key: cord-002774-tpqsjjet
authors: nan
title: Section II: Poster Sessions
date: 2017-12-01
journal: J Urban Health
DOI: 10.1093/jurban/jti137
sha: 
doc_id: 2774
cord_uid: tpqsjjet

nan

Food and nutrition programs in large urban areas have not traditionally followed a systems approach towards mitigating food related health issues, and instead have relied upon specific issue interventions char deal with downstream indicators of illness and disease. In June of 2004, the San Francisco Food Alliance, a group of city agencies, community based organizations and residents, initiated a collahorarive indicator project called rhe San Francisco Food and Agriculture Assessment. In order to attend to root causes of food related illnesses and diseases, the purpose of the Assessment is to provide a holistic, systemic view of San Francisco\'s food system with a focus on three main areas that have a profound affect on urban public health: food assistance, urban agriculture, and food retailing. Using participatory, consensus methods, the San Francisco Food Alliance jointly developed a sec of indicators to assess the state of the local food system and co set benchmarks for future analysis. Members collected data from various city and stare departments as well as community based organizations. Through the use of Geographic Information Systems software, a series of maps were created to illustrate the assets and limitations within the food system in different neighborhoods and throughout the City as a whole. This participatory assessment process illustrates how to more effectively attend to structural food systems issues in large urban areas by ( t) focusing on prevention rather than crisis management, (2) emphasizing collaboration to ensure institutional and structural changes, and (3) aptly translating data into meaningful community driven prevention activities.

To ~xplore the strategies to overcome barriers to population sample, we examined the data from three rapid surveys conducted at Los Angeles County (LAC). The surveys were community-based partic· 1patory surveys utilizing a modified two-stage cluster survey method. The field modifications of the method resulted in better design effect than conventional cluster sample survey (design effect dose to that if the survey was done as simple random sample survey of the same size). The surveys were con· ducte~ among parents of Hispanic and African American children in LAC. Geographic area was selected and d1.v1ded int.o small c~usters. In the first stage, 30 clusters were selected with probability proportionate to estimated size of children from the census data. These clusters were enumerated to identify and develop a list of households with eligible children from where a random sample was withdrawn. Data collectmn for consented respondents involved 10-15 minutes in-home interview and abstraction of infor· ma~ion from vaccine record card. The survey staff had implemented community outreach activities designed to fost~r an~ maintain community trust and cooperation. The successful strategies included: developing re.lat1on .w.1th local community organizations; recruitment of community personnel and pro· vide them with training to conduct the enumeration and interview; teaming the trained community Introduction: Though much research has been done on the health and social benefits of pet ownership for many groups, there have been no explorations of what pet ownership can mean to adults who are marginalized, living on fixed incomes or on the street in Canada. We are a community group of researchers from downtown Toronto. Made up of front line staff and community members, we believe that community research is important so that our concerns, visions, views and values are presented by us. We also believe that research can and should lead to social change.

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

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

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

Introduction The concept of a Healthy City was adopted by The World Health Organization some time ago and it includes strong support for local involvement in problem solving and implementation of solutions. While aimed at improving social, economic or environmental conditions in a given community, more significantly the process is considered to be a building block for poliq reform and larger scale 'hange, i.e. "acting locally while thinking globally." Neighbourhood planning can he the entry point for citizens to hegin engaging with neighbours on issues of the greater common good.

Methods: This presentation will outline how two community driven projects have unfolded to address air pollution. The first was an uphill push to create bike lanes where car lanes previously existed and the second is an ongoing, multi-sectoral round table focused on pollution and planning. Both dt•monstrate the importance of having support with the process and a health focus. Borrowing from traditions of "Technical Aid"• and community development the health promoter /planner has incorporated a range of "determinants of health" into neighbourhood planning discussions. As in most urban conditions the physical environment is linked to a range of health stressors such as social isolation, crowding, noise, lack of open space /recreation, mobility and safety. However typical planning processes do not hring in a health perspective. Health as a focus for neighbourhood planning is a powerful starti_ng point when discussing transportation planning or changing land-uses. By raising awareness on determmants of health, citizens can begin to better understand how to engage in a process and affect change. Often local level politics are involved and citizens witness policy change in action.

The environmental Liaison Committee and the Dundas East hike lanes project resulted from local level initiatives aimed at finding solutions to air pollution -a priority identified hy the community. SRCHC supported the process with facilitation and technical aid. _The processs had tangible results that ultimately improve living conditions and health. •tn the United Kmgdom plannm in the 60's established "technical aid" offices much like our present day Legal Aid system to provide professional support and advocacy for communities undergoing change.

P2-15 (C) Integrating Community Based Research: The Experience of Street Health, a Community Service Agency I.aura Cowan and Jacqueline Wood Street Health began offering services to homeless men and women in east downtown ~oronto in 1986. Nursing stations at drop-in centres and shelters were fo~lowed by HIV/AIDS prevent10~, harm reduction and mental health outreach, Hepatitis C support, sleeping bag exchange, and personal tdennfication replacement and storage programs. As Street Health's progi;ams expanded, so to~ did the agency:s recognition that more nee~ed t~ be done to. address the underl~ing causes of, th~ soct~l and economic exclusion experienced by its clients. Knowing t.h~t. a~voca~y ts. helped by . evtd~nce , Street He.alt~ embarked on a community-based research (CBR) initiative to 1dent1fy commumty-dnven research priorities within the homeless and underhoused population. Methods: Five focus groups were conducted with 46 homeless people, asking participants to identify positive and negative forces in their lives, and which topics were important to take action on and learn more about. Findings were validated through a validation meeting with participants.

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

Conclusions: Although participants expressed numerous issues and provided much valuable insight, definitive research ideas and action areas were not clearly identified by participants. However, engagement in a CBR process led to some important lessons and benefits for Street Health. We learned that the community involvement of homeless people and front-line staff is critical to ensuring relevance and validity for a research project; that existing strong relationships with community parmers are essential to the successful implementation of a project involving marginalized groups; and that an action approach focusing on positive change can make research relevant to directly affected people and community agency staff. Street Health benefited from using a CBR approach, as the research process facilitated capacity building among staff and within the organization as a whole. P2-16 (C) A Collaborative Process to Achieve Access to Primary Health Care for Black Women and Women of Colour: A Model of Community Based Participartory Research Notisha Massaquoi, Charmaine Williams, Amoaba Gooden, and Tulika Agerwal

In the current healthcare environment, a significant number of Black women and women of color face barriers to accessing effective, high quality services. Research has identified several issues that contribute to decreased access to primary health care for this population however racism has emerged as an overarching determinant of health and healthcare access. This is further amplified by simultaneous membership in multiple groups that experience discrimination and barriers to healthcare for example those affected by sexism, homelessness, poverty, homophobia and heterosexism, disability and HIV infection. The Collaborative Process to Achieve Access to Primary Health Care for Black Women and Women of Colour Project was developed with The University of Toronto Faculty of Social Work and five community partners using a collaborative methodology to address a pressing need within the community ro increase access to primary health care for Black Women and Women of Colour. Women's Health in Women's Hands Community Health Centre, Sistering, Parkdale Community Health Centre, Rexdale Community Health Centre and Planed Parenthood of Toronto developed this community-based participatory-action research project to collaboratively barriers affecting these women, and to develop a model of care that will increase their access to health services. This framework was developed using a process which ensured that community members from the target population and service providers working in multiculrural clinical settings, were a part of the research process. They were given the opportunity to shape the course of action, from the design of the project to the evaluation and dissemination phase. Empowerment is a goal of the participatory action process, therefore, the research process has deliberately prioritized _ro enabling women to increase control over their health and well-being. In this session, the presenters will explore community-based participatory research and how such a model can be useful for understanding and contextualizing the experiences of Black Women and Women of Colour. They will address. the development and use of community parmerships, design and implementation of the research prorect, challenges encountered, lessons learnt and action outcomes. They will examine how the results from a collaborative community-based research project can be used as an action strategy to POSTER SESSIONS v61 address che social determinants of women health. Finally the session will provide tools for service providers and researchers to explore ways to increase partnerships and to integrate strategies to meet the needs of che target population who face multiple barriers to accessing services.

