Search

This paper presents a cross-sectional study examining the influence of neighborhood violence on multiple aspects of mothers' health. While the influence of neighborhood violence on health is important to understand for all populations, mothers are especially important as they play a key role in protecting their children from the consequences of violence. Three hundred and ninety-two Baltimore City mothers of children 5 years and younger completed a self-administered survey that included questions about perceptions of their safety as well as their personal experiences with neighborhood violence. Separate models were run to compare the relationship between each measurement of neighborhood violence and five diverse health-related determinants and outcomes: self-reported health status, smoking, exercise, average hours of sleep a night, and sleep interruption. Controlling for mother's age, child's age, maternal education, and marital status, mothers with high exposure to neighborhood violence were twice as likely to report poorer health, smoking, never exercising, and poor sleep habits. Maternal perception of neighborhood safety was not related to any of the assessed health-related determinants and outcomes. This study emphasizes the importance of measuring exposure to neighborhood violence rather than solely assessing perceived safety. Neighborhood violence was a common experience for mothers in this urban sample, and should be considered by health professionals in trying to understand and intervene to improve the health of mothers and their children. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVE: To determine how likely parents would be to contribute to strategies to reduce pedestrian injury risks and how much they valued such interventions. DESIGN: A single referendum willingness to pay survey. Each parent was randomised to respond to one of five requested contributions towards each of the following activities: constructing speed bumps, volunteering as a crossing guard, attending a neighbourhood meeting, or attending a safety workshop. SETTING: Community survey. PARTICIPANTS: A sample of 723 Baltimore parents from four neighbourhoods stratified by income and child pedestrian injury risk. Eligible parents had a child enrolled in one of four elementary schools in Baltimore City in May 2001. Main results: The more parents were asked to contribute, the less likely they were to do so. Parents were more likely to contribute in neighbourhoods with higher ratings of solidarity. The median willingness to pay money for speed bumps was conservatively estimated at $6.43. The median willingness to contribute time was 2.5 hours for attending workshops, 2.8 hours in community discussion groups, and 30 hours as a volunteer crossing guard. CONCLUSIONS: Parents place a high value on physical and social interventions to improve child pedestrian safety. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The authors used data from a larger study to evaluate the long-term effects of a peer advocate intervention on condom and contraceptive use among HIV-infected women and women at high risk for HIV infection. METHODS: HIV-infected women in one study and women at high risk for HIV infection in a second study were selected from the Women and Infants Demonstration Project and assigned to a standard or an enhanced HIV prevention treatment group. The enhanced intervention included support groups and one-on-one contacts with peer advocates tailored to clients' needs. The authors interviewed women at baseline and at 6-, 12- and 18-months, and measured changes in consistency of condom and contraceptive use and in self-efficacy and perceived advantages and disadvantages of condom and contraceptive use. RESULTS: Of HIV-infected women, the enhanced group had improved consistency in condom use, increased perceived advantages of condom use, and increased level of self-efficacy compared with the standard group. Of women at risk, the enhanced intervention group at six months maintained consistent condom use with a main partner and perceived more benefit of condom use compared with the standard group. These differences diminished at 12 months. CONCLUSIONS: The enhanced intervention was generally effective in the HIV+ study. In the at-risk study, however, intervention effects were minimal and short-lived. Factors related to the theory, intervention design, and sample characteristics help explain these differences. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The purpose of this study was to evaluate Children's Village, a life safety education facility for children. SETTING: The study took place in Washington County, Maryland, a rural county. METHODS: Eight elementary schools with 20 second grade classrooms (410 students aged 7 and 8) were selected to participate. Using a quasiexperimental design, tests were administered to two cohorts of children before (pretest) and after (post-test) they attended the Children's Village during 1993-4. Parent and teacher surveys were also completed after the program. RESULTS: Among children who attended in December 1993-January 1994, there was a significant improvement in average test scores between the pretest (58% correct) and post-test (78%). Among children who attended in April 1994, there also was a significant improvement in test scores between pretest (74%) and post-test (85%). Among parents, 70% reported that their child learned a great deal at Children's Village and 33% reported having made changes in their home as a result. The parent survey also revealed that 25% of children and 35% of adults did not always wear their seat belts, and 74% of children did not always wear bicycle helmets. Teachers' responses to the program were generally positive. CONCLUSIONS: Children's Village brought together an extensive network of community leaders, parents, and teachers dedicated to safety education of children. The curriculum had a positive impact on children's knowledge and, to a lesser extent, on parents' safety practices. Program impact could be enhanced by more emphasis on automobile restraints and helmets (behaviors that parents reported were not consistently practiced) and by expanding the village services to parents as well as children. Others considering creating similar programs need to identify community leaders willing to commit the time, effort, and resources required to develop and sustain such programs. [ABSTRACT FROM AUTHOR]

