIDS, Club and Other Drug Transi-

b~) Study 15 a multi-level study aimed at determining the association between features of the urban

enYJrOnment mental health, drug use, and risky sexual behaviors. The study is randomly sampling

FOSTER SESSIONS v99

neighborhood residents and assessing the relations between characteristics of 36 ethnographically

defined urban neighborhoods and the health outcomes of interest. A limitation of existing systematic

methods for evaluating the physical and social environments of urban neighborhoods is that they are

expensive and time-consuming, therefore limiting the number of times such assessments can be con­

ducted. This is particularly problematic for multi-year studies, where neighborhoods may change as a

result of seasonality, gentrification, municipal projects, immigration and the like. Therefore, we devel­

oped a simpler neighborhood assessment scale that systematically assessed the physical and social envi­

ronment of urban neighborhoods. The IMPACT neighborhood evaluation scale was developed based on

existing and validated instruments, including the New York City Housing and Vacancy Survey which is

performed by the U.S. Census Bureau, and the NYC Mayor's Office of Operations Scorecard Cleanliness

Program, and modified through pilot testing and cognitive testing with neighborhood residents. Aspects

of the physical environment assessed in the scale included physical decay, vacancy and construction,

municipal investment and green space. Aspects of the social environment measured include social disor­

der, social trust, affluence and formal and informal street economy. The scale assesses features of the

neighborhood environment that are determined by personal (e.g., presence of dog feces), community

(e.g., presence of a community garden), and municipal (e.g., street cleanliness) factors. The scale is

administered systematically block-by-block in a neighborhood. Trained research staff start at the north­

east corner of an intersection and walk around the blocks in a clockwise direction. Staff complete the

scale for each street of the block, only evaluating the right side of the street. Thus for each block, three or

more assessments are completed. We are in the process of assessing psychometric properties of the

instrument, including inter-rater reliability and internal consistency, and determining the minimum num­

ber of blocks or street segments that need to be assessed in order to provide an accurate estimate of the

neighborhood environment. These data will be presented at the conference.

PS-04 (A) Processes of Initiation into Injection Drug Use

Nooshin Khobzi, Walter Cavalieri, Robert Bright, and Peggy Millson

Obj«tive: To describe and analyze the perceptions of longterm injection drug users (IDUs) about

their initiation into injecting. Method: One hundred and twenty open-ended qualitative interviews were conducted with IDUs in

Toronto. Purposive sampling was used to seek out an ethnoculturally diverse sample of IDUs of both

genders and from all areas of the city, through recruitment from harm reduction services and from refer­

ral by other study participants. Interviews asked about drug use history including first use and first

injecting, as well as questions about health issues, service utilization and needs. Thematic analysis was

used to examine initiation of drug use and of injection. Results: Two conditions appeared necessary for initiation of injection. One was a developed con­

ception of drugs and their (desirable) effects, as suggested by the work of Becker for marijuana. Thus vir­

tually all panicipants had used drugs by other routes prior to injecting, and had developed expectations

about effects they considered pleasureable or beneficial. The second condition was a group and social

context in which such use arose. No participants perceived their initiation to injecting as involving peer

pressure. Rather they suggested that they sought out peers with a similar social situation and interest in

using drugs. Observing injection by others often served as a means to initiate injection. Injection served

symbolic purposes for some participants, enhancing their status in their group and marking a transition

to a different social world. Concl111ion: Better understanding of social and contextual factors motivating drug users who ini­

tiate injection can assist in prevention efforts.

PS-OS (A) Relationship of RBC Folate Level, Serum Vitamin B 12 Level and BMD in the Elderly Population

Senait T eklehaimanot and Kalpana Ganesan

Introduction: Vitamin B12 & folate are important to DNA synthesis and may affect bone forma­

tion. Some studies have shown linear relationship between vitamin Bl2 level & bone mineral density

(BMD) -likely secondary to its effect on serum homocysteine levels. Vitamin 812 has been linked to

osteoblastic activity in clinical studies and cell cultures. Low serum folate tevel has also shown to have

similar effects on BMD. Both vitamin B12 and folate have been reported to decrease with age. We under­

took this study to examine the relationship between serum vitamin Bl2, serum folate levels & BMD in

the elderly population. Objective: To determine effects of Vitamin 812, folate on BMD.

Methods: The NHANES II database was analyzed. Study involved all male & female 65 years

and older- non institutionalized population. There were 5123 respondents to whom we studied their

v100 POSTER SESSIONS

demographics, lifestyle variables, history of osteoporosis, and family history of ~teoporosis, HRT trea~-& f · The pri'mary outcome variable used was BMD and the prunary Independent Van-

ment use o statms. . . bl Se V'tami·n B12 & serum folate ST AT A version 8.0 was used to analyze data taking mto

a es were rum 1 · . . . h d · nd wei'ght of the data Both univarite and multivariate analysis was used to analyu

account t e es1gn a · the data.

Results: All patients 65 & older were studied from ~~ES database. A.!11ong the 51.23 respon-

dents 66.5% were non-Hispanic white, 18.2% were non-H1spamc black & 15.3 Yo ":er~ Mexican Arner­. Of total number of respondents 46.7% were male & 51.7% were female. Ma1onty of populanon icans. . . h I h d (6201 ) & . . had good insurance coverage (98%). Majority of them perceived their eat :s goo. 10 ma!onty of them had higher educational level (57%-highschool or higher).About 20.2 Yo adffiltted to have history

of alcohol & another 12.4% had history of smoking. Only 3.2% people were on HRT & 3.1 % were receiving steroid. Majority of them (81.2) did not have history of osteoporosis. 13.6% have difficulty in

ambulating. Only 8.8% had family history of osteoporosis. BMD measurements as me~sured by dual x­

ray absorptiometry (DEXA) were used for the analysis. BMD results were compare~ w1~ RBC folate & serum vitamin B12 levels. No statistical significance found between BMD & serum v1taffiln B12 level but

high levels of folate level is associated with normal BMD in bivariate and multivariate analysis. Conclusion: In the studied elderly population, there was no relationship between BMD and vitamin

B12; but there was a significant association between folate levels & BMD.

PS-06 (A) How do Youth in Urban Communities of Beirut Self Identify Maya El Shareef and Rima Afifi Soweid

Introduction: Adolescence is a critical period for identity formation. Western studies have investi­gated the relationship of identity to adolescent well-being. Special emphasis has been placed on the influ­

ence of ethnic identity on health, especially among forced migrants in different foreign countries. Methodology: This study asses by the means of an open ended question identity categorization

among youth in three economically disadvantaged urban communities in Beirut, the capital of Lebanon.

These three communities have different histories of displacement and different socio-demographic make­

up. However, they share a history of displacement due to war. Results and Conclusion: The results indicated that nationality was the major category of identifica­

tion in all three communities followed by origin and religion. However, the percentages that self-identify by particular identity categories were significantly different among youth in the three communities, per­haps reflecting different context in which they have grown up.

PS-07 (A) The Effect of Socioeconomic Status on Patient Knowledge of Warfarin Therapy After Mechanical Heart Valve Replacement Amanda Hu, Chi-Ming Chow, Diem Dao, Lee Errett, and Mary Keith

Introduction: Patients with mechanical heart valves must follow lifelong warfarin therapy. War· farin, however, is a difficult drug to take because it has a narrow therapeutic window with potential seri· ous side effects. Successful anticoagulation therapy is dependent upon the patient's knowledge of this

drug; however, little is known regarding the determinants of such knowledge. The purpose of this study

was to determine the influence of socioeconomic status on patients' knowledge of warfarin therapy.

Methods: A telephone survey was conducted among 100 patients 3 to 6 months following mechan· ical heart valve replacement. A previously validated 20-item questionnaire was used to measure the patient's knowledge of warfarin, its side effects, and vitamin K food sources. Demographic information, socioeconomic status data, and medical education information were also collected.

Results: Sixty-one percent of participants had scores indicative of insufficient knowledge of warfarin therapy (score :s; 80%). Age was negatively related to warfarin knowledge scores (r= 0.27,

P = 0.007). In univariate analysis, patients with family incomes greater than $25,000, who had

greater. than a grade 8 education and who were employed or self employed had significantly higher warfarm knowledge scores (p= 0.007, p= 0.002 and p= 0.001 respectively). Gender, ethnicity, and

warfar~n therapy prior to surgery were not related to warfarin knowledge scores. Furthermore, none of t~e. m-hospital tea~hing practices significantly influenced warfarin knowledge scores. However,

panic1~ants who _rece1v~d post discharge co~unity counseling had significantly higher knowledge

scores tn comp~r1son with those who did not (p= 0.001 ). Multivariate regression analysis revealed that und~r~tandmg the ~oncept of 1?ternational Normalized Ratio (INR), knowing the acronym, age

and receiving ~ommum1!' counseling after discharge were the strongest predictors of warfarin kn~wledge. S~1oeconom1c status was not an important predictor of knowledge scores on the multi­vanate analysis.

POSTER SESSIONS v101

~The majority of patients at our institution have insufficient knowledge of warfarin ther­

apy.Post-discharge counseling, not socioeconomic status, was found to be an important predictor of warfarin

knowledge. Since improved knowledge has been associated with improved compliance and control, our find­

ings support the need to develop a comprehensive post-discharge education program or, at least, to ensure

that patients have access to a community counselor to compliment the in-hospital educatiop program.

PS-08 (A) Profiling Children with Prenatal Cocaine Exposure: A Pilot Study

Brenda Stade, Tony Barozzino, Lorna Bartholomew, and Michael Sgro

lntTotl#ction: Due to the paucity of prospective studies conducted and the inconsistency of results,

the effects of prenatal cocaine exposure on functional abilities during childhood remain unclear. Unlike

the diagnosis of Fetal Alcohol Spectrum Disorder, a presentation of prenatal cocaine exposure and devel­

opmental and cognitive disabilities does not meet the criteria for specialized services. Implications for

public policy and services are substantial.

Objective: To describe the characteristics of children exposed to cocaine during gestation who

present to an inner city specialty clinic.

Mnbods: Prospective cohort research design. Sample and Setting: Children ages 5 to 15 years old,

referred to an inner city Prenatal Substance Exposure Clinic since November, 2003. Data Collection:

Data on consecutive children seen in the clinic were collected over an 18 month period. Instrument: A

thirteen (13) page intake and diagnostic form, and a detailed physical examination were used to collect

data on prenatal substance history, school history, behavioral problems, neuro-psychological profile,

growth and physical health of each of the participants. Data Analysis: Content analysis of the data

obtained was conducted. Results: Twenty children aged 6 to 14 years (mean= 9.8 years) participated in the study. All partic­

ipants had a significant history of cocaine exposure and none had maternal history or laboratory (urine,

meconium or hair) exposure to alcohol or other substances. None met the criteria of Fetal Alcohol Spec­

trum Disorder. All were greater than the tenth percentile on height, weight, and head circumference, and

were physically healthy. Twelve of the children had IQs at the 19th percentile or less. For all of the chil­

dren, keeping up with age appropriate peers was an ongoing challenge because of problems in attention,

motivation, motor control, sensory integration and expressive language. Seventy-four percent of partici­

pants had significant behavioral and/or psychological problems including aggressiveness, hyperactivity,

lying, poor peer relationships, extreme anxiety, phobias, and poor self-esteem.

Conclusion: Pilot study results demonstrated that children prenatally exposed to cocaine have sig­

nificant learning, behavioural, and social problems. Further research focusing on the characteristics of

children prenatally exposed to cocaine has the potential for changing policy and improving services for

this population.

PS-09 (A) Release from Jail: Moment of Crisis or Window of Opportunity for Female Detainees in

Baltimore City? Rachel McLean, Jacqueline Robarge, and Susan Sherman

Background: Despite documentation of incarcerated women's heightened HIV risk and prevalence,

few such studies have focused on women in jail settings. We examined health and social conditions fac­

ing female detainees at the Baltimore City Detention Center.

Methods: Trained interviewers conducted anonymous quantitative surveys with a random sample

(n= 148) of female detainees upon providing informed consent. The survey focused on: sociodemo­

graphic background; health status; housing and neighborhood stability and social resource availability

upon release. Results: Participants were 70% African-American, 16% White, 9% Mixed Race and 5% Native

American. Participants' median age was 37, the reported median income was <S2,000 year, and 53%

reported receiving a high school diploma or equivalent. Women reported a number of health conditions

rypical of underserved populations, including asthma (42%), sexually transmitted infections (39%), high

blood pressure (19%), HCV (14%), diabetes (5%) and HIV (4%). Nearly half (46%) did not anticipate

having a place to stay for at least 30 days upon release. Factors significantly associated housing stability

upon release were: high Family Support Score (Adjusted Odds Ratio [AOR) 6.15; 95% Confidence Inter­

val (95% Cl) 1.76, 21.61), high Neighborhood Stability Score (AOR 4.41; 95% Cl 1.25, 15.52), want­

ing a commercial sex worker (CSW) support group (AOR 0.25; 95% Cl 0.10, 0.62); and identifying as

bisexual (AOR 0.24; 95% Cl 0.07, 0.75). Women desired employment (95%), housing (84%), educa­

tion (77%), drug treattnent (74%), help with custody of children (31 %), childcare (28%), and domestic

violence suppon (20%) services.

v102

Conclusions: Female detainees represent one of urban centers' most marginalized PCJPWatioos.

Short periods of detention represent a unique opportunity for _interven?~ns bri~ CO~s and

public health institutions. Service providers should collaborate ~1th local ~ails to .P~de a con1111uwnof

care for female detainees upon release that includes transportation, housing, residential drug treallllCnt,

employment, education, family reunification, childcare and domestic viol~nce su~rt. ~pecial attenlion

is warranted to lesbian and bisexual women and CSWs, who may be especially margmalized &om family

and service-based support networks.

PS-10 (A) Health Care and Ethnic Minority Immigrants: A Canada- United States ComparatinAnalysis

Daniyal Zuberi

Introduction: "Health Care and Ethnic Minority Immigrants" examines how health care policy dil·

ferences between Canada and the United States impact the health-related hardships, access and use of

preventative care, and health outcomes of urban ethnic minority immigrants in both countries.

Methods: The findings of this paper build on the results of my qualitative comparative study of

hotel workers in Vancouver, BC and Seattle, WA that revealed greater health related hardships for

similarly matched employees in Seattle compared to Vancouver. In this paper, I examine the generaliz­

ability of these findings at the cross-national level for similar ethnic minority immigrant groups. I com­

pare the impact of health care policy differences on specific groups that have emigrated to cities in

both Canada and the United States. These include immigrants from China, Viemam, Philippines, West

Indies, Africa, Sri Lanka, Pakistan, and Latin America. Comparative statistical analysis - utilizing rel·

evant data from Statistics Canada and the U.S. Census - reveal the extent to which health policy differ·

ences help explain how current health policy in the United States disadvantages urban ethnic minority

immigrants. Results: Many ethnic minority immigrants are a part of the working poor, a group which dispro­

portionately lacks health insurance coverage in the United States. Their position in the labour market

makes them most vulnerable to exclusion from health care services. The data reveals how current U.S.

health policy creates barriers for recently arrived ethnic minority immigrants to access health insurance

and care. It remains difficult to ascribe health outcome differences directly to policy differences because

of the challenge in disentangling the complex interacting interventing variables, including income ine­

quality, that determine health outcomes. Yer suggestive evidence suggests that health policy in the United

States is harming the health of urban ethnic minority immigrants.

Conclusion: The current health policy regime in the United States harms the health access, care, and

outcomes of urban ethnic minority immigrants. Comparing the fortunes of similar immigrants in Cana·

dian and U.S. cities reveals these patterns of disadvantage and some of their consequences. These barriers

are an understudied factor in the sociological literature on "segmented assimilation" and social exclu·

sion. The paper ends with policy recommendations to improve access to health care among ethnic minor·

ity immigrants in both countries, with the goal of reducing health related hardships, and improving

health outcomes.

PS-11 (A) Racial/Ethnic Disparities in Trends of Cardiovascular Disease Risk Factors According to Body

Mass Index

Deyu Pan, Richard Baker, and Keith Norris

Badtgrou~ Over the past 3 decades, there has been dramatic increase in prevalence of obesity in

the US population. However, the relationship between obesity and the prevalence of cardiovascular dis·

ease (CV~) risk factors in different race/ethnic groups over time is not well known.

. Ik~rgn: _We use 2 cross-sectional, nationally representative surveys: National Health and Nutri·

t10nal Examination Survey (NHANES III 1988-1994) (n= 14 029) and NHANES 1999-2002

(n= 8,591), including white, black, and Hispa~ic races who were no~preg~ant, aged 20 to 74 years.

Res11lt1: The preval~nce of high cholesterol level (~ 240 mg/dL), untreated high blood pressure

(2: l40/90 mm Hg) an~ diabetes were calculated according to BMI group (lean, <25; overweight, 25-29;

and obese, 2: 30) for different race/ethnicity groups. Over the approximately 10 years period (from 1988-

l ~94 ~o 1999-2002), reducrion in 3 CVD risk factors in non-Hispanic white has been observed. For

mmonty race/~hnicity groups, black and Hispanic, there had been increases in prevalence in high blood

fapressure and diabetes. The lean group experienced larger increase in prevalence of those CVD risk

ctors.

. fo~~ The prevalence in CVD risk factors over time had reduced in most of the BMI ca1ego­

~es r t e w ~~e population. However, for black and Hispanic, prevalence of 2 of 3 CVD risk factors

ave generaUy uncreased, especially in overweight and obese groups.

POSTER SESSIONS v103

Table Trends m CVD risk factors according to BMI group

Risk factors by White Black Hispanic

BMlgroup NHANES NHANES NHANES NHANES NH ANES NHANES

m CWTent m current m current

High cholest.erol level (?:240 mg/dL) <25 12.29 12.79 10.16 8.96 9.77 10.48

25-29.9 24.72 20.15 18.07 14.49 15.31 16.08

>30 25.76 21.16 20.30 16.56 19.78 15.85

HBP (?:140/90 mm Hg) <25 7.99 11.59 13.92 18.87 5.51 7.47

25-29.9 15.91 18.27 21.30 25.21 12.30 15.45

?:30 28.00 24.74 28.15 31.30 18.86 20.51

Diabetes <25 1.91 2.02 2.95 4.71 2.95 5.01

25-29.9 4.84 3.83 7.89 8.63 6.65 6.91

;::30 10.20 10.49 11.23 14.25 11.17 10.62

PS-12 (C) Toronto Community Health Profiles: A Strategy for Reducing Health Inequalities

Dianne Patychuk, Maria Creatore, Rick Glazier, Peter Gozdyra, Sarah Flicker, and Catalina Yokingco

Introduction: In the spring of 2005, the Toronto Community Health Profiles Partnership launched

a website (www.TorontoHealthProfiles.ca) to facilitate access to information for health planning and

advocacy to reduce health inequalities. The goals of the partnership are: to build community capacity to

use health information; to build deeper understanding of Toronto neighbourhoods in order to appreciate

the health needs of communities; to foster academic-hospital-community collaborations to improve pop­

ulation health; and to demonstrate health inequities in order to address them. (Partners: Centre for

Research on Inner City Health, St Michael's Hospital, former Toronto District Health Council, Toronto

Public Health, SETO, Wellesley Central Health Corporation).

Methods: Strategies identified to achieve these goals include: developing meaningful neighbourhood

and district boundaries for comparing health information, providing free access to neighbourhood health

profiles (including relevant data at the smallest level for which valid rates could be calculated); mapping

relationships of inequality at a variety of nested levels; providing a range of formats (maps, tables) to

meet the needs of users; providing technical support; seeking user input to advance and improve the site;

and conducting workshops to foster access and use of data for decision-making, advocacy and collabora­

tion. An evaluation strategy is being developed to assess the efforts and impact of these strategies. A pre­

liminary assessment of the results of the first six months of activity will be completed in October 2005.

Results: Significant differences in health are shown at all the geographic levels indicating success in

developing the boundaries. Results tabulated for the first six months use of the site include: site visits;

media use; reference/acknowledgement of the site in other documents; number of contacts through pre­

sentations and workshops; feedback from users identifying strengths and limitations; and, response from

health decision makers. Members of the partnership are identifying additional tools and services to fur­

ther support actions that reduce health inequalities. The assessment will be used to develop more specific

goals, targets and monitoring mechanisms.

Conclusions: Our experience with paper-based health profiles indicates that they have been used

extensively for program planning and advocacy. The greater availability of information in a publicly­

available web-based format is expected to translate into even greater usefulness and wider application.

The web site has had considerable usage to date, extensive media coverage. Site users and workshop par­

ticipants have provided positive feedback and suggestions for next steps. The six month review will be

available in October 2005.

PS-13 (C) Stigma and Discrimination of People Living with HIV I AIDS in Delhi, India

Sameena Azhar

In India, more than 4 and a half people are HIV-positive and half a million have AIDS. India currently

has the largest number of positive people in the world, oumumbering South Africa and accounting for nearly

one tenth of the global HIV/AIDS prevalence. The World Bank predicts that by 2015, there will be 35 mil­

lion HIV/AIDS cases in India. The central challenge facing HIV prevention efforts in South Asia today is

learning how to respond to the societal determinants of vulnerability to HIV. HIV/AIDS is an issue largely

engulfed by social stigma. Stigma and discrimination are often considered the foremost barriers to effective

POSTER SESS10Ns v104

prevention and care initiatives. Stigma can make a person afraid of disclosing their status~ ~yone else, and may make them feel depressed or alone. Stigma can .also le~d to poor adherence to medicanon, ~ likeli­hood to access health and social services, and less desire to hve. HIV+ men and women may beafraidtotd! their co-workers that they have HIV for fear of their reactions or for fear of losing their jobs. In a study 1 conducted of people living with HIV/AIDS in Delhi, India ov~r. 2003-~, many respo~ts shared their experiences of discrimination in their families, in their communmes, an~ m health ~e settmgs. These find­ings will be shared in the workshop, and will be compa~ed to m~ ex~nences workmg as an ~ co~l~ at the Center for AIDS Prevention Studies in San Francisco, Cahforma and Congreso de Lannos Unidos m Philadelphia, Pennsylvania. The workshop will include an overview of HIV/AIDS in urban contexts in tht United States (Los Angeles, San Francisco, New York, Philadelphia) and South Asia (Delhi, Hyderabad, Chennai). Differences in methods for outreach, prevention and treatment efforts between devdoped world and developing world contexts will be discussed. A large portion of the workshop will be centered on discus­sion. Participants will engage in an exercise to categorize their ideas of stigma. The workshop will also include a powerpoint presentation on the quantitative data gathered from the survey.

PS-14 (C) Evaluation of a Harm-Reduction Program for Street-Youth with/at Risk for Contracting Hepatitis C: Results from a Two-Year Study Alan Simpson

The number of homeless and runaway youth is increasing in Toronto, which is currently home to 3 out of 4 youth in the GT A who live alone, and it is the preferred locale for the street-involved and home­less youth. The city's youth population is expected to grow by nearly 20% by 2011, the school dropout rate is rising, and there are is a paucity of empirical data on what works with these at-risk youth. Over a two-year period, (2002-2004), YOUTHLINK-Inner City, conducted an evaluation of the impact of a harm reduction program aimed at reducing street youth's risk of contracting/infecting others with the HEP C virus, which has both short-term and long-term deleterious effects. Demographic data from 102 street-youth, along with resources/services used, employment methods, type and frequency of drug use, health status, police contacts, and their views of program impact were analyzed using a standardized sur· vey. Additionally, focus groups with youth, agency staff and community key informants were conducted, as well as in-depth interviews with three youth, over a sixth-month period. This paper details study results, which both inform both practice and future study about what works, why it works, and how best to work with these vulnerable youth.

PS-15 (C) The Characteristics of Contamination in Mining Area in Nandan Guangxi and its Effect on Sustainable Economy Development Xiying Zhang and Xixian Zhou

. The charact~ristics of contamination in the mining area in Nandan, Guangxi Providence, was deter­mined by analysis and characterization of mining wasteland and crop wasteland samples. The results sho~ed .that the wasteland in this area was contaminated by As Cd Zn Pb Cu simultaneously. The con­ta~matton of As ~d was quit significant. The contamination problems and environmental issues in this region are very. serious. The awareness on environmental and health issues was investigated by spot sur­vey and analysis. Overall awareness among the residents in the region is very poor. The Measures must be taken to assu~e t~e .sustainable economy development by local and central gorvernments. Keywords Nandan Guangx1; mmmg area; environmental awareness.

PS-16 (C) Health Pro~lc of the Street Children of Chandigarh, India Shyam Lamsal, Indari1t Walia, Rajesh Kumar, and Baljit Kaur

l~~uction.: The health condition of street children in India is generally poor4. Many suffer from ~romc ts:eascs hke tuberculosis, leprosy, typhoid, malaria, jaundice and liver and kidney disorders.

cnerea disease is rampant among older children (14yrs+). Scabies gangrene br~ken limbs and epilepsy arc common. HIV & AIDS ·d 1 ' · ' - k and h . cases are now w1 e Y seen. Most street children are exposed to dtrt, smo e

0;..:=•.ronme~t~I hazards. ~ey are constantly exposed to intense sun, rain and cold.4 . • Dcscnpnvc c:oss-secno~al study with convenient sample technique.

. 8-k~· More than 50 Yo street children were thin, had dirty hair and dandruff dry lips dirty nails, vanous s m problems, d"d ' k th · · · · ' ' u d . 1 n t now etr unmuruzanon status and had history of severe pain. More than .,.,.r were anaem c h d · · · f · d . 1 1 •.a parasmc m estanon, had history of injury in the past had BMI less than normal, an were mvo vcd m one or the other s b b Abo ' d bl __ .... "th u stance a use. ut ~rd had history of hospitalization an ~mg wt stool sputum urine r · M h · ·gh • • o vonutus. ore t an 10 children had health problems of ht

POSTER SESSIONS v105

concern like, epileptic fits, vision problems, earache, cough of more than 3 weeks and urinary problems.

Ninety-five subjects did not take bath regularly and 42 were exposed to sex.

Conclusion: The health problems identified are only of a particular point of time and it may be dif­

ficult to interpret the depth of "iceberg" of the street children's world also draw the health-illness contin­

uum. Periodic interaction and follow-up is very difficult as they generally disappear from the research

setting due to their frequent mobility for survival measures. As per the prediction of the iceberg theory,

only some problems may have been identified, larger problems in respect to their health may not have

been identified. In spite of various limitations, this attempt had proven that, it is possible to enter the

street children world, explore the iceberg of illnesses, and establish data of health-illness continuum

through an effective nursing agency. It is recommended to deworm these children, provide nutritional

education, establish "condom corners" and "street children help line" in the city and urban slum areas

and undertake action research on their health.

PS-17 (C) Nutritional Status of Socioeconomically Disadvantaged Urban Child in Bangladesh:

An Anthropometrical, Haematological and Biochemical Study

Zahirul Hoque and Tarek Hussain

Malnutrition is a serious problem in developing countries like Bangladesh. Malnutrition causes a

great deal of child suffering. Malnutrition is one of the major causes of morbidity and mortality among the

child. The aim of present study was to investigate the nutritional status and its relation to socioeconomic

conditions of urban disadvantaged child of under five years age. Nutritional status was determined by

anthropoemetric measurement(Height, Weight, Mid-arm circumference etc.). Determination of total pro­

tein and serum albumin were done for biochemical examination. Haematological examination was done by

blood haemoglobin profile estimation by cynmethhaemoglobin method and determination of haematocrit

value or packed cell volume (PCV). Stool examination for ova of Hook Worm, round worm, trichuris spe­

cies and other species were also done. Relevant information on socioeconomic characteristics was recorded

by interviewing the house hold head using pretested questionnaire. our study demonstrated that nutritional

status of the children are positively correlated with family income, parents level of formal education and

negatively related to the family size. The effect of family income on the nutritional status, haematological

and biochemical indices of urban disadvantaged child under five will be discussed in detail which will help

us to determine proper way of utilization of health care facilities exists in developing countries.

PS-18 (A) The Impact of Social Support, Depression and AIDS Diagnosis on Health-Related Quality of

Life in Adults with HIV-Infection

Sarah Lyons, Sergio Rueda, and Sean B. Rourke

Introduction: With the increase in morbidity and reduction in mortality and with the introduction

of highly active antiretroviral therapy (HAART), there is increasing focus on the determinants of health­

related quality of life (HRQOL) in HIV-infection. The focus on the present study is to examine the rela­

tionship between social support, depression, and HIV disease severity, and the extent to which these

variables impact on HRQOL in adult men with HIV- infection.

Methods: As part of a larger ongoing natural history study focusing on the neurobehavioural complica­

tions of HIV and AIDS, we administered questionnaires to assess depression (Beck Depression Inventory),

social support, and HRQOL (MOS-HIV) to 366 adult men with HIV-infection. A structured interview was

used to collect health information and data on HIV disease severity. Physical and Mental Health summary

scores (PHS and MHS) were derived through Principal Components Analysis. Participants were grouped

according to level of social support: "well supported" (n= 180), "moderately supported" (n=90), "little or

ineffective support" (n=96). Analysis of variance was conducted to assess the effects of three levels of per­

ceived social support, depression status (present vs absent), and HIV disease severity (AIDS vs non-AIDS) on

mental and physical health dimensions of HRQOL. Potential interaction effects were also evaluated.

Results: Social support was found to have a significant effect on both MHS and PHS. Presence of

depression was found to have a significant effect on MHS but not PHS. HIV disease severity (presence of

AIDS diagnosis) was found to have a significant effect on PHS but not MHS. MANOV A analyses

revealed no significant interactions effects. Conclusions and Implications: Level of social support, presence of depression and HIV disease severity

were shown to have independent effects on HRQOL. Feeling "well supported" appears to have significant

benefits for mental and physical health. Biological indicators of HIV disease appear to have a selective impact

on physical health while presence of depression is related to significant reductions in mental health. The devel­

opment and evaluation of behavioural interventions to improve perceived social support network and depres­

sion will likely result in significant improvements in health outcomes of adults with HIV and AIDS.

v106

PS-19 (A) Spatial Variations in AIDS Outcomes Within a Large Metropolitan Area: Increasing

Disparities in the Post-HAART Era . .

Paul Robinson, Keisha Paxton, Roberto Vargas, and Arleen Le1bow1tz

Introduction: Ongoing medical advances have greatly enhanced the longevity of Penons Living

With AIDS (PLWA). However, for certain subgroups living with HIV/AIDS, including, members of

minority groups, women and the economically underprivileged, AIDS outcomes have not changed so

favorably. One obvious factor to consider when explaining disparities in AIDS outcomes is the environ·

ment within which an individual resides. Few studies of AIDS outcomes have focused on how commu·

nity setting influences the effectiveness of care delivery. The principle research questions were: 1) What is

the relationship between the locations of areas with concentrations of PL WA and the distribution of

both primary and ancillary service providers? 2) How has the widespread availability of HAART (after

1996) impacted AIDS outcomes at the community level? 3) How do AIDS mortality and fatality rates

vary when related community characteristics, such as household income, ethnic mix, and geographic

access to primary and ancillary HIV/AIDS services are considered? We examine this issue across residen­

tial communities in the Los Angeles area.

Methods: Los Angeles County's comprehensive AIDS service providers database (compiled and

maintained by AIDS Project Los Angeles) was geo-referenced and distances between weighted mean pop­

ulation centers and the nearest HIV/AIDS service providers were calculated to provide a measure of

access which was then merged with AIDS diagnosis and mortality data along with relevant socioeco­

nomic and population indicators and for analysis using bivariate and multivariate statistics at the zip

code level. Results: There is a growing disparity in HIV/AIDS outcomes between low-income minority areas

and affluent non-minority areas in the post-HAART era (P = 0.002). Ancillary AIDS services such as case

management and counseling and testing are located near the places where low income HIV/AIDS service

consumers are likely to live (P =.000). In spite of having more access to ancillary services low income

areas continue to be associated with smaller decreases post-HAART AIDS mortality rates (P=0.301).

Conclusions: Given the increasing disparities in AIDS outcomes between lower and upper income

communities in the Post - HAART era, more specific research into the capacities of AIDS services pro­

viders and the efficiency of their interventions is required. Although it is clear that ancillary services are

operating in the areas of greatest need, their effectiveness remains limited. Understanding the reasons for

t~is, be they lack of adequate resources for inner city service providers, failure to reach target popula·

tmns or other causes, requires additional research.

PS-20 (A) Drug Use Among Canadian Street Youth: A Comparison Between Injection Drug Users and

Non-Injection Drug Users

Olayemi Agboola, Maritia Gully, The ESCSY Study Group, and Jennifer Suishansian

Introduction: Many young people are likely to experiment with drugs and for some, drug use may

beco~e a problem over time. For street youth (SY) in particular, experimentation may give way to the

perceived necessity of drug use as a coping mechanism to help deal with life on the street. Injection Drug

Use (IOU) and non-IOU are realities of life on the streets.

. Methods: The Enhanced Surveillance of Canadian Street Youth (ESCSY) is a repeated cross-sec·

ttonal survey that monitors STI prevalence and associated risk behaviours among SY aged 15-24 years.

In 20?3, Y.out~ who were able to speak either French or English and had been absent from their parent's/

c~regivers ~es.1dence for at least three consecutive nights took part in the survey which consisted of inter·

viewer-adm1mstered question~aires. P.arti~i~an~s were recruited from drop in centres in 7 cities across

<?-nada.Y~uth self-report as either using in1ect1on or non-injection drugs. Statistical analyses were car·

r1ed out using SAS version 8.

Rau~ts: 1656 S~ were recruited in 2003. IOU and non-IDU were reported by 22.3% and 73.1% of

SY res~vely. IOU ts more common than non-IDU among 20-24 year olds; 60.4% vs. 37.3%, while

non-IOU is mor~ common than IOU among 15-19 year olds; 62.7% vs. 39.6% (p=<.0001). lnjectiondrug

~sers. are more !1kely to have dropped out of school (80.1 % vs.68.3%, p=<.0001), live on the streetS all

e time (80.1 :<. vs.62.8%, p=<.0001), and left home because of sexual abuse (28.2% vs. 16.2%,

p=<.0001 ). When asked about source of income in the past 3 months injection drug users were less likely

~~rt regu~ work (~ 1.9% vs. 22.6%, p=<.0001) and more likeiy to report selling drugs (39.3% vs.

~ ooOr,-c· d 1 \ste:~ng/robbery/scams (29% vs. 15.4%, p=<.0001), prostitution (12.7% vs. 2.9%,

hav · been .an .. f~Ran mg 143· 1 % vs. 24.1 %, p=<.0001 ). Injection drug users are 3 times more likely to

sex ~R=l.1;1~a~ 3 3 ;/1 ·~2·18~· ~· 1 ?J• to ever trade sex 0R=3.3 (2.49, 4.23] and to ever have obligated

· • · · n Y m1ectton drug users reported ever having hepatitis C infection.

POSTER SESSIONS v107

Coru:l#sions: IDU more than non-IDU is often associated with risk behaviours, such as trading

sex and criminal activity. Harm reduction approaches including early interventions about the dan­

gers of IDU and information about safe drug use need to be available to SY. Multifaceted interven­

tions to address broader determinants of SY engaging in drug use (IDU or non-IDU) are also

needed.

PS-21 (A) Homemaking/Making Home: The Domestic Lives of Women Living in Poverty and Using

lllicit Drugs Emma Haydon

The 'home' is a contested site for many women living in urban areas. Women living in poverty and

using illicit drugs are largely excluded from participation in dominant 'home-base' gender roles of wife

and mother because of economic disadvantage. They thus 'make home' in ways that are specific to their

everyday experiences. While research has established links between housing, health and drug use, this lit­

erature does not tend to consider the meanings that home may have within the lives of women who lack

access to adequate tenured living spaces. This presentation reports the findings of my Master's thesis

work. Using grounded theory methodology within a poststructuralist feminist conceptual framework, I

conducted in-depth, open-ended interviews with 11 women living in the Toronto area. The women were

recruited from within the community through posters at different social service agencies (e.g., drop-in

centres, community health centres). They were asked to describe their housing experiences and what

home meant to them over the course of their lives. Through the data analysis process, a substantive the­

ory of 'making home' for women living in poverty and using illicit drugs emerged. The central concept of

making home is a continual process of learning about and interacting with the environment. The process

of making home entails different subprocesses: finding home (knowing what is available and accessible,

and accessing home), adaptation, and leaving home. The different meanings of home that women devel­

oped from their experiences and knowledge emerged as critical components for the process of making

home. The women I interviewed were very mobile and experienced constant change with regards to

home. Home was not considered only in relation to physical living space. Home could be made within a

relationship or with regards to a possession. While dominant meanings of home relation to tenured liv­

ing spaces are generally positive, my research indicated that home could also be a negative context. The

presentation will describe my research process and findings as well as the theoretical and policy implica­

tions of my results.

PS-22 (A) Social Citizenship and Health Inequality: Sex-Industry Workers in Victoria, BC and

Sacramento, California Rachel Phillips, Helga Hallgrimsdottir, Cecilia Benoit, Mikael Jansson, and William McCarthy

In the western democracies, social citizenship bundles the right to social provision (defined as a

share of the social good, not necessarily proportionate to the market value of a citizen's contribution)

with participation in the paid labour force. For this reason, social citizenship rights, which usually

involve some kind of redistributive measures, are a key mechanism by which states ensure economic

equality, or at least, economic equality of opportunity, but are also a mechanism of social exclusion.

Social rights are inscribed around a single kind of relationship, that which exists between a male family

breadwinner and the paid labor market; those who make economic contributions that fall outside this

relationship -such as unpaid care-work, or, work that occurs in shadow or underground economies -

are to a greater or lesser degree barred from accessing citizen-based social provisions. Furthermore,

social provision that occurs outside of the breadwinner/market-economy dyad is very often means­

tested and is accompanied by regulatory state apparatuses (this includes a range of social services, from

welfare payments, to child-care subsidies, to disability pensions). Social citizenship is thus stratified; the

legal relationship that is at the heart of social citizenship acts as a form of social closure against claims

for a share of the social good made by those who are 'lesser' citizens than others. Of particular interest

in this paper is how citizenship inequalities translate into inequalities in the social provisions that

emerge from economic participation: the right to safety on the job, protection from employer harass­

ment, protection from the vagaries of the market as well the right to adequate, comprehensive, and

appropriate health services. Drawing on mixed methods, longitudinal data from adult sex workers

(n= 170) located in two research sites with different social welfare regimes - one in Canada and one in

the U.S. - we examine the consequences of working in a "shadow" or "underground" economy on var­

ious facets of health and access to health services, taking into consideration the mediating role that citi­

zenship constructs and social welfare regimes play in accessing other key social and economic

determinants of health.

v108 POSTER SESS10N1

PS-23 (A) Differences in Mortality Between Amsterdam Heroin Users of Different Ethnic Groups and

the Influence of Injecting Marcel Buster, Guus Cruts, and Ingeborg Deerenberg

Introduction: Relatively low mortality rates have been observed among Amsterdam heroin users in

general and particularly among heroin users belo~ging to one of the major ethnic min~rities (ori~tin.g from Surinam, Morocco, Turkey and Dutch Antilles). It has been suggested that this low mortality 1s

related to the low prevalence of injecting drug users. This hypothesis is studied in an open cohort of

patients at a low threshold methadone treatment facility at the Municipal Health Service (MHS) of

Amsterdam. Methods: The study population included methadone patients (re)admitted at the MHS in the period

from 1/1/1996 to 31/1/2002, born in the Netherlands, Morocco, Surinam, Dutch Antilles or Turkye, and

officially registered in the population register of Amsterdam. The population register was used to ascer·

rain the vital status. Causes of death were provided by the Central Bureau of Statistics. Mortality was

categorised as HIV related, directly drug related (overdose) and other.mortality. Results: The methadone patients had the following characteristics: 38 years of age at entry; 81%

male; 37% ethnic minority; 37% ever injected. In total, 9558 personyear (py) of observation time and

173 deaths (18% HIV related, 14% overdose; 57% other) were observed. Hence, the crude mortality

rate was 18/1000 py (95% CI 16-21/1000 py). The percentage of (ever) injectors was higher among the

native Dutch than among the ethnic minorities, 51 % and 14 % respectively. Higher rates were observed

among native Dutch drug users compared to those belonging to an ethnic minority (age adjusted Hazard

ratio (HR) 1.9 (95% CI 1.4-2.7). The age adjusted HR of (ever) injecting drug users versus non injecting

users was 3.0 (95% Cl 2.2-4.1 ). After additional adjustment for route of administration a non significant

difference between the Dutch and ethnic minorities remained (HR 1.3, 95% Cl 0.9-1.9, p-value 0.151. Conclusion: The mortality rate among the heroin users in Amsterdam is strongly affected by the

high prevalence of non-injecting drug use. Moreover, this study confirms that differences in mortality

between the native Dutch and the ethnic minorities is related to differences in route of administration.

The ongoing reduction of injecting drug use (due tot selctieve mortality, and switching route ofadminis­

tration and popularity of crack cocaine) may lead to a further reduction of mortality rates among heroin

users in Amsterdam. Interventions preventing the initiation of injecting should be encouraged.

PS-24 (A) Personal Perspectives, Experiences and Consequences of Food Insecurity in Ottawa

E~izabeth Kristjansson, Vivien Runnells, Melissa Calhoun, Alexander Belanger, Caroline Andrew,

T1?1othy Aubry, Michael Birmingham, Robert Cushman, Nancy Edwards, Anna Farmer, Moe Garahan,

C~1f.f Gazee, Gary Goldfield, Janet Hatcher Roberts, Marguarite Keeley, Dafna Kohen, Ronald Labonte,

V1v1an Robinson, Peter Tugwell, and George Wells

. Introduction: Food insecurity is an inequality that is central in the lives of many low-income Cana·

d1ans. People lack food security when regular access to nutritious food is limited or variable due to high prices'. low income, lack of transportation or inadequate food distribution, or they become disadvan·

taged m other w~ys through the acquisition of food. A group comprising academics, health profession·

als, and commumty workers who have experience in food insecurity, developed a pilot study in Ottawa

that sought to und~rstand the lived experience of food insecurity. The study also used the United States

Department of Agriculture (USDA) Community Food Security Module.

Methods: A series of group meetings determined the best research approaches; questionnaires and

consent forms were developed by a working group. Twenty-three self-identified food insecure respon·

dents were interviewed. The data were analysed using frequency distributions· the Food Security Module

was coded according to the USDA coding guide, and open-ended responses w~re coded using a grounded approach.

Renlts: Preliminary results from our pilot study have given the research team cause for consider­

able concern. Out of 14 households without children, 11 experienced food insecurity with hunger; 5

~ere at the severe l~vel. Out of 9 households with children, 7 experienced food insecurity with hunger.

~•rst person reflecnons commonly featured feelings of depression low self-esteem and despair. Partic­ipants' account tha d "be b · · L ' ' •

fea 5 t escra o tatnmg rood to address hunger and lack of food in general as a domt· nant ture of da t -d · · · f

.1 bT Y.- 0 ay activity, contrast with an urban context characterized by high levels o avai ahi ity, expenditures on and consumption of food. Many of the contributors to food insecurity were t e result of external facto P · · k h h I h di d rs. amcipants new ow to cook, were aware of what constitutes a

ead t Y et, an. tried to budget their money; however, the overall lack of income expense of food an transportation d d · ffi 1 · ' . . an 1 cu ty gettmg to the store, severely limited putting knowledge and skills mto practice.

l'OSTER SESSIONS v109

Conclusion: Based on these early findings, our research team is looking to challenge what appear to

be assumptions about poverty and food insecurity and for best ways to use this information. Some policy

approaches and interventions that encourage people to eat better and exercise more, may be missing the

mark for low-income individuals, and may serve to maintain food insecurity. Future research will build

on this pilot. With methods augmentation, and a comprehensive knowledge dissemination plan, we hope

co contribute to research and policy frameworks at all levels.