Lynn Scruby and Rachel Rapaport Beck

The purpose of this project was ro bring traditionally disenfranchised Winnipeg and surrounding area women into decision-making roles. The researchers have built upon the relationships and information gachered from a pilot project and enhanced the role of input from participants on their policy prioriries. The project is guided by an advisory committee consisting of program providers and community representatives, as well as the researchers. Participants included program users at four Family Resource Cencres, two in Winnipeg and two located rurally, where they participated in focus groups. The participants answered a series of questions relating to their contact with government services and then provided inpuc as to their perceptions for needed changes within government policy. Following data analysis, the researchers will return to the four centres to share the information and continue che discussion on methods for advocating for change. Recommendations for program planning and policy development and implementation will be discussed and have relevance to all participants in the research program.

Women's Health Vera LeFranc, Louise Hara, Denise Darrell, Sonya Boyce, and Colleen Reid Women's experiences with paid and unpaid work, and with the formal and informal economies, have shifted over the last 20 years. In British Columbia, women's employability is affected by government legislation, federal and provincial policy changes, and local practices. Two years ago we formed the Coalition ior Women's Economic Advancement to explore ways of dealing with women's worsening economic situations. Since the formation of the Coalition we have discussed the need for research into women's employabilicy and how women were coping and surviving. We also identified how the need to document the nature of women's employability and reliance on the informal economy bore significanc mechodological and ethical challenges. Inherent in our approach is a social model of women's health that recognizes health as containing social, economic, and environmental determinants. We aim to examine the social contexc of women's healch by exploring and legitimizing women's own experiences, challenging medical dominance in understandings of health, and explaining women's health in terms of their subordination and marginalizacion. Through using a feminist action research (FAR) methodology we will explore the relationship between women's employability and health in 4 communities that represent Bricish Columbia's social, economic, cultural/ethnic, and geographic diversities: Skidegate, Fort St . .John, Lumhy, and Surrey. Over the course of our 2 year project, in each community we will establish and work with Advisory Committees, hire and train local researchers, conduct FAR (including a range of qualitative methods), and support action and advocacy. Since the selected communities are diverse, the ways that the research unfolds will 1·ary between communities. Expected outcomes, such as the provision of a written report and resources, the establishment of a website for networking among the communities, and a video do.:umentary, are aimed at supporting the research participants, Coalition members, and Advisory Conuniuces in their action efforts. P2t 9 (C) Health & Housing: Assessing the Impact of Transitional Housing for People Living with HIV I AIDS

Currently, there is a dearth of available literature which examines supporrive housing for PHAs in the Canadian context. Using qualitative, one-on-one interviews we investigace the impact of transitional housing for PHAswho have lived in the up to nine month long Hastings Program. Our post<'r pr<·senta-t1on will highlight research findings, as well as an examination of transitional housing and th<· imp;Kt it has on the everyday lives of PHAs in Canada. This research is one of two ground breaking undertakings within the province of Ontario in which fife House is involved.

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

Community Food Centre as a Working Model Charles l.evkoe Food hanks in North America have come co play a central role as the widespread response to growing rates of hunger. Originally thought to be a short term-solution, over the last 25 years, they have v62 POSTER SESSIONS be · · · 1· d wi'thi'n society by filling the gaps in the social safety net while relieving govemcome mst1tut1ona 1ze

.

. . t f the ir responsibilities. Dependent on corporate donations and sngmauzmg to users, food banks men so Th' . ·11 I I . are incapable of addressing the structural cause~ of ~u~ger.

1s pres~ntation w1 e~~ ore a ternanve approaches to addressing urban food security while bmldmg more sustamabl.e c~mmumt1es. i:nrough the f t h St p Community Food Centre, a Toronto-based grassroots orgamzanon, a model is presented case 0 e 0 h'l k' b 'Id · b that both responds to the emergency food needs of communities w 1 e wor mg to. u1 ~ sustama le and just food system. Termed, the Community Food Centre model. (CFC), ~he S~op is worki?g to widen its approach to issues of food insecurity by combining respectful ~1rect service wit~ com~~mty ~evelop ment, social justice and environmental sustainability. Through this approach, various critical discourses around hunger converge with different strategic and varied implications for a~ion. As a plac~-based organization, The Stop is rooted within a geographical space and connected directly to a neighbourhood. Through working to increase access to healthy food, it is active in maintaining people's dignity, building a strong and democratic community and educating for social change. Connected to coalitions and alliances, The Stop is also active in organizing across scales in connection with the global food justice movement.

Inner City Shelter Vicky Stergiopoulos, Carolyn Dewa, Katherine Rouleau, Shawn Yoder, and Lorne Tugg Introduction: In the city of Toronto there are more than 32,000 hostel users each year, many with mental health and addiction issues. Although shelters have responded in various ways to the health needs of their clients, evidence on the effectiveness of programs delivering mental health services to the home· less in Canada has been scant. The objective of this community based research was to provide a forma· tive evaluation of a multi-agency collaborative care team providing comprehensive care for high needs clients at Toronto's largest shelter for homeless men.

Methods: A logic model provided the framework for analysis. A chart review of 56 clients referred over a nine month period was completed. Demographic data were collected, and process and outcome indicators were identified for which data was obtained and analyzed. The two main outcome measures were mental status and housing status 6 months after referral to the program. Improvement or lack of improvement in mental status was established by chart review and team consensus. Housing outcomes were determined by chart review and the hostel databases.

Results: Of the clients referred 75% were single and 98% were unemployed. Forty four percent had a psychiatric hospitalization within the previous two years. The prevalence of severe and persistent men· tal illness, alcohol and substance use disorders were 60%, 26% and 37% respectively. Six months after referral to the program 37% of clients had improved mental status and 41 % were housed. Logistic regression controlling for the number of General Practitioner and Psychiatrist visits, presence of person· ality or substance use disorder and treatment non adherence identified two variables significantly associ· ated mental status improvement: the number of psychiatric visits (OR, 1.92; 95% CI, 1.29-2.84) and treatment non adherence (OR, 0.086; 95% CI, 0.01-0.78). The same two variables were associated with housing outcomes. History of forensic involvement, the presence of a personality or substance use disorder and the number of visits with a family physician were not significantly associated with either outcome.

Conclusions: Despite the limitations in sample sire and study design, this study can yield useful informa· tion to program planners. Our results suggest that strategies to improve treatment adherence and access to mental health specialists can improve outcomes for this population. Although within primary care teams the appropriate collaborative care model for this population remains to be established, access to psychiatric follow up, in addition to psychiatric assessment services, may be an important component of a successful program.

