9376.pdf
Media
- extracted text
-
THE INTERNATIONAL
SOCIETY FOR
URBAN HEALTH
International
Conference
on Urban Health
October 26 - 28, 2005
The Westin Harbour Castle
Toronto, Ontario Canada
The 4th International Conference on Urban Health is hosted by:
CENTRE FOR RESEARCH
ON INNER CITY HEALTH
St. Michael’s Hospital
Leading with Innovation
Serving with Compassion
St. Michael’s Hospital
A teaching hospital affiliated with the University of Toronto
ONSITE PROGRAM
08376
CUH 2005 Conference Sponsors
Conference Sponsors
We gratefully acknowledge the sponsors, partners, and supporters of the
4th International Conference on Urban Health.
Sponsors
St. Michael’s Hospital
THE INTERNATIONAL
SOCIETY FOR
URBAN HEALTH
Leading with Innovation
Serving with Compassion
CENTRE FOR RESEARCH
ON INNER CITY HEALTH
St. Michael’s Hospital
® Ontario
A rccrlurj; ftorpta! affiliated af:r. Or t'.-i.'r' .-.:; r-I i
Co-Sponsors
Platinum
BMO
. ,•Canadian Internation.:.
Development Agency
Financial •'
Agence canadienne de
developpement international
Diamond
AstraZeneca^?
U.S. Deparment of Health
and Human Services,
National Institutes of Health
The ONTARIO
HIV^Msk
Gold
-a
-a
CIHR IIRSC.....
CIHR IRSC.t •. I
Canadian Instiiulci ol
JA IV
Institute of Infection
and Immunity
Canadian Institute! ol
Hejlth Rrseatrh
£&
of Acins
Health Ke>cjr<h
■
■ .:»> ■■■
CIHR IRSC.. .
Canadian tnitilutea of
Health Research
-trdu Canada
Institute of Population
and Public Health
Canadian Institute
for Health Information
Institut canadien
d'information sur la sante
RBC I
(ENTRAL
HOME TO CANADIANS
Partners & Supporters
Community Advisory Panels at St. Mid
New York Academy of Medicine
Ontario Hospital Association
St. Joseph's Health Centre
St. Michael's Hospital Foundation
Toronto Public Health
West End Urban Health Alliance
Community Health Cell
Library and Information Centre
# 367, “Srinivasa Nilaya”
Jakkasandra 1st Main,
1st Block, Koramangala,
BANGALORE - 560 034.
Phone : 553 15 18 / 552 53 72
e-mail : chc@sochara.org
1
2
7
10
14
16
centre
centre
48
51
55
59
4^ International Conference on Urban Health
October 26 - 28, 2005
Toronto, Ontario, Canada
Full Conference Program
PROGRAM________________________________________
Wednesday, October 26, 2005
9:oo am - 7:00 pm
Location
12:00 pm - 4:00 pm
Registration/lnformation Desk Open
Metropolitan Grand Ballroom Foyer - Conference Centre, Second Level
Pre-Conference Workshops
Please refer to the Pre-Conference Workshops section for time and location
1:00 pm-4:00 pm
Location
5:00 pm - 7:00 pm
Location
Entertainment
Opening Reception
Speakers
Tours of Local Community Organizations
Please assemble in the Metropolitan Grand Ballroom Foyer - Conference Centre, Second Level
Poster Session I and Welcome Reception
Metro East/Metro Centre Ballroom - Conference Centre, Second Level
Red Spirit Singers & Dancers
Patricia O'Campo, (Conference Chair), Centre for Research on Inner City Health, St. Michael's Hospital
David Vlahov, International Society for Urban Health
Rick Blickstead, Wellesley Central Health
Arthur Slutsky, St. Michael's Hospital
Honourable Carolyn Bennett, Minister of State, Public Health, Government of Canada
- W ednesday
Conference Program - Wednesday
Conference Program - Thursday
Conference Program - Friday
Pre-ConferenceWorkshops
Community Tours
Abstracts
Program at a Glance
Westin Harbour Castle Floor Plan
Poster Presentations - Wednesday
Poster Presentations - Thursday
Poster Presentations - Friday
General Information
Table o f Contents / Program
PROGRAM________ __________
Table of Contents
i
Conference Program
- T hursday
PROGRAM
Thursday, October 27, 2005
Registration/lnformation Desk Open
7:30 am - 5:00 pm
Metropolitan Grand Ballroom Foyer - Conference Centre, Second Level
Location
Poster Session II and Continental Breakfast
7:30 am - 8:45 am
Location
Metro East Ballroom - Conference Centre, Second Level
9:00 am - 10:15 am
Welcome Address & Plenary Session
Convention Level, Metro Centre Ballroom
Location
Opening Remarks
Patricia O'Campo, (Conference Chair), Centre for Research on Inner City Health, St. Michael's Hospital
Guest Speakers
Robb Travers, Ontario HIV Treatment Network
Bill Downe, BMO Financial Group
Keynote Address
Gro Harlem Brundtland, Former Director General, World Health Organization
10:15 am - 10:30 am
Location
10:30 am - 12:00 pm
Refreshment Break
Metro East Ballroom - Conference Centre, Second Level
Breakout Session 1
A. Community Stream
Location
Moderator
Metro Centre Ballroom - Conference Centre, Second Level
Sean Rourke
HIV and Marginalized Populations
I.
Women Under Arrest Striving for Health Rights
Renata Luz
II.
A Community Based Participatory Approach to Developing an HIV Prevention for Severely Mentally
III Latinas
Sana Loue
III.
Community Empowerment Through Collaborative Research: The Sisters, Mothers, Daughters &
Aunties Project to Promote Equitable Access to Future HIV Vaccines for Black Women in Canada
Charmaine Williams
IV.
Committee for Accessible AIDS Treatment
Lynn Muir
B. Community Stream
Location
Moderator
Pier 3, Convention Level, Hotel
Robb Travers
Community-Based Participatory Research: Barriers and Facilitators
I.
A Survey of Community Based Research (CBR) in Canada: From Barriers to Solutions
Sarah Flicker
II.
Transgender People and Access to Care
Jake Pyne, Yasmeen Persad
III.
VIVA Intervention Working Group Sustaining an Urban Community-Based Participatory Research
Program Through a National Influenza Vaccine Shortage
Micaela Coady, Sarah Sisco
IV.
Harnessing Media to Achieve Social Justice in Urban Communities
Katerina Cizek
C. Academic Stream
Location
Moderator
Pier 2, Convention Level, Hotel
Ahmed Bayoumi
Conceptualizing and Measuring Social Justice
I.
Health Inequity in a Network Society: A Conceptual Framework
Roxana Sale hi
II.
Modeling Black-White Preterm Birth Disparity: Ecologic and Multilevel Models
Lynne Messer
III.
Maternal & Child Health Neighborhood Context: The Selection and Construction of Area-level
Variables
Jessica Burke
IV.
Exploring Ideological Barriers to Addressing Health Inequalities at the Local Level
Patricia Collins
D. Academic Stream
Location
Moderator
Bay, Conference Centre, Street Level
Patricia O'Campo
High-Risk Youth
I.
The Neighborhood Identification and Engagement Process: A Mixed Methodological Approach for
Exploring Urban Youth Violence
Michael Yonas
II.
The Emergency Department: Is it an Appropriate Venue for an Intervention Program to Reduce
Youth Violence
Carolyn Snider
III.
Risky Alcohol Use and Daily Cannabis Use Differ Between Low Educated Dutch Adolescents Living in
and Outside the City of Amsterdam: A Result of Differences in Pleasure-Seeking Behaviour?
Ineke Stolte
IV.
Environmental Influences on Youth Gambling: Is the Deck Stacked?
Jason Gilliland
E. Invited Panel: Urban Income Inequality and Health
Location
Moderator
Panelists
Title
10:30 am -12:00 pm
Location
12:00 pm - 1:45 pm
Location
12:30 pm -1:45 pm
Metro West Ballroom - Conference Centre, Second Level
Elizabeth Gyorfi-Dyke
James Dunn, Nancy Ross, Nazeem Muhajarine
Urban Income Inequality and Health
Tours of Local Community Organizations
Please assemble in the Metropolitan Grand Ballroom Foyer - Conference Centre, Second Level
Luncheon
Metro West Ballroom - Conference Centre, Second Level
Opening Remarks
Patricia O'Campo
Guest speakers
Featured speaker
Featured Multi-media
Presentation
Aileen Meagher, St. Michael's Hospital
Honourable George Smitherman, Minister of Health and Long-Term Care, Province of Ontario
Bill Butt, BMO Nesbitt Burns
Loretta Jones, Healthy African American Families
Katerina Cizek, National Film Board
Sponsor
BMO
Financial Group
B. Academic Stream
Location
Moderator
Metro Centre Ballroom - Conference Centre, Second Level
Nathan Taback
Global Urban Health
I.
The Urban Environment From the Health Perspective: The Case of Belo Horizonte, Minas Gerais,
Brazil
Waleska Caiaffa
II.
Sexual Behaviors of Street Children in Lahore, Pakistan: The Risk of Survival
Susan Sherman
III.
Reported Use of Violence Among Young Men in Dar es Salaam, Tanzania
Suzanne Maman
IV.
Health Impact of the Mumbai Floods: A City Deluged
AnantBhan
C. Academic Stream
Location
Moderator
Pier 2, Convention Level, Hotel
Phil Deacon
Homelessness and Housing
I.
The Aging of the Homeless Population: Fourteen-Year Trends in San Francisco
Judith Hahn
II.
The ESCSY Study Group, Risk Behaviours For Sexually Transmitted infections (STIs) in Canadian Street
Youth: Does Time Spent On The Street Matter?
Yemi Agboola
III.
Access to Health Care For Homeless People With Serious Health Conditions in Toronto, Canada
Stephen Hwang
IV.
Women Sleeping Rough: Health Outcomes after Five Years on the Streets of Boston, 2000-2004
James O'Connell
V.
Homelessness Following Eviction in Amsterdam
Matty de Wit
D. Academic Stream
Location
Moderator
Bay, Conference Centre, Street Level
Jeff Hoch
Mental Health
I.
Stressful Neighbourhoods and Depression: An Examination of 25 Metropolitan Areas in Canada
Flora Matheson
II.
A Learning Collaborative to Improve Mental Health Service Use For Low-Income, Urban Youth
Mary Cava Ieri
III.
Affective Suffering in Older Women: Evidence of a Threshold Affect that Varies by Race/Ethnicity
Cecile Yancu
IV.
Mental Illness as a Risk Factor For Poor Health, Substance Use, and Dependence Among Unmarried
Urban Mothers
Nancy Reich man
V.
Quality of Life Outcomes for Mental Health Care Clients Engaged in the Workman Theatre Project
Nicole Koziel
E. Academic Stream
Location
Moderator
Pier 3, Convention Level, Hotel
Geri Lynn Peak
IL
Gender Issues and the Health of Disadvantaged Persons
Rhonda Love
III.
Whither Gender in Urban Health?
Victoria Frye
IV.
Housing Policy, Women, and Health in Canadian Cities
Toba Bryant
3:00 pm - 5:00 pm
Location
PROGRAM
7:30 am - 2:00 pm
Location
8:00 am - 9:00 am
Location
8:00 am - 9:00 am
Location
9:00 am - 10:30 am
Location
Opening Remarks
Tours of Local Community Organizations
Please assemble in the Metropolitan Grand Ballroom Foyer - Conference Centre, Second Level
________
Friday, October 28, 2005
Registration/lnformation Desk Open
Metropolitan Grand Ballroom Foyer - Conference Centre, Second Level
Poster Session III and Continental Breakfast
Metro East Ballroom - Conference Centre, Second Level
Annual General Meeting of the International Society for Urban
Health
Bay, Conference Centre, Street Level
Plenary Session
Metro Centre Ballroom - Conference Centre, Second Level
Stephen Hwang, Centre for Research on Inner City Health, St. Michael's Hospital
Guest Speakers
Maria Paez-Victor, Community-Based Research Consultant, Toronto
Keynote Address
Richard Lessard, Montreal Regional Health and Social Services Board
Attempting to Redress Health Inequalities in an Urban Setting: Public Health Interventions
Featured Speaker
Francisco Armada, Minister of Health and Social Development of Venezuela
10:30 am - 10:45 am
Location
Refreshment Break
Metro East Ballroom - Conference Centre, Second Level
Conference Program
Gender Differences in Depression Among Low Income Recent Immigrants in Canadian Urban
Centres
Katherine Smith
- Friday
Gender and Urban Health
I.
10:45 am - 12:15 pm
Breakout Session 4
A. Community Stream
Location
Conference Program
- Friday
Moderator
Pier 3, Convention Level, Hotel
Oonagh Maley
Innovative Youth Engagement
I.
Toronto Teen Survey (TTS) Phase One: How Do We Meet the Specific Sexual Health Needs of Youth
in Diverse Urban Environments?
Susan Flynn
II.
Young People in Control; Doing It Safe. The Safe Sex Comedy
Juan Walter
Youth-Led Research: A Successful Model of Community-Based Participatory Action Research
Omar Guessous
III.
IV.
Queer Youth Speak: A Model for Developing Equitable Partnerships for Community-Based Research
Christine O'Rourke
V.
A Community-Based Participatory Approach To Assess The Context Of Sexual Risk Taking In Urban,
African-American Girls
Shani Peterson
B. Community Stream
Location
Moderator
Metro Centre Ballroom - Conference Centre, Second Level
Dennis Magill
Community-University Partnerships
I.
Making a SWITCH: Opportunities and Challenges in Establishing a Student-Run, Interprofessional
Health Clinic in a Saskatoon Core Neighbourhood
Maxine Holmqvist, Reid McGonigle, Ryan Meili
II.
Using Community-Based Participatory Research to Develop and Implement Church-Based Cancer
Education Modules
Barbra Beck
III.
Making Things Work: On Being an Academic Researcher Working with a Community Partner
Nina Bo ulus
IV.
The Art and Science of Integrating Community-Based Participatory Research Principles and the
Dismantling Racism Process to Design and Submit a Research Application to NIH
Michael Yonas, Nora Jones
V.
Urban Aboriginal Community-Based Research
Alan Anderson, Priscilla Settee
8
C. Academic Stream
Location
Moderator
Pier 2, Convention Level, Hotel
Stephen Hwang
Environmental Justice
I.
The Right to Clean Water: How Community Groups Mobilize to Block Water Privatization
Joanna Robinson
II.
Food Deserts: Do Food Deserts Exist in More Disadvantaged Communities and How Are They
Studied?
Julie Beau lac
III.
Neighborhood Poverty and Inequitable Exposure to Stressful Social Environments: Results From a
Community-Based Participatory Research Partnership In Detroit
Shannon Zenk
IV.
Pollution and Health in Two Toronto Neighbourhoods: Challenges to Ensuring Environmental Justice
Ronald Macfarlane
V.
Community Health Study in "Chemical Valley", Sarnia, Ontario
Dominic Atari
D. Academic Stream
Location
Moderator
Bay, Conference Centre, Street Level
Richard Glazier
II.
Serologic Immunity to Chickenpox Among Adult Immigrants and Refugees in Toronto
Kamran Khan
III.
The Role of the Urban Environment on Discrimination Among Latino Day Laborers and Migrant
Workers in California
Alex Kral
IV.
Socioeconomic Disparities in Birth Outcomes By Recent Immigration Status in Toronto, 1996-2000
Marcelo Urquia
V.
Help-Seeking Rates For Intimate Partner Violence (IPV) Among Canadian Immigrant Women
llene Hyman
E. Academic Stream
Location
Moderator
Metro West Ballroom - Conference Centre, Second Level
Anita Palepu
Injection Drug Use in Urban Settings
I.
Vancouver's Supervised Injection Facility: The First Two Years
Mark Tyndall
II.
HIV Outbreak Among Injecting Drug Users in the Helsinki Region: Social and Geographical Pockets
Pia Kivela
III.
Risk Profile of Individuals who Provide Assistance With Illicit Drug Injections
Nadia Fairbairn
IV.
Examining the Effects of Illicit Drug Markets and Local Labor Markets on Employment and SelfRated Health in Philadelphia
Chyvette Williams
V.
Residence in Vancouver's Downtown Eastside and Elevated Risk of HIV Infection Among a Cohort of
Injection Drug Users
Benjamin Maas
F. Academic Stream
Location
Moderator
Pier 7&8, Convention Level, Hotel
Mark Halman
HIV Intervention and Risk Reduction Strategies
I.
Addressing the Methamphetamine-Sexual Risk-Taking Link Among MSM: Information Exchange
Between Science and Practice
Perry Halkitis
II.
HIV Risk Taking and Associated Cultural Factors
Clemon George
III.
The Delayed Engagement With Healthcare: Experiences of People with HIV/AIDS in Beijing, China
Yanqiu Rachel Zhou
IV.
Employing Social Network Analysis in the Evaluation of Information Provision For HIV-Positive
Patients: An Exploratory Study Dean Behrens
Warren Winkelman
12:15 pm - 1:30 pm
Closing
Location
Metro Centre Ballroom - Conference Centre, Second Level
Speakers
Patricia O'Campo and David Vlahov
Student Award Presentations
Arnoud Verhoeff, Chair of ICUH 2006, Amsterdam, Netherlands
Mike Gibbons, ICUH 2007, Baltimore Maryland
Entertainment
Red Spirit Singers and Dancers
Conference Program
Community-Based Intervention Strategies to Prevent Obesity Among Turkish and Moroccan Women
in Amsterdam
Hilda van't Riet
- Friday
Immigrants and Urban Health
I.
9
4th International Conference on Urban Health
Pre-Conference Workshops
October 26, 2005
1
Into the Neighborhood - Mission Barrio Adentro: A Venezuelan
‘ Success Story on Bringing Health Care to the Marginalized
Facilitator
Affiliation
Time
Location
Maria Paez-Victor
University of Toronto
1:00 pm - 4:00 pm
Ontario Institute for Studies in Education of the University of Toronto
OISE: Room Ol - 2295
252 Bloor Street West
Toronto, Ontario M5S 1V6
2. Addressing Urban Health Needs: Toronto Public Health Practice
Framework
Facilitator
Maria Herrera
Affiliation
Toronto Public Health
Time
Location
1:00 pm - 4:00 pm
Ontario Institute for Studies in Education of the University of Toronto OISE: Room Ol
252 Bloor Street West
Toronto, Ontario M5S 1V6
The workshop is on the development of the Toronto Public Health Practice Framework to plan,
implement and evaluate appropriate public health programs and services to respond to the complex
and diverse nature of a large urban centre. The workshop will engage participants to explore and
identify:
10
Pre-Conference W orkshops
• what is unique about large urban centres like Toronto
• appropriate health strategies to respond to these needs
• elements of a Practice Framework including need for organizational change process, foundations
for inclusive practice and resources/tools developed to facilitate implementation of practice
• case studies
3. Ethical Challenges in Research with Marginalized Populations
Facilitator
James V. Lavery
Affiliations
Centre for Research on Inner City Health and Centre for Global Health Research, St. Michael's
Hospital, Toronto & Department of Public Health Sciences and Joint Centre for Bioethics, University
of Toronto
Time
Location
1:00 pm - 4:00 pm
Ontario Institute for Studies in Education of the University of Toronto
OISE: Room 01 - 2279
252 Bloor Street West
Toronto, Ontario M5S 1V6
This workshop will examine 3 major challenges in research ethics that have particular relevance for
research conducted with marginalized populations: (1) exploitation in research; (2) undue
inducements to participate in research; and (3) the ethical importance of community engagement
and collaborative partnership in research.
Exploitation in research: Social and economic disparities between researchers and research
participants and their communities can exacerbate the risk of exploitation of these individuals and
communities in research. This section of the workshop will examine the concept of exploitation in
research and review some recent proposals for reducing the risk of exploitation in research with
marginalized populations.
Undue inducements to participate in research: the compensation of research subjects for their time,
contributions and risks associated with participation in research remains a controversial issue in
research ethics. This session will examine the main models of compensation for research subjects
and their implications and suitability for marginalized populations. As well, this section of the
workshop will examine the concept of coercion and its relationship to undue inducement.
Collaborative partnership in research: although it has had a long-standing significance in
community-driven approaches to research in marginalized populations, collaborative partnership
has only recently been recognized as a separate principle of research ethics. This session will
examine the ethical significance of collaborative approaches to research and look at various ways in
which the ethical principle of collaborative partnership may be satisfied in research.
4. How to Understand and Conduct Research on Homelessness: A
Practical Guide
Facilitator
Stephen Hwang
Affiliation
Centre for Research on Inner City Health, St. Michael's Hospital
Time
Location
1:00 pm - 4:00 pm
Ontario Institute for Studies in Education of the University of Toronto
OISE: Room Ol - 2296
252 Bloor Street West
Toronto, Ontario M5S 1V6
This workshop will teach practical skills that are relevant to community members and new
researchers who are interested in the issue of homelessness. Participants will learn how to locate
and interpret research on homelessness from a variety of sources. For those who are considering
conducting their own research studies with persons experiencing homelessness, this workshop will
provide a brief introduction to the skills needed to develop a good research question, select an
appropriate research design, mobilize the necessary resources, and collect and analyze data.
5. Introduction to Urban Health
Facilitators
Sandro Galea
Danielle Ompad
David Vlahov
Affiliation
Center for Urban Epidemiologic Studies, New York Academy of Medicine
Time
Location
1:00 pm - 4:00 pm
St. Michael's Hospital
2010 Bond Board Room - 2nd Floor Bond Wing
The purpose of this course to introduce the participant to the principles and methods for the study
of urban health. Urbanization is one of the most important demographic shifts worldwide over the
past century and represents a substantial change from how most of the world's population has lived
for the past several thousand years. The study of urban health considers how characteristics of the
urban environment may affect population health. This course will review the empiric research
assessing the impact that urban living has on population health and the rationale for considering
the study of urban health as a distinct field of inquiry. We introduce a conceptual framework for
considering the relationship between cities and health that is focused within three broad themes:
the physical environment, the social environment, and access to health and social services. The
methodological and conceptual challenges facing the study of urban health, arising both from the
limitations of the research to date and from the complexities inherent in assessing the relations
among complex urban systems, disease causation, and health will be discussed. Examples from the
faculties' research will be provided.
6.
Facilitator
Affiliation
Time
Location
7.
Introductory Health Economics: An Urban Health Perspective
Ahmed Bayoumi
Centre for Research on Inner City Health, St. Michael s Hospital
1:00 pm - 4:00 pm
St. Michael's Hospital
Paul Marshall Lecture Theatre, (at) Queen Street. Lobby
This course will introduce the principles and practices of health economics in an urban health
setting The goal is to enhance understanding of how health econom.cs can be used to influence
decision making, including researchers, community members, and decision makers. We will provide
an overview of the basic principles of health economics using a case study approach focused on
issues relevant to disadvantaged populations. Specific topics include: plain language definitions of
economic concepts and jargon, clarification of the difference between cost-effectiveness and cost
benefit analysis, incorporating quality of life into economic analyses, economic modeling,
understanding and interpreting the results of an economic study, uncertainty and health economics,
and incorporating equity concerns into economic analysis. At the end of the workshop, attendees
will be able to critically appraise a health economics study.
Learning the Research Talk: Introduction to Research Methods,
Concepts and Jargon
Facilitator
Sarah Flicker
Affiliation
Wellesley Central Health Corporation
Time
Location
12:00 noon - 4:00 pm
Wellesley Central Health Corporation
45 Charles St. East
Toronto, Ontario M4Y 1S2
This interactive workshop is designed as an introduction to the research methods, concepts,
practices, and terminology commonly used in research studies. The overall goal of the session is to
familiarize participants with the language used by researchers when presenting their studies. Using
conference abstracts, we will begin to unpack and demystify research jargon - so that we can all
meaningfully participate in the upcoming conference.
Pre-Conference W orkshops
Workshop objectives include:
a.
b.
c.
8.
to build research capacity in community partner organizations
to assist communities and community organizations in understanding research approaches in
community health
to demystify research jargon for those new to the field of health research
The Politics of the Social Determinants of Health
Facilitator
Dennis Raphael and Toba Bryant
Affiliation
School of Health Policy and Management, York University and
Centre for Research on Inner City Health, St. Michael's Hospital
Time
Location
1:00 pm - 4:00 pm
Opposite St. Michael's Hospital
38, Shuter Street - Room B-1245 (Basement)
Despite the increasing recognition of the importance of the social determinants of health and
public policies that strengthen these determinants of health by academic researchers, civil society
organizations, and the World Health Organization, potent barriers exist that make implementation
of such an agenda difficult. These barriers include competing paradigms of health that emphasize
*
an. —aPProaches to health, ideological-commitments by governments to neopronnmirTnH
°r| ,nte aPProaches to health care and social service provision, and powerful
heino throuoh th^H °ri|eS that 0pp05e ecluity-based approaches to promoting health and wellsome of these f e eVh Opm®nt of health public policy. This pre-conference workshop identifies
health“co™and ide°nO
Y ir}f luenCe 9°Vernment receptivity to social determinants of
determ^nan^S health agenta^3"5 *
ba"-s
-plement a social
9. Using Distance and Travel Time to Measure Access to Health Care
and Resources for Healthy Living in Urban Neighbourhoods
Facilitator
Rick Glazier and Peter Gozdyra
Affiliation
Centre for Research on Inner City Health, St. Michael's Hospital
Time
Location
1:00 pm - 4:00 pm
Centre for Research on Inner City Health - Conference Room
4th Floor, 70 Richmond St. E
Toronto, Ontario M5C1N8
Geographic accessibility to health care services and to resources such as parks, recreation centres
and grocery stores are likely to be important for the health of people living in urban
neighbourhoods. A variety of methods can be used to measure concentration of resources as well as
distances or travel times. The Geographic Information System (GIS) technique of network analysis
utilizes information about residential locations, existing travel routes and available services. Various
modes of transit such as walking, public transit and by car can be analyzed. The output of the
analysis such as average travel time to a specific service for a given neighbourhood can then be
compared with specific health outcomes to look for relationships between travel times and health
status.
The objectives of this workshop are to learn: the basics of data representation on maps; about
accessibility theory and its possible applications; about Geographic Information System (GIS) tools
applied in network analyses including relevant terminology and research design methods; and to
apply findings from mock-up scenarios to policies that would result in more optimal service
provision.
Paper and transparent maps will be provided to allow for examination of concentrations of
population, travel routes, and service locations. Participants in small groups will be asked to
consider appropriate research designs and measures for specific scenarios. They will also use overlay
maps in order to identify under-serviced areas and neighbourhoods with difficult access to health
care services. Groups will present their findings to all workshop participants.
10. What's all this Talk about Community-Based Participatory
Research? Building Sustainable Capacities for Urban Health
Research Partnerships
Facilitator
Robb Travers
Affiliation
Department of Public Health Sciences, University of Toronto
Time
Location
12:00 noon - 4:00 pm
The Ontario HIV Treatment Network (OHTN)
1300 Yonge Street
Toronto, Ontario M4T 1X3
Unlike more traditional approaches to research, community-based participatory research (CBPR) is
described as a "collaborative, participatory, empowering... and transformative” approach to
research (Hills & Mullett, 2000). It has also been established as a powerful tool for identifying the
social determinants of health within marginalized communities. Through engaging communities
and academics as research partners, CBPR is an empowering process that builds sustainable
capacities and enhances the relevance and credibility of data. Ultimately, this increases the
likelihood of action outcomes to improve quality of life for disadvantaged communities.
This workshop will overview the theoretical underpinnings of CBPR and will provide a core set of
principles that drive this approach to research. We will explore challenges associated with
conducting CBPR and will learn what facilitates it. Finally, we will highlight the roles played by
community and academic partners in each stage of CBPR initiatives and will explore the promise
that collaborative inquiry holds for the health of marginalized communities.
4th International Conference on Urban Health
Community Tours
October 26 - 28, 2005
"Toronto is a creative city. Our community often creates innovative approaches that
improve quality of life and make Toronto a better place to live, work, learn and grow.
Toronto Community Foundation continually encounters leading-edge programs that
combine experience, expertise and ingenuity to create practical solutions." Vital Signs,
2005, Toronto Community Foundation" http://www.tcf.ca/pdf/Vital_ideas05_Website.pdf
The Community Engagement Subcommittee of the 4th International Conference on
Urban Health is delighted to offer community site visits to conference attendees. These
are intended to highlight innovation in urban health programming, advocacy, and
research in the community context. Five complimentary site visits are offered this year
that exemplify unique and leading-edge initiatives in Toronto reflecting the conference
theme "Achieving Social Justice in Urban Communities". Registration is limited. If you
sign up on-line, please ensure that you attend. If you change your mind, immediately
notify the registration desk at the conference so that we can accommodate others.
Community site visits cover diverse areas of interest and are timed to correspond with
conference sessions. They are listed below.
Please check at registration for availability and to register for Community Tours
1. Innovative Harm Reduction Programs
Wednesday, October 26, 1:00 pm - 4:00 pm
Host Organization
Queen West Community Health Centre
Other Participants
• Safer Crack Use Coalition
• The Works Needle Exchange Programme
• Toronto Harm Reduction Task Force
The Central Toronto Community Health Centres achieves its mission through health promotion,
harm reduction, education, community development, and advocacy, and through the provision of
medical, nursing, dental and counseling services. CTCHC provides information about their work with
marginalized and hard to serve people living in downtown west Toronto. The session will also
mclude information from the Safer Crack Use Coalition who provide harm reduction kits to users
an t e Toronto Harm Reduction Task Force who provide innovative peer learning opportunities,
ront-hne worker education, networking opportunities, and a regular newsletter.
2. Innovative Lesbian, Gay, Bisexual, Transgender and Transsexual
Youth Program
Wednesday, October 26, 1:00 pm - 4:00 pm
Host Organization
The 519 Church Street Community Centre
Other Participants
• Supporting Our Youth, A Program of Sherbourne Health Centre
• Pride and Prejudice Program, Central Toronto Youth Services
bisexual, transgender anTtranss
WOrk t09ether to irnProve quality of life for lesbian, gay,
funded, multi-servke'agencvZt^
The 519 Church Street Community Centre is a cityYouth Services' Pride and Preiurli % the heart of Toronto's vibrant gay village. Central Toronto
America and the Supporting our Youth^r™ ’’
'°n9eSt core'funded Pegram of its kind in No*
provides numerous supports and
ogram is a unique community development initiative
have come together to provide an T
f°r LGBT *°uth- These three leading-edge programs
their innovative programs advnra Vervi,ew of the history of their services and to showcase some
9 ams, advocacy work, and research and educational initiatives.