PS-25 (A) Mental Health and the Corrections System: Population-Based Analyses in Urban, Semi-Urban,

and Rural Settings Julian Somers, Robert Watts, and Michelle Patterson

Introduction: According to recent epidemiological research, rates of mental disorders vary consid­

erably across countries and across regions within countries. Nevertheless, rates of mental disorders

(including substance use disorders) are consistently higher in populations involved in the corrections sys-

1em. Courts have long recognized the heavy burden of mental illness within their purview, and have

developed innovative programs to better manage the needs of such individuals. The majority of these

innovations (e.g., specialized courts) exist in urban settings. However, few studies have examined the

degree of variability in rates of different mental disorders between courts in urban and other settings

(e.g., semi-urban, rural). Variability between courts in different settings, if present, holds implications for

needs-based resource planning. Method: The present study was conducted as part of a long-term Inter-Ministerial collaboration in

British Columbia (BC). Analyses were conducted on linked administrative data regarding population

health and correctional services. A database was constructed including all individuals sentenced in BC in

a single year (n=49,142). Corrections records were matched to records of health services utilization (hos­

pital and outpatient services) for mental disorders and substance use disorders in the years preceding sen­

tencing. Services for mental health and substance-related problems were aggregated into three groups:

severe mental illness (SMI); less-severe mental illness (LSMI); alcohol/other drug (AD). Courts were

grouped, based on their annual volumes, inro three categories: "Urban"; "Semi-Urban" and "Rural."

Rates of service use for mental disorders were compared between groups for 1-year and 5-years preced­

ing sentencing. Results: There were significant differences in the rates of mental disorders in courts of different size

(urban, semi-urban, rural). However, differences between the rates of disorders within each of these

groups exceeded the discrepancies between groups. Comparatively high and low rates of disorders were

observed in courts of each size. Moreover, the courts with the highest rates of certain disorders (e.g., AD)

did not have the highest rates of other types of mental disorders (e.g., SMI).

Conclusions: Rates of mental disorders differed significantly among the annual populations sen­

tenced across courts in BC. Urban courts (which process comparatively large numbers of people) have

implemented services to address the needs of the mentally ill. The present analyses strongly suggest that

program development should be closely linked to the demonstration of need. The results caution that a

uniform approach to court programs for the mentally ill is likely to be inefficient, over-supplying services

in some settings and underestimating need in others.

PS-26 (A) The Public Injecting Scene in the City of Vancouver

Will Small, Evan Wood, Patricia Spittal, and Thomas Kerr

Background: The injection of illicit drugs in public spaces is a growing urban health problem in

North America. Public injecting has a negative impact on individual and public health, as well as the per­

ception of community safety. The objective of this research was to investigate the locations where public

injecting occurs within the downtown eastside (OTES) of Vancouver and examine the social and physical

context of public injecting venues and related risk behaviors.

Methods: Data were collected through participant-observation methods in public injecting venues

from August of 2002 until 2004. Ethnographic mapping and a structured environmental survey of the

open drug scene within the OTES also provided data for this analysis.

Results: Public settings used for injection are characterized by highly unhygienic conditions, the

presence of unsafely disposed syringes, limited availability of sterile syringes and a lack of sterile water

for injecting. A number of unsafe injection practices observed were common among public injectors. The

presence of police officers nearby and the potential of assault by street predators fostered rushed inject­

ing among those consuming drugs in public spaces. The ecological features of these environments

encourage unhygienic and unsafe injecting practices, heighten risk for overdose and the transmission of

blood borne viruses.

v110

Conclusions: Public injecting venues in Vancouv~r _are high ri~k ~rug u_se sites where inj~prac· rices increase potential for blood borne virus transm1ss10n, ~~e~al mfectton and ov~dose. While the establishment of a safer injection facility has displayed a pos1ttve tmpa~ on th~ ~~he ~ use scene, some degree of public injection persists and ~herefore. furth~r resear~h wit~ pubhc. m)CCtOn 1s ~to develop additional interventions. Structural mtervent1ons aimed at 1mprovmg environmental condiboos in public injecting venues are needed.

PS-27 (A) The Cultural Context of Postpartum Depression: Results from a Quantitative and Qualitative Study with First- and Second-Generation Immigrant ~omen . . Paola Ardiles, Lana Mamisachvili, Grazyna Mancew1cz, Kapri Rahm, Noreen Stuckless, Sherry Thompson, and Lori Ross

Introduction: Approximately 13% of women experience depression in the first weeks or months after giving birth. Although it has been argued that postpartum depression (PPD) is a culture-bound P~ nomenon, experienced only in Western, industrialized countries, recent international research studies have confirmed that the prevalence of PPD is similar around the world. However, little is known about variables that may influence the experience of PPD in women from diverse cultures and immigrant women. Research is needed to identify the role culture may play in the presentation of PPD (i.e., types of symptoms most commonly reported), how women from various racial, ethnic and cultural backgrounds perceive and attribute their symptoms of PPD, and finally, how culture can be appropriately addressed in PPD treatment programs.

Method: To examine the role of culture in PPD, semi-structured interviews and self-report question· naires were administered to clients of the Women's Health Centre of St. Joseph's Health Centre, Tor· onto. Participants were identified as either first generation Canadians (relative newcomen) (N=8) or second generation Canadian (parents were immigrants to Canada) (N=6). Data were collected QD these two groups of women based on: severity of depression, symptom presentation, perceived role of social supports and culturally-specific traditions, and barriers and responses to treatment.

Rardti: The interview data were analyzed using qualitative methods (thematic content analysis), and the following themes were identified: 1) stress about passing on their culture to their children, 2) lack of social support and feelings of isolation, 3) perceived importance or lack of importance of cultural based tra· ditions, 4) conflicts with family members. about cultural traditions and beliefs, 5) mental health stigma within ethnic communities and beyond, 6) race- and sex-based discrimination, and 7) language barriers.

Conclrllion: Identifying the role culture plays in the presentation of PPD, and how women from diverse backgrounds perceive and attribute their symptoms of PPD, is critical in order to establishcultur· ally appropriate guidelines for treatment options. Furthermore, information gathered from this study can be used to develop policies and resources for delivering culturally competent care for newcomer wo~ who are dealing with PPD as well as the issues around acculturation (i.e., language barriers, racism). llus is of particular importance for urban health centers which provide postpartum care to diverse groups of women, and particularly recent immigrants or newcomers.

PS-~8 (Al. Contaminated 'Therapeutic Landscape': Perceptions of the Aamjiwnaang Fint Nation KeYln Smith and Isaac Luginaah

. In~: This. paper pres;ents the findings of an ongoing study among the Aamjiwnaang F!rst Nanon. Aam11wnaang is located m the heart of Samia's 'Chemical Valley', surrounded by cherrucal ~(ants such as Esso, Imperial Oil, Shell, Suncor Energy, and Canada's largest hazardous waste disposal sate. Safety Kleen. This Fint Nation community is located within the St. Clair River •Area of Concem'. as destgna~ by Health Canada for the population of Samia and the surrounding region. Although this comm_umty, by way of. its proximity to the numerous chemical plants is already exposed to high levels pollu~on, recent che?Ucal dumping in ~mjiwnaang, as well as a failed proposal for another ethanol plant m the community, only helped to mtensify community concerns about potential health impactS of exposure. Research on the cultural beliefs and traditions of First Nation communities has established that th~ ~isting rel~tionship between First Nations people and 'Mother Earth' is not only physical, but also_ spmtual. In this study we explore how the complex relationship between the Aamjiwnaang First Naaon and 'Mother Earth' be ha · · · I .. may c ngmg 111 a contammated 'therapeutic' landscape. The study a so ~lores h?w Aam11wnaang residents are coping with these changes and with the probable conramina· boa of their community.

Mdbods: Qualitative in-"'-1. · · "de • • .._..,u. mtervtews were conducted with Aamjiwnaang residents (n=18) to

pnm . a ~p~~ ~ of com~unity perceptions. The interviews were guided by several theme areas, mcludmg residents views on their relationship with 'Mother Earth', health concerns about living

POSTER SESSIONS v111

in a contaminated 'therapeutic landscape', and the changing perceptions of 'Mother Earth' as a result of

environmental contamination. Ra!Jts: Aamjiwnaang residents acknowledge that they are living in a contaminated environment

and are being impacted by emissions from the surrounding 'Chemical Valley' especially for future gener­

ations, and have expressed concerns that members of the community and Mother Earth are 'sick' as a

result of this exposure. While moving from that 'place' has been discussed, residents have strong per­

sonal and generational connections to the land and insist however, that Aamjiwnaang is their 'home' and

will remain that way despite growing community concerns about the impact from industry.

Conclusions: The contribution of this study lies in the direct involvement of community leadership

in designing and conducting this research and distributing the results to further local policy development

regarding community concerns on the reserve.

PS-29 (A) Factors Contributing to Drug Abuse Among Truck Driver in Selected Urban Area of Eastern

Part of Nepal Anil Deo and Shyam Lamsal

Background: Truck driver are at very high risk for drug abuse because the factor contributing to

drug abuse among driver are multiple. It is important to gain an understanding of the key factors that

contributing to drug abuse among truck drivers.

Methods: seventy-truck driver aged 25-35 years were conveniently selected from the population. All

the participants were male. An interview schedule was developed in the light of literature data and data

were collected by personal interview with informed consent in selected urban area of Eastern part of

Nepal. Results: A considerable percentage of truck driver have less knowledge about drug abuse, its effect on

body and their complication. Majority of the participants (90%) explained that lack of education, financial

crisis were leading factors of drug abuse. The average numbers of respondents were believed that lack of

meaning in life, marital disharmony. Friendship with drug abuser, stress, tiredness, modernization of life

pattern and freedom from the home pressure were the influencing risk factors to drug abuse.

Conchuion: This study reveals those truck drivers are at risk in urban area for developing drugs

abuse, mostly influenced by social and environmental factors. Hence, these groups should undergo cer­

tain educational programme to prevent not only drug abuse, but also prevent transmission of infectious

disease among these groups.

PS-30 (A) Food Insecurity in Ottawa - Perspectives and Experiences of Community Workers

Vivien Runnells, Melissa Calhoun, Elizabeth Kristjansson, Alexander Belanger, Caroline Andrew,

Timothy Aubry, Michael Birmingham, Robert Cushman, Nancy Edwards, Anna Farmer, Moe Garahan,

Cliff Gazee, Gary Goldfield, Janet Hatcher Roberts, Marguarite Keeley, Dafna Kohen, Ronald Labonte,

Vivian Robinson, Peter Tugwell, and George Wells

Introduction: Food insecurity is an inequality that is central in the lives of many low-income Cana­

dians. Our group of university researchers, health professionals, and community developers conducted a

study in Ottawa with community workers who work with people identified as food insecure. The pur­

pose of the study was to understand the nature of their work, and their perspectives, perceptions and

experiences of the causes and consequences of food insecurity. (A parallel study was conducted with

food insecure participants). Methods: Sampling was through local knowledge of organizations involved in the provision of food

to community members. Written permission for the researchers to contact workers in confidence was

obtained from each organization. Thirteen in-depth interviews were conducted. The interviews consisted

of a number of open-ended questions. The data were collated, and analysed using a grounded approach.

Results: Workers interviewed represented organizations that offered diverse programming and

methods of food distribution intended to address the needs of the community. The provision of food was

seen as a necessary response to address hunger that arose for the majority from poverty caused by low

income, or levels of government income support and safety nets that were insufficient to support food

requirements. Workers reported that food requirements varied according to different. ethnic back­

grounds, ages of recipients and family configurations, and with food preferences, and d'.etary (health)

requirements. Workers' observations of the effects of insufficient food on adults and children such as

depression, low energy and non-participation or social disengagement matched those of food insecure

respondents. Food insecurity was cited as "another srressor among the mountain of problems." Overall,

workers presented a picture of a silent, stigmatized, poor population including children, and a lack of

advocacy to address the issues.

v112 POSTER SESSIONS

C I · . Although workers provided descriptions about the causes and consequences of food one usron. · be tha th · ·ty the results suggest that workers and organizations, like the commuruty mem rs t ey msecun • · · · · f ilab'l' f food · t d ·n thei·r ab1'l1'ty to address food insecurity. L1m1tanons m terms o ava 11ty o , serve, are restnc e 1 . . funding, and donations appeared to set the para?1eters of pr~g:am r.espon~ to commuruty food msecu­rity. Workers were concerned with program des1g": and a~m1mstranon that m general addr~d hunger on an emergency short-term basis, although food msecunty was long-ter_m for ~any. Sustainable solu­tions that include knowledge translation strategies, and health and social pohcy responses were sug­gested and will be explored in future research that hopes to build on this pilot.

PS-31 (A) Social Support and not Socioeconomic Status is Predictive of Depressive Symptomatology in Patients Undergoing Coronary Artery Bypass Graft Surgery Mary Keith, Roberta Hood, Victoria Tully, Rose Mokbel, Sean B. Rourke, and Lee Errett

Background: Socioeconomic deprivation as well as low levels of soc!al s.uppoi:r have .been associ­ated with poor outcomes following cardiac surgery. Pre-operative depression m ~anents with coron~ry artery disease awaiting CABG ranges from 27-47% and is an independent predictor of post-operanve mortality. Since St. Michael's Hospital has a large inner city population, this study was designed to deter­mine the both the prevalence of depressive symptomatology (DS) in patients awaiting CABG as well as its relationship with socioeconomic status (SES) and social support.

Methods: Consecutive patients referred for isolated CABG were invited to complete the Centre for Epidemiological Studies Depression Scale (CES-D) as well as a social support scale and a life streSsors inventory. A CES-D score of 2: 16 represents mild DS and a score of 2:27 represents moderate to severe DS. Participants also recorded information on functional status, perceived progression of heart failure, demographic and SES variables. All participants with CES-D scores 2: 16 were considered to have DS.

Results: Of the 75 patients (75%) who returned the survey, 22 (29.3%) of participants had a CES­D score 2: 16 with 8 (10.7%) of those having scores suggestive of severe depression. Females and those with ongoing medical concerns tended to have more DS (p= 0.06 and p= 0.07 respectively). Age was not related to DS. Perceived worsening of symptoms and increased CCS angina class were significantly related to the presence of DS (p= 0.03 and p= 0.03 respectively) but not the number of diseased heart ves­sels. Satisfaction with personal relationships including having someone to confide in (p=0.01), feeling lonely (p= 0.04) and not having a partner (p= 0.007) were significantly related to DS. Being very upset by a recent breakup in the immediate family was also significantly related to DS (p= 0.02). Having greater than a grade 9 education was the only SES variable related to DS (p=0.06). Multivariate logistic regression suggested that not being partnered and having low education were the most significant predictors of DS.

ConclNSion: Pre-operative depression is present in at least one quarter of patients referred for CABG. Since DS is related to poor outcomes following CABG, single patients with few social supports and low education should be considered at high risk for DS. These findings support the need for the development of supportive interventions in patients at risk in order to decrease post-operative morbidity.

PS-32 (A) Impact of Sexual Abuse/Assault on HIV-Risk-Related Behaviours in Street Youth Alison Paradis, jean-Yves Frappier, Pierre McDuff, and Elise Roy

This study examines the relationship between childhood sexual abuse, sexual assault during adoles­cence, and HIV-Risk-Related behaviours in a sample of 919 homeless youths. Over the past decade, there has been increasing research devoted to the impact of childhood sexual abuse. Some studies have suggested that the experience of childhood sexual abuse is associated with substance use and abuse, at· risk sexual behaviour and subsequent higher rates of HIV infection (Ompad et al., 2005; Cinq-Mars et al., 2003; Brown et al., 1997). Other studies have found that childhood abuse, especially sexual abuse, is c_o~n among stree~ youth (Noell et al. 1999). This study compares sexually abused males and females livtng on the street ~th non-sexually abused street youth, with regards to unsafe sexual behaviours and e~ures to potmnal t:DV sources (e.g., tattooing, body piercing and injection drug use). The hypothe­SIS oft~ ~nt study IS that the prevalence of HN-risk-related behaviours will be higher among street youth vtctuns of sexual abuse than those who have not been sexually abused. The sample includes 919 youths aged 13 to 25 who met specific criteria's for itinerancy (649 male and 270 female, with a mean ~of 19.4 Y· and a standard deviation of 2.9). They were recruited through five organisations working ~th~ you~ and were~ of an ongoing cohort study. All youth completed a 45 to 60 minute ques· ~onnaue on their sexual behaviours, use of drugs and alcohol and other HIV risk behaviours. Oral spec· unens for HIV testing were. also collected. A total of 357 (38.9%) youth reported at least one incident of ~I •~use/assault (1~1 girls (67.0% of all the girls) and 176 boys (27.2% of all the boys]). Preliminary descnpnve analyses pomt to sexually abused/assaulted youth showing the highest prevalence of sexual

POSTER SESSIONS v113

at-risk behaviours. For example, 43.3% of sexual abuse/assault victims have engaged in prostitution in

their lives compared with 13.4% in the non-sexually abused/assaulted group. In addition, 42.6% of sex­

ual abuse/assault victims reported having injected drugs, compared with 32.0% in the non-sexually

abused/assaulted group. More statistical analyses will bring other significant factors to light, especially

when we analyze separately those victim of childhood sexual abuse as compare to those victim of sexual

assault after childhood. Elucidating the risk factors for getting involved in HIV-Risk-Related behaviours

is important for the development of comprehensive and appropriate prevention and treatment interven­

tion strategies.

PS-33 (A) Identifying and Managing Intestinal Parasitic Worm Infections in New Immigrants and

Refugees to Toronto Kamran Khan, Kim Chow, Miriam Cho, Vicky Fong, Jun Wang, and Meb Rashid

Introduction: New immigrants and refugees to Canada frequently emigrate from regions of the

world where intestinal parasitic infections with worms are endemic. Of note, some of these parasites area

capable of surviving for years to decades within a given host and can have life threatening consequences

many years after initial infection. Thus, early diagnosis and treatment of intestinal parasitic worms is

considered important in high risk immigrant populations, however there remains a lack of consensus

regarding the best method of accomplishing this. Diagnosing worm infections through stool examina­

tions is costly and has limited sensitivity, while presumptive treatment of all immigrants, although advo­

cated by some, is expensive and results in healthy individuals being unnecessarily treated. Herein, we

examine the utility of a hematologic marker (i.e. peripheral blood eosinophilia) as a screening instrument

to identify parasitic worm infections in new immigrants to Toronto.

Methods: We identified 192 adults, 15 years of age or older, who were screened for intestinal para­

sitic infections by stool examination as part of a recently developed screening protocol at a downtown

Toronto community health centre. We examined the prevalence of infections with worms and subse­

quently evaluated the impact of several demographic factors on the presence of worm infections. We also

determined the sensitivity and specificity of peripheral blood eosinophilia (defined as greater than 500

eosinophils per ml) as a marker for intestinal parasitic worm infections.

Results: Overall, 21 % of the 192 immigrants tested had evidence of at least one worm infection on

a single stool examination, while 4% of such individuals bad infections with multiple worms concur­

rently. Age did not appear to be associated with the presence of worms, however 29% of males had evi­

dence of worm infections compared with 16% of females (p= 0.03). Immigrants from Asia, sub-Saharan

Africa, and Central America had the highest burden of overall infection. The sensitivity and specificity of

peripheral blood eosinophilia for worm infections was 24% and 92% respectively.

Conclusions: One in five recent immigrants presenting to a community health centre in downtown

Toronto had evidence of at least one intestinal parasitic worm infection. The highest burden of illness

was in men and in those emigrating from less developed regions of the world. Peripheral blood eosino­

philia is a poor screening test for worm infections however its presence is highly suggestive of the exist­

ence of worms in new immigrants.

PS-34 (A) The Health Behaviors of African American Men at Historically Black.Colleges and

Universities: Is There Limited Research?

Daphne Watkins, B. Lee Green, and Christine Stanley

More than a decade ago, the Journal of American College Health recommended that a national

study be conducted to measure the health status of African American college students, 'both health dispar­

ities and [their] positive healthful behaviors' (Fennell, 1994). It was later decided that when exploring the

level of health risk behaviors for African American students, gender is an important variable and should

be included in the research (Fennell, 1997). At historically Black college and universities (HBCUs) college

health researchers must tackle gender disparities through highly-effective health promotion and disease

prevention programs. The purpose of this review is to examine the literature that addresses the overarch­

ing health behaviors (i.e. risky sexual behavior, poor diet, smoking, physical inactivity, etc.) of African

American men who attend HBCUs. Despite the various social, cultural, and academic benefits of African

American students who attend HBCUs, the number of research studies that adequately address their

health and health behaviors is limited. Studies indicate that African American men who attend HBCUs are

actively engaged in poor health behaviors. Compared to females at HBCUs, African American men are

more likely to behave in ways that could result in injuries and the use tobacco, alcohol, and ~ther dru~.

Conclusions of this review inquire about the limited research on the health an~ hea~th behav1?rs of Afri­

can American men who attend HBCUs, and the future directions of research with this population.

v114

PS-35 (A) Enumerating Toronto's Homeless Population: A Review of the Controversy

and Methodological Options

Brent Berry

POSTER SESSIONS

The City of Toronto has recently proposed to conduct a street count of the homeless. Like propos­

als that have come before, this most recent proposal is controversial among many homeless advocates

and service providers because it is perceived as intrusive, likely to undercount the target population, and

unnecessary for addressing the problem. Advocates of the count view it as necessary to gauge the scope

of the problem and advise city leaders about how to most effectively direct resources ro.the various

homeless services. This paper first reviews the history of efforts to count homeless populat10ns m Tor­

onto, describing the motivations and arguments of people on both sides of the issue. Second, the paper

reviews the methodological complexities of counting homeless populations, describing approaches that

use shelter-counts, administrative data and street observations. Those interested in counts for Toronto

and elsewhere can benefit from this review of approaches that have been proposed and carried out in

other municipalities. Third, the paper proposes a new community-based strategy that joins the skills of

methodologists, local experts, and service providers to ensure a fair and accurate count. The method of

systematic social observation avoids some of the problems of early counts by utilizing a repeated identifi­

cation approach to minimize undercount bias. The method also has the advantage of involving and com­

pensating homeless individuals for assisting with the street count estimates. The estimation approach can

be implemented on a rolling basis throughout the year.

PS-36 (A) Delineating Neighborhoods for Studies of the Urban Social and Physical Environment

Linda Weiss, Danielle Ompad, David Vlahov, and Sandro Galea

Introduction: IMPACT (Inner-City Mental Health Study Predicting HIV/AIDS, Club and Other

Drug Transitions) is a multi-level study aimed at examining the associations between features of the

urban environment and mental health, drug use, and risky sexual behaviors. Research participants are

being recruited in 36 New York City (NYC) neighborhoods. An essential first step in the implementation

of this study was to delineate boundaries for each target neighborhood that could then be used to estab­

lish sampling frames and as key units of analytic interest. Although many neighborhood studies rely on

pre-established definitions (e.g. those used for the census or administrative purposes), such definitions do

not always reflect contemporary settlement patterns. We felt that street level observations were a neces·

sary component of the definition process.

Methods: The procedures used to delineate neighborhoods were: (1) development of census block

maps of targeted areas; (2) review of land use maps and census tract data to ensure, prior to going into the

field, tha.t particular blocks are residential and likely to have sufficient population for recruitment purposes;

and (3) field VISltS and observation in each of the targeted areas. Field observations focused on: housing char­

acteristics, including housing type and condition; characteristics of commercial areas, such as likely customer

base (e.g. local or no~, socio-economic status and ethnicity of customers); pedestrian volume (including con·

gregauons of people m parks and outside stores or residences); obstructions to pedestrian traffic (e.g. ma1or

thoroughfares, multi-block industry or institutions); and maintenance and use of open spaces.

Results: In making the final decisions regarding neighborhood boundaries and the inclusion or

exclusion of particular. blocks, we considered a broad range of factors including evidence of homogeneity

an~ heterogeneity (socmeconomic, ethnic, housing type, environmental) across blocks within and blocks

ad1acent to a nei.ghborhood, and across the 36 sample neighborhoods; the potential for efficient recruit·

ment of appropriate particip.ants (i.e. sufficient local pedestrian traffic); and boundaries used in reporting

census data (s? that population data can be used in our analysis).

. Conclus_ums: Altho~gh utilization of field observations for neighborhood definitions is relatively

time consuming (ap~~ox1mately 2 hours for a 12 block area, with more diverse neighborhoods taking

even longer), we annc1p~t~ that it will substantially improve the quality and consistency of our data gath·

~rmg ~nd analyse~. Spec1f1c e?'amples from neighborhoods defined through this process will be given dur·

m~ this presentatmn. We will also discuss the merits and limitations of characterizing neighborhoods

usmg street level observations.

plo~-3~ (A) Personal and Social Network Factors Associated with Secondary Syringe Exchange Among 1ecnon Drug Users

Carole Morissette, Prithwish De, Joseph Cox. Ann Jolly, and Jean-Franr;ois Boivin

lntrodru:tion• The provis' n b · · · d been ed · 10 Y an m1ect1on rug user (IOU) of sterile syringes to another IDU has

term secondary syringe exchange (SSE). Limited research exists on the recipients of SSE and there

POSTER SESSIONS v115

has been no consideration for how social networks are associated with SSE. The objective of this study

was to identify personal and social network characteristics associated with being a recipient of SSE.

Metbods: In this cross-sectional study, IDUs who injected in the past 6 months were recruited from

syringe exchange programs in Montreal, Canada, between April 2004 and January 2005. Information

on each participant and on the persons with whom contact had occurred in the past month were elicited

using a structured, interviewer-administered questionnaire. Participants provided detailed demographic

and drug use information on up to 5 IDU members with whom drugs or injecting materials were shared.

Using logistic regression, personal and network characteristics were examined in relation to receipt of

sterile syringes. Res.Its: Of 277 IDUs, 39% reported receiving sterile syringes in the past month from another IDU.

The sample mean age was 33 years (range 18-55), 73% male, 91 % Caucasian, and 85% cocaine injec­

tors. In multivariate analyses adjusted for age and gender, recipients of sterile syringes were more likely

than non-recipients to share drugs after preparation (0R=2.39(1.06-5.42)), to require help or to have

helped inject another IDU (OR= 3.48(1.60-7.60)), to have asked someone to get sterile syringes from a

syringe exchange program (OR=2.54[1.20-5.40)), to lend syringes (OR=2.44[1.16-5.16)) and to use

drug preparation water that was previously used by another IOU (0R=2.46(1.42-4.28)) during the past

6 months. Recipients also had a higher rate of change (p=0.01) of IDUs in their drug injecting network

during the past month. With respect to social networks, 45% ( 171/348) of IDU network members were

providers of sterile syringes and were more likely than non-providers to inject everyday (OR= 2.50( 1.51-

4.15)). When stratified by their role as a sexual partner or as someone who provides support (e.g. friend,

family member), further risk behaviours were observed in relation to sharing injecting materials with the

participant. Conclusion: Recipients of sterile syringes and their IDU network members had several high-risk

behaviours for infection with bloodborne diseases. SSE may afford an opportunity for the dissemination

of other salutary behaviours such as information sharing on safe injecting practices between recipients

and distributors. Furthermore, drug injecting networks may be an avenue to reach IDUs who may not

otherwise be exposed to preventive measures.

PS-38 (A) Stigma and Labelling in a Culturally Diverse Society

Hazel Markwell and Steve Abdool

There are numerous sources of stigma and labelling of mental and physical illness. First, the socio­

cultural dimension to stigma and labelling clearly influences patients, families, health care professionals

and society's perception and treatment of illness. This creates multiple challenges related to illness identi­

fication and recovery, particularly in culturally diverse societies. Second, the media is a major source of

stigma and stereotyping with regard to a variety of mental and physical illnesses. Despite increased pub­

lic knowledge of many illnesses, studies have shown that stigma has intensified over the years in certain

cases. A third element of stigma and labels appears with the use of diagnosis as a solution to human

problems with the result that difficult to treat patients are repudiated and social issues are unaddressed.

This presentation will serve to outline the development of stigma, various expressions of stigma, and

consequences of stigma. It will provide some practical recommendations for the reduction of stigma

related to mental and physical illness.

PS-39 (A) Perceptions About Immunization Among African American and Hispanic Parents in

Los Angeles County Magda Shaheen, Cheri Todoroff, and Al Amin Nelson

Purpose: To assess the knowledge, attitude, and practice about immunization for parent of 2-3

years old Hispanic and African American children in Los Angeles County (LAC).

Methods: We conducted two cluster surveys in LAC. The sample was selected with probability propor­

tionate to estimated size at the first stage and simple random sample of children at the second stage. Data

were collected through interview. We absuacted vaccine coverage data from immunization record card (IRC)

at home or from clinic records. The participation was 81 % in Hispanics and 83% in African Americans pop­

ulations. IRC was not available at home for 26% of African American and 16% of Hispanic children.

Results: All parents perceived their children got all necessary vaccine~. Fa~orable attitudes to.w~rd

immunization were reported by 82 % of African American and 90% of H1s?amc parents. '.he m~1ority

of the parents (90% African American and 95% Hispanic) agreed that vaccines prevent senous d1se~ses

among children. Regarding vaccine safety, significantly more Hispanic parents (91 %) than African

American parents (75%) mentioned that vaccines are safe.

v116

PS-40 (A) Do Lesbians Need Papanicolau Tests?

Amanda Hu

POSTER SESSIONS

Introduction: Cervical cancer has been shown to be preventable by Papanicolau tests in heterosex­

ual women; however, the utility of Papanicolau test in lesbians is controversial. Cervical cancer is caused

by the human papillomavirus (HPV) which is transmitted by sexual _intercourse; howev_er, its' transmis­

sion by homosexual intercourse is also controversial. The goal of this study was to review the evidence

for Papanicolau tests in lesbians. Methods: A Pub Med, OVID ( 1996 to 2005 ), and Cochrane library search was performed using the

MeSH headings "Homosexuality, Female," "Vaginal Smears," and "Papillomavirus, Human." In Pub

Med, the Clinical Queries feature was used with "diagnosis" and "broad, sensitive" filters. A Google

Advanced Search of the internet was conducted with the terms "lesbian," "cervical cancer," and "pap

rest." The url was limited to ".ca," ".edu," or ".gov."

Results: The search yielded 8 original articles and 4 reviews, but no Cochrane reviews. None of the

publications were Canadian. 111 website hits were found and selected websites were reviewed. Studies

showed that lesbians have fewer Papanicolau tests than heterosexual women; however, many reported

risk factors for cervical cancer, including multiple past or current sexual partners (male and female),

early age of first coitus, history of sexually transmitted diseases, and cigarette smoking. HPV has been

detected in 13-30% of lesbians and 6-19% of lesbians who have never had sex with men. Case studies of

abnormal Papanicolau tests in lesbians who have never had sex with men have also been reponed. Sex­

ual transmission of HPV among lesbians can be explained by several factors: 1) 53-99% of lesbians have

had sex with men and 21-30% of lesbians continue to have sex with men. 2) HPV may be transmitted by

sexual behaviours among women, like digital-vaginal sex, digital-anal sex, oral sex, and the use of inser­

tive sex toys. 3) HPV transmission requires only skin-to-skin contact. Genital HPV has been identified on

human fingers. Some professional organizations, like the Society of Obstetricians and Gynecologists of

Canada and the American Cancer Society, recognize the need for Papanicolau tests in lesbians. Other

organizations, like the Canadian Cancer Society, do not have official policy statements. The current

Ontario Cervical Screening Program does not specifically address lesbians.

Conclusion: Although the data was limited, most studies recommended that lesbians should receive

Papanicolau tests. The frequency of these tests was controversial. Policy makers and professional organi­

zations should address the needs of this special population and make specific recommendations.

PS-41 (A) Working Conditions and Mental Health Among Elderly from Three Underprivileged Urban

Communities in Beirut

Monique Chaaya, Ahia Sibai, Hiam Chemaitelly, and Zana El Roueiheb

. Literature concerning the mental and physical effect of work at an old age is contradictory. In addi-

non, urban environments are physically and socially harsh with reduced potential for income generation

and employment and increased potential for depression. The present paper is an attempt to study how do

work, or lack of work, link to the experience of depression among older adults in underprivileged Leba­

nese urban communities. The data comes from a cross-sectional survey, where 740 elderly residing in 3

underprivileged communities in Beirut, including a Palestinian refugee camp, were successfully inter­

v1ewed through face-to-face interviews. Logistic regression was performed to assess the effect of work on

depression ad_justing for many other covariates. Data showed that 17.5% of people aged 60 years and

more were still workmg. There was a highly protective effect of work on depression in elderly males

(OR= 0.342, 95% Cl= 0.128-0.909). The current study is the first of its kind in the Arab region and

more work shou_ld be _don_e in this area. It is important for the Lebanese government to consider elderly

rights for social mclus10n m terms of employment opportunities.

PS-42 _(A) Socioeconomic Status and Mortality: For whom is There a Gradient?

Amam Nuru-Jeter, Nancy Adler, and Burton Singer

. l~u~on:_ The Socioeconomic gradient is perhaps the most persistent and significant finding in

social epidem1ological research. The insistent nature of the SES effect is evidenced by its significance after

acc?untmg for ~umerous confounds. The significance and magnitude of the effect, however, varies by

::•al group. Evidence_ o_f the relative effect of race and SES is inconclusive. Further, less attention has

f ~ ptid to the specific interactions of race and SES than to examinations of which is a better predictor

0 d ~ th. ~sues are further complicated by the explanatory complexity of the various measures of SES

anl . owht ey relate to the health of various social groups. Understanding the specific nature of these

re a11ons ips 1s necessary for guiding he Ith d · I 1· · h a an soc1a po mes and programs aimed at improving t e

POSTER SESSIONS v117

health of our most disadvantaged groups, and therefore population health, overall. This study examines

the synergistic effects of SES with both race and gender in predicting group differences in mortality.

Methods: Analyses use data from the National Longitudinal Mortality Survey (N= 559, 715) for the

years 1979, 1980, and 1981-85; and were linked to the National Death Index for deaths occurring

through 1985. Results were confirmed using data from the National Mortality Followback Survey for

people who died in 1986 (N= 13,491) and the 1986 National Health Interview Survey (denominator).

We used correlation analysis and the standardized mortality ratio to examine SES (education and

income), race, and gender as predictors of group differences in changes in mortality.

Results: For the total population, analyses support the income gradient showing significant declines

in mortality ratios from low to high income along the income strata. Education shows a significant drop

in mortality with completion of high school and completion of college, exhibiting a threshold rather than

a gradient effect. Compared to whites, Blacks receive diminishing health returns for each subsequent

level of income and education; with whites closely mirroring the total population in SES thresholds.

Similarly, compared to men, women do not experience the same health gains at comparable SES levels. For

education, Black men and women only show significant mortality declines upon completion of high school.

Conclusions: The SES gradient operates differently among race and gender subgroups. Threshold

effects suggest resource gains in life opportunities at particular milestones along the SES gradient. Fur­

ther, SES matters less for Blacks and women compared to whites and men suggesting differing implica­

tions for health and social policy aimed at reducing disparities.

P5-43 (A) Disproportionate Impact of Diabetes in a Puerto Rican Community of Chicago

Abigail Silva, Steve Whitman, and Ami Shah

Objective: We assessed the impact of diabetes in a large Puerto Rican community of Chicago by

measuring the prevalence of diagnosed diabetes and calculating the diabetes mortality rate.

Methods: We analyzed data from a comprehensive health survey conducted in randomly selected

households in community areas. Questions on diagnosed diabetes and selected risk factors were asked. In

addition, mortality data were analyzed in order to calculate the age-adjusted diabetes mortality rate.

When possible, rates were compared to those found in other studies.

Results: The diabetes prevalence located in this community (20.8%: 95% Cl= 10.1 %-38.0%) is one

of the highest ever reported for Puerto Ricans. For instance, it is more than three times higher than the

prevalence for the US (6.1 %) and twice the prevalence for Puerto Ricans in New York ( 11.3%) and

Puerto Rico (9.3%-9.6%). Diagnosed diabetes was found to be significantly associated with obesity

(p=0.023). The prevalence was particularly high among older people, females, those horn in the US, and

those with a family history. The diabetes mortality rate (67.6 per 100,000 population) was more than

twice the rate for all of Chicago (31.2) and the US (25.4). Conclusions: Understanding why the diabetes and mortality rates for Puerto Ricans in this commu·

nity are so much higher than those of other communities is imperative. Collaboration between research­

ers, service providers and community members can help address the issues of diabetes education, early

screening and diagnosis and effective treatment needed in this community.

PS-44 (A) Determinants of Psychological Distress Associated with SARS in a Canadian Inner City Hospital

Lorraine Lee, Rosane Nisenbaum, Sergio Rueda, Ken Balderson, William Lancee, Robert Maunder,

Donald Wasylenki, and Sean B. Rourke

Introduction: SARS is a respiratory illness that is spread from person to person through dose con­

tact. This infectious disease outbreak was unusual due to the high rate of infection among health care

workers. The aim of the study is to explore the demographic and attitudinal determinants of psychologi­

cal distress due to SARS among health care workers of a Toronto Hospital.

Methods: A total of 997 adult participants completed questionnaires co assess psychological distress

(Impact of Event Scale - JES) and attitudes to SARS. Of these, 845 participants completed the question­

naire during the SARS I outbreak, and 152 participants completed the questionnaire during the SARS II

outbreak. Participants also provided information on demographic variables, including occupation and

exposure to SARS. Principal components analysis was used to derive eight attitudinal scales: Fear: sys­

tem, protection, prevention, job stress, stigma, instrumental coping, and psychological copm~. L111ear

regression analyses were applied to evaluate the associations of the demographic and amtudmal vari-

ables, as well as time, with psychological distress. . .

Results: Regression analyses showed that time and higher scores on fear, 1ob stress, stigma'. and

instrumental coping were associated with a higher total IES score: (R2 =.30). Contrary to expectations,

none of the demographic variables was associated with total IES score.

v118

Conclusion: The presence of psychological distress in health care workers is indicative of intrusive

or avoidant responses to thoughts, feelings, and memories associated with the SARS outbreak. This

study shows that ( 1) fear for one's health and the he~lth of.others, (2) ex~erien~in~ job stress, (3)_tbe per·

ception of stigma, (4) usage of instrumental copmg skills, ~n~ (5) t1m_e s1grufi~an~ly c~nmb~te to

increased psychological distress in health care workers. Potential mterventmns during mfecttous diseaie

outbreaks in health care settings should be targeted to minimize the impact of these factors.

PS-45 (C) Understanding Dominican Mothers' Beliefs, Knowledge and Practices Related to Feeding

Infants and Children Lynn Babington

Purpose: The purpose of this study was to expand knowledge regarding feeding practices, know!·

edge and nutritional beliefs of mothers currently residing in the Dominican Republic (DR). The rising

incidence of obesity in children is a major national health concern and obesity in first and second-generation

immigrant children also continues to rise. We know that parents (particularly mothers) shape children's

early diet patterns and that immigrant mothers experience additional challenges related to acculturation

and assimilation into a new culture, however there is a paucity of literature concerning the effect of

immigrant adaptation to American culture on the nutrition of children. In addition, new immigrant

knowledge about the causes of obesity and the resulting health implications for childhood obesity has

not been assessed and reported. This qualitative study used focus group methodology to discuss views

and practices related to the introduction of food for infants and feeding practices for young children,

along with a discussion on knowledge and beliefs related to the causes and health implications of child·

hood obesity. Ten Dominican Mothers' of young children (birth to 6 years old) who reside in a small

town in the western frontier area of the DR were participants in the focus group. Results from this srudy

will be compared to results from an identical study that will be conducted in Fall 2005 with new immi·

grant mothers from the DR to the Boston area. We will compare feeding practices, beliefs and knowledge

about nutrition for young children between these two groups.

Methods: Using participatory principles, a focus group design was used to interview a group of

mothers in the DR. The investigator along with a bilingual translator conducted the focus group. The

session was tape recorded and is currently in the process of being transcribed and translated. Transcribed

data will be systematically analyzed themes will be identified. A qualitative data analysis software will be

used to organize and code the data according to the specific aims of the study. Supporting quotations

will be selected to substrate each theme.

lmpli~tions for Urban Health Practice: An ultimate goal of this study is to lay a foundation for

understanding the process of acculturation on feeding practices of mothers when they immigrate to the

US. Understanding beliefs, knowledge and feeding practices that mothers use with young children will

help m ~he ~evelopment of culturally and linguistically appropriate educational strategies and materials

for use m primary prevention of pediatric obesity.

P~-4~ (C) Health Disparities Among Older Immigrants in Urban Canada N1dh1 Kumar Tyagi

In Canada more than seventy-five percent of immigrants choose to stay in three major urban cen­

ters of Toronto, Montreal and Vancouver. Approximately fifty percent of the immigrants eventually set·

tie m ~~e greater Tor<_>nto area. There is mounting evidence that the increasing immigrant population has

a_ sigmfic~nt health disadvantage over Canadian-born residents. This health disadvantage manifests par-

ticularly m the ma1"ority of 1"mm1"gr t h h d be · · h . . . . an s w o a en m Canada for longer than ten years. This group as

~n associ~te~ with higher risk of chronic disease such as cardiovascular diseases. This disparity

twccb n ma1onty of the immigrant population and the Canadian-born population is of great importance to ur an health providers d" · I I ·

b as isproporttonate Y arge immigrant population has settled in the ma1or ur an centers. Generally the health stat f · · · · · · h h been . us 0 most 1mm1grants 1s dynamic. Recent 1mm1grants w o av_e

ant •;ffca~ada _for less ~han ~en years are known to have a health advantage known as 'healthy imm1•

~ants r::r · ~:s eff~ 1~ defined by the observed superior health of both male and female recent immi­

g "d rofu~ ~wer m~dences of chronic diseases. The 'healthy immigrant effect' is lost as time of res1 ence o 1mm1grants m Canada becom I s · ' · d tL- d · f es onger. ome studies suggest the loss of this effect 1s ue to "" a opnon o an unhealthy lifestyle · d · h · f

· · , 1 associate wit acculturation. However this explanat1on or 1mm1grants oss of health advantage had · d ' Th studies sugg t h h . . proven ma equate according to some recent studies. ese

estyle the ;s t a~ t 7 immi~ants with lower health status are not necessarily adopting unhealthy lif­

the t;endsre ofre ot er acdtorsldm1~t bc_the cause of health status. This work examines recent studies for o recent an o er 1mm1gra t' · · d

n s soc10-econom1c status, self-assessed health status an

POSTER SESSIONS v119

immigrant participation in Canadian society particularly the labour market. A new explanation of the

loss of 'healthy immigrant effect' is given with the help of additional factors. lt appears that the effects of

social exclusion from the labour market leading to social inequalities first experienced by recent immi­

grant has been responsible for the loss of healthy immigrant effect. This loss results in the subsequent

health disadvantage observed in the older immigrant population.

PS-47 (C) A Study on Patients Perspectives Regarding Tuberculosis Treatment

Sathiya Chander

A study on Patients perspectives regarding tuberculosis treatment By S.j.Chander, Community

Health Cell, Bangalore, India. Introduction: The National Tuberculosis Control Programme was in place over three decades; still

Tuberculosis control remains a challenge unmet. Every day about 1440 people die of tuberculosis in

India. Tuberculosis affects the poor more and the poor seek help from more than one place due to vari­

ous reasons. This adversely affects the treatment outcome and the patient's pocket. Many tuberculosis

patients become non-adherence to treatment due to many reasons. The goal of the study was to under­

stand the patient's perspective regarding tuberculois treatment provided by the Bangalore City Corpora­

tion. (BMC) under the RNTCP (Revised National Tuberculosis Control Programme) using DOTS

(Directly Observed Treatment, Short course) approach.

Methods: Forty patients under the RNTCP programme implemented through the Health Centers of

BMC were identified. The information was collected using an in-depth interview technique. They were

both male and female aged between 4-70 years suffering from pulmonary and extra pulmonary tubercu­

losis. All patients were from the poor socio economic background.

Results: Most patients who first sought help from private practitioners were not diagnosed and

treated correctly. They sought help form them as they were easily accessible and available but they. Most

patients sought help later than four weeks as they lacked awareness. A few of patients sought help from tra­

ditional healers and magicians, as it did not help they turned to allopathic practitioners. The patients inter­

viewed were inadequately informed about various aspect of the disease due to fear of stigma. The patient's

family members were generally supportive during the treatment period there was no report of negative

attitude of neighbours who were aware of tuberculosis patients instead sympathetic attitude was reported.

There exists many myth and misconception associated with marriage and sexual relationship while one

suffers from tuberculosis. Patients who visited referral hospitals reported that money was demanded for pro­

viding services. Most patients had to borrow money for treatment. Patients want health centres to be clean

and be opened on time. They don't like the staff shouting at them to cover their mouth while coughing.