Mount Sinai Hospital (MSH) has become one of the pre-eminent hospitals in the world by contributing to the development of innovative approaches to effective health care and disease prevention. Recently, the hospital has dedicated resources towards the development of a strategy aimed at enhancing the hospital's integration with its community partners. This approach will better serve the hospital in the current health care environment where Local Health Integration Networks have been struck to enhance and support local capacity to plan, coordinate and integrate service delivery. MSH has had early success with developing partnerships. These alliances have been linked to programs serving key target populations with _estabhshe~. points of access to MSH. Recognizing the need to build upon these achievements to remain compe~mve, the hospital has developed a Community Integration Strategy. At the forefront of this strategy is C.A.R.E (Community Advisory Reference Engine): the hospital's compendium of POSTER SESSIONS v63 Community Partners. As a single point of access to community partner information, C.A.R.E. is more than a database. C.A.R.E. serves as the foundation for community-focused forecasting and a vehicle for inter and intra-organizational knowledge transfer. Information gleaned from the catalog of community parmers can be used to prepare strategic, long-term partnership plans aimed at ensuring that a comprehensive array of services can be provided to the hospital community. C.A.R.E. also houses a permanent record of the hospital's alliances. This prevents administrative duplication and facilitates the formation of new alliances that best serve both the patient and the hospital. C.A.R.E. is not a stand-alone tool and is most powerful when combined with other aspects of the hospital's Community Integration Strategy. It iscxpected that data from the hospital's community advisory committees and performance measurement department will also be stored alongside stakeholder details. This information can then be used to drive discussions at Senior Management and the Board, ensuring congruence between stakeholder, patient and hospital objectives. The patient stands to benefit from this strategy. The unique, distinct point of reference to a wide array of community services provides case managers and discharge planners with the information they need to connect patients with appropriate community services. Creating these linkages enhances the patient's capacity to convalesce in their homes or places of residence and fosters long-term connections to neighborhood supports. These connections can be used to assist with identifying patients' ongoing health care needs and potentially prevent readmission to hospital.

Introduction: Recruiting high-risk drug users and sex workers for HIV-prevention research has often been hampered by limited access to hard to reach, socially stigmatized individuals. Our recruitment effom have deployed ethnographic methodology to identify and target risk pockets. In particular, ethnographers have modeled their research on a street-outreach model, walking around with HIV-prevention materials and engaging in informal and structured conversations with local residents, and service providers, as well as self-identified drug users and sex workers. While such a methodology identifies people who feel comfortable engaging with outreach workers, it risks missing key connections with those who occupy the margins of even this marginal culture.

Methods: Ethnographers formed a women's laundry group at a laundromat that had a central role as community switchboard and had previously functioned as a party location for the target population. The new manager helped the ethnographers invite women at high risk for HIV back into the space, this time as customers. During weekly laundry sessions, women initiated discussions about HIV-prevention, sexual health, and eventually, the vaccine research for which the Center would be recruiting women.

Ra.Its: The benefits of the group included reintroducing women to a familiar locale, this time as customers rather than unwelcome intruders; creating a span of time (wash and dry) to discuss issues important to me women and to gather data for future recruitment efforts; creating a location to meet women encountered during more traditional outreach research; establishing the site as a place for potential retention efforts; and supporting a local business. Women who participated in the group completed a necessary household task while learning information that they could then bring back to the community, empowering them to be experts on HIV-prevention and vaccine research. Some of these women now assist recruitment efforts. The challenges included keeping the group women-only, especially after lunch was provided, keeping the membership of the group focused on women at risk for HIV, and keeping the women in the group while they did their laundry.

Conclusion: Public health educators and researchers can benefit from identifying alternate congregation sites within risk pockets to provide a comfortable space to discuss HIV prevention issues with high-risk community members. In our presentation, we will describe the context necessary for similar research, document the method's pitfalls and successes, and argue that the laundry group constitutes an ethical, respectful, community-based method for recruitment in an HIV-prevention vaccine trial.

P3-0t (C) Upgrading Inner City Infrastructure and Services for Improved Environmental Hygiene and Health: A Case of Mirzapur in U.P. India Madhusree Mazumdar

In urgency for agricultural and industrial progress to promote economic d.evelopment follo_wing Independence, the Government of India had neglected health promotion and given less emphasis on infrastructure to promote public health for enhanced human pro uct1v_ity. ong wit r~p1 m astrucrure development, which has become essential if citie~ are to. act ~s harbmger.s of econ~nuc ~owth, especially after the adoption of the economic liberalization policy, importance _is a_lso ~emg g1ve.n to foster environmental hygiene for preventive healthcare. The World Health Orga~1sat10~ IS also trJ:'1!1g to help the government to build a lobby at the local level for the purpose by off~rmg to mrroduce_ its Heal.thy City concept to improve public health conditions, so as to reduce th_e disease burden. This pape~ 1s a report of the efforts being made towards such a goal: The paper descr~bes ~ c~se study ?f ~ small city of India called Mirzapur, located on the banks of the nver Ganga, a ma1or lifeline of India, m the eastern part of the State of Uttar Pradesh, where action for improvement began by building better sanitation and environmental infrastructure as per the Ganga Action Plan, but continued with an effort to promote pre· ventive healthcare for overall social development through community participation in and around the city.

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

Introduction: Air pollution and socio-economic status are both known to be associated with asthma in concentrated urban settings but little is known about the relationship between these factors. This study investigates socio-economic variation in ambulatory physician consultations for asthma and assesses possible effect modification of socio-economic status on the association between physician visits and ambient air pollution levels for children aged 1 to 17 and adults aged 18 to 64 in Toronto, Canada between 1992 and 2001.

Methods: Generalized additive models were used to estimate the adjusted relative risk of asthma physician visits associated with an interquartile range increase in sulphur dioxide, nitrogen dioxide, PM2.5, and ozone, respectively.

Results: A consistent socio-economic gradient in the number of physician visits was observed among children and adults and both sexes. Positive associations between ambient concentrations of sul· phur dioxide, nitrogen dioxide and PM2.5 and physician visits were observed across age and sex strata, whereas the associations with ozone were negative. The relative risk estimates for the low socio-«onomic group were not significantly greater than those for the high socio-economic group.

Conclusions: These findings suggest that increased ambulatory physician visits represent another component of the public health impact of exposure to urban air pollution. Further, these results did not identify an age, sex, or socio-economic subgroup in which the association between physician visits and air pollution was significantly stronger than in any other population subgroup.