3. Advocacy and HIV/AIDS
Thursday, October 27, 10:30 am - 12:00 pm
Host Organization
Ontario AIDS Network
Other Participants
• Voices of Positive Women
• Canadian Treatment Action Council
Toronto has a very large and diverse HIV/AIDS sector that contributes on an international level to
advocacy, service and education efforts. Three leading Toronto-based organizations have come
together to showcase their innovative work. The Ontario AIDS Network is a network of community
based organizations which were formed as a grass-roots response to the need for AIDS services and
information. Voices of Positive Women is a provincial, community-based non-profit organization
directed by and for women infected with HIV/AIDS living in Ontario that offers confidential support,
outreach, information and education, and represents the issues of women living with HIV/AIDS. The
Canadian Treatment Action Council is a national, non-governmental organization directed by
people living with HIV/AIDS. CTAC informs public policy and promotes public awareness on
treatment access and health care issues that impact people living with HIV/AIDS.
4. Innovative Health Care for the Homeless
Thursday, October 27, 1:45 pm - 3:15 pm
Host Organization
Other Participants
Street Health
• Health Bus, Sherbourne Health Centre
Street Health is an innovative, community-based health care organization providing services to
address a wide range of physical, mental and emotional needs in those who are homeless, poor and
socially marginalized. Support, education and advocacy are key components of our services.
Sherbourne Health Centre operates the Health Bus - a mobile health clinic that provides a ready
point of access and entry to health care for a variety of people in Southeast Toronto. This site visit
will focus on innovative health care delivery to the homeless and socially marginalized in denselypopulated downtown Toronto.
5. Hospital/Community Partnerships
Thursday, October 27, 3:30 pm - 5:00 pm
Host Organization
Other Participants
Seaton House
• All programs of Seaton House
Seaton House is a single men's shelter for more than 600 homeless or marginally-housed men
operated by the City of Toronto. It provides seven separate programs within one main site and
three satellite locations including an infirmary and a moderated drinking program for chronically
homeless men. In conjunction with St. Michael's Hospital, located in Toronto's inner city, a unique
partnership was developed to provide a full range of health care services for men in the shelter. You
will tour the site, meet with service providers, and learn about the development and
implementation of this unique hospital-community partnership.
02-02 (C): Transgender People and Access to Care
Samuel Lune, Jake Pyne, Yasmeen Persad
inf|uence barriers in receiving adequate, helpful, appropriate
Transgender people face a daunting range ot societal
unsure or uncomfortable asking basic questions because little
care and emergency services. Well-meaning providers are o
have emerged as a population at extremely high risk for HIV
training exists on this topic. At the same time, transgeri
p
Toronto where it is estimated that the trans sex-working
infection. This is especially of concern in major urban
and where there is an extremely high incidence of poverty,
community has a 63-75% rate of HIV infection (A
,
there js current|y increased visibility of people
homelessness, addictions and other social determman
,
derserved population. In particular, trans people fact
identifying as transgender, they remain an o er' ™rgi
she|ters, detox centres and drop-ins. This training will provide
significant bartners in accessing s®x‘se9rega e
,
t strategies and resources for incorporating appropriate, effective
basic information about transgender® ,
Th£
ion wi|| focus on four essential steps towards providing good care: 1)
support in the clinical or advocacy relationship. Th ®ss
both medically and socially; 2) differentiating
understanding the range o
with referrals and protocols for care; and^)
to addressing those barriers. The trainers are members of the transgender
community and experienced in leading trainings for both health care and homers
to be interactive and skills-oriented to provide participants with information and strategies to use in their current work.
02-03 (C): Sustaining an Urban Community-Based Participatory Research Program Through a National Influenza
Vaccine Shortage
Micaela Coady, Sarah Sisco, Danielle Ompad, Kay Glidden, David Vlahov, Sandro Galea, VIVA Intervention Working
Abstracts
18
Group
Introduction: In the U.S., influenza causes 36,000 deaths annually in persons with chronic medical conditions, predominantly in
the elderly and in those who are immunocompromised. Rates of obtaining immunization to prevent such deaths are persistently
low, particularly for low-income, elderly, Hispanic and African-American populations. Because the reasons for low vaccine uptake
in urban areas are complex, we initiated a community-based participatory research project with Harlem Community and
Academic Partnership (H-CAP) members in eight neighborhood areas in East Harlem and the Bronx, New York City to explore
these issues further. Originally, four of these areas would receive free flu vaccine via door-to-door sampling in Year 1, with the
other four areas receiving it in Year 2. Per direction of our subcommittee (the VIVA Intervention Working Group, or VIWG), in
Year 1 we conducted bilingual (English-Spanish), street-based outreach to engage the "hard-to-reach," only to encounter a
national flu vaccine shortage once flu season arrived. The vaccine shortage threatened to compromise the engagement and trust
of our local community members, as well as the future of our project. The VIWG, in collaboration with CUES researchers, had to
determine (i) how to sustain our community presence, (ii) if an alternative vaccine could be provided, and (iii) what else we
might learn from the shortage. Methods. During the project's first ten months, four outreach workers administered a five-minute
questionnaire to community members via venue-based, door-to-door, and capture-recapture sampling, simultaneously delivering
information about free flu shots and educating passers-by about the flu vaccine. Results. When the vaccine shortage began in
early October, 2004, the following adjustments were made: (i) Outreach workers remained in the streets and provided preventive
education about influenza, and news updates outlining where eligible persons could get immunized; (ii) The VIWG discussed
pros and cons of alternate vaccines, including FluMist, tetanus, and Pneumovax, as well as challenges of educating people about
the substitute vaccine; (iii) With researchers, the VIWG proposed changes to the survey instrument, including exploring
knowledge about the shortage, perceived health seeking behaviors, and trust. Conclusions. In January 2006, the NYC
Department of Health announced that it had a surplus of flu vaccine. Two of our four areas were thus able to receive flu vaccine
before the end of influenza season, with the alternate two areas receiving vaccine against pneumococcal infection. Results,
including ramifications of programmatic flexibility through a national vaccine shortage, will be discussed.
02-04 (C): Harnessing Media to Achieve Social Justice in Urban Communities
Katerina Cizek
The National Film Board of Canada is creating a pilot Filmmaker-in-Residence program The filmmaker will explore how
communications media (including v deo photooranhv intomot
h vyiam. ne rnmmaKer win explore nvi
a 21st century spin on the NFS's fnnovative ChaNenq for Chance
‘°
S°Cial jUSti“'
seventies. Back then, the NFB sent filmmakers into numerous XnfranT
* WaVeS
the 'ate S'XtieS
**
activists, leaders and 'ordinary people' tostimulate the develnn
♦ ?communlties across Canada to hook up with
conception to production to distribution, the Challenqe for Cha^? °
engaged citlzenry bY using the power of media, ro
development, self-reflection, empowerment and social rhsnn tx pro9ram weaved the filmmaking process with community
contemporary models of Challenge for Change This revio>«, » i ° current Filmmaker-in-Residence will work to explore
of the filmmaker-in-residence and participator media in a *
the concePts' m°dels, methodology, questions and insights
proposed case studies and early results. The general concl Urba" health/medica' context. It will feature a look at some
inner city citizenship, and when harnessed can enrirh
US'°n 'S ,at tbe Producti°n and consumption of media is critical to
social justice.
mocracy, develop self-_expression, bridge communication and achieve
Conceptualizing and Measuring Social Justice
03-01 (A): Health Inequity In a Network Society: A Conceptual Framework
Roxana Salehi
Introduction. The purpose of this paper is to construct a comprehensive framework that can assist in conceptualization of health
equity issues. In simple terms, health inequity stems from the fact that some differences in access to health care, or in health
outcomes are unfair and unjust. Health inequities, like other types of inequities, arise from the imbalance of power. I bring
toget ler Castells Network Theory and Burris et al.'s Nodal Governance Theory, in order to explain the complex issue of health
equity in the context of Low Middle Income Countries (LMICs). Both of these theories deal with the relationships of power
wit in social structures, and hence, are very suitable for this discussion. From the perspective of network theory, hospital X in
Ontario is a node within the network of Ontario's health care system. Although it has its unique plans (codes), it is strongly
affected by the larger provincial policies. Nodal Governance Theory is concerned with the characteristics of individual nodes:
what is the mentality of hospital X? What resources are made available to hospital X? etc. In the first part of this paper, I have
delineated what I refer to as the Global Health Network (GHN). Wealthy nations and major capitalist financial institutions can be
thought of as the major nodes" and their policies can be thought of as the 'major codes'. In the second part of this paper, I
have studies smaller networks as well as the individual nodes that operate within them using a case study from Africa. Methods:
The data collected from local and international academic journals, news papers, and conference proceedings, as well as papers
published by governmental and non-governmental organizations, served as the empirical basis for the theoretical analysis
developed here Results: Policies aimed at increasing health equity succeed or fail depending on the major players (nodes), their
agenda (codes) and the characteristics of smaller networks and individual nodes. The current policies and agendas of important
nodes within GHN have profound, and for the most part negative, influences on battling health inequities, particularly in LMICs.
Although LMICs share common characteristics, each country has its own set of cultural and social traits that make them operate
quite differently from any other country. Conclusion: The aforementioned theories provide a suitable conceptual framework for
analyzing why certain health equity oriented interventions can, or cannot, mobilize positive change.
£3-02 (A): Modeling Black-White Preterm Birth Disparity: Ecologic and Multilevel Models
Lynne Messer, Jay Kaufman
Introduction: The disparity between black and white women's adverse birth outcomes has been subject to much investigation,
yet the factors underlying its persistence remain elusive, which has encouraged research on neighborhood-level influences. This
work considers two main questions: 1) to what extent are neighborhood-level factors (violent crime, deprivation, suboptimal
housing) associated with black-white (B-W) preterm birth (PTB) disparity? 2) Is neighborhood-level B-W PTB disparity associated
with PTB risk for the women residing in these neighborhoods? Methods: The authors examine B-W PTB disparity in Raleigh NC
census tracts (1999-2001) using linear and logistic models. Geocoded vital records, city crime reports and US Census data were
analyzed. PTB was defined as birth at < 37weeks (& < 3888g) gestational age. B-W disparity was defined as the difference in
proportions between black PTB and white PTB per tract. A 10-item standardized index estimated neighborhood deprivation.
Tertiles of deprivation, suboptimal housing and violent crime were modeled. Race-stratified random effects logistic models with
fixed slope predictor values and randomly distributed tract-specific intercepts were fit; analyses were restricted to tracts with >50
black and white births. B-W PTB disparity was scaled so each 0.1 unit increase in disparity corresponded to a 1% increase in PTB.
Results: Black and white non-Hispanic women live in different neighborhood environments. Black non-Hispanic women live in
tracts with more crime (mean=67 crimes, standard deviation [sd] 49) and deprivation (mean=1.4, sd 3.5), than white non-Hispanic
women (mean=29 crimes, sd 35; mean deprivation= -1.1, sd 1.3). At the ecologic-level, high deprivation (third fertile) (difference
=0.07; 95%CI: 0.00, 0.15), suboptimal housing (beta=0.10; 95% Cl: 0.03, 0.16) and violent crime (beta=0.07; 95%CI: 0.01, 0.14)
were associated with increased B-W disparity after adjustment for tract maternal age, education and marital status structures,
compared with the first tertiles. Multilevel models adjusted for maternal age, education and tract deprivation found B-W PTB
disparity associated with decreased preterm birth odds in white women (Odds Ratio [OR] = 0.98; 95% Confidence Interval [Cl]:
0.98, 0.99) and increased odds in black women (OR=1.05; 95% Cl: 1.03, 1.06). Conclusions: The neighborhood environment may
influence preterm birth disparity. Exposure to preterm birth disparity at the tract-level appears differentially associated with
preterm birth odds. Implications: PTB disproportionately affects disadvantaged populations in the U.S.; understanding how
exposure to PTB disparity influences individual risk is important for planning effective policy interventions.
03-03 (A): Maternal & Child Health and Neighborhood Context: The Selection and Construction of Area-Level
Variables
Jessica Burke, Julie Rajaratnam, Patricia O'Campo
Introduction: Increasingly, maternal and child health researchers are employing the statistical approach of multilevel modeling
analysis to simultaneously examine the relationship between contextual and individual determinants and maternal and child
health outcomes. This review addresses the following questions; 1) What categories of neighborhood characteristics have been
addressed? and 2) How were those neighborhood characteristics operationalized? Methods: A literature review identified 31
relevant articles published between January 1999 and March 2004. The articles were read with special attention toward the
measurement of neighborhood characteristics. RESULTS: Twelve categories of neighborhood characteristics represented in the
articles include income/wealth, employment, family structure, population composition, housing, mobility, education, occupation,
social resources, violence & crime, deviant behavior, and physical conditions. A wide diversity of approaches were used measure
these characteristics. The most widely utilized source of data was that of administrative records from the census or local
government authorities. Although most authors provided theoretical explanations of their choice to examine broad
19
neighborhood constructs; few were explicit about why certain indicators were selactadt0 -^hborhood context which must be
There are theoretical, methodologica! and practical barriers in the measu
“ons
addressed for the fieid to move forward. These barriers will be discussed and
future research.
03-04 (A): Exploring Ideological Barriers to Addressing Health Inequalities at the Local Level
Patricia Collins, Julia Abelson, John Eyles
Introduction: In the 1990s, the social determinants of health (SDOH) emerged as a novel f^evvork“d'diselse a^
health and well-being of populations. The overarching concept conveyed by the SDOH was that health, ancI disease are
determined by numerous factors, not simply access to healthcare services and lifesty e prac ices_
rnn,PDt remain The
among academics, policy-makers, and service providers, tremendous barriers to operationa izing
fariiitatnr< or
objective of this study was to understand how the values of active citizens in Hamilton, n ano co
j„mn|n
f
barriers to addressing local health inequalities. Methods: A postal survey was administered to volunteers a d
p oyees of
community based organizations (CBOs) in Hamilton. CBOs were targeted because of their ro e in oca servic
ry an
eir
unique position to directly address local health inequalities. The target sample size was Nrespon en s.
urvey assesse
respondents'awareness of the SDOH, as well as their understanding (proxy for openness) an atti u es owar s proxy or
support for addressing) the SDOH. It also gauged their SDOH-related political values, left/rig t se p acernen , an po itica
activity. Statistical analyses employed various non-parametric tests, including Mann-Whitney U, Krus a
a is, an
e en als
tau-b statistic. Statistical significance was determined using the 97.5% level of confidence, to account for multiple comparisons.
Results: A total of N=240 completed surveys were returned, generating a 55% response rate. Less than ha (46 /o) o
respondents were aware of the SDOH prior to the study. Being aware was positively associated with increased openness and
greater support for addressing the SDOH. Understanding and attitudes were also significantly associated with demographic
characteristics. Liberal values were similarly associated with increased openness and support for addressing the SDOH, whereas
the opposite trend was observed with conservative values Liberal-leaning respondents were more politically active than
conservative respondents. Conclusions: Greater knowledge transfer of the SDOH framework should be a priority among
academics and Health Canada, particularly since awareness was associated with increased support for the SDOH, and greater
alignment with SDOH-related political values. Dissemination efforts could be particularly effective if they target demographics
that are more receptive to SDOH. The statistical associations observed between values, understanding, attitudes, and political
behaviours suggest that liberal values could act as facilitators, while conservative values could pose barriers to addressing local
health inequalities.
20
Abstracts
_____I
High-Risk Youth
04-01 (A): The Neighborhood Identification and Engagement Process: A Mixed Methodological Approach for
Exploring Urban Youth Violence
Michael Yonas, Patricia O'Campo, Jessica Burke
Introduction: Violence is a significant public health problem facing youth in urban communities. Effective methods are needed
for identifying neighborhoods appropriate for study as well as for respectfully approaching and involving neighborhood
individuals. This investigation utilized a mixed-methods participatory needs assessment approach to explore and characterize
individual and contextual level factors related to urban youth violence. Methods: Principle components analysis was conducted
on seventeen violence related, demographic, economic, education and employment data variables, to identify, rank and select
low-income high and low risk for youth violence study neighborhoods. Once potential neighborhoods were identified, an
intensive participatory neighborhood engagement process was initiated. This process involved contacting local businesses,
churches, and organizations as well as engaging neighborhood residents by personally walking throughout the selected study
neighborhoods, meeting people, describing the project, and identifying those individuals perceived locally as those involved in
efforts to address neighborhood youth violence. Identified individuals where invited to participate in in-depth qualitative
interviews. Results: Principal components analysis yielded four potential U.S. Census Block group neighborhood clusters with
contiguous high and low risk for youth violence neighborhoods. While more than 50 individuals were met during the initial
neighborhood engagement process, a total of 16 prominent neighborhood individuals (PNIs) from among four neighborhoods
were invited to participate and completed the interview process. The majority of these local experts were either current or past
residents of the study neighborhoods (13 of 16), and participants included parents, pastors, local program coordinators, and drug
dealers. Ten were men, six were women and they ranged in age from 32 to 77 years of age. In depth interviews provided a
wealth of information regarding neighborhood history, culture, and the local social and environmental factors perceived as
related with youth Violence. Conclusion: Principal components analysis is a useful quantitative alternative that provides the
opportunity for including multip e correlated factors in the process of identifying high and low risk for youth violence
neighborhoods. Conducting a patient, transparent, and respectful neighborhood engagement process was essential to
developing comfort and trust with local individuals for aainino an inddpr'c narenoHx■
P . SS Was essential t0
violence. This locally customized data gathering process is essential for characterizin'^6 ° JSSlteS rJ. ated t0 nei9hborhood yout
variety of public health issues, including youth violence.
9' Un erstanc*ln9 ar,d ultimately addressing a
Youth Wolence?016^60^ Department",s ** an Appropriate Venue For an Intervention Programme to Reduce
Carolyn Snider
Urban c’t'^s' t^iere is growing concern with youth violence. Emergency departments worldwide are often
mnrp liUok/ tr. J ° 3 enn9 injuries tflat occur as a result of this violence. Previous studies have shown that victims of violence are
rpnularlv dicrh eCOme r^Peat victims of violence and are frequently perpetrators of future violence. Health care workers
nrpvpntinn ’ far9e ^outn'
° ^ave been injured due to violence from the emergency department with little to no violence
of iniurip ' m
100 u IS
^e^nes the scope of this problem in Toronto by presenting results of an observational study
.
p fS CaUSe
y°ut^ violence. This inquiry also demonstrates that the emergency department is an excellent venue for an
in rven ion programme to reduce youth violence. Methods: An observational study was designed to determine the cause of
emograp ics o the injured, and disposition of the patients aged 19 and under who presented to emergency
depa meritsi with injuries that resulted from violence during a period of two years (April 2002 - March 2004). Data was collected
uuf fZe r°m * e rxiat‘ona' Ambulatory Care Reporting System (NACRS) database collected by the Canadian Institute for
ea
n ormation (CIHI). Results: A total of 4622 patients aged 19 and under who incurred injuries due to violence visited
oronto emergency departments during the period of this study. Assault or homicide due to bodily force (vs. sharp objects, guns
or other) was the most common cause of injury due to violence (52%) [95%CI 50-53%] Patients aged 15-19 accounted for 76%
of the injuries [95%CI 75-77%]. Males accounted for 72% [95%CI 71-73%] of victims. The majority of patients (90% [95%CI 891 L°|
discharged directly from the emergency department. Conclusions: Males aged 15-19 who have been assaulted by
bo i y orce form the most common group of youth incurring injuries due to violence who visit Toronto emergency departments.
Large proportions (90%) of these youth are discharged directly from emergency departments. Given victims often become repeat
victims and/or future perpetrators, an opportunity exists for the development of youth violence prevention initiatives in
emergency departments. A sound understanding of previous youth violence intervention programmes in emergency
departments will be essential in the development of an effective programme for emergency departments in Canada.
04-03 (A): Risky Alcohol Use and Daily Cannabis Use Differ Between Low Educated Dutch Adolescents Living in
and Outside the City of Amsterdam: A Result of Differences in Pleasure-Seeking Behaviour?
Ineke Stolte, Adele Diepenmaat, Wilco Schilthuis, Marcel Wai
Introduction: The prevalence of alcohol and cannabis use is known to be associated with neighbourhood differences and with
pleasure-seeking behaviour (e.g. cafe, disco, cinema, coffee shop). These neighbourhood differences might be partly due to the
availability of locations for pleasure and therefore pleasure-seeking behaviour. Our study objectives were 1) to investigate the
prevalence of risky alcohol use and daily cannabis use among Amsterdam students of intermediate vocational (IV) schools, living
in and outside Amsterdam, and 2) to investigate which specific locations for pleasure-seeking are related to risky alcohol and
daily cannabis use. Methods: A survey was conducted among 4370 students of IV schools in Amsterdam. Only Dutch students
who reported that they had been drinking or blowing in the month prior to the questionnaire were included, resulting in a
study population of 1309 students (median age 17 years). Self-reported information about socio-demographics, alcohol use,
cannabis use, and pleasure-seeking behaviour was collected using a questionnaire. Risky alcohol use was defined as daily
drinking or 3-6 times a week more than three standard glasses of alcohol. Students answered questions about whether they
visited various locations for pleasure seeking or not. Univariate and multivariate logistic regression was used for analyses.
Results: The overall prevalence of risky use of alcohol was 20.6% (264/1281), with the prevalence being significantly higher
among students living outside Amsterdam compared to them living in Amsterdam (OR: 1.64, 95%CI [1.19-2.25]). The overall
prevalence of daily blowing was 13.1% (84/643) with the prevalence being significantly lower among students living outside
Amsterdam (OR: 0.46, 95%CI [0.29-0.74]). Locations for pleasure-seeking that were independently related to risky alcohol use
were cafe, disco, coffee shop, and house party, while visiting a coffee shop was independently related to daily cannabis use.
Pleasure-seeking behaviour did not explain the differences in risky alcohol and daily cannabis use between students living in and
outside Amsterdam. Conclusion: Risky alcohol use and daily cannabis use differed for students in and outside the city of
Amsterdam, despite the fact that all students attained school in Amsterdam. As differences were not explained by pleasure
seeking behaviour, there have to be other social or cultural (non-ethnical) differences between students living in and outside
Amsterdam. Interestingly, visiting a coffee shop is an important determinant for both daily cannabis use and risky alcohol use,
even though coffee shops are not allowed to sell cannabis to individuals aged younger than 18 years.
04-04 (A): Environmental Influences on Youth Gambling: Is the Deck Stacked?
Jason Gilliland, Dana Wilson, Nancy Ross
Introduction: The proliferation of government-sponsored gambling venues in North America over the past two decades has
created one of the most controversial social justice issues facing urban communities today. This paper presents results from a
study of youth video lottery terminal (VLT) gambling, which links ecological aggregate and local individual-level data to gain a
richer understanding of how neighbourhood environments influence opportunities for, and participation in, risky health-related
behaviours Methods: Locations of all high schools and establishments holding VLT licenses in the Census Metropolitan Area
(CMA) of Montreal were geocoded by street address. Geomatic techniques were used to derive measures of VLT proximity to
schools Census tracts were characterized by socio-economic indicators and measures of VLT concentration. A survey of students
was conducted to discover individual-level behaviours and attitudes concerning VLT use. Data were analyzed using logistic
regression Results: Geomatic analyses revealed that video lottery opportunities are heavily concentrated near high schools and
students from neighbourhoods of low socio-economic status are the most heavily exposed. Logisitic regression analyses indicated
that higher levels of gambling by youth are associated with elements of the social and physical environment, such as: low
parental supervision having friends who play VLTs, and the presence of VLTs near school. Conclusion: Gambling activity is linked
to opportunity, and the spatial distribution of VLTs reflects local geographies of socio-economic disadvantage. Any effort to
reduce the burden of gambling-related health and social problems must recognize the spatial distribution, indeed socio-spatial
distortion, of gambling opportunities in the environment.
05-01 (A): Urban Income Inequality and Health
|nstjtute for Hea|th information (CIHI)
Sponsored by the Canadian Population Health Imtiativ
Muhaiarine
, ,
Mancv Ross, Nazeem MUnajaruie
Elizabeth Gyorfi-Dyke (Moderator), ames
,
Nazeem Muhajarine will provide an overview of recent research
CPHI-funded researchers Dr. James Dunn, Dr. Nancy koss, a
^nn and Nancy Ross will present key findings from their
findings related to urban income inequality and health.
,
|ncome inequality and population health in Canadian
CPHi-funded research program examining the relations ip
Canadian situation differs from the United States. Dr.
society, the factors that contribute to this relationship an
-llnHpd research project examining community and family
Nazeem Muhajarine will present findings findings from his CPHi-funded
characteristics, income dynamics and child health outcomes.
,
, .nrio-economic indicators for metropolitan areas (i.e., cities of more than
Drs. Dunn and Ross are currently developing a set
<artors are most strongly related to income inequality and
50,000) in Canada and the U.S. in order to
|nc|uding the relationship between residential segregation (based on
population health A number-ofissues w II b d
d
relationship between the wage gap and population health in the
income) and population health in Canadian and U.S
,
affect opu|ation health outcomes in Canada.
two countries; and the time it takes for changes in income
q
y
A
kw mcMrrhprc at the University of Saskatchewan and at Dalhousie University,
Dr. Muhajarme's research proje! , con u
y
provinces of Saskatchewan and Nova Scotia over two select
identified children born to mothers living in four major cities in i
p
years The research team collected data related to parents, birth outcomes, and children's use of all health care services up to six
yea after b rth. information about the neighbourhoods in which children lived at birth and health services available to them
were also examined. Dr. Muhajarine will present key findings from his research including the factors and conditions that may
lead to healthy outcomes in children in the first six years of life.
Peer-Led Harm Reduction
06-01 (C): Crystal Clear: A Peer to Peer Health Promotion Project
Caitlin Padgett
Issue: A coalition of community agencies established a peer training and outreach program. It empowers marginalized streetinvolved youth using methamphetamine to make safer, healthier choices, and address drug-related issues such as trauma, abuse,
poverty, homelessness, depression and other linked mental health concerns. Setting: According to anecdotal evidence,
methamphetamine predominates as the drug of choice for the 700 to 1000 street youth in Vancouver's Downtown South, a
community of about 80,000 residents. In preliminary results from a survey of street youth in Vancouver's south downtown, over
70% reported trying the drug, while 47% of that group reported using methamphetamine within the last seven days. This
evidence suggests youth who are afflicted by poverty and homelessness are some of Vancouver's most vulnerable residents.
Project: The youth participants are selected to pursue the goal of participatory research, street level outreach, harm reduction
and support, and advocacy, as well as increasing the awareness of the larger community about the needs of street-involved
youth that use methamphetamine. Their training involves extensive skills building, development of a training curriculum for
street-involved youth, training in crisis intervention, emergency response, peer support and advocacy, and development of peerdriven resources stemming from a community mapping exercise, and training in participatory research and survey development.
The participants also training with leading doctors and mental health workers familiarized with health concerns specific to
street-involved youth. Outcomes: The peer networks developed the youth's capacity to act as peer educators within the informal
social networks that already exist within their community. The peer education increases each individual's ability to minimize
harm related to methamphetamine use, to examine beliefs and knowledge of methamphetamine use for themselves and their
peers, and to develop an analysis of the impact of methamphetamine use on their peers and the community at large. The
youths peer advocacy and referrals increase access to support groups for youth that are HIV or Hepatitis C positive, and increase
access to community detox and health services. The project has partnered with a community clinic to conduct a pilot study of the
modrSp|aoOmin^nnCheaalth
t Stre®t:involved a"d marginalized youth to primary health care and needle exchange. A
model of training hea th promotion and integration has been developed and is transferable to any urban community orsubcommumty m need of increased awareness and access to health-related services, education and advocacy
Users: A pfer^FMsiWHty Study
'mpacts of Medical|y Supervised Smoking Facilities for Crack Cocaine
Kate Shannon, Tom,ye ishida, Arthur Bear, Rob Morga^ Megan
Introduction: There is growing attention being paid to thp
cocaine smoking, particularly the risk of HIV and Heoatif ^riOUS Pu°*'c health and community harms associated with crack
in Vancouver, Canada are proposing to pilot a medicallv
rans^liss,on- In response, community advocates and policy makers
reluctance on the part of health authorities and Health Ca pe™lsec\smokin9 facility (SSF) for non-injection drug users. Current
harms associated with crack cocaine along with questions
dUe m Part tO the lack of informat'on related to the direct
such, a partnership between the Rock Users' Group of Van eSardln9 the P°tential uptake of such a facility were it to open. As
research project at the BC Centre for Excellence in HIV/AIDS
Area Network of Dru9 Users (VANDU) and a community-based
crack cocaine smokers. Methods: Through a participator/ re
artook an assessment of the willingness to use a SSF among
all aspects of the research, including defining research needed
process' members of the Rock Users' Group were involved m
alley patrol, and peer-administering of questionnaires Afte,JeveJopin9 research tools, recruitment of participants through
rovi ing written informed consent, participants were invited to
complete an interviewer-administered questionnaire. They were given CanSIO -for their participation. Univariate analyses were
use to determine associations with willingness to use a SSF and a logistic regression was performed to adjust for potentially
confounding variables (p <0.05). Results: Among 437 regular crack cocaine smokers, 303 (69%) reported a willingness to use a
SSF should one be made available. Willingness to use a SSF was associated with rushed crack smoking in public places (aOR=4.37,
95% Cl: 2.71-8.64), borrowing crack pipes (aOR=2.50, 95% Cl: 1.86-3.40), smoking crack in public places (aOR=2.48, 95% Ci: 1.653.27), crack bingeing (aOR=2.16, 95% Cl: 1.39-3.12), having equipment confiscated or broken by police (aOR=1.96, 95% Cl: 1.242.85), and recent injection drug use (aOR=1.72, 95% Cl: 1.09-2.70). Conclusions: There was a high level of willingness among
regular crack users to use a medically supervised smoking facility and this was especially evident among individuals who reported
risky crack use behaviors. The results suggest a strong potential for a SSF to reduce the health related harms of crack smoking,
address issues of public order and provide an opportunity to connect with a highly marginalized population.