Conclusion: Community education would lead to seek help early and to take preventive measures.

Adequate patient education would remove all myth and conception and help the patients adhere to treat­

ment. Since TB thrives among the poor, Poverty eradiation measures need to be given more emphasis.

Mere treatment approach would not help control tuberculosis.

PS-48 (C) Prevalence of Oncogenic Human Papillomavirus Infection and Pap Test Abnormalities in

Street Y outb Eileen McMahon and Beth Hayhoe

lntrod#ction: The main causative factor in cervical cancer is the presence of oncogenic human papillo­

mavitus (HPV). Several factors have been identified in the acquisition of HPV infection and cervical cancer

and include early coitarche, large number of lifetime sexual partners, tobacco smoking, poor diet, and con­

comitant sexually transmitted diseases. It is known that street youth are at much higher risk for these fac­

tors and are therefore at higher risk of acquiring HPV infection and cervical cancer. Thus, we endeavoured

to determine the prevalence of oncogenic HPV infection, and Pap test abnormalities, in street youth.

~tbods: This quantitative study uses data collected from a non governmental, not for profit drop­

in centre for street youth in Canada. Over one hundred females between the ages of sixteen and twenty­

four were enrolled in the study. Of these females, all underwent Pap testing about those with a previous

history of an abnormal Pap test, or an abnormal-appearing cervix on clinical examination, underwent

HPV-deoxyribonucleic (DNA) testing with the Digene Hybrid Capture II.

Results: Data analysis is underway. The following results will be presented: 1) number of positive

HPV-DNA results, 2) Pap test results in this group, 3) recommended follow-up. .

Conclusion: The results of this study will provide information about the prevalence of oncogemc

HPV-DNA infection and Pap test abnormalities in a population of street youth. The practice implic~­

tions related to our research include the potential for improved gynecologic care of street youth. In addi­

tion, our recommendations on the usefulness of HPV testing in this population will be addressed.

v120 POSTER SESSIONs

PS-49 (C) A Health Screening Instrument Adapted to the Unique Needs of New Immigrants

and Refugees in Toronto .

Kim Chow, Kamran Khan, Miriam Cho, Vicky Fong, Jun Wang, and Meb Rashid

Introduction: The health needs of immigrants are strongly influenced by life experiences in their

native countries. Many of these experiences can have lasting effects on the health and well being of an

immigrant, long after their arrival to a new country. Thus, attending to the needs of migrant populations

requires an appreciation and understanding of living conditions in the immigrant's country of origin.

Unfortunately, few healthcare providers are trained and experienced to address these kinds of com~lex

issues. Moreover, there are currently very little data to aid in the development of evidence-based guide·

lines to promote health and prevent disease in immigrant and refugee populations.

Methods: A health promotion and disease prevention tool was developed over a period of several years

to meet the health needs of recent immigrants and refugees seen at Access Alliance Multicultural Community

Health Centre (AAMCHC), an inner city community health centre in downtown Toronto. This instrument

was derived from the anecdotal experience of health care providers, a review of medical literature, and con·

sultations with experts in migration health. Herein we present the individual components of this instrument,

aimed at promoting health and preventing disease in new immigrants and refugees to Toronto.

Results: The health promotion and disease prevention tool for immigrants focuses on three primary

health related areas: 1) globally important infectious diseases including tuberculosis (TB), HIV/AIDS,

syphilis, viral hepatitis, intestinal parasites, and vaccine preventable diseases (VPD), 2) cancers caused by

infectious diseases or those endemic to developing regions of the world, and 3) mental illnesses includiog

those developing among survivors of torture.

Conclusions: The health needs of new immigrants and refugees are complex, heterogeneous, and ohen

reflect conditions found in the immigrant's country of origin. Ideally, the management of all new immigrants

should be adapted to their experiences prior to migration, however the scale and complexity of this strategy

prohibits its general use by healthcare providers in industrialized countries. An immigrant specific disease pre­

vention instrument could help quickly identify and potentially prevent the spread of dangerous infectious dis­

eases, detect cancers at earlier stages of development, and inform health care providers and decision makers

about the most effective and efficient strategies to prevent serious illness in new immigrants and refugees.

PS-50 (C) High Risk Youth and Health Problems in Urban Areas

Rana Ahmad

lntrodMction: As poverty continues to grip Pakistan, the number of urban street children grows and

has now reached alarming proportions, demanding far greater action than presently offered. Urbaniza­

tion, natural catastrophe, drought, disease, war and internal conflict, economic breakdown causing

unemployment, and homelessness have forced families and children in search of a "better life," often

putting children at risk of abuse and exploitation.

Objectives: To reduce drug use on the streets in particular injectable drug use and to prevent the

transmission of STDs/HIV/AIDS among vulnerable youth.

Methodology: Baseline study and situation assessment of Health problems particularly HIV and

STDs among street children of Quetta, Pakistan.

Activities and Conclruion: The program launched a peer education program, including: awareness

o_f self and body protection focusing on child sexual abuse, STDs/HIV/AIDS, life skills, gender and sexual

rights awareness, preventive health measures, and care at work. It also opened care and counseling cen­

ter for these working and street children ar.d handed these centers over to local communities. Relation­

ships among AIDS-related knowledge and bt:liefs and sexual behavior of young adults were determined.

Rea.sons for unsafe sex included: misconception about disease etiology, conflicting cultural values, risk

demal, partner pressur~, trust and partner significance, accusation of promiscuity, lack of community

endorsement of protecnve measures, and barriers to condom access. In addition socio-economic pres­

sure, physiological issues, poor community participation and anitudes and low ~ducation level limited

the effectiveness of existing AIDS prevention education. According to 'the baseline study the male chil­

dren are ex~ to ~owledge of safe sex through peers, Hakims, and blue films. Working children

found sexual mfor~anon through older children and their teachers (Ustad).

Recommendations: It was found that working children are highly vulnerable to STDs/HIV/AIDS, as

they lack protective meas":res in sexual abuse and are unaware of safe sexual practices. Training of ado­

l~t as peer.educators ts recommended. Ours being an Islamic society, such information should be

~~ to youth ma way that does not challenge local norms and values. Problem-based learning and par-

napatory edu ti i · · kn · h Id be i:a on or unproVJng owledge and condom use and community-based intervenoons

s ou considered for STDs/HN/AIDS prevention.

POSTER SESSIONS v121

PS-51 (A) Non-Fatal Overdos~ is Associated with Crystal Methamphetamine Use Among a Cohon of

Injection Drug Users in Vancouver

Nadia Fairbairn, Evan Wood, Mark Tyndall, Kathy Li, Julio Montaner, and Thomas Kerr

Backgrrnmd/Objectives: Non-fatal overdose is common among injection drug users (IDU) and is a

primary determinant of morbidity within this population. We sought to evaluate the prevalence and cor­

relates of non-fatal overdose among a polysubstance-using cohort of IDU in Vancouver.

Mnbods: We evaluated factors associated with non-fatal overdose among participants enrolled in the

Vancouver Injection Drug User Study (VIDUS) using Pearson's Chi-square test and Fisher's exact test.

Results: Of the 551 participants followed from December 1st, 2003 to June 1st, 2005, including

225 (43.8%) women and 186 (36.2%) individuals of Aboriginal origin. In total, 37 (6.7%) individuals

reported experiencing non-fatal overdose in the previous 6 months. Factors positively associated with

non· fatal overdose included street injecting (OR =4.74, 95% CI: 2.35 - 9.37, p < 0.001), crystal meth­

amphetamine use (OR =4.11, 95% CI: 1.91 - 8.83, p <0.001), injection crystal methamphetamine use

(OR =3.63, 95% Cl: 1.73 - 7.61, p <0.001), morphine use (OR =3.55, 95% Cl: 1.73 - 7.31, p

<0.001), use of non-injection opiates (OR = 3.30, 95% Cl: 1.63 - 6.69, p < 0.001 ), and sex trade work

(OR =2.12, 95% Cl: 1.03 - 4.26, p =0.03). Factors negatively associated with non-fatal overdose

included participation in methadone maintenance therapy (OR =0.31, 95% Cl: 0.13-0.71, p =0.004)

and injecting alone (OR =0.36, 95% Cl: 0.17-0.78, p =0.007).

Conclusion: Non-fatal overdose was a common occurrence for IDU in Vancouver, and was associ­

ated with several factors considered including crystal methamphetamine use. These findings indicate a need

for structural interventions that seek to modify the social and contextual risks for overdose, increased

access to treatment programs, and trials of novel interventions such as take-home Naloxone programs.

P5-52 (A) Race and Criminal Justice Involvement Among Injection Drug Users

Alexis Martinez, Ricky Bluthenthal, Jennnifer Lorvick, and Alex Kral

Background: Injection drug users (IDUs) are at elevated risk for involvement in the criminal justice

system due to possession of illicit drugs and participation in drug sales or markets. The criminalization of

drug use may produce significant social, economic and health consequences for urban poor drug users.

Injection-related risks have also been associated with criminal justice involvement or risk of such involve­

ment. Previous research has identified racial differences in drug-related arrests and incarceration in the

general population. We assess whether criminal justice system involvement differs by race/ethnicity

among a community sample of IDUs. Methods: We analyzed data collected from IDUs (N = 1,084) who were recruited in San Francisco,

and interviewed and tested for HIV. Criminal justice system involvement was measured by arrest, incar­

ceration, drug felony, and loss/denial of social services associated with the possession of a drug felony.

Multivariate analyses compared measures of criminal justice involvement and race/ethnicity after adjust­

ing for socio-demographic and drug-use behaviors including drug preference, years of injection drug use,

injection frequency, age, housing status, and gender. Results: The six-month prevalence of arrest was highest for Whites (32%), compared to African

Americans (25%) and Latinos (27% ), in addition to the mean number of weeks spent in jail in the past 6

months (7.0 vs. 5.8 and 4.2 weeks). These differences did not remain statistically significant in multivari­

ate analyses. Latinos reported the highest prevalence of a lifetime drug felony conviction (48%) and

mean years of lifetime incarceration in prison (13.3 years), compared to African Americans (48%, 10.7

years) and Whites (34%, 6.9 years). Being African American was independently associated with having a

felony conviction and years of incarceration in prison as compared to Whites.

Discussion: The history of involvement in the criminal justice system is widespread in this sample.

When looking at racial/ethnic differences over a lifetime including total years of incarceration and drug

felony conviction, the involvement of African Americans in the criminal justice system is higher as com­

pared to Whites. More rigorous examination of these data and others on how criminal justice involve­

ment varies by race, as well as the implications for the health and well-being of IDUs, is warranted.

P5-53 (A) The Demographics, Lifestyle Patterns and Expressed Needs of the Street Dwellers in the City

of Manila: Implications on Urban Health Service Delivery

Gregory Vincent Ferrer

Homelessness is a major social concern that has great im~act on th~se living.in urban commu?ities.

Metro Manila, the capital of the Philippines is a highly urbanized ar~ w.1t~ the h1gh~st concentration of

urban poor population- an estimated 752,229 families or 3,005,857 md1v1duals. This exploratory study

v122

is the first definitive study done in Manila that explores the needs and concerns of street dwdlent\omc.

less. It aims to establish the demographic profile, lifestyle patterns and needs of the streetdwdlersindit

six districts City of Manila to establish a database for planning health and other related interventions.

Based on protocol-guided field interviews of 462 street dwellers, the data is useful as a template for ref!!.

ence in analyzing urban homelessness in Asian developing country contexts. Results of the study show

that generally, the state of homelessness reflects a feeling of discontent, disenfranchisement and pow!!·

lessness that contribute to their difficulty in getting out of the streets. The perceived problems andlar

dangers in living on the streets are generally associated with their exposure to extreme weather condiriOll!

and their status of being vagrants making them prone to harassment by the police. The health needs of

the street dweller respondents established in this study indicate that the existing health related servias

for the homeless poor is ineffective. The street dweller respondents have little or no access to social and

health services, if any. Some respondents claimed that although they were able to get service from heallh

centers or government hospitals, the medicines required for treatment are not usually free and are

beyond their means. This group of homeless people needs well-planned interventions to hdp them

improve their current situations and support their daily living. The expressed social needs of the sucet

dweller respondents were significantly concentrated on the economic aspect, which is, having a perma·

nent source of income to afford food, shelter, clothing and education. These reflect the street dweller's

need for personal upliftment and safety. In short, most of their expressed need is a combination of socio­

economic resources that would provide long-term options that are better than the choice of living on the

streets. The suggested interventions based on the findings will be discussed.

PS-54 (A) Estimates of HIV, HCV and Syphilis in Two Mexican Border Cities Derived &om Respondent

Driven Sampling: Do Referral Networks Influence Disease Prevalence?

Kimberly Brouwer, Remedios Lozada, Maria Elena Ramos, Carlos Magis, and Steffanie Strathdee

. Introduction: Respondent-driven sampling (RDS), a chain-referral sampling approach, is increas·

m~ly used to recrui~ participants from hard to reach populations, such as injection drug users (IDUs).

U~mg RDS, we derived prevalence estimates for HIV, HCV and syphilis among IDUs in Tijuana and

Cmdad Juarez, two Mexican cities bordering San Diego, CA and El Paso, TX, respectively.

. Methods: IDU~ aged I 8 and older who injected drugs within the prior month were recruited in 2005

usmg RDS which relies on referral networks to generate unbiased prevalence estimates. A diverse and mon·

vated g~o~p of IDU "seeds." were given three uniquely coded coupons and encouraged to refer up to three

other ehgibl~ IDU~, for which they received $5 USD per recruit. All subjects provided informed consent, an

anonymous 1~terv1ew and a venous blood sample for serologic testing of HIV, HCV and syphilis anti~!·

Results. A total of 213 IDUs were recruited in Tijuana and 206 in Juarez, of whom the maion!)'

were .male <9.l.4% and 92.2%) and median age was 34.8 and 35.3 respectively. After conrroUing for

recruitment patterns homophily d k · R ' I d ' ch blood Ix . . ' an networ size, DS population estimates were calcu ate 1or ea

T' >rne infection across both study sites. Crude RDS Adjusted Prevalence (%) Prevalence(%)

H1c'~van9a5(6n=921143S) Hlh~l.3.1 1.7 HCV 95.2 95.9 Syphilis 16.110.5 Ciudadjuarez (n=206)HIVJ.02.3

. . YP I IS 3.6 7.2. Conclusion· Based on pr · I · · · · di

·d 1 . . • opomona recrmtment across groups (i e probability of HIV posmve in •

vf I uHalsVrecHruCVmngdHIV ~~~tive individuals) and estimated mean nern:o~k size for each group, prevalence

or • an syph1hs m both ·it' d d 1· h II H d. d h.1. 1: ies ecrease s 1g tly, suggesting that sources of bias are sma · ow·

ever, a JUste syp 1 1s prevalence in J · ·f· Alth gh HIV I 1 uarez was s1gm 1cantly higher than the crude prevalence. ou

HIV p~dva e.nce wlads ow among IDUs in both cities, HCV prevalence was very high suggesting that an

ep1 enuc cou occu I · ' ·

b. sed 1 . r un ess vigorous prevention efforts are undertaken Overall the abiliry to obtain

un ia preva ence estimate · RDS · · · ' s usmg is invaluable for program planning and policy development.

PS-SS (A) Size of the Eth · C • .

Urban Citi n- t hmc ommuruty and Health Status of the Aging Chinese in Canada: Are Smaller

es •••1:-ner 1or t e Health of Aging Chin -C di Shirley Chau and Daniel Lai ese ana ans?

llfhodiu:tion: Despite the increase of I I d' · · · d

health and well be' f h . cu tura 1vers1ty m Canada's population attention towar

Although the ch· mg~ the lagmg ~p~lation from culturally diverse backgrounds i; relatively limited.

mese is t e argest v1s1ble · · · · d ·

this country· and the p . f h mmority group m most of the major Canadian cines an 18

. • roport1on o t e aging po I · th h' · · ( n'velv higher than most visibl . . pu anon among e C mese-Canad1ans 1s re a .

e mmority groups little re ch d' f h · Chi·

ncse in Canada is availabl Th' ' . seu on pre 1ctors of health status o t e aging

nity on the health out e. f this pa~r exammed the effect of the population size of an ethnic commu·

h come o e agmg immigrant fr h · that as not been answered· h . . s om t e same community, a research quesnon

m researc on ethmc mmority aging populations.

POSTER SESSIONS v123

Melhotls: Using the data from a multi-site survey on health and well being of a random sample of

older Chinese in seven Canadian cities, this paper examined the effects of size of the Chinese community

and the health status of the aging Chinese. The sample (N=2,272) consisted of aging Chinese aged 55

years and older. Physical and mental status of the participants was measured by a Chinese version Medi­

cal Outcome Study Short Form SF-36. One-way analysis of variance and post-hoc Scheffe test were used

to test the differences in health status between the participants residing in cities representing three different

sizes of the Chinese community. Regression analysis was also used to examine the contribution of size of

the Chinese community to physical and mental health status.

Rmdts: In general, aging Chinese who resided in cities with a smaller Chinese population were

healthier than those who resided in cities with a larger Chinese population. The size of the Chinese com­

munity was significant in predicting both physical and mental health status of the participants. The find­

ings also indicated the potential underlying effects of the variations in country of origin, access barriers,

and socio-economic status of the aging Chinese in communities with different Chinese population size.

Conclusion: The study concluded that size of an ethnic community affected the health status of the

aging population from the same ethnic community. The intra-group diversity within the aging Chinese

identified in this study helped to demonstrate the different socio-cultural and structural challenges facing

the aging population in different urban settings.

P5-56 (A) Child Morbidity and Health Seeking Behavior Among Slum Residents in Nairobi City, Kenya

Jean Christophe Fotso, Robert Ndugwa, Eliya Zulu, and Zewdu Woubalem

lntrodiu:tion: This paper examines the consequences of livelihood conditions, dwelling characteris­

tics and other socioeconomic and environmental factors on child health among the urban poor. The

goals are to analyze the health conditions of the urban poor by: (i) describing patterns of morbidity

among children in urban poor settlements; (ii) examining how household socioeconomic status (SES) and

other environmental and behavioural factors influence child morbidity in urban poor settlements; and

(iii) examining how livelihood conditions of families and other socioeconomic factors such as maternal

education affect health seeking behaviors of parents/caregivers in informal settlements.

Methods: The study uses longitudinal data collected in 2003, 2004 and 2005 from the Nairobi

Urban Health and Demographic Surveillance System, which is implemented by the African Population &

Health Research Center (APHRC) in two slum settlements of Nairobi city. This study focuses on common

child illnesses including diarrhea, fever, cough, common cold and malaria, as well as on curative health

care service utilization. Measures of SES were created using information collected at the household level.

Other variables of interest included are maternal demographic and cultural factors, and child characteris­

tics. Statistical methods appropriate for clustered data were used to identify correlates of child morbidity.

Preliminary Ratdts: Morbidity was reported for 1,087 (16.1 %) out of 6,756 children accounting

for a total of 2,691 illness episodes. Cough, diarrhoea, runny nose/common cold, abdominal pains,

malaria and fever made up the top six forms of morbidity. The only factors that had a significant associ·

ation with morbidity were the child's age, ethnicity and type of toilet facility. However, all measures of

socioeconomic status (mother's education, socioeconomic status, and mother's work status) had a signif­

icant effect on seeking outside care. Age of child, severity of illness, type of illness and survival of father

and mother were also significantly associated with seeking health care outside home.

Conclusion: The results of this study have highlighted the need to address environmental condi­

tions, basic amenities, and livelihood circumstances to improve child health in poor communities. The

fact that socioeconomic indicators did not have a significant effect on prevalence of morbidity but were

significant for health seeking behavior, indicate that while economic resources may have limited effect in

preventing child illnesses when children are living in poor environmental conditions, being enlightened

and having greater economic resources would mitigate the impact of the poor environmental conditions

and reduce child mortality through better treatment of sick children.

PS-57 (A) Human Health and Inner City Deprivation in the Third World: The Crack in Social justice

Usman Raheem

Inequality in human life chances is about the most visible character of the third world urban space.

F.conomic variability and social efficiency have often been fingered to justify such inequalities. Within

this separation households exist that share similar characteristics and are found to inhabit a given spa­

tial unit of the 'city. The residential geography of cities in the third world is thus characterized by native

areas whose core is made up of deteriorated slum property, poor living conditions and a decayed envi­

ronment; features which personify deprivation in its unimaginable ma~t~de. There are .eviden~es that

these conditions are manifested through disturbingly high levels of morbidity and mortality. This paper

v124 POSTER SESSIONS

h h d ance of these conditions in the inner cities of the third world bear close rela-argues t at t e prepon er . . d 1 al· fie · · · h. · h h va1·1·ng circumstances of ab1"ect poverty, ignorance, 1lhteracy an cu tur m xibil­

uons 1p wit t e pre 1 . . . · h" ban · h h d- and a host of other factors (corrupt10n, msens1t1ve leaders 1p, poor ur 1ty on t e one an , . · 1 f · 1 · · Th

t ) that Suggest cracks in the levels and adherence to the prmc1p es o socta 1usnce. ese governance, e c . . . . .

PS £factors combine to reinforce the impacts of depnvat10n and perpetuate these unpacts. By 1den· grou o . ·1 "Id .. bothh tifying health problems that are caused or driven by either matena _or soc1a e~nvanon or , t e

paper concludes that deprivation need not be accepted as a way. of hfe a~d a deliberate effon must be

made to stem the tide of the on going levels of abject poverty m the third world. To the extent that

income related poverty is about the most important of all ramifications of po~erty, efforts n_iu_st include

fiscal empowerment of the poor in deprived areas like the inner c~ty. This will ~p~ove ~he willingness of

such people to use facilities of care because they are able to effectively demand 1t, smce m real sense there

is no such thing as free medical services.

P5-58 (A) Perceived Impact of HIV and its Associated Treatment on Activity Limitations: Role

of Symptom Burden

Sergio Rueda, Winston Husbands, Gerald Devins, Michael Wilson, and Sean B. Rourke

Introduction: With the development and availability of highly active antiretroviral therapy

(HAART), there has been a dramatic reduction in morbidity and increase in survival, and increasingly a

need to understand how HIV disease may affect everyday functionin.

Methods: As part of an OHTN-funded study examining the natural history of neurobehavioural

complications associated with HIV and AIDS and their impact on everyday functioning and hea~th­

related quality of life (HRQOL), 450 adults with HIV were administered detailed neuropsychological

testing, measures of depression (Beck Depression Inventory), cognitive symptoms (Patient's Assessment

of Own Functioning Inventory), HRQOL which included measures of pain and fatigue [MOS-HIV], and

everyday functioning (Illness Intrusiveness Rating Scale [IIRS]). There were 322 men with HIV-infection

included in the present study (mean age and education of 41.8 (SD=8.4) and 13.9 (SD=2.7), respec­

tively). A series of multiple regressions were used to examine the unique contributions of symptom bur­

den (depression, cognitive, pain, fatigue), neuropsychological impairment (psychomotor efficiency),

demographics (age and education) and HIV disease (CDC- 93 staging) on IIRS total score and JIRS sub­

scores: ( 1) Activities of daily living (work, recreation, diet, health, finances); (2) Psychosocial functioning

(e.g., self- expression, community involvement); and (3) Intimacy (sex life and relationship with partner).

ResNlts: Total IIRS score (R2"0.43) was associated with AIDS diagnosis (Ii= 0.11, p <0.01) and

symptoms of pain (Ii= -0.14, p < 0.01 ), fatigue (ji = - 0.34, p < 0.001) and cognitive difficulties (p =0.30, P

< 0.001 ). For the three dimensions of the IIRS, multiple regression results revealed: ( 1) activities of daily liv­

ing (R2=0.42) were associated with AIDS diagnosis (Ii =0.17, p < 0.01) and symptoms of pain <P =-0J6,

P < 0.01 ), fatigue (ji = - 0.31, p < 0.001) and cognitive difficulties (ji =0.32, p < 0.001 ); (2) Psychosocial

functioning (R2=0.31) was associated with was associated with symptoms of fatigue (Ii= -0.25, p <0.001)

and cognitive difficulties <Ii =0.19, p <0.001); and (3) Intimacy (R2=0.17) was related to was associated

with symptoms of fatigue (IJ = - 0.17, p < 0.01) and cognitive difficulties (Ii= 0.19, p < 0.001 ).

Conc:buion: Symptoms of pain, fatigue and cognitive difficulties have a significant burden on every­

day functioning and activities of daily living in adults with HIV and AIDS. More attention is needed to

develop and test out interventions to reduce this symptom burden and improve HRQOL.

P5-59 (A) Two Year Results &om the Evaluation of Vancouver's Safer Injection Facility

Thomas Kerr, Mark Tyndall, Jo-Anne Stoltz, Kathy Li, Ruth Zhang, Julio Montaner, and Evan Wood

. ~nd!Ob;ecti~s: In September 2003, North America's first medically supervised safer ini_ec-

non fac1hty (SIF) opened m Vancouver, Canada. Our objective is to report on 2 years of evaluauon

results from the Vancouver SIF scientific evaluation project.

Methods: The SIF evaluation methodology involves a comprehensive database located at the SIF, a

randomly selected p~o.spective coh~rt of SIF users, and two pre-existing external control cohorts.

. . ~ts: In addmon to reporting process data and descriptions of the SIF users, we report on data

indicating that the establishment of the SIF has been independently associated with reductions in public

~':°g ~ (p <?.001), and syringe sharing (AOR =0.3[95%CI: 0.1 _ 0.7); p =0.013) and other unsafe

m1ecnon pract1_ces_ (p ~ 0.010), and increased uptake of detox services (log-rank p =0.017). As well, we

report on da~ md1cat1ng that the SIF has not prompted adverse changes in community drug use patterns.

CondNStons: The Vancouver SIF has been well accepted by the target population, and while

adve~ events s~c~ as overdoses have occurred, these events have been successfully managed. Externally

compiled data indicate that the SIF has been associated with substantial declines in public disorder

!'OSTER SESSIONS v125

associated with injection drug use, syringe sharing, and increased uptake of detox services. As well, the

establishment of the SIF has not exacerbated community drug use patterns. Ongoing evaluation activities

wiU involve assessing the impact of the SIF on a variety of outcomes, including infectious disease trans­

mission, fatal overdose, and utilization of health and social services.

PS-60 (A) Intra-Urban Dynamics of Dengue Epidemics in Belo Horizonte City, Brazil, 1996-2002

Maria Cristina Almeida, Waleska Caiaffa, Renato Assum;iio, and Fernando Proietti

Dengue cases were described according to time, space, intensity, age, gender, onset of symptoms,

residence address and census tract. Spatial distribution of two groups (children and women over 64 years

old and men aged 20-59) were compared, under assumption that they have distinct behaviors regarding

their displacement around the city. Analysis included local Moran index, Ripley\\\\\'s K function and

recurrence of census areas over time. About 99,559 cases were identified in seven epidemic waves. Con­

centration of cases in small areas, followed by a spread either in space or time suggested endemic pat­

terns. Regarding age-gender groups, distinct patterns suggested that residence might not be a good proxy

in determining the local of infection for men aged 20-59. Dengue is shifting to endemic pattern in this

city and transmission may not be sole related to home environment, suggesting that additional spatial

information must be coUected aiming efficient control measures.

P5-61 (A) Disabled Children in Kerala in South India: A Fresh Look into Their Health Status

and Quality of Life Murukan Kandamuthan and Subodh Kandamuthan

lnl7Uduction: Illness or disablement of a child may affect the economic functioning of a family as it

alters the employment pattern and earnings of parents This paper tries to assess the health status and the

quality of life of disabled children, and how generally, severe disablement in a child affected their fami­

lies\\' finances, and to quantify any such effects the problems faced by children in their home and to pro­

vide information relevant to the formation of criteria for new or increased cash support.

Methods: A case-control study was done in the Thiruvananthapuram district, capital city of Kerala by

selecting a random sample of 300 families with severely disabled children below 15 years and a random sam­

ple of 300 normal children matched for age and occupation of the parents. Comparative and subjective data

were collected. Money spent on children\\'s medical care, loss of earnings of the parents, and other economic

burden to the family due to the disability of the child in the family. A discriminant analysis along with

univariate analysis was done to assess the factors that mostly differentiate the disabled and normal children.

Results: The mean expenditure of the families with a disabled child was Rs. 852/- per month, which

is significantly higher than the corresponding expenditure of Rs. 389/- per month of families with normal

child, (t= 16.86, P <.00001). Of the disabled children, 81 % were not getting any social security payments

and 90% had no special concessions for medical and other educational purposes. The analysis of income

and expenditure pattern indicated that financial impact of disablement in a child on the family is signifi­

cant. The discriminant model results revealed that medical expenditure was a significant variable that

differentiated the disabled and normal child. Conclusion: The study found that the health status and quality of life of the disabled children were

far from satisfactory. This in fact affected the economic status of the disabled children. In addition to

reduced earnings, there are extra costs for disabled children for travel, domestic help, medical care, and

health care expenditures (hospital care, physician services, dentistry, drugs and others) for disabled indi­

viduals. A strong case can be made for their long-term care by improving the financial support to such

families possibly through the introduction of an allowance specially to compensate for the earnings lost

by parents due to the disability of their children.

PS-62 (A) Do Older Widows Better off in Urban Setting in India: Evidence &om National Sample Survey

Pushpanjali Swain

Widows in India are considered disadvantage group of population. Because they are characterized

by pangs of separation from spouse, and consequently they go through mental agony, social ~s?lation,

and economic dislocation. In addition to these, poverty, landlessness, homelessness, malnutr1non etc.

endure serious deterioration of their health. According to census 2001, there are 44 million women are

widowed and one fourth live in urban areas. There is a noticeable increase of urban widows from the

previous census (almost half). The paper examines the type of disability and chronic ailment borne

among elderly widows (60 years and above). Fifty second round of National Sample Survey aske~ the

individuals three sets of questions regarding their health: their status of health, whether they are physically

POSTER SESSIONS v126

immobile, and whether or not they have had any specific chronic illnesses. Although health infrastruc-1 1 ·1 ble 1·n urban setting in India as compared to rural counterpart, prevalence of tures are arge y ava1 a . . . . .

h · ·11 · h h"gher 1"n urban areas Analysis shows 1omt problems m old age qmte common c romc 1 ness is muc 1 • . . and nearly 44 percent elderly widows are suffering from this ail'.11ent in urban areas. One-fifth of widows are suffering from high/low BP. Heart disease, diabetes and urinary problems are much ~ore pre~alent in urban areas though disabilities is comparatively lower in urban areas. However, the d~fference is not statistically significant. Disability with respect to vision is more pronounced and one third_ of the total respondents have problems regarding eyesight. One fifths ofdderly widows are _ha.rd of hearing. Though disability increases with age, similar trend is not observed with respect to chr~mc illness. The percepnon of self-health among elderly becomes poorer as their age increases. The perceived health status need not be always corrected to objective indicators of health. It is noted that around 27 per~en~ of those per­ceived their health as "excellenr" or "very good" are found to be suffering from chrome disease of1omts and 17 percent have visual disability. To conclude an elderly widow living in urban areas have similar health problems as she Jives in rural areas. This can be easily explained, as they were not made aware to seek treatment from health facility. In addition, the study shows that the economic conditions are deter­rent factors for their illness. It is essential that intervention should be taken up improving their economic conditions so that wellbeing of this most vulnerable group of the society can be taken care of.

PS-63 (A) Heart Failure: An Urban Crisis Maribeth Gregory

Heart failure is a disease that affects nearly 15 million people world wide. The United States alone accounts for one third of this population. Blacks are stricken with heart failure twice as often as whites. Men are more likely to develop CHF than women, however since the majority of the CHF population are seniors, there are actually more women than men. Congestive heart failure (CHF) has become a pan­demic. As the baby boomer generation ages, the number of CHF cases will rise dramatically. (Young, J. & Mills, R.,2004). After the age of 45, each proceeding decade doubles the incidence level of CHF. The average person has a 1 in 5 chance of developing heart failure within their lifespan according to the Framingham study (NIH.gov). Individuals aging 65 or older compose over half of the entire documented heart failure population. In this age group, CHF is the leading cause of hospitalization. Many patients are continuously readmitted. It is estimated that the CHF population will increase by one million within the next 25 years. Mortality was at 50% for a two year period and 70% for five years (Young, J. & Mills, R.,2004 ). data from: AHA As technology evolves, the understanding of the nature of heart failure has become clearer. In the beginning of the 20th century heart failure was diagnosed as a condition that presented with edema (swelling) in the extremities caused by water retention. Treatment in the beginning of the past cenrury was limited to abdominal drainage and diuretics. The discovery of the heart's insuffi­cient pumping ability in heart failure patients lead to new surgeries and devices such as heart transplants and ventricular assist devices (bridge until transplant is available). Ventricular hypertrophy often occurs before the development of heart failure. Hypertrophy is the term given for cardiac remodeling. Cardiac remodeling also includes chamber dilation (Young, J. & Mills, R.,2004). CHF financial burden The US Healthcare Financing administration has ranked CHF as the highest cost illness in the diagnose-related area. Direct costs related to CHF in the US for 2004 were nearly $26 billion. These costs included hospi­tal admissions, physician fees, home health aids and medications. Indirect costs were over $2 billion in 2004. Loss of jobs or death due to CHF was the criteria for this category (Young, J. & Mills, R., 2004).

PS-64 (A) Content Validation of the Injection Drug User Quality of Life Scale (IDUQOL) Anita Palepu, Anita Hubley, and Lara Russell

. Introduction: The Injection Drug User Quality of Life Scale (IDUQOL) is a relatively new scale ~es1gned to capture the unique and individual circumstances that determine quality of life among injec­tion drug users (IDUs). The 20 life areas comprising the instrument were based on the research literature an~ ~ocus group discussions with IDUs. The purpose of the present study was to evaluate the content validity of t.h~ IDUQOL using judgmental methods based on subject matter experts' (SMEs) ratings. Content vah~1ty refers to the de~ee to which elements of an assessment tool are representative of the construct of interest and appropnate for a given population.

Methods: Data were obtained from six SMEs, from the field of IDU research and practice, who ~ere. asked t.o evaluate various aspects of the IDUQOL, including the title of the instrument, administra­~on instruchons, clarity of the names and descriptions of each life area, response format, scoring instruc­no~s and examples, record form and whether each life area should be included in the instrument. SME ratings were made using either 3 or 4 point scales. SM Es were also given the opportunity to comment on

POSTER SESSIONS v127

each section and to suggest whether important life areas had been overlooked, were redundant, not rele­

vant, or in need of revision. Renlts: Two commonly used measures of interrater agreement, the Content Validity Index

(CVI) and the ~v.erage ~eviation Index (AD) were used to evaluate SMEs' agreement on ratings of

the content vahd1ty vanables. Both measures provided support for the content validity of various

aspects of the IDUQOL, although results from the stricter AD index noted some areas of disagree­

ment, including the description of particular life areas (e.g., being useful, drugs, sex), the inclusion of

some life areas (e.g., drug treatment, education, independence and free choice), and the ease of the

scoring instructions. Condruion: The findings from this study provide (a) content validity evidence to support the use of

the IDUQOL as well as (b) recommendations to suengthen both the instrument (e.g., improved descrip­

tions for some items) and the accompanying administration and scoring manual (e.g., an easier scoring

template). Changes made to the instrument and its manual make the IDUQOL even easier for research­

ers, practitioners, and program evaluators to use as a way of assessing, and tracking changes over time or

as a result of interventions in, quality of life in injection drug users.

P5~5 (A) A Systematic Review of the Effectiveness of Behavioural Interventions to Improve Adherence

to Antiretroviral Therapy in HIV I AIDS Sergio Rueda, Laura Park-Wyllie, Richard Glazier, Ahmed Bayoumi, Anne-Marie Tynan,

Tony Antoniou, and Sean 8. Rourke

Introduction: Strict adherence to prescribed regimens is required to derive maximal benefit from

highly active antireuoviral therapy (HAART) in persons living with HIV/AIDS (PHAs). Adherence is a

key determinant of the degree and durability of viral suppression. Adherence is also essential in reducing

the spread of HIV and ensuring that today's treatments remain effective for as long as possible. The

objective of this study is to conduct a systematic review of the research literature on the effectiveness of

education and patient support strategies for improving adherence to HAART.

Methods: A systematic search of the core databases was performed from January 1996 until May

2005. Randomized Controlled Trials examining the effectiveness of education and patient support inter­

ventions to improve the adherence to HAART were considered for inclusion. Only those studies that

measured adherence at a minimum of six weeks were included. Study selection, quality assessments, and

data abstraction were performed independently by two reviewers. Results: Study heterogeneity with respect to differing populations, interventions, outcomes, and

length of follow-up did not allow for meta-analysis. We included 19 studies involving 2, 159 PH As. Sam­

ple sizes ranged from 22 to 367. Study duration ranged from a single session to a variable number of ses­

sions delivered over one year. Many of the interventions involved the provision of an educational

component to improve adherence and often addressed strategies to overcome barriers to adherence and

the development of problem-solving skills. They ranged from simple interventions (e.g., the provision of

reminder devices) to complex interventions (e.g., cognitive-behavioural therapy delivered by licensed

psychologists). Eleven of the 19 studies demonstrated a statistically significant advantage associated with

the described adherence intervention. The advantage associated with adherence outcomes does not seem

to translate into the more clinically relevant outcome of viral suppression. Only 4 out of 12 studies that

reported virological or immunological results found a significant effect associated with the intervention.

The studies had several methodological shortcomings. Conclusions: There is a need for standardization and methodological rigour in the conduct of

adherence trials. Some interventions may have a significant impact on improving adherence. Further

research is required before any specific adherence improving strategy can confidently be incorporated

into standard clinical practice.

P5-66 (A) Paying the Price to Stay Alive: HIV Medications and Longevity with HIV Without Future Hopes

Laura Park-Wyllie, Carol Strike, Tony Antoniou, and Ahmed Bayoumi

Objective: To identify the effects of antiretroviral therapy on quality of life and whether important

content areas are missing from the MOS-HIV Health Survey. . Iksign and Methods: Focus groups were used to collect data from a purposive sample of treatment-

experienced participants. focus group data were analyzed using a grou~ded t~eory appr~ach. i:ne

themes identified from the interviews were used to identify the effects of ant1rerrov1rals on quality of hfe.

The content of the MOS-HIV was appraised against the themes identified from our analysis. Participants

also completed the MOS-HIV survey and were asked whether the survey covered all important aspects of

quality of life on antiretroviral medications.

v128 POSTER SESSIONS

Results: Five key informant interviews and five focus groups with 38 participants were used to iden­tify effects on quality of life that are not directly ~aptu~ed by_ the MOS-HIV Health Survey. Our~~ showed that our participants described quality of hfe as mvol~mg_ a set of ~rsonal trad~ffs ~stay alive. In most cases, worsened quality of life was traded-off for gams 1~ longeVlty from ~~canon use. These eff~'ts or tradeoffs included: ( 1) Downstream Consequences of Side effects and toXlanes; (2) Loss of lrufe. pende~t Decision-Making Privileges, (3) Having to Choose Drugs over ~areer; (~)Burden of Medication­Taking Responsibilities; and (5) Living Life Under a Pretense and Havmg to Hide- The net effect of the tradeoffs, or "prices" to pay led to what was described as "longevity with HN without hope and future~.

Conclusion: Our study highlights five major themes summarizing the impact of HAART on quality on life, and suggests that currently used scales for measuring quality of life do not a~atd~ cap~e these findings and the associated consequences. The conceptual framework for measuring quality of bfe in HIV should be reconsidered in order to better capture the important effects of the medications on quality of life. This may involve widening the boundaries of the definition of health-related quality oflife to include aspects such as finances, employment, and housing. We should further consider the develop­ment of a HAART adverse effect specific instrument, using a broad definition of adverse effect in order to capture all types of adverse impacts of HIV treatments on quality of life.

PS-67 (A) Seroiogic Immunity to Measles Among Adult Immigrants and Refugees in Toronto Kamran Khan, Kim Chow, Miriam Cho, Vicky Fong, jun Wang, and Meb Rashid

Introduction: Measles (rubeola) is the most contagious vaccine preventable disease of humans. While cases of measles are uncommon in Canada today, the disease continues to be a leading cause of morbidity and death in the developing world. As a result of human migration, measles cases still occur in Canada, primari~ among immigrants, returning travelers, and other susceptible groups. Canada's National Advisory Council on Immunizations (NACI) recommends that immigrants without records of measles immunization be considered for vac:cination since these individuals may not have been appropriately vaccinated in their native country. On rhe other hand, natural immunity to measles in immigrants is likely to be high given the high incidence of dis­ease in developing parts of rhe world. Thus it remains unclear if the most efficient strategy to achieve high lev­els of measles immunity in immigrants should entail initial serologic screening followed by vaccination of susceptible individuals or preemptive vaccination of all persons lacking immunization records. Understanding the epidemiology of measles immunity in immigrant populations could help guide such decisions. .

Methods: We identified 527 adults, 15 years of age or older, who were screened for serologtc immunity to measles as part of a recently developed screening protocol at a downtown Toronto commu­nity health centre. We subsequently determined if these individuals had any immunization records from their native country or from within Canada. We then examined the relationship between several demo­graphic factors and immunity to measles.

Results: 93% of immigrants had no prior immunization records. Overall, 93% of the 527 immi­grants rested for immunity to measles were found to be immune; 88% of those under the age of 20, 93% of those between 20 and 39 years of age, 99% of those between 40 and 59 years of age, and 100% of those 60 years of age or older. Gender, education status, household income, and immigration status were nor ~ssoc1ated wirh immunity to measles. Immunity to measles was lowest among immigrants from East­ern Europe (8~%), whil~ immigrants from other regions of the globe had greater than 90% immunity.

C~lusrons: Immigrants and refugees appear to have reasonably high levels of immunity to mea· sics, possibly related to natural infection wirh the measles virus. Immigrants from Eastern Europe appear to have slightly. lower l~vel~ of immunity to the measles virus. Universal screening for immunity to mea­~les or preemptive vac:cmauon may both be inefficient public health strategies, however further research IS needed to corroborate these findings.

PS-68 (A) Body Mass Index in Urban Canada: Neighbourhood and Metropolitan Area Effects Nancy R~ss, Stephane Tremblay, Saeeda Khan, Daniel Crouse, Mark Tremblay, and jean-Marie Berrhelor

O~ve: The speed of the rise in obesity in places like Canada suggests that rather than a shift in the gcncnc_ com~sirion of the population, the root of the obesity pandemic is an environment that sup­~rrs ~besity. This paper examines the influence of neighbourhood and metropolitan characteristics. mdudmg urban sprawl, on body mass index (BMI) in urban Canada in 2001

h Methods: A m~lti-level analysis of a cross-sectional survey of men and ~omen nested in neigbbour-oods and merropohran areas across Canada.

bour~lts:. While accounting. for individual socio-demographics and behaviours, residents of neigh­s with a large proportmn of poorly educated individuals had higher BMis than those living in

POSTER SESSIONS v129

neighbourhoods with more highly educated individuals (p <.01 ). Residing in a neighbourhood with a

high proportion of recent immigrants was associated with lower BMI for men (p<.01), but not women.

Neighbourhood dwelling density, a proxy for walkability, was not associated with BM! for either sex.

Metropolitan sprawl was associated with higher male BMI (p=.02) but the effect was negligible for

women (p=.09). BMI was significantly lower for women (p<.01) living in a city in the province of Que­

bec, even after accounting for the influence of individual and neighbourhood covariates.

Conclusions: BM! was strongly patterned by individual-level social position in urban Canada. The

incremental influence on BMI of neighbourhood related to the neighbourhood's social conditions and

not to their physical form. Metropolitan sprawl was associated with higher BM! for men, a group with

longer car-dependent commutes than women. The findings suggest that both individuals and their envi­

ronments (both social and physical) influence the distribution of BMI in urban populations.