Background: Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes., Methods: Children (n = 102) aged 0-7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression., Results: The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97)., Conclusions: Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Background: Prior to the COVID-19 pandemic, 44% of all reported injuries in U.S. households occurred in the home. Spending more time at home due to the pandemic may increase the number of home injuries., Methods: A nationally representative sample of 2011 U.S. adults were surveyed online between June 17 - June 29, 2020. Propensity score weighting and T-tests were used., Results: Twenty-eight percent (28%) of households reported a home injury or ingestion during the pandemic; 13% reported experiencing both. Injuries were most often due to falls (32%). Medication ingestions were reported by 6%; household product ingestions were reported by 4%. Relative to households that experienced no injuries or ingestions, those that reported either or both were more likely to: be in urban areas, have household incomes > $100,000, and have children living in them. Among households reporting more time spent at home, those with children were significantly more likely than those without to report an injury or ingestion., Conclusions: Results help target prevention messages while U.S. families are continuing to work and learn remotely. During this pandemic and future stay-at-home orders, there is a need for public health efforts to prevent home injuries and ingestions.

Nationally, 80% of pedestrian fatalities occur in urban environments, yet the distribution of injuries across urban areas is not uniform. Identifying street-level risk factors for pedestrian injury is essential for urban planning and improvement projects, as well as targeted injury prevention efforts. However, creating and maintaining a comprehensive database of a city's traffic safety infrastructure can be cumbersome and costly. The purpose of this study was to create and validate a neighborhood environmental observational assessment tool to capture evidence-based pedestrian safety infrastructure using Google Street View (GSV)-The Inventory for Pedestrian Safety Infrastructure (IPSI). We collected measures in-person at 172 liquor stores in Baltimore City from June to August 2015 to assess the tool's reliability; we then collected IPSI measures at the same 172 locations using GSV from February to March 2016 to assess IPSI reliability using GSV. The majority of items had good or excellent levels of inter-rater reliability (ICC ≥ 0.8), with intersection features showing the highest agreement across raters. Two scales were also developed using exploratory factor analysis, and both showed strong internal consistency (Cronbach's alpha ≥ 0.6). The IPSI provides a valid, economically efficient tool for assessing pedestrian safety infrastructure that can be employed for a variety of research and urban planning needs. It can also be used for in-person or GSV observation. Reliable and valid measurement of pedestrian safety infrastructure is essential to effectively prevent future pedestrian injuries.

The objective of this study was to describe changes in carbon monoxide (CO) safety knowledge and observed CO detector use following distribution of a CO detector use intervention in two environments, a pediatric emergency department (Ohio) and an urban community (Maryland). A total of 301 participants completed the 6-month follow up (Ohio: n = 125; Maryland: n = 176). The majority of participants was female, 25–34 years of age, and employed (full or part time). We found that CO safety knowledge did not differ between settings at enrollment, but significantly improved at the follow-up visits. The majority of CO detectors observed were functional and installed in the correct location. Of those with CO detectors at follow up, the majority had not replaced the battery. The success of the intervention varied between settings and distribution methods. The majority of participants showed improved knowledge and behaviors. Improved device technology may be needed to eliminate the need for battery replacement.

Unintentional injuries are a persistent public health problem in the United States. A new health care landscape has the potential to create a clinical environment that fosters greater involvement by health care providers in injury prevention. The aim of this article is to provide evidence supporting the need for engagement by primary care providers in unintentional home injury prevention along with examples of how this could be accomplished. We know a great deal about what population groups are at risk for certain types of injuries. We also know that many injuries can be prevented through policies, programs, and resources that ensure safe environments and promote safe behaviors. For example, the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative comprises clinical decision support tools and educational materials for health care providers. Two effective interventions that have demonstrated a reduction in falls among children are the redesign of baby walkers (engineering) and the mandated use of window guards (enforcement). Primary care clinicians can play a key role in promoting their patient's safety. Taken collectively, a focused attention on preventing unintentional home injuries by primary care providers can contribute to the reduction of injuries and result in optimal health for all.