06 03 (C): The Vancouver Area Network of Drug Users (VANDU): The Evolution of a User-run Organization in
Vancouver's Downtown Eastside
Rob Morgan, Greg Liang, Julia Chapman, Evan Wood, Thomas Kerr
Objectives: In 1997, in response to the emerging health crisis among injection drug users (IDUs) and to government inaction, a
group of individuals gathered in Vancouver to form a user-run organization. This group eventually became the Vancouver Area
Network of Drug Users (VANDU). This study reports on an effort initiated by Health Canada to describe the genesis, evolution,
organizational structure, and activities of VANDU. Methods: In accordance with VANDU's philosophy we employed a community
based case study methodology. Peer researchers worked with external researchers in gathering data using various methods and
sources, including structured interviews, participant observation, and organizational documents. Key informants included
founding and current VANDU members, employees, policy makers, funders, and services providers. Results: While the early
organizing work of VANDU focused on political activism and advocacy, the organization has since expanded its activities and
now participates on community and government task forces, and provides public health and education programs for IDUs.
Current activities include support groups for women with HIV, persons with hepatitis C, and methadone users. VANDU also
operates a street- and hotel- based syringe exchange program, and alley patrols that provide care to the most marginalized drug
users. At present VANDU has over 1,000 members, and approximately 800 peer volunteers participate in VANDU programs each
year. Conclusions: VANDU has demonstrated that IDUs can organize themselves and make valuable contributions to their
community and the community at large. Lessons learned in Vancouver's Downtown Eastside will be extremely valuable for IDU
and persons that work with drug users elsewhere.
06-04 (C): Community Driven, Participatory Research Projects
Manual
22 peer workers (users/ex-users) collaborated to conduct research, enabling them to design, write, edit, produce and distribute a
guide for peer workers and agencies. This 100+ page manual includes sections on harm reduction, boundaries, confidentiality,
orientation, training, supervision and appendices illustrating samples (e.g. mission statement, employment contract, skills
inventory). 250 hard copies, 500 licensed copies and electronic access has been available to harm reduction workers and users
internationally via www.canadianharmreduction.com ("Ichip" page).
Network
15 users/ex-users with experience as peer educators worked together to form a Toronto-based harm reduction network for peers.
Regular meetings were held to conduct community based research through participation in front line workers meetings. Other
harm reduction training events were also utilized. This network continues to have an impact through participation of members
in planning the City of Toronto's new Drug Strategy Initiative.
Education & Training
6 peer educators conducted community based research and developed/ delivered a full day workshop based on the manual to
fellow peer workers. 20 peer workers from five Toronto agencies attended the pilot and reported a high level of satisfaction
with receiving training from their peers. Three project participants obtained paid peer positions as a direct result of their
involvement with this project, and continue to deliver training to peer workers.
*1) (Riley, et al)
*2) With funding support from the City of Toronto, Drug Prevention Grants (Toronto Public Health), and the Government of
Canada's Supporting Community Partnerships Initiative administered by the City of Toronto.
*3) In the fall of 2005 we began work on a play relating to homelessness/substance use. 10-12 users/ex-users who have
experienced homelessness and use/used illicit drugs will write, produce, and present the play, "No Fixed Address" to premier
at the annual THRTF harm reduction forum in the spring of 2006.
23
Abstracts
Holly Kramer, Andrew Nolan, Valerie Cartledge, Frank Coburn, Gerry Leslie, Tammy Mackenzie
The Toronto Harm Reduction Task Force (THRTF) is an association of professionals, agencies and community members working
together to reduce the harms to individuals and communities associated with substance use/distribution. Defining harm
reduction as: "...decreasing the adverse health, social and economic consequences of drug use, without requiring abstinence..."
*1 the THRTF has built a reputation for working with users/ex-users, benefiting from their life expertise to offer a social
justice/public health response to substance use. Since 2002, three peer driven projects *2 have been instrumental in building
capacities.
Advocacy for Social Justice in Urban Health
07-01 (C): Improving the Post Approval Surveillance System for Prescription Drugs
Louise Binder, Jean-Pierre Belisle, Patrick Cupido, Mardie Serenity
Because of the passive nature of the current Post Approval Surveillance System (PASS) for prescription1 drugs,
term and long-term side effects of medications take too much time to be identified and/or recognize
1
the quality of life of persons taking certain drugs and could be avoided by a more proactive an consumer ce
*■ 6
1998, the Canadian Treatment Action Council (CTAC) has initiated a series of interventions to improve the situatio
g antiHIV drugs as its pilot focus. Method: In 1998, CTAC created a PASS Committee which hosted consultations and developed a
discussion paper which was published in 2000. This Committee recommended the establishment of an Advisory Committee to
oversee the implementation of a community-based participatory research project
the PASS study — to test various community
based methods of reporting adverse events to anti-HIV drugs. Using a common survey, three reporting met o s were es e
between November 2002 and June 2003 : a national bilingual toll-free line; face-to-face interviews in Montreal, Toronto and
Vancouver; and a free reply mail/fax survey. In addition, four focus groups were conducted within the Aboriginal community.
Following the completion of the final report in July 2004, a second Advisory Committee was created to oversee the ongoing
dissemination of the results within the community and the identification of the path forward. Results: Of the three methods
tested by the PASS study, face-to-face interviews were the most successful with 933 surveys collected, while only 97 were
obtained via mail/fax and 40 via phone interviews. Face-to-face Interviews were successful because HIV+ respondents were
approached in familiar surroundings (e.g. peer-driven organizations) and often by interviewers perceived as trustworthy (e.g.
HIV+ individuals, treatment activists). The information collected via interviews also seemed more reliable than that obtained via
mail/fax. In total, 996 respondents reported at least one adverse event. This indicates that a community-based reporting system
can capture information that is not obtained through the existing PASS. Conclusion: Our community-based participatory research
has demonstrated that face-to-face interviews are a successful reporting method and that community-based organizations,
especially peer-driven organizations located in large urban areas, can become key sentinel components of an improved PASS. A
community-friendly summary version of the final report will be widely disseminated during Fall 2005. Workshops will be held to
share the results with the communities which participated in the research and to identify with them the next steps and strategies
for action.
07-02 (C): In Our Own Voices. Surveying Asian Pacific American Lesbian, Gay, Bisexual, and Transgender People
Alain Dang
Introduction: Asian Pacific Americans (APA) are among the fastest growing minority groups in the United States. More and more
APA lesbian, gay, bisexual, and transgender (LGBT) people are coming out of the closet, yet they still face invisibility, isolation,
and stereotyping. The lives of APA LGBT people involve a complex web of issues arising from being sexual, racial/ethnic,
language, gender, immigrant, and economic minorities. This study presents an opportunity to center communities at the
margins. It looks at multiple identities, experiences, and concerns as individuals and communities within the broader context of
experiences as Asian Pacific Americans in the mostly white LGBT community, and as queers among APA communities. Methods:
The survey focused on basic demographic information, experiences with discrimination, policy priorities, and political behavior.
Also included were questions that asked about the attitudes of APA LGBT individuals towards both LGBT and straight
organizations that are either predominantly APA or predominantly white. Results: Among the key findings of the report: •
Nearly every respondent (95%) had experienced at least one form of discrimination and/or harassment in their lives. For
example, 82% said that they had experienced discrimination based on their sexual orientation, and 82% had experienced
discrimination based on their race or ethnicity. • The three most important issues facing APA LGBT community members were
immigration, hate violence/harassment, and media representation. • Nearly all respondents (96%) agreed that homophobia
and/or transphobia is a problem within the APA community. And, over 80% agreed that APA LGBT people experience racism
within the predominantly white LGBT community. • The majority of respondents felt that LGBT organizations inadequately
address issues of race (58%), class (80%), and disability (79%). Conclusion: This study documents the diversity of experiences,
identities, needs, and political perspectives that exist within the larger LGBT and APA communities in the U.S. It details and '
validates a myriad of APA LGBT experiences. Social activists and researchers can utilize the findings to advocate for and
implement policy changes at the local, state, and national levels. Respondents reported significant homophobia in the APA
community and racism in the LGBT community. It is interesting that respondents reported being more comfortable working in
predominantly white LGBT environments than they did working in predominantly straight APA environments. Predominately
straight APA organizations and predominately white LGBT organizations must expand efforts to serve all members of their
communities, including Asian and Pacific American LGBT people.
07-03 (C): Women in Transit: Organizing for Social Justice in Our Communities - A PAR project of the Bus Riders
Union
J
Martha Roberts
Introduction: The Bus Riders Union (BRU) is a multi-racial membership-based organization of over 800 transit dependant bus
nders in the Lower Mainland of British Columbia. The BRU represents the mass transit and public health needs of the transit
dependent. We work with regional author, les and bus riders to put the needs of transit dependent people overwhelmingly
working class, and disproportionately people of colour, at the centre of public policy. We organize because affordable reliable
and environmentally sound mass transit is a human right. Human and environmental needs must be the leadino social no ideal
and economic priority. Methods: In 2004 the BRU completed a participatory action research projea JitkaHySning the
impacts oi public transit mega-projects and privatization on the lives, health, and environment of transit-dependent women.
Thousands of women were directly involved on buses and in communities. Women's direct testimonies and vision, collected on
the Right to Public Transit Violation Report Form' culminated in a hard-hitting popular report 'Women in Transit: Organizing for
Social Justice in Our Communities'. This report contains three key themes: Defend and Expand Public Services; End Transit Racism;
and Public Health and Environmental Justice. In the fall of 2004, transit-dependant women presented this research to the
regional transit authority TransLink and won the support and attention of many local grassroots organizations and the media.
Results: This PAR project involved women from the grassroots in the democratic processes of the region and resulted in major
gains. One significant public health victory was the extension of Night Owl service from 1:30 am to 3:30 am; previously hundreds
of late night workers grappled with sleep derivation and/or economic hardship due to loss of working hours. The BRU witnessed
a significant shift in the consciousness of TransLink directors as directors began to speak openly about the implications of their
decisions on transit-dependant communities. Conclusion: BRU involvement in regional democratic processes and our popular
education on the bus have sparked a new campaign and further PAR research to 'Lower the Fare, Now! For Community Health
and Social Justice'. It is an environmental and social justice imperative for low-income communities to stand together and speak
publicly about our health and environmental needs. The combination of popular qualitative and quantitative research and
community organizing continues to positively impact the health of our communities; we uphold this combination as an
important model for the future of social change. To preview our report see: http://bru.resist.ca/wit
07-04 (C): The Development of Peer-driven Intervention for Individuals Requiring Assistance With Injection
Diane Tobin, Ann Livingston, Ron Morgan, Nadia Fairbairn, Evan Wood, Thomas Kerr
Introduction: Receiving assistance with injections is a common practice among illicit injection drug users (IDU) that carries
significant risk for health-related harm, including increased risk for HIV infection and overdose. The Vancouver Area Network of
Drug Users (VANDU) is a drug user-run organization focused on political activism, advocacy and the provision of peer support
programs for IDU. In response to the ongoing problem of assisted injection and related government inaction, VANDU has
developed a peer-driven intervention to address the risks associated with dangerous practice. Methods: The VANDU Injecting
Team has been initiated as a harm reduction strategy for IDU who require assistance with illicit drug injections. The Injecting
Team, in collaboration with VANDU's existing outreach-based Alley Patrol Program, provides education regarding safer assistedinjection and instruction on how to self-inject to those who need it. The effectiveness of this intervention will be evaluated
through an ongoing prospective cohort study of local IDUs. Results: We will report on the specific activities of the Injecting
Team, the evaluation methodology, and the evaluation results to date. Conclusions: Drug user-driven activities have been shown
to reach vulnerable populations that are not adequately served by existing public health programs. The VANDU Injecting Team
has potential to address a significant gap in current programs for IDU by providing peer education and support to those
requiring assistance with injections.
Urban Neighbourhoods
08-01 (A): Finding Good Places to Play: Exploring Social Justice and Public Park Provision in Urban
Neighbourhoods
Martin Holmes, Patricia Tucker, Jason Gilliland, Jennifer Irwin, Meizi He, Paul Hess
Introduction: Research indicates that rising rates of childhood obesity in North American cities are due not only to individual
level factors (i.e., genetics, lifestyle), but various environmental factors as well. For example, it is suggested that whether (or not)
good quality public parks are available in the local environment has a significant influence on physical activity levels among
youth. This study examines the location of neighbourhood parks in the city of London, Ontario in order to determine if these
public facilities are adequately and equitably distributed throughout the city. Methods: A geographic information system (GIS)
was employed to map the current distribution of public parks throughout the entire census metropolitan area (CMA) of London.
The spatial patterning of parks are analyzed in relation to neighbourhood socio-economic characteristics (e.g., income,
education, employment), as determined with data from the 2001 Census of Canada. City of London planning districts (n 43) are
used as a proxy for neighbourhoods. Comprehensive field surveys were conducted in every urban and suburban neighbourhood
in the CMA (rural districts were excluded) in order to qualitatively assess every public park in the City according to a list of
environmental factors (e.g., equipment, maintenance, greenspace). A census was taken at each park to record level of use.
Results: The preliminary results of this study suggest that neighbourhood recreational opportunities are equitably distributed
and only a small number of areas appear to be 'recreational deserts'. Nevertheless, a closer look in the field reveals that all parks
are not created equal. Significant differences in quality appear between areas of high and low socioeconomic status in terms of
park amenities, maintenance, safety, and aesthetical appeal. Moreover, park use is directly related to quality. Conclusions: The
preliminary findings of this ongoing study suggest that although little disparity exists in the allocation of City parks in London
according to neighbourhood social characteristics, a socio-spatial disparity exists with respect to the quality of public parks
provided to each neighbourhood. These findings are crucial in the struggle against childhood obesity as exercise has been
offered as one way in which obesity can be avoided. It is also of great importance that these social relations are uncovered as
people in areas of lower SES are at 3 higher risk of becoming obese and developing related disorders. Planners, health
promoters and health educators must all become aware of these differences in order to make changes that create healthier
environments.
08-02 (A): The Usefulness of Geographic Information Systems (GIS) to Reduce Inequalities in Urban Road Safety
. .
,
In Montreal, Canada, it is a mean of
Introduction: Every day, thousands of pedestrians are victims of road acclde^J'
accidents are unevenly distributed
five pedestrian a day that are injured in a road accident. Moreover, it is well know
IO • .
.
linked to hioher risk of
among social classes and urban areas. Researches have found that social and materia aepri/a
°
’ WHO urged
accident, due to many known risk factors such as traffic density, greater in poorer neighbourhood In 2^WHO urged
communities and governments to target this rising public health problem. This paper argues that spatial ar.u^s.s and geography
information systems (GIS) can create relevant and unique information on the extent and location of this. prob,ern in crt.es m
Cloutier Marie-Soleil, Patrick Morency
order to integrate oublic health objectives in transportation decision-making. Briefly, Gl are
~ 3 ,’
j t shn-v ri i
management; analysis and reporting of thematic data within their geographic context. Methods: GIS Con oe used to sno./ clearly
where and for which population transportation health effects are important. The mapping o. tne norm.u
'
transportation, including pedestrian accidents and pollution (air and noise), has the potentia to nignugm i
ou.
i
building and management of urban infrastructures. This allows to go beyond blaming indivi ue s on io ie..e in^o
consideration the effect of the surroundings environment on the health and well-being o< urban resi ems, is issu- eing
persistent in public health. Results: The usefulness of GIS in the advocacy of pedestrian safety has been emons race tn a pi ot
study carried out in Montreal. It can be used to influence stakeholders (city planners, police, politicians, citizens) on major issues.
Once the geographic distribution of pedestrian insecurity is shown on maps, the magnitude o< the pro : em o-comes oo.ious, as
well as the need for global environmental measures, for example targeting traffic and vehicle speed. Changes in streets design
need to be implemented on a larger scale than the usual selection of a few intersections in order to reduce inequalities among
citizen in terms of access to safe transportation and reduction of health impacts. Conclusion: The study completed in Montreal
has already influenced the way to view road insecurity: Montreal transportation planning will now adopt a new perspective
including pedestrian and cyclist safety. Maps resulting from this project are now used by many interest groups to improve their
knowledge of the situation and their strategy of action. The presentation will take this example to illustrate the points
mentioned above.
08-03 (A): Socioeconomic Inequality of Urban Core Neighbourhood Residents in Saskatoon
Mark Lemstra, Cory Neudorf, Leanne McLean, Johnmark Opondo, Judith Wright
Abstracts
2 26
Introduction: The Saskatoon Health Region, and its broad base of community partners, have developed a system to identify and
address socioeconomic inequalities in health status. The Comprehensive Community Information System (CCIS) will collect a
broad range of health and social indicator information that will be interactive, flexible and available to the community at no
cost on the web. The authors present a scenario on how information from a core, urban neighbourhood can be used. Methods:
There are six neighbourhood associations in Saskatoon (all touching) that meet a definition of low income status defined a priori
by 2001 census information. The health status of this core neighbourhood (n=18,228) was compared to the rest of Saskatoon (N=
184,284) for the year 2001. Health information was received directly from Saskatchewan Health and Population Health at the
Saskatoon Health Region. The disease rates are age standardized by ICD9 code. Results: Comparing 2001 age-standardized
hospital separations between the core neighbourhood and the rest of Saskatoon, the rate ratio was significantly higher for
suicide attempts (RR=3.75; 95% Cl 2.65-5.30), mental disorders (RR=1.85; 95% Cl 1.56-2.19), injuries and poisonings (RR=1.54;
95% Cl 1.39-1.72), diabetes (RR=3.98, 95% Cl 2.72-5.82), chronic obstructive pulmonary disease or COPD (RR=1.38; 95% Cl 1.001.92) and coronary heart disease (RR=1.34; 95% Cl 1.07-1.68). For number of patients that visited a physician once, the rate ratio
between the core neighbourhood and the rest of Saskatoon had significant differences for mental disorders (RR= 1.24; 95% Cl
1.20-1.28), injuries and poisonings (RR= 1.06; 95% Cl 1.03-1.09), diabetes (RR= 1.49; 95% Cl 1.37-1.61) and COPD (RR= 1.22; 1.171.28). Reviewing public health information, we found that comparing the core neighbourhood to the rest of Saskatoon resulted
in rate ratios of 4.32 for chlamydia (95% Cl 3.68-5.07), 7.76 for gonorrhea (95% Cl 5.46-11.02), 8.04 for hepatitis C (95% Cl 5.9010.95) 4.21 for teen pregnancy (95% Cl 3.16-5.60), 5.48 for infant mortality (95% Cl 2.00-15.02) and 1.46 for low birth weight
(95% Cl 1.01-2.12) Space limits discussion of comparisons between the low income neighbourhood and the affluent
neighbourhood, of which differences in health were magnified. Conclusion: Significant health disparity was found in Saskatoon
when comparing a low income neighbourhood to the rest of Saskatoon. The Comprehensive Community Information System can
be used to identify health disparity at the local level and then assist with planning and prioritization of human and financial
resources at various government and community levels.
08-04 (A): Neighborhood Mapping as a Participatory Tool for Evaluating Community-Based Urban Health
Initiatives
Anne Wallis, Patricia O'Campo, Robert Aronson
Introduction: Although neighborhood or community mapping has been used widely in needs assessment and formative research
for program planning, there are few examples illustrating the utility of neighborhood mapping in evaluation research The
purpose of th.s paper is to demonstrate the use of neighborhood mapping in the context of an evaluation of an urban-based
infant mortality prevents program. Neighborhood mapping is a process of collecting data through direct observations and
from secondary data sources to describe the physical conditions of neighborhoods the locations
°Dsenat,ons an
and the social and demographic characteristics of residents. Neighborhood mapping is also an analytic tn \'°nSresour<;e '
visually in order to observe the spatial distribution of neighborhood characteristics.9^ paper describes
f preSen d
neighborhood mapping in the community evaluation of Baltimore City Healthy Start a federal!.,
! USe °
prevention initiative. Methods: The primary objectives of the community evaluation werto
ess the n
,
context (including physical and social features, community assets, and community concerns) Xch mav inX
implementation and outcomes, and to study the nature and course of community-level chanoe DatT Y lnf'uenc® Pro9ram
y level cnange. Data on physical features were
c° ec e
y community residents during street-by-street neighborhood walkthroughs. Other data sources included the U.S.
ensus, lary an Vital Records, the Baltimore City Liquor Board, and other routinely collected data from Baltimore City Planning
apartment. Analytic methods included geo-coding; factor analysis, which was used to create spatial density indicators of
neignoor oo reaiures, and multiple regression. Results: We used neighborhood mapping to create visual displays based on
a ress in ormation oi neighborhood features (e.g., locations of liquor stores) and program participation levels. We also assessed
interaction between participation level and residential context, and we mapped baseline indicators to study the process and
direction or neighborhood transformation. Conclusions: We suggest that these methods can strengthen evaluations by involving
participants in data collection and engendering a more complete understanding of physical context as a research variable to
better understand participant outcomes and create powerful visual displays of contextual data.
08-05 (A): Spatial Association Between Diabetes Prevalence and Neighbourhood Characteristics and Environments
for Healthy Living in Toronto, Canada
Peter Gozdyra, Gillian Booth, Maria Creatore, Kelly Ross, Liane Porepa, Richard Glazier
Policies and Interventions to Promote Social Justice
09-01 (A): Barriers to Disability Benefits for Homeless and Underhoused People
Laura Cowan, Sarah Shartal
The transition into and out of homelessness is affected by many factors, perhaps most importantly by the availability of
affordable housing and people's incomes. Government disability benefits in Ontario (through the Ontario Disability Support
Program) generally provide enough income for an individual with a disability to maintain stable, albeit marginal, housing.
However, front-line staff working in the homeless community saw many homeless people living with disabilities. Street Health, a
community-based agency providing services to homeless men and women, undertook an action research project to explore why
many homeless people with disabilities did not receive benefits, and to assist people to secure benefits through the Ontario
Disability Support Program (ODSP). Methods: A series of interviews were conducted with 85 homeless people with disabilities,
and personal histories regarding disability and past attempts to secure disability benefits were created. Information was also
gathered to inform current applications for disability benefits, and applications and appeals were made. Results: Several aspects
of ODSP created barriers to accessing benefits for study participants. Many barriers to getting information and application forms
for ODSP existed, such as participants' lack of telephone access (70%) and inability to follow automated telephone instructions
(85%), which first contact with the system requires. The majority of participants (85%) were not able to fill out ODSP forms
without assistance. Medical forms presented significant barriers for the majority of participants, e.g. 65% could not get clear
diagnoses for their conditions. Characteristics inherent in the application process posed significant barriers, including the system's
lack of accommodation of disabilities, and applicants' experiences of indignity and lack of respect throughout the process. Delays
once applications were submitted were also important barriers to receiving benefits, as a total wait time of 8-9 months led many
participants to lose housing or become increasingly ill waiting for benefits. 30 of the ODSP applications undertaken for this
project have successfully secured benefits, while an additional 55 applications and appeals continue. Conclusions: There are
multiple barriers at various stages of the ODSP application process that make it difficult for homeless people with disabilities to
apply for and secure benefits. The findings from this study point to several recommendations for how to make ODSP more
accessible, including implementing face to face interviews between applicants and program staff; making program workers
available to applicants in accessible community spaces; reducing language and literacy barriers to applying; and reducing wait
times for benefits.
27
Abstracts
Objective: Diabetes mellitus is rapidly increasing in prevalence in most developed countries, related in large part to unhealthy
dietary patterns, lack of physical activity and resulting obesity. This project examines associations between diabetes and
neighbourhood social and demographic characteristics. It also investigates relationships between diabetes and density of and
geographic accessibility to sources of healthy and unhealthy foods, places facilitating physical activity and community-based
health services in Toronto neighbourhoods. Methods: We analyzed the geographic distribution of age-sex adjusted diabetes
prevalence rates in Toronto and their association with mean household income and percent visible minority populations using
Pearson correlation coefficients. We further examined spatial associations between diabetes and grocery stores, convenience
stores, parks and recreation centres, fast food outlets, and family doctors accepting new patients and diabetes community
programs. Neighbourhoods were used as areal units for two types of accessibility analyses: 1) area density of each factor per
capita, and 2) minimum average travel time to the closest factor by walking and/or public transit. Local Indicator of Spatial
Association (LISA) analyses were conducted to examine spatial correlations between diabetes prevalence and accessibility to
neighbourhood environments for healthy living. Results: High rates of diabetes coincided to a large degree with Toronto's low
household income and high visible minority neighbourhoods (correlations -0.61 with income and 0.58 with visible minority
populations, both p-values < 0.001). Clusters of high diabetes and poor accessibility to healthy factors (or good accessibility to
the unhealthy factor) were mostly limited to low income and high visible minority neighbourhoods, but not all such
neighbourhoods had poor accessibility and poor accessibility was found in a variety of different kinds of neighbourhoods.
Conclusions: Diabetes in Toronto disproportionately affects low income and high immigration neighbourhoods, some of which
have poor accessibility to resources of healthy living. These analyses represent inter-sectoral and multi-disciplinary approaches
that can be used for planning community services and allocating resources to neighbourhoods and for policy development.
Further study of diabetes rates and accessibility to neighbourhood resources for healthy living in low income and high visible
minority neighbourhoods is warranted.
09 02 (A): Dismantling Racism: Promoting Social Justice Through Individual Awareness, Institutional Policy
Change and Institutional and Community Partnerships
Michael Yonas, Vanessa Jeffries, Mondi Mason, Mary Linker
Introduction: Research indicates that U.S. racial and ethnic groups continue to experience lower quality health services that
perpetuate health disparities. In order to address these disparities, Chatham County Public Health Department (CCPHD) has
implemented a comprehensive Dismantling Racism (DR) initiative. This report summarizes the process of implementing a DR
process in a local public health department as a form of promoting social justice. Methods: Recognizing the need to examine the
dynamics of race and power and its affect on health department staff and county residents, CCPHD contracted with
ChangeWork, an independent consultant, to facilitate the DR process. Using an organizing approach, CCPHD focused its efforts
on: (1) understanding racism and developing a common definition; (2) realizing how racism impacts Whites and People of Color;
(3) understanding how racism impacts health disparities; and (4) developing an action plan to become an ant-racist organization.
Multi-day trainings were conducted to examine the dynamics of institutional racism and power in U.S. society. A "Change Team",
comprised of health department staff, community representatives, and academic partners, was established to organize around
the DR process. "Caucuses", consisting of individuals from specific identity groups, met to collectively provide a forum for
support, discussion and problem solving. Collaboration with university partners provided capacity for evaluation, the
development of a surveillance system to monitor DR activities, and cultural competency training. Results: Results include: 1)
institutionalized policy that requires all employees to participate in the DR training within the first year of employment; 2)
development of an Action Plan to begin the process of transforming the organization at the individual, organizational, and
institutional/community levels, and 3) participants continued involvement in the Change Team and Caucuses. Additionally, public
awareness of the DR initiative has led to increased public perception of the CCPHD. The ongoing development of the Change
Team, as well as institutional and community partnerships continues to expand support for and organize around the DR
initiative and its goals. Conclusion: Although challenging, dedication of key leaders to the DR process has led to organizing and
social change necessary to work towards social justice in the form of eliminating health inequities. Lack of consistent support
from top leadership is a critical challenge but developing community allies in support the dismantling racism process has been a
valuable component of continuing the efforts toward creating an anti-racist public health department. Benefits and challenges
of maintaining academic and institutional partnerships will be discussed.
09-03 (A): Is the Public Ready? Understanding Public Attitudes Toward Federal Action to Reduce Inequalities in
Healthcare - United States' Perspectives
Kalahn Taylor-Clark
Introduction: Federal policymakers and educational campaign planners have recently dedicated increasing attention to
healthcare inequalities in the United States. These efforts come at a time vyhen public interest in broad racially targeted
government legislation is decreasing while support for greater healthcare spending is increasing. This paper explores the trend in
public support for government action to reduce racial healthcare inequalities from 1995-2004, and disentangles the influence of
two factors that have been shown in the literature to affect public attitudes in other areas, knowledge about inequalities and
perceptions of causal responsibility. The goal of this presentation is to help campaign planners increase the public visibility of
disparities and to offer insight for policymakers seeking to create sustainable racially targeted healthcare programs.
Methodology: I use national survey time series data from Kaiser Family Foundation/Washington Post and Harvard University
from three points in time (1995, 2001, 2004). Cross tabulations show main independent variable, demographic and political party
differences in support for federal action to reduce inequalities. Three binary logistic regressions regress support for government
action on the main independent, demographic, and political party variables. Results: There is a significant and declining trend in
public support for federal intervention to deal with racial inequalities in healthcare. Further, although knowledge about the
existence of inequalities has increased over time, knowledge does not seem to significantly influence overall support.
Respondents who believed that discrimination against African Americans is the most important reason that healthcare
inequalities exist were most likely to say that the government should do something to ensure that African Americans have equal
quality healthcare services as Whites. Further, people who don't know why inequalities exist and people who believe that
patient behavior (i.e. not seeking care enough or not following physicians' recommendations) is the major reason for inequalities
in healthcare were the least likely to say that the government should be responsible for dealing with the problem. Finally, most
people cited access/structural causes (i.e. poverty or residential segregation) as the major reason for the existence of inequalities.
This belief conferred increased support for federal action. Conclusion: Policy advocates seeking to raise the profile of inequalities
in healthcare should be aware that the public's mood toward race targeting may challenge the viability of proposals. Also,
campaign planners seeking to increase support for federal efforts should consider publicly exposing discrimination and access
problems associated with inequalities in healthcare.