PS-69 (A) Prevalence of Elevated Blood Pressure, Random Blood Glucose and Proteinuria Among

Asymptomatic Adults in Singapore

Veena Joshi, Jeremy Lim, and Benjamin Chua

Introduction: Urban environments have been linked to a range of human health issues. In Sin­

gapore, Prevalence of End Stage Renal Disease (ESRD) is predicted to rise (2633 in 1999 to 6000 in

2010, Kidney International, Vol.67, 2005). The clinical and economic burden of ESRD has promoted

development of strategies aimed at preventing the development and progression of chronic kidney dis­

ease. These include population based screening programs such as the National Kidney Foundation, Sin­

gapore\'s (NKFS) "Partnership for Prevention."The program, aims to reduce incidence of ESRD through

comprehensive intervention and screening for early detection of urinary abnormalities, blood pressure

(BP), and random blood glucose (RBG). Objective of this study is to examine gender, race and age wise

prevalence of elevated BP, RBG and proteinuria.

Methodology: This current analysis includes 575,438 subjects, age 18 to 86 years, who underwent

screening during September 1999 and December 2004. Participants were asked to give demographic infor­

mation and the history of diseases. Tests were given to get clinical information such as proteinuria, blood

glucose, SBP, and DBP. Blood pressure abnormalities were defined according to ]NC VI criteria. Proteinuria

was defined as the presence of 1 plus or greater protein (equivalent to> 30 mg/di) on dipstick analysis.

Results: There were 296, 116 (51.5%) males. Racial distribution was Chinese (78.8% ), Malay

(8.8% ), Indians (8. 7%) and others (3. 7% ).Among participants, who were apparently "healthy" (asymp­

tomatic and without history of DM, HT, or KD), gender and race wise % prevalence of elevated

(BP> 140/90), RBG (> 140 mg/di) and positive urine dipstick for protein was as follows Male: (20.5;6.9;

3.5) Female:(13.6;5.0;3.2) Chinese:( 17.1;6.0;3) Malay: (19.4;7.3;5.6) Indian:( 15.9;7.5;3.0) Others:

(15.4;4.5;2.9) Total:(l 7.1, 6.1,3.2). Percentage of Participants with more than one abnormality were as

follows. Those with BP> 140/90mmHg, 14% also had RBG> 140mg/dl and 6.4% had Proteinuria> I.

Those with RBG> 140mgldl, 11 % also had Proteinuria> 1 and 35% had BP> 140/90mmHg. Those with

Proteinuria> 1, 18% also had RBG> 140mg/dl, and 38% had BP> 140/90mmHg.

Conclusion: We conclude that sub clinical abnormalities in urinalysis, BP and RBG readings are preva­

lent across all genders and racial groups in the adult population. The overlap of abnormalities, point towards

the high risk for ESRD as well as cardiovascular disease. This indicates the urgent need for population based

programs aimed at creating awareness, and initiatives to control and retard progression of disease.

PS-70 (A) Psychological Vulnerability in Individuals Infected with HIV Predicts Poor Psychological and

Physical Outcomes: A Longitudinal Study

Sarah Rubenstein, William Lancee, Sean B. Rourke, and Douglas Saunders

Introduction: Various theories have been proposed that link differential psychological vulnerability

to health outcomes, including developmental theories about attachment, separation, and the formation

of psychopathology. Research in the area of psychosomatic medicine suggests an association between

attachment style and physical illness, with stress as a mediator. There are two main hypotheses explored

in the present study: ( t) that individuals living with HIV who were upsychologically vulne~able" at study

entry would be more likely to experience symptoms of depression, anxiety and phys1ca! illness over. the

course of the 9-month study period; and (2) life stressors and social support would mediate the relat10n-

ship between psychological vulnerability and the psychological ~nd physical outcomes. .

Methods: Eighty-two adults living with HIV participated m a study mvesnganng the behavioural

determinants associated with adherence to HAART; each participant received up to 14 assessments over

a 9-month follow-up. Measures were the Revised Adult Attachment Scale (RAAS), Dys~nctional Atti­

tude Scale (DAS), Provision of Social Relations Scale (PSRS), Responses to Stressful Life Events scale

v130 POSTER SE5SIONS

(RSLES), State-Trait Anxiety Inventory (STAI), Beck Depr~ssi~n lnvento~ (BDI), and~ _21-item pbys~I symptoms inventory. We characterized participants as havmg psychological vulnerability and low resil­ience" as scoring above 35 on the RAAS (insecure attachment) or above 120 on the DAS (negative

expectations about oneself). . . . . . " . . ,, . Results: At baseline, 55% of parnc1pants were classified as havmg low resilience. Focusmg on

anxiety, the average cumulative STAI score of the low-resilience group was significandy hi~e~ than that of the high-resilience group ( 18.45 SD= 10.6 versus 9.57 SD= 8.6; F(l,80)= 16.74, P <.001). Similar results were obtained for BDI and physical symptoms (F( 1,80)= 14.65, p<.001 and F( 1,80)= 5.50, p<.05, respec· tively). After controlling for resilience, the effects of variance in life stres".°rs averaged over time wa~ a_sig· nificant predictor of depressive and physical symptoms, but not of anxiety. Ho~e_ver, these assooan~s became non-significant when four participants with high values were removed. S1ID1larly, after controlling for resilience, the effects of variance in social support averaged over time became insignificant.

Conclusion: Not only did "low resilience" predict poor psychological and physical outcomes, it was also predictive of life events and social support; that is, individuals who were low in resilience were more likely to experience more life events and poorer social support than individuals who were resilient. For individuals with vulnerability to physical, psychological, and social outcomes, there is need to develop and test interventions to improve health outcomes in this group.

PS-71 (A) Awareness About Contraceptives Among Rural and Urban Youth of New Delhi, India Rajat Kapoor, Ruby Gupta, and jugal Kishore

Introduction: Young people in India represent almost one-fourth of the total population. They face significant risks related to sexual and reproductive health. Many lack the information and skills neces· sary to make informed sexual and reproductive health choices.

Objective: To study the level of awareness about contraceptives among youth residing in urban and rural areas of Delhi.

Method: A sample of 211 youths was selected from Barwala (rural; N= 112) and Balmiki Basti (urban slums; N= 99) the field practice areas of the Department of Community Medicine, Maulana Azad Medical College, in Delhi. A pre-tested questionnaire was used to collect the information. When/(calen· dar time), By 2, fisher exact and t were appliedxwhom (authors?). Statistical tests such as as appropriate.

Result: Nearly 9 out of 10 (89.1 %) youth had heard of at least one type of contraceptive and majority (81.5%) had heard about condoms. However, awareness regarding usage of contraceptives was as low as 9.4% for terminal methods to 39.3% for condom. Condom was the best technique before and after marriage and also after childbirth. The difference in rural and urban groups was statistically signif· icant (p=.0001, give confidence interval too, if you provide the exact p value). Youth knew that contra· ceptives were easily available (81 %), mainly at dispensary (68.7%) and chemist shops (65.4%). Only 6.6% knew about emergency contraception. Only advantage of contraceptives cited was population con· trol (42.6%); however, 3.8% believed that they could also control HIV transmission. Awareness of side effects was poor among both the groups but the differences were statistically significant for pills (p=0.003). Media was the main source of information (65%). Majority of youth was willing to discuss a~ut contraceptive with their spouse (83.4%), but not with others. 51.2% youth believed that people in their age group use contraceptives. 35% of youth accepted that they had used contraceptives at least once. 81 % felt 2 children in family is appropriate, but only 59.7% believed in 3 year spacing. . Conclusion: Awareness about contraceptives is vital for youth to protect their sexual and reproduc·

tive health .. Knowledge about terminal methods, emergency contraception, and side effects of various contraceptives need to be strengthened in mass media and contraceptive awareness campaigns.

PS-72 (A) Religiosity and Elderly Mental Health: Evidence &om Refugee and Non-Refugee Underprivileged Urban Communities Monique Chaaya, Ahia Sibai, Rima Fayad, and Zana EI Roueiheb

l~on: Rel~giosity is _an important aspect of elderly's life, particularly in the Arab region where religiosity is salient. Studies have documented the relationship between religiosity and mental ~Ith ?f elderly, namely depression, but none in the region. This study is also relevant as no consensus ~n the literature has been reached yet on which dimensions of religiosity (extrinsic, intrinsic and ideolog· 1cal) are mostly related to health.

Mdbot:ls: 740 elderly aged 60+ were interviewed in 3 poor communities in Beirut the capital of f:ebanon, ~e of which is a Palestinia~. refugee camp. Depression was assessed using the i 5-item Geriat· nc Depressi~n Score (~l?S-15). Specific q~estions relating to the 3 aspects of religiosity were asked as well as questions perta1rung to demographic, psychosocial and health-related variables.

POSTER SESSIONS v131

Results: Depression was prevalent in 24% of the interviewed elderly with the highest proportion

being in the Palestinian refugee camp (31 %). Mosque attendance significantly reduced the odds of being

depressed only for the Palestinian respondents. Depression was further associated, in particular commu­

nities, with low satisfaction with income, functional disability, and illness during last year.

Condiuion: Religious practice, which was only related to depression among the refugee population,

is discussed as more of an indicator of social cohesion, solidarity than an aspect of religiosity. Furthermore,

it has been suggested that minority groups rely on religious stratagems to cope with their pain more than

other groups. Implications of findings are discussed with particular relevance to the populations studied.

P5-73 (A) Health Status of Children in Urban Slums of Chennai

M. Uma Maheswari

Nearly thirty percent of India's population lives in urban areas. The outcome of urbanization has

resulted in rapid growth of urban slums. In a mega-city Chennai, the slum populations (25.6 percent) face

greater health hazards due to overcrowding, poor sanitation, lack of access to safe drinking water and

environmental pollution. Amongst the slum population the health of Women and Children are most

neglected, resulting in burden of both communicable and non-communicable diseases. The focus of the

paper is to present the epidemiology profile of children (below 14 years) in slums of Chennai, their health

status, hygiene and nutritional factors, the social response to health, the trends in child health and urban­

ization over a decade, the health accessibility factors, the role of gender in health care and assessment

impact of health education to Children. The available data prove that child health in slums is worse than

rural areas. Though the slum population is decreasing there is a need to explore the program intervention

and carry out surveys for collecting data on some specific health implications of the slum children.

P5-74 (A) Socioeconomic Position and Excess Mortality During the Heat Wave of 2003 in Barcelona

Carme Borrell, Marc Mari-Dell'Olmo, Maica Rodriguez-Sanz, Patricia Garda-Olalla, Joan Cayla,

Joan Benach, and Carles Muntaner

Objective: During the summer of 2003 there was a heat wave in central Europe, producing an

excess number of deaths in many countries including Spain. The city of Barcelona was one of the places

in Spain where temperatures often surpassed the excess heat threshold related with an increase in mortal­

ity. The objective of the study was to determine whether the excess of mortality which occurred in Barce­

lona was dependent on age, gender or educational level, important but often neglected dimensions of

heat wave-related studies. Methods: Barcelona, the second largest city in Spain (1,582,738 inhabitants in 2003), is located on

the north eastern coast. We included all deaths of residents of Barcelona older than 20 years that

occurred in the city during the months of June, July and August of 2003 and also during the same

months during the 5 preceding years. All the analyses were performed for each sex separately. The daily

number of deaths in the year 2003 was compared with the mean daily number of deaths for the period

1998-2002 for each educational level. Poisson regression models were fitted to obtain the RR of death in

2003 with respect to the period 1998-2002 for each educational level and age group.

Results: the excess of mortality during that summer was more important for women than for men

and among older ages. Although the increase was observed in all educational groups, in some age-groups

the increase was larger for people with less than primary education. For example, for women in the

group aged 65-74, the RR of dying for 2003 compared to 1998-2002 for women with no education was

1.30 (95%CI: 1.04-1-63) and for women with primary education or higher was 1.19 (95%CI: 0.90-

1.56). When we consider the number of excess deaths, for total mortality (>=20 years) the excess num­

bers were higher for those with no education ( 17 5. 7 for women and 46. 7 for men) and those with less

than primary education (112.5 for women and 11-2 for men) than those with more than primary edm:a­

tion (75.0 for women and -10.3 for men). Conclusion: Age, gender and educational level were important in the 2003 Barcelona heat wave. It is

necessary to implement response plans to reduce heat morbidity and mortality. Policies should he addressed

to all population but also focusing particularly to the oldest population of low educational level.

P5-75 (C) Impact of Homelessness on Health and Supports Needed for Successful Housing: Perspectives

of Individuals Experiencing Homelessness this Research Study is Supported by a Small SSHRC Grant

Isolde Daiski

Introduction: Recently there has been much public discourse on homelessness and its imp~ct on

health. Measures have intensified to get people off the street into permanent housing. For maximum

v132 POSTER SESSIONS

success it is important to first determine the needs of those to be housed. Their views on housing and

support requirements have to be considered, as th~y ar~ the ones affected. As few res.earch studies mclude

the perspectives of homeless people themselves, httle IS known on ho~ they e~penence the 1mpacrs on

their health and what kinds of supports they believe they need to obtain housing and stay housed. The

purpose of this study was to add the perspectives of homeless people to the discourse, based in the

assumption that they are the experts on their own situations and needs. Housing is seen as a major deter·

minant of health. The research questions were: What are the effects of homelessness on health? What

kind of supports are needed for homeless people to get off the street? Both questions sought the views of

homeless individuals on these issues. Methods: This study is qualitative, descriptive, exploratory. Semi-structured interviews were con­

ducted with homeless persons on street corners, in parks and drop-ins. Subsequently a thematic analysis

was carried out on the data. Results: The findings show that individuals' experiences of homelessness deeply affect their health.

Apart from physical impacts all talked about how their emotional health and self-esteem are affected.

The system itself, rather than being useful, was often perceived as disabling and dehumanizing, resulting

in hopelessness and resignation to life on the street. Neither welfare nor minimum wage jobs are suffi­

cient to live and pay rent. Educational upgrading and job training, rather than enforced idleness, are

desired by most initially. In general, the longer persons were homeless, the more they fell into patterned

cycles of shelter /street life, temporary employment /unemployment, sometimes addictions and often

unsuccessful housing episodes.

Conclusions: Participants believe that resources should be put into training and education for

acquisition of job skills and confidence to avoid homelessness or minimize its duration. To afford hous­

ing low-income people and welfare recipients need subsidies. Early interventions, 'housing first', more

humane and efficient processes for negotiating the welfare system, respectful treatment by service provid­

ers and some extra financial support in crisis initially, were suggested as helpful for avoiding homeless­

ness altogether or helping most homeless people to leave the street.

P5-76 (C) Being Street Sick: Exploring Health Issues of Canadian Street Youth

Jeff Karabanow

This study is a National Homelessness Initiative funded analysis examining the experiences and per­

ceptions of street youth vis-a-vis their health/wellness status. Through in-depth interviews with 140

street youth in Halifax, Montreal, Toronto, Calgary, Ottawa and Vancouver, this paper explores healthy

and not-so healthy practices of young people living on the street. Qualitative interviews with 45 health/

social service providers complement the analysis. More specifically, the investigation uncovers how street

youth understand health and wellness; how they define good and bad health; and their experiences in

accessing diverse health services. Findings suggest that living on the street impacts physical, emotional

and spiritual well·being, leading to cycles of despair, anger and helplessness. The majority of street youth

services act as "brokers" for young people who desire health care services yet refuse to approach formal

heal~h care organizational structures. As such, this study also provides case examples of promising youth

services across Canada who are emerging as critical spaces for street youth to heal from the ravages of

~treet cultur~. As young people increasingly make up a substantial proportion of the homeless population

in Canada, it becomes urgent to explore the multiple ways in which we can support them to regain a

sense of wellbeing and "citizenship."

P5-77 (C) Health and Livelihood Implications of Marginalization of Slum Dwellers in Provision of

Water and Sanitation Services in Nairobi City

Elizabeth Kimani, Eliya Zulu, and Chi-Chi Undie

. ~ntrodfldion: UN-Habitat estimates that 70% of urban residents in Kenya live in slums; yet due to

their illegal status, they are not provided with basic services such as water sanitation and health care.

~nseque~tly, the services are provided by vendors who typically provide' poor services at exorbitant

prices .. This paper investigates how the inequality in provision of basic services affects health and liveli­

hood circumstances of the poor residents of Nairobi slums .

. Methods: This study uses qualitative and quantitative data collected through the ongoing longi­

tudmal .health and demographic study conducted by the African Population and Health Research

Center m slum communities in N ·rob" W d · · · · ai 1. e use escnpnve analytical and qualitative techmques to

assess h~w concerns relating to water supply and environmental sanitation services rank among the

c~mmumty's general and health needs/concerns, and how this context affect their health and livelihood circumstances.

POSTER SESSIONS v133

Results: Water (32%) and sanitation (20%) were the most commonly reported health needs and

also key among general needs (after unemployment) among slum dwellers. Water and sanitation services

are mainly provided by exploitative vendors who operate without any regulatory mechanism and charge

exorbitantly for their poor services. For instance slum residents pay about 8 times more for water than

non-slum households. Water supply is irregular and residents often go for a week without water; prices

are hiked and hygiene is compromised during such shortages. Most houses do not have toilets and resi­

dents have to use commercial toilets or adopt unorthodox means such as disposing of their excreta in the

nearby bushes or plastic bags that they throw in the open. As a direct result of the poor environmental

conditions and inaccessible health services, slum residents are not only sicker, they are also less likely to

utilise health services and consequently, more likely to die than non-slum residents. For instance, the

prevalence of diarrhoea among children in the slums was 31 % compared to 13 % in Nairobi as a whole

and 17% in rural areas, while under-five mortality rates were 151/1000, 62/1000 and 113/1000 respec­

tively. Conclusion: The results demonstrate the need for change in governments' policies that deprive the

rapidly expanding urban poor population of basic services and regulatory mechanisms that would pro­

tect them from exploitation. The poor environmental sanitation and lack of basic services compound

slum residents' poverty since they pay much more for the relatively poor services than their non-slum

counterparts, and also increase their vulnerability to infectious diseases and mortality.

P5-78 (C) Citizenship for IDU and People Living with HIV/AIDS

Elisa Yoshida, Regina Bueno, Renata Luz, and Marcelo Carneiro

Since 1991 IEPAS've been working in Harm Reduction becoming the pioneer in Latin America that

brought this methodology for Brazil. Nowadays the main goal is to expand this strategy in the region

and strive to change the Drug Policy in Brazil. In this way Harm Reduction: health and citizenship Pro­

gram work in two areas to promote the Citizenship of !DU and for people living with HIV/AIDS offering

law assistance for this population and outreach work for Needle Exchange to reduce damages and dis­

semination of HIV/AIDS/Hepatitis. The methodology used in Outreach work is peer education, Needle

Exchange, condoms and folders distribution to reduce damages and the dissemination of diseases like

HIV/AIDS/Hepatitis besides counseling to search for basic health and Rights are activities in this Pro­

gram. Law attendance for the target population at IEPAS headquarters every week in order to provide

law assistance that includes only supply people with correct law information or file a lawsuit. Presenta­

tions in Harm Reduction and Drug Policy to expand these subjects for Police chiefs and governmental In

the last year attended 150 !DU and 403 NIDU reached and 26.364 needles and syringes exchanged. In

law assistance 740 (420 people living with Aids, 247 drug users, 43 inject drug users, 30 were not in pro­

file) people attended. 492 lawsuits filed 218 lawsuits in current activity. Broadcasting of the Harm

Reduction strategies by the press helps to move the public opinion, gather supporters and diminish con­

troversies regarding such actions. A majority number of police officer doesn't know the existence of this

policy. It's still polemic discuss this subject in this part of population.

PS-79 (C) Developing a More Woman-Centered Focus On Reproductive Health

John Ojo and Ifode Ajari

Women remain one of the most under seviced segments of the Nigerian populationand a focus on

their health and other needs is of special importance.The singular focus of the Nigerian Family welfare

program is mostly on demographic targets by seeking to increase contraceptive prevalence.This has

meant the neglect of many areas of of women's reproductive health. Reproductive health is affected by a

variety of socio-cultural and biological factors on on e hand and the quality of the service delivery system

and its responsiveness on the other.A woman's based approach is one which responds to the needs of the

adult woman and adolescent girls in a culturally sensitive manner.Women's unequal access to resources

including health care is well known in Nigeria in which stark gender disparities are a reality .Maternal

health activities are unbalanced,focusing on immunisation and provision of Iron and folic acid,rather

than on sustained care of women or on the detection and referral of high risk cases.

Methods: A cross-sectional study of a municipal Government -owned Hospitalfrom each of the 6

Geo-Political regions in igeria was carried out (atotal of 6 Ce~ters) .. As _part ~f t~e re.search, the H~spital

records were uesd as a background in addition to a 3- week mtens1ve mvesuganon m the Obstemc and

Gynecology departments. . . .

Results: Little is known for example of the extent of gynecological morbtdtty among women; the

little known suggest that teh majority suffer from one or more Reproductive tr~ct Infect~ons. Although

abortion is widespread, it continues to be performed under ilegal and unsafe condmons. With the growing

v134 POSTER SESSIONS

HIV pandemic, while high riskgroups such asComn;iercial Sex workers and their clients have been stud­ied, little has been accomplished in the large populat10ns, and particularly among women, regardmgSTD

an HIV education. . . Conclusions: Programs of various Governmentalor Non-Governmental agen,c1es to mvolve strate-

gies to broaden the narrow focus of services, and more importan~, to put wo~en s reproducnve health services and information needs in the forefront are urgently required. There IS a n~d to reonent com­muication and education activities to incorprate a wider interpretation of reproducnve health, to focus on the varying information needs of women, men, and youth and to the media most suitable to convey

information to these diverse groups on reproductive health.

PS-80 (C) The Impact of an FHN Satellite Clinic on the Health of Inner City Ottawa Youth

Melanie Mason and Cathy Tocchi

Introduction: It is estimated that there are 250-300 youths living on the streets, on their own with the assistance of social services or in poverty with a parent in Ottawa. This population is under-serviced in many areas including health care. Many of these adolescents are uncomfortable or unable to access the health care system through conventional methods and have been treated in walk-in clinics and emer­gency rooms without ongoing follow up. In March 2004, the Ontario government provided the CT Lam­ont Institute with a grant to open an interdisciplinary and teaching medical/dental clinic for street youth in a drop-in center in downtown Ottawa. Bringing 5 community organizations together to provide pri­mary medical care and dental hygiene to the streetyouths of Ottawa ages 12-20, it is staffed by a family physician, family medicine residents, a nurse practitioner, 2 public health nurses, a dental hygienist, den­tal hygiene students and a chiropodist who link to social services already provided at the centre including

housing, life skills programs and counselling. Project Objectives: 1. To improve the health of high risk youth by providing accessible, coordinated,

comprehensive health and dental care to vulnerable adolescents. 2. To model and teach interdisciplinary adolescent care to undergraduate medical students, Family Medicine residents and dental hygiene students.

Methods: Non-randomized, mixed method design involving a process and impact evaluation. Data Collection- Qualitative:a) Semi-structured interviews b) Focus groups with youth Quantitative:a) Elec­tronic medical records for 12 months b) Records (budget, photos, project information).

Results: In progress- results from first 12 months available in August 2005. Early results suggest that locating the clinic in a safe and familiar environment is a key factor in attracting the over 130 youths the clinic has seen to date. Other findings include the prevalence of preventative interventions including vaccinations, STD testing and prenatal care. The poster presentation will present these and other impacts that the clinic has had on the health of the youth in the first year of the study.

Conclusions: 1) The clinic has improved the health of Ottawa streetyouth and will continue beyond the initial pilot project phase. 2) This project demonstrates that with strong community partnerships, it is possible meet make healthcare more accessible for urban youth.

PS-81 (C) Right to Health Care Campaign Sathiya Chander

Right to health care campaign By S.J.Chander, Community Health Cell, Bangalore, India. Introduction: The People's Health Movement in India launched a campaign known as 'Right to

Health care' during the silver jubilee year of the Alma Ata declaration of 'Health For All' by 2000 AD in collahoration with the National Human Rights Commission (NHRC). The aim of the campaign was to

establish the 'Right to Health Care' as a basic human right and to address structural deficiencies in the pubic health care system and unregulated private sector .

. Methods: As part of the campaign a public hearing was organized in a slum in Bangalore. Former chairman of the NHRC chaired the hearing panel, consisting of a senior health official and other eminent people in the city. Detailed documentation of individual case studies on 'Denial of access to Health Care' in different parts of the city was carried out using a specific format. The focus was on cases where denial of health services has led to loss of life, physical damage or severe financial losses to the patient.

Results: _Fourte_en people, except one who had accessed a private clinic, presented their testimonies of their experiences m accessing the public health care services in government health centres. All the peo­ple, e_xcept_ one person who spontaneously shared her testimony, were identified by the organizations worki_ng with the slum dwellers. Corruption and ill treatment were the main issues of concern to the peo­ple. Five of the fourteen testimonies presented resulted in death due to negligence. The public health cen· n:s not only demand money for the supposedly free services but also ill-treats them with verbal abuse. Five of these fourteen case studies were presented before the National Human Right Commission. The

POSTER SESSIONS v135

NHRC has asked the government health officials to look into the cases that were presented and to rectify

the anomalies in the system. As a result of the public hearing held in the slum, the NHRC identified

urban health as one of key areas for focus during the National Public Hearing.

Cond#Sion: A campaign is necessary to check the corrupted public health care system and a covet­

ous private health care system. It helps people to understand the structure and functioning of public

health care system and to assert their right to assess heath care. The public hearings or people's tribunals

held during the campaign are an instrument in making the public health system accountable.

PS-82 (A) Violence Among Women who Inject Drugs

Nadia Fairbairn, Jo-Anne Stoltz, Evan Wood, Kathy Li, Julio Montaner, and Thomas Kerr

Background/Objectives: Violence is a major cause of morbidity and mortality among women living

in urban settings. Though it is widely recognized that violence is endemic to inner-city illicit drug mar­

kets, little is known about violence experienced by women injection drug users (!DU). Therefore, the

present analyses were conducted to evaluate the prevalence of, and characteristics associated with, expe­

riencing violence among a cohort of female IDU in Vancouver.

Methods: We evaluated factors associated with violence among female participants enrolled in the

Vancouver Injection Drug User Study (VIDUS) using univariate analyses. We also examined self-reported

relationships with the perpetrator of the attack and the nature of the violent attack.

Results: Of the 346 active IOU followed between December 1, 2003 and May 6, 2005, 73 (21.1 %)

had experienced violence during the last six months. Variables positively associated with experiencing

violence included: homelessness (OR= 3.46, 95% CI: 1.66- 7.21, p < 0.01), public injecting (OR= 3.45,

95% CI: 1.43 - 8.35, p < 0.01 ), frequent crack use (OR= 2.99, 95% CI: 1. 72 - 5.17, p < 0.01 ), recent

incarceration (OR =2.81, 95% Cl: 1.38 - 5.72, p < 0.01), receiving help injecting (OR =2.77, 95% Cl:

1.54- 5.00, p < 0.01 ), shooting gallery attendance (OR =2.46, 95% CI: 1.22 - 4.93, p < 0.01 ), sex trade

work (OR =2.30, 95% Cl: 1.35 - 3.93, p < 0.01 ), frequent heroin injection (OR= 1.96, 95% Cl: 1.13 -

3.40, p < 0.02), and residence in the Downtown Eastside (odds ratio [OR] = 1.85, 95% CI: 1.09 - 3.13,

p < 0.02). Variables negatively associated with experiencing violence included: being married or com­

mon-law (OR =0.47. 95% CI: 0.25 - 0.87, p < 0.02) and being in methadone treatment (OR =0.53,

95% CI: 0.31 - 0.91, p < 0.02). The most common perpetrators of the attack were acquaintances

(48.0%), strangers (27.4%), police (9.6%), or dealers (8.2%). Attacks were most frequently in the form

of beatings (65.8%), robberies (21.9%), and assault with a weapon (13.7%).

Conclusion: Violence was a common experience among women !DU in this cohort. Being the vic­

tim of violence was associated with various factors, including homelessness and public injecting. These

findings indicate the need for targeted prevention and support services, such as supportive housing pro­

grams and safer injection facilities, for women IOU.

PS-83 (A) The Environment of Youth Related to Tobacco in Lebanon: Analysis by Gender and Tobacco Type

Maya El Shareef, Rima Afifi Soweid, Mayssa Nehlawi, and Aida Rouhana

Introduction: Although research on determinants of tobacco use among Arab youth has been car­

ried out at several ecologic levels, such research has included conceptual models and has compared the

two different types of tobacco that are most commonly used among the Lebanese youth, namely ciga­

rette and argileh. This study uses the ecological model to investigate differences between the genders as

related to the determinants of both cigarette and argileh use among youth.

Methodology: Quantitative data was collected from youth in economically disadvantaged urban

communities in Beirut, the capital of Lebanon. Results: The results indicated that there are differences by gender at a variety of ecological levels of influ­

ence on smoking behavior. For cigarettes, gender differences were found in knowledge, peer, family, and com­

munity influences. For argileh, gender differences were found at the peer, family, and community l.evels.

Conclusion: The differential prevalence of cigarette and argileh smoking between boys and girls 1s there­

fore understandable and partially explained by the variation in the interpersonal and community envi.ronment

which surrounds them. Interventions therefore need to be tailored to the specific needs of boys and girls.

PS-84 (A) Assessing the Relationship Between Children's Health and Parents' Employment Status in

Professional Immigrant Families Living in Vancouver

!raj Poureslami and Clyde Hertzman

Introduction: The objective of this study was to assess the relationship between parents' employment

status and children' health among professional immigrant families in Vancouver. Our target communmes

v136 POSTER SESSIONS

included immigrants from five ethnicity groups: South Korean, Indian, Chine~e, ~ussian, and Irani~

with professional degrees (i.e., MDs, Lawyers, Engineers, Ma?~ger~, and Uru~ers1ty Professors) w11h

no relevant job to their professions and those who had been hvmg m the studied area at least for 36

months. Methodology: The participants were recruited by collaboration from three local community agen­

cies and were interviewed individually during the fall of 2004.

Ra#lts: Totally, 109 complete interviews were analyzed: 33 from South-East Asia, 59 from South

Asia, 17 from Russia and other Eastern Europe. Overall, 14.5% were employed, 38.5% were underem­

ployed, 46% indicated they were unemployed. Overall, 58.5% were not satisfied with their current job.

Russians and other Eastern Europeans were most likely satisfied with their current job, while South-east

Asians were most satisfied from their life in Canada. About 53% indicated that their spouses were not

satisfied with their life in Canada, while 55% believed that their children are very satisfied from their life

in Canada. In addition, around 30% said they were not satisfied from their family relationship in Can­

ada. While most of the responders ranked their own and their spouses' health status as either poor or

very poor, jut 3% indicated that their first child's health was very poor. In most cases they ranked their

children's health as excellent or very good. Conclusion: The results of this pilot study show that there is a need to create culturally specific

Child Health and Behavioral Scales when conducting research in immigrant communities. For instance,

in many Asian cultures, it is customary for a parent either to praise their children profusely, or to con­

demn them. This cultural practice, called "saving face," can affect research results, as it might have

affected the present study. Necessary steps, therefore, are needed to revise the current standard health

and behavioral scales for further studies by developing a new scale that is more relevant and culturally

sensitive to the targeted immigrant families.

P5-8S (A) InOuence of Demographic Structure on Health Services Use by Urban Older Adult Population in Madrid Region (Spain)

Maria Eugenia Prieto, Gloria Fermindez-Mayoralas, Fermina Rojo, Vicente Rodriguez,

Jose-Manuel Rojo, and Lorenzo Aguilar

Introdiu:tion: More than 95% of the population in Madrid Region live in urban municipalities, and

31 % are 50 years and over (urban older adult population). National Health System provides universal

coverage, except for dental services. This communication describes (within a wider research on Quality

of Life in the Region) the relationship between the study population structure and health services use.

Metboda: Database: 2003 National Health Survey (Ministry of Health www.msc.es). Two thou­

sand interviews were performed among Madrid population (0.04% of the whole); 593 corresponded to

older adults (0.04% of the 1. 7 million aged 50 years and over). Study sample constitutes 95.3% (565 out

of 593) of those older adults, who live in urban areas. Demographic structure (by age and gender) of this

population in relation to health services use (medical consultations, dentist visits, emergence services,

hospitalisation) was studied using General Linear Model Univariate procedure. A p0.005), while age was

associated with emergence services use (26% of the population: 21 %, 28% and 45% of each age group)

and hos~italisation (17% .oft~~ population: 13%, 20% and 31%, of each age ~oup) (p0.005) was

fou~d with respect to dennst v1s1ts (18% vs 20%), medical consultations (29% vs 36%), and emergence

services use (26% vs 26%), while an association (p= 0.005) was found according to hospitalisation (20%

vs 16%). Age. an~ g~der interaction effect on health services use was not found (p> 0.005), but a trend towards bosp1tal1sanon (p=0.04) could be considered.

Concl.uions: Demographic structure of urban older adults is associated with two of the four health

se~ices use studi~. A relation.ship ber_ween age. and hospital services use (emergence units and hospitali­

sanon), but not with ~ut-hosp1tal sei:vices (medical and dentist consultations), was found. In addition ro age, gender also contnbutes to explam hospitalisation.

z-i::=c Differences in Unwanted Sexual Experiences Among Adolescents in Amsterdam,

Adele Diepenmaat, Marcel van der Wal, Pim Cuijpers, and Remy Hirasing

1~1 h Ith. • ~nw~nted sexual experience in childhood and adolescence can have a mayor impaa on menta ea . Little 1s known about the I f · · children and ad I . . . preva ence o unwanted sexual experiences among nugrant

. 0 ~ts ~vmg 10 Ei~rope. More than half of the adolescents living in Amsterdam bas nugraot parents. It 1s possible that differen es · l' · d I d to .1:u.. • c 10 re igious an cultural values among migrant groups, ea uun:renc:es m prevalence of unwanted 1 · ' · of unwanted sexual · . . sexua experiences. We exammed the prevalence

expenences 10 relation to ethnic origin and other sociodemographic variables as wc1I as

Y1J7

die relation between unwanted sexual experiences, depression and agreuion. We did so for boys and

prts separately. Mdhods: Data on unwanted sexual expcric:nces, depressive symptoms (CE.S-D), aggrc:uion (BOHi-Di

and sociodemographic facron were collected by self-report quescionnairc:s administettd to 35 31 students

in the: 2nd grade (aged 12-16) of secondary schools in Amsterdam, the Netherlands. Data on the nature

ol unwanted sexual experiences were collected during penonal interviews by trained schoolnursn.

ltaiJtJ: Overall prevalences of unwanted sexual experiences for boys and girls were 6.5% and

5.7% respectively. Unwanted sexual experiences were more often ttported by Turkish ( 17.1 %), Moroc·

an (10.4%) and Surinamese/Anrillian boys (7.4%) than by Dutch boys (2.2%). Moroccan and Turkish

girls, however, reported fewer unwanted sexual experiences (respectively 2.3 and 2.7%) than Durch girls

did (6.9%). Depressive symptoms(OR=4.6, Cl=3.1-7.0) covert agression (0R•4.9, Cl•3.2-7.7) and

cmrt aggression (OR= 2.6, Cl• 1.6-4.4) were more common in girls with an unwanted sexual experi·

met. Boys with an unwanted sexual experience reported more depressive symptoms (OR= 2.2; Cl• I . .l·

3.9) and oven agression (OR= 1.5, Cl= 1.0-2.4). Of the reported unwanted sexual experiences rnpec·

timy 17.5% and 73.5% were confirmed by male and female adolescents during a personal interview.

Cond11Sion: We ..:an conclude that the prevalence of unwanted sexual experiences among Turkish

and Moroccan boys is disturbing. It is possible that unwanted sexual experiences are more reported hy

boys who belong to a religion or culture where the virginity of girls is a maner of family honour and

talking about sexuality is taboo. More boys than girls did not confirm their initial disdosurc of an

lllWalltc:d sexual experience. The low rates of disclosure among boys suggcsu a necd to educ.:atc hcahh

care providen and others who work with migrant boys in the recognition and repomng of 1exu.il ... PS-87 (A) Mocher and Child Health Status and Services on Decline in Urben Slum of Vedodara. India

Prakash Kocec:ha

Ob/«tiw of tM Shldy: To measurc thc current Mothcr and Child Health 1erv11:e ..:ovcraicc in urh.in

m ara of Vadodara ciry of India. Mdhod: Two stage cluster sample study. a..111: The study made 2003 in 30 slum areas (proportionatt to liul coverinic 1214 hou.n and

6475 population as repre1entative of Vadodara urban 1lum1 con1i1tinic of .H7 1lum arH• ovcr ~OS70

homehotda and 2,45,000 population have revealed the 1ervtcn provided and uuhud by tht- pt"ttplt 1n

Ylrious areas of child health and maternal health servicn. It givn a relattn 1dca "' i:umparrJ to I Y9K

wliea similar study was conducted. Child Health: Vaccinatmn ..:ovcraicr for youngrr children ha• J11thtly

dcduwd in 2003 (67%1 compared to 1998 (72%1 and indicatn the nttd for an 1mmed11tc i:orm.ttvr

ICtion. Viramin A aupplc:tMntation i1 at .H'Yo, 1till far from tafl'eted 100%. Feedinit pracn~:n panKu·

lerty for new born earn demand lot of educatton ernpha111 a• cxdu11ve hrealt fecdtnit for dnared rcnoJ

of 6 months was observtd in only 6.S% of childrrn thoulh colcKturm w.11 givm 1n rn% of MWly horn

ct.ildrm. The proportion of children hclow-2 WAZ (malnounshrdl .con" a• h!Jh •• 42.6% anJ "rt'I·

acimy tc.. 11 compared to 1998 data. Mother's ~alth: From all IS 10 womm in ttprod~uvr •Ill'

poup, 83% were married and among marned w~ .\9% only W\"rt' u1mic wmr cnntr.-:cruve mt1h·

odL 44% were married bdorc thc •Ar of 18 yean and 27% had thnr ftnc prcicnancy hcftitt dlt' •icr nf

21 yean. The lt'f'Vicn are not uutfactory or they arc adequate but nae unh1ed opumally. Of thote' l'H

mothen who had deliverrd in last one year, 80% had nailed 11ntmaral eum1nat1on 11 Ira" oncc, .~o-...

bad matt rhan four ttmn and ma1ortty had 1heir tetanus toxotd tnin,"t1or"'" nlht "'"'"· lJn1r11ned rn· Win ronductrd 12.4% dchvcnn and 26% had home deh\'t'OC'I. ~Md~: The tervtcn unbud or u111led are !tu than dnaraMe. The wr·

l'Kft provided are inadequate and on dechM reprcwnttng a looun1t ~P of h11hnto good coYtti\#' ol wr·

ncn. l!.ckground chanpng pnoriry cannoc be ruled out u °"" of thc coatnbutory bc10f.

PS-II IA) Dcpn:wioa aad AnUccy ia Mip'mu ia Awccr._ Many de Wn, Witco Tui~bmjer. jack Dekker, Aart·Jan lttkman, Wim GonMc:n. and

Amoud Verhoeff

~ A Dutch commumry-bucd ICUdy thawed 12-moarh•·prc:Yalm«I al 17 .44'1. kw anx1·

ay daorden and 13. 7% fOI' dqrasion m Anmttdam. nm .. 11p1tficantly hlllhn than dwwhrft .. dw

~Thew diffamca m pttYalcnca att probably rdarcd to tlK' largr populanoa of napaan 111

..\mturdam. <Turkish 5%, Moroccan 9%, and Surinam 10%1. lndttd. IC'Wt'll ltudla hatt ~ ~ high prevalena rata among migrant poupi in rbe Ncdwrlands. HowC'Ytt aU tt- lluchn IUffenod

from wry low raporne rara, or med screnung talel thac lack a ~Y Yabdarcd ~

POSTER SESSIONS v138

In order to study the prevalence of depression and anxiety, and the (barriers to) use of mental health care among the different ethnic groups the following study was recently conducted: .

Methods: The study consisted of a two-step approach. The first step was mcl~ded m the ~ H Ith Survey of 2004 (AHS), and consisted of three screening scales for depression and aruaety (KlO, G::Q-12 and MHl-5). In this survey all respondents were asked_ permission for~ second app~ 1:'18t consisted of a structured interview containing the CIDI for aruaety and depression, and questtollllalres on health care seeking, amongst others. All respondents who gave permission for a second approachwere invited by Jetter for a suuctured interview with multilingual interviewers at home at a preset date and time in the following week. .

Ra#lts: In total, 439 Dutch, 317 Turkish, 322 Moroccan and 124 Surinam respondents took part in the AHS and gave permission for a second approach. In the second step, fo~ 21~ Tur~h, 184M~roc­can 87 Surinamese and 320 Dutch respondents, information from the extensive interview was available (res~nse rates between 60 and 70% ). Since the data collection was completed only recently (june 2005), prevalence estimates can be presented at the conference for the first time.

Conclusion: We have shown that with this approach it is feasible to achieve an acceptable response rate in a study on mental health among migrants. Therefore we expect that this study will provide reli· able estimates of depression and anxiety in the Turkish, Moroccan and Surinam migrants in Amstw!3~· for the first time. In addition, insight into mechanisms underlying the differences between and within ethnic groups and into barriers to mental health care will provide pretexts for the improvement of pre· vention and mental health care for migrant groups.

PS-89 (A) Homicides, Adolescent Pregnancy, Asthma and Two Mosquito-Borne Diseases - Dengue and Visceral Leishmaniasis in a Urban Context: The Belo Horizonte Observatory on Urban Health (BHOSUH) Experience. Waleska Caiaffa, Maria Cristina Almeida, Claudia Oliveira, Amelia Augusta Friehe, SOnia Matos, Maria Angelica Dias, Maria da Consolaioao Cunha, Fernando Proietti, and Eduardo Pessanha

This study aimed to determine spatial patterns of mortality and morbidity of five major health problems in an urban environment: homicides, pregnancy among adolescents ((<20 years old), asthma hospitalization among young children(< 5 years old) and two mosquito-borne diseases - dengue and vis­ceral leishmaniasis, during 1999-2003. All events were obtained through the City Health database and, subsequently, geoproccsscd using the address of residence and the geographical and administrative divi­sion of the municipality, composed by 80 unit of planning (UP), which in tum were formed, each one, by census tract units. Two research questions were investigated: are there spatial patterns to the events dis· tribution, and moreover, are these patterns overlapping across space? We use thematic maps, index of comparative mortality/morbidity by UP and the overlapped rank of the 20th worse UP rates for each event. A spatial pattern of high rates of homicides, proportion of young mothers and hospitalization of asthma were overlapping in areas social and economically disadvantaged. For mosquito-borne diseases, high rates with great dispersion were found in unprivileged areas in contrast with very low rares among privileged ones. These results pointed toward a coexistence of heavier burden of diseases for those living in areas of the city where misery, poverty, lack of political public health may be modulating social health problems. A possible environmental intervention in one mosquito•bome disease might be playing a role in the occurrence of other. Although with limitations, this study may provide useful information for a joint urban planning under the public perspective, articulated for use in health impact assessment.

PS-90 (A) Income Related Health Disparities in Metropolitan Canada Jalil Safaei

bdrod#aion: The association of socioeconomic status (SES), usually measured by income, and health status is an established result in bcalth studies. The poor and low income individuals have lower health sta· tus then_ those with higher incomes. in general. Such finding has been usually obtained from sample surveys on speafic populations. A problem with many sample survey$ is that their results are not comparable aaoss ~ndaries as they may use different sampling methods, ask different questions, categorize the answers differently, or define groups differently. Moreover, the sample data need to be standardized using the demographic: katurea of a ~ population. This study, however, uses the National Population Health Survey (NPHS) Cycle 3 Public Use Mictodata Files which is based on a common survey template ·~~three~ area in Canada, namely Montreal, Toronto, and Vancouver. It also utili7.es the built-m stanclatdizaaon of the NPHS data which accounts for its complex survey design. . ~:The Stu~ USC:S two well-known measures of health inequality - the relative index of meqaality and die concentranon index - to capture the extent of income related health inequality among

POSTER SESSIONS v139

urban female and male populations in each of the three metropolitan areas. Personal income is classified

into ten groups by the NPHS with "no income" as the first group and "more than $60,000" as the last.

Health status is measured by three variables - Having a chronic condition (CHC), Self Assessed Health

(SAH), and Health Utility Index (HUI) - using appropriate indices. Alternative formulations are used to

calculate the standard deviations of the estimated or calculated measures.