We evaluated a synergistic epidemic (syndemic) of substance use, mental illness, and familial conflict non-negotiation among HIV-positive injection drug users (IDU). Baseline BEACON study data was utilized. Latent class analyses identified syndemic classes. These classes were regressed on sex, viral suppression, and acute care non-utilization. Females were hypothesized to have higher syndemic burden, and worse health outcomes than males. Nine percent of participants had high substance use/mental illness prevalence (Class 4); 23 % had moderate levels of all factors (Class 3); 25 % had high mental illness (Class 2); 43 % had moderate substance use/mental illness (Class 1; N = 331). Compared to Classes 1-3, Class 4 was mostly female (p < .05), less likely to achieve viral suppression, and more likely to utilize acute care (p < .05). Interventions should target African-American IDU females to improve their risk of negative medical outcomes. Findings support comprehensive syndemic approaches to HIV interventions, rather than singular treatment methods.

Child passenger safety remains an important public health problem because motor vehicle crashes are the leading cause of death for children, and the majority of children ride improperly restrained. Using a mobile app to communicate with parents about injury prevention offers promise but little information is available on how to create such a tool. The purpose of this article is to illustrate a theory-based approach to developing a tailored, smartphone app for communicating child passenger safety information to parents. The theoretical basis for the tailoring is the elaboration likelihood model, and we utilized the precaution adoption process model (PAPM) to reflect the stage-based nature of behavior change. We created assessment items (written at ≤6th grade reading level) to determine the child's proper type of car seat, the parent's PAPM stage and beliefs on selected constructs designed to facilitate stage movement according to the theory. A message library and template were created to provide a uniform structure for the tailored feedback. We demonstrate how messages derived in this way can be delivered through new m-health technology and conclude with recommendations for the utility of the methods used here for other m-health, patient education interventions., (© The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Residential sprinkler systems (RSS) are one intervention to prevent fire injury and death, yet there is no literature documenting why RSS homeowners opt to purchase a sprinkler-equipped home. This manuscript describes homeowners' decisions to purchase homes with residential sprinkler systems (RSS) and their experiences with the technology. It also compares how RSS homeowners and owners of homes without RSS value sprinklers and their levels of support for policies to mandate RSS in new homes., Methods: We used a national online web panel to sample owners of 1- and 2-family homes, and descriptive methods to analyze the resulting data., Results: Our final sample included 1,357 homeowners of 1- and 2-family homes without RSS and 976 homeowners with RSS. RSS homeowners were more likely than owners of non-RSS homes to indicate they would buy an RSS home in the future (75 % vs. 30 %), and more often indicated a willingness to pay for sprinklers (70 % vs. 40 %). RSS homeowners also expressed higher levels of support for policies to mandate RSS in all new 1- and 2-family homes (48 % vs. 19 %)., Conclusions: The findings offer insight into educational and policy strategies to promote RSS in all new homes, and provide a foundation for future research in this area.

Background: Prompted by a series of fatal and nonfatal pedestrian-vehicle collisions, university leadership from one urban institution collaborated with its academic injury research center to investigate traffic-related hazards facing pedestrians., Methods: This descriptive epidemiologic study used multiple data collection strategies to determine the burden of pedestrian injury in the target area. Data were collected in 2011 through a review of university crash reports from campus police; a systematic environmental audit and direct observations using a validated instrument and trained raters; and focus groups with faculty, students, and staff. Study findings were synthesized and evidence-informed recommendations were developed and disseminated to university leadership., Results: Crash reports provided some indication of the risks on the streets adjacent to the campus. The environmental audit identified a lack of signage posting the speed limit, faded crosswalks, issues with traffic light and walk sign synchronization, and limited formal pedestrian crossings, which led to jaywalking. Focus groups participants described dangerous locations and times, signal controls and signage, enforcement of traffic laws, use of cell phones and iPods, and awareness of pedestrian safety. Recommendations to improve pedestrian safety were developed in accordance with the three E's of injury prevention (education, enforcement, and engineering), and along with plans for implementation and evaluation, were presented to university leadership., Conclusions: These results underscore the importance of using multiple methods to understand fully the problem, developing pragmatic recommendations that align with the three E's of injury prevention, and collaborating with leadership who have the authority to implement recommended injury countermeasures. These lessons are relevant for the many colleges and universities in urban settings where a majority of travel to offices, classrooms, and surrounding amenities are by foot.