Eco-Life-Center (ELA) in Albania supports a holistic approach to justice, recognizing the environ· mental justice, social justice and economic justice depend upon and support each other. Low income cit· izens and minorities suffer disproportionately from environmental hazards in the workplace, at home, and in their communities. Inadequate laws, lax enforcement of existing environmental regulations, and ~ea.k penalties for infractions undermine environmental protection. In the last decade, the environmental 1ust1ce m~ve~ent in Tirana metropolis has provided a framework for identifying and exposing the links ~tween irrational development practices, disproportionate siting of toxic facilities, economic depres· s1on, and a diminished quality of life in low-income communities and communities of color. The envi· ~onmental justice agenda has always been rooted in economic, racial, and social justice. Tirana and the issues su.rroun~ing brow~fields redevelopment are crucial points of advocacy and activism for creating ~ubstantia~ social chan~~ m low-income communities and communities of color. We engaging intensively m prevcnnng co'.'1mumnes, especially low income or minority communities, from being coerced by gov· ernmenta~ age_nc1es or companies into siting hazardous materials, or accepting environmentally hazard· ous_ practices m order to create jobs. Although environmental regulations do now exist to address the environmental, health, and social impacts of undesirable land uses, these regulations are difficult to POSTER SESSIONS v65 enforce because many of these sites have been toxic-ridden for many years and investigation and cleanup of these sites can be expensive. Removing health risks must be the main priority of all brown fields action plans. Environmental health hazards are disproportionately concentrated in low-income communities of color. Policy requirements and enforcement mechanisms to safeguard environmental health should be strengthened for all brownfields projects located in these communities. If sites are potentially endangering the health of the community, all efforts should be made for site remediation to be carried out to the highest cleanup standards possible towards the removal of this risk. The assurance of the health of the community should take precedence over any other benefits, economic or otherwise, expected to result from brownfields redevelopment. It's important to require from companies to observe a "good neighbor" policy that includes on-site visitations by a community watchdog committee, and the appointment of a neighborhood environmentalist to their board of directors in accordance with the environmental principles. Vancouver 1976-2001 Michael Buzzelli, Jason Su, and Nhu Le This is the second paper of research programme concerned with the geographical patterning of environmental and population health at the urban neighbourhood scale. Based on the Vancouver metropolitan region, the aim is to better understand the role of neighbourhoods as epidemiological spaces where environmental and social characteristics combine as health processes and outcomes at the community and individual levels. This paper builds a cohort of commensurate neighbourhoods across all six censuses periods from 1976 to 2001, assembles neighbourhood air pollution data (several criterion/health effects pollutants), and providing an analysis to demonstrate how air pollution systematically and consistently maps onto neighbourhood socioeconomic markers, in this case low education and lone-parent families. We conclude with a discussion of how the neighbourhood cohort can be further developed to address emergent priorities in the population and environmental health literatures, namely the need for temporally matched data, a lifecourse approach, and analyses that control for spatial scale effects.

Solid Waste Management and Environment in Mumbai (India) by Uttam Jakoji Sonkamble and Bairam Paswan Abstract: Mumbi is the individual financial capital of India. The population of Greater Mumbai is 3,326,837 and 437 Sq. Km. area. The density of population 21, 190 per Sq. Km. The dayto-day administration and rendering of public services within Gr. Mumbai is provided by the Brihan Mumbai Mahanagar palika (Mumbai Corporation of Gr. Mumbai) that is a body of 221 elected councilors on a 5-year team. Mumcial corporation provides varies conservancy services such as street sweeping, collection of solid waste, removal and transportation, disposal of solid waste, disposal of dead bodies of animals, construction, maintance and cleaning of urinals and public sanitary conveniences. The solid waste becoming complicated due to increase in unplanned urbanization and industrialization, the environment has deteriorated significantly due to inter, intra and international migration stream to Mumbai. The volume of inter state migration to Mumbai is considerably high i.e. 20.89 lakh and international migrant 0.77 lakh have migrated to Mumbai. Present paper gives the view on solid waste management and its implications to environment and health. Pollution from a wide varity of emission, such as from automobiles and industrial activities, has reached critical level in Mumbai, causing respiratory, ocular, water born diseases and other health problems. Sources of generation of waste are -Household waste, commercial waste, Institutional waste, street sweeping, silt removed from drain/nallah/cleanings. Disposal of solid waste in Gr. Mumbai done under 1 incineration 2. Processing to produce organic manure. 3. Vermi-composting 4. Landfill The study shows that the quantity of waste disposal of through processing and conversion to organic ~anure is about 200-240 M.T. per day. The processing is done by a private agency M/S excel Industries Ltd. Who had set up a plant at the Chincholi dumping ground in western Mumbai for this purpose. The corporation is also disposal a plant of its waste mainly market waste through the environment friendly, natural pro-ces~ known as Vermi-composing about 100 M.T. of market waste is disposed of in this manner at the various sites. There are four land fill sites are available and 95 percent of the waste matter generated m Mumbai is disposed of through landfill. Continuous flow of migrant and increa~e in slum population is a complex barrier in the solid waste management whenever community pamc1pat1on work strongly than only we can achieved eco-friendly environment in Mumbai.

Persons exposed to residential craffic have elevated races of respiratory morbidity an~ ~ortality. Since poverty is an important determinant of ill-health, some h~ve argued that t~es~ assoc1at1ons may relate to che lower socioeconomic status of those living along ma1or roads. Our ob1ect1ve was to evaluate the association between traffic intensity at home and hospital admissions for respiratory diagnoses among Montreal residents older than 60 years. Morning peak traffic estimates from the EMMEJ2 Montreal traffic model (MOTREM98) were used as an indicator of exposure to road traffic outside the homes of those hospitalised. The influence of socioeconomic status on the relationship between traffic intensity and hospital admissions for respiratory diagnoses was explored through assessment of confounding by lodging value, expressed as the dollar average over road segments. This indicator of socioeconomic status, as calculated from the Montreal property assessment database, is available at a finer geographic scale than socioeconomic information accessible from the Canadian Census. There was an inverse relationship between traffic intensity estimates and lodging values for those hospitalised (rho -0.23, p 3160 vehicles during che 3 hour morning peak), even after adjustment for lodging value (crude OR 1.35, Cl95% 1.22-1.49; adjusted OR 1.13, Cl95% 1.02-1.25). In Montreal, elderly persons living along major roads are at higher risk of being hospitalised for respiratory illnesses, which appears not simply to reflect the fact that those living along major roads are at relative economic disadvantage.

The paper argues that human beings ought to be at the centre of the concern for sustainable development. While acknowledging the importance of protecting natural resources and the ecosystem in order to secure long term global sustainability, the paper maintain that the proper starting point in the quest for urban sustainability in Africa is the 'brown agenda' to improve che living and working environment of che people, especially che urban poor who face a more immediate environmental threat to their health and well-being. As the UN-Habitat has rightly observed, it is absolutely essential "to ensure that all people have a sufficient stake in the present to motivate them to take part in the struggle to secure the future for humanity.~ The human development approach calls for rethinking and broadening the narrow technical focus of conventional town planning and urban management in order to incorporate the emerging new ideas and principles of urban health and sustainability. I will examine how cities in Sub-Saharan Africa have developed over the last fifty years; the extent to which government policies and programmes have facilitated or constrained urban growth, and the strategies needed to achieve better functioning, safer and more inclusive cities. In this regard I will explore insights from the United Nations Conferences of the 1990s, especially Local Agenda 21 of the Rio Summit, and the Istanbul Declaration/Habitat Agenda, paying particular attention to the principles of enablement, decentralization and partnership canvassed by these movements. Also, I will consider the contributions of the various global initiatives especially the Cities Alliance for Cities Without Slums sponsored by the World Bank and other Partners; che Sustainable Cities Programme, the Global Campaigns for Good Governance and for Secure Tenure canvassed by UNHABIT AT, the Healthy Cities Programme promoted by WHO, and so on. The concluding section will reflect on the future of the African city; what form it will take, and how to bring about the changes needed to make the cities healthier, more productive and equitable, and better able to meet people's needs.