09-04 (A): Recognition of Sexual Diversity in Urban Health Policy
Nick Mule
Introduction: This paper focuses on the micro aspect of a large qualitative, international comparative research study that looked
at the degree of recognition accorded to lesbians, gays and bisexuals (LGBs) in public health promotion policies. The study
compared Canada, the UK and USA, focusing at the micro level on Toronto, Manchester and New York City. The purpose was to
determine whether sexually diverse individuals were recognized as a distinct population with unique and specified health needs
within formalized municipal health policy. Methods: This study was conducted between 2001 and 2003, in which data were
gathered via content analysis of existing governmental public health promotion policies and semi-structured interviews carried
out with policy makers in the municipalities of Toronto, Manchester and New York City. Macro-sociological discourse analysis was
then applied to the gathered data in determining results, implications and recommendations. Results: Recognition of LGBs as
inrliKinn nf « ' Ji?
P° 1Cy Wa$ ^°Unc* ’,n
equity realm in all three urban centers, with Bs being absent from one. Although,
nthpr anvprnmpnt \ i erse P°Pu,at'ons 'n municipal equity policy is seen as progressive, particularly in comparison to policies at
thpw
3 +uVe * ° J
countr'es' municipal level public health promotion policies generally lack the infusion of
S VXI r^L?ar tO fund'n9, programming, services and structural integration. Conclusion: The municipal level of
ronarHinn ro /
S aS' Q m<^st Prom’sin9 of all levels of government researched in each of the three countries studied
noroccar i
t
°i3 ^iverse populations in policy. Recognition within the equity realm nevertheless, does not
..
1 ¥ Gx Gn ° pu ic ealth promotion policy to address the unique and specified health and wellbeing issues of sexually
V . popu a IO^S' Part,cu srly outside of HIV/AIDS, in an infused manner. The implications of these findings speak to
specia ize sexua y i verse health service organizations and programs and their need to advocate for improved policy
recognition an municipal support, policy makers and their need to be more inclusive in policy development and
imp emen a ion an t e sexually diverse communities themselves to question why their broad health and wellbeing issues are
not being equitably addressed.
09-05 (A). Pharmacists As Health Service Linkages: Expanding Service Referrals to Injection Drug Users Through
the Expanded Syringe Access Program, New York City, 2001-2004
Wendy Caceres, Shannon Blaney, Nirali Shah, La Roux Pendleton, Katherine Standish, David Vlahov, Crystal Fuller
Introduction: The Expanded Syringe Access Demonstration Program (ESAP), effective in 2001 in New York State, permits sale of
syringes without a prescription with the goal of reducing HIV and other infectious disease transmission by increasing sterile
syringe access among injection drug users (IDUs). The New York Academy of Medicine in collaboration with Beth Israel and the
National Development and Research Institutes evaluated the program. The ESAP evaluation and a community based
participatory research intervention to increase ESAP participation in Harlem suggest that the pharmacist-patient relationship has
potential to reduce disparities in access to healthcare and drug treatment for IDUs in much the same way syringe exchange
programs have done. Methods: As part of the evaluation, annual anonymous cross sectional telephone surveys of pharmacists in
New York City assessed attitudes and practices around pharmacy syringe sales between 2001-2004. Results: Each year following
the inception of ESAP, pharmacists' negative attitudes, namely beliefs that the community would be littered with dirty syringes
due to ESAP (55%, 49%, 43%, 43%), that their business would suffer because customers would not want to wait in line with
IDUs (40%, 37%, 34%, 25%), and that their business would suffer because the community would think that their pharmacy
encourages drug use (39%, 33%, 31%, 24%, Cochran-Armitrage test for trends p<0.01, p<0.0001, p<0.0001 respectively),
significantly declined. Pharmacists' positive attitudes such as support of in store pamphlets on safe injection (70%, 82%, 94%,
95%), and beliefs that selling syringes to IDUs is an important part of HIV prevention (72%, 76%, 80%, 85%), and would
decrease HIV transmission (75%, 78%, 85%, 86%, Cochran-Armitrage test for trends p<0.0001 for all) significantly increased from
2001-2004. In the 2004 survey, 88% of ESAP pharmacists were willing to take time to offer drug treatment information (n=153),
about half believed the customers would be willing to receive this information and about 59% reported having had a
conversation with IDUs (n=138) with injection safety and drug treatment being the most common topics. Conclusion: The
increase in supportive attitudes of pharmacists towards ESAP and their willingness to spend extra time with syringe purchasing
customers, suggests that pharmacists could play a key role in linking underserved populations, in this case IDUs, with available
health and social services in the community. The design and implementation of a feasibility project utilizing pharmacists as
linkages to health and social services is underway with community partners.
Urban Crises
01
10(A): Surmortality Related to the August 2003 Heat Wave. An Ecological Study of Socio-Economic Factors in
Paris (France)
Emmanuelle Cadot, Alfred Spira
Introduction: During the August 2003 heat wave in France, almost 15,000 excess deaths were recorded. Paris was severely
affected with 1,067 excess deaths corresponding to an excess death rate of 190%. The aims of this ecological study was to
describe spatialdistribution of deaths within Paris and to examine the impact of neighborhood socio-economic characteristics on
the excess death rates according to the place of residence. Methods: The study population included all people who died
between August 1st and 20th, 2003 and during the same period in reference years (2000, 2001, 2002). Spatial heterogeneity in
mortality distribution was analysed by calculating standardized mortality ratio (SMR) within Paris at quartier level (N=80).
Households’ average income and the two classical Carstairs and Townsend deprivation index were used as indicators of socio
economic status. The analysis is based on an hierarchical bayesian model at the quartier level. Results: Large differences were
observed in SMR computed by quartier of residence. Maps showed a gradient of excess deaths increasing from the north-west to
the south-east in 2003 and a classical zone of excess deaths in the north-east during reference years. We therefore observed a
shift in excess mortality towards the South in August 2003. Contextual socio-economic conditions had a significant impact on
mortality both during heat wave and referral years. The principal contextual factor in August 2003 was the households' average
income- between the richest and the poorest districts, the relative risk of mortality was 0.60 [0.49-0.74], However, during the
heat wave the socio-economic factors impact was weaker than during the reference years. Analysis of residual relative risks of
mortality underlined the finding that the excess deaths observed in the south part of the town were not well explained.
Conclusions- Spatial distribution of the excess deaths observed in August 2003 generated a new map of the capital. The impact
of socio-economic context independently of the individual socio-demographic characteristics was proved. These results suggest
that the heat wave was not simply the consequence of high temperature. They confirm a double level of risk during heat wave:
individual and contextual, and that both must be taken into account to understand the effects of a heat wave on mortality and
its prevention.
10-02 (A): High Rise Building Evacuation: Lessons Learned From the World Trade Center Disaster
Robyn Gershon, Kristine Qureshi, Melissa Erwin, Marcie Rubin, Martin Sherman
Introduction: In an urban setting, the number of occupants of both residential and business high rise buildings can be
considerable; in New York City alone, there are more than 2,000 high rise office buildings. Since most fire safety plans rely upon
"defend-in-place" tactics, the plans for full building evacuation are usually not detailed or even addressed. Fortunately, very few
high rise buildings experience catastrophic events that necessitate a full evacuation, and even in those that occur, data ^rom
evacuees is rarely, if ever, collected. Consequently, we know very little about the facilitators and barriers to high rise building
evacuation. Methods: A large sample of evacuees from the World Trade Center, Towers 1 and 2, were surveyed as part of the
World Trade Center Evacuation Study, using a confidential, 10 page, 95 item questionnaire. Results: Data from the first 700
respondents to the survey indicate that a number of individual, organizational and structural (environmental) factors served as
barriers to the initiation and progression of the evacuation process. Frequently cited individual barriers included: (1) lack of
familiarity with the safety features of the building, including stairwell locations; (2) searching for personal articles, colleagues,
friends, or someone to evacuate with; (3) waiting for directions (lack of independent behavior); (4) inappropriate footwear; and
(5) poor physical condition or current health problem. Organizational barriers included: (1) lack of training and practice in
evacuation, only 25% of respondents had ever fully evacuated the building, most during the 1993 bombing; (2) lack of
empowerment of individual employees to act independently; (3) poor delineation of training responsibilities; (4) lack of planning
for the disabled- especially when elevators were inoperable; and (5) lack of planning at the street level. Structural barriers
included: (1) lack of back-up or alternative communication systems; (2) locked egress (security lock-out); (3) poor design at cross
over points in stair wells; (4) failure of emergency egress systems inside the elevators. Conclusion: A number of modifiable risk
factors at the individual, organizational, and structural levels were identified. Fire safety planning for high rise occupancies
should address all aspects of full building evacuation, with a special emphasis on the factors identified here. The lessons learned
from the WTC Disaster can be useful to building owners and managers, emergency responders, city planners and developers, and
high rise occupants.
10-03 (A): Hurricane Katrina, the Race/Class Conundrum and the Triumph of Neoliberalism in U.S. Politics
Adolph Reed
01:
11Panel: Community, Professional, and Scientific Collaboration for Environmental and Social Justice in the
South-West of Spain
Aurelio Gonzalez, Janet Howitt, Antonio Munoz, Joan Benach
In Spain, during the last decade despite increased social concerns and occupational, environmental, and health care government
regulations, social inequalities in health are large (i.e. 35.000 excess of deaths estimated annually among the economically
deprived populations) and have grown in recent years. While areas of Andalusia have recently benefited from the development
and economic growth that has brought investments on tourism, services and industries, in the early 60s many undesirable
industries (high pollution and poor working conditions) were located in these poorer areas because the land and labor were
inexpensive, and under Franco's dictatorship communities lacked political power to oppose them. Today, in western Andalusia
the significance of existing pollution and environmental threats associated with many industries is such that an environmental
group has raised a formal complaint to the European Commission. To understand why polluting industries, occupational hazards
and social factors are consistently situated in specific communities, it is necessary to look upstream. To remedy public health
consequences of this situation it is necessary that communities downstream be empowered to understand and participate more
effectively in determining their own futures. Therefore, an integrated and cross-disciplinary research approach is needed.
Community members often feel frustration when these concerns fail to be satisfied by findings of scientific studies and non
accomplished political promises. Only an integrated approach, involving both scientists and communities will provide a broad
picture able to obtain proper explanations and action against adverse health effects and environmental contaminants. While
each community needs to generate local responses according to their specific environmental and social problems, a number of
general lessons may be drawn from the public health crisis faced by the south-west of Spain. In this panel we'll describe the
health problems of a number of municipalities, we'll illustrate the struggle for justice taken by environmentalists and citizens
that want to protect environment and human health, and we'll explain grassroots activities and strategies of civil and
environmental movement which fight against economic and political interests that benefit from the lack of power of citizens.
Global Urban Health
01
12-
(A): The Urban Environment From the Health Perspective: The Case of Belo Horizonte, Minas Gerais, Brazil
Waleska Caiaffa, Fernando Proietti, Maria Cristina Mattos, Amelia Augusta Friche, Sonia Mattos, Maria Angelica
Dias, Maria da Consolaqao Cunha, Eduardo Pessanha, Claudia Oliveira
Introduction: We 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 in children <5 years old and two mosquitoborne diseases - dengue and visceral leishmaniasis. Methods: The ecological study was conducted in Belo Horizonte, the third
largest city in Brasil, with about 2.5 million inhabitants. All events were obtained through the City Health database and
geoprocessed using the address of residence and 80 unit of planning (UP) composed by census tract units. We use thematic maps,
index of comparative mortality/morbidity by UP and the overlapped rank of the 20th worse UP rates for each event. Results: 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 rates among privileged ones. Conclusions: Our results pointed toward a coexistence of heavier
10:30 am - 12:oo pm
Tour of Local Community Organizations
Location Please assemble in the Metropolitan Grand Ballroom Foyer
12:00 pm - 1:45 pm
Luncheon
Location Metro West Ballroom
Breakout Session 2
Community Stream - Peer-Led Harm Reduction Location Pier 2
Community Stream - Advocacy for Social Justice in Urban Health Location Pier 3
Academic Stream - Urban Neighbourhoods Location Metro Centre Ballroom
Academic Stream - Policies and Interventions to Promote Social Justice Location Bay
• Academic Stream - Urban Crises Location Metro West Ballroom
1:45 pm - 3:15 pm
Tour of Local Community Organization
Location Please assemble in the Metropolitan Grand Ballroom Foyer
3:15 pm - 3:30 pm
Refreshment Break
Location Metro East Ballroom
3:30 pm - 5:00 pm
Breakout Session 3
• Community Panel: Community Health and Social Justice - Community, Professional, and Scientific
Collaboration for Environmental and Social Justice in the Southwest of Spain
Location Metro West Ballroom
• Academic Stream - Global Urban Health Location Metro Centre Ballroom
• Academic Stream - Homelessness and Housing Location Pier 2
• Academic Stream - Mental Health Location Bay
• Academic Stream - Gender and Urban Health Location Pier 3
3:30 pm - 5:00 pm
Tour of Local Community Organizations
Location Please assemble in the Metropolitan Grand Ballroom Foyer
FRIDAY, OCTOBER 28, 2005
8:00 am - 9:00 am
Poster Session III and Continental Breakfast
Location Metro East Ballroom
8:00 am - 9:00 am
Annual General Meeting of the International Society for Urban
Health
Location Bay
9:00 am - 10:30 am
Plenary Session
Location Metro Centre Ballroom
*•
4
I
10:30 am - 10:45 am
Refreshment Break
Location Metro East Ballroom
10:45 am - 12:15 pm
Breakout Session 4
• Community Stream - Innovative Youth Engagement Location Pier 3
• Community Stream - Community-University Partnerships Location Metro Centre Ballroom
• Academic Stream - Environmental Justice Location Pier 2
• Academic Stream - Immigrants and Urban Health Location Bay
• Academic Stream - Injection Drug Use in Urban Settings Location Metro West Ballroom
. Academic Stream - HIV Intervention and Risk Reduction Strategies Location Pier7&8
12:15 pm -1:30 pm
Closing
Location Metro Centre Ballroom
Program at a Glance
1:45 pm - 3:15 pm
Conference Centre
Second Level
Elevalo-jr
Meeting and Banquet Facilities
\ Metro East
TKE. WeSHN aiARBCXBt CASTU
fgui«LariLu«
Men's Washnom
Frontenac
Ballroom
Ladies
Washroom
Elevators
Escalators
Washrooms
M&F
Pier 9
Harbour
Ballroom
(Jlicch's
%■
Yonge
Pier:
— Pier 8
Pier 7
— Pier 6
r=-—=t=
I
Convention
(Saloni Salon t Salon
J A e
B
' Level — Hotel
Pier
Pier 3
Main Lobby
I - Hotel
Wellington
Conference
Centre
Street Level
l. TLower it
Level
Regalia J
Dockside ty
Dockside V—
Business tenure
Docksicfe I
-Hotel
i
Dockside III
Dockside II
Westin Harbour Castle Floor Plan
W estin Harbour Castle Floor Plan
Metro West \
PROGRAM
at a Glance
WEDNESDAY, OCTOBER 26, 2005
9:00 am - 7:00 pm
Registration/lnformation Desk Open
Metropolitan Grand Ballroom Foyer
Pre-Conference Workshops
Program at a Glance
12:00 pm - 4:00 pm
1:00 pm - 4:00 pm
• Learning the Research Talk: Introduction to Research Methods, Concepts and Jargon
Location Wellesley Central Health Corporation
• What's all this Talk about Community-Based Participatory Research? Building Sustainable
Capacities for Urban Health Research Partnerships
Location The Ontario HIV Treatment Network (OHTN) 1300 Yonge Street
• Into the Neighborhood - Mission Barrio Adentro: A Venezuelan Success Story on Bringing Health
Care to the Marginalized
Location Ontario Institute for Studies in Education of the University of Toronto, OISE: Room Ol- 2295
• Addressing Urban Health Needs: Toronto Public Health Practice Framework
Location Ontario Institute for Studies in Education of the University of Toronto, OISE: Room 01-2281
• Ethical Challenges in Research with Marginalized Populations
Location Ontario Institute for Studies in Education of the University of Toronto , OISE: Room Ol -2279
• How to Understand and Conduct Research on Homelessness: A Practical Guide
Location Ontario Institute for Studies in Education of the University of Toronto, OISE: Room Ol- 2296
• Introduction to Urban Health
Location St. Michael's Hospital, 2010 Bond Board Room - 2nd Floor Bond Wing
• Introductory Health Economics: An Urban Health Perspective
Location St. Michael's Hospital, Paul Marshall Lecture Theatre, (at) Queen Street Lobby
• The Politics of the Social Determinants of Health
Location Opposite St. Michael's Hospital, 38 Shuter Street - Room B-1245 (Basement)
• Using Distance and Travel Time to Measure Access to Health Care and Resources for Healthy
Living in Urban Neighbourhoods
Location Centre for Research on Inner City Health - Conference Room
1:00 pm - 4:00 pm
Tours of Local Community Organizations
Location Please assemble in the Metropolitan Grand Ballroom Foyer
5:00 pm - 7:00 pm
Poster Session I and Welcome Reception
Location Metro East/Metro Centre Ballroom
THURSDAY, OCTOBER 27, 2005
7:30 am - 5:00 pm
Registration/lnformation Desk Open
Location Metropolitan Grand Ballroom Foyer
7:30 am - 8:45 am
Poster Session II and Continental Breakfast
Location Metro East Ballroom
9:00 am - 10:15 am
Welcome Address & Plenary Session
Location Metro Centre Ballroom
ions am -10:30 am
Refreshment Break
Location Metro East Ballroom
10:30 am -12:00 pm
Breakout Session 1
• Community Stream - HIV and Marginalized Populations Location Metro Centre Ballroom
* LoratonXr'r3"1~Community'Based Participatory Research: Barriers and Facilitators
• Academic Stream - Conceptualizing and Measuring Social Justice
• Academic Stream-High-Risk Youth Location Bay
• Invited Panel - Urban Income Inequality and Health
Location Pier 2
Location Metro West Ballroom
social health nrnhlom
occurrence of etho ti
assessment
areas °*ttle c'ty where misery, poverty, lack of political public health may be modulating
P°jS' e env'ronrnental intervention in one mosquito-borne disease might be playing a role in the
$ °
prov'de useful information for a joint urban planning, articulated for use in health impact
12 02 (A). Sexual Behaviors of Street Children in Lahore, Pakistan: The Risk of Survival
Susan Sherman, Christopher Martin, Salman Quereshi, Tariq Zafar
BaCkf,r°U"d3re an estimated 5,000 street children in Lahore, Pakistan, a disproportionate number whom engage in risky
evtont e av'°rs 1 at p ace them at risk for such deleterious outcomes such as victimization and HIV/STIs. Understanding the
• n an na ure o these children's sexual practices and how sex functions in their life can inform interventions that address
ej°°, CauSeS an consec1uerices of unsafe sexual practices. Methods: Since August, 2003, Project SMILE has provided food,
r<Ca Car k a" SOC'a' suPPort to street children on a mobile van daily throughout Lahore, Pakistan. All recipients of services
i e out a rie registration form which included demographic information, drug use patterns, and sexual behaviors. The
current ana ysis describes the sexual behaviors of all registrants, comparing variables of interest between those who have and
ave not ad sex. A multivariate logistic model examines correlates of ever having had sex. As 96% of participants were male,
the current analysis is restricted to boys (n=604) Results: Participants were a median of 13 years old and 53% had no formal
education. The median length of time living on the streets was 18 months and 80% primarily slept on the streets, as opposed to
their parents home. Forty-one percent of the sample reported ever having had sex and of those, 65% reported having had
recent (in the past 3 months) sex with a man and 81% reported recent sex with boys their own age. The median age of sexual
debut was 10 years old (IQR: 9, 11). Of those who reported having had sex, 94% had exchanged sex for shelter, food, or
entertainment, 62% reported having had sex with men, and 80% had had sex with boys. In the presence of other variables,
correlates of having had sex were: months spent on the street (AOR: 1.20; 95% Cl: 1.10-1.50), ever having used drugs (AOR: 2.90;
95% Cl: 1.629-5.175), and ever having been arrested (AOR: 1.554; 95% Cl: 1.079-2.238). Conclusions: Having sex is prevalent
among very young street children in Lahore and is part of a constellation of risky survival and coping mechanisms. Rising rates of
HIV have been documented in Pakistan in the past few years, and street children will be one of the first groups to bear the
brunt of the disease burden. Targeted programs towards men who take advantage of street children's vulnerability as well as
those targeting street children are needed.
03
12-
(A): Reported Use of Violence Among Young IVlen in Dar es Salaam, Tanzania
Suzanne Maman, Fiona Kouyoumdjian, Richard Kaballa, Melissa Roche, Jessie Mbwambo
04
12-
31
Abstracts
Introduction: Violence has been demonstrated to be a risk factor for various negative health outcomes, recently including HIV.
Given the magnitude of this public health problem, relatively little is known about the epidemiology of violence, in particular
from the perspective of young men in developing country contexts. Methods: Men between the ages of 16 and 24 living in Dar
es Salaam, Tanzania, were enrolled in an intervention study aimed at reducing violence and HIV risk behaviours between May
and August 2004. Baseline data for the study were analyzed using Stata 7.0. Results: 949 men were enrolled in the study. More
than 10% (101) men reported a history of childhood sexual abuse, and 42.7% (406) reported serious physical violence in
childhood. Almost half (46.14%) of men reported feeling that it is acceptable for a man to beat his partner in specific situations.
Of the 660 men who reported having had intercourse, 23.2% (153) reported having been sexually or physically violent ever with
a sexual partner. Odds of violence was higher in those men with a history of sexual (OR 1.90; OR: 1.15-3.00) and physical (OR
1.89; 95% Cl 1.30-2.75) violence in childhood, and in those men who reported thinking that violence was acceptable under many
conditions (OR 3.27; 95% Cl 1.29-8.29). Conclusions: Young men at the beginning of their sexual lives report a history of
violence, a high level of acceptance of violent behaviours, and common physical and sexual violence with sexual partners.
Ongoing basic epidemiologic data as well as innovative interventions are required to reduce violence and thereby the risk of HIV
and other health and social sequelae.
(A): Urban Health in a Large city: The Case of Mumbai, and the Role of the Voluntary Sector
Anant Bhan
Mumbai experienced the heaviest rainfalls ever experienced by any part of India in a single day on July 26, 2005. Many people
died and thousands were displaced and lost their property, homes and livelihoods. The sudden rise of floodwaters disrupted the
transport system and commuters were stranded at various points on the roads for hours on end in pouring rainfall and without
access to food or water Since the airport and railway tracks were also flooded, Mumbai became cut off from the rest of the
world The collapse of cellular networks added to the misery. The response of the government machinery and also the public
health authorities was slow and this contributed to the high morbidity and mortality. Information was not readily available and
the crisis response cell was not able to do an effective job. Hospitals became over crowded and an outbreak of leptospirosis
occurred Panic buying of antibiotics by a misinformed population led to unavailability of crucial drugs, as well as unnecessary
inqestion of antibiotics, which have doubtful prophylactic value for leptospirosis. The exaggerated coverage of health problems
by the media also caused widespread confusion. Correct information was not available and an attempt was made to conceal the
.A
truth to protect the government's image. The case of the Mumbai floods is a symptom of the mala.se of lop sided development
■.
in a urban economic centre in the developing world, as well as the failure of the public hea th system in settings where
governments are withdrawing from public services like education, health under the gu.se of reforms being pushed by the neo- . Hberal Economic world order. The impact of the floods was most on disadvantaged populations like those living in slums m low ; .; >
econom
and on women and children, a phenomenon observed also in last year s Tsunami. Social ,. <
hjstte
are all atplay in this paradigm. While Mumteifc back to'nwmal'today, the
, '. (
experience of 26H should be a pointer to structural failures in urban governance and publ.c health which lead to such a h.gh
, •
toll dX disasters. A complex web of factors influences urban health and there are lessons to be learnt from such experiences
...
to be able to respond much more effectively in the future.
«-rsr-
.
0S37R
■
Homelessness and Housing
01
13-
(A): The Aging of the Homeless Population: Fourteen-Year Trends in San Francisco
Judith Hahn, Margot Kushel, David Bangsberg, Elise Riley, Richard Clark, Andrew Moss
Introduction: Homelessness is associated with high rates of health and substance use problems. The number of homeless persons
has increased in the past 25 years, as have emergency shelter capacities and free meal programs, yet only one study has
examined trends in the homeless population. Methods: We examined trends in fourteen years of cross sectional studies of
homeless adults (age 18 and older) that were conducted at homeless service providers in San Francisco, from 1990 to 2003. We
limited the analysis to those who were literally homeless (defined as spending any nights in a shelter or outside), and were
sampled at any of four shelters and two meal programs that were visited repeatedly across the time periods. The sample size for
analysis was 3534. Results: In the study period, the median age increased from age 37 to 46, at a rate of 0.66 years per calendar
year (p=50) homeless were in poorer health while using fewer drugs and alcohol Conclusions: The homeless population as a
whole is getting older and experiencing more outdoor living and chronic homelessness. The aging phenomenon seen in our
sample is consistent with trends seen in several other cities. This effect is consistent with a static cohort. Without a substantial
influx of new homeless persons, an intervention such as supportive housing, which aims to house the difficult to house
chronically homeless, could result in a significant lessening in the total numbers of homeless. These results also indicate that
homeless health and service providers need to plan for the medical conditions associated with the aging and increasing street
living among the homeless.
02
13(A): Risk Behaviours For Sexually Transmitted Infections (STIs) in Canadian Street Youth: Does Time Spent
On The Street Matter?
Olayemi Agboola, Jennifer Suishansian, Maritia Gully, The ESCSY study group
Abstracts
32
Introduction: Street youth (SY) maybe more preoccupied with meeting their daily basic needs than with concern for health risks;
for most, this is the risk they have to face just to survive. Their life style may predispose them to engage in high-risk behaviours
such as unprotected sex, sex with high risk partners and multiple sex partners that increase their risk of contracting and
transmitting STIs. Methods: The Enhanced Surveillance of Canadian Street Youth (ESCSY) is a repeated cross-sectional survey that
monitors STI prevalence and associated risk behaviours among SY aged 15-24 years. In 2003, youth who were able to speak
either French or English and had been absent from their parent's/caregivers' residence for at least three consecutive nights took
part in the survey which consisted of interviewer-administered questionnaires. Participants were recruited from drop in centres
in 7 cities across Canada.Youth self-reported time spent on the streets. Statistical analyses were carried out using SAS version 8.
Results: 1656 SY were recruited in 2003. 60.2% reported spending all the time on the streets in the past month while 39.8%
reported spending some of the time on the streets. Mean age was 19 years. SY who reported spending all the time on the
streets had on average more lifetime sexual partners (32 vs.20) and more partners in the past 3 months (4 vs.2) than those who
reported spending some of the time on the streets. SY who reported spending more time on the street were more likely to
report using injection drugs (29.8% vs. 15.6%, p <.0001), to binge drink in the past three months (42 5% vs. 31.4%, p=0.0001), to
report ever being obligated to have sex (20.1% vs. 15.3%, p=0.008), to ever trade sex (22.3% vs. 18.1%, P=0.05 ), and to have
sexual partners that use injection drugs (82.6% vs. 73.6%, P=0.0002) and non-injection drugs (18.9% vs.5.3%, P=<.0001). They
were also less likely to report using condoms with male sexual partners (18.9% vs.5.3%, P=<.0001). Conclusions: SY may become
initiated and engage in high risk behaviours the more time they spend on the streets. Programs aimed at getting youth off the
street in the least amount of time would help to alleviate this problem. Effective interventions for STI prevention need to be
developed targeting this section of the nation's youth. Harm reduction approaches including information about safe sexual
behaviours and safe drug use, also needs to be available to street youth.
03
13-
(A): Access to Health Care for Homeless People with Serious Health Conditions in Toronto, Canada
Stephen Hwang, Shirley Chiu, Erika Khandor, Kate Mason, Laura Cowan, George Tolomiczenko, Alex Kiss, Marko
Katie, Donald Redelmeier, Wendy Levinson
Introduction: Homeless people have poorer health status than the general population and often experience difficulties obtaining
needed health care. However, little information is available on homeless people's access to care under Canada's system of
universal health insurance. This study examined access to health care among single homeless persons in Toronto who reported
having a serious health problem. Methods: Recruitment of randomly selected homeless persons took place at 55 shelters and 23
meal programs in Toronto, Ontario. Enrollment at each site was proportionate to the number of unique homeless individuals
using the site each month. Enrollment was stratified by sex to allow oversampling of women. Between December 2004 and
March 2005, 360 homeless persons unaccompanied by dependent children were interviewed. Participants were asked if they had
any of 22 serious health conditions, including cardiovascular and respiratory diseases, hepatitis and other liver diseases,
gastrointestinal ulcers, diabetes, anemia, epilepsy, cancer, and HIV/AIDS. Data were obtained on demographics, usual sources of
health care, barriers to obtaining care, and recent experiences with health care providers. Results: Analyses were based on the
198 participants (55% of the total sample) who reported having at least one serious health condition. Of these individuals, 31 %
were female; 26% were aged 16-24, 55% were aged 25-49, and 19% were aged 50-70. Median monthly income was C$300.
More than one serious health condition was reported by 63%. Although only 12% of the Canadian general population does not
have a primary care provider, 33% of homeless individuals had no usual source of care or used an emergency department as
their usual source of care. Within the last two years, 50% of homeless persons reported not following their clinician's advice or
treatment plan at least one time; 35% of these individuals stated that the plan was too difficult to follow and 25% cited the cost
of treatment. Within the last 12 months, 31% reported a health care visit in which they felt they were judged unfairly or treated
with disrespect because they were homeless. Conclusions: Despite Canada's system of universal health insurance, many single
homeless persons in Toronto who have serious health conditions have no regular primary care provider. Discrimination on the
basis of homelessness is a commonly reported barrier. Because adequate income and housing are central to enabling access to
health care, social programs and policies should be re-examined to ensure that all Canadians can benefit from the health care
system.