Background: Door-to-door canvassing and installation of smoke alarms have been found to be effective at increasing the number of homes protected. This analysis reports on how smoke alarm coverage changes six months after a home visiting program in a large urban sample, and how this change varies by characteristics of the residents and characteristics of the services delivered during the home visit., Methods: Fire department Standard and Enhanced home visiting programs were compared. During the home visit, fire fighters installed lithium battery smoke alarms. Residents in the Enhanced program received tailored education about fire safety. Six months after the home visit, participating residences were visited to complete a follow-up survey and to have the installed alarms checked., Results: 81% of the 672 homes that had a working smoke alarm on every level of the home at the end of the home visit remained safe at follow-up, and 87% of the residents found the home visit was very useful, and these rates did not differ between the Enhanced and Standard programs. The degree to which firefighters delivered their services varied, although households in which the resident's engagement with the fire department team was rated as excellent were 3.96 times as likely to be safe at follow-up compared to those with poor or fair resident engagement (p=0.03)., Conclusions: There is a need to better understand how to maximize the time spent with residents during smoke alarm home visiting programs. This study helps with the development of methods needed for implementing and evaluating such programs in real-world settings.

The authors conducted a household survey and observation to assess carbon monoxide (CO) knowledge and risks as well as prevalence of CO alarms in an urban community prior to the enactment of a mandatory ordinance requiring CO alarms in one U.S. city. From July to December 2009, household surveys and observations were completed in 603 residences. Participants were mostly African-American (61%), women (70%), 25-54 years in age (66%), and with a high school education or less (51%). Most homes visited contained CO-producing appliances, including gas stoves (86%), gas furnaces (82%), and gas water heaters (79%). Participants' overall mean percentage correct knowledge score was 57%. CO alarms were reported by 33% of participants and observed among 28% of households. Low rates of CO knowledge and CO alarm ownership, combined with high rates of CO-producing sources in homes, suggests the need for widespread campaigns to promote CO alarms. Recommendations are also made to integrate the lessons learned from the public health community's experience promoting smoke alarms.

While largely preventable, fire and hot water-related injuries are common in the United States. Measures recommended to reduce these injuries are smoke alarms (SAs) and lowered hot water temperatures. This study aims to: (i) describe the prevalence of working SAs and safe water temperatures among low-income, urban communities and (ii) explore the relationship between these behaviors and individuals' knowledge and beliefs about them. In this cross-sectional study, the Health Belief Model was used as a guide for understanding the safety behaviors. A total of 603 households had their SAs and hot tap water temperatures tested and were surveyed about their knowledge and beliefs related to these safety behaviors. We found that 40% of households had working SAs on every level and 57% had safe hot water temperatures. Perceived severity and self-efficacy were significantly associated with SA coverage, whereas perceived susceptibility and beliefs about benefits were significantly associated with safe hot water temperatures. This study demonstrates the need to increase the number of homes with working SAs and safe hot water temperatures. Messages focused on a safe home environment could communicate the ease and harm reduction features of SAs and benefits and risk reduction features of safe hot water temperatures.

The role of social norms has played an often unrecognized role in the perception of and action to assist low-income urban women who are in violent relationships. Two forms of social norms will be assessed, including descriptive norms--what people typically do to assist women in a violent relationship--and injunctive norms--defined as what people should do to assist women. This study will present our initial findings into the development of measures to assess women's perception of their community's social norms toward assisting women who have experienced intimate partner violence (IPV) and how these norms are related to women's perception of the community, reasons for community assistance toward women experiencing IPV, and women's own experience of IPV. Systematic measurement development processes were applied to reliably and validly develop the social norms measures. A three-phase approach was used to develop eight paired items measuring descriptive and injunctive norms. A total of 176 low-income urban women were interviewed and the scale responses were compared to length of time at the residence, perceptions of their neighborhood, perceived reasons for community involvement and non-involvement in assisting women experiencing IPV, and IPV experienced as an adult. The two developed social norms scales were found to have high internal consistency alpha coefficients of 0.84 for descriptive norms and 0.93 for injunctive norms. Paired t tests were statistically significant, denoting higher injunctive than descriptive social norms. Lowered descriptive norms were found among younger women, women who reported that they did not think their neighborhood was a good place to live, women who had ever experienced intimate partner violence as an adult, and perceived lower reasons for neighbor involvement and higher reasons for neighbor non-involvement toward assisting women experiencing IPV. Higher levels of injunctive social norms were statistically associated with living in a good place and increased perceived reasons for neighbor involvement toward assisting women experiencing IPV. Significant differences between descriptive and injunctive norms suggest that women, especially those who are currently experiencing IPV, would prefer greater support from community neighbors than they are currently providing. The descriptive and injunctive social norms scales demonstrated a high level of internal reliability and significantly associated with other influencing factors thought to be associated with social norms. Overall, the performance of the injunctive and descriptive norms scales support their use as a tool to investigate social norms toward neighbors taking action to assist women experiencing IPV.