Heather jones-Otazo, john Clarke, Donald Cole, and Miriam Diamond Urban areas, as centers of population and resource consumption, have elevated emissions and concentrations of a wide range of chemical contaminants. We have developed a modeling framework in which we first ~stimate the emissions and transport of contaminants in a city and second, use these estimates along with measured contaminant concentrations in food, to estimate the potential health risk posed by these che.micals. The latter is accomplished using risk assessment. We applied our modeling framework to consider two groups of chemical contaminants, polycyclic aromatic hydrocarbons (PAH) a.nd the flame re~ardants polybrominated diphenyl ethers (PBDE). PAH originate from vehicles and stationary combustion sources. ~veral PAH are potent carcinogens and some compounds also cause noncancer effects. PBDEs are additive flame retardants used in polyurethane foams (e.g., car seats, furniture) 105fER SESSIONS v67 and cl~ equipm~nt (e.g., compute~~· televisio~s). Two out of three PBDEs formulations are being voluntarily phased by mdustry due to rmng levels m human tissues and their world-wide distribution. PBDEs have been .related to adv.erse neurological, developmental and reproductive effects in laboratory IJlimals. We apphed our modelmg framework to the City of Toronto where we considered the southcattral area of 21 by 21 km that has a population of 1.3 million. For PAH, local vehicle traffic and area sources contribute at least half of total PAH in Toronto. Local contributions to PBDEs range from 57-85%, depending on the assumptions made. Air concentrations of both compounds are about 10 times higher downtown than 80 km north of Toronto. Although measured PAH concentrations in food date to the 1980s, we estimate that the greatest exposure and contribution to lifetime cancer risk comes from ingestion of infant formula, which is consistent with toxicological evidence. The next greatest exposure and cancer risk are attributable to eating animal products (e.g. milk, eggs, fish). Breathing downtown air contributes an additional 10 percent to one's lifetime cancer risk. Eating vegetables from a home garden localed downtown contributes negligibly to exposure and risk. For PBDEs, the greatest lifetime exposure comes through breast milk (we did not have data for infant formula), followed by ingestion of dust by the toddler and infant. These results suggest strategies to mitigate exposure and health risk.

P4-01 (A) Immigration and Socioeconomic Inequalities in Cervical Cancer Screening in Toronto, Canada Aisha Lofters, Rahim Moineddin, Maria Creatore, Mohammad Agha, and Richard Glazier llltroduction: Pap smears are recommended for cervical cancer screening from the onset of sexual activity to age 69. Socioeconomic and ethnoracial gradients in self-reported cervical cancer screening have been documented in North America but there have been few direct measures of Pap smear use among immigrants or other socially disadvantaged groups. Our purpose was to investigate whether immigration and socioeconomic factors are related to cervical cancer screening in Toronto, Canada.

Methods: Pap smears were identified using fee codes and laboratory codes in Ontario physician service claims (OHIP) for three years starting in 1999 for women age 18-41 and 42-66. All women with any health system contact during the three years were used as the denominator. Social and economic factors were derived from the 2001 Canadian census for census tracts and divided into quintiles of roughly equal population. Recent registrants, over 80% of whom are expected to be recent immigrants to Canada, were identified as women who first registered for health coverage in Ontario after January 1, 1993. Results: Among 397,967 women age 18-41 and 328,885 women age 42-66, 55.3% and 55.5%, rtSpcctively, had Pap smears within three years. Low income, low education, recent immigration, visible minority and non-English language were all associated with lower rates (least advantaged quintile:most advantaged quintile rate ratios were 0.84, 0.90, 0.81, 0.85, 0.83, respectively, p < 0.05 for all). Similar gradients were found in both age groups. Recent registrants comprised 22.5% of women and had mm;h lower Pap smear rates than non-recent registrants (37.2 % versus 63. 7% for women age 18-41 and 35.9% versus 58.2% for women age 42-66).

ConclNSions: Pap smear rates in Toronto fall well below those dictated by evidence-based practice. At the area level, immigration, visible minority, language and socioeconomic characteristics are associated with Pap smear rates. Recent registrants, representing a largely immigrant group, have particularly low rates. Efforts to improve coverage of cervical cancer screening need to be directed to all ~omen, their providers and the health system but with special emphasis on women who recently arrived m Ontario and those with social and economic disadvantage.

Challeges Faced: a) Most of the resources are now being ~pent in ~reventing the sprea.d of HIV/ AIDS and maintaining the lives of those already affected. b) Skilled medical ~rs~nal are dymg under· mining the capacity to provide the required health care services. ~) Th.e comphcat1o~s of HIV/AIDs has complicated the treatment of other diseases e.g. TBs d) The ep1dem1c has led. to mcrease number of h n requiring care and support. This has further stretched the resources available for health care. orp a s d db . . I Methods used on our Research: 1. A simple community survey con ucte y our orgamzat1on vo · unteers in three urban centres members of the community, workers and health care prov~ders were interviewed ... 2. Meeting/Discussions were organized in Hospitals, commun.ity centre a~d with Government officials ... 3. Written questionnaires to health workers, doctors and pohcy makers m th.e health sectors.

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

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

Implications of our Research: Community Members and Civic Society-introduction of home based care programs to take care of the sick who cannot get a space in the overcrowded public hospitals. PRl-V A TE SECTOR Private sector has established programs to support and care for the staff already affected. GOVERNMENT Provision of support to care-givers, in terms of resources and finances. Training more health workers.

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

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

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

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

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

Methods: This work is based on a qualitative study on the health care experiences of San Francisco Chinatown in the United States, an ethnic community with a model ethnic-specific health care infrastrucrure. Using snowball sampling, interviews were conducted with key stakeholders and archival research was conducted to trace and model the developmental process that led to the current ethnic-specific health care system available to the Chinese in San Francisco. Grounded theory was the methodology IJltd to analysis of qualitative data.

The result of the study is four-stage developmental model of ethnic-specific health infrastrueture development that emerged from the data. The first stage of development is the creation of the human capital resources needed for an ethnic-specific health infrastructure, with emphasis on a bilingual and bicultural health care workforce. The second stage is the effective organization of health care resources for maximal access by constituents. The third is the strengthening and stability of those institutional forms through increased organizational capacity. Integration of the ethnic-specific health care system into the mainstream health care infrastructure is the final stage of development for an ethnic-specific infrastructure.

Conclusion: Integrated ethnic-specific health care systems are an effective, long-term strategy to address the linguistic and cultural barriers that are being faced by the spectrum of ethnic populations in urban areas, acting as culturally appropriate points of access to the mainstream health care system. The model presented is a roadmap to empower ethnic communities to act on the constraints of their health and political environments to improve their health care experiences. At a policy level, ethnic-specific health care organizations are an effective long-term strategy to increase access to care and improve qualiiy of care for marginalized ethnic groups. Each stage of the model serves as a target area for policy interventions to address the access and care issues faced by culturally and linguistically diverse populations.

Users in Baltimore MD: 1989-2004 Noya Galai, Gregory Lucas, Peter O'Driscoll, David Celentano, David Vlahov, Gregory Kirk, and Shruti Mehta Introduction: Frequent use of emergency rooms (ER) and hospitalizations among injection drug users (IDUs) has been reported and has often been attributed to lack of access to primary health care. However, there is little longitudinal data which examine health care utilization over individual drug use careers. We examined factors associated with hospitalizations, ER and outpatient (OP) visits among IDUs over 14 years of follow-up.