04
13-
(A): Women Sleeping Rough: Health Outcomes After Five Years On the Streets of Boston, 2000-2004
James O'Connell, Jill Roncarati, Stacy Swain
Purpose: The obstacles to health care faced by women who live on the streets (rough sleepers) are daunting. A dearth of
literature exists concerning medical illnesses and health outcomes of urban female street dwellers. Previous efforts to care for
this population have been limited to acute and episodic interventions and lack of continuity. The Boston Health Care for the
Homeless Program (BHCHP) utilizes a multidisciplinary team to offer comprehensive and consistent care directly on the streets.
The Street Team works with outreach teams from shelters, conducts hospital-based clinics and provides specialty and inpatient
care at Massachusetts General Hospital (MGH) and Boston Medical Center (BMC). Immediate access is available directly from the
street to dual diagnosis detoxification units as well as BHCHPs 90-bed medical respite. Methods: In January 2000, a cohort of 119
high-risk persons was identified including 28 women. The entire cohort was identified from over 800 street persons cared for by
the Street Team. All persons in this cohort were over age 18, had lived on the streets for at least six months, and met at least
one of several criteria for increased morbidity and mortality. 88% of the high-risk cohort suffer from the tri-morbidity of chronic
medical illness, major mental illness, and active substance abuse. Data is recorded on each patient at a weekly meeting. Other
data sources include BHCHPs electronic medical record, hospital records, and a supplemental street database maintained by the
team. Results: After five years, we identified the whereabouts of all 28 women: 5 (18%) are deceased, 1 (3%) is in a nursing
home, and 2 (7%) are in recovery programs. 16 (57%) are housed or living fulltime with families. Only 4 (14%) remain on the
streets. Only one woman did not have health insurance. The average age was 46 years, and the demographics included 23 (80%)
White, 3 (11%) Black, 1 (3%) Native American, and 1 (3%) Hispanic. Cirrhosis was the cause of 3 deaths, 1 woman died of
Huntington's Disease and another from suicide. Conclusions: Mortality and morbidity are high among those living on the streets.
BHCHPs service delivery model provided continuity of primary and preventive care to a high-risk cohort of women sleeping
rough, with primary care outcomes comparable to those achieved for the sheltered homeless population receiving care from
BHCHP. The Street Team offers a model of street care for cities seeking strategies to reach this vulnerable and disenfranchised
population.
13-05 (A): Homelessness Following Eviction in Amsterdam
Introduction: To combat the problem of homelessness in Amsterdam, a study was conducted to answer the following questions: What households are evicted and how many end up homeless? - What is done to prevent eviction? - What is done to prevent
long-term homelessness of evicted households? Methods: Data were collected through interviews with all parties involved in
evictions. Questionnaires about characteristics of all households at risk were completed by housing corporations and nuisance
coordination centers. Structured interviews were held with 120 recently (<2 years) homeless persons about their first period of
homelessness. Results: The number of evicted households in Amsterdam is increasing. In 2003, 1300 households were evicted;
90% because of rental arrears, 5% due to nuisance and 5% to illegal occupation. The majority of evicted households consisted of
single men (56%); 16% included children. For households with rental arrears, only a minority of housing corporations paid house
visits. These corporations have a lower percentage of evictions (23% versus 38%). Housing corporations do report to be aware of
social and medical problems in a substantial part of the households with rental arrears (alcohol: 4%, drugs 7%, psychiatry 12%).
However, the only assistance offered is a written referral to financial help. From the households evicted because of rental
arrears, for only 17% the destination after eviction is known, of which 18% become homeless immediately. For nuisance
households, a preventive network approach exists, resulting in more contact with care providers and more information on the
underlying problems and destination after eviction. Of the recently homeless persons, 39% lost their last housing due to
eviction. One third of the recently homeless stayed with friends immediately after loosing their home, 25% slept outside and
21% in a shelter. Within three months after loosing their home, 71% slept outside or in a shelter. Conclusions: Little assistance is
offered to those evicted because of rental arrears, even though housing corporations are aware of underlying problems. Home
visits can help in decreasing the number of evictions. For the majority of evicted households, no information on their
whereabouts after eviction was available, implying that no help is offered to prevent them from becoming and remaining
homeless. Implications A pilot project has now started for active outreaching help to households with rental arrears, similar to
the network approach for nuisance households. Two projects have started to stimulate a quick return back to society for the
recently homeless.
Mental Health
01
14-
(A): Stressful Neighborhoods and Depression: An Examination of 25 Metropolitan Areas in Canada
Flora Matheson, Rahim Moineddin, James Dunn, Maria Creatore, Piotr Gozdyra, Richard Glazier
Objective: Both sociological and epidemiological research indicate that features of the social environment in which we live are
important predictors of healthy lives. In this study we adopt an ecological approach to examine the association between
33
Abstracts
Matty de Wit, Igor van Laere, Theo Sluijs
environmental stress at the neighborhood-level and prevalence of depression. Methods: Rates of depression for each
neighborhood (census tract) are derived from the 2001 Canadian Community Health Survey, a national Canadian probability
sample of approximately 49,743 respondents living in 3,224 urban census tracts. Measures of environmental stress and control
variables are derived from the 2001 Canada census. Using factor analysis of census data we developed two measures of
neighborhood stress - neighborhood instability and material deprivation. Factor analysis further identified two additional
neighborhood characteristics, ethnic diversity and social dependency that might act as protective agents Results: The adjusted
model for the full sample, which included demographic variables (average age, proportion female and population) and an
indicator for region (i.e., Atlantic, Quebec, Ontario, Prairies, Alberta and British Columbia), showed that neighborhood instability
(OR = 1.101, Cl = 1.021 - 1.190) and material deprivation (OR = 1.112, Cl = 1.019 - 1.214) increase the risk of neighborhood
depression. Ethnic diversity (OR=0.864, Cl= 0.800 - 0.936) and social dependency show protective effects (OR=0.914, Cl= 0.845 0.991). Stratified analyses explore these relationships for a male and female sub-sample. Conclusions: Understanding the
association between contextual effects and mental health problems is important in providing population strategies that reduce
the burden of disease through public health interventions.
02
14-
(A): A Learning Collaborative to Improve Mental Health Service Use for Low-income, Urban Youth
Mary Cavaleri, Geetha Gopalan, Mary McKay
Introduction: The current study examines the effects of the Learning Collaborative, an inter-agency program developed to
improve mental health service use among low-income, urban children. Despite many youth experiencing pressing mental health
difficulties, most are not engaged in treatment or drop out prematurely. Children residing in low-income, urban communities are
in particular jeopardy, given they evidence higher than average rates of mental health difficulties, yet have the lowest rates of
service use. Recent studies provide strong evidence that intensive engagement interventions implemented during initial contacts
with youth and their families can boost service use substantially. Yet despite these promising interventions, there is relatively
little guidance as to how community mental health agencies can assist youth and families in becoming involved in needed
mental health services. The Learning Collaborative was designed for this purpose by 1) bringing multiple agencies across New
York City together with the goal of improving service use among low-income, urban youth with mental health needs; 2) training
the agencies in administering intensive engagement strategies; and, 3) monitoring agency progress and any difficulties in
implementation. II. Methods: Fifteen outpatient child mental health agencies within New York City partnered to form the
Learning Collaborative with the goals of 1) improving the show-rate for the first intake appointment for all new evaluations of
children and adolescents, and 2) improving attendance at any scheduled clinic appointments subsequent to the first kept intake
appointment. Key features of the Learning Collaborative included provider training focused on evidence-based phone contact
and initial interview engagement skills, evaluating the effects of new engagement procedures, and fostering providers' ability to
form collaborative working relationships with adult caregivers and youth. III. Results: As of April 2005, outcomes indicate
significant success in increasing proportion of youth and families keeping first intake appointments. More specifically, after five
months. Learning Collaborative members report an almost 20% increase in the proportion of kept intake appointments. This
represents 324 more children completing intake evaluations when compared to baseline estimates. IV. Conclusions: Results
suggest that utilizing the collective strength of the Learning Collaborative can change the strategies mental health agencies use
to engage and retain low-income, urban youth. These results may also direct policy-makers and stakeholders to implement
empirically-validated engagement strategies such as these to improve service use for low-income, urban children and families
throughout the mental health care service sector.
03
14-
(A): Affective Suffering in Older Women: Evidence of a Threshold Affect that Varies by Race/Ethnicity
Cecile Yancu
Introduction: The persistent finding of women's excess of depression continues to be a source of great debate with vulnerability
having been attributed to a variety of psychosocial factors, particularly those conditions unique to women's lives. One striking
consistency with such explanatory models is that all appear to be predicated on a generalized assumption that one's risk of
depression is greater because one is either a woman (a biological distinction) or a female (a role-based or social-psychological
distinction). What is not clear from the epidemiological evidence to date is whether this fundamental sex/gender vulnerability
assumption remains equally viable across diverse racial/ethnic groups, and in particular among older women. Methods: The
generalizability of greater female vulnerability to depressed mood is questioned using a representative study of 1,475
racial/ethnically-diverse, older women residing in the urban northeast. Depressive suffering was assessed both categorically and
linearly with the Index of Affective Suffering (IAS), a flexible hierarchal measure designed to combine intensity and extensity of
suffering. In-home interviews by specially trained raters also collected demographic, functional and social health data. Prevalence
rates of affective suffering were examined separately for Latino (46.8%), Black (36.5%), and White (18.6%) women. Results:
Categorical analysis showed that both older Latino and white females were significantly more likely to report a clinically-relevant
level of affective suffering than similarly aged black women. Moreover, when affective suffering was analyzed across a spectrum
of mood impairment these data detected a threshold effect in the upper range of affective suffering that was present among
Latinas and white females but not so among the Black women in this sample. Conclusions: These findings point to a need for
research to appreciate the heterogeneity of older women. With women now routinely living 25 to 30 years beyond menopause
many health research and advocacy organizations have called for studies of those conditions that affect women differently,
predominantly or out of proportion relative to men. At the same time numerous studies have highlighted the existence of
considerable disparity along racial/ethnic lines in both health and health care. In this light, one implication of this study is that
research focused on the recognition, presentation, and treatment of depressive symptoms may benefit from examining them
both dimensionally and within the context of racial/ethnic variation. Promoting such cultural sensitivity could benefit future
efforts to detect and/or intervene among older persons suffering from depressed affect in a way that combines individual
attributes and social context.
04
14(A): Mental Illness as a Risk Factor For Poor Health, Substance Use, and Dependence Among Unmarried
Urban Mothers
Nancy Reichman, Julien Teitler
Introduction: Mental illness is thought to play a key role in shaping unmarried mothers' ability to be self-sufficient. It may
permeate many aspects of their lives and compound other disadvantages they face. However, diagnosed mental illness among
unmarried mothers is rarely available in population-based longitudinal data sets. As a result, little is known about the extent to
which this aspect of maternal health impedes self-sufficiency and contributes to material hardship among unmarried mothers
and their children. Methods: In this paper, we: 1) document the prevalence of mental illness among urban unmarried mothers; 2)
assess the extent to which the prevalence of mental illness varies by neighborhood poverty; 3) examine how mental health
affects employment, reliance on public assistance, and material hardship among urban unmarried mothers; and 4) investigate
the co-occurrence of mental illness and other prenatal psychosocial and behavioral risk factors, including smoking, drinking, and
using illicit drugs and whether the effects of mental illness are mediated by these behaviors. We use data from three waves of
the Fragile Families and Child Wellbeing study, a panel study of 4898 randomly sampled urban U.S. births that occurred between
1998 and 2000. Survey data from mothers and fathers are linked to information from the mothers' hospital medical records prior
to the initial interview and census tract level characteristics. The survey data, which span 3 years beginning at the birth of a
child, are rich in measures of maternal employment, program participation (TANF, food stamps, Medicaid, WIC, housing), and
material hardship (hunger, homelessness, utility shutoffs, inadequate medical care, poor physical health). The medical records
contain detailed information on both pre-existing mental illness and substance use. Results and conclusions: We estimate nested
multiple logistic regression models, first controlling for a rich set of sociodemographic factors, then including measures of census
tract poverty, and then including potentially mediating factors including substance use and neighborhood characteristics.
Preliminary results indicate that diagnosed maternal mental illness is an important "third" factor explaining many outcomes for
this population. The results have important implications for public assistance programs that target urban unmarried mothers.
14-05 (A): Quality of Life Outcomes for Mental Health Care Clients Engaged in the Workman Theatre Project
Individuals experiencing mental health problems face significant societal stigma and often lack social support. An international
movement in Art in Mental Health is attempting to use involvement in the arts to assist mental health care clients to develop
their strengths and forge relationships with others, as well as to educate the public on mental illness. The Workman Theatre
Project (WTP) was established in Toronto in 1987 to meet these objectives by providing artistic support and training to
individuals who receive mental health care services and by showcasing their work to the public. This study explored the impact
that the Workman is having on its members' quality of life in the following domains: mental health, social adjustment, daily
functional capacity, living conditions, and overall sense of wellbeing. A series of three questionnaires were developed and used
in conjunction with the World Health Organization Quality of Life Assessment, brief version (WHOQOL-Bref). Since previous
research has struggled to find appropriate standardized instruments to evaluate Art in Mental Health program outcomes, this
study compared the domains found in the WHOQOL-Bref to five areas of life identified as important by study participants.
Results indicate that the WTP improves member enjoyment of life, sense of meaning in life, and satisfaction with self. Positive
effects are also noted in the areas of social relationships, concentration, energy, and capacity for work. Members report that the
Workman has greatly affected their overall quality of life, and this effect increases the longer that members have belonged to
the organization. Increased confidence and a sense of inclusion are two areas not directly surveyed, but which were frequently
identified in an open-ended question. No effects were found in living conditions. Participants' self-selected areas of importance
in life were congruent with those identified by WHOQOL-Bref. However, the WHOQOL-Bref fails to capture the importance of
creative expression in this population. Approximately two-thirds of Workman members choose some form of artistic expression
as one of the most important areas of their life. The WTP and other art organizations in Canada are working to support mental
health consumers/survivors and break down stigma against mental illness. While the United Kingdom has set up a national
advisory board to investigate Art in Mental Health programs, Canada has not devoted much attention to this area. With the
potential to transform the lives of economically and socially disadvantaged individuals, this study hopes to encourage similar
interest and research in Canada.
Gender and Urban Health
01
15-
(A): Gender Differences in Depression Among Low Income Recent Immigrants in Canadian Urban Centres
Katherine Smith, Flora Matheson, Rahim Moineddin, Richard Glazier
Introduction: Immigrants tend to initially settle in urban centres. It has been previously established that immigrants have lower
rates of depression than the Canadian born population, with the lowest rates among immigrants who have arrived most recently
in Canada. It is known that women and individuals with low income are more likely to have depression. Given that recent
immigration appears to be a protective factor for depression and female gender and low income are risk factors, the aim of this
study was to explore a recent immigration-low income interaction by gender. Methods: The study used 2001 Canadian
Community Health Survey 1.1 data. The sample consisted of 44,754 adults living in 25 Canadian census metropolitan areas.
Depression was measured using a cut-off of 4 on the Composite International Diagnostic Interview-Short Form. Recent
immigration was defined as immigration to Canada within the previous 10 years. Low income individuals were those whose
household income fell below Statistics Canada's threshold based on number of occupants per household. Logistic regression was
Abstracts
Nicole Koziel, Lisa Brown, Michael Bagby
used to examine the effect of the interaction on depression in an unadjusted model and in a model controlling for age, marital
status, educational attainment, and visible minority status. Results: The rate of depression in Canadian urban centres was 8.7%,
6.3% for men and 10.9% for women. For recent immigrants, females with low income were 3.3 times (11.1% vs. 3.4%) more
likely to be depressed than their male counterparts. For high income recent immigrants, this ratio was 1.3 (5.4% vs 4.1%).
Among non-recent immigrants, these ratios were 1.3 (16.5% vs. 12.4%) and 1.7 (11.0% vs. 6.5%), respectively. For men, low
income recent immigrants had a slightly lower rate of depression than high income recent immigrants (3.4% vs. 4.1%). Male low
income non-recent immigrants were 3.6 times (12.4% vs. 3.4%) more likely to be depressed than male low income recent
immigrants. The interaction term for income and immigration was significant in the adjusted models for men (p=0.034) and
women (p=0.048). Conclusions: These results confirm what we know about the effects of income, immigration and gender on
depression. The novel finding is a differential income effect where male recent immigrants have lower than expected rates of
depression and female recent immigrants have higher rates. These findings have implications for public health planning,
immigration and settlement services and policy development. Future research should explore the mechanisms through which
income and immigration exert their effects.
02
15-
(A): Gender Issues and the Health of Disadvantaged Persons
Rhonda Love
Gender as a descriptive, analytical and theoretical category is a major factor in understanding the health of disadvantaged
populations. Gender is socially constructed but this understanding is not reflected in most of our health-related research. Most of
our research simply asks people to describe themselves as either male or female and this does not capture any nuanced
understanding of what it is to be a "man" or a "woman." This presentation is a critique of current social-epidemiological work
from the perspective of "gender" and takes a global perspective on health. It will be argued that men and women have
different life experiences and different frames of reference which affect their representation in health research in theorizing
about health. Although much of our health-related research examines data by sex, there is an under-theorizing of gender in our
work. For example, research on social capital and social cohesion may show that men and women have different experiences of
social life and social life as it relates to health, but feminist theory, which takes as its starting point the different social
experiences of men and women, has not been a major starting point for health researchers. Mental health, as an example, is
experienced differently by men and women yet social scientists and health researchers are often in theoretical and
methodological "silos" and do not inform one another's research into this critically important focus on health. The failure of
theoreticians and others to incorporate feminist thinking into most social epidemiological work limits both feminist theorizing
and the applicability of health research to everyday life. This presentation will explore ways in which feminist theory can inform
social epidemiological theorizing and research and will offer suggestions for policy research that will have direct applicability to
both academics and community-based health workers.
03
15-
(A): Whither Gender in Urban Health?
Victoria Frye, Patricia O'Campo, Sara Putnam
Remarkably rare in the current public health discourse surrounding "urban health" is the notion of gender as a social construct,
femaleness as a status characteristics or even women as a distinct population subgroup. The subsequent observation that women
are differently or uniquely affected by urbanization, urbanicity and urban living conditions is consequently underemphasized.
Recently proposed conceptual models of urban health have admirably focused on context and place and acknowledged the
complex and dynamic relationship between the individual and environment However, with a few notable exceptions,
conceptual models or empiric studies within the public health literature have not sought to understand how a gendered social
and physical environment influences the health and well-being of women and men. In contrast, urban sociologists have clearly
demonstrated the profound influence that race, class and gender have on the health and well-being of young, inner city Black
men (see for example Anderson, 1999), particularly on their expression and experience of violence. This work connects social and
physical structure to culture and place. In addition, earlier work within environmental health has framed an understanding of
how women interact with their environments as intersecting "life spaces" (Kettel, 1996) that transcend urban/rural and
social/physical dichotomies. In this paper we argue for an explicitly sociological approach that first acknowledges status
characteristics as fundamental social structures and systems. Thus, gender is seen as a social structure that intersects other
fundamental social structures such as race and class (Risman, 2004). Adopting such an approach forces an intersectional analysis
of how the health of an individual who is socially situated as and has the status characteristics of a woman, Black and poor
person is influenced by her environment, which has also been shaped by these fundamental social structures of gender, race, and
class. This approach results in an understanding of how "life places" influence women's health. In this paper, we apply this
approach and describe how the health of urban women has been affected by a gendered social and physical environment using
the examples of violence and HIV.
04
15-
(A): Housing Policy, Women, and Health in Canadian Cities
Toba Bryant
Introduction: Health and health policy are increasingly conceptualized as concerned with broader societal issues that influence
population health rather than focused on health care. The development of progressive health policy can serve to reduce health
inequalities within populations in general, between men and women, and among groups of women. These health policy
approaches should address what are called the social determinants of health, particularly the social determinants of housing and
income. Method: Consistent with the conference themes of health status of disadvantaged populations and policies promoting
social justice, this project examined how housing policy, income policy and gender interact to influence women's health. 2001
Census and employment survey data were used to examine a number of income and housing indicators such as housing tenure,
shelter costs, core housing need, and shelter-to-income ratios by gender and household type in Montreal, Toronto, and
Vancouver Census Metropolitan Areas (CMAs). The households of particular interest were unattached men and women aged
either less than or older than 65 years, couples with children, and female and male lone-parents. Results: The study found that
female lone-parents and unattached elderly females are the most socially and economically disadvantaged of all groups
examined. They are most likely to rent and have core housing need. They are also more likely than their male counterparts to
live in poverty for longer periods of time. These situations result from Canadian public policy decisions concerning the
availability and quality of these health determinants to the population. Conclusions: Women's incomes provide the context in
which the effects of housing occur and these have detrimental effects on women's health. Because of their low income women
are particularly vulnerable to federal and provincial housing and income policies. Recent policy change such as the
implementation of vacancy decontrol in Ontario and the absence of a national housing strategy have fostered housing and
income insecurity for low-income women in Canada. This economic insecurity has implications for the health of these women
and their children as extensive research has documented the health effects of material deprivation which is closely related to
income status.
Innovative Youth Engagement
1601
(C): Toronto Teen Survey (TTS) Phase One: How Do We Meet the Specific Sexual Health Needs of Youth in
Diverse Urban Environments?
Susan Flynn, June Larkin, Sarah Flicker, Jason Pole, Alycia Fridkin
02
16-
(C): Young People in Control; Doing It Safe. The Safe Sex Comedy
Juan Walter, 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 .
Methods: 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 successful 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 STI/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, HIV and 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 recognized the situations displayed. Eighty
percent of the audients found the show entertaining and 60% found it educational. From this 60%, one third considers the
information as new. Almost all respondents pointed out that they would promote this show to their friends. Conclusion: The
show reached the hard-to-reach group of young people out of the urban scene and was considered entertaining, educational
37
Abstracts
Background: ground: Youth do not have comprehensive knowledge of risk factors associated with unprotected sexual activity or
the skills necessary to ensure their own sexual health. One size fits all prevention strategies aimed at youth have not proven
effective. As Toronto's youth community becomes more racially and culturally diverse, community-based organizations must
adapt their approaches. The need to examine how youth feel about services is an important first step. Planned Parenthood of
Toronto, a community-based agency, in conjunction with the University of Toronto, academic partner, and the City of Toronto,
policy maker, will undertake research to create an accessible and effective sexual health strategy for diverse youth. Methods: The
TTS uses a community-based participatory research model to engage teens in developing a positive response to some of the
issues they face on a daily basis in their lives. In phase one, a diverse group of 12 youth aged 13-17 years worked collaboratively
to develop a research design, instruments and protocol. They developed a survey to determine what sexual health services are
being used by youth, what barriers prevent youth from using sexual health services and what solutions are required to increase
access to sexual health services. To ensure diversity and representation a Youth Advisory Committee (YAC) was recruited through
a combination of distribution techniques. YAC met six times and sessions were facilitated by a research coordinator and recorded
by a note taker. Results: The YAC developed the protocol for a city-wide youth survey. YAC were extremely vocal about sexual
health issues and services in their communities. The group reflected many of the same issues identified through research
including a lack of comprehensive sexual health knowledge and dissatisfaction with current resources. Sessions revealed that
although youth in urban centres face similar sexual health issues, the way sexual health is understood and practiced is very
different depending on the community of youth being served. Choices youth make operate within larger socio-cultural and
political contexts which must be considered in effective program planning. Implications: The findings have the potential to
improve quality of life for Toronto youth and consequently their communities. Sexual health as a health goal aims to enhance
life and relationships, and is an integral aspect of the overall health and well being of every person. Acceptance of and action
for positive, responsible youth sexuality has the potential to have a great impact on our whole social fabric.
and realistic. In addition, the program was able in addressing important issues, and impacted on the perceived personal risk of
acquiring an STI when not using condoms, as well as on basic knowledge about STI's.
03
16-
(C): Youth-Led Research: A Successful Model of Community-Based Participatory Action Research
Omar Guessous, Michael Armstrong
Whereas traditional research views youth as subjects and/or recipients of research, youth-led research (YLR) redefines them as
researchers and decision-makers. They are provided with the necessary tools, guidance, and structure to investigate a topic that
is salient to their lives and communities. This paper provides a case study of Fulton Youth Investigators (FYI), a YLR effort, that is
facilitated by the authors. The group consists of nine African American youth who attend public high schools and who are
concerned with documenting the educational inequalities within their county school system. Specific areas of inquiry include
resources and infrastructure, social climate, administrative support, and racism. The youth are using mixed-methods that combine
survey, interview, photographic, and archival data. The youth are responsible for the research process including the study’s
formation, design, data collection using self-created tools, and analysis. As an action-oriented project, the youth are also
creatively disseminating the findings and implications to decision-makers and community members in order to raise awareness
and promote systems change. This mixed-methods case study will present empirical evidence for YLR's significant contributions
to social justice and urban health. The qualitative data consists of monthly interviews, focus groups, and detailed observational
data. The quantitative data stems from time-series surveys that the youth completed throughout the YLR process. Anecdotal and
visual illustrations will be provided to enrich the presentation. This study found that unlike traditional youth development
settings that tend to be hierarchical and potentially adultist, YLR settings are more socially just because of their democratic and
empowering process and structure. This model also enhances youths' sense of agency, identity, and leadership-all indicators of
positive youth development. YLR, especially when it emphasizes consciousness-raising and social justice, also promotes
sociopolitical development-the attitudes, skills and long-term commitment that underlie activism and community engagement.
Because YLR tackles issues of concern to youth, it typically confronts oppression and injustice (e.g., FYl's focus on race- and class
based inequalities). YLR can therefore promote the well-being of communities. Such is the case for FYI, with its obvious focus on
education quality-a consistent predictor of health outcomes. This paper will conclude with implications for youth workers and
action researchers who are concerned with social justice work for youth, by youth. Indeed, our previous and current research
clearly indicates that such work is not only central to adolescent development, but also predictive of mental health and academic
outcomes (Watts & Guessous, in press).
04
16-
(C): Queer Youth Speak: A Model for Developing Equitable Partnerships for Community-Based Research
Christine O'Rourke, Ayden Scheim, Melanie Ollenberg, Cathy Callaghan, Joan Nandal
The aim of this paper is to contribute to the knowledge base of community mobilization, hospital-community agency-youth
research partnerships, and how to create empowering community-based research processes. This paper describes the
development stages of a community based research project between the queer youth community. Shout Clinic, and The
Community Research and Evaluation Team (CRPET) at the Centre for Addiction and Mental Health (CAMH). The purpose of this
preliminary research is to identify research priorities for homeless LGBTQ youth who seif-identify as having lived experience with
mental health and/or substance use concerns. The intended outcome of this project is to create a youth steering committee to
facilitate the development of a policy relevant community based research proposal. That proposal will reflect what youth have
told us about the strengths and challenges in their communities and their research priorities. The partnership between the youth
community. Shout Clinic and CRPET is based on the shared values of research that is empowering and collaborative, that draws
on the strength of lived experience, that is reflective of the needs of community members, that is committed to bridging the gap
between research and practice, and that supports social change. Within this context, the partners work as equals on all stages of
the project, respecting members' diversity of experience, expertise, and leadership style The team committed time to ongoing
partnership building activities, such as a "social location" mapping exercise to look at the identity and lived experience of
individual team members and the project team as a whole. This neutralized power differentials, recognized all members of the
team as equals and experts in their own right, verbalized biases and intentions, built trust between members, and gave a
framework to relate to the population being consulted. In this presentation, members from each partner community (youth
community, community agency and hospital), will reflect on the process, lessons learned, benefits and challenges of creating
meaningful, equitable partnerships. We argue that having all members participate as experts and equals improves data
collection, generates a richer body of research and a richer understanding of how youth, community agencies and hospitals can
work together as agents of change.
05
16(C): A Community-Based Participatory Approach to Assess the Context of Sexual Risk Taking in Urban,
African-American Girls
Shani Peterson, Denise Kelly
Introduction: In the U.S., African-American girls and women living in urban areas have the highest rates of HIV infection
nationwide. In response to this health crisis, a multitude of behavioral interventions targeting adolescent sexual risk taking have
been developed. Unfortunately, many interventions have been created in the absence of youth and community development
activities. This may limit the effectiveness of community-based interventions. The goal of Project Power was to employ principles
of community-based participatory research (CBPR) to assess, and ultimately improve sexual health outcomes in urban AfricanAmerican girls. Method: Project Power participants were recruited from existing summer and after school programs in a
community center affiliated with a Baltimore-based community serving organization, from neighborhood schools, and through
word of mouth. The program met twelve times, for two hours a day, over a six week period. To assess the context of sexual risk
taking, each day participants were asked to answer questions related to sexuality in a journal. Results: Approximately 22 girls
between ages 11 and 15 participated in the program. Of those participants, 27% attended at least half of all 12 sessions.
Another 27% attended at least 4 sessions. To analyze the journals, each participants' journal entries were transcribed. Then, all
entries were collapsed by topic, into one document. Next, a content analysis was conducted to extract sexual themes. Identified
themes were related to power (sexual coercion, interpersonal conflict), safety (rape, physical abuse), and self-efficacy (pregnancy,
HIV infection, peer pressure, substance abuse). The journal entries demonstrated that urban girls are concerned with their sexual
health, but often feel powerless to protect and/or assert themselves in the context of romantic relationships. They also are keen
observers and are able to identify clear links between alternative risky behaviors (e.g. substance abuse) and sexual risk taking.
Conclusion: The findings from this study suggest that the context of adolescent sexual risk behaviors should be considered when
developing and implementing community-based risk prevention programs. By increasing our understanding of adolescent
sexuality, we can be better equipped to protect the sexual health of urban girls.