Aim: Alcohol in the media influences norms around use, particularly for young people. A recent spate of celebrity arrests for drinking and driving (DUI) has received considerable media attention. We asked whether these newsworthy events serve as teachable moments or problematic social modeling for young women., Method: Qualitative analysis of US media coverage of four female celebrities (Michelle Rodriguez, Paris Hilton, Nicole Richie and Lindsay Lohan) was conducted over the year following their DUI arrest (December 2005 through June 2008). The media sample included five television and three print sources and resulted in 150 print and 16 television stories., Results: Stories were brief, episodic and focused around glamorous celebrity images. They included routine discussion of the consequences of the DUI for the individual celebrities without much evidence of a consideration of the public health dimensions of drinking and driving or possible prevention measures., Conclusions: Our analysis found little material in the media coverage that dealt with preventing injury or promoting individual and collective responsibility for ensuring such protection. Media attention to such newsworthy events is a missed opportunity that can and should be addressed through media advocacy efforts.

Local-level public health interventions require action from multiple agencies, organizations and individuals, yet little is known about how best to work with stakeholders to facilitate change. We sought local stakeholders' perspectives on how best to address impediments to implementing interventions designed to reduce child pedestrian injury by improving the pedestrian environment. We conducted 20 in-person, key informant interviews with people who would be the likely advocates for environmental change to improve the pedestrian environment in one US city, Baltimore, Maryland. We discuss the importance of reframing child pedestrian injury risk as a livability issue, increasing awareness about the potential impact of environmental changes to improve public safety, and the need for a formal efficient process to facilitate communication between local government and other stakeholders. These findings provide public health professionals and advocates with useful insight into how local stakeholders view the issue and their perspectives on how best to achieve change.

This study explored how young boys and girls living in low income urban neighborhoods defined and described reasons associated with youth violence. Five focus groups were conducted with 29 youth between the ages of 8 and 12 recruited from four selected study neighborhoods. Participants were asked to describe youth violence. Appropriate probes were used to explore similarities and differences by gender with regard to the reasons for violence. Definitions of youth violence were consistent across participants and included verbal threats, physical contact, and often the use of a weapon. Several common reasons for violence were found among both boys and girls; romantic relationships, respect, idle time, gangs/cliques, and witnessing violence. Reasons for violence unique to boys include fighting about issues related to money and illicit drugs. Gossip was identified as a reason specific to why girls engage in violence. Youth violence was perceived as a common problem impacting the lives of the boys and girls in this study. Although many of the reasons identified for violence are similar among boys and girls, select gender differences do exist. Future research and prevention efforts to address youth violence should engage young people in efforts to understand and address this important public health topic.

While neighbourhood influences on the risk of intimate partner violence have been reported, this body of research has suffered from a lack of strong theoretical and conceptual guidance, and few studies have examined the potential pathways from neighbourhoods to intimate partner violence. This paper used concept mapping methods with 37 women who were residents of Baltimore City to obtain cluster maps representing the important neighbourhood domains that affect the prevalence, perpetration, severity, and cessation of intimate partner violence. Domains important for intimate partner severity and perpetration differed from those important for cessation of intimate partner violence. Finally, diagrams of the domains, drawn by the concept mapping participants, illustrated the pathways by which neighbourhood characteristics potentially influence intimate partner violence severity, perpetration, and cessation. These results can be used to generate testable hypotheses regarding neighbourhood influences on intimate partner violence in future quantitative research and to inform the design of public health intimate partner violence programmes.