Results: The findings of the study suggest that the measured health inequality depends on the health

measure used. For CHC and HUI the measured inequality indices do indicate poorer health for lower

income individulas, however, they are not statistically insignificant. Health inequalities are more pro­

nounced when health is measured by SAH. The results do not support any systematic ranking of the

three metropolitan areas in terms of health inequalities. They do not reveal any systematic pattern of ine­

quality between men and women, either. Conclusions: Despite the use of highly aggregated NPHS data, income related health disparities are

observed in the three metropolitan areas in Canada. This is more the case with self perceived (SAH)

health. Such disparities are preventable and call for broader health policies that address poverty and low

income among other social determinants of health.

PS-91 (A) Newborn Babies and Their Mothers in Belo Horizonte City, Brazil, 2001: A Spatial Analysis

Amelia Augusta Friehe, Waleska Caiaffa, Cibele Cesar, Lucia Maria Goulart, and

Maria Cristina Almeida

Introduction: The analysis of health indicators under the spatial perspective is configured as an

important instrument in the detection of intra-urban differentials. This study aimed to examine the spa­

tial distribution of the births occurred in Belo Horizonte, in 2001, analyzing the presence of spatial clus­

ters of health indicators for newborns (RN) and their mothers, using data from the Information System

on Live Birth Database (SINASC). Method: For each covered area of the Basic Units of Health (UBS), we calculated the proportion of:

adolescent mothers, mothers with less than 8 years of schooling, first pregnancy, mothers with four or

more pregnancies, dead babies born on previous pregnancies, stillbirths, cesarean section, less than four

prenatal care attendance, moderate and severe hypoxemia in the 1st and 5th minutes of life, low or very

low birth weight. We used empiric Bayesian methods for smoothing the estimates. For spatial analysis,

the indicators obtained from the global Moran (I) index and Local Indicators of Spatial Association

(LISA) were used. Maps were built to allow the visualization of the spatial clusters. In all analysis, signif­

icance statistics was considered p~ 0.05. Results: A total of 36, 12 7 births of residents in Belo Horizonte were registered in 200 I. The esti­

mated Bayesian proportions for the entire municipality was close to the one observed for all variables.

Analysis using LISA showed the presence of relevant spatial clusters for adolescent and low educated

mothers, dead babies form previous pregnancies, cesarean section, low attendance to the prenatal care

especially in area with low socio-demographic characteristics. Three areas presented consistent clusters,

with important spatial auto-correlation for almost all studied indicators. Conclusion: The used methodology was configured as a great instrument of detection risk areas

where clustering occurs. It can easily be incorporated in any surveillance system as a mechanism for con­

trolling events related to births in the municipality. Moreover, it can be applied to discriminate target

areas for prompt public health interventions, such as improving health services access and the consolida­

tion of better obstetric practices.

PS-92 (A) Gentrification and Health Russell Lopez

Introduction: Gentrification, the displacement of low income and non-majority people out of long­

time neighborhoods and residences is a global phenomenon. It has been identified as occurring in both

developed and less developed countries and as inequality persists or increases, many communities are

vulnerable to disruption and loss. While there may be some benefits to gentrification, these benefits are

less likely to impact those who have been forced to move out of a gentrifying community or those who

remain but economically stressed. . . . . Methods: This paper lays out a theoretical framework for 1dent1fymg and ~ddressm~. the_ health

consequences of gentrification on residents living in a community prior .to o.r durmg gent~1~1cat.10n. By

drawing on the literature of housing, sociology, health and urban plannmg, 1t places genmf1catt~n and

neighborhood change into the context of other forces affecting th~ .hea.lth of vulnerable populations. It

then proposes solutions to prevent or mitigate the impacts of genmf1cat1on.

v140 POSTER SESSIONS

Results: Four main categories of consequences potentiallr re~ult from ~entr~fica~~n: !'°°r housing·

related issues, spatial effects, mental health impacts and contr1bunons to racial ~spanttes m heal~. The

housing issues include increased susceptibility to asthma, lead exposure, allergiesl~topy an~. acetdents/

injuries. Spatial effects include reduced access to health ~are, reduce~ access to 1obslttadinonal food

sources, decreased physical activity, and increased obesity. The __ pnmary mental health effects_ :ire increased stress increased risk of depression and disruption of trad1t1onal support networks. In addinon

to the above he~lth issues, gentrification has the potential to increase racial disparities in health by reduc·

ing access to long term and multi-culturally experienced health care provide~s.

Conclusions: Public health practice provides a framework for addressmg the health consequences

of gentrification. In this context primary prevention would involve preventing gentrification in the first

place along with a renewed commitment to helping distressed communities a~~ im_proving the quality ~f

life for long term residents. The next layer of meeting the challenges of gentrification would be to aSSJst

long rime residents to stay in a community and thus potentially allowing them to participate in the bene~ts

of gentrification (such as better public services). Only if all these efforts fail - and these other prevennon

strategies must be a priority, public policy should then work to help people and instirutions move to other

communities through grants and the provision of alternative safe affordable housing and neighborhoods.

INTERNATIONAL PERSPECTIVES ON URBAN HEALTH

P6-01 (A) Urban-Rural Differences in Depression and its Help-Seeking in Canada 2002

Sarah Romans, Marsha Cohen, and Tonia Forte

lnh'odlletion: There has been sustained interest in urban rural (UR) differences in mental health

over the last 50 years of epidemiological research, with most studies reporting higher urban rates of mor·

bidity, particularly when psychotic disorders have been studied. Most recently, in Britain, urban rates of

non-psychotic disorder were greater than rural and semi-rural rates, both before and after the more

adverse circumstances of urban dwellers were considered (Paykel et al 2003). Surprisingly, there were no

UR differences in help seeking. In Canada, Wang (2004) found greater urban rates for major depression

only after he controlled for the confounding effects of race, immigration, employment and marital status,

a result reminiscent of work from the US (Blazer et 1985). Rural participants were less likely to have

sought help for their mental health problems. In this study, we sought to examine urban/rural differences

in rates of depression and help seeking in Canada.

Method; data came from the 2000 Canadian Community Health Survey 1.2, a community survey

conducted by Statistics Canada of people aged 15 and older, with the total sample size of 36,984 respon·

dents, 77% response. Analyses used weighted data; differences were assessed by chi-squared.

Ra.Its: bivariate cross-tabulations showed a modest increase in 12 month depression rates for

urban (5.4%) over rural (4.3%, p= 0.03) dwellers; there were no UR differences when the sample

was examined separately by gender and age group ( 15-29, 30-44, 45-69). In general, more urban

(10.6%) than rural people (8. 7%, p= 0.002) had sought mental health treatment in the past year.

There was no UR difference in helping seeking amongst those with depression (U 58.9%, R 50.1 %

ns). Amongst the whole population, helping seeking was gendered with more urban men accessing

help (7.4%) than rural men (5.4%, p=0.004); this did not apply for women (13.7% vs 12.1% p=0.1).

~ons: The urban-rural demographic continues to generate intriguing findings, even recently

when internal migration is common and people can seek out the environment most conducive to their

health, ~th physical and mental. People with depression are a disadvantaged, frequently stigmatized

group, with ~r quality of life a_nd often impaired function. Unlike many other factors associated wi~h urban or rural hfe per se, depression can be treated. The low help seeking rates is a cause for concern, m

both the ur~n and_ rural populations. It behooves researchers, policy makers and service planners to

ensutt effective services are available for both humane and economic reasons.

P6-02 (A) Rela~onships Between Premature Mortality and Community Income Levels in Manhattan JL Burcham, Michael Gusmano, and Victor Rodwin

1~ The World Cities Project compares health, social services, and quality of life among

four world Cities: New York, London, Paris, and Tokyo. Premarure mortality is a well-accepted mea­

su~ of health starus. This study explores correlations between community income levels and age-ad1usted premarure mortality ..... 'thi M h

ra ..... WI n an attan, and among "urban cores" of the four cities.

POSTER SESSIONS v141

Methods: Using United States 2000 census income data, we assigned the 12 Manhattan community

districts to two major socioeconomic groups, Manhattan I and II. Manhattan I is composed of community

districts with average household incomes above the median for New York City; Manhattan II is those

below. With public New York City Department of Health 1999 death records and 2000 US census data,

we calculated a "standard" New York City population and estimated mortality rate distributions for Man­

hattan I and II. We then compared these age-adjusted actual mortality distributions with a standard t-test.

Results: We explored premature deaths using several cut-off points (before the ages of 65, 70, and

75), and with subcomparisons for males and females. Every comparison showed the wealthier area,

Manhattan I, to have significantly lower premature mortality rates than the lower income Manhattan II.

Further, we compared age-adjusted mortality rates among the city's five boroughs, and found no signifi­

cant differences based on local geography alone. Conclusions: These findings suggest that in Manhattan, characterized by its extremes of wealth and

poverty, health status, as measured by premature mortality, does vary significantly with the local income

level. In Manhattan, the relative average income by community district varies as much as 4: 1. This ratio

is greater than that found in the other cities we have studied: for example, the range among Tokyo's kus

is half that in Manhattan, or about 2: 1. Paris has shown the longest life expectancy and changing prema­

ture mortality rates. From our preliminary work, we expect to find less variation in premature mortality

rates in comparable cities. This study will continue to explore the relationship of premature mortality

rates and life expectancy to income levels and different health systems among WCP cities with a view to

measuring health policy options.

P6-03 (A) Smoking Cessation in Oaxaca, Mexico: A Limited Priority Among Health Care Providers

Lindsay Rhodes, Marcie Rubin, and Julie Brandies

Introduction: According to the World Health Organization (WHO), smoking-related illness is cur­

rently the world's second major cause of death, currently responsible for one out of ten adult deaths

worldwide. The WHO's Framework Convention on Tobacco Control (FCTC) aims to reduce tobacco­

related disease and deaths by changing national public policies. Mexico, which, according to the WHO,

had smoking prevalences of 32% among adults in 1998 and 23% among health care providers (HCPs) in

1997, ratified the FCTC in 2004. Objective: To examine knowledge of and attitudes towards cigarette smoking and smoking cessa­

tion among HCPs, and clinical practices regarding smoking cessation. Methods: In June 2005, a convenience sample of HCPs from one public clinic in urban Oaxaca,

Mexico, part of Mexico's national network of public health care clinics, were interviewed in Spanish

using a verbally administered questionnaire that was standard among all participants. During primary

care outpatient visits, HCPs were observed treating patients to assess the relative importance of smoking

cessation as a health care priority. Results: Of the 18 HCPs interviewed, including ten physicians, three nurses, and five medical stu­

dents, 67% reported smoking regularly. All HCPs reported assessing patients' history of smoking, knowl­

edge of the health risks associated with smoking, and feeling qualified to discuss these risks with patients.

All HCPs reported counseling patients who currently smoked to quit. All HCPs reported recommending

nicotine replacement therapy (eg., patch and/or gum) and/or behavioral therapy (eg., psychologist, sup­

port groups) to patients who smoked. All HCPs reported that there was no government funding for smok­

ing cessation, and that all costs associated with smoking cessation were patients' out-of-pocket expenses.

Observation of HCP interaction with patients revealed that HCPs always inquired about smoking history

with new patients and rarely inquired about smoking history with returning patients. HCPs were not

observed counseling patients who reported current smoking on smoking cessation methods and its bene­

fits. Observation of the clinical environment suggested a focus on preventative child health (eg., immuni­

zation, water-borne illnesses), family planning, and chronic diseases (eg., diabetes, hypertension).

Conclusions: While the Mexican government has made smoking cessation a public health priority

and HCPs report addressing smoking cessation, observation of HCPs suggests: 1) smoking status is

assessed only in new patients; and 2) smoking cessation methods are not addresse~. Observ_atio~ of

HCPs and the clinical environment in a public clinic in Oaxaca suggests that smoking cessation 1s of

lower priority than other heath care issues.

P6-04 (A) Urban Agriculture and Food and Nutrition Security in Kampala, Uganda

Fiona Yeudall, Renee Sebastian, Abdelrahman Lubowa, Selahadin Ibrahim, and Donald Cole

Introduction: Urban agriculture is an important livelihood strategy contributing to household food

security by increasing access and availability to food in urban settings (Koc et al., 1999). The purpose of

POSTER SESSIONS v142

rhis study was to examine relationships between child nutritional securiry outcomes, household food security, and urban agriculture activiries in Kampala, Uga~da. . .

Mnhods: Questionnaires assessing socio-demographic, farmmg and household food secunry (HFSI characreristics were administered to 270 households. Food diversiry was ~lculate~ from ~e number of foods consumed over 24 hours for one child (2-5 years) per household. Heigh~ weight,. nud-upper·ann· circumference (MUAC) and tricep skinfolds (TSF) were measured for the mdex child. Z-sc.ores for height-for·age (HAZ), weighr-for-age (WAZ) and body mass index (ZBMI) were ~~ulated usmg Cen· rres for Disease Control and Prevenrion reference data. Z-scores for body composition measures were calculated using NHANES I and II data for African Americans. The LMS method was used to c~.t for skewed z·score indices. All dara was checked for normaliry and univariable and backward mulnvanablc linear regression analysis conducted.

Ruwlts: Household food securiry was significantly associated with wealth (B= 0. 71, p< 'A acre were more dependenr on assets for HFS. Although sex of head of household was ~ot related to J-:IFS, it modi· fied relationships in rhar female headed households had greater food securtry when fai:mmg less than 1,4 acre compared ro male headed households, and vice versa. HFS was significantly associated with food diversiry (S=0.15, p).

P6-05 (A) Toward Social justice:Environmental Qualiry, Health Outcomes and Urban Social capital in Low-Income Areas in Francistown, Botswana Tirelo Moroka

Urbanization, especially in developing countries, has substantially increased the vulnerability of rhe mass of low-income urban dwellers. The livelihoods and quality of life for many of the poor espe· cially in Larin America, Asia, and Africa, have deteriorated significantly over the years. Urban areas are increasingly unable to provide for their populations, resulting in poverry, massive unemploymenr, job cuts, poor housing, lack of or poor public services, and a compromised health status. Botswana, a country rhat lies in the sourhern parr of Africa, has had its share of urban problems such as rhe mush· rooming of squarters and low-income urban sertlements. Despite efforts to address the substandard living conditions in low-income urban areas, these problems have continued to grow. These living con· diuons are porenrially stressful to rhe residenrs and likely affects their health. The primary aim of the 11udy wa1 to examine the complex relationship between communiry-level stressors and interveners and health-related quality of life among residents of low-income neighborhoods in Francistown, Botswana. U1i"" a croa1-iCCtional quantitative design (both descriptive and explanatory) and using primarily cloae-mded interview• with a random sample of 388 residents, this study examined the role of chrome life 1trnson and environmental quality on overall health status qualiry of life) and the physical, psy· chological and level of independence domains of health. The major hypothesis of the study was that community-levrl stre1Sor1 would influence health-related quality of life and that social capital would moderate these relationships. Findings indicate that neighborhood quality is a powerful predictor of healrh 1tatu1 rhan socioeconomic status and individual life stressors. Social capital was also found to he a 11111ificant positive predictor of healrh and also moderator of structural factors. Social capital moderated the effects of low environmental quality on level of indrpendence and on physical health outcomn, but nor on psychological and global health outcomes. These findings suggest that as the environment get1 betttr. stresson are reduced, hence promoting berter health outcomes. The study ends with implication• for social justice, public health and social work practice, and research, focusing mostly on the ~ole of social capital and the environmental quality in predicting health outcomes. Spt· cafically • anenhon should be focused on political and civic society's commitment for social justice and poveny alleviation, ~uction of the threat of insecuriry and violence; cultivating social capital and good governance; and improving the health and social environments, especially housing and environ· mental 1aiutanon to name a few.

P6-06 (A) Social Coa8ia u a Core Concept in Urban Health Samuel Friedman, Melissa Bolyard, Naomi Braine, Hannah Cooper, Pardis Mahdavi, Carey Maslow, Pedro Mateu-Gd.bert, Geoffrey Ream, Diana Rossi, Risa Friedman, and Milagros Sandoval

Urban health theory ca? benefit .from making social conflict a core concept. We discuss examples of such soc_aal confl.acts ~od ~health •~pacts, drawing mainly on research on HIV, STis, and illicit drug we. Social conflacts, including (a) raciaVerhnic and class-based conflicts of interest over urban develop­ment pohcy, (bl wars. and (c) national political transitions have had major urban health impacrs­:!::1"' thew impacts vary depending on contextual and historical factors. Some of these impactS create

diry. For HIV and rn, for example, actions by elites (such as urban redevelopment and war), and

POSTER SESSIONS v143

urban and other uprisings by non-elites that lead to transitions, can disrupt sexual and injection "risk"

networks that transmit infectious diseases by changing mixing patterns. They can also weaken urban

social networks, their associated protective norms and their informal social control mechanisms

which can lead to increased sexual and drug risk behaviors and violence (Fullilove 2004; Wallace & Wallace1998, Aral 2002, Friedman & Reid 2000; Hankins et al 2002). For example, the 1979 revolu­

tion and transition to theocratic rule, and subsequent urban and national conflicts, have been followed

by many urban youth in Iran engaging in clandestine high-risk sexual and drug behaviors. In Palestine,

conflicts and restrictions on movement have led to increased fatalities from chronic diseases due to

limited access to hospitals and modern medical facilities (Union of Palestinian Medical Relief Commit­

tees); and heroin use and violence-related blood exposure have also increased. Social movements

"from below" that are rooted both in urban social network dynamics and in underlying patterns of

injustice can have both protective and risky effects. For example, the social movements that led to the

collapse of the USSR and its dependent governments in other countries-with subsequent increases in

sex trade, alcoholism, drug use, tuberculosis, HIV, STis, and mortality in many localities-were based

originally on such city-based movements in Eastern Europe. Their impacts on health were mediated by

urban social dynamics and structures. Some urban social movements have improved health by prevent·

ing the spread of HIV, hepatitis and other diseases. Examples include movements of (a) gays and lesbi­

ans and (b) drug users. These have been rooted in social networks that overlap with risk networks.

Theories of urban health should include social conflict as a core concept. Mechanisms that generate

conflicts and the pathways by which conflicts affect health should be a major part of Urban Health

research agendas.

P6-07 (C) Demographic Characteristics of People seen with Tuberculosis in Lagos State University

Teaching Hospital (LASUTH) Chest Clinic John Bako, Adewale Akeredolu, and Wale Alabi

Tuberculosis has become a resurgent Public Health problem in recent times in the world. Because

resources are limited, control programmes frequently must target population at greatest risk. The pur­

pose of this study was to study the Demographic Characteristics of people seen with Tuberculosis in

Lagos State University Teaching Hospital. A total of 76 patients who have been both radiologically

and bacteriologically confirmed tuberculosis patients were used for this study between January and

March. 57 (75%) were males, while 19 (25%) were females. Notable risk factors among patients with

tuberculosis were overcrowding (46.1 % ), homelessness ( 11.8%) cigarette smoking (22.4% ), alcohol­

ism (30.3%), Non vaccination (25%), secondary contact (36.8%) and poor knowledge (92. l 'X,). Man·

agement history patterns among the patients were herbs ( 13.2 'Yo), orthodox medicine ( .H . .l'X.).

Intervention targeting early-identified groups may be an effective way to reduce the incidence of tuber·

culosis. Such intervention should focus on health education, modification of life style and improve­

ment of standard of living.

P6-08 (C) Profiles in Urban Health in 9 Cities of the Americas

Marilyn Rice

In the countries of the Americas, there is an increasing migration of national and international

populations to urban centers. This presentation will focus on some of the issues created by this

influx of populations, the ways that 9 cities in 8 countries are dealing with them, and the efforts to

promote local participation and solutions in management and decision-making. The methodology

used to collect this information has been to draw upon and analyze information produced by the

mayor's and Ministry of Health and Development offices in each of the cities under consideration.

An analysis of the impact of urbanization on health and health determinants will be presented. The

information covers issues such as health status by geographic areas within the cities, highlighting

issues such as marginality, barriers and physical, economic and cultural constructs and inequities in

the delivery of and access to essential services (such as health, education, water, and basic sanita­

tion). Issues of governance and citizen participation will be highlighted to provide insight in~o the

balance of power and mechanisms for decision-making at the local level. Part of the analysis will

show the relationship between democratic processes and social participation. Public ~olicies will be

reviewed to indicate those that are most beneficial in promoting health and overcoming barriers to

it, as well as ways of capitalizing on local assets and resources. Final~y, evidence of effectiveness of

various strategies will be indicated. The presentation will conclude wuh suggesuons for future stra­

tegic directions to improve the quality of life and the promotion of health in large urban centers of

the Americas.

v144 POSTER SESSIONS

P6-09 (A) Migration Trends and Drug Treatment Needs Among Injection Drug Users in the Mexico/U.S.

Border City of Tijuana, Mexico . . Kimberly Brouwer, Michelle Firestone, Remedios Lozada, Carlos Mag1s-Rodnguez, and

Steffanie Strathdee

Introduction: Much of the illicit drug in Mexico is concentrated in northern border areas. The 2000 mile border between the U.S. and Mexico is also characterized by migration; the border crossing between Tijuana, Baja California, Mexico and San Diego, California, U.S.A. is rep~rt~dl~ the busiest land border crossing in the world. We attempt to describe the migration scene among m1ect1on drug users (IDUs) m

Tijuana and investigate service needs. Methods: Migration trends were investigated in a cross-sectional study conducted from February to

June 2005 among IDUs in Tijuana. Enrollment criteria included informed consent, being 18 years or older, and having injected drugs within the prior month. Subjects were recruited by respondent-dnven sampling and were administered a quantitative survey and serology for HIV, HCV, and syphilis. Logistic regression was used to compare IDUs who had migrated to the U.S. versus those who had not.

Results: Of 222 IDUs enrolled, 91 % were male and median age and age at first injection were 35 and 20, respectively. Drug combinations injected most frequently in the past 6 months were heroin (35%1 and crystal methamphetamine mixed with heroin (53%). Of those enrolled, 212 responded to quesnons on migration and drug treatment and were included in this analysis. Although 76% had resided in Tijuana for at least 5 years, 70% of users were born outside of Baja California. Working outside of Mexico was common, with 38% working abroad in the last 10 years (94% in U.S.), and 17% in the past year. In the last 6 months, 10% of IDUs had crossed the border to the U.S., with 57% crossing at least once per month. Those working outside of Mexico in the past year were less likely to have ever received substance abuse treatment, [29% vs. 53%, OR 0.38, 95% CI (0.17-0.83)] and were marginally less likely to have received drug treatment in the past 6 months [6% vs. 18 %, OR 0.28, 95% CI (0.06-1.2)]. Drug use pat­terns, age and gender did not differ between migrants and non-migrants, although migrants were more likely to report being in need of substance abuse treatment (68% vs. 57%, respectively).

Conclusions: Migration is common among IDUs in Tijuana. Maintaining drug treatment regimens and determining how to best target education and services to a highly mobile population pose challenges to officials on both sides of the border. These data underscore the need to develop coordinated bina­tional prevention and treatment efforts.

P6-10 (A) International Perspectives on Public Health Policy Dennis Raphael

Introduction: Despite the expanding literature on the important role public policy plays in influenc­ing the broader determinants of the public\'s health, profound differences exist among jurisdictions in rhe attention placed upon such activities. We take an international perspective on health by examining rhe d?minant public _health paradigms of Canada, USA, UK, and Sweden and exploring how these para­digms shape public health practice.

_Method: We carefully analyze governmental and public health agencies documents to discern ~he dommant para~igms driving public health approaches and practices. We also consider the unique paht1· cal and economic contexts within each nation and consider how these contexts drive public health pahcY and approaches.

. . ~u~: The Canadian and USA public health communities - with some exceptions -- focus upOn m~ividuahzed approaches to risk management. In contrast, the UK and Swedish public health scenes are oriented toward broader approaches to health determinants. We find that the extent to which govern· ments, public health agencies and public health workers concern themselves with public policY approaches £<_> ~ddress ~ro.ad~r .determinants of health depends upon the particular health parad'.~ adhered. ~o withm each 1urisd1ctton. And whether a paradigm is adopted depends upon the ideologi~a and pol~ncal context of each nation. Nations such as Sweden that have a long tradition of public policies promonng social jus~ce an~ equity are naturally receptive to evolving population health concepts. '[he USA represen~ a ~bey en~ro~~t where such is~ues are clear!~ subordinate. .,

Conclusions. Our findings mdicate that there 1s a strong political component that influences pubh ~ealth a~proaches and practi~ within the jurisdictions examined. The implications are that those seek· m~ to raise the broader detennmants of the public's health should work in coalition to raise these issueS with non-health organizations and age · Ca d d th · - ..A ffo . ncies. na a an e USA represent s1tuanons where concerti'~ e. n to1~nfluenc_e g~vemmental policy directions by these organizations and the public health coRJillU' ruty co~ reap sigruficant benefits by reinforcing actions that suppon both social justice and the imple· mentat1on of equity-supporting public policies.

POSTER SESSIONS v145

P6-11 (A) Psychosocial Factors Associated with Perceived Forgone Healthcare: A Comparative Study in

Paris, France, and Antananarivo, Madagascar

Pierre Chauvin, Isabelle Parizot, Mireille Razafindrakoto, Fran~ois Roubaud, and Sylvain Terroni

Badrgrollnd: In developed countries, social inequalities in health have endured or even worsened

comparatively throughout different social groups since the 1990s. In France, a country where access to

medical and surgical care is theoretically affordable for everyone, health inequalities are among the high·

est in Western Europe. In developing countries, health and access to care have remained critical issues. In

Madagascar, poverty has even increased in recent years, since the country wenr through political crisis

and structural adjustment policies. Objectives. We aimed to estimate and compare the impact of socio·

economic status but also psychosocial characteristics (social integration, health beliefs, expectations and

representation, and psychological characteristics) on the risk of having forgone healthcare in these 2 dif·

fercnt contexts. Methods: Population surveys conducted among random samples of households in some under·

served Paris neighbourhoods (n= 889) and in the whole Antananarivo city (n= 2807) in 2003, using a

common individual questionnaire in French and Malagasy.

Reslllts: As expected, the impact of socioeconomic status is stronger in Antananarivo than in Paris.

But, after making adjustments for numerous individual socio-economic and health characteristics, we

observed in both cities a higher (and statically significant) occurrence of reponed forgone healthcare

among people who have experienced childhood and/or adulthood difficulties (with relative risks up to 2

and 3.S respectively in Paris and Antananarivo) and who complained about unhealthy living conditions.

In Paris, it is also correlated with a lack of trust in health services.

Coneluions: Aside from purely financial hurdles, other individual factors play a role in the non-use

of healthcare services. Health insurance or free healthcare seems to be necessary hut not sufficienr to

achieve an equitable access to care. Therefore, health policies must not only focus on the reduction of the

financial barriers to healthcare, but also must be supplemented by programmes (e.g. outreach care ser·

vices, health education, health promotion programmes) and discretionary local policies tailored to the

needs of those with poor health concern .. Acknowledgments. This project was supported by the MAl>IO

project and the National Institute of Statistics (INSTAT) in Madagascar, and hy the Development

Research Institute (IRD) and the Avenir programme of the National Institute of Health and Medical

Research (INSERM) in France.

P6-12 (A) Health and Human Capital in Developing-Country Slums

Mark Montgomery

For the cities of developing countries, poverty is often described in terms of the living standard~ of

slum populations, and there is good reason to believe that the health risks facing these populations are

even greater, in some instances, than those facing rural villagers. Yet much remains to be learned ahour

the connections between urban poverty and health. It is not known what percentage of all urban poor

live in slums, that is, in communities of concentrated poverty; neither is it known what proportion of

slum residents are, in fact, poor. Funhermore, no quantitative accounting is yet available that would sep·

arare the health risks of slum life into those due to a househoid•s own poverty and those stemminic from

poveny in the surrounding neighborhood. If urban health interventions are to be effectively targeted in

developing countries, substantial progress must be made in addressing these cenrral issues. This paper

examines poverty and children's health and survival using two large surveys, one a Demographic and

Health Survey fielded in urban Egypt (with an oversampling of slums) and the other a survey of the

slums of Allahabad, India. Using multivariate statistical methods. we find, in both settings: ( 11 substan·

rial evidence of living standards heterogeneity within the slums; (21 strong evidence indicating that

household-level poverty is an imponant influence on health; and (3) staristically significant (though less

strong) evidence that with household living standards held constant, neighborhood levels of poverty

adversely affect health. The paper doses with a discussion of the implications of these findings for the

targeting of health and poverty program interventions.

P6-13 (A) Urban Environment and the Changing Epidemiological Surfacr. The Cardiovascular ~

&om Dorin, Nigeria Usman Raheem

The emergence of cardiovascular diseases had been explained through the concomitants o_f the

demographic transition wherein the prevalent causes of morbidity and monality ~hangr pr~mmant infectious diseases to diseases of lifestyle or chronic disease (see Deck, 1979). A ma1or frustration m the

v146 POSTER SESSIONS

case of CVD is its multifactural nature. It is acknowledged that the environment, however defined is the d · f · t' b tween agents and hosts such that chronic disease pathogenesis also reqmre a me 1an o mterac ion e .

spatio-temporal coincidence of these two parties. What is not clear is which among ~ever~( potennal fac· · h b pace exacerbate CVD risk more· and to what extent does the ep1dem1olog1cal trans1· tors m t e ur an s ' . . . .

tion h othesis relevant in the explanation of urban disease outlook even the developmg cities like Nigeri~: Thesis paper explorer these within a traditional city in Nigeria. . . .

Method: The data for the study were obtained from two tertiary level hospitals m the metropolis for 10 years (1991-2000). The data contain reported cases of CVD in the two facilities for the period. Adopting a series of parametric and non-parametric statistics, we draw inferences between the observed cases of CVDs and various demographic and locational variables of the patients.

Findings: About 28% of rhe cases occurred in 3 years (1997-1999) coinciding with the last year of military rule with great instability. 55.3% occurred among male. 78.8% also occurred among people aged 31-70 years. These are groups who are also likely to engage in most stressful life patterns. ~e study also shows that 63% of all cases occurred in the frontier wards with minor city areas also havmg their •fair' share. Our result conformed with many empirical observation on the elusive nature of causation of CVD. This multifactoral nature had precluded the production of a map of hypertension that would be consistent with ideas of spatial prediction. CVD - Cardiovascular diseases.

P6-14 (A) Urban Health in a Large City: The Case of Mumbai and the Role of the Voluntary Sector Anant Bhan

Mumbai is the commercial capital of India. As the hub of a rapidly transiting economy, Mumbai pro­vides an interesting case study into the health of urban populations in a developing country. With high-rise multimillion-dollar construction projects and crowded slums next to each other, Mumbai presents a con· trast in development. There are a host of hi-tech hospitals which provide high quality care to the many who can afford it (including many westerners eager to jump the queue in their healthcare systems-'medical tour· ism'), at the same time there is a overcrowded and strained public healthcare system for those who cannot afford to pay. Voluntary organizations are engaged in service provision as well as advocacy. The paper will outline role of the voluntary sector in the context of the development of the healthcare system in Mumbai. Mumbai has distinct upper, middle and lower economic classes, and the health needs and problems of all three have similarities and differences. These will be showcased, and the response of the healthcare system to these will be documented. A rising HIV prevalence rate, among the highest in India, is a challenge to the Mumbai public healthcare system. The role of the voluntary sector in service provision, advocacy, and empowerment of local populations with regards to urban health has been paramount. The emergence of the voluntary sector as a major player in the puzzle of urban Mumbai health, and it being visualized as voices of civil society or communiry representatives has advantages as well as pitfalls. This paper will be a unique attempt at examining urban health in India as a complex web of players. The influence of everyday socio·polirical-cultural and economic reality of the urban Mumbai population will be a cross cutting theme in the analysis. The paper will thus help in filling a critical void in this context. The paper will thus map out issues of social justice, gender, equiry, effect of environment, through the lens of the role of the voluntary sector to construct a quilt of the realiry of healthcare in Mumbai. The successes and failures of a long tradi· tion of the active advocacy and participation of the voluntary sector in trying to achieve social justice in the urban Mumbai community will be analyzed. This will help in a better understanding of global urban health, and m how the voluntary sector/NGOs fir into the larger picture.

P6-IS (C) Improving Water and Sanitation Access for the Urban Poor: A Case Study of Nairobi Ann Yoachim

Ba~und: O~er. half _of N~irobi's 2.5 million inhabitants live in illegal informal settlements that compose 5 Yo of the city s res1dent1al land area. The majority of slum residents lack access to proper san· iranon and a clean and adequate water supply. This research was designed to gain a clearer understand· mg of what Kappr · · · H f . . opnate samtanon means or the urban poor, to determine the linkages between gender, hvehhoods, and access to water and sanitation, and to assess the ability of community sanitation blocks to meet water and sanitation needs in urban areas.

M~tboJs_: _A household survey, gender specific focus groups and key informant interviews were con­ducted m Maih Saba, a peri-urban informal settlement. Qualitative and quantitative research tools were u~ to asses~ the impact and effectiveness of community sanitation blocks in two informal settlements. K1bera and K1ambm.

Results: "App · t · · H • I d · · f . ropna e samtarmn me u es not only safe and clean latrines, but also provision ° adequate drainage and access to water supply for cleaning of clothes and homes. Safety and cleanliness

POSTER SESSIONS v147

were priorities for women in latrines. Levels of poverty within the informal settlements were identified

and access to water and sanitation services improved with increased income. Environmental health prob­

lems related to inadequate water and sanitation remain a problem for all residents. Community sanita­

tion blocks have improved the overall local environment and usage is far greater than envisioned in the

design phase. Women and children use the blocks less than men. This is a result of financial, social, and

safety constraints. Conclusion: The results highlight the importance a need to expand participatory approaches for the

design of water and sanitation interventions for the urban poor. Plans need to recognize "appropriate

sanitation" goes beyond provision of latrines and gender and socioeconomic differences must be taken

into account. Lessons and resources from pilot projects must be learned from, shared and leveraged so

that solutions can be scaled up. Underlying all the challenges facing improving water and sanitation for

the urban poor are issues of land tenure.

P6-16 (C) Integrating TQM (Total Quality Management), Good Governance and Social Mobilization

Principles in Health Promotion Leadership Training Programmes for New Urban Settings in 12

Countries/ Areas: The Prolead Experience

Susan Mercado, Faren Abdelaziz, and Dorjursen Bayarsaikhan

Introduction: Globalization and urbanization have resulted in "new urban settings" characterized

by a radical process of change with positive and negative effects, increased inequities, greater environ­

mental impacts, expanding metropolitan areas and fast-growing slums and vulnerable populations. The

key role of municipal health governance in mitigating and modulating these processes cannot be overem­

phasized. New and more effective ways of working with a wide variety of stakeholders is an underpin­

ning theme for good governance in new urban settings. In relation to this, organizing and sustaining

infrastructure and financing to promote health in cities through better governance is of paramount

importance. There is a wealth of information on how health promotion can be enhanced in cities.

Despite this, appropriate capacity building programmes to enable municipal players to effectively

respond to the challenges and impacts on health of globalization, urbanization and increasing inequity in

new urban settings are deficient. The WHO Kobe Centre, (funded by the Kobe Group( and in collabora­

tion with 3 Regional Offices (EMRO, SEARO, WPRO) with initial support from the Japan Voluntary

Contribution, developed a health promotion leadership training programme called "Prolead" that

focuses on new and autonomous structures and sustainable financing for health promotion in the con­

text of new urban settings. Methodology: Country and/or city-level teams from 12 areas, (China, Fiji, India, Japan, Lebanon,

Malaysia, Mongolia, Oman, Philippines, Republic of Korea, Tonga and Viet Nam) worked on projects to

advance health promotion infrastructure and financing in their areas over a 9 month period. Tools were

provided to integrate principles of total quality management, good governance and social mobili1.ation.

Results: Six countries/areas have commenced projects on earmarking of tobacco and alcohol taxes

for health, moblization of sports and arts organizations, integration of health promotion and social

health insurance, organizational reforms, training in advocacy and lobbying, private sector and corpo­

rate mobilization and community mobilization. Results from the other six areas will be reported in 01..;obcr.

Conclusions: Total quality management, good governance and social mobilization principles and

skills are useful and relevant for helping municipal teams focus on strategic interventions to address com­

plex and overwhelming determinants of health at the municipal level. The Prolead training programmes

hopes to inform other processes for building health promotion leadership capacity for new urban settings.

P6-t7 (C) Urban Change and Health Conditions: The (in)Visible Challenge and its Implications for

Environmental justice Among Low Income Communities in Kampala City Uganda

Hanningron Sengendo and Paul Mukwaya

The impact of city living and urbanization on the health of citizens in developing countries has

received increasing attention in recent years. Urban areas contribute largely to national economies. How­

ever, rapid and unplanned urban growth is often associated with poverty, environmental degradation

and population demands that outstrip service capacity which conditions place human health at risk.

Local and national governments as well as multi national organizations are all grappling with the chal­

lenges of urbanization. With limited data and information available, urban health characteristics, includ­

ing the types, quantities, locations and sources in Kampala, are largely unknown. Moreover, there is n?

basis for assessing the impact of the resultant initiatives to improve health ~onditions amo~g ~o":1":1um­

ties settled in unplanned areas. Since urban areas are more than the aggregation ?f ~?pie w~th md_1v1dual

risk factors and health care needs, this paper argues that factors beyond the md1V1dual, mcludmg the

POSTER SESSIONS v148

· I d h · I · ment and systems of health and social services are determinants of the health soc1a an p ys1ca environ . of urban populations. However, as part of an ongoing study? ~s pape~ .addresses the basic concerns of urban health in Kampala City. While applying the "urban hvmg conditions and the urban heal~ pen· alty" frameworks, this paper use aggregated urban health d~ta t~ explore the role of place an~ 111st1tu· tions in shaping health and well-being of the population m Kampala by understanding how characteristics of the urban environment and specific features of the city are causally related to health of invisible and forgotten urban poor population: Results i~dica~e that a .range o~ urb~n he~l~h hazards m the city of Kampala include substandard housing, crowdmg, mdoor air poll.ut1on, msuff1c1ent a~d con· taminated water, inadequate sanitation and solid waste management services, vector borne .diseases, industrial waste increased motor vehicle traffic among others. The impact of these on the envtronment and community.health are mutually reinforcing. Arising out of the withdra"'.al of city pl~nning systems and service delivery systems or just planning failure, thousands of people part1cularl~ low-mc~me groups have been pushed to the most undesirable sections of the city where they are faced with ~ va_r1ety ~f enVJ· ronmental insults. The number of initiatives to improve urban health is, however, growing mvolVJng the interaction of many sectors (health, environment, housing, energy, transportation and urban planning) and stakeholders (local government, non governmental organizations, aid donors and local community groups).

Key words: urban health governance, health risks, Kampala.

INTERVENTIONS TO IMPROVE THE HEALTH OF URBAN COMMUNITIES

P7-01 (A) Subway Health and Safety Hazards Robyn Gershon, Marissa Barrera, and Frank Goldsmith

Introduction: The viability of urban communities is dependent upon reliable and affordable mass transit. In particular, subway systems play an especially important role in the mass transit network, since they provide service to vast numbers of riders- seven of the 95 subway systems worldwide report over one billion passenger rides each year. Surprisingly, given the large number of people potentially affected, very little is known about the health and safety hazards that could affect both passengers and transit workers; these include physical (e.g., noise, vibration, accidents, electrified sources, temperature extremes), biological (e.g., transmission of infectious diseases, either through person-to-person spread or vector-borne, for example, through rodents), chemical (e.g., exposure to toxic and irritant chemicals and metals, gas emissions, fumes), electro-magnetic radiation, and psychosocial (e.g., violence, workstress). More recently, we need to consider the threat of terrorism, which could take the form of a mass casualty event (e.g., resulting from conventional incendiary devices), radiological attack (e.g., "dirty bomb"), chemical terrorist attack (e.g., sarin gas), or bioterrorist attack (e.g., weapons grade anthrax). Given the large number of riders and workers potentially at risk, the public health implications are considerable.

Methods: To assess the hazards associated with subways, a structured review of the (English) litera· ture was conducted.

Ruults: Based on our review, non-violent crime, followed by accidents, and violent crimes are most prevalent. Compared to all other forms of mass transit, subways present greater health and safety risks. However, the rate of subway associated fatalities is much lower than the fatality rate associated with automobile travel (0.15 vs. 0.87 per 100 million passenger miles), and cities with high subway ridership rates have a 36% lower per capita rate of transportation related fatalities than low ridership cities (7.5 versus 11.7 annual deaths per 100,000 residents). Available data also suggest that subway noise levels and levels of air pollutants may exceed recommended levels. . ~: There is a paucity of published research examining the health and safety hazards asso-

ciated with subways. Most of the available data came from government agencies, who rely on passively reported data. Research is warranted on this topic for a number of reasons, not only to address impor­tant knowled~ gaps, but also because the population at potential risk is large. Importantly, from an urban perspecnve, the benefits of mass transit are optimized by high ridership rates- and these could be adversely affu:ted by unsafe conditions and health and safety concerns.

P7-02 (A) EffcctiYCDcss of Educational Program for Diabetics on HbA1c Values Veena Joshi, Jeremy Lim. and Benjamin Chua

~ ~rban health issues have moved beyond infectious diseases and now centre largely on chrome diseases. Diabetes is one of the most prevalent non-communicable diseases globally. 9 % of adult

v149

Siappore11111tt diabetic (National Health Survey 2004). DU.bnes i1 alto kading .:aUK of end·sugr

ieaal clileue ia Singapore, accounting for more than SO% of new can. Thia hn prompced the: N.uion.11

Kidney Foudlrion, Singapore (NKFS) to embark on a Prevention Program (PP) 10 empo~r d1ahc'fict 10

1J1U1F dieir condition bttter, emphasizing education and disease sdf·managemen1 lkilla a. essennal

camponenn of good glycaemic control. We sought 10 explore the effects of a 1pecialiJed edu.:a11on pro·

pun OD glycacmic conuol, as indicated by, serum HbA IC values.

Md6otlt: 98 ambulatory patients with Type II OM were recruited for 1hi1 11udy from 1he NKFS

Prnention C.COrre1, nune-led facililin es1abli1hed 10 complement the phyt1cian1' medical trea1men1 of

diabela. Budine serum HbA IC values were determined before un<k-rgmng the education progr ;am,

which couisted of comprehensive dietary advice, ideal weight goals, and improving lipid profiln. Serum

HbAIC values were obtained ar 3,6,9 months later to determine impact of the program. Analy11• wu

done Uling paired !·tests. Statistical significance was taken ar pc 0.00011 from 0 to 3, 6 &: 9mon1h1. f8(;

mis at 0,3,6,9,months were 146.68 ±69.9, l.l4.29 ±4S.3S, I .l4.66 ± 47.76 &: 141.61±49.41. 11gmh·

candy lower (p < 0.001) from 0 to 3, 6 months. Significant reduction in HbA le levels from 0 ro 9 month•

was observed in females, Chinese race, older age group(> SO yean). ohew- IBMI ~ 27.nwm2, Wai11 Hip

Ratio> l),up to primary and above secondary level education and those having OM for up to S ye.m.

Urine IClt showed that increasing HbAlc levels (9) had increasing urmary protein (38.± 117; .18 ±I IH;

.SO± 136) and crearinine (S2.S ± 64; 7S ± 71; IOI± 7S) levels.

~ HbAlc and FBG rnults showed that the management nf d1abetn m the NKFS Preven·

tion Programme is effec;rive. Results also indicated 1har HbA le leve11 have a linnr trend wnh unnary

protein and creatinine which are imponant determinants of renal diseate.

P7.0J (Al N-.tal Family-Focused Cinical Palbway1 Promoce Politivc OutcOllln for ua Inner City

Canu allicy Brenda S..de, Kathryn Buller, Catherine Bishop, jenmfrr Dockrry, K1n1en M1;Fadym, t:nuly Wona,

Jtanne Zielonka, Carol Blake· Annon, Joanne Smith, and F..lhc:I Yinit

""'°"1ldiolt F1mily-Focusrd Oinical ParhwaY' (CP.I dncribe !'""'"'"'"""'' llJ" IPMAI JerrnJm1

care llCtivirits in preparation for an infanr'' dilchargr honlr, and art m1endnl lo improve effi.:k'fl.:tn of

c.are. 11lere i11 paucity of tttran:h, and inconsi1trncy of rnulta on 1ht- •m!*-1 of f1m1ly·fc"-'UW d1nM;.tl

palhwtys on patient ou1comn when med in a neoNtal vninK wn•RK an inner dry ,·ommumry.