Community-University Partnerships
01
17(C): Making a SWITCH: Opportunities and Challenges in Establishing a Student-Run, Interprofessional
Health Clinic in a Saskatoon Core Neighbourhood
Maxine Holmqvist, Ryan Meili, Sheila Achilles, Reid McGonigle, Patrick Lapointe
02
17(C): Using Community-Based Participatory Research to Develop and Implement Church-Based Cancer
Education Modules
Barbra Beck, Staci Young
Introduction: Age-adjusted cancer incidence rates in Wisconsin between 1996 - 2000 were 450 per 100,000 for whites, and 523.5
per 100,000 for African-Americans. Similarly, age-adjusted cancer mortality rates in Wisconsin between 1996 - 2000 were 193.5
per 100,000 for whites and 271.6 per 100,000 for African-Americans.(1) These numbers suggest a need for more cancer education
and prevention within the African-American community in Wisconsin. Churches, which are often cornerstones within the AfricanAmerican community, offer a natural gathering place to provide health education. They have a strong tradition of caring for
others, providing fellowship, support and education. The purpose of this study is to assess the effectiveness of church-based,
cultural and literacy appropriate cancer education modules for African-Americans which were developed using a Community
Based Participatory Research (CBPR) process. Methods: A CBPR process was used whereby church members and academic
representatives jointly developed four, one-hour, culturally and literacy appropriate, interactive cancer education modules that
addressed 1) cancer in the African-American community, 2) breast cancer, 3) colorectal cancer, and 4) prostate cancer. Each
module covered attitudes toward screening, myths, incidence and mortality rates, signs and symptoms, and prevention strategies
for the respective cancer types. Modules were implemented by church members at four separate one-hour education sessions
over a one-month period. A written, eight-item pre and post test was administered to assess changes in respondents' attitudes
and knowledge of various cancer types and screening recommendations. Descriptive statistics were used to compare pre and post
test responses.'Results: Participation at the education sessions ranged from 24 - 28 church members who represented various
ages and economic groups. Post test responses improved or stayed the same, when compared to pre test scores, for all survey
items for all modules. Questions addressing attitudes toward screening, risk factors, signs and symptoms, and lifestyle choices
showed the greatest increase in correct responses. Questions that addressed incidence and mortality showed fewer positive
responses for both pre and post tests. Conclusions: Results indicate that using CBPR to develop and implement culturally and
literacy appropriate cancer education modules for African-American churches positively affects respondents' attitudes toward
screening, and knowledge of risk factors and signs and symptoms of various cancer types. Results also suggest that applying
CBPR to the development and implementation of other health education materials for African-American church communities
may also yield positive results. References 1. American Cancer Society. Cancer Statistics. 2004
39
Abstracts
The Student Wellness Initiative Toward Community Health (SWITCH) is a student organization dedicated to establishing and
maintaining a student-directed interprofessional primary health clinic in a Saskatoon core neighbourhood. Through this clinic,
SWITCH aims to improve the health of the community, to enhance the education of future health professionals and to
strengthen the relationship between Saskatchewan's post-secondary educational institutions and the community-at-large while
providing key services to a low income, primarily Aboriginal population. This service-learning project is a unique collaboration
involving student volunteers from nine different disciplines, the Saskatoon Health Region-Primary Health Services, the Westside
Community Clinic, Saskatchewan's educational institutions (the University of Saskatchewan, the University of Regina and the
Saskatchewan Institute of Applied Science and Technology), the White Buffalo Youth Lodge and many other community-based
organizations. SWITCH seeks to simultaneously address a lack of access to healthcare for a marginalized urban population and a
relative gap in the education of health professional students regarding the delivery of appropriate services to disadvantaged
groups. Inspired by the Community Health Initiative by University Students (CHIUS) in downtown Eastside Vancouver, a group of
interested students formed SWITCH in 2003. Initially, SWITCH members assessed community strengths and needs through a
variety of formal and informal methods. Guided by this information, interprofessional primary healthcare teams composed of
students and professional mentors will provide integrated, culturally sensitive services based out of the Westside Community
Clinic on evenings and weekends. An extensive ongoing evaluation process was designed in order to monitor operations and
provide insight into the opportunities and challenges of working with urban communities. The SWITCH clinic will open in
October, 2005, following a two year process of community consultations, partnership building and program development. The
result is a distinctive intervention in which students, professional mentors and community partners will provide clinical services
and health promotion programs to an underserved urban community. SWITCH has been innovative in terms of addressing the
unmet health needs of an urban population in Saskatoon and developing a community-based educational program for future
health professionals. A number of important challenges that have arisen from this ambitious project, including divergent views
on desired outcomes and process on the part of the various partners, funding and liability issues, sustainability, and ongoing
community member involvement, will be discussed.
03
17-
(C): Urban Aboriginal Community-Based Research
Alan Anderson, Priscilla Settee
This presentation addresses models of community-based participatory research; specifically, it focusses on involvement of urban
Aboriginal communities in research, drawing from the experience of the Bridges and Foundations Project on Urban Aboriginal
Housing. This comprehensive project, based in Saskatoon in 2001-2005, has involved collaboration between universities and
other institutions of higher education, Aboriginal organizations, homebuilders, and other community organizations. Over 2000
Aboriginal residents of this western Canadian city were interviewed; over fifty separate projects were conducted, many by
Aboriginal/community organizations, including some contracted directly with and conducted by particular First Nations bands.
The salient purpose of this presentation will be to discuss Aboriginal views of research, and particularly the notion of respectful
research ethics, distinguishing between traditional academic views of the expectations of Aboriginal communities. The
presentation will raise pertinent questions concerning the viability of traditional academic research practices, especially when
Aboriginal communities are being studied; it will suggest new approaches to participatory research; and will discuss changing
relationships in the form of confidence-building between Aboriginal and non-Aboriginal communities.
04
17-
(C): Making Things Work: On Being an Academic Researcher Working With a Community Partner
Nina Boulus
40
Introduction: Recently, there has been increasing focus on bridging between university researchers and community-based health
organizations. Various training programs illustrate support for such collaborations , however, little research has been conducted
to explore this movement. To address this issues I reflect upon my current research . Together with the community partner, a
non-profit community healthcare centre , I explore the implementation of the Electronic Medical Record (EMR). Methodology:
The fieldwork was initiated in October 2004, and is still in progress. For collection and analysis of empirical data, I employed a
combination of techniques, including interviews and participant observations. I also attended several EMR-training sessions
provided by the vendor, and participated in several Practice Enhancement Collaboratives organized by the Vancouver Coastal
Health Authority. The theoretical framework for this ethnographic research constitutes an institutional ethnographic approach,
supplemented with a social constructivist approach. Results: In this shifting landscape, the focus of the research evolves
according to which issues the clinic views as important or interesting. This change towards a greater involvement and real time
in situ feedback, implies that I am being asked to focus on certain issues, which are not necessarily of my own "neutral"
preference. Fostering such a close collaboration with the community partner, provides me with easy access to the field; however,
at the cost of greater dependence on the community partner. In such a case, it is naive to think I can objectively talk 'in the
name of' the clinic. Instead I acknowledge the fact that I am a dynamic participant actively engaged in the construction of the
knowledge. One may then ask whether it is possible to preserve a critical stance while being so closely involved in the project.
Conclusions: I argue that collaborative research can neither be simply good or bad, nor can they be unproblematically measured
on a scale of usefulness or successfulness. The case presented here illustrates that action research harbors both threats and
promises for potential new research practices. If we acknowledge that such applied research implies intervening and affecting
the research, we can move the discussion towards a more detailed and reflective exploration of such engagement. It can be
instructive and fruitful to focus on finding local and practical strategies to deal with such complex collaborations. Aiming to
change the social world, we should view ourselves as part of the world rather than distancing ourselves from it.
05
17(C): The Art and Science of Integrating Community-based Participatory Research Principles and the
Dismantling Racism Process to Design and Submit a Research Application to NIH
Michael Yonas, Nora Jones, Eugenia Eng, Anissa Vines
Introduction: In public health research, significant merit has been accorded to community-academic partnerships and their use of
participatory and transparent approaches to eliminate disparities in health and healthcare. In such research efforts, it is critical to
engage participants, and their providers early to build trust and collaboration to ensure that findings are context-sensitive and
culturally-relevant. Yet, missing from the scientific literature are the nuances and practicalities of: (1) convening potential
research partners; (2) adopting common language and framework for discussing institutional racism; and (3) collectively distilling
research questions, study design, methods and funding options. This paper presents the details from a 18-month planning grant
that integrated an Undoing Racism (UR) process with a community-based participatory research (CBPR) approach to establish a
community-academic research partnership that conceptualized, designed, wrote, and submitted an NIH grant. Methods: All
partners participated in formal UR and CBPR training. UR training was conducted by the People's Institute for Survival and
Beyond which provided the skills for assessing how racial oppression and white privilege and supremacy are internalized, and
how racism and discrimination is operationalized throughout the major institutions in society. All partners signed a "full value
contract" describing the CBPR principles to be followed. Multi-disciplinary CBPR teams met to conceptualize the goals, aims, and
objectives of the proposed research, integrating UR and CBPR knowledge and principles. Results: Results include the formation
of the Health Disparities Collaborative, a partnership with the local municipal healthcare system, and the submission of 2 NIH
grant proposals to support the Collaborative's efforts. Over 15 weeks, the Collaborative worked in teams to develop the research
questions, methodological approaches, and a research budget for exploring potential deviations from reasonable breast cancer
care obtained by African American patients, as compared to White patients, and their association with racial disparities in breast
cancer mortality. Conclusion: The formation of effective research partnerships requires commitment, energy, patience, and
respect. Lessons include: (1) community organizing strategies to identify and recruit partners were effective with local
organizations, academic institutions, and the hospital system, but less so with the private medical care community; (2) adopting a
common language and framework for exploring institutional racism was essential and generated a power analysis of racial and
ethnic health disparities; (3) signing a full value contract by each partner was necessary to codify the principles of CBPR; and (4)
creating a structure for equitable participation to respectfully accommodated conflict within the Collaborative.
Environmental Justice
01
18-
(A): The Right to Clean Water : How Community Groups Mobilize to Block Water Privatization
Joanna Robinson
The Right to Clean Water: How Community Groups Mobilize to Block Water Privatization Introduction The issue of water rights
has become increasingly important globally, particularly in debates over water scarcity and stewardship, ownership,
environmental health and social justice. My paper focuses on the global movement for water rights. It analyzes two episodes of
collective action related to the privatization of municipal water delivery systems and discusses how water as an environmental
health and social justice issue is used to mobilize collective action on a global scale. Methods I examine two case studies or
'episodes' of collective action around water rights and privatization: Stockton, California, and Greater Vancouver, Canada. While
the privatization of the Greater Vancouver Regional District's water treatment system was successfully prevented, this was not
the case in Stockton, California, despite overwhelming public opposition. Using theories of resource mobilization, I examine the
how community groups mobilized in response to the threat of water privatization, including the use of issue framing, social
networks, and political opportunity structures. I use content analysis, such as media reports, documents, publications and
Minutes from the community organizations involved in each episode to identify critical factors in the organization of people
around the issue of water and privatization and to determine why one movement succeeded while the other failed. Results
Based on the analysis of the archival documents used, I argue that the anti-water privatization movement in Greater Vancouver
was successful because the problem was framed as both a social justice and environmental health issue, allowing for the
mobilization of people from multiple organizations. In Stockton, the movement failed because of the single issue frame which
did not allow for the mass mobilization of people across different social movements. The findings show that community groups
that use both a social justice and environmental health frame, as well as build coalitions with public health advocates are more
successful in achieving their desired outcome, compared to those groups that use a single-issue frame. Conclusion My paper adds
to the sociological understanding of social movements and social change as well as to the understanding of how water as an
urban health issue is used to mobilize people on a global scale. It also contributes to the understanding of globalization and the
emergence of global social movements, particularly those organized around water.
02
18-
(A): Food Deserts: Do Food Deserts Exist in More Disadvantaged Communities and How Are They Studied?
Julie Beaulac
03
18(A): Neighborhood Poverty and Inequitable Exposure to Stressful Social Environments: Results From a
Community-Based Participatory Research Partnership in Detroit
Shannon Zenk, Amy Schulz, Carmen Stokes, Barbara Israel, Graciela Mentz, Srimathi Kannan
Introduction: Racial and socioeconomic disparities in health are among the most important health issues of our time. The
Healthy Environments Partnership (HEP), funded by the National Institute of Environmental Health Sciences [R01 ES10936-01], is
a community-based participatory research partnership affiliated with the Detroit Community-Academic Urban Research Center
working to increase understanding of aspects of the social and physical environments that contribute to racial and
socioeconomic disparities in cardiovascular disease risk in Detroit, Michigan. In this presentation, we examine relationships
between neighborhood poverty, neighborhood racial composition, and self-reported stressors, as important predictors of health
outcomes, among Detroit residents. Methods: Using data from the HEP survey, a stratified random sample survey (n=919)
administered to African-American, white and Latino residents of Detroit, we used hierarchical linear modeling (HLM 6.0) to
examine relationships between neighborhood (census block group) poverty, neighborhood racial composition, and self-reported
stress, controlling for individual age, gender, marital status, race/ethnicity, income, education, and labor force participation.
Neighborhood poverty level was defined as follows: low-poverty (40%). Neighborhood racial composition was defined as
follows: low African-American (80%). Results: We found statistically significant effects of concentrated poverty and, to a lesser
extent, neighborhood racial composition on self-reported stressors. Living in a moderately-poor or high-poverty neighborhood
I 41
Abstracts
Introduction: The study of food deserts is concerned with the potential place effect of eating patterns. Currently, controversy
exists regarding the existence of food deserts. This review seeks to respond to the question of whether food deserts - systematic
geographical variations in access to food - exist in more disadvantaged communities. More specifically, the purpose of this review
is to provide a methodological summary of how food deserts are studied and to review the empirical evidence on food retail
store and food item characteristics by socio-demographic characteristics at the spatial level (e.g., socio-economic status,
ethnicity). A response to this research question is timely, particularly given the increasing international attention on the causes
and potential solutions of obesity, diabetes, and other nutrition related concerns. Methods: Both published and grey literature
was included and study inclusion criteria were carefully formulated. Two main research methodologies are discussed in this
review: analysis of the characteristics of food items through market basket comparison (e.g., availability, price, and quality of
food items) and analysis of the characteristics of food stores by spatial area (e.g., distance, type of food stores, number of
residents to available food store). In addition, mixed methods are discussed. Twenty-eight studies were included in this review.
Results: Overall, evidence supports the hypothesis that systematic variations in access to food exists, disfavouring more
disadvantaged geographic areas. Regardless of the methodological approach, support was provided for a significant gap in
access to food, to the disadvantage of inner city and rural/remote areas and geographic areas characterized by low income and
predominately minority residents. Conclusions: Sufficient evidence does currently exist that inequitable access is sometimes and
for some places a real concern. Improved equity in access to healthy affordable food within environments will necessitate
changes to be made at the community and policy level. More research is needed, however, to confirm that the same sociodemographically patterned disparity in access to food is a problem in Canada and countries other than the US and the UK At
the same time, however, it is also time to more forward and study (1) how to effectively identify food deserts and (2) effective
interventions to tackle the problem of systematic and inequitable access to healthy affordable foods in more disadvantaged
communities.
was associated with greater stress associated with the social environment, physical environment, and child well-being. Residents
of high-poverty neighborhoods reported less financial vulnerability than residents of low-poverty neighborhoods. Residence in a
neighborhood with a medium or high proportion of African-American residents was associated only with stress related to
everyday unfair treatment. There were no neighborhood effects on safety stress or perceived control of stress as measured by
the Cohen perceived stress scale. Conclusion: Our results contribute to evidence that concentrated poverty in urban
neighborhoods is associated with a range of self-reported stressors. Associations remained statistically significant after
controlling for neighborhood racial composition, as well as a wide variety of individual characteristics. Taken together with
evidence suggesting that stressful life conditions are associated with health, the differential distribution of stressful life
experiences by neighborhood poverty level may contribute to disparities in health within urban areas. Community-based
participatory research partnerships that work together to elucidate these relationships can also pool their resources to develop
strategies to address the inequalities that underlie these health disparities.
04
18-
(A): Pollution and Health in Two Toronto Neighbourhoods: Challenges to Ensuring Environmental Justice
Ronald Macfarlane, Loren Vanderlinden, Angela Li-Muller, Murray Finkelstein, Anthony Ciccone
Abstracts
42
Introduction: In the late 1980s, municipal authorities were proposing to expand the sewage treatment plant at Ashbridges Bay
(ABTP) in Toronto and begun an environmental assessment process. To address unresolved concerns, the City of Toronto entered
into a mediation process with representatives of the surrounding community, which resulted in an agreement to undertake
various studies, including an Air Emissions Study of the ABTP and a Health Status Study of South Riverdale and The Beaches
communities. Methods: Toronto Public Health gathered a Project Advisory Committee consisting of representatives of the
community, City staff, government experts and other stakeholders who were involved in defining the scope of the studies,
provided input into the study design, and reviewed draft reports. Each study was led by a project team consisting of Toronto
Public Health staff, academic experts and the consultant hired to undertake the research. In the Air Emissions Study, an inventory
was made of the all chemicals that could potentially be emitted from the plant and emissions of 17 chemicals of most concern
were modelled over time until 2010. Modelling results were compared against air quality standards and health benchmarks. The
Health Status study looked at mortality (for circulatory and respiratory causes), hospitalization (for circulatory and respiratory
causes), and cancer mortality and incidence (for lung, brain and blood-related cancers). Comparator neighbourhoods were
identified using a deprivation index that considered income, education and unemployment. On study completion in May 2005,
results were reported to the Toronto Board of Health and a public meeting. Results: Overall, with the closing of the incinerators
(in 2003) and the installation of odour controls the impact of ABTP emissions on local air quality is reduced and meet health
based criteria by 2010. The health status study results suggested that there were higher rates of death and hospitalization in
these communities compared to similar neighbourhoods elsewhere in Toronto. Conclusions: While it was not possible to assess
the relative contribution of various factors, it was concluded that the differences in health outcomes were likely due to an
inequitable distribution of adverse influences on health, including both socio-economic factors and local sources of industrial
pollution. There is a challenge to identifying the most appropriate public health response to concerns about the impact of
pollution on residents in a neighbourhood, especially when facilities of concern meet environmental standards. This presentation
discusses ways to address environmental justice issues.
05
18-
(A): Community Health Study in 'Chemical Valley', Sarnia, Ontario
Dominic Atari, Isaac Luginaah, Eleanor Maticka-Tyndale, Karen Fung, Iris Xu, Kevin Gorey, Margaret Keith, Abe
Reinhartz
Introduction: This research investigates the perceptions of health risks posed by the environment in the Sarnia, Ontario. The
Sarnia area is highly industrialized with major companies like Bayer, Dow Canada, and Esso all having plants located there. These
industries are all clustered along the St Clair River. Hence the area is generally known and as 'Chemical Valley'. Recently the area
and many others in the Great Lakes region received popular and political attention when Health Canada using existing levels of
environmental pollution designated some geographic regions as 'Areas of Concern'. 'Chemical Valley' found itself within the St.
Clair River 'Area of Concern'. This 'labeling' was based on the hypothesis that environmental pollution negatively affects health.
Further, the Health Canada report concluded that there is limited scientific research, on the environmental determinants of
health in designated 'Areas of Concern'. This presentation is part of a larger research program that responds to the call by
Health Canada for investigations into the health of populations living in these areas. It addresses residents' risk awareness,
understanding of and responses to living in a 'place' called 'Chemical Valley' and in a designated 'Area of Concern'. Methods:
We conducted 27 in-depth interviews with key informants and community members. The interviews were guided by a checklist
containing topics related to our key objectives. The contents were analyzed using grounded theory. Results While residents
identified the beauty of the waterfront and employment opportunities as major benefits of living in the area, the images of
Sarnia as a highly industrialized landscape referred to as 'Chemical Valley' were obvious during the interviews. Participants
frequently referred to numerous industrial plants, invisible and odourless emissions, noise annoyance, soot deposits, the orange
haze, smog and traffic in the area. Children and long-term health effects were a major concern for participants. The stigma
associated with 'Chemical Valley' within an 'Area of Concern’ was applied not only by 'outsiders’ but also differentially within
Sarnia itself, with people from the North end of the city, frequently saying those in the South, and geographically closest to the
'Valley' are the ones to worry. Residents tend to employ emotion-focused coping strategies such as pragmatic acceptance, and
problem-focused strategies such indoor evacuation. Conclusions: These findings suggest that there is a need for local health
policy that moves beyond the focus on technological measures to reduce emissions to address the psychological and social
concerns of residents in 'Chemical Valley'.
Immigrants and Urban Health
01
19(A): Community-based Intervention Strategies to Prevent Obesity Among Turkish and Moroccan Women in
Amsterdam
Hilda van't Riet, Henriette Dijkshoorn, Renee Corstjens
Introduction: Over 80% of Turkish and Moroccan women in Amsterdam are overweight. However, little is known about effective
strategies to prevent overweight in these groups. This project aimed to identify determinants and prevention opportunities and
to develop interventions with participation by the target population and intersectoral collaboration with stakeholders from
professional and policy making backgrounds. Methods: The research identified specific determinants of obesity for Turkish and
Moroccan women in Amsterdam and possibilities for prevention of obesity, by conducting in-depth interviews with professionals
involved with these women: community migrant activity workers, dieticians, fysiotherapists, community sports workers, and
others. Furthermore, target group women were interviewed and invited for group discussions, together ensuring involvement of
all stakeholders early in the project. During intervention development, group meetings were held with target group women and
other stakeholders. Jointly, decisions on interventions to be developed were taken. Target group women volunteered to
participate in subgroups to help develop the interventions and ensure activities fit into their daily lives and take into account the
obstacles the women experience, as the research had shown. Results: Obesity was considered a problem among the women. All
women showed interest in performing sports activities, main obstacles for participation being the presence of men, time of day,
price and distance. Aerobics classes were favourite with the target group and have been organized for women only, during
school hours, for an affordable price, in two nearby places. Women indicated knowing what is healthy or unhealthy about
nutrition, but not how to implement it at home, therefore, an intervention was developed to learn skills for daily life. The
intervention consisted of a tour in shops where the women buy their daily groceries with a dietician and two cooking sessions
with healthier versions of traditional recipes. Conclusions and implications: The community-based approach enabled the
tailoring of interventions to the needs and possibilities of the target groups, providing opportunities for structural embedding
and policy change. This may lead to longterm increased physical activity among the target group and availability of a tailored
nutrition intervention for all Turkish and Moroccan women in Amsterdam. Lessons learned are: all stakeholders have to be
informed and involved early in the project; they have to be informed of all steps and results continuously to keep them involved;
the start of the activities has to be as fast as possible, after the joint decision process, otherwise the target group will loose
interest.
02
19-
(A): Help-Seeking Rates for Intimate Partner Violence (IPV) Among Canadian Immigrant Women
llene Hyman
Objective: Violence against women has been identified both as a major public health issue throughout the world. Although
there are many forms of violence against women, this paper deals specifically with intimate partner violence (IPV). Despite the
serious adverse health impacts of IPV on women's lives, studies suggest that many abused women do not seek help. However
little research has been conducted on help-seeking for IPV among immigrant women. It is well recognized that immigrant
women are not a homogeneous group and that factors such as length of stay influence health and health behaviour. The
objective of this study was to examine rates of help-seeking for intimate partner violence (IPV) among recent (0-9 years in
Canada) and non-recent (10+ years in Canada) immigrant women. Methods: The study involved the secondary analysis of data
from the 1999 GSS, a national, cross-sectional, voluntary telephone survey conducted by Statistics Canada since 1985. Help
seeking variables included disclosure of IPV, reporting IPV to police, use of social services subsequent to IPV, and barriers to social
service use. Results: Among the 8,842 female respondents with had a current or ex- partner with whom they had contact within
the previous 5 years, 1,596 (18.0%) were immigrants and within this group, 389 (24.4%) were recent and 1,207 were non-recent
immigrants. Recent immigrant women who experienced abuse were less likely than non-recent immigrant women to disclose IPV
to family, friends or neighbors, or others but differences in rates of disclosure were not statistically significant. Compared to non
recent immigrant women, recent immigrant women were significantly more likely to report IPV to the police (50.8% vs.26.0%).
Recent immigrant women were significantly less likely to use social services compared to non-recent immigrant women (30.8%
vs. 52.8%). The majority of non-recent immigrant women did not seek help because they did not want or need help. The main
reason why services were not used among abused non-recent immigrant women was the same as that reported by women in the
general population Conclusions: This study was among the first to examine help-seeking for IPV among recent and non-recent
immigrant women using a large population-based representative sample. Findings indicate that immigrants are not a
homogeneous group and rates of help-seeking, particularly reporting IPV to police and using social services, vary according to
length of stay in the host country. Study findings have important implications for prevention and detection of IPV in immigrant
communities and future research.
03
19-
(A): Serologic Immunity to Chickenpox Among Adult Immigrants and Refugees in Toronto
Kamran Khan, Kim Chow, Miriam Cho, Vicky Fong, Jun Wang, Meb Rashid
Introduction: Chickenpox is a highly contagious illness caused by the varicella zoster virus. Prior studies have suggested that the
global distribution of varicella is correlated with distance from the equator (i.e. higher incidence in temperate versus tropical
climates). While chickenpox has historically been considered a right of passage for children born in Canada, children from less
developed parts of the world often remain susceptible to this infection into adulthood. Thus, some immigrant groups are at
elevated risk of developing chickenpox in Canada as adults. This scenario is particularly worrisome given that chickenpox can
cause severe illness in adults, with more than one in three infections resulting in death. Despite this fact. Citizenship and
Immigration Canada (CIC) does not require that new immigrants provide evidence of immunity to varicella during their
immigration medical exam. Universal or targeted screening for immunity may be useful in identifying at risk groups who could
benefit from vaccination. However, the efficiency of this approach is unclear given the current lack of information regarding the
epidemiology of immunity to varicella among adult immigrants. Methods: We identified 328 adults, 15 years of age or older,
who were screened for serologic immunity to varicella 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 varicella. Results: 93% of immigrants had no prior immunization records. Overall. 89% of the 328 immigrants tested for
immunity to varicella were found to be immune; 84% of those under the age of 20, 89% of those between 20 and 39 years of
age, 94% 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 not associated with immunity to varicella. Of note, 47% of immigrants from the
Caribbean islands (n=34) were identified as lacking immunity to varicella. Conclusions: Immunity to varicella appears to be
suboptimal among younger adult immigrants and those emigrating from the Caribbean islands. Targeted screening of these
groups may be warranted in order to identify individuals who could benefit from varicella vaccination and subsequently prevent
the development of this highly contagious and potentially life-threatening illness.
04
19(A): The Role of the Urban Environment on Discrimination Among Latino Day Laborers and Migrant
Workers in California
Alex Kral, James Quesada, Daniel Cearley, Andrea Scott, Assunta Ritieni
Abstracts
Introduction: Latino migrant workers are often marginalized in the US based upon ethnicity, language, documentation status,
poverty, and occupational status. Such discrimination can contribute to the risk environment for these individuals and have
deleterious health effects by limiting basic access to health care, employment, housing, and food. Objective: To assess whether
Latino migrant laborers differentially experience discrimination based upon whether they are living in urban or non-urban areas.
Methods: Ethnography and quantitative data collection were conducted with Latino day laborers in San Francisco, CA (SF urban) and migrant agricultural workers in Monterey County, CA (MC - non-urban) in 2004-2005. Ethnography was conducted in
each area by local ethnographers. The quantitative study included 251 participants and consisted of a 45 minute survey,
conducted in Spanish, and HIV testing/counseling. Results: The quantitative sample was 72% male, 42% under 30 years old, and
88% Mexican or Mexican American. The median amount of time since moving to the US was 21 months. There were sizable
differences in self-reported discrimination by urban/non-urban location. Discrimination overall was reported by 65% of urban
workers and 46% of non-urban workers. Urban workers were more likely than rural workers to report discrimination based on
Hispanic descent (48% vs. 26%); language (54% vs. 15%); poverty (35% vs. 7%); and documentation status (44% vs. 5%).
Laborers in the urban setting were also more likely to report that discrimination limited their access to health services (27% in SF
vs. 4% in MC), employment (62% in SF vs. 17% in MC), and housing/food (3686 in SF vs. 13% in MC). All reported differences are
statistically significant (p <.0S). Ethnographic data corroborate these findings. Conclusion: Experiences of discrimination are more
common among Latino day laborers in urban settings than migrant workers in non-urban settings. Self-reported discrimination
has an adverse effect on to access to health and other basic services. Work is needed understand the features of the urban
environment that contribute to the experience of discrimination among Latino laborers.
05
19-
(A): Socioeconomic Disparities in Birth Outcomes By Recent Immigration Status in Toronto, 1996-2000
Marcelo Urquia, Richard Glazier, John Frank, Rahim Moineddin
Introduction: The city of Toronto receives around half of all the immigrants to Canada every year. Immigrants arrived within a
five-year period account for one third of all deliveries in recent years, contributing to shape the reproductive outcomes of the
entire city. While it is well known that socioeconomic disadvantage increases the risk of adverse birth outcomes, it is uncertain
how this affects the outcomes of recent immigrant mothers. This study assesses the differential effects of socioeconomic
disadvantage in selected birth outcomes among infants born to recent immigrant mothers and long-term Toronto residents.
Methods: A study population of 142,748 infants born in Toronto in the years 1996 - 2000, including several maternal and
pregnancy characteristics, was extracted from the Discharge Abstract Database. Information on recent immigration status of the
mothers was obtained from the Ontario Health Insurance Plan, and socioeconomic position (SEP) was expressed as a score based
on neighborhood low-income quintiles, obtained from the Census 1996. A cross-sectional design was used to model preterm
birth (PB), low birth weight (LBW), and full-term small-for-gestational-age (FT-SGA), by means of multiple logistic regression. All
analyses were carried out with SAS 8.2. Results: After controlling for maternal and pregnancy characteristics, the adjusted Odds
Ratios between the most disadvantaged and the most advantaged quintiles were consistently stronger among long-term
residents compared to recent immigrants: AOR (95% Cl): 1.30 (1.19-1.43) versus 1.01 (0.86-1.18) for PB; 1.50 (1.35-1.68) versus
1.24 (1.05-1.46) for LBW; and 1.60 (1.35-1.89) versus 1.32 (1.04-1.68) for FT-SGA, respectively. The difference between the two
subgroups is also evident for the remaining income quintiles. Conclusions: Recent immigrants are contributing to reduce
Toronto's PB rates and also the SEP disparities in PB, LBW, and FT-SGA, beyond the pattern that would exist in the absence of
such immigration. Long-term resident women living in low-income areas constitute a more vulnerable population for birth
outcomes, suggesting the influence of lasting socioeconomic disadvantage. The differential role that socioeconomic
disadvantage plays in these subgroups should be taken into account by health promotion and prenatal programs. Further
research is encouraged to unravel differential pathways leading to adverse birth outcomes in these subpopulations.