Methods: IDUs were recruited through community outreach into the AIDS Link to lntraVenous Experience (ALIVE) study and followed semi-annually. 2,551 who had at least 2 follow-up visits were included in this analysis. Outcomes were self-reported episodes of hospitalizations and ER/OP visits in the prior six months. Poisson regression was used accounting for intra-person correlation with generalized estimation equations.

hits: At enrollment, 73% were male, 95% were African-American, 33% were HIV positive, median age was 35 years, and median duration of drug use was 15 years. Over a total of 37,512 visits, mean individual rates of utilization were 11 per 100 person years (PY) for hospitalizations and 123 per 100 PY for ER/OP visits. Adjusting for age and duration of drug use, factors significantly associated with higher rates of hospitalization included HIV infection (relative incidence [RI(, 1.4), female gender (RI, 1.2), homelessness (RI, 1.6), as well as not being employed, injecting at least daily, snorting heroin, havmg a regular source of health care, having health insurance and being in methadone mainte.nance treatment (MMT). Similar associations were observed for ER/OP visits except for MMT which was not associated with ER/OP visits. Additional factors associated with lower ER/OP visits were use of alcohol, crack, injecting at least daily and trading sex for drugs. 10% of the cohort accounted for 45% of total ER/OP visits, while 11 % of the cohort never reported an OP visit during follow-up.

. . . LGBT) populations. We hypothesized that prov1dmg .appomtments .for p~t1~nts w1thm 24 hours would ensure timely care, increase patient satisfaction, and improve practice eff1c1ency. Further, we anticipated that the greatest change would occur amongst our homeless patients.. . Methods: We tested an experimental introduction of advanced access scheduling (usmg a 24 hour rule) in the primary care medical clinic. We tracked variables inclu~ing waiting ti~e fo~ next available appointment; number of patients seen; and no-show rates, for an eight week penod pnor to and post introduction of the new scheduling system. Both patient and provider satisfaction were assessed using a brief survey (2 questions rated on a 5-pt scale).

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

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

Methods: A telephone survey of 658 London, Ontario residents is currently being conducted to assess: a) community resource availability, quality, access and use, b) participation in neighborhood activities, c) perceived quality of neighborhood, d) neighborhood problems, and e) neighborhood cohesion. The survey instrument is composed of indices and scales previously validated and adapted to reflect London specifically. Thirty city planning districts are used to define neighborhoods. The sample size for each neighborhood reflects the size of the planning district. Responses will be compared within and across neighborhoods. Data will be linked with census information to study variation across socio-eco· nomic and demographic groups. Linear and GIS-based methods will be used for analysis.

Preliminary Results: The survey follows a qualitative study providing a first look at how experts involved in community resource planning and administration and city residents perceive the availability, accessibility, and quality of community resources linked to neighborhood health and wellbeing, and what are the most immediate needs that should be addressed. Key-informant interviews and focus groups were used. The survey was pre-tested to ensure that the language and content reflects real experiences of city residents. The qualitative research confirmed our hypothesis that planning districts are an acceptable surrogate for neighborhood, and that the language and content of the survey is appropriate for imple· mentation in London. Scales and indices showed good to excellent reliability and validity during the pre· test (Cronbach's alpha from 0.57-0.96). Preliminary results of the survey will be detailed at the conference.

Conclusions: This study will help assess where community resources are lacking or need improve· ment, thus contributing to a more effective allocation of public funds. It is also hypothesized that engaged neighborhoods with a well-developed sense of community are more likely to respond to health programs and interventions. It is hoped that this study will allow London residents to better understand the needs and problems of their neighborhoods and provide a research foundation to support local understandmg of community improvement with the goal of promoting healthy neighborhoods.

P4-08 (A) HIV Positive in New York City and No Outpatient Care: Who and Why? Hannah Wolfe and Victoria Sharp Introduction: There are approximately 1 million HIV positive individuals living in the United Sta!es. About. 50% of these know their HIY status and are enrolled in outpatient care. Of the remaining 50 Yo, approx~mately half do not know their status; the other group frequently know their status but are not enrolled m any .sys~em of outpatient care. This group primarily accesses care through emergency departments. When md1cated, they are admitted to hospitals, receive acute care services and then, upon POSTER SESSIONS v71 di5'harge, disappear from the health care system until a new crisis occurs, when they return to the emergency department. As a large urban HIV Center, caring for over 3000 individuals with HIV we have an active inpatient service ".'ith appr~xi~.ately 1800 discharges annually. We decided to survey our inpatients to better charactenze those md1v1duals who were not enrolled in any system of outpatient care. Results: 18% of inpatients were not enrolled in regular outpatient care: 2% at Roosevelt Hospital and 35% at St.Luke\'s Hospital. Substance abuse and homelessness were highly prevalent in the cohort of patients not enrolled in regular outpatient care. 84% of patients not in care (vs. 33% of those in care) were deemed in need of substance use treatment by the inpatient social worker. 74% of those not in care were homeless (vs. 15% of those in care.) Patients not in care did NOT differ significantly from those in me in terms of age, race, or gender. Patients not in care were asked "why not:" the two most frequent responses were: "I haven't really been sick before" and "I'd rather not think about my health.

Conclusions: This study suggests that there is an opportunity to engage these patients during their stay on the inpatient units and attempt to enroll them in outpatient care. Simple referral to an HIV clinic is insufficient, particularly given the burden of homelessness and substance use in this population. Efforts are currently underway to design an intervention to focus efforts on this group of patients.

P4.Q9 (A) Healthcare Availability and Accessibility in an Urban Area: The Case of Ibadan city, Nigeria

In oder to cater for the healthcare need of the populace, for many years after Nigeria's politicl independence, empphasis was laid on the construction of teaching, general, and specialist hospital all of which were located in the urban centres. The realisation of the inadequacies of this approach in adequately meeting the healthcare needs of the people made the country to change and adopt the Primary Health Care (PHC) system in 1986. The Primary Health Care system which is in line with the Alma Ata declaration of of 1978, wsa aimed at making health care available to as many people as possible on the basis of of equity and social justice. Thus, close to two decades, Nigeria has operated Primary Health Care system as a strategy for providing health care for rural and urban dwellers. This study focusing on urban area, examimes the availabilty and accessibility of health care in one of Nigeria's urban centre, Ibadan city to be specific. This is done within the contest of the country's National Heath Policy of which Pimary Health Care is the main thrust. The study also offers necessary suggestion for policy consideration. In spite of the accessibility to services provided by educated and trained midwifes in many parts of Fars province (Iran) there are still some deliveries conducted by untrained traditional birth attendants in rural parts of the province. As a result, a considerable proportion of deliveries are conducted under a higher risk due to unauthorised and uneducated attendants. This study has conducted to reveal the pro· portion of deliveries with un-authorized attendants and some spatial and social factors affecting the selection of delivery attendants.

Method: This study using a case control design compared some potentially effective parameters indud· ing: spatial, social and educational factors of mothers with deliveries attended by traditional midwifes (n=244) with those assisted by educated and trained midwifes (n=258). The mothers interviewed in our study were selected from rural areas using a cluster sampling method considering each village as a cluster.

Results: more than 11 % of deliveries in the rural area were assisted by traditional midwifes. There are significant direct relationship between asking a traditional birth attendant for delivery and mother age, the number of previous deliveries and distance to a health facility provided for delivery. Significant inverse relationships were found between mother's education and ability to use a vehicle to get to the facilities.