°"""'1a: To determinr whrthrr implrmentation of family.focuted C:Pt 1n 1 Ntnn.tt.tl Unit W"n

mg an inner city 1;ommunity drcl't'aKI leftarh of lf•Y (I.OSI and rromclll'I family uo•fkllon and rt.1J1

nest for dikhargr. Md6odt: Family-focuK"d CPI ~initiated in a Neon.t1.tl llm1 localed m the inner '"" ol Tnrurun,

C'~nada in August, 2004. They Wrtt implemented Ulina a muh1d1"'1pinary tdu.:.:mon rrow.tm. 1041

data wm coll«ted for all infant• horn btrwttn 29 and 36 Wft"k• 1t"lal111MI atr who wrtt .1dm111ed to

the Ntonatal Unit. Two cohom wttr compated: June - Srpcrmhn, 2004, lrtt·tlfflUP· n • 'I I, anJ (l,.to·

brr, 2004 - January, 2005, (pmt-group, n • 49). A 111ri1fact1on quneionnaire wH 1dnum"rred to lam•·

lin who had uted the er •. An incl't'rnmtal ""' analy111 WU prrfonned.

lftlllb: Binhwright (206 7 :t: 498 n. 2128 t 408 pnal. PMA at htnh C H.1 t I.I n. l l4 t I .ft •l"1·

and PMA and wright on admi111on 10 rhe Nronatal Unit 114.1 t 1. 7 n. l4 .. l t I .S wlu.; 2024 t 414 n.

2068 t 439 IP"•) were 11m1l.1r m both cohont lpre·CP YI.. poM-<.P, mt an t Ml. p • O.O'I. Thc'tt' w..-tt no

11p11hun1 differences m Apgar .corn, need for vc:nolatory suppon or oxyp, 11111 1ncidrrkr o4 lw.1te·

lmiang between pre and pt.a goup. Lmgdl of -.y 111. 9 n. 14.8 daY'o p c O.OSI ind PMA .11 d•Mr.,

ho.nr 137.3 t 1.3 n. 36.4 ± I. I wb, p < O.OS) wett N«01fiamly F.lfrt 1n the pre.(]' poup. ~11.fxtMon

ICOfn for famihn wrre high. and families noctd thc:y wnr mott prepued to ah thrar t..lby "'-·

Thett was .a cosi uving of S 1,814 (Cdn) per patient d1teharpd home 1n the pmi-CP poap c.-pated 10

the P"''lfOUP· CortclaioN· lmplrmrnr.rion of family·foanrd C:P. in a Nrona1.1I Umt tC"fYIDI an 1nnn an com·

muniry decre.ned length of'"'" mft with a high dcgrft of family uuJamon, and wrre COll~nT.

Uw of 1he Cl'\ in other Nroru1al Umrs semng an mnrr city coaununlfl' may he btnefKaal.

'7-04 (C) H.aikoa's HC!lpiuh-Sllckcn Worlmis CnNp

Niki Gardy

Hamilton'• Hmpiul1-Shdtrn Worlung Group cHSWG> wat concnwd 10 add'"'.-- Mlf'fOUf'd·

ing ditehargcs 10 the city's Wlrrn of .-rimn nprriracinl ~-- Shdm pnmdrn ~ concnm th.at more patients ~ Ming dircha,.d without prior commuruat-. wdhouc cnnudn'anon

v150 POSTER SESSIONS

of community resources, and without adequate follow-up. In November 2003 shelter pr.oviders ~et with hospital social workers and CCAC to strike a Working Group to address some of th~ issues by mcre.as­ing knowledge among hospital staff of issues surrounding homelessness, and to build a stro?g workmg relationship between both systems in Hamilton. To date the HSWG has conducted four w~lkmg to~ of downtown shelters for hospital staff and local politicians. Recently the HSWG launched its ·~ool.k1t for Staff Working with Patients who are Homeless', which contains community resources and gu1dehnes to help with effective discharge plans. A SCPI proposal has been submitted to incre~se the capacity of the HSWG to address education gaps and opportunities with both shelters and hospitals around homeless­ness and healthcare. The purpose of this poster presentation is to share Hamilton's experience and learn­ings with communities who are experiencing similar issues. It will provide for intera~tion around shared experiences and a chance to network with practitioners across Canada re: best practices.

P7-05 (A) Health Capacity: A Different Perspective Ian Potter and Salma Pardhan

Introduction and Objectives: Canadians view health as the biggest priority for the federal govern­ment, where health policies are often based on models that rely on abstract definitions of health that pro­vide little assistance in the policy and analytical arena. The main objectives of this paper are to provide a functional definition of health, to create a didactic model for devising policies and determining forms of intervention, to aid health professionals and analysts to strategize and prioritize policy objectives via cost benefit analysis, and to prompt readers to view health in terms of capacity measures as opposed to status measures. This paper provides a different perspective on health, which can be applied to various applica­tions of health such as strategies of aid and poverty reduction, and measuring the health of an individual/ community/country. This paper aims to discuss theoretical, conceptual, methodological, and applied implications associated with different health policies and strategies, which can be extended to urban com­munities. Essentially, our paper touches on the following two main themes of this conference: •Health sta­tus of disadvantaged populations; and •Interventions to improve the health of urban communities.

Methodology: We initially surveyed other models on this topic, and extrapolated key aspects into our conceptual framework. We then devised a theoretical framework that parallels simple theories of physkal energy, where health is viewed in terms of personal/societal Health Capacities and Effort components. After establishing a theoretical model, we constructed a graphical representation of our model using self­rated health status and life expectancy measures. Ultimately, we formulated a new definition of health, and a rudimentary method of conducting cost benefit analysis on policy initiatives. We end the paper with an application example discussing the issues surrounding the introduction of a seniors program.

Results: This paper provides both a conceptual and theoretical model that outlines how one can go about conducting a cost-benefit analysis when implementing a program. It also devises a new definition and model for health barred on our concept of individual and societal capacities. By devising a definition for health that links with a conceptual and theoretical framework, strategies can be more logically con­structed where the repercussions on the general population are minimized. Equally important, our model also sets itself up nicely for future microsimulation modeling and analysis.

Implications: This research enhances one's ability to conduct community-based cost-benefit analy­sis, and acts as a pedagogical tool when identifying which strategies provide the best outcome.

P7-06 (A) Good Playgrounds are Hard to Find: Parents' Perceptions of Neighbourhood Parks Patricia Tucker, Martin Holmes, Jennifer Irwin, and Jason Gilliland

Introduction: Neighbourhood opportunities, including public parks and physical activity or sports fields hav~ been. iden.tified as correlates to physical activity among youth. Increasingly, physical activity among children 1s bemg acknowledged as a vital component of children's lives as it is a modifiable deter­minant of childh~d obesity. Children's use of parks is mainly under the influence of parents; therefore, the purpose of this study was to assess parents' perspectives of city parks, using London Ontario as a case study.

M~~: This qualitative study targeted a heterogeneous sample of parents of children using local parks w1thm London. Parents with children using the parks were asked for 5 minutes of their time and if willing, a s.hort interview was conducted. The interview guide asked parents for their opinion 'of city parks, particularly the one they were currently using. A sample size of 50 parents is expected by the end of the summer.

Results: Preliminary findings are identifying parents concern with the current Jack of shade in local parks. Most parents have identified this as a limitation of existing parks, and when asked what would make the parks better, parents agree that shade is vital. Additionally, some parents are recognizing the

POSTER SESSIONS ¥151

benefit in providing splash pads in more parks. Given the high temperature and humidity of London

summers, this is an important aspect and asset of parks. Interviewed parents claimed to visit city parks

anywhere between 1 to 6 days per week.

Corrduion: Given that the vast majority of Canadian children are insufficiently active to gain

health benefits, identifying effective qualities of local parks, that may support and foster physical activity

is essential. Strategies to promote activity within children's environments are an important health initia­

tive. The results from this study have implications for city planners and policy makers; parents' opinions

of, and use of city parks provides feedback as to the state current local parks, and modifications that

should be made for new ones being developed. This study may also provide important feedback for

health promoters trying to advocate for physical activity among children.

'Y'l--07 (A) Socioeconomic Deprivation, and Child Health and Survival Among the Urban Poor in Kenya

Eliya Zulu and jean Christophe Fotso

Introdt1clion: A rapidly increasing proportion of urban dwellers in Africa live below the poverty

line in overcrowded slums characterized by uncollected garbage, unsafe water, and deficient sanitation

and overflowing sewers. This growth of urban poverty challenges the commonly held assumption that

urban populations enjoy better health than their rural counterparts. The objectives of this study are (i) to

compare the vaccination status, and morbidity and mortality outcomes among children in the slums of

Nairobi with rural Kenya, and (ii) to examine the factors associated with poor child health in the slums.

Mdbods: We use data from demographic and health survey representative of all slum settlements in

Nairobi City carried out in 2000 by the African Population & Health Research Center. A total of 3,256

women aged 15-49 from 4,564 households were interviewed. Our sample consists of 1,210 children aged

0-35 months. The comparison data are from the 1998 Kenya Demographic and Health Survey. The out­

comes of interest include child vaccination status, morbidity (diarrhea, fever and cough) and mortality,

all dichotomized. Socioeconomic, environmental, demographic, and behavioral factors, as well as child

and mother characteristics, are included in the multivariate analyses. Multilevel logistic regression models

are used. l'Nlimin11ry Rest1lts: About 32 % of children in the slums had diarrhea in the two weeks prior to the

survey, compared to 16% of rural children. These disparities between the urban poor anJ the rural resi­

dents are also observed for fever (64% against 42%), cough (46% versus 20%), infant mortality (91/

1000 against 76/1000), and complete vaccination (48% against 64%). Preliminary multivariate results

indicate that health service utilization and maternal education have the strongest predictive power on

child morbidity and mortality in the slums, and that household wealth has only minor, statistically insig­

nificant effects. Conclruion: The superiority of health of urban children, compared with their rural counterparts,

masks significant disparities within urban areas. Compared to rural residents, children of slum dwellers

in Nairobi are sicker, are less likely to utilize health services when sick, and stand greater risk to die. Our

results suggest policies and programs contributing to the attainment of the millennium development goal

on child health should pay particular attention to the urban poor. The insignificance of socioeconomic

status suggests that poor health outcomes in these communities are compounded by poor environmental

sanitation and behavioral factors that could partly be improved through female education and behavior

change communication.

P7-08 (A) Emerging Urban Health Service Model-Surat City, India

Vikas Desai and lshwar Patel

Introduction: Historic trade city Surat with its industrial and political peace has remained a center

of attraction for people from all the comers of India resulting in to pop.ulatio~ explosio~ a~d stressed

social and service infrastructure. The topography,dimate and demographic profile of the city 1s threat to

the healthy environment. Aim of this analysis is to review the impact of managemt'nt reform on health

indicators. Method: This paper is an analysis of the changing profile of population, sanitary infr~s~rucrure,

local self Government management and public health service reform, secondary health stat1st1cs data,

health indicator and process monitoring of 25 years. . .

Rauh and Conclt1Sion: Surat city have faced five floods since 1959, last being 2004. The rams,

humidity and temperature pattern is conducive to vector born diseases. ~ailed city of 8.81 Sq. km.

(1963) have been extended to 112.16 Sq. Km. (1986). 1981 -1991 era expenen~ed un~~~ted popu­

lation influx 92.7% which was followed by 60.3% in next decade. 40% population residing. m 300 slums

within city and number of slums surrounding outskirts of the city imposes threat to the environment and

POSTER SESSIONS v152

health of entire city and challenge to the management system. Plague outbr~ak (1994) was the turning point in the history of civic service management including p~blic ~e~lth service management. ~ocal self government management system was revitalized by reg~lar_ field v1s1ts o~ al~ cadre~, _decentraltzanon of power and responsibility, equity, regular vigilant momtormg, commumcanon facility, ream_approach and people participation. Reform in Public health service management was throu_gh stan~~rd1Zed inter­vention protocol, innovative intervention, public private partnership, community part1c1panon, aca­demic and service institute collaboration and research. Sanitation service coverage have reached nearer to universal. Area covered by safe water supply reached to 98%(2004) from 40% (1991) and under­ground drainage to 97% (2004) from 17% ( 1991) The overhauling of the system have reflected on health indicators of vector and water born disease. Malaria SPR declined to 1.23 (2004) from 23.06'Yo(!991) and diarrhea case report declined to 1963(2004) from 3431(2004). Except Dengue fever in 2002 no major disease outbreaks are reported after 1991. City is recipient of international/national awards/ranking for these achievements. The health department have developed an evidence and experi­ence based intervention and monitoring system and protocol for routine as well as disaster situation. The health service and management structure of Surat city have emerged as an urban health model for the country.

P7-09 (C) Using Community Based Participatory Research to Assess Milwaukee Public Housing Women's Perceptions of Breast Health Staci Young and Barbra Beck

Introduction: The Center for Healthy Communities (CHC) in the Department of Family and Com· munity Medicine at the Medical College of Wisconsin developed a pilot project to: 1) Assess the know· ledge, attitudes, and behaviors of female Milwaukee public housing residents related to breast cancer; 21 Develop culturally and literacy appropriate education and screening modules; 3) Implement the devel­oped modules; 4) Evaluate the modules; and 5) Provide follow-up services. Using a community-based participatory research model the CHC worked collaboratively with on-site nurse case management to meet these objectives.

Methods: A "breast health kick off event" was held at four separate Milwaukee public housing sites for elderly and disabled adults. Female residents were invited to complete a 21-item breast health survey, designed to accommodate various literacy levels. Responses were anonymous and voluntary. The survey asked women about their previous physical exams for breast health, and then presented a series of state· ments about breast cancer to determine any existing myths. The final part gathered information about personal risk for breast cancer, the highest level of education completed, and whether the respondents h;td ever used hormone replacement therapy and/or consumed alcohol. Responses were collected for descriptive analysis.

Results: A total of 45 surveys (representing 18% of the total female population in the four sites) were completed and analyzed. 89% reported that they had a physical exam in the previous rwo years. 96% of respondents indicated they never had been diagnosed with breast cancer. 85% reported having had a mammogram and 87% having had a clinical breast exam. Those that never had a mammogram reported a fear of what the provider would discover or there were not any current breast problems ro warrant an exam. 80% agreed that finding breast cancer early could lower the chance of dying of cancer. Over 92% reported that mammograms were helpful in finding cancer. However, 27% believed that hav· ing a mammogram actually prevents breast cancer. 14% indicated that mammograms actually cause cancer and 16% reported that a woman should get a mammogram only if there is breast cancer in her family.

Conclusion: This survey indicates that current information about the importance of mammograms and clinical breast exams is reaching traditionally underserved women. Yet there are still critical oppor· tunities to provide valuable education on breast health. This pilot study can serve as a tool for shaping future studies of health education messages for underserved populations.

P7-10 (A) The Development of an Interdisciplinary and Teaching Medical/Dental Clinic for Inner City Street Youth as a Satellite Clinic of the Bruyere Family Health Network: A Demonstration Project Melanie Mason and Cathy Tocchi

lntro'!"ction: The C.T .. Lamont Institute opened a satellite interdisciplinary and teaching medicaU ~ental chm~ for street youth m March 2004 with an Ontario government grant. Located in a yourh serv· ~ng agency m downtow~ Ottawa, the clinic brings together community partners to provide primary med­ical care. and dent~I hygiene t? the street youths of Ottawa aged 12-20. The primary goal of the project is to provide accessible, coordinated, comprehensive health and dental care to vulnerable adolescents.

POSTER SESSIONS v153

These efforts respond to the pre-existing body of evidence suggesting that the principle barrier in access­

ing such care for these youths are feelings of intimidation and vulnerability in the face of a complex

healthcare system. The Bruyere FHN Satellite Clinic is located in the basement of a downtown drop-in

and brings together a family medicine physician and her residents, a dental hygienist and her 2nd year

students, a nurse practitioner, a chiropodist and 2 public health nurses to provide primary care. The

clinic has been extremely busy and well received by the youth. This workshop will demonstrate how five

community organizations have come together to meet the needs of high risk youths in Ottawa. This pre­

sentation will showcase the development of the clinic from its inception through its first year including

reaction of the youths, partnerships and lessons learned. It will also focus on its sustainability without

continued funding. We hope to have developed a model of service delivery that could be reproduced and

sustained in other large cities with Faculties of Medicine.

Methods: Non-randomized, mixed method design involving a process and impact evaluation. Data

Collection- Qualitative-a) Semi structured interviews with providers & partners b)Focus groups with youth

Quantitative a)Electronic medical records for 12 months Records (budget, photos, project information).

Results: 1) Successfully built and opened a medicaUdental clinic which will celebrate its 1 year anni­

versary in August. 2) Over 140 youths have been seen, and we have had over 300 visits.

Conclusion: 1) The clinic will continue to operate beyond the 18 month project funding. 2) The

health of high risk youth in Ottawa will continue to improve due to increased access to medical services.

P7-11 (A) Health Services - for the Citizens of Bangalore - Past, Present and Future

Savita Sathyagala, Girish Rao, Thandavamurthy Shetty, and Subhash Chandra

Bangalore city, the capital of Karnataka with 6.5 million is the 6th most populous city in India; sup­

porting 30% of the urban population of Karnataka, it is considered as one of the fastest growing cities in

India. Known as the 'silicon valley of India', Bangalore is nearly 500 years old. Bangalore City Corpora­

tion (BMP), is a local self government and has the statutory commitment to provide to the citizens of

Bangalore: good roads, sanitation, street lighting, safe drinking water apart from other social obligations,

cultural development and poverty alleviation activities. Providing preventive and promotive heahh

services is also a specific component. The objective of this study was to review the planning process with

respect to health care services in the period since India independence; the specific research questions

being what has been the strategies adopted by the city planners to address to the growing needs of the

population amidst the background of the different strategies adopted by the country as a whole. Three

broad rime ranges have been considered for analysis: the 1950s, 1970s and the 1990s. The salient results

are: major area of focus has been on the maternal and child care with activities ranging from day-care to

in-patient-care; though the number of institutions have grown from 5 to the current day 79, their distri­

bution has been far from satisfactory; Obtaining support from the India Population projects 3 and 8

major upgradarions have been undertaken in terms of infrastructure; Over the years, in addition to the

dispensaries of modern system of medicine, local traditional systems have also been initiated; the city has

partnered with the healthy cities campaign with mixed success; disease surveillance, addressing the prob­

lems related to the emerging non-communicable diseases including mental health and road traffic injuries

are still in its infancy. Isolated attempts have been made to address the risks groups of elderly care and

adolescent care. What stands out remarkably amongst the cities achievements is its ability to elicit partic­

ipation from NGOs, CBOs and neighbourhood groups. However, the harnessing of this ability into the

health sector cannot be said totally successful. The moot question in all the above observed development

are: has the city rationally addressed it planning needs? The progress made so far can be considered as

stuttered. The analysis and its presentation would identify the key posirive elements in the growth of

Banglore city and spell a framework for the new public health.

P7-12 (A) Behavior Change Trials of Improved Practices (TIPS) for Anaemia in Pregnancy and IFA

Tablets Consumption in Vadodara Urban, India

Alpesh Shah and Prakash Kotecha

Introduction: Anaemia associated with pregnancy is a major public health problem all over the

world. Different studies in different parts of India shown prevalence of anaemia between 60-90%.

Anaemia remains a serious health problem in pregnancy despite of strong action taken by the Govern­

ment of India through national programmes. In the present study we identified th~ social beha~iors,

responsible for low compliance of IF A tablets consumption in pregnancy at community level and inter-

vention was given with new modified behaviors on trial bases. .

Methodology: This is an intervention study carried out in ~adodara urban durm~ June 2004 to July

2005. There are 289 anganwadies running under Integrated Child Development Services (ICDS proJect)

v154 POSTER SESSIONS

in Vadodara urban. 60 anganwadies out of 289 were selected from the list by random sampling for TIPS

(Trials of Improved Practices) study. . . Participants: 266 pregnant women (132, intervention group+ 134, control. group) registered m the

above 60 anganwadies. Study was conducted in to three phases: Phase: 1. Formative research and baseline

survey (FRBS). Data was collected from all 266 pregnant women to identify behaviors that are responsible

for low compliance of IFA tablets. Both qualitative and quantitative data were collected. Haemoglobin was

estimated of all pregnant women by Haemo-Cue. Phase: 2. Phase of TIPS. Behaviors were identified both

social & clinical for low compliance of IFA tablets consumption in pregnancy from FRBS and against those,

modified behaviors were proposed to pregnant women in the intervention group on trial bases by health

education. Trial period of 6 weeks was given for trial of new behaviors to pregnant women in the interven·

tion group. Phase: 3. In this phase, feedbacks on behaviors tried or not tried were taken from pregnant

women in intervention group. Haemoglobin estimation was carried out again in all 266 pregnant women. At

the end of the study, messages were formulated on the bases of feedbacks from the pregnant women.

Results: All pregnant women in the intervention group had given positive feedback on new modi­

fied behaviors after intervention. Mean Haemoglobin concentration was higher in intervention group

(10.04±0.11 gm%) than control group (9.60±0.14 gm%). IFA tablets compliance was improved in

intervention group (95.6%) than control group (78.6%). Conclusion: All pregnant women got benefits after trial of new modified behaviors in the interven­

tion group. Messages were formulated from the new modified behaviors, which can be used for long­

term strategies for anaemia control in the community.

P7-13 (A) Pilot Development and Early Assessment of Maternal and Child Health Handbook at an

Urban Public Maternity Hospital in Bangladesh Shafi Bhuiyan

Introduction: In order to develop a comprehensive MCH handbook for pregnant women and to

assess its effect among them, a pilot study was carried out at the Maternal and Child Health Training

Institute (MCHTI), in Dhaka, Bangladesh. Methods: From MCHTI a sample of 600 pregnant women was selected and all subjects were

women who were attending the first visit of their current pregnancy by using a random sampling

method. Of the 600 subjects, 240 women were given the MCH handbook as case and 360 women were

not given the handbook as control. Data on pre and post intervention of the handbook from the 240

cases and 360 controls were taken from data recording forms between the 1st of November 2002 and

31st of October, 2003 and data was analysed by using a multilevel analysis approach. This was a hospi­

tal-based action (case-control) research, and was applied in order to measure the outcome of pre and

post intervention following the introduction of the handbook. Data was used to assess the effects of util­

isation of the handbook on women's knowledge, practice and utilisation of MCH services.

Results: This study showed that the change of knowledge about antenatal care visits was 77.1%

among case mothers. Knowledge of danger signs improved 49.2 %, breast feeding results 31.5%, vaccination

32.0% and family planning results improved 60.3% among case. Results showed some positive changes in

women's attitudes among case mothers and study showed the change of practice in antenatal care visits was

.U.5% in the case. Other notable changes were: change of practice in case mother's tetanus toxoid (TI),

55.2%; and family planning 41.2%. In addition, handbook assessment study indicated that most women

brought the handbook on subsequent visits (83.3%), the handbook was highly utilised (i.e. it was read by

84.2%, filled-in by 76.1 %, and was used as a health education tool by 80.4%). Most women kept the hand­

book (99.5%) and found it highly useful (78.0%) with a high client satisfaction rate of 88.0%.

Conclusion: Pregnant women in the case group had higher knowledge, better practices, and higher

utilisation of MCH services than mothers in the control groups who used alternative health cards. If the

handbook is developed with a focus on utilising a problem-oriented approach and involving the recom­

~endations .of end~users, it is anticipated that the MCH handbook will contribute significantly to ensur­ing the quahry of hfe of women and their children in Bangladesh.

~-14 (C) Fetal Alcohol Spectrum Disorder: Meeting the Needs of the Urban Aboriginal Community Rita Anderson, Juhe Debassige, Brenda Stade, and Michael Sgro

. l~~ction: In Canada, the incidence of Fetal Alcohol Spectrum Disorder (FASD) is estimated at I

m .100 hve bmhs. FASD is the leading cause of developmental and cognitive disabilities among Canadian

children and ns eff~ts are ~i~e lasting. W~ile FASO is found among all of Canada's people, it is more

prevalent m Canada s Aboriginal community due to adverse social conditions. Meeting the needs of the urban Aboriginal community can be a tremendous challenge.

POSTER SESSIONS v155

A(Jproach: Large city hospitals often demonstrate little or no knowledge of Aboriginal culture and

often employ few Aboriginal professionals. This has lead to reluctance of some Aboriginal clients to seek

care at St._Mich~el's Hospita~'s (SMJ:I) FASO Clinic located in Toronto's inner city. Thus, in .January of

2004 Native Ch1I~ and F~mily. Services of Toronto and St. Michael's Hospital formed a partnership.

After several meetmgs to identify the needs of the community, a FASO clinic was opened at NCfS.

Health care professionals from SMH joined with developmental and social service workers from NCFS

to implement the FASO diagnostic process and to provide culturally appropriate after-care. The clinic is

unique in that its focus is the high risk urban aboriginal population of Toronto. It accepts referrals of not

only children and youth, but also of adults.

Lessons Learned: Response to the FASO clinic at Native Child and Family Services has been over­

whelming. Aboriginal children with F ASD are receiving timely diagnosis and interventions. Aboriginal

youth and adults who have been struggling with poveny, substance abuse, and homelessness are more

willing to enter the NCFS centre for diagnosis and treatment. Aboriginal infants prenatally exposed to

alcohol born at St. Michael's Hospital or referred by other centres have access to the developmental pro­

grams located in both of the partnering agencies. The presentation will describe the clinic's development,

and will detail the outcomes described, including interventions unique to the Aboriginal culture.

P7-15 (C) Seeds, Soil, and Stories: An Exploration of Community Gardening in Southeast Toronto

Carolin Taran, Sarah Wakefield, Jennifer Reynolds, and Fiona Yeudall

Introduction: Community gardens are increasingly seen as a mechanism for improving nutrition

and increasing food security in urban neighbourhoods, but the evidence available to support these claims

is limited. In order to begin to address this gap in a way that is respectful of community knowledge and

needs, the Urban Gardening Research Opportunities Workgroup (UGROW) project explored the bene­

fits and potential risks of community gardening in Southeast Toronto.

Methods: The project used a community-based research (CBR) model to assess community gardens

as a means of improving local health. The research process included interviews, focus groups, and participant

observation (documented in field notes). We also directly engaged the community in the research pro­

cess, through co-learning activities and community events which allowed participants to express their

views and comment on emerging results. Most of the research was conducted by a community-based

research associate, herself a community gardener. Key results were derived from these various sources

through line-by-line coding of interview transcripts and field note review, an interactive and iterative

process which involved both academic and community partners.

Results: These various data sources all suggest that enhanced health and access to fresh produce are

important components of the gardening experience. They also highlight the central importance of

empowering and community-building aspects of gardening to gardeners. Community gardens were

thought to play a role in developing friendships and social support, sharing food and other resources,

appreciating cultural diversity, learning together, enhancing local place attachment and stewardship, and

mobilizing to solve local problems (both inside and outside the garden). Potential challenges to commu­

nity gardens as a mechanism for communiry development include bureaucratic resistance to gardens,

insecure land tenure and access, concerns about soil contamination, and a lack of awareness and under·

standing by community members and decision-makers of all kinds.

Conclusion: The results highlight many health and broader social benefits experienced by commu·

nity gardeners. They also point to the need for greater support for community gardening programs, par·

ticularly ongoing the ongoing provision of resources and education programs to support gardens in their

many roles. This research project is supported by the Wellesley Central Health Corporation and the

Centre for Urban Health Initiatives, a CIHR funded centre for research development hased at the Univer·

sity of Toronto.

P7-16 (C) Developing Resiliency in Children Living in Disadvantaged Neighbourhoods

Sarah Farrell, Lorna Weigand, and Wayne Hammond

The traditional idea of targeting risk reduction by focusing on the development of eff~ctive coping

strategies and educational programs has merit in light of the research reportmg_ that_ ~10lupl.e forms of

problem behaviour consistently appear to be predicted by increasing exposure to 1den_uf1able risk factors.

As a result, many of the disadvantaged child and youth studies have focused on trymg to better _unde.r·

stand the multiple risk factors that increase the likelihood of the development of at nsk behaviour m ch1l­

dren/youth and the potential implications for prevention. This in turn has led t_o. the conclus1on that

community and health programs need to focus on risk reduction by helpm~ md1v1duals develop more

effective coping strategies and a better understanding of the limitations of cenam pathologies, problematic

v156 POSTER SESSIONS

coping behaviours and risk factors potentially inheren~ in high needs co~unities. ~owever, another ai:ea

of research has proposed that preventative interventions should cons1de~ .~rotecnve fa~ors alo~~ with

reducing risk factors. As opposed to just emphasizing problems, vulnerab1ht1es, and deficits, a res1liency­

based perspective holds the belief that children, youth and their families. have strengths, reso~ce.s and the

ability to cope with significant adversity in ways that are not only effective, but tend to result m mcreased

ability to constructively respond to future adversity. With this in mind, a participatory research project

sponsored by the United Way of Greater Toronto was initiated to evaluate and determine the resiliency

profiles of children 8 - 12 years (n = 500) of recent immigrant families living in significantly disadvan­

taged communities in the Toronto area. The presentation will provide an overview of the identified pro­

tective factors (both intrinsic and extrinsic) and resiliency profiles in an aggregated format as well as a

summary of how the children and their parents interpreted and explained these strength-based results. As

part of the focus groups, current community programs and services were examined by the participants as

to what might be best practices for supporting the development and maintaining of resiliency in children,

families and communities. It was proposed that the community model of assessing resiliency and protec­

tive factors as well as proposed best strength-based practice could serve as a guide for all in the commu­

nity sector who provide services and programs to those in disadvantaged neighbourhoods.

P7-17 (C) Naloxone by Prescription in San Francisco, CA and New York, NY

Emalie Huriaux

The Harm Reduction Coalition's Overdose Project works to reduce the number of fatal overdoses

to zero. Located in New York, NY and San Francisco, CA, the Overdose Project provides overdose edu­

cation for social service providers, single-room occupancy hotel (SRO) residents, and syringe exchange

participants. The Project also conducts an innovative naloxone prescription program, providing nalox­

one, an opiate antagonist traditionally administered by paramedics to temporarily reverse the effects of

opiate overdose, to injection drug users (IDUs). We will describe how naloxone distribution became a

reality in New York and San Francisco, how the Project works, and our results. The naloxone prescrip­

tion program utilizes multiple models to reach IDUs, including SRO-and street-based trainings, and

office-based trainings at syringe exchange sites. Trainings include information on overdose prevention,

recognition, and response. A clinician conducts a medical intake with participants and provides them

with pre-filled units of naloxone. In New York, funding was initially provided by Tides Foundation.

New York City Council provides current funding. New York Department of Mental Health and Hygiene

provides program oversight. While the New York project was initiated in June 2004, over half the train­

ings have been since March 2005. In San Francisco, California Endowment, Tides Foundation, and San

Francisco Department of Public Health (SFDPH) provide funding. In addition, SFDPH purchases nalox­

one and provides clinicians who conduct medical intakes with participants. Trainings have been con­

ducted since November 2003. To date, nearly 1000 individuals have been trained and provided with

naloxone. Approximately 130 of them have returned for refills and reported that they used naloxone to

reverse an opiate-related overdose. Limited episodes of adverse effects have been reported, including

vomiting, seizure, and "loss of friendship." In New York, 400 individuals have been trained and pro­

vided with naloxone. Over 30 overdose reversals have been reported. Over half of the participants in

New York have been trained in the South Bronx, the area of New York with the highest rate of overdose

fatalities. In San Francisco, 570 individuals have been trained and provided with naloxone. Over 96

overdose reversals have been reported. The majority of the participants in San Francisco have been

trained in the Tenderloin, 6th Street corridor, and Mission, areas with the highest rates of overdose fatal­

ities. The experience of the Overdose Project in both cities indicates that providing IDUs low-threshold

access to naloxone and overdose information is a cost-effective, efficient, and safe intervention to prevent accidental death in this population.

P7-18 (C) Successful Strategies to Regulate Nuisance Liquor Stores Using Community Mobilization,

Law Enforcement, City Council, Merchants and Researchers Tahra Goraya

Presenta~ion _will discuss ~uccessful environmental and public policy strategies employed in one

Southen:1 Cahf?rmna commumty to remedy problems associated with nuisance liquor stores. Partici­

pants ~111 be given tools to understand the importance of utilizing various substance abuse prevention

str~tegi~ to change local policies and the importance of involving various sectors in the community to

a~_1st with and advocate for community-wide policy changes. Recent policy successes from the commu­

~ltles of Pa~ad~na and Altad~na will highlight the collaborative process by which the community mobi­

lized resulnng m several ordmances, how local law enforcement was given more authority to monitor

POSTER SESSIONS v157

nonconforming liquor stores, how collaborative efforts with liquor store owners helped to remove high

alcohol content alcohol products from their establishments and how a community-based organiz,uion

worked with local legislators to introduce statewide legislation regarding the regulation of nuisance

liquor outlets.

P7-19 (C) "Dialogue on Sex and Life": A Reliable Health Promotion Tool Among Street-Involved Youth

Beth Hayhoe and Tracey Methven

Introduction: Street involved youth are a marginalized population that participate in extremely

risky behaviours and have multiple health issues. Unfortunately, because of previous abuses and neg­

ative experiences, they also have an extreme distrust of the adults who could help them. In 1999,

Toronto Public Health granted funding to a non governmental, nor for profit drop-in centre for

Street Youth aged 16-24, to educate them about how to decrease rhe risk of acquiring HIV. Since

then the funding has been renewed yearly and the program has evolved as needed in order to target

the maximum number of youth and provide them with vital information in a candid and enjoyable

atmosphere. Methods: Using a retrospective analysis of the six years of data gathered from the "Dialogue on Sex

and Life" program, the researchers examined the number of youth involved, the kinds of things dis­

cussed, and the number of youth trained as peer leaders. Also reviewed, was written feedback from the

weekly logs, and anecdotal outcomes noted by the facilitators and other staff in the organization.

Results: Over the five year period of this program, many of youth have participated in one hour ses­

sions of candid discussion regarding a wide range of topics including sexual health, drug use, harm

reduction, relationship issues, parenting, street culture, safety and life skills. Many were new youth who

had not participated in the program before and were often new to the street. Some of the youth were

given specific training regarding facilitation skills, sexual anatomy and physiology, birth control, sexu­

ally transmitted infections, HIV, substance use/abuse, harm reduction, relationships and discussion of

their next steps/future plans following completion of the training. Feedback has been overwhelmingly

positive and stories of life changing decisions have been reported.

Conclusion: Clearly, this program is a successful tool to reach street involved youth who may oth­

erwise be wary of adults and their beliefs. Based on data from the evaluation, recommendations have

been made to Public Health to expand the funding and the training for peer leaders in order ro target

between 100-200 new youth per year, increase the total numbers of youth reached and to increase the

level of knowledge among the peer leaders.

P7-20 (C) Access to Identification and Services

Jane Kali

Replacing identification has become increasingly more complex as rhe government identification

issuing offices introduce new requirements rhar create significant barriers for homeless people to replace

their ID. New forms of identification have also been introduced that art' not accessible to homekss peoplt­

(e.g. the Permanent Resident card). Ar rhe same time, many service providers continue to require identifi·

cation ro access supports such as income, housing, food, health care, employment and employmt·nt train­

ing programs. Street Health, as well as a number of other agencies and Community Health Centres, h,1,

been assisting with identification replacement for homeless peoplt· for a number of years. The rnrrt·nr

challenges inherent within new replacement requirements, as well as the introduction of new forn1' of

identification, have resulted in further barriers homeless people encounter when rrring to access t:ssential

services. Street Health has been highlighting these issues to government identification issuing offices, as

well as policy makers, in an effort to ensure rhar people who are homeless and marginalized have aC'ess

to needed essential services.

P7-21 (C) Bandar Wangari Muriuki and Maurice Adongo

Bandar is a Somali word for •·a safe place." The Bandar Research Project is the product of the

Regent Park Community Health Centre. The research looks ar the increasing number of Somali and Afri·

can men in the homeless and precariously house population in the inner city core of down~own Toronto.

In the first phase of the pilot project, a needs assessment was conducted to 1dennfy barners and issues

faced by rhe Somali and other African men who are homeless and have add1cr10ns issues. Th_e second

phase of rhe research project was to identify long rerm resources and service delivery mechamsms that

v158 POSTER SESSIONS

would enhance the abiity of this population to better access detox, treatment, and post treatment ser· vices. The final phase of the project was to facilitate the development of a conceptual model of seamless continual services and supports from the STREETS to DETOX to TREATMENT to LONG TERM REHABILITATION to HOUSING. "Between the pestle and Mortar" -safe place.

P7-22 (C) Successful Methods for Studying Transient Populations While Improving Public Health Beth Hayhoe, Ruth Ewert, Eileen McMahon, and Dan Jang

Introduction: Street Youth are a group that do not regularly access healthcare because of their mis· trust of adults. When they do access health care, it is usually for issues severe enough for hospitalization or for episodic care in community clinics. Health promotion and illness prevention is rarely a part of their thinking. Thus, standard public health measures implemented in a more stable population do not work in this group. For example, Pap tests, which have dearly been shown to decrease prevalence of cer· vical cancer, are rarely done and when they are, rarely followed up. Methods to meet the health care needs and increase the health of this population are frequently being sought.

Methods: A drop-in centre for street youth in Canada has participated in several studies investigat­ing sexual health in both men and women. We required the sponsoring agencies to pay the youth for their rime, even though the testing they were undergoing was necessary according to public health stan· dards. We surmised that this would increase both initial participation and return.

Results: Many results requiring intervention have been detected. Given the transient nature of this population, return rates have been encouraging so far.

Conclusion: It seems evident that even a small incentive for this population increases participation in needed health examinations and studies. It is possible that matching the initial and follow-up incen­tives would increase the return rate even further. The fact that the youth were recruited on site, and not from any external advertising, indicates that studies done where youth trust the staff, are more likely to be successful.

P7-23 (C) Lessons from a Community Empowerment Project; Role of Self-Help/Mutual Aid Strategies in Development and Delivery of Health Promotion and Disease Prevention Educational Materials Roya Rabbani

The presentation will share the results of the "Empowering Stroke Prevention Project" which incor· porated self-help mutual aids strategies as a health promotion methodology. The presentation will include project's theoretical basis, methodology, outcomes and evaluation results. Self-help methodology has proven successful in consumer involvement and behaviour modification in "at risk," "marginalized" settings. Self-Help is a process of learning with and from each other which provides participants oppor· tunities for support in dealing with a problem, issue, condition or need. Self-help groups are mechanisms for the participants to investigate existing solutions and discover alternatives, empowering themselves in this process. Learning dynamic in self-help groups is similar to that of cooperative learning and peer­training, has proven successful, effective and efficient (Haller et al, 2000). The mutual support provided by participation in these groups is documented as contributory factor in the improved health of those involved. Cognizant of the above theoretical basis, in 2004 the Self-Help Resource Centre initiated the "Empowering Stroke Prevention Project." The project was implemented after the input from 32 health organizations, a scan of more than 300 resources and an in-depth analysis of 52 risk-factor-specific stroke prevention materials indicated the need for such a program. The project objectives were:• To develop a holistic and empowering health promotion model for stroke prevention that incorporates self­help and peer support strategies. • To develop educational materials that place modifiable risk factors and lifestyle information in a relevant context that validates project participants' life experiences and perspectives.• To educate members of at-risk communities about the modifiable risk factors associated with stroke, and promote healthy living. To achieve the above, a diverse group of community members were engaged as "co-editors" in the development of stroke prevention education materials which reflected and validated their life experiences. These community members received training to become Lay Health Promoters (trained volunteer peer facilitators). In collaboration with local health organizations, these trained lay Health Promoters were then supported in organizing their own community-based stroke prevention activities. In addition, an educational booklet written in plain language, entitled Healthy Ways to Prevent Stroke: A Guide for You, and a companion guide called Healthy Ways to Pre· vent Stroke: A Facilitator's Guide were produced. The presentation will include the results of a tw<>­tiered evaluation of the program methodology, educational materials and the use of the materials beyond the life of the project.

POSTER SESSIONS

P7-24 (C) Street Outreach - An Innovative Capacity Building Approach

Valine Vaillancourt

v159

This poster presentation will focus on the development and structure of an innovative street out­

reach service that assists individuals who struggle mental illness/addictions and are experiencing home­

lessness. The Mental Health/Outreach Team at Public Health and Community Services (PHCS) of

Hamilton, Ontario assists individuals in reconnecting with health and social services. Each worker brings

to the ream his or her own skills-set, rendering it extremely effective at addressing the multidimensional

and complex needs of clients. Using a capacity building framework, each ream member is employed

under a service contract between Public Health and Community Services and a local grassroots agency.

There are Public Health Nurses (PHN), two of whom run a street health centre and one of Canada's old­

est and most successful Needle Exchange Programs, mental health workers, housing specialists, a harm

reduction worker, youth workers, and a United Church Minister, to name a few. A Community Advi­

sory Board, composed of consumers and professionals, advises the Program quarterly. The program is

featured on Raising the Roors 'Shared Learnings on Homelessness' website at www.sharedlearnings.ca.

Through our poster presentation participants will learn how to create effective partnerships between

government and grassroots agencies using a capacity building model that builds on existing programs.

P7-25 (A) Assessing the Effectiveness of Different Methods of Communication on Farsi-Speaking

Immigrants' Perception Toward and Intention to Use a Government-Sponsored Health Information

Program in Greater Vancouver Area Irving Rootman and Iraj Poureslami

This study aims to assess the effects of broadcasting a series of documentary and drama videos,

intended to provide information about the BC HealthGuide program in Farsi, on the awareness about

and the patterns of the service usage among Farsi-speaking communities in the Greater Vancouver Area.

The major goals of the present study were twofold; ( 1) to compare two methods of communications

(direct vs. indirect messages) on the attitudes and perceptions of the viewers regarding the credibility of

messengers and the relevance of the information provided in the videos, and (2) to compare and contrast

the impact of providing health information (i.e., the produced videos) via local TVs with the same mate­

rials when presented in group sessions (using VCR) on participants' attitudes and perceptions cowards

the BC HealrhGuide Services. Results: Through a telephone survey, 545 Farsi-speaking adults were interviewed in November and

December 2004. The preliminary findings show that 53% of the participants had seen the aired videos,

from which, 51 % watched at least one of the 'drama' clips, 8% watched only 'documentary' clip, and

41% watched both types of video. In addition, 27% of the respondents claimed that they were aware

about the program before watching the aired videos, while 73% said they leaned about the services only

after watching the videos. From this group, 14% said they called the BCHG for their own or their "hil­

dren's health problems in the past month. 86% also indicated that they would use the services in the

future whenever it would be needed. 48% considered the videos as "very good" and thought they rnuld

deliver relevant messages and 21 % expressed their wish to increase the variety of subjects (produ\:e more

videos) and increase the frequency of video dips. Conclusion: The results of this study will assist public health specialists in BC who want to choose

the best medium for disseminating information and apply communication interventions in multi\:ultural

communities.

P7-26 (A) Evolution of Research Design with Workplace Stakeholders as Part of the Process

Desre Kramer and Donald Cole

Introduction: Many theorists and practitioners in community-based research (CBR) and knowledge

transfer (KT) strongly advocate for involvement of potential users of research in the development of

research projects, yet few examples of such involvement exist for urban workplace health interventions.

We describe the process of developing a collaborative research program.

Methods: Four different sets of stakeholders were identified as potential contributors to and users

of the research: workplace health policy makers, employers, trade unions, and health and safety associa­

tions. Representatives of these stakeholders formed an Advisory Committee which met quarterly. Over

the 13 month research development period, an additional 21 meetings were held between resc:ar~h~rs

and stakeholders. In keeping with participant observation approaches, field notes of group and md1v1~­

ual meetings were kept by the two co-authors. Emails and telephone calls were also documented. Qu~h­

tative approaches to textual analysis were used, with particular attention paid to collaborattve

v160 POSTER SESSIONS

relationships established (as per CBR), indicators of stakeholders' knowledge utilization (as per KT), and transformations of the proposed research (as per CBR).