Injection Drug Use in Urban Settings
01
20-
(A): Vancouver's Supervised Injection Facility; The First Two Years
Mark Tyndall, Evan Wood, Ruth Zhang, Julio Montaner, Thomas Kerr
Background and Objectives: North AmericaVs first government sanctioned supervised injection facility (Insite) was opened in
September 2003 as part of a comprehensive approach to problem drug use. It was established in the Downtown Eastside (DTES)
of Vancouver that is home to an estimated 7,000 injection drug users (IDUs) with HIV prevalence rates approaching 30%. It is
open 16 hours per day (10:00 am - 4:00 am) and allows individuals to inject pre-obtained drugs in a clean, monitored
environment. We describe the attendance, demographic characteristics, drug use patterns, and interventions conducted during
the first 24 months of operation. Methods: A non-obtrusive, but highly efficient database has been established at Insite. Clients
are required to sign- in at each visit using a moniker of their choice. In addition to attendance records, the database records type
of drug being injected, time at Insite, nursing interventions, counseling, and referrals. The data is kept in a secure database that
ensures client confidentiality. All users of Insite are asked to sign a waiver that outlines the liabilities and expectations of the
participants. Results: Attendance has remained steady at between 600 to 800 visits per day and over 4,700 different individuals
have used the site at least once. The median age is 39 years, 73% are male, and 22% are Aboriginal. The drugs injected are
mainly opiates (37% heroin, 13% morphine, 5% dilaudid, 1% oxycotin) and cocaine (29% cocaine powder, 4% crack cocaine).
There have been no fatal overdoses (OD), although the staff has performed 190 OD interventions. Over 2,000 referrals have been
arranged and include addiction counseling, withdrawal management, hospital assessment, methadone maintenance therapy,
and housing. Conclusions: Insite is now well established in the DTES community and has been used by over 4,700 individuals
during the first 2 years. Concerns that women, people of Aboriginal ethnicity, and cocaine users would be underrepresented
have been largely unfounded. Health and social outcomes are being prospectively measured in order to evaluate the health and
social impacts of Insite on this community and determine if more of these facilities are required.
02
20-
(A): HIV Outbreak Among Injecting Drug Users in the Helsinki Region: Social and Geographical Pockets
Pia Kivela, Anneke Krol, Susan Simola, Mari Vaattovaara, Pekka Tuomola, Henrikki Brummer-Korvenkontio, Matti
Ristola
Introduction: Incidence of newly diagnosed HIV infections among injecting drug users (IDUs) in Helsinki rose from 0 per 100000
inhabitants in 1997 to 2,9 in 1998 and to 11,1 in 1999. Thereafter incidence declined to 2,1 in 2003. If HIV has spread among
young or casual drug users, continued transmission might occur among IDUs and between IDUs and the general population.
Here we studied the sociodemographic profile and spatial distribution of HIV-positive IDUs who were diagnosed in the
beginning of the Finnish outbreak and those diagnosed later. Methods: Data were collected from interviews of 176 HIV-positive
IDUs who attended the university hospital in Helsinki from 1998 until 2003. The indicator used to illustrate the spatial
differentiation within the Helsinki metropolitan area is % employed males aged 25-64. Results: The HIV outbreak occurred
among a very marginalized population of IDUs characterized by a long history of injecting drug use (10,7 years), mean age of 32
years, homelessness (66,3%), and history of imprisonment (74,7%) and psychiatric hospital care (40,6 %). Compared with 98 early
cases diagnosed during the first 2 years of the epidemic, 47 recent cases diagnosed after 2001 were slightly (4 years) older but
equally marginalized. Except for the Helsinki city centre, both early and recent cases had been living or using drugs in the same
deprived neighbourhoods with the highest unemployment rates. Up to 40% of cases in the biggest clusters did not have contact
with the city centre where the needle exchange services were available. Conclusion: The Finnish HIV outbreak is restricted
socially to a very marginalized IDU population, and spatially to local pockets of poverty. This favors early decentralization of
prevention activities in low prevalence countries.
03
20-
(A): Risk Profile of Individuals Who Provide Assistance With Illicit Drug Injections
Nadia Fairbairn, Evan Wood, Will Small, Jo-Anne Stoltz, Kathy Li, Thomas Kerr
Introduction: Receiving assistance with injections is a common practice among illicit injection drug users (IDU) that carries
significant risk for health-related harm, including increased risk for HIV infection. However, little is known about individuals who
provide assistance with injections. In order to better understand this risk behaviour among IDU, the present study was
undertaken to characterize individuals who provide assistance with illicit drug injections. Methods: We evaluated factors
associated with providing help injecting among participants enrolled in the Vancouver Injection Drug User Study (VIDUS) using
univariate and logistic regression analyses. We also examined the self-reported relationship between the provider and the
receiver of assisted injections, if compensation was offered for assistance with an injection, and the type of compensation
offered. Results: Of the 704 IDU followed between December 31, 2003 and May 1, 2004, 193 (27.4%) had provided help injecting
during the last six months. Variables independently associated with providing help injecting included: lending one's own syringe
(adjusted odds ratio [AOR] = 3.99, p = 0.004), frequent heroin injection (AOR = 3.75, p < 0.001), unstable housing (AOR = 2.15, p
< 0.001); bingeing (AOR = 2.01, p = 0.012), frequent cocaine injection (AOR = 1.95, p = 0.002), and frequent use of crack cocaine
(AOR = 1.85, p = 0.002). Help was most often provided to a casual (47.1%) or close friend (41.5%). Of the 96 (49.7%) individuals
that received compensation for providing help, the most common forms of compensation were drugs (44.6%) and money
(22.8%). Conclusion: Providing help injecting was a common practice among IDU in this cohort that was independently
associated with various high-risk behaviours, in particular, markedly elevated levels of syringe lending. These findings indicate
the need for interventions, such as increased education concerning proper sterile injecting techniques and policy changes to
allow assisted injection at safer injection facilities (SIF), which aim to offset the risks associated with this dangerous practice.
2004
(A): Examining the Effects of Illicit Drug Markets and Local Labor Markets on Employment and Self-Rated
Health in Philadelphia
Chyvette Williams, Aaron Curry, Julie Becher, Dennis Culhane
Introduction: Unemployment is a serious problem in inner cities and adversely affects health. Lack of convenient, adequate-wage
jobs and presence of illicit drug markets contribute to inner city unemployment. Evidence suggests that illicit drug markets are
often geographically located in economically disadvantaged neighborhoods, including neighborhoods with few and/or
"undesirable" businesses. Theoretically, illicit drug markets can be linked to unemployment via several mechanisms including
historical redlining practices and by offering residents an alternative to mainstream employment. To date, no one has examined
the effect of this phenomenon on the health of local residents. The primary aim of this study is to examine the effect of local
labor markets, presence of drug markets, on individual employment status and self-rated health. Methods: This is a multi-level
study employing data at both the individual and census tract levels. Individual-level employment and health data (N=4133) come
from a representative sample of adults living in Philadelphia in 2002. Tract-level data (N=365) come from both the Philadelphia
Police Department and the 2000 US Census. We use multiple logistic regression to test the association of local labor market and
illicit drug market presence on individual employment status and self-rated health. We use the percent of non-institutionalized,
non-disabled working age persons who are not in the labor force (discouraged workers) and average commute time to work (job
spatial mismatch) as measures of job availability in local areas, and the number of drug arrests in an area as a measure of illicit
drug market presence. Results: Significant positive correlations were found between drug market presence and percent of
population not in the labor force. In unadjusted models, drug market presence and depressed local labor markets were
significantly associated with both poorer self-rated health and increased unemployment. Further, unemployment was
significantly associated with poorer self-rated health status. Results from adjusted models controlling for demographics, show
that the relationship between depressed local labor markets, individual unemployment, and poorer self-rated health persists.
Conclusion: Drug market presence and depressed labor markets are associated with poorer health and the relationship is
mediated by employment status. Drug market presence varies significantly by race and socioeconomic status variables, which
may account for the attenuated relationship between drug market presence and health in the adjusted models. Implications for
policy indicate a need for business re-investment and improved drug control strategies in disadvantaged neighborhoods in order
to improve health of urban residents. Additional research in this area is needed.
2005
(A): Residence in Vancouver’s Downtown Eastside and Elevated Risk of HIV Infection Among a Cohort of
Injection Drug Users
Benjamin Maas, Nadia Fairbairn, Evan Wood, Julio Montaner, Kathy Li, Thomas Kerr
Background/Objectives: Vancouver's Downtown Eastside (DTES) is home to over 16,000 long-term residents, and approximately
4,700 of Vancouver's estimated 8,000 injection drug users (IDUs) live in the underprivileged neighborhood. This study was
undertaken to investigate geographic residence in a poor, urban neighborhood as an environmental risk factor for HIV infection
among IDUs. Methods: We evaluated baseline factors associated with DTES residence among participants enrolled in the
Vancouver Injection Drug User Study (VIDUS), a prospective observational cohort study. HIV incidence rates were examined using
Kaplan-Meier methods and Cox proportional hazards regression. Results: Of 1035 IDUs recruited between May 1996 and
December 2004, 582 (56.2%) reported DTES residence at baseline and 453 (43.7%) reported residing elsewhere in Vancouver. At
baseline, DTES residents were more likely to be 24 or older (odds ratio [OR] = 1.6; p = 0.004), Aboriginal (OR = 1.6; p = 0.003),
reside in unstable housing (OR = 6.9; p < 0.001), be involved in the sex trade (OR = 1.3; p = 0.044), inject cocaine daily (OR = 1.8;
p < 0.001), and to inject drugs at a shooting gallery (OR = 1.4; p = 0.03). At 48 months after recruitment, the cumulative HIV
incidence rate was 16.1% among those who resided in the DTES compared to 8 9% among those who resided in other areas of
Vancouver (p < 0.001). In the adjusted Cox model, DTES residence remained independently associated with time to HIV
seroconversion (relative hazard = 2.02, 95% Cl: 1.35-3.00, p < 0.001) after adjustment for other statistically significant risk factors
Conclusion: While some risk factors were more common among DTES IDUs, DTES residence remained an independent predictor
of HIV seroconversion after substantial multivariate adjustment. Targeted structural interventions and broader community-level
development programs are needed in higher-risk neighborhoods like the DTES in addition to the more general public health
efforts that target IDU risk behaviors. Overall, these findings indicate the need for a greater recognition of geographic location
as a determinant of HIV transmission in urban settings and an increased awareness of the higher infection risk associated with
residence in an under-serviced urban neighborhood.
HIV Intervention and Risk Reduction Strategies
2101
(A): Addressing the Methamphetamine-Sexual Risk-Taking Link among MSM: Information Exchange
Between Science and Practice
Perry Halkitis, Barbara Warren
Behavior researchers at New York University's Center for HIV/AIDS Studies & Training in collaboration with the Lesbian, Gay,
Bisexual and Transgender Community Center of New York City conducted a targeted capacity expansion project to develop
methamphetamine prevention education and services targeted to gay, bisexual and other men who have sex with men (MSM) in
the greater New York metropolitan area. The infrastructure project was funded by the Substance Abuse and Mental health
Service Administration (SAMHSA) and included the development of two components (1) internet and community-based outreach
with development of prevention education methods, resources and activities, and (2) development and evaluation of a
prevention counseling intervention using Motivational Enhancement Therapy to reduce risk behaviors, targeting potential and
current users of methamphetamine and other dub/party drugs commonly associated with sexual risk taking and the transmission
of HIV. The overall goal of this project, the Crystal Meth Prevention and Intervention Services Initiative (CMPII), was to develop
the capacity to implement an outreach, education and intervention initiative targeted at gay, bisexual and other men who have
sex with men (MSM, ages 18 and up, in New York City who are current or potential users of crystal methamphetamine and other
frequently associated party drugs (e.g., MDMA, ketamine etc.). Our work led to the development of print and Internet based
materials, the first of their kind in New York City, as well as trainings of local area practitioners and dissemination of
intervention strategies targeting the dual methamphetamine-HIV transmission epidemic. We propose to share the processes
involved in this collaboration with an emphasis on the manifestation of the science-practitioner model, and provide quantitative
findings from our Internet-based data collection system as well as our peer forums and therapist trainings. The work that will be
described provides a strong model of translation of behavioral research into the communities of need.
02
21-
(A): HIV Risk Taking and Associated Cultural Factors
Clemon George
Introduction: Epidemiologists have not yet fully accepted the principles of community based research and as a result, these
studies do not fully serve the needs of their target populations. Further, studies of the determinants of high risk behaviour for
HIV seldom take into account participant's cultures, further reducing their utility for prevention initiatives. The present work
illustrates this gap and identifies different ways of improving epidemiological studies. Methods: Three epidemiological research
of sexual behaviour were critically analyzed to appraise how sexual orientation, cultures, and ethnicities of participants, within
the context of their social, economic and political environments were integrated into the studies. The first study was a cross
sectional study of sexual behaviour among high school students, conducted in Dominica in 2000. The second study looked at the
changes in high risk sexual behaviour among men who have sex with men (MSM) in Montreal (1997 - 2003). That study was
based on the Omega Cohort, a longitudinal study to determine the incidence of HIV in Montreal and psychosocial, demographic
and other factors associated with seroconversion to HIV. The third study characterised the sexual and other high risk behaviour
of 4 groups of MSM — White born in Canada, White born outside of Canada, other race/ethmcity born in Canada, other
race/ethnicity born outside of Canada — based on data gathered from the Omega Cohort and the Vanguard Project, a similar
study to the Omega study but carried out in Vancouver. Results: The results of the studies themselves are important to HIV
prevention activities in these populations: the first study showed that early sexual activity and inconsistent condom use were
frequent among girls; the second study showed that the proportion of men practising unprotected anal intercourse (UAI)
increased over time; the third study showed that White men who were born outside of Canada were more likely to practice UAI
while travelling outside of their home province. However, there were clear indications that the usefulness of the studies to
community based AIDS organizations could have been improved, if the target communities were involved in all stages of the
research process. Conclusion: The results of this study emphasize the need for a more targeted approach to epidemiological
studies of diverse populations. It is imperative that scientific investigators adopt a community based approach in carrying out
epidemiological studies so that more appropriate and meaningful results will be obtained, leading to more effective
intervention strategies.
03
21-
(A): The Delayed Engagement With Healthcare: Experiences of People With HIV/AIDS in Beijing, China
Introduction: Epidemiological reports state that by the end of 2003, the estimated cumulative number of HIV cases in China was
840,000 (SCAWCO & UNTG, 2004). However, only about 10 per cent of the estimated HIV/AIDS cases were confirmed by health
authorities (ibid.), which means that the predominant majority of this population has not yet accessed AIDS-related health
services. Most current research on HIV/AIDS in China is carried out from an epidemiological perspective, paying little attention to
the health and health practices of people living with HIV/AIDS (PLWHAs). This paper focuses on examining the healthcare
experiences of Chinese PLWHAs, shedding light on various barriers this population faces in accessing healthcare. Methods: Using
a phenomenological approach, the data of this study were collected through semi-constructed in-depth face-to-face interviews
with 10 forefront professionals working with Chinese PLWHAs and with 21 adult PLWHAs 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. Results: Healthcare is perceived as one of their
primary needs by Chinese PLWHAs in this study. Three main themes in this regard are identified. First, the post-infection
healthcare access of Chinese PLWHAs was constrained by the availability of health-related resources and social discrimination
towards PLWHAs in China. Lack of AIDS knowledge had delayed PLWHAs in taking the HIV test, which, subsequently, delayed
their engagement with health care services. Second, affordability was reported to be a salient barrier to PLWHAs' accessing
antiretroviral drugs, while the widespread discrimination also inhibited those who had medical welfare using it. Though some
participants obtained free medication through participating in drug trials, extreme side effects to these medicines were often
reported. Third, PLWHAs' interactions with health workers played an important role in their post-infection health and well
being, though the negative interactions in this regard often proved to be destructive. Conclusion: The results of this qualitative
study illustrate the gaps existing between the current institutional resources (e.g., knowledge dissemination, health/social
welfare and service delivery) in China and the post-infection needs of Chinese PLWHAs as a group. This type of knowledge is
important for developing more sensitive and responsive policies, programs, and service delivery systems for this population,
which, in turn, will improve their access to health services and quality of life in the long term.
04
21(A): Employing Social Network Analysis in the Evaluation of Information Provision for HIV-Positive Patients:
An Exploratory Study
Dean Behrens, Warren Winkelman
Introduction: Health information, such as that found in brochures and on public web sites, has little to no effect on behaviors or
health outcomes if it is not accepted and used by patients. We intend to demonstrate through social network analysis that
consideration of social context of information provision is essential to maximize the positive impact of information promoting
health and wellness behaviors among urban dwelling HIV-positive individuals. Methodology and Methods: An exploratory
approach was employed: 81 individuals with HIV infection or at risk for HIV infection were recruited through focused advertising
in daily Toronto newspapers. Semi-structured interviews captured each individuals HIV-illness experience, ego-centered social
environment, information and socio-emotional support needs, demographics, personality traits, and health status. Data were
collected concerning the size and density of individuals' socio-emotional and informational support networks, the types of
relationships within the networks, the characterization of the relationship with each member of the networks, and the
perception of HIV stigma. In addition, a sub-group of 41 HIV-positive persons were re-interviewed six months later to assess for
changes over time. Results: HIV-positive patients' perceived health status is directly related to perceived informational and socioemotional support. At a network-level of analysis, the perceived stressors and social stigma particular to HIV infection have no
confounding effect on the relationship between perceived support and perceived health status. Conclusions: As in other
populations of chronic patients, informational and socio-emotional forms of support are mutually interdependent for urbandwelling HIV positive patients. However, at a network level, information provides benefits that can potentially overcome the
powerfully destructive impact of HIV-related social stigma. This implies that for some urban-dwelling HIV-positive patients,
information to promote healthy behaviors, sexual and otherwise, may be more effective and perceived as more useful when
distributed through the personal social networks of HIV-positive patients themselves (through virtual communities, shared
private weblogs, private listservs, and on-line support groups), rather than through broad, public campaigns employing the
media, public health institutions, AIDS service organizations and community health centers.
Abstracts
Yanqiu Rachel Zhou
Poster Presentation
- W ednesday
Poster Presentation - Wednesday, October 26, 2005
5:00 - 7:00 pm
P 01
Home Based Care Promotion: Improving Access to
Quality Services and Livelihood in the Face of AIDS
Joseph Kamoga
P 17
Effectiveness of Educational Program For Diabetics On
Hbatc Values
Veena Joshi
P 02
Spatial Variations in AIDS Outcomes Within a Large
Metropolitan Area: Increasing Disparities in the PostHAART Era
Paul Robinson
P 18
Fetal Alcohol Spectrum Disorder: Meeting the Needs of
the Urban Aboriginal Community
Brenda Stade
P 19
P 03
Social Support and Not Socioeconomic Status Is
Predictive of Depressive Symptomatology in Patients
Undergoing Coronary Artery Bypass Graft Surgery
Roberta Hood
Successful Strategies to Regulate Nuisance Liquor Stores
Using Community Mobilization, Law Enforcement, City
Council, Merchants and Researchers
Tahra Goraya
P 20
P 04
Factors Contributing to Drug Abuse Among Truck
Driver in Selected Urban Area of Eastern Part of Nepal
Anil Deo
Accessibility Does Not Necessarily Mean Using the
Health Facilities
Mohammad Fararouei
P 21
P 05
Health Profile of the Street Children of Chandigarh,
India
Shyman Lamsal
Making a SWITCH: Opportunities and Challenges in
Establishing a Student-Run, Interprofessional Health
Clinic in a Saskatoon Core Neighbourhood
Ryan Meili
P 06
Impact of Sexual Abuse/Assault On HIV-Risk-Related
Behaviours in Street Youth
Alison Paradis
P 22
Differences in Mortality Between Amsterdam Heroin
Users of Different Ethnic Groups and the Influence of
Injecting
Marcel Buster
P 07
Developing Resiliency in Children Living in
Disadvantaged Neighbourhoods
Wayne Hammond
P 23
Release From Jail: Moment of Crisis Or Window of
Opportunity For Female Detainees in Baltimore City?
Rachel McLean
P 24
The Health Behaviors of African American Men At
Historically Black Colleges and Universities: Is There
Limited Research?
Daphne Watkins
P 25
Bandar
Wangari Muriuki
P26
Street Outreach - An Innovative Capacity Building
Approach
Valine Vaillancourt
P27
Behavior Change Trials of Improved Practices (TIPS) For
Anemia in Pregnancy and IFA Tablets Consumption in
Vadodara Urban, India
Alpesh Shah
P 28
Profiling Children With Prenatal Cocaine Exposure: A
Pilot Study
Brenda Stade
P 29
Homemaking/Making Home: The Domestic Lives of
Women Living in Poverty and Using Illicit Drugs
Emma Haydon
P 30
Subway Health and Safety Hazards
Robyn Gershony
P 31
Health Capacity: A Different Perspective
Ian Potter
P32
Food Insecurity in Ottawa - Perspectives and
Experiences of Community Workers
Vivien Runnels
P 08
Dilemma of Free Health Care in Spokane, WA
David Bunting
P 09
How HIV/AIDS Have Affected Health Care Services in
Urban Centres of Botswana
Josiah Muritu
P 10
Sustaining an Urban Community-Based Participatory
Research Program Through a National Influenza
Vaccine Shortage
Micaela Coady
P 11
How Do Youth in Urban Communities of Beirut Self
Identify
Maya El Shareef
P 12
Mobility in Prostitution and the Impact of Health
Therese Van der Helm
P 13
Personal Perspectives, Experiences and Consequences of
Food Insecurity in Ottawa
Elizabeth Kristjansson
P 14
Social Citizenship and Health Inequality: Sex-Industry
Workers in Victoria, BC and Sacramento, California
Helga Hallgrimsdottir
P 15
Neonatal Family-Focused Clinical Pathways Promote
Positive Outcomes For an Inner City Community
Brenda Stade
P 16
Integrated Ethnic-Specific Health Care Systems: Their
Development and Role in Increasing Access to and
Quality of Care For Marginalized Ethnic Minorities
Joshua Yang
P 34
Pilot Development and Early Assessment of Maternal
and Child Health Handbook At an Urban Public
Maternity Hospital in Bangladesh
Shafi Bhuiyan
P 35
Is Canada’s Universal Health Care System Universal? A
Description of Undocumented Immigrants At an Inner
City Community Health Centre in Toronto
Meb Rashid
P 36
The Transformation of an Old and Dismissed Hospital
Into a Multi-Functions Center. A Project For the Seaside
Hospital in Venice Lido, Italy
Raniera Barbisan
P 37
Evaluation of a Harm-Reduction Program For StreetYouth With/At Risk For Contracting Hepatitis C: Results
From a Two-Year Study
Alan Simpson
P 48
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
P 49
"Dialogue On Sex and Life": A Reliable Health
Promotion Tool Among Street-Involved Youth
Tracey Methven
P 50
Immigration and Socioeconomic Inequalities in Cervical
Cancer Screening in Toronto, Canada
Aisha Lofters
P 51
Mobilizing For Food Security and Health Research
Charles Levkoe
P 52
HIV Positive in New York City and No Outpatient Care:
Who and Why?
Victoria Sharp
P 53
Measuring Specific Features of Neighborhood
Environments
Mahasin Mujahid
P 38
Healthcare Availability and Accessibility in an Urban
Area: The Case of Ibadan City, Nigeria
Femi Agholor
P 54
A Scale to Evaluate the Urban Neighborhood and Social
Physical Environment
Danielle Ompad
P 39
Drug Use Among Canadian Street Youth: A Comparison
Between Injection Drug Users and Non-lnjection Drug
Users
Olayemi Agboola
P 55
Drugs, Culture and Disadvantaged Populations
Cecilia Rado
P 56
Health Care For One. Health Care For All!
Katharina Kovacs Burns
P 57
Relationship of RBC Folate Level, Serum Vitamin Bl2
Level and BMD in the Elderly Population
Senait Teklehaimanot
P 58
The Community-Hospital Integration Program
Framework: Community-Hospital Partnerships to
Improve the Population's Health
Richard Blickstead
Good Playgrounds Are Hard to Find: Parents'
Perceptions of Neighbourhood Parks
Patricia Tucker
P 59
Longitudinal Patterns of Health Care Utilization Among
Community-Based Injection Drug Users in Baltimore
MD: 1989-2004
Noya Galai
Nutritional Status of Socioeconomically Disadvantaged
Urban Child in Bangladesh: An Anthropometrical,
Haematological and Biochemical Study
Zahirul Hoque
P 60
Modeling Black-White Preterm Birth Disparity: Ecologic
and Multilevel Models
Lynne Messer
P 61
Seeding Research, Sprouting Change: A Funder's
Perspective
Sarah Flicker
P 62
Meeting the Needs of a Very Diverse Community
Yasmin Vali
P 63
Health Services - For the Citizens of Bangalore - Past,
Present and Future
Savita Sathyagala
P 64
Identification and Optimization of Service Patterns
Provided By Assertive Community Treatment Teams in a
Major Urban Setting: Preliminary Findings From
Toronto, Canada
Jonathan Weyman
P 40
The Public Injecting Scene in the City of Vancouver
Will Small
P 41
Successful Methods For Studying Transient Populations
While Improving Public Health
Beth Hayhoe
P 42
P 43
P 44
The Characteristics of Contamination in Mining Area in
Nandan Guangxi and Its Effect On Sustainable Economy
Development
Xiying Zhang
P 45
Public Health and Urban Sprawl in Ontario - A Review
of the Pertinent Literature
Riina Bray
P 46
Emerging Urban Health Service Model-Surat City, India
Vikas Desai
P 47
Socioeonomic Status and Surgery in Children:
Myringotomies and Tonsillectomies in Ontario, Canada,
1996-2000
Ruth Croxford
- W ednesday
The Cultural Context of Postpartum Depression: Results
From a Quantitative and Qualitative Study With First
and Second-Generation Immigrant Women
Paola Ardiles
Poster Presentation
P 33
49
- W ednesday
Poster Presentation
P 65
Availability and Access Exemplified: A Case Study
Ruth Ewert
P 66
Racial/Ethnic Disparities in Trends of Cardiovascular
Disease Risk Factors According to Body Mass Index
Deyu Pan
P 67
Associations of Maternal Depressive Symptoms With
Offspring Substance Use From Childhood to Young
Adulthood in a National U.S. Sample
Jen Jen Chang
P 68
Bringing Health Care Outreach to the Workplace:
Strategies For NYC's South Asian Taxi Drivers
Mitchell Rubin
P 69
Toronto Community Health Profiles: A Strategy For
Reducing Health Inequalities
Dianne Patychuk
P 70
Racial and Ethnic Differences in Unmet Need For Vision
Care Among Children With Special Healthcare Needs in
the United States
Kevin Heslin
P 71
Assessing the Relationship Between Community
Resources and Neighborhood Health and Well-Being in
London, Ontario
Sean Mcintyre
P 72
Identifying and Managing Intestinal Parasitic Worm
Infections in New Immigrants and Refugees to Toronto
Kamran Khan
P 73
Processes of Initiation Into Injection Drug Use
Nooshin Khobzi
P 74
Contaminated 'Therapeutic Landscape': Perceptions of
the Aamjiwnaang First Nation
Kevin Smith
P 75
Health Care and Ethnic Minority Immigrants:
A Canada - United States Comparative Analysis
Daniyal Zuberi
P 76
Applications of Community-Based Participatory
Research (CBPR) in the Development of Innovative
Urban Health Interventions
Shani Harris Peterson
P 77
Promoting Justice and Well-Being in the Community
Through Organizational Change
Leslie Collins, Scot Evans, Diana Mccown, Courte
Voorhees
P 78
Count Us In! - How a Community Based Participatory
Research Project On Social Inclusion "Walks its Talk"
Krissa Fay, Michael Fay, Karen Haan, Tekla Hendrickson,
Adonica Huggins, Barbara Miles, Ramin Shokat
Pourtorab, Catherine Tur!
P 79
Youth Voices: Expression and Action Through Media
Technologies
Harvey Skinner, Charlotte Lombardo, Suhail Abual
Sameed, Aamer Esmail, Rob Davis, Junie Henry
P 80
Social Inclusion, Social Justice and HIV/AIDS: A
Community-Based Research Approach to Examine the
Link Between HIV/AIDS, Health and Housing
Saara Greene, Ruthann Tucker, Amrita Ahluwalia
P 81
Community-Oriented Environmental Undergraduate
Research Projects
Venera Jouraeva
P 82
Ensuring Fair and Accountable Government:
Ombudsman Ontario
Judith Klie
P 01
Prisoner Health Care in Australia - Opportunities For
Addressing Health Deficits
Michael Levy
P 17
Paying the Price to Stay Alive: HIV Medications and
Longevity With HIV Without Future Hopes
Laura Park-Wyllie
P 02
Race and Criminal Justice Involvement Among Injection
Drug Users
Alexis Martinez
P 18
Two Year Results From the Evaluation of Vancouver's
Safer Injection Facility
Thomas Kerr
P 03
Size of the Ethnic Community and Health Status of the
Aging Chinese in Canada: Are Smaller Urban Cities
Better For the Health of Aging Chinese-Canadians?