Conclusion: Despite the accessibility of mothers to educated birth attendants and health facilities (according to the government health standards), some mothers still tend to ask traditional birth attendants for help. This is partly because of unrealistic definition of accessibility. The other considerable point is the preference of the traditional attendants for older and less educated mothers showing the necessity of changing theirs knowledge and attitude to understand the risks of deliveries attended by traditional and un-educated midwifes.

P4-12 (A) Identification and Optimization of Service Patterns Provided by Assertive Community Treatment Teams in a Major Urban Setting: Preliminary Findings &om Toronto, Canada Jonathan Weyman, Peter Gozdyra, Margaret Gehrs, Daniela Sota, and Richard Glazier Objective: Assertive Community Treatment (ACT) teams are financed by the Ontario Ministry of Health and Long-Term Care (MOHLTC) and are mandated to provide treatment, rehabilitation and support services in the community to people with severe and persistent mental illness. There are 13 such teams located in various regions across the city of Toronto conducting home visits 1-5 times per week to each of their approximately 80 respective clients. Each team consists of multidisciplinary health professionals who assist clients to identify their needs, establish goals and work toward them. Due to complex referral patterns, the need for service continuity and the locations of supportive housing, clients of any one team are often found scattered across the city which increases home visit travel times and decreases efficiency of service provision. This project examines the locations of clients in relation to the home bases of all 13 ACT teams and identifies options for overcoming the geographical challenges which arise in a large urban setting.

Methods: Using Geographic Information Systems (GIS) we geocoded all client and ACT agency addresses and depicted them on location maps. At a later stage using spatial methods of network analysis we plan to calculate average travel rimes for each ACT team, propose optimization of catchment areas and assess potential travel time savings.

ResNlts: Initial results show a substantial scattering of clients from several ACT teams and substan· rial overlap of visit travel routes for most teams.

Conclusions: Reallocation of catchment areas and optimization of ACT teams' travel patterns should lead to substantial savings in travel times, increased service efficiency and better utilization of resourc_~· ~e l'<!tenri~I modifications to catchment areas must be conducted with appropriate attention to specific clients servtce needs, service continuity and applicable regulations by the MOHL TC. Venice Lido is a popular island within and outside Italy because it hosts the International Cinema Festival yearly. Only few people remember the island for its hospital, which, in the fifties, was one of the most important hospitals in Italy and in Europe, being a modern center for wind-, sun-and thermal-therapy. Since the sixties, its fame became to drop away, since its structure was no longer adequate for the evolving medicine science. At the end of the seventies all the wards were moved into a new big building in the same area. At present the hospital is made up by about forty 'pavilions' (mostly partially used or empty) and a big building, disseminated in a 10 hectares area, on the sea front, on the 500 m long beach. The aim of my research is to suggest a realistic solution, sustainable on the functional use of the area according to basic local needs and economically realizable. I used a philological and multi-disciplinary method, more in detail: -from historical documents, I found what was the very first call of the property and how it adapted to the needs of the demographic development and the sanitary supply over time; -by contacting some operators from different fields, I realized which functions were suitable to the buildings in existence, to the population's needs and to the present sanitary supply. Moreover the planning idea considers: -the debate going on between local people who strongly want to preserve the property, and die ones who want to renew it by different new opportunities; and -the regional sanitary politics, aiming at rationalizing the regional hospitals dislocation, and the budget needs. This plan analyzes and proposes some new alternative solutions to satisfy different needs. The different activities will be dealt out and the environmental fall will be limited as much as possible. After having analyzed its basic call, considered its environmental peculiarities and its position, verified the emerging needs of the local population, the plan proposes 5 different activities: the Hospital; the Social-Rehabilitation Center; the Elderly House; the Thermal Center; the Residential Center; and other activities. Such a plan wants to share in the solution of a basic problem by giving architectonic and functional dignity to an historical completely degraded area and by starting again a social-economical broken off process, by bringing in Venice Lido some fresh necessary elements for its so wished new throw.

P4-14 (C) Dilemma of Free Health Care in Spokane, WA David Bunting Introduction: The paper reports on the activities of Project Access Spokane [PAS], a physician sponsored initiative to provide uncompensated health care to low income, uninsured residents of Spokane County WA. Program providers included all county hospitals, over 600 physicians, other medical professionals, and specialized clinics. Each prescription requires only a $4 co-payment. Sponsored and administered by the county medical society, PAS is funded by local and national foundations, private corporations, municipalities, civic organizations and individuals.

Method: The paper is based on a first year assessment report funded by PAS, using HCFA [Health Care Financing Administration] insurance claim data documenting utilization rates, disease categories and donated charge information and patient CARES [Centralized Applications, Referrals and Enrollment Status) data.

Results: While essentially free for enrollees, the program involved real costs. An administrative organization to refer over 700 patients to any of over 800 providers had to be developed and staffed, using both paid and unpaid personnel. Methods to identify potential patients and veri.fy eligibility. had to ~devised. Patient appointments and transportation had to be scheduled and monitored. Pu~hc relanons, provider solicitations and fundraising activities were continuous. Information requirements regarding program operation were also significant. Data reporting the volume. ~nd value of dona~ed medical services were necessary to demonstrate accomplishments and attr~ct addmon~l support. Providers required assurances their contributions were both significant and eqmtable. Funding sources sought evidence that their support had important consequences. However, generating this ~~ta proved difficult.

Many providers failed to submit appropriate insurance claims forms because .of a~dmonal donated effort and administrative cost, thereby not only reducing their own apparent conmbut1ons but also the overall Significance of the program.

Conclusions: During its initial year, the estimated cost to deliver free health care was ~bout 5500 per enrollee. The lesson is that without an elaborate administrative structure and record keeping s.yst~~· efforts to provide free health care probably will fail. Eligible enrollees c~n not be ~parated from in~hgi ble ones, care will not be accessed or delivered in an efficient manner, neither fundmg nor ~upport "". 1 11 be offered without evidence of tangible benefits, and providers will withdraw if they perceive mequ1table tteannent. v74 P4-1S (C) Mobility in Prostitution and the Impact of Health Therese Van der Helm and Henk Sulman POSTER SESSIONS Introduction: Many of the estimated 8.000 commer~ial ~ex wor~ers (C~W)in A'.'1~terdam ~~me from developing countries and Eastern Europe. To gain ins~ght mto their workmg and_ hvmg condinons the Intermediary Project (IP) at the Municipal Health Serv1~e _contacts these women via ?utreach work on regular basis. Since the new brothel law in October 2000 1s 1~troduc~d, ~SW ~rom outside the EU and who have no Dutch residence permit are not allowed to work m prost1tut10n. Smee then, many of these CSW therefore have gone "underground." The consequences of the new law in the Netherlands will be discussed with regard to the accessibility of CSW and their risk for STl/HIV acquisition and unplanned pregnancies.

Methods: Topics during outreach work are the interventions to increase the knowledge of safe sex and birth control for CSW. Written information is handed out in relevant languages and with addresses of health and social services. In conversations with the women, it appeared that many are not aware of these services. To provide easier access to health care for women, staff of the IP carries out free STI control CSW working places, in windows brothels and sex houses. Also, women are offered vaccination against hepatitis B (HBV).