Behavioral and social sciences theories and models have the potential to enhance efforts to reduce unintentional injuries. The authors reviewed the published literature on behavioral and social science theory applications to unintentional injury problems to enumerate and categorize the ways different theories and models are used in injury prevention research. The authors conducted a systematic review to evaluate the published literature from 1980 to 2001 on behavioral and social science theory applications to unintentional injury prevention and control. Electronic database searches in PubMed and PsycINFO identified articles that combined behavioral and social sciences theories and models and injury causes. The authors identified some articles that examined behavioral and social science theories and models and unintentional injury topics, but found that several important theories have never been applied to unintentional injury prevention. Among the articles identified, the PRECEDE PROCEED Model was cited most frequently, followed by the Theory of Reasoned Action/Theory of Planned Behavior and Health Belief Model. When behavioral and social sciences theories and models were applied to unintentional injury topics, they were most frequently used to guide program design, implementation or develop evaluation measures; few examples of theory testing were found. Results suggest that the use of behavioral and social sciences theories and models in unintentional injury prevention research is only marginally represented in the mainstream, peer-reviewed literature. Both the fields of injury prevention and behavioral and social sciences could benefit from greater collaborative research to enhance behavioral approaches to injury control.

The assessment of a person's quality of life as it relates to health, HIV status and intimate partner violence (IPV) among women has been limited in its scope of investigation. Consequently, little is known about the adjusted and combined effects of IPV and HIV on women's health status and QOL. 445 women (188 HIV + 257 HIV -) residing in an urban low income area were interviewed regarding current IPV experiences (no IPV, IPV more than 1 year ago, IPV in last year), HIV status (positive and negative), use of illicit drugs, and presence of instrumental social support. Health-related QOL (HRQOL) was measured using the MOS-HIV. Stratified bivariate analyses demonstrate that living with HIV or having experienced IPV in the past year was significantly associated with poorer levels of HRQOL. Multiple logistic regression models indicate a robust negative relationship between the experience of IPV in the past year, living with HIV, use of illicit drugs and a protective effect of social support on women's reported HRQOL. The results of the bivariate and multivariate analyses provide evidence that there are independent and adjusted detrimental associations of the experience of IPV and living with HIV with women's HRQOL. As HRQOL is a good indicator of physical and mental health, these findings should alert health care and other service providers to their responsibility to screen and treat women experiencing intimate partner violence and living with HIV.

The purpose of this study was to describe parents' child pedestrian safety practices, knowledge, risk perceptions, and beliefs. We surveyed 732 parents from four elementary schools in urban neighborhoods that differed in income, and child pedestrian injury risks. Findings indicated that most parents taught their children street safety. Few (16%) knew basic pedestrian safety facts; 46% believed children younger than 10 years could safely cross streets alone; 50% believed a child pedestrian crash was likely. Parents in lower income neighborhoods reported the highest rates of unpleasant walking environments and concerns about drug dealers, crime, violence, and trash. We conclude that education should focus on children's risk, developmental capabilities, and supervision needs. Promoting physical activity in urban neighborhoods, especially lower income ones, must address concerns about the physical and social environment.

Women living in poor urban communities are doubly disadvantaged with regard to increased risk for two major public health crises in the United States today--HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) and violence. This study moves beyond the comparison of rates of lifetime abuse among women to incorporate contextual information of the abusive situation and experiences of HIV-positive women and a sample of sociodemographically similar HIV-negative women. A total of 611 women, 310 of whom were diagnosed as HIV positive, provided interviews integrating quantitative data and qualitative text on their lifetime experience of abuse. Quantitative results yielded few statistically significant differences between the lifetime experiences of violence between HIV-positive women and their HIV-negative counterparts. Of the women, 62% reported intimate partner violence, and 38% reported experiencing nonpartner abuse as an adult. A majority of the abused women reported that their alcohol or drug use or their partner's alcohol or drug use was associated with the abuse experienced. Significant differences were found between HIV-positive women and HIV-negative women in the pattern of abuse experienced as a child, the frequency of abuse as an adult, and the involvement of women's drinking before or during a violent episode. Qualitative excerpts from the interviews were found to differ thematically and were integrated with the quantitative data to provide a more comprehensive understanding of the women's contextual situation in understanding interpersonal violence experienced by both HIV-positive and HIV-negative women.