Results: Despite initial strong differences of opinion both among stakeho~ders .an~ between stake­holders and researchers, goodwill was noted among all involved. Acts of rec~proc1ty included mu.rual sharing of assessment tools, guidance on data utilization to stakeho~der orga~1zat10ns, and suggestions on workplace recruitment to researchers. Stakeholders demonstrated mcreases m concep~ual. un~erstand­ing of workplace health e.g. they more commonly discussed more complex,. psychosocial md1cators of organizational health. Stakeholders made instrumental use of shared materials based on research e.g. adapting their consulting model to more sophisticated dat~ analysis. Sta~ehol?~rs recogni_zed the strate­gic use of their alliance with researchers e.g., transformational leadership trainmg as a~ inducement to improve health and safety among small service franchises. Stakeholders helped re-define the research questions, dramatically changed the method of recruitment from researcher cold call to stakeholder­based recruitment, and strongly influenced pilot research designs. Owing a great deal to the elaborate joint development process, the four collaboratively developed pilot project submissions which were all successfully funded.

Conclusion: The intensive process of collaborative development of a research program among stakeholders and researchers was not a smooth process and was time consuming. Nevertheless, the result of the collaborative process was a set of projects that were more responsive to stakeholder needs, more feasible for implementation, and more broadly applicable to relevant workplace health problems.

P7-27 (A) Evaluating Urban Outdoor Pesticide Use Reduction Activities Donald Cole, Loren Vanderlinden, Kara Giffin, Carol Mee, and Leslie Jermyn

Introduction: Environmental groups, municipal public health authorities and, increasingly, the general public are advocating for reductions in pesticide use in urban areas, primarily because of con­cern around potential adverse health impacts in vulnerable populations. However, limited evidence of the relative merits of different intervention strategies in different contexts exists. In a pilot research project, we sought to explore the options for evaluating pesticide reduction interventions across Ontario municipalities.

Methods: The project team and a multi-stakeholder Project Advisory Committee (PAC), generated a list of potential key informants (Kl) and an open ended interview guide. Thirteen KI from municipal government, industry, health care, and environmental organizations completed face to face or telephone interviews lasting 30-40 minutes. In a parallel process, a workshop involving similar representatives and health researchers was held to discuss the role of pesticide exposure monitoring. Minutes from PAC meetings, field notes taken during KI interviews, and workshop proceedings were synthesized to generate potential evaluation methods and indicators.

Results: Current evaluation activities were limited but all Kls supported greater evaluation effons beginning with fuller indicator monitoring. Indicators of education and outreach services were imponant for industry representatives changing applicator practices as well as most public health units and envi­ronmental organizations. lndictors based on bylaw enforcement were only applicable in the two cities with bylaws, though changing attitudes toward legal approaches were being assessed in many communi­ties. The public health Rapid Risk Factor Surveillance System could use historical baseline data to assess changes in community behaviour through reported pesticide uses and practices, though it had limited penetration in immigrant communities not comfortable in English. Pesticide sales (economic) data were only available in regional aggregates not useful for city specific change documentation. Testing for watercourse or environmental contamination might be helpful, but it is sporadic and expensive. Human exposure monitoring was fraught with ethical issues, floor effects from low levels of exposure, and pro­hibitive costs. Clinical episodes of pesticide exposure reported to the Regional Poison Centre (all ages) or the Mother Risk program (pregnant or breastfeeding women) are likely substantial underestimates that would be need to be supplemented with sentinel practice surveillance. Focus on special clinical popula­tions e.g., multiple chemical sensitivity would require additional data collection efforts .

. Conc~ons: Broad support for evaluation and multiple indicators were proposed, though con­s~raints associate~ with access, coverage, sensitivity and feasibility were all raised, demonstrating the dif­ficulty of evaluating such urban primary prevention initiatives.

P7-28 (C) The Rotterdam Youth Monitor: Local Evidence-Based Youth Policy Rina Labbe-Koopman and Erik de Wilde

. In 2003', the city of Rotterdam decided to fully implement a system of continuous assement of indi-vidual youth\ s health and feedback on various levels of aggregation: the Rotterdam youth Monitor

P05TR &IONS v161

(R.YM). The instrument is used by all, i.e. more than 100 School doctors and nursn, rncarchen and

interVentionists.

An important aim of the Youth Monitor is to learn more about the health development of children

and adolescents and the factors that can influence this development. Special attention is paid to emo·

tional and behavioural problems. The Youth Monitor identifies high-risk groups and factors that are

associated with health problems.

At various stages, the Youth Monitor chancrs the course of life of a child. The sources of informa·

tion and methods of research are different for each age group. The results arc used to generate various

kinds of repons: for children and young persons, parents, schools, neighbourhoods, boroughs and the

municipality of Rotterdam and its environs. Any problems can be spotted early, at borough and neigh·

bourhood level, based on the type of school or among the young persons and children themselves.

Together with schools, parents, youngsters and various organisations in the area, the municipal health

service aims to really address these problems. On request, an overview is offered of potentially suitable

interventions. The authors will present the philosophy, working method, preliminary effects and future develop­

ments of this instrument, which serves as the backbone for the Rotterdam local youth policy.

P7-l9 (A) Preparing Social Workers to be Leaders in Response to Aging Urban Populations:

The Practicum Partnership Program

Sarah Sisco, Alissa Yarkony, and Patricia Volland

1"'"1tliu:tion: Across the US, 77.5% of those over 65 live in urban areas. These aging urban popu·

lations, including the Baby Boomers, have already begun encounter a range of heahh and mental hcahh

conditions. To compound these effects, health and social service delivery fluciuates in cities, whit:h arc

increasingly diverse both in their recipients and their systems. Common to other disciplines (medicine,

nursing, psychology, etc.) the social work profession faces a shortage of workers who are well-equipped

to navigate the many systems, services, and requisite care that this vast population requires. In the next

two decades, it is projected that nearly 70,000 social workers will be required to provide suppon to our

older urban populations. Social workers must be prepared to be aging-savvy leaders in their field,

whether they specialize in gerontology or work across the life span.

MllhotU: In 2000, a study conducted at the New York Academy of Medicine d<>1:umcntcd the need

for improved synchroniciry in two aspects of social work education, classroom instruction and the field

experience. With suppon from the john A. Hanford foundation, our team created a pilot proj~"t entitled

the Practicum Pannership Program (PPP) in 11 master's level schools of social work, to improvt" aginR

exposure in field and classroom content through use of the following: I) community-university partnrr·

ships, 2) increased, diverse student field rotations, ll infusion of competcn1."}'·drivm coursework, 41

enhancement of field instructors' roles, and 5) concentrated student recruitment. We conductt"d a prr·

and post-teSt survey into students' knowledge, skills. and satisfaction.

ICarlJa: Surveys of over 400 graduateS and field inltnK."tors rcflected increased numlK-n of .1Rrm:y·

univmity panncrships, as well as in students placed in aging agencin for field placements. There wa1 11

marked increase in student commitments to an aging specialization. Onr year por.t·gradu:nion rcvealrd

that 93% of those surveyed were gainfully employed, with 80% employed in the field of aginic. By com·

bining curricular enhancement with real-world experiences the PPP instilled a broad exposurr for llU·

dents who worked with aging populations in multiple urban settings.

Coltdtuion: Increased exposure to a range of levels of practicr, including clinical, policy/aJvocaq,

and community-based can potentially improve service delivery for older adulh who live in elfin, and

potentially improve national policy. The Hanford Foundation has now elected to 1uppon cxpantion of

the PPP to 60 schools nationwide (urban and rural) to complement other domntic initiatives to cnhalk"C"

holistic services for older adults across the aging spectrum.

P7-30 (C) Mmtal Health Neecl1 of Transitional Street Youth

Elizabnh McCay, John Langley, Linda Cooper, Heather Beanlands, Patricia Robinson, C'.arol Hown,

Karen Bach, Colin Dan, Susan Miner, Naomi Mudachi, and Marianne Rigatti

Bodrgnn.ntl: We arc a team of rcscarcbcn and community panncn working tCJ8C(her to develop an

in"itepth understanding of the mental health needs of homeless youth ~ages 16 to 24) (using qualiutivc

and quantitative methods 8' panicipatory rncarch methods). It is readily apparmt that '-neless youth

cxpcricnce a range of mental health problems. For youth living on the street, menul illnew may be either

a major risk factor for homelessnal or may frequently emcsge in response to coping with rhe multitudi­

nous stressors associated with homclCSlllCSI including exposure to violence, prasutt to pamaplte in

v162 POSTER SESSIONS

survival sex and/or drug use. The most frequent psychiatric diagnoses amongst the homeless gencrally include: depression, anxiety and psychosis. . . .

Raetlrr:h Goals and Objectives: The ultimate ob1ective of the pr~am of rei:e~ IS to ~evelop a plan for intervention to meet the mental health needs of street youth. Prior t_o pl~nnmg mtervenbOns, .it is necessary to undertake a comprehensive assessment ~f mental health needs m this ~lnerable populanon. Thus, the immediate objective of this research study is to undertake a comprehensive assessment of men· tal health needs. . .

Melbotlology: A mixed methodology triangulating qualitative, participatory acnon and quantitative methods will capture the data related to mental health needs of homeless youth. A purposive sample of approximately 60-80 subjecrs. ages 16 to 24, is currently being ~ted ~participate from the commu.nity agencies Covenant House, Evergreen Centre fo~ srrc;et Youth, Turning P?1?t and Street ~ Serv~. Youth living on the street or in short -term residennal programs for a mmimum of 1 month pnor to their participation; ages 16 to 24 and able to give infonned consent will be invited to participate in the study.

O..tcomes: The expected outcome of this initial survey will be an increased understanding of mental health needs of street youth that will be used to develop effective interventions. It is anticipated that results from this study will contribute to the development of mental health policy, as well as future pro­grams that are relevant to the mental health needs of street youth.

Note: It is anticipated that preliminary quantitative data (25 subjects) and qualitative data will be available for the conference. The authors intend to present the identification of the research focus, the formation of our community-based team, relevance for policy, as well as preliminary results.

P7-31 (A) The Need for Developing a Firm Health Policy for Urban Informal Worken: The Case of Urban Farmen in Kenya Chrispus Kiliko

Despite their critical role in producing food for urban in Kenya, urban farmers have largely been ignored by government planners and policymakers. Their activity is at best dismissed as peripheral eveo, inappropriate retention of peasant culture in cities and at worst illegal and often some-times criminal· ized. Urban agriculture is also condemned for its presumed negative health impact. A myth that contin· ues despite proof to the contrary is that malarial mosquitoes breed in maize grown in East African towns. However, potential health risks are insignificant compared with the benefits of urban food pro­duction. Recent studies too rightly do point to the commercial value of food produced in the urban area while underscoring the importance of urban farming as a survival strategy among the urban poor, espe­cially women-headed households. Since the Millennium Declaration, health has emerged as one of the most serious casualties consequent on the poverty, social exclusion, marginalisation and lack of sustain· able development in Africa. HIV/AIDS epidemic poses an unprecedented challenge, while malaria, tuber· culosis, communicable diseases of childhood all add to the untenable burden. Malnutrition underpins much ill-health and is linked to more than 50 per cent of all childhood deaths. Kenya's urban poor peo­ple ~ace ~ h~ge burde~ of preventable and treatable health problems, measured by any social and bi~ medical md1cator, which not only cause unnecessary death and suffering, but also undermine econonuc development and damage the country's social fabric. The burden is in spite of the availability of suitable tools and re:c=hnology for prevention and treatment and is largely rooted in poverty and in weak healah •rstems. This pa~ therefore challenges development planners who perceive a dichotomy instead of con· tmuum between informal and formal urban wage earners in so far as access to health services is con· cemed. It i~ this gap that calls for a need to developing and building sustainable health systemS among the urban mformal ~wellers. We recommend a focus on an urban health policy that can build and strengthen the capacity of urban dwellers to access health services that is cost-effective and sustainable. Such ~ health poli<=>: must strive for equity for the urban poor, displaced or marginalized; mobilise and effect1~ely use sufficient sustainable resources in order to build secure health systems and services. Special anenti_on. should ~ afforded HIV/AIDS in view of the unprecedented challenge that this epidemic poses to Africa s economic and social development and to health services on the continent.

thcP7·lRl (~) MC8IUl'Cllleaf 1 of Cydilt Exposure to the Potential Dangers of Daily Activity· Travel l'allallS in qpoa o Montreal

!'!~!~::~~:an-Pierre Thouez, Jacques Bergeron, Yves Bussiere, Andre Rannou,

Obi«tiw: The ob1" ecti f th _1.:..i. uld U ve 0 e present study is to elaborate and validate a measurement WlJIU'

WO a OW US to identify the circu J dail · · vel . ~stances and levels of cyclist exposure to the potential daDgelS

Y actmty-tra patterns m the region of Montreal.

POSTER SESSIONS v163

Methods: A review of the literature led us to construct three simple models and a composite model

of exposure to traffic. The data were collected with the help of a daily diary of travel activities using a

sample of cyclists who went to or come back from work or study. To calculate the distance, the length of

journey, and the number of intersections crossed by a cyclist different Geographic Information Systems

(GIS) were operated. Statistical analysis was used to determine the significance between a measure of

exposure on the one hand, and the sociodemographic characteristics of the panicipants or their geo­

graphic location on the other hand.

RestlltJ: Our results indicate that cyclists were significantly exposed to road accidents, no matter of

where they live or what are their sociodemographic characteristics. We also stress the point that the fact

of having been involved in a road accident was significantly related to the helmet use, but did not reduce

the propensity of the cyclists to expose themselves to the road hazards.

Condlllion: The efforts of the various authorities as regards road safety should not be directed

towards the reduction of the exposure of the vulnerable users, but rather towards the reduction of the

dangers to which they could face.

Keywords: cyclist, daily diary of activities, measures of exposure to traffic, island of Montreal.

P7-33 (A) Intra Urban Disparities and Environmental Health: Some Salient Features of Nigerian

Residential Neighbourhoods Olumuyiwa Akinbamijo

Intra Urban disparities and Environmental Health: Some salient features of Nigerian residential

neighbourhoods Abstract Urbanization panicularly in Nigerian cities, ponends unprecedented crises of

grave dimensions. From physical and demographic viewpoints, city growth rates are staggering coupled

with gross inabilities to cope with the consequences. Environmental and social ills associated with

unguarded rapid urbanization characterize Nigerian cities and threaten urban existence. This paper

repons the findings of a recent study of the relationship between environmental health across inrra­

urban residential communities of Akure, South West Nigeria. It discuses the typical urbanization process

of Nigerian cities and its dynamic spatial-temporal characteristics. Physical and socio-demographic

attributes as well as the levels and effectiveness of urban infrastructural services are examined across the

core residential districts and the elite residential layouts in the town. The incidence rate of cenain envi­

ronmentally induced tropical diseases across residential neighborhoods and communes is examined.

Salient environmental variables that are germane to health procurement in the residential districts, inci­

dence of diseases and diseases parasitology, diseases prevention and control were studied. Field data

were subjected to analysis ranging from the univariate and bivariate analysis. Inferential statistics using

the chi-square test were done to establish the truthfulness of the guiding hypothesis. Given the above, the

study affirms that there is strong independence in the studied communities, between the environment and

incidence of diseases hence health of residents of the town. This assertion, tested statistically at the dis­

trict levels revealed that residents of the core districts have very strong independence between the envi­

ronment and incidences of diseases. The strength of this relationship however thins out towards the city

peripheral districts. The study therefore concludes that since most of the city dwellers live in urban depri­

vation, urban health sensitive policies must be evolved. This is to cater for the urban dwellers who

occupy fringe peripheral sites where the extension of facilities often times are illegally done. Urban infra­

structural facilities and services need be provided as a matter of public good for which there is no exclu­

sive consumption or access even for the poorest of the urban poor.

P7-34 (A) Toronto Centre for Substance Use in Pregnancy: One-Stop Care for Pregnant Substance Users

Alice Ordean, Meldon Kahan, Althea Prescod, Deana Midmer, George Tolomiczenko, Lydia Pantea, and

Margaret Leslie

lntrod11ction: Pregnant substance users face considerable difficulty in obtaining adequate treatment.

Many suffer from low-self esteem, shame and guilt about their drug use. In addition, they often lack sup­

pon or encounter opposition from their panners, family and friends in seeking treatment. These personal

barriers are compounded by fragmented addiction, prenatal and social care services, inflexible intake sys­

tems and poor communication among sectors. The experience of accessing adequate care between services

can be overwhelming and too demanding. The Toronto Centre for Substance Use in Pregnancy (T-CUP)

is a unique program developed to minimize barriers by providing Kone-stop" comprehensive healthcare.

T-CUP is a primary care based program located in the department of Family Medicine at St. Joseph\'s

Health Centre, a community teaching hospital in Toronto. The interdisciplinary staff provides prenatal

and addiction services, case management, as well as care of newborns affected by substance use. Regular

care plan meetings are held between T-CUP, Labour and Delivery nurses and social workers in the

Y164 POSTER SESSIONS

Maternity and Child Care program. T-CUP also connects "'.omen with. inpatient treatment programs and community agencies such as Breaking the Cycle, an on-site counselmg group for pregnant substance

users. · f · d d h Ith Method: Retrospective chart review, qualitative patient ~ans action stu ~· an ea care provider surveys are used to determine outcomes. Primary outcomes mclude changes m maternal su~tance use, psychosocial status and obstetrical complications (e.g. pre-rupture of membrane, pre-eclampsia, placen· ral abruption and hemorrhage). Neonatal measures ~~nsisted of .bir~h pa_rame~ers, length of h~spital st.ay and complications (e.g. feral distress, meconium stammg, resuscitation, 1aund1ce, hypoglycemia, seventy of withdrawal and treatment length). Chart review consisted of all T-CUP patients who met clinical cri· reria for alcohol or drug dependence and received prenatal and intra-partum care at St. Joseph's from October 2003 to June 2005. Participants in the qualitative study included former and current T-CUP patients. Provider surveys were distributed on-site and to a local community hospital.

Raulb: Preliminary evaluation has demonstrated positive results. Treatment retention and satisfac­tion rates were high, maternal substance use was markedly reduced and neonatal outcomes have shown to be above those reported in literature.

Conclusion: This comprehensive, primary care model has shown to be optimal in the management of substance use in pregnancy and for improving neonatal outcomes. Future research will focus on how this inexpensive program can be replicated in other health care settings. T-CUP may prove to be the opti­mal model for providing care to pregnant substance users in Canada.

P7-3S (A) Employing Healthy City Platform to Build Up Smoke-Free Environments: Tainan Experience Susan C. Hu and Shiann-Far Kung

lntrod11ction: Cigarette smoking is one of the most serious health problems in Taiwan. The preva­lence of smoking in 2002 is 48.1 % in males 5.9% in females aged 18 years and older. Although the gov­ernment of Taiwan passed a Tobacco Hazards Control Act in 1997, it has not been strongly enforced in many places. Therefore, community residents have often reported exposure of second hand smoke. The purpose of the study was to establish a device to build up more smoke-free environments in the city of Tainan.

Methods: Unique from traditional intervention studies, the study used a healthy city approach to help build up smoke-free environments. The major concept of the approach is to build up a healthy city platform, including organizing a steering committee, setting up policies and indicators, creating intersectoral collabora­tion, and increasing community participation. First, more than 80 enthusiastic researchers, experts, govern­mental officers, city counselors and community leaders in Tainan were invited in the healthy city committee. Second, smoke-free policies, indicators for smoke-free environments, and mechanisms for inter-departmen· tal inspections were set up. Third, community volunteers were recruited and trained for persuading related stakeholders. Lastly, both penalties and rewards were used for help build up the environments.

Raults: Aher two-year (2003-2005) execution of the project, the results qualitatively showed that smoke-free environments in Tainan were widely accepted and established, including smoke-free schools, smoke-free workpla~es, smoke-free households, smoke-free internet shops, and smoke-free restaurants. Smoke~s were. effectively educated not to smoke in public places. Community residents including adults and children m the smoke-free communities clearly understand the adverse effects of environmental tobacco smoke and actively participated anti-smoking activities.

Conclruions: Healthy city platform is effective to conquer the barrier of limited anti-smoking rc:sources. Nor. only can it enlar:ge community actions for anti-smoking campaigns, but also it can pro­vide par_merships for collaboratJOn. By establishing related policies and indicators the effects of smoke· free environments can be susta1·ned a d th · · · ' · n e progression can be monitored m a commuruty.

P7-36 (Al Community Health Int...,.. n' · A · Health I U .... __ . . -..-a on m Chon: Collaborative Approaches to Improve the 0

rv1111 Populabons m Toronto Downtown West Eleanor Sam, John Stevenson, Sonja Nerad, and Ann-Marie Marcolin

f 1"'""f"ctio": The West End Urban Health Alliance (WEUHA) is a unique voluntary collaboration

o twcnty-1our health scrv· """'" · · h b·on to d f l'L WEice -..-mzanons t at provide care across the continuum from health promo-

en -o -11e care UHA's g I · d.,. . 'de • . oa s are to: improve the health of the people living in West En ,or-

onto, prov1 a seamless and mtcgrat d fl f h . • ... h · I 1 e ow o ealth care from health promotion to primat'Y -~ Olplta care, ong-tcnn care and to e d f rf · ' tht

best quality of health ~ h . n -o - 1 e care; integrate and strengthen the system to ensure. These issues are used ~· oi::c It~ goals, WEUHA identifies issues that put people's health at risk. Presently, team com~u:C: ran ee~tion !earns. (IATs) that design integrative solutions ~teSJ'°~

g om six to fifteen members. Methods In order to establish WO-

POSTER SESSIONS v165

projects for WEUHA, the following approach was undertaken: I. A project-polling template was created

and sent to all members of the Alliance for their input. Each member was asked to identify thdr top two

population groups, and to suggest a project on which to focus over a 12-18 month period for each iden­

tified population. 2. There was a 47% response to the poll and the top three population groups were

identified. Data from the Toronto Community Health Profile database were utilized to contextualize the

information supplied for these populations. A presentation was made to the Steering Committee and

three population-based projects were selected, leaders identified and IATs formed.

Three Population-Based Projects: The population-based projects and health care issues identified are:

Newcomer prenatal uninsured women; This project will address the challenges faced by providers to a grow­

ing number of non-insured prenatal women seeking care. A service model where the barrier of "catchments"

is removed to allow enhanced access and improved and co-ordinated service delivery will be pilot-tested.

Children/Obesity/Diabetes: Using a health promotion model this team will focus on screening,

intervention, and promoting healthy lifestyles (physical activity and nutrition) for families as well as for

overweight and obese children.

Seniors Health Promotion and Circle of Discharge: This team will develop an early intervention

model to assist seniors/family unit/caregivers in accessing information and receiving treatment/care in the

community. The Circle of Discharge initiative will address ways of utilizing community supports to keep

seniors in the community and minimize readmissions to acute care facilities.

Results/Expected Outcomes: Coordinated and enhanced service delivery to identified populations,

leading to improved access, improved quality of life, and health care for these targeted populations.

P7-37 (C) Stigma, Rights and HIV Rana Ahmad

Introduction: Basic human rights are often denied to high-risk populations and people living with

HIV/AIDS. Their rights to work and social security, health, privacy, non discrimination, liberty and freedom

of movement, marriage and having a family have been compromised due to their sero-positive status and

risk of being positive. The spread of HIV/AIDS has been accelerating due to the lack of general human

rights among vulnerable groups. To formulate and implement effective responses needs dialogue and to

prevent the epidemic to go underground barriers like stigma need to be overcome.

Objective: How to reduce the situation of stigma, discrimination and human rights violations expe­

rienced by people living with HIV/AIDS and those who are vulnerable to HIV/AIDS.

Methodology and Findings: Consultation meetings were strm.-rured around presentations, field visits,

community meetings and group work to formulate recommendations on how Govt and NGOs/CBOs should

move forward based on objective. Pakistan being a low prevalence country, the whole sense of compl;u:enc.:y

that individuals are not subject to situations of vulnerable to HIV is the major threat to an explosion in th•·

epidemic, therefore urgent measures are needed to integrate human rights issues from the very start of the

response. The protection and promotion of human rights in an integral component of ;tll responses to the

HIV/AIDS epidemic. It has been recognized that the response to HIV/AIOS must he multi sectoral and multi

faceted, with each group contributing its particular expertise. For this to occur along with other knowlcdg<"

more information is required in human rights abuses related to HIV/ AIDS in a particular scenario. The ~·on­

sultarion meetings on HIV/AIDS and human rights were an exemplary effort to achieve the same ohj<..:tivc.

Recommendations: The need for a comprehensive, integrated and a multi-sectoral appro;u.:h in

addressing the issue of HIV/AIDS was highlighted. The need social, cultural and religious asp•·ct' to he:

prominently addressed were identified. It was thought imperative measures even in low prevalence coun­

tries. Education has a key role to play, there is a need for a code of ethics for media people and h<"alth

care providers and violations should be closely monitored and follow up action taken.

P7-38 (C) How can Community-Based Funding Programs Contribute to Building Community Capacity

and How can we Measure this Elusive Goal?

Mary Frances Maclellan-Wright, Brenda Cantin, Mary Jane Buchanan, and Tammy Simpson

Community capacity building is recognized by the Public Health Agency of Canada (PHAC) as an

important strategy for improving the overall health of communities by enabling communities to addre~s

priority issues such as social and economic determinants of health. In 2004/2005 PHAC.:, Alberta/NWf

Region's Population Health Fund (PHF) supported 12 community-based projects to build community

capacity on or across the determinants of health. Specifically, this included creating accessible and sup·

portive social and physical environments as well as creating tools and processes necessary for healthy

policy development and implementation. The objective of this presentation is to highlight how the

Community Capacity Building Tool, developed by PHAC AB/NWf Region, can demonstrate gains in

v166 POSTER SESSIONS

· · the course of a pror· ect and be used as a reflective tool for project planning and community capacity over . . . .

I · A art of their reporting requirements, 12 pro1ect sites completed the Community Caparny eva uanon. s p . . Th T I II I'd d . Building Tool at the beginning and end of their ~ne-year prorect. e oo ~o ects va 1 an reliable data in the context of community-based health prorects. Developed through a vigorous ~nd collabora11ve research process, the Tool uses plain languag~ to expl~re nine key f~atures o~ commuruty cap~city with

35 't ch with a section for contextual information, 26 of which also mdude a four-pomt raong 1 ems, ea f fu d ·

scale. Results show an increase in community capacity over the course o the nde prorects. Pre and post aggregate data from the one-year projects measure~ statistic.ally si~n~ficant changes for 17 of the 26 scaled items. Projects identified key areas of commumty capacity bmldmg that needed strengthemng, such as increasing participation, particularly among people with low incomes; engaging community members in identifying root causes; and linking with community groups. In completing the Tool, projects examined root causes of the social and economic determinants of health, thereby exploring social justice issues related to the health of their community. Results of the Tool also served as a reflec· cion on the process of community capacity building; that is, how the project outcomes were achieved. Projects also reported that the Tool helped identify gaps and future directions, and was useful as a project planning, needs assessment and evaluation tool. Community capacity building is a strategy that can be measured. The Community Capacity Building Tool provides a practical means to demonstrate gains in community capacity building. Strengthening the elements of community capacity building through community-based funding can serve as building blocks for addressing other community issues.

P7-39 (C) Creating a Comprehensive Harm Reduction Model for Addressing the Health and Social Needs of Marginalized Crack Users Lorraine Barnaby, Victoria Okazawa, Barb Panter, Alan Simpson, and Bo Yee Thom

Background: The Safer Crack Use Coalition of Toronto (SCUC) was formed in 2000 in response to the growing concern for the health and well-being of marginalized crack users. A central concern was the alarm· ing Hepatitis C rate ( 40%) amongst crack smokers and the lack of connection to prevention and health ser· vices. SCUC is an innovative grassroots coalition comprised of front-line workers, crack users, researcher! and advocates. Despite opposition and without funding, SCUC has grown into the largest crack specific harm reduction coalition in Canada and developed a nationally recognized sarer crack kit distribution program (involving 16 community-based agencies that provide outreach to users). The success of our coalition derives from our dedication to the issue and from the involvement of those directly affected by crack use.

Setting: SCUC's primary service region is Greater Toronto, a diverse, large urban centre. Much ofour work is done in areas where homeless people, sex trade workers and drug users tend to congregate. Recently, SCUC has reached out to regional and national stakeholders to provide leadership and education.

Mandate: Our mandate is to advocate for marginalized crack users and support the devdopmentof a com.p.rehensive harm reduction model that addresses the health and social needs facing crack users; and to fac1htare the exchange of information between crack users, service providers, researchers, and policy developers across Canada.

Owrview: The proposed workshop will provide participants with an overview of the devdopment of SCUC, our current projects (including research, education, direct intervention and consultation), our challenge~ and s~ccesses and the role of community development and advocacy within the coalition. Pre­senter~ will consist of community members who have personal crack use experience and front-line work· ers-, SC.UC conducted a community-based research project (Toronto Crack Users Perspectives, 2005), in w~ich 1 S focus groups with marginalized crack users across Toronto were conducted. Participants iden· t1f1ed health and social issues affecti h b · · · d " red . . ng t em, arrsers to needed services, personal strategies, an oue recommendations for improved services. Presenters will share the methodology, results and recommen· datmns resulting from the research project.

Conc/usio": Research, field observations and consultations with stakeholders have shown that cradck shmoke~s are at an. increased risk for sexually transmitted infections HIV/AIDS Hepatitis C, TB an ot er serious health issues Health · ff, · ' ' · ·

. · issues a ectmg crack users are due to high risk behavmurs, socio· economic factors, such as homeless d. · · · · d

· 1 . 1 . ness, 1scrsmmat1on, unemployment, violence incarceraoons, an soc1a 1so at1on, and a lack of comprehe · h I h · '

ns1ve ea t and social services targeting crack users.

P7-40 (C) Parental Influence on Adoles Sc al Ri k . . . (an Urban Perspective) cent xu - s Behaviors: The Role of Commurucauon

Salvation Okoro and Winifred Ojarikre

l"'""'-ction: It is claimed that ab 1 1 Mill' 511 )are """'rttd annually am N' . d out · ion cases of Sexually transmitted Infections ( 5 ·-.- ong 1genan a olescents Thi h 1 · · sinCt

· s, owever arge remains a gross underesurnaoon.

POSTER SESSIONS v167

these are Hospital-based reports and many known cases go unreported. However teh case, young age at first intercourse, inconsistent condom use and multiple partnersplace adolescents at high risks for a diverse array of STls, including HIV. About 19% of female Nigerian Secondary School Students report initiating Sexual intercourse before age 13 years. 39% of Nigerian female Secondary School students report not using a condom the last time they had sexual intercourse. More than 60% of Urban Nigerian teens report inconsistent condom use.

Methods: 371 adolescents were studied, ages 12 to 19, from Benin City in Edo State. The models used were Mother-Daughter(119), Mother -Son(99), Father -Son(87), and Father-Daughter(66). The effect of Parent-Child sexual communicationat baseline on Child\'s report of sexual behavior, 6 to 12 months later were studied. Greater amounts of sexual risk communication were asociated with markedly fewer episodes of unprotected sexual intercourse, reduced number of sexual partners and fewer episodes of unprotected sexual intercourse.

Results: This study proved that Parents can exert more influence on the sexual knowledge attitudes and practise of their adolescent children through desired practises or rolemodeling, reiterating their val­ues and appropriate monitoring of the adolescents\' behavior. They also stand to provide information about sexuality and various sexual topics. Parental-Child sexual communication has been found to be particularly influential and has been associated with later onset of sexual initiation among adolescents, less sexual activity, more responsible sexual attitudes including greater condom use, self efficacy and lower self -reported incidence of STis.

Conclusions: Parents need to be trained to relate more effectively with their Children/Wards about issues related to sex and sexuality. Family -based programs to reduce sexual risk-taking need to be devel­oped. There is also the need to carry out cross-ethnicaland cross-cultural studies to identify how Parent­Child influences on adolescent sexual risk behavior may vary in different regions or Countries, especially inthis era of the HIV pandemic.

P7-41 (C) Urban Health Informatics: Linking Data for Multilevel Mapping of Health Policy and Health Disparities Irina Campbell and Ann Curley

Introduction: Public health interventions to identify and eliminate health disparities require evi­dence-based policy and adequate model specification, which includes individuals within a socioeco­logical context, and requires the integration of biosociomedical information. Multiple public and private data sources need to be linked to apportion variation in health disparities ro individual risk factors, the health delivery system, and the geosocial environment. Multilevel mapping of health dis­parities furthers the development of evidence-based interventions through the growth of the Public Health Information Network (PHIN-CDC) by linking clinical and population health data. Clinical encounter data, administrative hospital data, population socioenvironmental data, and local health policy were examined in a three-level geocoded multilevel model to establish a tracking system for health disparities. NJ has a long established political tradition of "home rule" based in 566 elected municipal governments, which are responsible for the well-being of their populations. Municipalities are contained within Counties as defined by the US Census, and health data are linked mostly at the municipality level.

Methods: I.) A multilevel database was constructed at the level of municipality by linking data for the year 2000 from the a.) US Census2000, b.) claims data, c.) NJ Environmental Protection d.) NJ Cen­ter for Health Statistics, e.) Dartmouth Atlas of Health Care, g.) HRSA Medically Underserved Areas, h.) state, county, municipal health policies; 2.) Individuals were nested within hospitals, within municipali­ties, within counties; 3.) Outcome measures replicated the Dartmouth Atlas of Health Care: any mortal­ity; five hospitalized conditions (hip fracture, surgical treatment of cancer of the colon/lung, GI hemorrhage, acute Ml, stroke); hospital level predictors were derived from claims data; macro munici­pality-level predictors included a.) shortage of Primary Medical professionals; b.) environmental hazards; c.) sociodemographic predictors; d.) health policy; 4.) Multilevel model outcomes were compared to a.) a model replicating the Harvard Public Health Disparities Geocoding ABSM measures; and b.) a model of the Dartmouth Health Atlas Hospital Referral Region measures.

Conclusions: I.) A statewide multilevel database of public and private geocoded health infor­mation across NJ linked health status, health policy, quality of health delivery systems, socioecolog­ical, and community context; standard codes for critical information were proposed; 2.) An evaluation of the multilevel model of health disparities was made with the Harvard Public Health Disparities aggregated macro poverty indicator at the municipality level and the Dartmouth Health Atlas Hospital Referral Regions; 3.) A map was constructed of the variation of health status across municipalities.

v168 POSTER SESslONS

P7-42 (C) Hunger: A Serious Medical Issue for OW an~ ODSP Recipients. Everyone Should be Entidfd

10 Healthy Food - Learn About Prescribing a Special Diet Needs Supplement

Marika Schwandt

Community organizers from the Ontario Coaliti~n Again~t Pove~, .along ":ith ~edical practitio­

ners who have endorsed the campaign and have been mvolved m prescnbmg special diet needs for OW

and ODSP recipients, will discuss the Raise the Rates campaign. The organizati~n has used a special diet

needs supplement as a political tool, meeting the urgent needs o.f .poor ~ople m Toront~ while raising

the issues of poverty as a primary determinant of health and nutrtnous diet as a preventative health mea·

sure. Health professionals carry the responsibility to ensure that they use all means available to them to

improve the health of the individuals that they serve, and to prevent future disease and health conditions.

Most health practitioners know that those on social assistance are not able to afford nutritious foods or

even sufficient amounts of food, but many are not aware of the extra dietary funds that are available

aher consideration by a health practitioner. Responsible nurse practitioners and physicians cannot, in

good conscience, ignore the special needs diet supplement that is available to all recipients of welfare and

disabiliry (OW and ODSP). A number of Toronto physicians have taken the position that all clients can

justifiably benefit from vitamins, organic foods and high fiber diets as a preventative health measure. We

know that income is one of the greatest predictors of poor health. The special needs diet is a health pro­

motion intervention which will prevent numerous future health conditions, including chronic conditions

such as cardiovascular disease, cancer, diabetes and osteoporosis. Many Communiry Health Centres and

other providers have chosen to hold clinics to allow many patients to get signed up for the supplement at

one time. Initiated by the Ontario Coalition Against Poverty, these clinics have brought together commu·

niry organizers, community health centers, health practitioners, and individuals, who believe that pov­

erty is the primary determinant of poor health. We believe that rates must be increased to address the

health problems of all people on social assistance, kids, elders, people with HIV/AIDS -everyone. Even

in the context of understaffing, it could be considered a priority activity that has potentially important

health promotion benefits. Many clients can be processed in a two hour clinic. Most providers find it a

very interesting, rewarding undertaking. In 2004 the Ontario Coalition for Social Justice found that a

Toronto family with two adults and two kids receives $14,316. This is $21,115 below the poverty line.

P7-43 (C) The Health of Street Youth Compared to Similar Aged Youth Beth Hayhoe and Ruth Ewert

. lntrod~on: Street Youth are at an age normally associated with good health, but due to their

risky ~hav1ours and th~ conditions in which they live, they experience health conditions unlike their

peer~ an more stable env1r~nments. In addition, the majority of street youth have experienced significant

physical, sexual ~nd em.ot1onal abuse as younger children, directly impacting many of the choices they

make around their physical and emotional health. We examined how different their health really is.

. , Methodl: Using a retrospective analysis of the 11 years of data gathered from Yonge Street Mis· 510~ 5• Evergreen Health Centre, the top 10 conditions of youth were examined and compared with

national tren~s for similar aged youth. Based on knowledge of the risk factors present in the group, rea· sons for the difference were examined.

d' ~Its: Street youth experience more illness than other youth their age and their illnesses can bt

. irect t ·~kc~ to the. conditions in which they live. Long-term impacts of abus~ contribute to such signif·

~~nt te t 0 d~slpl air that youth may voluntarily engage in behaviours or lack of self care in the hope at t cir 1ve~ w1 perhaps come to a quicker end.

Concl11non: Although it has Ion b k h th' dy clearly shows 3 d'fi . h g ee~ no~n t at poverty negatively affects health, ~SIU be used to make ; erence m t .e health of this particular marginalized population. The infonnanon can relates to th . ecommendatio.ns around public policy that affects children and youth, especially as it

e1r access to appropriate health care and follow up.

P7-44 (Cl Why do Urban Children · B gt . Tarek Hussain 10 an adesh Die: How to Save our Children?

The traditional belief that urban child alid. A recent study (DHS d fr 17 r~n are better off than rural children might be no longer v

urban migrants are highata th om h c~untn~s I demonstrates that the child survival prospects of rural· er an t ose m their r J · · ·grants.

In Bangladesh, currently 30 million 0 ~r~ 0~1gm and lower than those of urban non-IDI

million. Health of the urban 1 ~ p~e are hvmg m urban area and by the year 2025, it would be SO the popu at1on 1s a key A eals that

urban poor have the worse h 1 h . concern. recent study on the urban poor rev ea t situation than the nation as a whole. This study shows that infant

POSTER SESSIONS v169

mortality among the urban poor as 120 per thousand, which are above the rural and national level esti­

mates. The mortality levels of the Dhaka poor are well above those of the rest of the city's population

but much of the difference in death rates is explained by the experience of children, especially infants.

Analyzing demographic surveillance data from a large zone of the city containing all sectors of the popu­

lation, research showed that the one-fifth of the households with the least possessions exhibited U5 child

mortality almost three times as high as that recorded by the rest of the population. Why children die in

Bangladesh? Because their parents are too poor to provide them with enough food, clean water and other

basic needs to help them avoid infection and recover from illness. Researchers believed that girls are

more at risk than boys, as mothers regularly feed boys first. This reflects the different value placed on

girls and boys, as well as resources which may not stretch far enough to provide for everyone. Many

studies show that housing conditions such as household construction materials and access to safe drink­

ing water and hygienic toilet facilities are the most critical determinants of child survival in urban areas

of developing countries. The present situation stressed on the need for renewed emphasis on maternal

and child healthcare and child nutrition programs. Mapping Path for progress to save our children

would need be done strategically. We have the policies on hand, we have the means, to change the world

so that every child will survive and has the opportunity to develop himself fully as a healthy human

being. We need the political will--courage and determination to make that a reality.

P7-45 (C) Sherbourne Health Centre: Innovation in Healthcare for the Transgendered Community

James Read

Introduction: Sherbourne Health Centre (SHC), a primary health care centre located in downtown

Toronto, was established to address health service gaps in the local community. Its mission is to reduce

barriers to health by working with the people of its diverse urban communities to promote wellness and

provide innovative primary health services. In addition to the local communities there are three popula­

tions of focus: the Lesbian, Gay, Bisexual, Transgendered and Transexual communities (LGBTT); people

who are homeless or underhoused; and newcomers to Canada. SHC is dedicated to providing health ser­

vices in an interdisciplinary manner and its health providers include nurses, a nurse practitioner, mental

health counsellors, health promoters, client-resource workers, and physicians. In January 2003 SHC

began offering medical care. Among the challenges faced was how to provide responsive, respectful ser­

vices to the trans community. Providers had considerable expertise in the area of counselling and com­

munity work, but little in the area of hormone therapy - a key health service for those who want to

transition from one gender to another. Method: in preparing to offer community-based health care to the trans community it was clear that

SHC was being welcomed but also being watched with a critical eye. Trans people have traditionally expe­

rienced significant barriers in accessing medical care. To respond to this challenge a working group of

members of the trans community and health providers was created to develop an overall approach to care

and specific protocols for hormone therapy. The group met over a one year period and their work culmi­

nated in the development of medical protocols for the provision of hormone therapy to trans individuals.

Results: SHC is currently providing health care to 281 registered clients who identify as trans indi­

viduals (March 31 2005) through primary care and mental health programs. In an audit of SHC medical

charts (January 2003 to September 2004) 55 female-to-male (FTM) and 82 male-to-female (MTF) clients

were identified. Less than half of the FTM group and just over two-thirds of the MTF group presented

specifically for the provision of hormones. Based on this chart audit and ongoing experience SHC contin­

ues to update and refine these protocols to ensure delivery of quality care.

Conclusion: This program is an example of innovative community-based health delivery to a popu­

lation who have traditionally faced barriers. SHC services also include counselling, health promotion,

outreach and education.

P7-46 (C) Healthy Cities for Canadian Women: A National Consultation

Sandra Kerr, Kimberly Walker, and Gail Lush

On March 4 2005, the National Network on Environment and Women's Health held a Pan­

Canadian consultation to identify opportunities for health research, policy change, and action. This con­

sultation also worked to facilitate information sharing and networking between Canadian women work­

ing as urban planners, policy makers, researchers, and service workers on issues pertaining to the health

of women living in Canadian cities. Methods: For this research project, participants included front-line service workers, policy workers,

researchers, and advocates from coast to coast, including Francophone women, women with disabilities,

racialized women, and other marginalized groups. The following key areas were selected as topics for

v170 POSTER SESSIONS

focused discussions during the consultation: 1. Women in _Poverty 2. Women with Disability 3. Immi·

grant and Racialized Women 4. The Built and _Physica_l Environment. . . . . R Its· Participants voiced the need for integration of the following issues withm the research and

policy :::na; t) The intersectional nature of urban women's health i~sues wh~ch reflects the reality of women's complex lives 2) The multisectional aspect of urban wo_m~n s health, 1ss~es, which reflects the diversity within women's lives 3) The interse~roral _dynamics within _womens hves and urban health issues. These concepts span multiple sectors - mdudmg health, educat10n, and economics - when lever­

aging community, research, and policy support, and engaging all levels of government. Policy Jmplicatiom: Jn order to work towards health equity for women, plans for gender equity

must be incorporated nationally and internationally within urban development initiatives: • Reintroduce "Women" and "Gender" as distinct sectors for research, analysis, advocacy, and action. •Integrate the multisectional, intersectional, and intersecroral aspects of women's lives within the framework of research and policy development, as well as in the development of action strategies. • Develop a strategic framework to house the consultation priorities for future health research and policy development (for example, advocacy, relationship building, evidence-based policy-relevant research, priority initiatives}.

Note: Research conducted by NNEWH has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.