Daniel Lai
P 19
Underground Community Participatory Research:
Cannabis Compassion Clubs As Outlaw Social Justice
Andrew Hathaway
P 20
P 04
Sherbourne Health Centre: Innovation in Healthcare
For the Transgendered Community
James Read
The Health of Street Youth Compared to Similar Aged
Youth
Beth Hayhoe
P 21
P 05
Using Feminist Action Research to Examine the
Relationship Between Employability and Women's
Health
Vera LeFranc
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
P 22
P 06
Measurement of Socioeconomic Status of Immigrants
to Canada
Farah Mawani
Sharing Expertise: A Role For the Hospital Lactation
Consultant in the Community
Dina McGovern
P 23
P 07
A Systematic Review of the Effectiveness of Behavioural
Interventions to Improve Adherence to Antiretroviral
Therapy in HIV/AIDS
Sergio Rueda
Stigma and Labeling in a Culturally Diverse Society
Hazel Markwell
p ^4
Prevalence of Oncogenic Human Papillomavirus
Infection and Pap Test Abnormalities in Street Youth
Eileen McMahon
p
Determinants of Psychological Distress Associated With
SARS in a Canadian Inner City Hospital
Lorraine Lee
p 26
Health & Housing: Assessing the Impact of Transitional
Housing For People Living With HIV/AIDS
Sue Ferrier
p 27
Child Morbidity and Health Seeking Behavior Among
Slum Residents in Nairobi City, Kenya
Jean Christophe Fotso
P 28
Healthy Cities For Canadian Women: A National
Consultation
Sandra Kerr
P 08
P 09
Care and Treatment For Hepatitis C in Active Substance
Users
Brian Edlin
Realities and Complexities of Community Involvement:
Experiences From Impoverished Urban Neighborhoods
in Lebanon
Afamia Kaddour
P 10
Parental Influence On Adolescent Sexual- Risk
Behaviors: The Role of Communication (An Urban
Perspective)
Salvation Okoro
p 11
The Evaluation of an Inter-Agency Collaborative Care
Team Serving Homeless Men At an Inner City Shelter
Vicky Stergiopoulos
_,g
P 12
Employing Healthy City Platform to Build Up SmokeFree Environments'. Tainan Experience
Susan C. Hu
P 13
Socioeconomic Status and Mortality: For Whom Is There
a Gradient?
Amani Nuru-Jeter
P 14
Perceived Impact of HIV and Its Associated Treatment
On Activity Limitations: Role of Symptom Burden
Sean Rourke
P 15
Content Validation of the Injection Drug User Quality
of Life Scale (IDUQOL)
Anita Palepu
P 16
Healthy Child Screening: An Innovative Service Initiative
AnnMarie Marcolin
Correlates of Homelessness Differ By Gender Among
Poor and Marginally Housed Persons
Elise Riley
P 30
Indoor Air Quality As an Issue of Social Justice
Ann Phillips
P 31
Urban Health in a Large City: The Case of Mumbai, and
the Role of the Voluntary Sector
Anant Bhan
Pp
Welcome to UFO: Community Based Participatory
Research With Young Injection Drug Users in San
Francisco
Lydia Guterman
P 33
Welfare: Definition By New York Ci'
Maribeth Gregory
pG v - l%0
09 378 Coy-
- T hursday
7:30 - 8:45 am
Poster Presentation
Poster Presentation - Thursday, October 27, 2005
51
- T hursday
Poster Presentation
P 34
The Need or Developing a Firm Health Policy For Urban
Informal Workers: The Case of Urban Farmers in Kenya
Chrispus Kiliko
P 50
Levelling the Playing Field - Bridging Services For
Underserved Cancer Patients
Joanne Hohenadel
P 35
Utilization of Mammography Screening and Predictors
of Utilization Among Muslim Women in Southern
California
Magda Shaheen
P 51
Can Social Responsibility Be Taught? Exploring the
Impact of a Service Learning Strategy On Attitudes of
Health Sciences Students Towards Poverty,
Homelessness and Future Practice
Dyanne Semogas
P 36
Working Conditions and Mental Health Among Elderly
From Three Underprivileged Urban Communities in
Beirut
Monique Chaaya
P 52
Evolution of Research Design With Workplace
Stakeholders As Part of the Process
Desre Kramer
P 53
Paws For Thought
Paula Tookey
P 54
Heart Failure: An Urban Crisis
Maribeth Gregory
P 55
Assessing the Effectiveness of Different Methods of
Communication On Farsi-Speaking Immigrants'
Perception Toward and Intention to Use a GovernmentSponsored Health Information Program in Greater
Vancouver Area
Irving Rootman
P 56
Folic Acid Knowledge and Use in a Large Multi-Ethnic
Pregnancy Cohort: the Role of Language Proficiency
Manon Van Eijsden
P 57
Intra Urban Disparities and Environmental Health:
Some Salient Features of Nigerian Residential
Neighbourhoods
Olumuyiwa Akinbamijo
P 58
Disabled Children in Kerala in South India: A Fresh Look
Into Their Health Status and Quality of Life
Subodh Kandamuthan
P 59
Do Older Widows Better Off in Urban Setting in India.
Evidence From National Sample Survey
Pushpanjali Swain
P 60
Health Sector Reforms in Kenya and Its Implications On
Healthcare Access and Availability
Chrispus Kiliko
P 61
Perceptions About Immunization Among African
American and Hispanic Parents in Los Angeles County
Magda Shaheen
P 62
Community Health Integration in Action: Collaborative
Approaches to Improve the Health of Urban
Populations in Toronto Downtown West
Eleanor Sam
P 37
Understanding Dominican Mothers' Beliefs, Knowledge
and Practices Related to Feeding Infants and Children
Lynn Babington
P 38
Radiation Induced Pollution in Kerala in South India:
Health Care Availability and Access to the Local Poor
Subodh Kandamuthan
P 39
Preparing Social Workers to Be Leaders in Response to
Aging Urban Populations: The Practicum Partnership
Program
Sarah Sisco
P 40
From Resistance to Celebration: The Anatomy of a
Dynamic and Cost Effective User-Run Needle
Exchange/Harm Reduction Program in Toronto
Raffi Balian
P 41
How Can Community-Based Funding Programs
Contribute to Building Community Capacity and How
Can We Measure This Elusive Goal?
Tammy Simpson
P 42
Justice As a Determinant of Community Well-Being:
Illustrations From the Lives of People With Disabilities
Ora Prilleltensky
P 43
Title Mobile Behaviour Change Communication As a
Tool For HIWAIDS Prevention Strategy
Wale Alabi
P 44
Intra-Urban Dynamics of Dengue Epidemics in Belo
Horizonte City, Brazil, 1996-2002
Waleska Caiaffa
P 45
Implementing an HIV and STD Screening Program in an
Emergency Department (ED): Lessons Learned
Abigail Silva
P 46
Maternal & Child Health and Neighborhood Context:
The Selection and Construction of Area-Level Variables
Jessica Burke
P 47
Enhancing and Supporting Local Capacity Through
Community Integration
Susan Owen
P 63
A Study On Patients Perspectives Regarding
Tuberculosis Treatment
Sathiya Chander
P 48
Understanding Homosexuality in the Context of
HIV/AIDS: Illness Experiences of Men Who Have Sex
With Men in China
Yanqiu Rachel Zhou
P 64
Eating Our Way to Justice: Widening Grassroots
Approaches to Food Security, the Stop Community Food
Centre As a Working Model
Charles Levkoe
P 49
Beyond Participatory Research: Promoting RecoveryOriented Praxis Based On the Indigineous Knowledge
of Consumer/Survivors
Joan Nandlal
P 65
The Mobile Health Unit: An Urban Reproductive Health
Model For Immigrant and Refugee Women
JoAnne Hunter
52
P 83
Building a Healthy City: Community Engagement in
Neighbourhood Environmental Planning
Paul Young
p 84
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
P 85
Program and Policy Directions: Including Low Income
Women With Children
Rachel Rapaport Beck
P 86
Do Lesbians Need Papanicolau Tests?
Amanda Hu
p 87
International Cooperation in Health Care Between
Low-Middle Income Countries: the Case of Venezuela's
"Barrio Adentro"
Sergio Rueda
Embodied Marginalization: Young Men With Muscular
Dystrophy and Symbolic Violence
Barbara Gibson
p 88
Serologic Immunity to Measles Among Adult
Immigrants and Refugees in Toronto
Kamran Khan
Friends in Good Places: A Mixed-Methods Evaluation of
the Neighborhood Health Initiative in Des Moines, Iowa
Disa Lubker
p 89
Variation in the Spatial Accessibility of Low- and NoCost Mammography Facilities By Neighborhood
Socioeconomic and Racial Characteristics in Chicago
Shannon Zenk
P 90
Health Disparities Among Older Immigrants in Urban
Canada
Nidhi Kumar Tyagi
P 67
The Relationship Between Social Capital and Substance
Abuse Treatment Utilization Among Drug Using Puerto
Rican Women
Humberto Reynoso-Vallejo
P 68
Enumerating Toronto's Homeless Population: A Review
of the Controversy and Methodological Options
Brent Berry
P 69
A Health Screening Instrument Adapted to the Unique
Needs of New Immigrants and Refugees in Toronto
Kim Chow
P 70
Domestic Violence in Nigeria-Addressing the Issues in
the Niger Delta Context
Ifode Ajari
P 71
P 72
P 73
High Risk Youth and Health Problems in Urban Areas
Rana Ahmad
P 74
Stigma, Rights and HIV
Rana Ahmad
P 75
Delineating Neighborhoods For Studies of the Urban
Social and Physical Environment
Danielle Ompad
P 91
Who Benefits From Community Based Participatory
Research: A Case Study of the Positive Youth Project
Sarah Flicker
P 76
The Casey House Approach: An Innovative Case
Management Model
Lisa Shishis
P 92
Measurement of Cyclist Exposure to the Potential
Dangers of Daily Activity-Travel Patterns in the Region
of Montreal
Marcellin Gangbe
P 77
Estimates of HIV, HCV and Syphilis in Two Mexican
Border Cities Derived From Respondent Driven
Sampling: Do Referral Networks Influence Disease
Prevalence?
Jonathan Magis
P 93
Why Do Urban Children in Bangladesh Die: How to
Save Our Children?
Tarek Hussain
P 94
African American Community-Based Tobacco Control
Organizations
Pamela Jones
P 95
Urban Health Informatics: Linking Data For Multilevel
Mapping of Health Policy and Health Disparities
Irina Campbell
P 96
From 'Working For' Towards 'Working With'
Community
Tarek Hussain
P 97
Disproportionate Impact of Diabetes in a Puerto Rican
Community of Chicago
Abigail Silva
p 98
Investigating Barriers to Accessing Sexual Health
Services For Vancouver Asian Men Who Have Sex With
Men: A Community Based Participatory Approach
Shimpei Chihara
P 78
Antiretroviral Therapy in HIV Infected Infants: When to
Initiate Therapy an African Experience
Kingsley Okonkwo
P 79
The Baltimore Health and Nutritional Exam Survey
(BHANES)
Chris Gibbons
P 80
Toronto Centre For Substance Use in Pregnancy: OneStop Care For Pregnant Substance Users
Alice Ordean
P 81
Strategies to Overcome Barriers to Population
Sampling: Experience From the Rapid Surveys in Los
Angeles County (LAC)
Magda Shaheen
- T hursday
Identifying Key Techniques TO Sustain Interpretation
Services For Assisting Newcomers Isolated By Linguistic
and Cultural Barriers From Accessing Health Services
5. Gopi Krishna
Hunger: A Serious Medical Issue For OW and ODSP
Recipients. Everyone Should Be Entitled to Healthy
Food - Learn About Prescribing a Special Diet Needs
Supplement
Marika Schwandt
Poster Presentation
P 82
P 66
Poster Presentation
- T hursday
P 99
54
Community Food Programs For the Homeless: Whose
Needs Are They Meeting?
Valerie Tarasuk
P 100 Non-Fatal Overdose Is Associated With Crystal
Methamphetamine Use Among a Cohort of Injection
Drug Users in Vancouver
Nadia Fairbairn
P 101
Evaluating Urban Outdoor Pesticide Use Reduction
Activities
Donald Cole
P 102 Having Or Not a Regular Family Doctor: Social
Determinants in 2 Underprivileged Neighbourhoods in
Paris, France
Pierre Chauvin
P 103 Creating a Comprehensive Harm Reduction Model For
Addressing the Health and Social Needs of
Marginalized Crack Users
Lorraine Barnaby
P 104 The Effect of Socioeconomic Status On Patient
Knowledge of Warfarin Therapy After Mechanical
Heart Valve Replacement
Amanda Hu
Are Sexually Assaulted Women's Needs Being Met?
Preliminary Findings From an Evaluation of a MedicoLegal Intervention For Rape
Janice Du Mont
P 02
Health Problems and Health Care Use of Young Drug
Users in Amsterdam
Anneke Krol
P 03
P 18
Health and Human Capital in Developing-Country
Slums
Mark Montgomery
P 19
Health and Livelihood Implications of Marginalization
of Slum Dwellers in Provision of Water and Sanitation
Services in Nairobi City
Elizabeth Kimani
Hepatitis C Virus Infection Screening and Care
Behaviours of Canadian Family Physicians
Lisa Graves
P 20
Body Mass Index in Urban Canada: Neighbourhood and
Metropolitan Area Effects
Nancy Ross
P 04
A Neighbourhood Cohort For Population and
Environmental Health: Air Pollution in Vancouver.
1976-2001
Michael Buzzelli
P 21
Youth Research and Evaluation: Growing Up in
Canadian Cities
Jackie Amsden
P 22
P 05
Violence Among Women Who Inject Drugs
Nadia Fairbairn
Relationships Between Premature Mortality and
Community Income Levels in Manhattan
JL Burcham
P 06
Location and Health in Two Contrasting
Neighbourhoods in Hamilton, Ontario, Canada
Anneliese Poetz
P 23
Validity of Retinomax Autorefractor to Comprehensive
Eye Examinations in School-Aged Children in Los
Angeles County
Magda Shaheen
P 07
Ethnic Differences in Unwanted Sexual Experiences
Among Adolescents in Amsterdam, the Netherlands
Adele Diepenmaat
P 24
Newborn Babies and Their Mothers in Belo Horizonte
City, Brazil, 2001: A Spatial Analysis
Waleska Caiaffa
A Time Series Analysis of the Relationship Between
Social Disadvantage, Air Pollution, and Asthma
Physician Visits in Toronto, Canada
Tara Burra
P 25
Awareness About Contraceptives Among Rural and
Urban Youth of New Delhi, India
Rajat Kapoor
Mental Healthcare Utilization Patterns of Ethiopian
Immigrants in Toronto
llene Hyman
P 26
Assessing the Relationship Between Children's Health
and Parents' Employment Status in Professional
Immigrant Families Living in Vancouver
Clyde Hertzman
P 27
Healthcare Services: The Context of Nepal
Meen Poudyal Chhetri
P 28
Being Street Sick: Exploring Health Issues of Canadian
Street Youth
Jeff Karabanow
P 29
Using Community Based Participatory Research to
Assess Milwaukee Public Housing Women's Perceptions
of Breast Health
Barbra Beck
P 08
P 09
P 10
Mother and Child Health Status and Services On
Decline in Urban Slum of Vadodara, India
Prakash Kotecha
P 11
Transgender People and Access to Care
Samuel Lurie
P 12
Turning Up the Volume: Marginalized Women's Health
Concerns
Setty Jane Richmond
P 13
Socioeconomic Position and Excess Mortality During the
Heat Wave of 2003 in Barcelona
Carles Muntaner
P 14
Religiosity and Elderly Mental Health: Evidence From
Refugee and Non-Refugee Underprivileged Urban
Communities
Monique Chaaya
P 30
Providing Primary Healthcare to a Disadvantaged
Population At a University-Run Community Healthcare
Facility
Tracey Rickards
P 15
Applying a Social Justice Framework to Community
Mental Health: The Clubhouse Approach to
Opportunity and Recovery
Brenda Singer
P 31
The Impact of an FHN Satellite Clinic On the Health of
Inner City Ottawa Youth
Melnaie Mason
P 32
P 16
Empowering School Clinics of Urban Communities As
Partners in TB Treatment: The Philippine Experience
Loyd Brendan Norella
Programming For HIV/AIDS in the Urban Workplace:
Issues and Insights
Joseph Kamoga
P 33
P 17
Mental Health Needs of Transitional Street Youth
Elizabeth McCay
Developing a More Woman-Centered Focus On
Reproductive Health
Ifode Ajar
- Friday
P 01
8:00 - 9:00 am
Poster Presentation
Poster Presentation - Friday, October 28, 2005
i
55
P 34
P 36
P 37
P 50
Hamilton's Hospitals-Shelters Working Group
Niki Gately
P 51
Improving Water and Sanitation Access For the Urban
Poor: A Case Study of Nairobi
Ann Yoachim, MPH
Health Status of Children in Urban Slums of Chennai
M. Uma Mheswari
P 52
Smoking Cessation in Oaxaca, Mexico: A Limited
Priority Among Health Care Providers
Lindsay Rhodes
Potentially Healthy Municipalities Network: A Way to
Achieve Urban Health
Ana Maria Sperandio
P 53
Profiles in Urban Health in 9 Cities of the Americas
Marilyn Rice
Citizenship For IDU and People Living With HIV/ AIDS
Elisa Yoshida
P 54
Prevalence of Elevated Blood Pressure, Random Blood
Glucose and Proteinuria Among Asymptomatic Adults
in Singapore
Veena Joshi
Migration Trends and Drug Treatment Needs Among
Injection Drug Users in the Mexico/U.S. Border City of
Tijuana, Mexico
Kimberly Brouwer
P 55
Everyday Life in a Disadvantaged Neighbourhood and
Its Impact On Health: Insights From an South Australian
Study
Fran Baum
Personal and Social Network Factors Associated With
Secondary Syringe Exchange Among Injection Drug
Users
Prithwish De
P 56
Perceptions of and Responses to Intimate Partner
Violence Among Canadian Born and Immigrant Young
Women
Robin Mason
Maternal Cultural Participation and Child Health Status
in a Middle Eastern Context: Evidence From the Urban
Health Study
Marwan Khawaja
P 57
Toward Social Justice:Environmental Quality, Health
Outcomes and Urban Social Capital in Low-Income
Areas in Francistown, Botswana
Tirelo Moroka
P 58
Social Conflict As a Core Concept in Urban Health
Samuel Friedman
P 59
Hospital Capacity and Use in America's Cities and
Suburbs During Shifting Economic Times: Implications
For the Safety Net in Metropolitan Areas
Dennis Andrulis
P 60
Access to Identification and Services
Jane Kali
P 61
Gentrification and Health
Russell Lopez
P 62
An In-Depth Analysis of Medical Detox Clients to Assist
in Evidence Based Decision Making
Aslam Anis
P 63
Exposure and Potential Health Risks to Toronto
Residents Posed By Two Chemical Contaminants
Miriam Diamond
P 64
Urban Health in Kathmandu, Nepal: A Review of
Innovative and Effective Programs
Poonam Kandel
P 65
Psychosocial Factors Associated With Perceived Forgone
Healthcare: A Comparative Study in Paris, France, and
Antananarivo, Madagascar
Pierre Chauvin
P 66
Harnessing Media to Achieve Social Justice in Urban
Communities
Katerina Cizek
P 67
Income Related Health Disparities in Metropolitan
Canada
Jalil Safaei
Poster Presentation
- Friday
P 35
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
P 38
P 41
Human Health and Inner City Deprivation in the Third
World: The Crack in Social Justice
Usman Raheem
56
P 42
Addiction Shared Care: The Effectiveness of a SharedCare Model For Addiction Patients
Meldon Kahan
P 39
P 40
P 43
Seeds, Soil, and Stories: An Exploration of Community
Gardening in Southeast Toronto
Carolin Taron
P 44
Upgrading Inner City Infrastructure and Services For
Improved Environmental Hygiene and Health: A Case
of Mirzapur in U.P. India
Madhusree Mazumdar
P 45
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
Faten Abdelaziz
P 46
Urban-Rural Differences in Depression and Its HelpSeeking in Canada 2002
Tonia Forte
P 47
Voluntary Counseling and Testing For Human
Immunodeficiency Virus in Pregnant Nigerian Women:
An Evaluation of Awareness, Attitudes and Beliefs
Kingsley Okonkwo
P 48
Planning Healthy and Sustainable Cities in Africa
Geoffrey Nwaka
P 49
Community Palliative Care in an Urban Setting:
Building a Model
Joe Bornstein
P 85
The Rotterdam Youth Monitor: Local Evidence-Based
Youth Policy
Erik de Wilde
P 69
Right to Health Care Campaign
Sathiya Chander
P 86
P 70
Repeat Substance Using -Suicidal Clients -How Can We
Be Helpful?
Yvonne Bergmans
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
P 87
P 71
Depression and Anxiety in Migrants in Amsterdam
Matty de Wit
P 72
Early Detection of Emerging Diseases in Urban Settings
Through Syndromic Surveillance: 911 Data Pilot Study
Kate Bassil
Unraveling Socioeconomic Disparities in Mental Health
Service Use in Canada: Finding the Appropriate Targets
For Policy Intervention
Kenneth Lee
P 88
Traffic Intensity, Lodging Value and Hospital Admissions
For Respiratory Disease Among the Elderly in Montreal
(Canada): A Case-Control Analysis
Audrey Smargiassi
Urban Environment and the Changing Epidemiological
Surface: The Cardiovascular Disease From llorin, Nigeria
Usman Raheem
P 89
Young People in Control; Doing It Safe. The Safe Sex
Comedy
Juan Walter
P 90
A Wired Waiting Room: Can Health Information
Websites Empower Everyone?
Karen Smith
P 91
Influence of Demographic Structure On Health Services
Use By Urban Older Adult Population in Madrid Region
(Spain)
Maria Eugenia Prieto
P 92
The Environment of Youth Related to Tobacco in
Lebanon: Analysis By Gender and Tobacco Type
Mayssa Nehlawi
P 73
P 74
Psychological Vulnerability in Individuals Infected With
HIV Predicts Poor Psychological and Physical Outcomes:
A Longitudinal Study
Sarah Rubenstein
P 75
Urban Agriculture and Food and Nutrition Security in
Kampala, Uganda
Fiona Yeudall
P 76
Mental Health and the Corrections System: PopulationBased Analyses in Urban, Semi-Urban, and Rural
Settings
Julian Somers
P 93
P 77
Urban Change and Health Conditions: The (In)Visible
Challenge and Its Implications For Environmental
Justice Among Low Income Communities in Kampala
City Uganda
Paul Mukwaya
Confronting Stigma: The Use of Narrative Inquiry With
Individuals Who Have Experienced Chronic
Homelessness and Alcoholism
Dyanne Semogas
P 94
The Inner City Public Health Project
Leeann Owens
International Perspectives On Public Health Policy
Dennis Raphael
P 95
Does Racial Concordance Between Patients and
Providers Influence Trust in the Health Care System For
Homeless, HIV-Infected Patients in NYC?
Nancy Sohler
P 96
Solid Waste and Environment in Mumbai (India)
Uttam Sonkamble
P 97
The Environmental Justice in the Metropolis of Tirana
Luan Balliu
P 98
Advanced Access Scheduling: Decreasing Barriers to
Health in Marginalized Inner City Populations
Yuriy Tatuch
P 99
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
P 78
P 79
Voices For Vulnerable Populations: Communalities
Across CBPR Using Qualitative Methods
Martha Ann Carey
P 80
Free Primary Education: A Reality Or a Mirage For the
Urban Poor in Nairobi City?
Eugene Darteh
P81
Demographic Characteristics of People Seen With
Tuberculosis in Lagos State University Teaching Hospital
(Lasuth) Chest Clinic
Wale Alabi
P 82
Violence in Families and Intimate Relationships:
Challenges For Health Promoters
Margaret Malone
P 83
Women Sleeping Rough: Health Outcomes After Five
Years On the Streets of Boston, 2000-2004
James O'Connell
P 84
Geographical Accessibility and Health Promotion Filling an Urban Research Gap?
Eric Hemphill
P 100 Hispanic Males and Healthcare Access: A Snapshot of
New York City
John Jasek
- Friday
the World Trade Center Health Registry: A Unique
Resource For Urban Health Researchers
Deborah Walker
Poster Presentation
P 68
57
P 101
Building a Caring Community
Terry Kettleson
Poster Presentation
- Friday
P 102 The Impact of Social Support, Depression and AIDS
Diagnosis On Health-Related Quality of Life in Adults
With HIV-Infection
Sarah Lyons
58
P 103 Mapping the Physical Environment of Inner City
Workplaces
/ggy Kosny
P 104 Health Care Access and Healthy Lifestyle Measures
Among New York City Adults With Multiple
Cardiovascular Disease Risk Factors
Dejana Selenic
P 105 Treating the "Untreatable": The Politics of Public
Health in Vancouver's Inner City
Denielle Elliott
P 106 Ethnic Health Care Advisors in Information Centers On
Health Care and Welfare in Four Districts of Amsterdam
Arnoud Verhoeff
P 107 The Single Practice Network Initiative: Harnessing
Private Sector Resources of Urbancommunities in the
Fight Against Tuberculosis
Loyd Brendan Norella
Information
Message Centre
Attendees cannot be paged while attending the Conference, however, a message board will be
located in the Registration/lnformation area. If you are expecting a message or wish to leave one
for a colleague attending the Conference, please direct your caller to 416-869-1600 and ask for the
Urban Health Conference office. We respectfully ask that you turn your cell phones and pagers off
or to vibrate only while in Conference sessions.
Speaker Preparation Area
A speaker preparation area for Guest and VIP speakers is located in the Conference Office, in the
Yonge Room in the Conference Centre, Street Level.
Posters
Posters will be located in the Metro East Ballroom from Wednesday, October 26 to Friday, October
28. All participants are encouraged to visit the poster area during specific times, as well, continental
breakfast and refreshment breaks will be served in the poster viewing area.
Continuing Medical Education
This event is an accredited group learning activity as defined by the Maintenance of Certification
program of the Canadian College of Health Service Executives (CCHSE). Individuals wishing to
receive a certificate of attendance must submit a complete program evaluation form to the
registration desk and request on the form that a certificate of attendance be mailed to them.
Accreditation
This program meets the accreditation criteria of the College of Family Physicians of Canada and has
been accredited for up to 10.5 Mainpro-M1 credits.
The Continuing Education Office, Faculty of Medicine, University of Toronto designates this
educational activity for a maximum of 10.5 category 1 credits toward the American Medical
Assocation Physician's Recognition Award. Each physician should claim only those credits that he/she
actually spent in the activity.
This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of
Certification program of the Royal College of Physicians and Surgeons of Canada, approved by
University of Toronto for 10.5 hours.
Restaurants
Toronto offers a wide variety of restaurants covering most palates and costs. For more information
on local restaurants, contact the information desk.
Medical or Other Emergencies
If you should experience an emergency situation, please contact the Registration/lnformation desk,
or dial the hotel operator for assistance.
59
G eneral In fo rm atio n
GENERAL
Conference Chair
Dr. Patricia O'Campo
Centre for Research on Inner City Health
St. Michael's Hospital
Conference Advisory Committee
Ahmed Bayoumi
Kathleen Campbell
David Davenport
Maria Herrera
Pat Hetherington
Stephen Hwang
Kamran Khan
Marilyn McCrea
Aileen Meagher
Patricia O'Campo
Laura Park-Wyllie
Sara Putnam
Sean Rourke
Monica Serrano
John Stevenson
Joshua Tepper
Robb Travers
Catherine Turl
David Vlahov
Tania Xerri
60
Com m ittees
Community Engagement Subcommittee
Louise Binder
Laura Cowan
David Davenport
Sarah Flicker
Stephen Hwang
Wendy Lai
Aileen Meagher
Patricia O'Campo
Maria Paez-Victor
Brian Parris
Tomislav Svobada
Robb Travers
Catherine Turl
Conference Organizational Committee
Kathleen Campbell - Manager
Matthew Aleksic
Tina Daid
Lauren Freedman
Evie Gogosis
Christina Salmon
Monica Serrano
Claudeth White
Brigette Williams
Tania Xerri
GGD Amsterdam
•
The 5t^1 International Conference on Urban Health (ICUH)
Amsterdam 25 - 28 October 2006
Dear Colleague:
The annual meeting of the International Society for Urban Health
(ISUH) has become the leading international forum for the
discussion of issues relating to urban health. This conference
provides ample opportunity for researchers, practitioners,
community members, and policy makers to present leading-edge
research and reviews relating to urban health and to discuss how
to translate research into practice and policy. The past
conferences have had increasing international attendance and
representation from a wide variety of research disciplines.
Conference theme
On-line registration
Registration will only be possible via the internet:
www.icuh2006.com as of March, 1, 2006.
Abstract submission
Abstracts can be submitted on-line from March, 1, 2006, until
June, 15, 2006. Abstract submissions by both community
members/organisations and academic researchers are welcome.
Further information will follow on the website
www.icuh2006.com
The International Society for Urban Health
Are you interested in joining the International Society for Urban
Health or do you want more information? Visit their website:
www.isuh.org.
Population mobility and its effect on urban health
Conference
With special interest in the consequences of migration on health
and health care in urban settings.
English will be the official language of the conference.
Scientific programme
The conference will consist of plenary lectures, symposia,
workshops and poster sessions providing an opportunity for
education and discussion on the latest information relevant to all
aspects on urban health. Oral presentations and posters will be
selected from abstracts submitted.
Intended audience
Participants include domestic and international researchers,
community-based organisations, students, policy makers and
. representatives from the public foundation sectors.
Exhibition
Facilities for the exhibition of scientific and professional material
will be available. Potential exhibitors may request exhibition
documents from the Conference Secretariat.
Conference venue
The ICUH 2006 conference will be held at the
Vrije Universiteit
Aula Complex
De Boelelaan 1105
Amsterdam
Amsterdam - a compact metropolis!
Organising Committee, under the auspices of the
International Society for Urban Health:
President: Arnoud Verhoeff, Municipal Health Service Amsterdam,
the Netherlands.
Conference co-ordinator: Maria Oud, Municipal Health Service
Amsterdam, the Netherlands
Programme support: Willem Schokker, Municipal Health Service
Amsterdam, the Netherlands
How best to introduce a unique city that has so much to offer?
Amsterdam is bursting with culture and a perfect mixture of
history and the energy of a trendy metropolis. At the same time,
Amsterdam is compact and all the city's tourist attractions and
places of interest are within walking distance from one another.
2nd Announcement
The 2nd announcement will follow in February 2006.
Not viewed