Objectives: To examine the validity of self reported data on parents' home safety practices of using smoke alarms and stair gates, and having syrup of ipecac., Setting: Families from a pediatric continuity clinic in a large, urban teaching hospital with infants from birth to 6 months were enrolled in the study., Methods: As part of a randomized controlled trial to promote home safety, parents' responses to personal interviews were compared to observations made in the respondents' homes two to four weeks after the interview. Positive and negative predictive values, sensitivity, and specificity were computed and compared between the intervention and control group families., Results: Sensitivities were high among the four safety practices. Specificities were much lower and fell into a much wider range than sensitivities. The positive predictive values were low and the negative predictive values were high. No differences in these indicators of validity were found between intervention and control group families., Conclusions: If the main interest in an evaluation is on the relative difference between study groups, rather than the absolute value of the outcome measure, our results suggest that self reported data may be of acceptable validity. However, when assessing a patient's risk, clinicians need to recognize the problem of over-reporting of safety practices.

This paper describes the frequency of women's disclosure of their HIV status, examines the extent to which they experience adverse social and physical consequences when others learn they are infected, and analyzes correlates of these negative outcomes. There were 257 HIV-positive women between the ages of 18 and 44, recruited from HIV/AIDS primary care clinics and from community sites, who completed a face-to-face interview. Women in the sample were 33 years old on average; 92% were African-American; 54% had less than 12 years of education; 56% had used intravenous drugs; and 30% knew they were HIV positive for 5 or more years. There were 97% who disclosed their HIV status; 64% told more than 5 people. Negative consequences associated with others knowing they were HIV-positive were reported by 44%, most commonly the loss of friends (24%), being insulted or sworn at (23%), and being rejected by family (21%). There were 10 women (4%) who reported being physically or sexually assaulted as a result of their being HIV positive, and 16% reported having no one they could count on for money or a place to stay. Violence was widespread in this sample, with 62% having experienced physical or sexual violence, including sexual abuse or rape (27%), being beaten up (34%), and weapon-related violence (26%). Logistic regression analysis indicated that women with a history of physical and sexual violence were significantly more likely to experience negative social and physical consequences when their infection became known to others, adjusting for age and the number of people women had disclosed to, both of which were only marginally significant. Partner notification policies and support programs must be responsive to the potential negative consequences associated with others learning that a woman is HIV positive. The high rates of historical violence in the lives of women living with HIV underscore the need for routine screening and intervention for domestic violence in all settings that provide health care to HIV-positive women.

Study Purpose: Injury remains the leading cause of death in children aged 1 to 4 years. Past studies of determinants of injuries among young children have most often focused on the microlevel, examining characteristics of the child, parent, family, and home environments. We sought to determine whether and how selected neighborhood economic and physical characteristics within these low-income communities are related to differences in risk of events with injury-producing potential among infants and young children., Methods: Our study used both individual-level data and information on the characteristics of the neighborhood of residence to describe the prevalence of events with injury-producing potential among infants and young children in three low-income communities in Baltimore City, Maryland. Our sample was 288 respondents who participated in a random household survey. Information on respondent (age, employment, and length of residence in the neighborhood) and neighborhood characteristics (average per capita income, rate of housing violations, and crime rate) were available. Methods of multilevel Poisson regression analysis were employed to identify which of these characteristics were associated with increased risk of experiencing an event with injury-producing potential in the month prior to the interview., Results: Although all three communities were considered low income, considerable variation in neighborhood characteristics and 1-month prevalence rates of events with injury-producing potential were observed. Younger age of respondent and higher rates of housing violations were associated significantly with increased risk of a child under 5 years old in the household experiencing an event with injury-producing potential., Conclusions: Information on community characteristics was important to understanding the risks for injuries and could be used to develop community-based prevention interventions.

Although women had been under recognized in the literature on HIV/AIDS, increasing numbers of studies have focused on the lives and experiences of women living with HIV/AIDS. Areas of research in which the study of women and HIV continues to be noticeably lacking include health related quality of life (HRQOL). This paper describes HRQOL in an inner city sample of 287 HIV positive non-pregnant women, interviewed as part of a larger multi-site CDC funded study of the reproductive health of women. The average age of the respondents was 33 years and women had known their HIV status an average of 41 months. HRQOL was assessed using a 17-item modified version of the Medical Outcomes Study-HIV Health Survey and demonstrated acceptable internal consistency (0.64-0.89) and variability. Women in our study were similar to other HIV-positive female samples and reported lower levels of well-being and functioning than some HIV-positive male samples. Women's responses to individual items and areas of potential need for health care are discussed. Examination of HRQOL in women with HIV can aid in the comparison of how women and men are affected by HIV and can help health care professionals identify needed services and include possible interventions to promote quality of life.