P7-47 (C) Drugs, Culture and Disadvantaged Populations Leticia Folgar and Cecilia Rado

lntroducci6n: A partir de un proyecto de reducci6n de daiios en una comunidad urbana en situ· aci6n de extrema vulnerahilidad surge la reflexion sobre el lugar prioritario de los elementos socio­cuhurales en el acceso a los servicios de salud de diferentes colectivos urbanos. Las "formas de hacer, pensar y sentir" orientan las acciones y delimitan las posibilidades que tienen los individuos de definir que algo es o no problema, asf como tambien los mecanismos de pedido de ayuda. El analisis permanenre del campo de "las culturas cotidianas" de los llamados "usuarios de drogas" aporta a la comprension de la complejidad del tema en sus escenarios reales, y colabora en los diseiios contextualizados de politicas y

propuestas socio-sanitarias de intervenci6n, tornandolas mas efectivas. Mitodos: Esta experiencia de investigaci6n-acci6n que utiliza el merodo emografico identifica ele­

mentos socio estructurales, patrones de consumo y profundiza en los elementos socio-simb61icos que estructuran los discursos de los usuarios, caracterizandolos y diferenciandolos en tanto constitutivos de IDENTIDADES SOCIA LES que condicionan la implementaci6n del programas de reduccion de daiios.

Resultados: Los resultados que presentaremos dan cuenta de las caracteristicas diferenciadas v rela­ciones particulares ~ntre los consumidores de drogas en este contexto espedfico. A partir de este e~tudio de caso se mtentara co1?1enzar a responder preguntas que entendemos significativas a la hora de pensar intcrvcnciones a la med1da de poblaciones que comparten ciertas caracteristicas socio-culturales. (Cuales serian las .motivaciones para el cambio en estas comunidades?, cQue elementos comunitarios nos ayudan

a i:nnstnur dema~~a? • cQue tenemos para aprender de las "soluciones" que ellos mismos encuenrran a los usos problemat1cos?

Co?clusi~ne~: Las suhculturas que se consolidan en contextos de pohreza extrema y exclusion· seg-mentac1on terntonal fucrtemente m d ( ' · · · · · · · I . _ ' area as por og1cas as1stenc1ahstas ex1gen mtervenc1ones en as que d d1scno de herramientas e 'f d d ., ' · · d

. . speci icas e re ucc1on de daiios contribuya a la conectar con serv1c1os e atcnc1on de salud accesibles a las n "d d ' · ·

h . . ecesi a es Y caractensncas de los usuarios. Effective and compassion-ate arm reductmn policies in Latin A · · I I d. . . . - mencan countries do not seem to be really possible if the mu npc

1mcnsmns of polmcal soci I · d I J • . ' a• economic an cu rural exclusion of important segments of the popu anon

arc not simultaneously addressed.

P7-48 (A) Mapping the Physical Environment of Inner City W k I Iggy Kosny, Sarah Hayday, and Linn Holness or paces

Introduction: This mapping pr · · · I h I h 3 d f f . o1ect examines the working conditions and occupanona ea 1

n sa ety o workers m nonprofit · I · . . . . . · T Some researchers h f d h ' socia service organizations w1thm the mner city of oronio.

ave oun t at the daily st f 1· · · · hbour· hood where dang . · d . ress o 1vmg (and perhaps working) m a ne1g

er• crime an disorder h (R and Mirowsky 2001) w d h are common can be damaging to healt oss ing service~ to ma~gin:l~zapd~e t e_ physical environments of areas surrounding workplaces providd·

e mner city inhabitant o b . . d ch an recommendations regard· h . s. ur o servat1ons have mforme our resear .

mg t e importance of pl d h I h We dis-cuss the utility of urban . d ace an external environments on eat ·

· mappmg an offer several k · h. thodol-ogy in a variety of settings. ey recommendations about using t 1s me

POSTER SESSIONS v171

Methods: Our study was conducted by a team of two researchers at three different sites. The map­ping consisted of filling in a chart of observable neighbourhood features such as graffiti, litter, and boarded housing, and the presence or absence of each feature was noted for each city block. Qualitative observations were also recorded throughout the process. Researchers analyzed the compiled quantitative and qualitative neighbourhood data and then analyzed the process of data collection itself.

Results: This study reveals the need for further research into the effects of physical environments on individual health and sense of well-being, and perception of investment in neighbourhoods. The process reveals that perceptions of health and safety are not easily quantified. We make specific recommendations about the mapping methodology including the importance of considering how factors such as researcher social location may impact the experience of neighbourhoods and how similar neighbourhood characteris­tics are experienced differently in various spaces. Further, we discuss some of the practical considerations around the mapping exercise such as recording of findings, time of day, temperature, and researcher safety.

Conclusion: This study revealed the importance of exploring conceptions of health and well-being beyond basic physical wellness. It suggests the importance of considering one's environment and one's own perception of health, safety, and well-being in determining health. This conclusion suggests that attention needs to be paid to the connection between the workplace and the external environment it is situated in. The individual's workday experience does not start and stop at the front door of their work­place, but rather extends into the neighbourhood and environment around them. Our procedural obser­vations and recommendations will allow other researchers interested in the effect of urban environments on health to consider using this innovative methodology.

P7-49 (A) Are Sexually Assaulted Women's Needs Being Met? Preliminary Findings from an Evaluation of a Medico-Legal Intervention for Rape Janice Du Mont and Deborah Parnis

Introduction: Responding ro protests against poor medical attention for sexually assaulted women and deplorable conviction rates for sex offenders, in the late 1970s, the Ontario government established what would become over 30 hospital-based Sexual Assault Care and Treatment Centres (SACTCs) across the province. These Centres, staffed around the clock with specially trained heath care providers, have become the centralized locations for the simultaneous health care treatment of and forensic evidence col­lection from sexually assaulted women for the purpose of facilitating positive social and legal outcomes. Since the introduction of these Centres, very little evaluative research has been conducted to determine the impact of this intervention. The purpose of our study was to investigate it from the perspectives of sexu­ally assaulted women who have undergone forensic medical examinations at these Centres.

Method: Women were referred to our study by SACTC Coordinators across Ontario. We devel­oped an interview schedule composed of both closed and open-ended questions. Twenty-two women were interviewed, face-to-face. These interviews were approximately one-to-two hours in length, and were transcribed verbatim. To date, 19 have been analyzed for key themes.

Results: Preliminary findings indicate that most women interviewed were Canadian born (79'Yo), and ranged in age from 17 to 46 years. A substantial proportion self-identified as a visible minority ( 37'X.). Approximately half were single or never married (47%) and living with a spouse or family of origin (53%). Most were either students or not employed (68%). Two-thirds (68%) had completed high school and one­third (37%) was from a lower socio-economic stratum. Almost two-fifths (37%) of women perceived the medical forensic examination as revictimizing citing, for example, the internal examination and having blood drawn. The other two-thirds (63%) indicated that it was an empowering experience, as it gave them a sense of control at a time when they described feeling otherwise powerless. Most (68%) women stated that they had presented to a Centre due to health care concerns and were very satisfied ( 84 % ) with their experiences and interactions with staff. Almost all (89%) women felt supported and understood.

Conclusions: This research has important implications for clinical practice and for appropriately addressing the needs of sexually assaulted women. What is apparent is that continued high-quality med­ical attention administered in the milieu of specialized hospital-based services is essential. At the same time, we would suggest that some forensic evidence collection procedures warrant reevaluation.

P7-50 (A) Confronting Stigma: The Use of Narrative Inquiry with Individuals Who have Experienced

Chronic Homelessness and Alcoholism Dyanne Semogas, Helen Kirkpatrick, Linsey George, Kristin Cleverley, Jennifer Blythe, Helen Thomas,

and Anna Cleverley

Introduction: This qualitative/quantitative longitudinal study will document the experiences of 20 homeless individuals living with alcohol dependence as they move from the streets through their first 9

v172 POSTER SESSIONS

h I. · · managed alcohol environment. Such individuals can experience being stigmatized for mont s 1vmg m a . . both their addiction and their homelessness. Unhke abstme~ce .and zero toleran~ models, ~r.n1 reduc­

tion through a managed alcohol environment focuses on principles of: pragmansm, humarusnc values,

harm and immediate needs (Long, 2002). . . . .

Methods: The study will take an experiential, approach by chroruclmg the impa~ of the transition

f m the streets to stabilization in a managed alcohol program through the techruque of narrative

i~:uiry. In keeping with the shift in thinking in the mental health fie!~ ~his stu~y is based on a paradigm

of recovery rather than one of pathology. The "inner views of part1c1pants hves as they portray their

worlds, experiences and observations" will be presented (Charm~z, 1991, ~· 38~)-"I?e p~ of the

study is to: identify barriers to recovery. It will explore the exJ?Cnence of ~n~t1zanon pnor to entry

into the program; and following entry will: explore the meanmg ~nd defirutto~s of r~overy ~~d the

impact of the new environment and highlight what supports were instrumental m movmg pan1apants

along the recovery paradigm.

P7-St (A) Treating the "Untreatable": The Politics of Public Health in Vancouver's Inner City

Denielle Elliott

Introdudion: This paper explores the everyday practices of therapeutic programs in the treaDnent of

HIV in Vancouver's Inner City. As anthropologists have shown elsewhere, therapeutic programs do not siin­

ply treat physical ailments but they shape, regulate and manage social lives. In Vancouver's Inner City, there

are few therapeutic options available for the treatment of 1-IlV. Public health initiatives in the Inner City have

instead largely focused on prevention and harm reduction strategies such as needle exchange programs, safe

injection sites, and safer-sex education. Epidemiological reports suggest that less than a quarter of those living

with HIV in the Downtown Eastside (DTES) are taking antiretroviral therapies raising critical questions

regarding the therapeutic economy of antiretrovirals and rights to health care for the urban poor.

Methods: This paper is drawn from ethnographic fieldwork in Vancouver's OTES neighborhood

focusing on therapeutic programs for HIV treatment among "hard-to-reach" populations. The research

includes participant-observation at Inner City Health Clinics specializing in the treatment of HIV; semi·

structured interviews with HIV positive participants, health care professionals providing HIV treatment,

and administraton working in the field of Inner City public health; and, lastly, observation at public

meetings and conferences surrounding HIV treatment.

R.awlts: HIV prevention and treatment is a central concern in the lives of many residents living in

the Inner City - although it is just one of many health priorities afflicting the community. Concerns

about drug resistance, cost of antiretrovirals, and illicit drug use means that HIV therapy for most is

characterized by the daily observation of their medicine ingestion at health clinics or pharmacies. Daily

observed treatment (DOT) is increasingly being adopted as a strategy in the therapeutic management of

"untreatable" populations. DOT programs demand a particular type of subject - one who is "compli­

ant" to the rules and regimes of public health. Over emphasis on "risky practices," "chaotic lives," and

"~dh~rence" preve~ts the public health system from meaningful engagement with the health of the mar­

ginalized who continue to suffer from multiple and serious health conditions and who continue to expe­

rience considerable disparities in health.

~ The ~ffec~s of HIV in the Inner City are compounded by poverty, laclc of safe and affordable houamg, vanous 1llegal underground economies increased rates of violence and outbreaks of

~~~·~ly tr~nsmitted infections, Hepatitis, and tuberculosi: but this research suggests 'that public health

uunauves aimed at reducing health disparities may be failing the most vulnerable and marginal of citiztl1s.

P7-S2 (A) Violence in Families and Intimate Relationships: Challenges for Health Promoters Margaret Malone

1~ Vi~lence that occurs in families and in intimate relationships is a significant urban,

~unity, and pu~hc health problem. It has major consequences and far-reaching effects for women,

~~--renho, you~ sen1on, and families. Violence also has significant effects for those who provide and uKllC w receive health care Violence · · I · · . all

lasses, · is a soc1a act mvolvmg a senous abuse of power. It crosses

:':' ~ 11 s;nden, ag~ ~ti~, cultures, sexualities, abilities, and religions. Societal responses

Hali ra y oc:used on identificatton, crisis intervention and services for families and individuaJs. promoten are only "-"--:-g to add h · ' · I in

intimate relationshi with"-~"'." . ress t e issues of violence against women and VJoence

lenga to consider i~ m families. In thi_s P~per, I analyze issues, propose strategies, and note c~· cannot be full -...L'-~ whork towards erad1canng violence, while arguing that social justice and equity

Y -.1ucvcu w en thett are people wh · be b" . · the' · .: .... It relationships, fami1i d . . o connnue to su 1ected to v10lence m ll' m....-

es, an communmes, locally, nationally, and globally.

POSTER SESSIONS v173

Mnhod: Critical social theory, an analysis that addresses culturally and ethnically diverse commu­

nities, together with a population health promotion perspective frame this analysis. Social determinants

of health are used to highlight the extent of the problem of violence and the social and health care costs.

The Ottawa Charter is integrated to focus on strategies for developing personal skills, strengthening

community action, creating supportive environments, devdoping healthy public policies, and re-orientat­

ing health and social services. Attention is directed to approaches for working with individuals, families,

groups, communities, populations, and society.

Ratdts: This analysis demonstrates that a comprehensive interdisciplinary, multisectoral, and mul­

tifaceted approach within an overall health promoting perspective helps to focus on the relevant issues,

aitical analysis, and strategies required for action. It also illuminates a number of interacting, intersect­

ing, and interconnecting factors related to violence. Attention, which is often focused on individuals who

are blamed for the problem of violence, is redirected to the expertise of non-health professionals and to

community-based solutions.

Conduions: The challenge for health promoters working in the area of violence in families and in

intimate relationships is to work to empower ourselves and the communities with whom we work to cre­

ate health-promoting urban environments. Social justice, equiry, and emancipatory possibilities are posi­

tioned in relation to recommendations for future community-based participatory research, pedagogical

practices for health care practitioners, and policy development in relation to violence and urban health.

P7-53 (A) A Wll'Cd Waiting Room: Can Health Information Websites Empower Everyone?

Karen Smith

The Mid-Main Community Health Center, located in Vancouver British Columbia (BC), has a

diverse patient base reflecting various cultures, languages, abilities, and socio-economic statuses. Due to

these differences, some Mid-Main patients experience greater digital divide barriers in accessing computers

and reputable, government produced consumer health information (CHI) websites, such as the BC

HealthGuide and Canadian Health Network. Inequitable access is problematic because patient empow­

erment is the basis of many government produced CHI websites. An Internet terminal was introduced at

Mid-Main in the summer of 2005, as part of an action research project to attempt to bridge the digital

divide and make government produced CHI resources useful to a broad array of patients. Multi-level

interventions in co-operation with patients, with the clinic and eventually government ministries were

envisioned to meet this goal. The idea of implementing multi-level interventions was adopted to counter

the tendency in interactive design to implement a universal solution for the 'ideal' end-user [ 1 ), which

discounts diversity. To design and execute the interventions, various action-oriented and ethnographic

methods were employed before and during the implementation of the Internet terminal. Upon the intro­

duction of the Internet terminal, participant observation and interviews were conducted using a motion

capture software program to record a digital video and audio track of patients' Internet sessions. This

research provided insight into the spectrum of patients' capacities to use technology to fulfil their health

information needs and become empowered. At the Mid-Main clinic it is noteworthy that the most signif­

icant intervention to enhance the usefulness of CHI websites for patients appeared to be a human rather

than a technological presence. As demonstrated in other ethnographic research of community Internet

access, technical support and capacity building is a significant component of empowerment (2). The

Mid-Main wired waiting room project indicates that medical practitioners, medical administrators, and

human intermediaries remain integral to making CHI websites useful to patients and their potential

empowerment. (1) Nyce, James and Gail Bader. "On Foundational Categories in Software Develop­

ment" in Social thinking-software practice. [Eds. Yvonne Dittrich, Christiane Floyd, and Ralf Klis­

chewski]. Cambridge: MIT Press, 2002. (2) Clement, Andrew et. al. "Public Access, Personal Privacy,

and Media Interweaving in Everyday Internet Experiences: Exploring Current Policy Concerns Via a

"Neighbourhood Ethnography" in Seeking Convergence in Policy and Practice: Communications in the

Public Interest. Volume Two. [Eds. Marita Moll and Leslie Regan Shadef. Ottawa: Canadian Centre for

Policy Alternatives, 2004.

P7-54 (A) Youth Research and Evaluation: Growing Up in Canadian Cities

Jackie Amsden

How can community organizations create enabling environments to suppon young people .as

agents of change in the urban environment? Insight into this question lies with youth and th~ co~un~ty

organizations and projectS they are already working with-which is the approach taken up m this parbC­

ipatory research project. As part of a national project, called Growing up in. Canadian Cities, this. Van­

couver based project is examine the youth development approach of the Envll'Onmental Youth Alliance.

v174 POSTER SESSIONS

Over the past 5 years the Environmental Yo~th Alliance has been of~ering a.youth As~t. Mappin~ pro­

gram which trains young people in community research and evaluation. Wh1~st the positive expenenc~

and relationships that have developed over this time attest to the success of this program, no evaluations

has yet been undertaken to find out what works for t.he youth, what ~ould be changed, and what long

term outcomes this approach offers for the youth, their local community, and urban governance. These

topics will be shared and discussed to help other community disorganizing and uncials governments

build better, youth-driven structures in the places they live.

P7-55 (A) The World Trade Center Health Registry: A Unique Resource for Urban Health Researchers

Deborah Walker, Lorna Thorpe, Mark Farfel, Erin Gregg, and Robert Brackbill

Introduction: The World Trade Center Health Registry (WfCHR) was developed as a public

health response to document and evaluate the long-term physical and mental health effects of the 9/11

disaster on a large, diverse population. Over 71,000 people completed a WfCHR enrollment baseline

survey, creating the largest U.S. health registry. While studies have begun to characterize 9/11 bealth

impacts, questions on long-term impacts remain that require additional studies involving carefully

selected populations, long-term follow-up and appropriate physical exams and laboratory tests.

WTCHR provides an exposed population directory valuable for such studies with features that make ita

unique resource: (a) a large diverse population of residents, school children/staff, people in lower Man·

hattan on 9/11 including occupants of damaged/destroyed buildings, and rescue/recovery/cleanup work·

ers; (b) consent by 91 % of enrollees to receive information about 9/11-related health studies; (c)

represenration of many groups not well-studied by other researchers; (c) email addresses of 62% of

enrollees; (d) 30% of enrollees recruited from lists with denominator estimates; and (e) available com·

parison data for NYC residents. WfCHR strives to maintain up-to-date contact information for all

enrollees, an interested pool of potential study participants. Follow-up surveys are planned.

Methods: To promote the WTCHR as a public health resource, Guidelines for External Researcher.;

were developed and posted on (www.wtcregistry.org) which include a short application form, a two­

page proposal and documentation of IRB approval. Proposals are limited to medical, public health, or

other scientific research. Researchers can request de-identified baseline data or have DOHMH send

information about their studies to selected WfCHR enrollees via mail or email. Applications are scored

by the WTCHR Review Committee, comprised of representatives from DOHMH, the Agency for Toxic

Subst~nces and Disease Registry, and WTCHR's scientific, community and labor advisory committees. A

data file users manual will be available in early Fall 2005.

~suits: Three external applications have been approved in 2005, including one &om a non-U.S.

~esearcher, all requesting information to be sent to selected WTCHR enrollees. The one completed mail·

mg~~ WTCHR enrollee~ (o 3,700 WfC tower evacuees) generated a positive survey response rate. Three

additional researchers mtend to submit applications in 2005. WfCHR encourages collaborations

between researchers and labor and community leaders.

Conclusion: Studies involving WTCHR enrollees will provide vital information about the long·

term health consequences of 9/11. WTCHR-related research can inform communities, researcher.;, policy

makers, health care providers and public health officials examining and reacting to 9111 and other disasters.

P7-56 (A) Repeat Substance Using- Suicidal Clients - How can We be Helpful?

YvdonnehBergmans, Carol Strike, Paul Links, Jeffrey Ball, Anne Rhodes Julie Spence William Warson, an Ra c:I Eynan ' '

B4dground· Using a qu l't r' h h d . • a 1 a ive researc met od we explored the role hospital emergency epart·

mentsl 5IEDl4a5nd primary care settings play in the mem~I health care of suicidal and substance using men ages to .

t.,. dp'"f'osed: Thi is presentation will discuss the findings of attitudes toward the repeat male client iden· 1 ie as su1e1 a and substance us'n p · · · · I

· 'd . . - 1 g. articipants will learn about some identified effective strategies or service prov1 ers to assist this group of I · f men are oft · d bl men. n emergency care settings, studies show that this group 0

en viewe as pro emaric patient d I r for mental health p bl h h 5 an are more ikely to be discharged without an assessmen 200!) Ea 1 1 rofr ems t. an or er, more cooperative patients (Forster and Wu 2002· Hickey er al.,

· r Y resu ts om this study suggest th · · ' ' l · d tel' mining how best to h 1 . d 1 at negative amtudes towards patients, difficu nes e ·

As well pathways L_e_ p patientsblan ~ck of conrinuity of care influence pathways to mental health care. • UC\:Ome pro emat1c when p ti k · che

system. M a ems present repeatedly and become "get stuc ID

Methods: Semi-structured intervie d . · (n=5), ED nurses (n=5) other ED ;s were con ucted with male ED patients (n=25), ED phys1oans

' sta (n= 7) and family physicians (n= 7). Patients also completed a

POSTER SESSIONS v175

diagnostic interview. Interviews were tape-recorded, transcribed verbatim and managed using N6. Tran­

scripts were coded using an iterative process and memos prepared capture emergent themes. Ethics

approval was obtained and all participants signed a detailed informed consent form.

References: Forster PL, Wu LH. Assessment and treatment of suicidal patients in an emergency set­

ting. In Michael H. Allen (ed). Emergency Psychiatry. Review of Psychiatry, Volume 21, Washington:

American Psychiatric Publishing, Inc. 2002. Hickey K, Hawton K, Fagg J, Weitzel H. Deliberate self­

harm patients who leave the accident and emergency department without a psychiatric assessment: A

neglected population at risk of suicide. Journal of Psychosomatic Research 2001; 50:87-93.

P7-57 (C) Urban Health in Kathmandu, Nepal: A Review of Innovative and Effective Programs

Poonam Kandel

Nepal is a landlocked country located in the central part of Asia. Nepal is also a crowded, develop­

ing country with 21 million people living in an area of about 147, 181 sq. km. Like many other cities in

Asia, urbanization rate in Nepal is 5% (greater than the natural population increase). Kathmandu, the

capital of Nepal, has experienced an explosion of population growth in the last two decades and has

reached almost 700,000. The challenges and opportunities in Kathmandu have attracted people form

different pans of the country. Urbanization has also been aggravated hy the recent Maoist insurgency in

the rural areas. The urbanization process in Kathmandu has, however, been haphazard and inefficient

and of less than desired density; and many areas of the city suffers from poor access to basic services. At

least 35% percent of the Kathmandu population lives in slum like conditions with poor access to basic

health services. In these disadvantaged areas, a large proportion of children do not receive treatment due

to inaccessibility to medical services. In these areas, diarrhea, pneumonia, and measles, are the key deter­

minants of infant mortality. Protein energy malnutrition and Vitamin A deficiency persists and commu­

nicable diseases are compounded by the emergence of diseases like HIV/AIDS. While the health

challenges for disadvantaged populations in Kathmandu are substantial, the city has also experienced

various forms of innovative and effective community development health programs. For example, there

are community primary health centers established by the Kathmandu Municipality to deliver essential

health services to targeted communities. These centers not only provide equal access to health services to

the people through an effective management system but also educate them hy organizing health related

awareness programs. This program is considered one of the most effective urban health programs. The

Paper/Presentation This paper will review large, innovative, and effective urhan health programs that are

operating in Kathmandu. Most of these programs are currently run by international and national NGOs.

Where available, the paper will also provide evidence of the impact of these programs. The key purpose

of the paper will be to share these 'good' practices with other participants of the Conference. The paper

will provide an introduction on the health status of disadvantaged Kathmandu population (vis a vis rural

population). It will then provide an overview of the innovative and effective programs, focusing on (a)

access; (b) quality; (c) cost-effectiveness; and (d) sustainability.

P7-58 (A) Early Detection of Emerging Diseases in Urban Settings Through Syndromic Surveillance: 911

Data Pilot Study Kate Bassil, Donald Cole, Effie Gournis, and Elizabeth Rea

Introduction: Urban settings are particularly susceptible to the emergence and rapid spread of nt•w

or rare diseases. The emergence of infectious diseases such as SARS and increasing concerns over the

next influenza pandemic has heightened interest in developing and using a surveillance systt·m which

detects emerging public health problems early. Syndromic surveillance systems, which use data b,1scd on

symptoms rather than disease, offer substantial potential for this by providing near-real-rime data which

are linked to an automated warning system. In Toronto, we are piloting syndromic data from the 911 ·

Emergency Medical Services (EMS) database to examine how this information can be used on an ongoing

basis for the early detection of syndromes including heat-related illness (HRI), and influenza-like-illness

(Ill). This presentation will provide an outline of the planned desi_gn of this system and proposed evaluation.

Methods: For one year, 911 call codes which reflect heat-related illness or influenza-like-illness

will be selected and searched for daily using software with a multifactorial algorithm. Calls will he

stratified by call code, extracted from the 911-EMS database and transferred electronically to Toronto

Public Health. The data will be analyzed for clusters and aberrations from the expected with the Real­

time Outbreak and Disease Surveillance (RODS) system, a computer-based public health tool for the

early detection of disease outbreaks. This 911-EMS surveillance system will be assessed in terms of its

specificity and sensitivity through comparisons with the well-established tracking systems already in

place for HR! and Ill. Others sources of data including paramedic ambulance call reports of signs and

v176 POSTER SESSIONS

d d rtment (ED) chief complaint information will also be compared to the symptoms an emergency epa

911 data. h b h h 1· d d f Results: It is expected that such a system has the potential to en ~nc~ . ot t e qua •TJ:' an spee o

bl . h I h t I sters of HRI and ILi Given the ready ava1lab1hty of 911 data m most urban pu 1c ea t responses o c u · . . . . .

h. d Id be eas1"ly accessed by other pubhc health units 1f proven useful. Addmonally, areas, t 1s ata source cou . . this study will introduce complementary data sources t~ the ED ch1e~ complamt an~ o~~r- the-counter

pharmacy sales syndromic surveillance data currently bemg evaluated m ~ther Ontar~o cltles. .

Conclusions: Syndromic surveillance is a unique approach to proactive(~ dete~tmg early c.hangesm

the health status of urban communities. The proposed study aims to provide evidence of differential

effectiveness through investigating the use of 911-EMS call data as a source of syndromic surveillance

information for HR! and ILi in Toronto.

P7-59 (A) Addiction Shared Care: The Effectiveness of a Shared-Care Model for Addiction Patients

Meldon Kahan, Kingsley Wans, Lynn Wilson, Hee Yung Lim, Althea Prescod, Michael Dean, Nadine

Smith, Robyn Little, and Deana Midmer

Introduction: There is strong evidence that primary care interventions, including screening, brief

advi<:e, treatment referral and pharmacotherapy are effective in reducing morbidity and mortality caused

by substance abuse. Yet physicians are poor at intervening with substance users, in part because of lack

of time, training and support. This study examines the hypothesis that shared care in addictions will

result in decreased substance use and improved health status of patients, as well as increased use of pri­

mary care interventions by Primary Care Practitioners (PCPs).

Methods: The Addiction Medicine Service (AMS) at St. Joseph's Health Centre's Family Medicine

Department is in the process of being transformed from its current structure as a traditional consult ser­

vice into a shared care model called Addiction Shared Care (ASC). The program will have three compo­

nents: Education, office systems and clinical shared care. As opposed to a traditional consult service, the

patient will be booked with both a Primary Care Liaison Worker (PCL) and Addictions Physician.

Patients referred from community physicians, the emergency department and inpatient medical and psy­

chiatric wards will be recruited for the study as well as PCPs from the surrounding community. The tar­

get sample size is 100-150 physicians and a similar number of patients. After initial consult, patient will

be recruited into the study with their consent. The shared-case model underlines the interaction and col­

laboration with the patient's main PCP. ASC will provide them with telephone consults, advice, support

and re-assessment for their patients, as well as educational sessions and materials such as newsletters and informational kits.

Results: The impact of this transition on our patient care and on PCP's satisfaction with the ASC

model is currently being evaluated through a grant provided by the Ministry of Health & Long Term

Care. A retrospective chart review will be conducted using information on the patient's substance use,

ER/clinic visits, and their health/mood status. PCP satisfaction with the program will be measured

through surveys and focus groups. Our cost-effectiveness analysis will calculate the overall cost of the program per patient.

. Conclusion: This low-cost service holds promise to serve as an optimal model and strategy to

improve outcomes and reduce health care utilization in addict patients.

P7-60 (C) The Inner City Public Health Project Leeann Owens and Diane Doering

The Inner City Public Health Project Introduction The Inner City Public Health Project (ICPHP)

was desi.gned to explore new an~ innovative ways to reach marginalized inner city populations that par­

t1c1pate m high health-nsk beha~1ors. Much of this population struggles with poverty, addictions, mental

illness and homelessness, creatmg barriers to accessing health services and receiving follow-up. This

pro1ect was de~igned to evaluat~ .~e success of offering clinics in the community for testing and follow­

up of communicable diseases uuhzmg an aboriginal outreach worker to build relationships with individ­uals and agencies.

. Mnbods: In late 2003 Capital Health Public Health Division opened an office in Edmonton's inner

city, staffed by an .outreach worker w~o is a Community Health Representative (CHR) with specialized

trammg m the ~livery _of health services to Aboriginal people. The CHR paired with nurses from the Sexually Transmitted Diseases Centre to ff h 1· · · · h I

d d . . . 0 er outreac c mies at vanous local community agencies, s e -ters adn. rop-m c~ntres. Tradiaonal public health services such as testing for communicable diseases and prov1 mg 1mmumzation and education we H ed JI · · · D II ed d . h. . . re 0 er • as we as hnkmg clients to relevant health semces.

ata co ect unng t ts protect mcluded self-reported information collected from clients at intake

POSTER SESSIONS v1n

(demographics~ history ~f testi~g ~nd immunization and participation in various health-risk behaviors),

records of tesnng and 1mmumzat1ons, and mterviews with partner agency and project staff after one

year. . Results: T~e CHR ~as i~strumental in building relationships with individuals and partner agencies

'.° the c~mmun_1~ re_sultmg m req~ests for on-site outreach clinics from many of the agencies. The

increase m parnc1pat10n, the CHR mvolvement in the community, and the positive feedback from the

agen? staff de~onstrated that.the project was successfully creating partnerships and becoming increas­

ingly integrated m the community. Data collected from clients at the initial visit indicated that the project

was reaching its target populations and highlighted the unique health needs of clients, the large unmet

need for health services and the barriers that exist to accessing those services.

~usion: The outreach clinics were successful at providing services to target populations of high

health-nsk groups and had great support from the community agencies. The role of the CHR was critical

to the success of the project and proved the value of this category of health care worker in an urban

aboriginal population. The unmet health needs of this disadvantaged population support the need for

more dedicated resources with an emphasis on reducing access barriers.

P7-61 (C) Building a Caring Community

Terry Kettleson

Building a Caring Community Old Strathcona's Whyte Avenue, a district in Edmonton, brought

concern about increases in the population of panhandlers, street people and homeless persons to the

attention of all levels of government. The issue was not only the problems of homelessness and related

issues, but feelings of insecurity and disempowerment by the neighbourhood residents and businesses.

Their concerns were acknowledged, and civic support was offered, but it was up to the community itself

to solve the problem. Within a year of those meetings, an Adult Outreach Worker program was created.

The Outreach worker, meets people in their own environments, including river valley camps. She

provides wrap-around services rooted in harm reduction and health promotion principles. Her relation­

ship-based practice establishes the trust for helping clients with appropriate housing, physical and/or

mental health issues, who have little or no income and family support to transition from homelessness.

The program is an excellent example of collaboration that has been established with the businesses, com­

munity residents, community associations, churches, municiple services, and inner-city agencies such as

Boyle Street Community Services. Statistics are tracked using the Canadian Outcomes Research Institute

HOMES database, and feedback from participants, including people who are street involved. This

includes an Annual General Meeting for community and people who are homeless. The program's holis­

tic approach to serving the homeless population has been integral, both in creating community aware­

ness and equipping residents and businesses to effectively interact with people who are homeless.

Through this community development work, the outreach worker engages Old Strathcona in meeting the

financial and material needs of the marginalized community. The success of this program has been sur­

prising - the fact is that homeless people's lives are being changed; one person at a time and the commu­

nity has been changed in how they view and treat those without homes. Over two years, the program has

successfully connected with approximately seventy-five individuals who call Old Strathcona home, but

are homeless. Thirty-six individuals are now in homes, while numerous others have been assisted in

obtaining a healthier and safer lifestyles by becoming connected with other social/health agencies. The

program highlights the roots of homelessness, barriers to change and requirements for success. It has

been a thriving program and a model that works by showing how a caring community has rallied

together to achieve prosperous outcomes.

P7-62 (C) The Single Practice Network Initiative: Harnessing Private Sector Resources of Urban

Communities in the Fight Against Tuberculosis

Elmer Soriano, Loyd Brendan Norella, and Marilou Costello

TB is a major health problem in the Philippines. The 2005 WHO Report ranks the country as 9th

among 22 countries with a high TB prevalence, placing 3rd in the Asia-Pacific Region. About 18 _n_ulhon

Filipinos are infected with about 75 Filipinos dying of TB each day. Much has been done by the Phthppme

government in trying' to combat the disease. A major activity was the creation of DOTS-enabled health cen­

ters and public facilities that provide active case detection and treatment. Because o~ ~he natur~ of TB trans­

mission, congested urban poor communities in major cities of the coun~ a~e. specifically at n~k. Through

its Single Practice Network (SPN) Initiative, the Philippine Tuberculosis lmnat1ves f~r the Pnv~te Sect~r

(Philippine TIPS), aims to develop and test tools and mechanisms that would allow ~m~e-pracnce physt·

cians to deliver DOTS to private patients in collaboration with DOTS Support Orgamzanons (DSOs.) The

v178 POSTER SESSIONS

· · · · ps ami/or institutions that are committed to delivering DOTS to target DSOs are private organizations, grou . · · h th k h Id

· · h · · · ( h s urban poor communities) in coordmation wit o er sta e o ers. patients m t e1r umque settings sue a . ' . . · I The SPN has created models of TB service delivery to be used m part~ers~1p with phannaceunca compa-

. · · -. t' ns cooperatives and health maintenance orgamzanons (HMOs). For example, the mes, c1v1c orgamza 10 , . · b TB d' · SPN has established a system with pharmaceutical companies that help patients to uy me 1cmes at a special discounted rate. This scheme also allows patients to get a free one-_month's worth of~ dru_g supply if they purchase the first 5 months of their regimen. The sy_s~e~s were ~es1gned to be cm~pattble with eXISt­ing policies for recording and documentation of the Ph1hppme National Tuberculosis Program (NTP). Aside from that, stakeholders were also encouraged to be DOTS-enabled through the use of m~nual~ and on-line training courses. The SPN initiative offers an alternative in easing the burden of TB sc:rv1ce delivery from rhe public sector through the harnessing of existing private-sector (DSOs). The learnmgs from the SPN experience would benefit groups from other locales that _work no~ only on ~ but other health con­cerns as well. The SPN experience showcases how well-coordinated private sector involvements help pro­mote social justice in health delivery in urban communities.

P7-63 (C) Young People in Control; Doing It Safe. The Safe Sex Comedy Juan Walter and Pepijn v. Empelen

Introduction: High prevalence of chlamydia and gonorrhoea have been reported among migrants youth in Amsterdam, originating from the Dutch Antilles, Suriname and Sub-Sahara Africa. In addition, these groups also have high rates of teenage-pregnancy (Stuart, 2002) and abortions (Rademakers 1995), indicating unsafe sexual behaviour of these young people. Young people (aged 12 - 30) from the so· called Urban Scene (young trendsetters in R&B/hip hop music and lifestyle) in Amsterdam have been approached by the Municipal Health Service (MHS) to collaborate on a safe sex project. Their input was to use comedy as vehicle to get the message a cross. For the MHS this collaboration was a valuable opportunity to reach a hard-to-reach group.

Mdhods: First we conducted a need assessment by means of a online survey to assess basic knowl­edge and to similtaneously examine issues of interest concerning sex, sexuality, safer sex and the oppo­site sex. Second, a small literature study was conducted about elements and essential conditions for succesful entertainment & education (E&E) (Bouman 1999), with as most important condition to ensure that the message is realistic (Buckingham & Bragg, 2003). Third a program plan was developed aiming at enhancing the STl/HIV and sexuality knowledge of the young people and addressing communication and educational skills, by means of drama. Subsequently a safe sex comedy show was developed, with as main topics: being in love, sexuality, empowerment, stigma, STI, HIVand safer sex. The messages where carried by a mix of video presentation, stand up comedy, spoken word, rap and dance.

Results: There have been two safe sex comedy shows. The attendance was good; the group was divers' with an age range between 14 and 50 year, with the majority being younger than 25 year. More women than men attended the show. The story lines were considered realistic and most of the audients recognised the situations displayed. Eighty percent of the audients found the show entertaining and 60% found it edm:arional. From this 60%, one third considers the information as new. Almost all respondents pointed our that they would promote this show to their friends.

Con.clusion: The s.h<_>w reached the hard-to-reach group of young people out of the urban scene and was cons1d_ered entert~mmg, educational and realistic. In addition, the program was able in addressing important ISSues, and impacted on the percieved personal risk of acquiring an STI when not using con­doms, as well as on basic knowledge about STl's.

POLICIES PROMOTING SOCIAL JUSTICE

P8:-0I (A) Potentially Healthy Municipalities Network: A Way to Acheive Urban Health Miguel Serrano, Ana Maria Sperandio, and Carlos Correa

. Introduction and Objective: A county Communication and Information Network has been aimed at bemg created m ?rder to develop projects targeted to health promoting perspectives viewing at creating a heal~hy commum~ for fro~ a widened logic. It has been intended to collaborate with different health pro­m~noThn prMacnces m a ~rdmated way, considering mainly the intersectoriality and the social participation axis. e erhodology 1s composed of meetings · h h d. · · Such meeri k I thl Th wit speec es, 1scuss1on groups and drafts of new proJectS· h ngsh tda. e Pace mon Y· e speeches are defined according to participants' needs discussions on

t e approac e issue and the drafts of ne · Th ' · w pro1ecrs. e process comprises establishing a contmuous

POSTER SESSIONS v179

knowledge network, where they are able to learn and share new lines of thoughts, as well as to (re)build plans which lead to a healthy space, the life quality. They must learn to know, enjoy and respect people and the spaces around them. The network has been being formed within part of the State of Sao Paulo-Brazil.

Partial Results: .Despite the short time of work, about 30 counties, have projects developed or reformulated new prorect proposals after the Network activities. Four books, divided into volumes, were produced as the theoretical support instrument to the participants. The laws that refer to public politics and new projects towards life quality have been created after this network. Other results which must be mentioned is the partnership amongst the University, the IPES (Non-Government Organization) and the Pan-American health Organization, which have been united for, together with the counties, learning to

create spaces in which we can transform collectively information into knowledge in such a way as to use it to enhance their life quality.

Conclusion: The counties have become more sensitive, reflective and have moved on to reconsider articulate projects in places where health is no longer the central axis.

PS-02 (C) Applying a Social Justice Framework to Community Mental Health: The Clubhouse Approach to Opportunity and Recovery Brenda Singer, Rachel Forman, and Bonnie Kirsh

Introduction: Modernity has contributed mightily to the marginality of adults who live with mental illnesses and the subsequent denial of opportunities to them. Limited access to social, vocational, educa­tional, and residential opportunities exacerbates their disenfranchisement, strengthening the stigma that has been associated with mental illness in Western society, and resulting in the denial of their basic human rights and their exclusion from active participation in civil society. The clubhouse approach tn recovery has led to the reduction of both marginality and stigma in every locale in which it has been implemented judiciously. Its elucidation via the prism of social justice principles will lead to a deeper

appreciation of its efficacy and relevance to an array of settings. Methods: A review of the literature on social justice and mental health was conducted to determine

core principles and relationships between the concepts. In particular, Fondacaro and Weinberg's (2002)

conceptualization of social justice in community psychology suggests the desirability of the clubhouse approach in community mental health practice. A review of clubhouse philosophy and practice has led to

the inescapable conclusion that there is a strong connection between clubhouse philosophy-which rep­resents a unique approach co recovery-- and social justice principles. Placing this highly effective model of community mental health practice within the context of these principles is long overdue. Via textual analysis, we will glean the principles of social justice inherent in the rich trove of clubhouse literature,

particularly the International Standards of Clubhouse Development. Results: Fondacarao and Weinberg highlight three primary social justice themes within their com­

munity psychology framework: prevention and health promotion; empowerment, and a critical pnsp<"<·­tive. Utilizing the prescriptive principles that inform every detail of clubhouse development and th<" movement toward recovery for individuals at a fully-realized clubhouse, this presentation asserts that both clubhouse philosophy and practice embody these social justice themes, promote human rights, and empower clubhouse members, individuals who live with mental illnesses, to achieve a level of wdl-heing

and productivity previously unimagined. Conclusion: A social justice framework is critical to and enhances an understanding of the club­

house model. This model creates inclusive communities that lead to opportunities for full partic1pil!ion 111 civil society of a previously marginalized group. The implication is that clubhouses that an· based on the International Standards for Clubhouse Programs offer an effective intervention strategy to guarantee the

human rights of a sizable, worthy, and earnest group of citizens.

PS-03 (A) Free Primary Education: A Reality or a Mirage for the Urban Poor in Nairobi City?

Eliya Zulu and Eugene Darteh

Introduction: The government of Kenya introduced Free Primary Education (FPEI in 200.~. leading to a drastic increase in school enrollment from 5.9 million in 2002 to 7.5 million in 200.S. However, while gross enrollment rates increased to 104°/., in the whole country after the introduction of FPE, it remained conspicuously low at 62% in the capital city, Nairobi. Nairobi City's enrollment rate is lower .than thatof all regions in the country except the nomadic North-Eastern province. !h.e.d1sadvantage of children bas_ed in the capital city was also noted in Uganda after the introduction of FPE m the late 1990s_- Many_ educa­tion experts in Kenya attribute the City's poor performance to the high propornon of children hvmg m slums, which are grossly underserved as far as social services are concerned. This paper ~xammes the impact of FPE and explores reasons for poor enrollment in informal settlements m Na1rob1 City.

v180 POSTER SESSIONS

Methods: The study utilizes quantitative and qualitative schooling data from the longitudinal health and demographic study being implemented by the African Population and Health Research Center in two informal settlements in Nairobi. Descriptive statistics are used to depict trends in enrollment rates for children aged 5-19 years in slum settlements for the period 2000-2005.

Results: The results show that school enrollment has surprisingly steadily declined for children aged 15-19 while it increased marginally for those aged 6-14. The number of new enrollments (among those aged 5 years) did not change much between 2001 and 2004 while it declined consistently among those aged 6-9 since 2002. These results show that the underlying reasons for poor school attendance in pov­erty-stricken populations go far beyond the lack of school fees. Indeed, the results show that lack of finances (for uniform, transportation, and scholastic materials) has continued to be a key barrier to schooling for many children in slums. Furthermore, slum children have not benefited from FPE because they mostly attend informal schools since they do not have access to government schools where the pol­

icy is being implemented. Conclusion: The results show the need for equity considerations in the design and implementation

of the FPE program in Kenya. Without paying particular attention to the schooling needs of the urban poor children, the millennium development goal aimed at achieving universal primary education will remain but a pipe dream for the rapidly increasing number of children living in poor urban neighbor­hoods.

PS-04 (C) Programing for HIV/AIDS in the Urban Workplace: Issues and Insights Joseph Kamoga

HIV/AIDS has had a major effect on the workforce. according to !LO 35million persons who are engaged in some form of production are affectefd by HIV/AIDS. The working class mises out on pro­grams that take place in communities, yet in a number of jobs, there are high risks to HIV infection. working persons sopend much of their active life time in workplaces and that is where they start getting involved in risky behaviour putting entire families at risk. And when they are infected with HIV, working people face high levels of seclusion, stigmatisation and some miss out on benefits especially in countries where there are no strong workplace programs. Adressing HIV/AIDS in the workplace is key for sucess­full responses. This paper presents a case for workplace programing; the needs, issues and recommenda­tions especially for urban places in developing countries where the private sector workers face major challenges.