A smoking cessation and relapse prevention intervention was tested in an urban, prenatal clinic serving predominantly low-income, African-American women. At their first prenatal visit, 391 smokers were randomly assigned to an experimental (E) group to receive usual clinic information plus a prenatal and postpartum intervention or to a control (C) group to receive only usual clinic information. The intervention consisted of individual skills instruction and counseling by a peer health counselor on the use of a self-help cessation guide and routine clinic reinforcement. Among the E group (n = 193), 6.2% were cotinine-confirmed quitters at third trimester and among the C group (n = 198) the quit rate was 5.6%. Quitters were light smokers at entry into prenatal care. Many had tried to quit smoking at least once prior to pregnancy.

This report describes a mid-course process evaluation of an HIV risk-reduction counseling intervention delivered by specially trained peer paraprofessionals. One of the key questions addressed is whether paraprofessionals can successfully implement a theory-based counseling intervention. The project, known as Project CARES, is a 5-year demonstration research project to prevent HIV infection and unplanned pregnancies in women at risk for HIV infection and transmission who were recruited from homeless shelters, drug treatment facilities, and hospital-based service settings for HIV-infected women. Project CARES uses an enhanced counseling intervention based on the Transtheoretical Model, also known as the Stages of Change model, to promote condom and other contraceptive use for women who wish to avoid pregnancy, condom use for disease prevention, and reproductive health service use. Peer paraprofessionals, called advocates, provide stage-tailored counseling using a structured manual which guides them in the selection of specific counseling activities appropriate to a woman's level of readiness to change her behavior. Data from process evaluation forms completed by advocates in Philadelphia and Baltimore document that the delivery of the intervention is consistent with the theoretical model upon which it was based. Paraprofessionals can become skilled in the delivery of a stage-based counseling intervention in health and social service settings. The use of paraprofessionals in HIV prevention service delivery may be a cost-effective way to enhance and extend services for women.

Objectives: Many contextual analyses that bridge the micro-level-macro-level gap in identifying risk factors for adverse outcomes have not used methods appropriate for multilevel data. The purpose of this paper is to illustrate the application of appropriate multi-level analytic methods and discuss their implications for public health., Methods: A previously published individual-level model of physical violence perpetrated by male partners during the childbearing year was reanalyzed to include variables describing the neighborhoods where the women resided. Logistic regression with estimation methods of the generalized estimating equation was used for the contextual analysis. To assess the advantages of the generalized estimating equation over conventional logistic regression, both were used for the two-level model., Results: The regression coefficients from the contextual model differed from the betas obtained in the individual-level model. Not only were neighborhood-level variables related to the risk of partner-perpetrated violence, but the presence of these macro-level variables in the models modified the relationships of the individual-level variables to the risk of violence., Conclusions: Two-level models that include individual- and community-level factors may be beneficial for purposes of explanation in public health research.

Data from an urban obstetrics clinic on 291 unmarried women with a current unplanned pregnancy show that women with only one partner in the past year are older and are more likely to use the most effective contraceptive methods than are women who have more than one partner. Women with only one partner are also more likely to be solely responsible for decision-making about the choice of contraceptive methods, and are not as likely to use drugs in conjunction with sex. However, women with one partner are also less likely than others to use condoms or to protect in some other way against sexually transmitted diseases or the human immunodeficiency virus.

Objectives: The passage of a mandatory bicycle helmet law for children in Howard County, Maryland, provided an opportunity to compare legislation and education as strategies to increase helmet use., Methods: In 1991, a survey was mailed to fourth-, seventh-, and ninth-grade students attending a stratified sample of public schools in Howard County and in two similar suburban/rural counties without helmet laws., Results: Of 7217 students surveyed, 3494 responded (48.4%). Self-reported helmet use in Howard County rose from 11% to 37% after the law and accompanying educational campaign went into effect. Helmet use changed from 8% to 13% in Montgomery County, where educational efforts were undertaken, and from 7% to 11% in Baltimore County, where helmet promotion activities were minimal. Predictors of helmet use included having friends who wore helmets, believing helmet laws are good, being in fourth grade, living in Howard County, and using seatbelts regularly., Conclusions: Legislation combined with education appears to increase bicycle helmet use substantially more than does education alone. The Howard County law may be considered a successful model of a strategy to increase children's helmet use.