Results: From January 2004 till July 2005 we approached 900 CSW for first contact. One third was Dutch; others were from developing countries, other EU countries and Eastern Europe. 350 STI consul· rations were done among non-IV drug using sex workers, of whom 50 % was Dutch. Of these, 2 % was diagnosed with syphilis, 1 % with gonorrhea, and 9% with Chlamydia. Of 234 women tested for HIV, none were infected. Due to the high turnover of CSW in .brothels, most wnmen were tested only once. Among 845 CSW tested for HBV -of whom one third is Dutch -22 % had antibodies for HBV, 12 were carrier of HBV, most of whom came from HBV endemic areas.

Conclusions: STI control and HBV vaccination in brothels is an important support in health care. Our findings suggest that CSW do not play an important role in the transmission of STI. Many CSW are highly mobile and often not aware of the existing health and social services. Continuous outreach is important to remain in contact with this mobile population. Regulations in the new brothel law should not hamper contacts with (illegal) CSW. Heart Disease (CHO) is projected to become the leading cause of death. Studies conducted in Europe and the United States have proven a higher rate of CHO in South Asians who have migrated from South Asia, most notably India, Pakistan and Bangladesh. Approximately 50% of all heart attacks among South Asian men occur under the age of 55; 25% of them occur under the age of 40-unheard of in any other population. Associated risk factors such as diabetes, high blood pressure and cholesterol are also com· mon in this group. The population of South Asians residing in NYC has more than doubled over the past decade to over 300,000, the majority being young, working-class and with limited health care access. Many South Asian men are employed as taxi drivers (4 out of 10 NYC taxi drivers are from South Asial, working daily12 hour plus shifts.

Methods: Acknowledging that this vulnerable, at-risk group was unavailable for outreach through conventional venues, three of the hospitals of the New York City Health and Hospital Corporation, (Elmhurst, Queens and Bellevue) conducted a one day outreach effort at NYC's JFK International Air· ~rt's taxi holdin~ ar~a, ~here over one thousand taxis regularly assemble. Bringing an outreach event directly to the taxi dnvers workplace, a tent was set up where cardiovascular-related health screenings, in~luding bl~ pressure, sugar, cholesterol, body mass index (BMI), were provided. Results were shared with and explamed to the drivers and each participant received a South Asian health education brochure. A total of 84 taxi drivers who identified as South Asian were involved.

Rau/ts: Participants were all male, ranging from 20 to 61 years; mean age, 41.5. Screenings revealed 57% hypertensive; 46% had cholesterols over 200; 26% blood glucose over 160; 91 % had a BMI greater than 25.

Conc~on: A unique outreach activity, adapting to logistical, occupational limitations, is pre· se~ted. On-site f~back and explanation of results, reiterating and reinforcing the concern that South Asia~. men are at mcreased danger for early coronary heart disease, and the dissemination of a culturally sensmve and r~levant brochure, may heighten awareness of prevailing cardiac risk factors in this immi· grant community.

P4-17 (C) The Community-Hospital Integration Program Framework: Community-Hospital panoenhips to Improve the Population's Health John Stevenson, Richard Blickstead, Ann-Marie Marcolin, and Sandi Kendal v75 Introduction: St. Josephs Health Centre is a Catholic community teaching hospital located in the heart of Southwest Toronto. St. Joseph\'s was founded from a community-expressed need for hospital services, and since then has stayed committed to fostering a healthy community through collaboration and parmership. St. Joseph's has developed an innovative model, the Community-Hospital Integration Program (CHIP), to strengthen St. Joseph's partnerships with community stakeholders, and facilitates the building of links between community needs, service provision, and public policy outcomes to improve the health and wellness of the diverse neighbourhoods they together serve.

Methods: Development of the CHIP Framework St. Joseph's Health Centre developed the CHIP framework through a multidisciplinary approach that included extensive international literature reviews, consultations, and key informant interviews with community service agencies and academics. To ensure active community voice, St. Joseph's has hosted a number of community consultations including a Community Outreach Forum attended by over ninety representatives from 68 community partners.

Results: The CHIP Framework The CHIP framework aims to improve the health and wellness of the urban communities served by St. Josephs Health Centre through four intersecting pillars: • Raising Community Voices provides an infrastructure and process that supports community stakeholder input into health care service planning, decision-making, and delivery by the hospital and across the continuum of care; • Sharing Reciprocal Capacity promotes healthy communities through the sharing of our intellectual and physical capacity with our community partners; • Cultivating Integration Initiatives facilitates vertical, horizontal, and intersectoral integration initiatives in support of community-identified needs and gaps; and • Facilitating Healthy Exchange develops best practices in community integration through community-based research, and facilitates community voice in informing public policy.

The CHIP framework drives the complex inter-relationships between community-hospital engagement, reciprocal capacity-building, integration initiatives, and community-based research and evaluation, to create an interconnected network of health care services. The fluidity and simplicity of this framework, and its dedication to balancing community needs and hospital mandate, posits the St. Josephs Health Centre's CHIP model as an integral component in building healthy and thriving communities.

P4-18 (C) Home Based Care Promotion: Improving Acess to Quality Services and Livelihood in the Face of AIDS

Home Based care is a service provided to persons affected/living with HIV/AIDS, a menu of care/support services at home/community. It is a prominent alternative approach. In Uganda, hospital bed ocupacny is high, patient health care worker ratio deteriorating. Empowering communities offers solutions to the problems; adressing cost, effectiveness of care. HIV/AIDS demands changes in attitudes, behaviour, approaches which is enhanced in home/community settings. For example ART requires high levels of adherecnce, which medical workers have vety little opportunity to enforce. It also demands other support mechanisims in terms of Nutrition, personal displine, etc which work best in stigma free environments. Hence the relevance of home based care. This paper highlights the gaps that call for increased action in terms of home based care, examples of whre it has worked key challenges and recommendations for the future.

P4-19 (C) Health Care For One ... Health Care For Alli Katharina Kovacs Burns Introduction: At the surface, it appears that every person in Canada _has. ~ccess to a publicly funded health care system. Those living in urban centers should have the best ava1l~b1hty, chmce, and access to a variety of health care services because of the distribution of health care services, fac1lmes, and health professionals in concentrated in urban centers. This is not true for everyone -people with low income or who are homeless experience the challenges of social exclusion and being marginalized: There are many factors at play making it difficult for the latter group of people to access health care. service they need,.when they need them. Health care is not as accessible or inclusive as intended. The quesuon to be explore.cl 1~: If health care is available and accessible to one person, what makes it not available to all people? The ~1gmfic~nce of having marginalized people accessing health care and other services includes e~hanced quality of hfe and decreased risks associated with being homeless, and cost savings in Ion~ ter~ w1rh acute health care.

Methodology: Community-based Participatory Research is applied m a case study on health care access and challenges experienced by low income and homeless people in one urban centre, Edmonton, Edmonton, and their challenges. The data is being gathered and ana_lyzed usmg basic m1x~d methods. Results: The results will focus on how services can be more mtegrated and accessible to all people with low income and who are homeless. There will also be discussion about specific perceptions of not only the service providers but also of people with low income an~ who are homeless~ and vario~s decision makers. The results will be compared to the literature regardmg health care services access mother urban centers in Canada and elsewhere.

Conclusions: Recommendations will need to address social exclusion and other factors which can make health care and other services more available to all people in the community. The implications for health care will also be discussed. Additional information will be gathered in the next phases of the study to develop a Community Services Access Model.

P4-20 (C) Availability and Access Exemplified: A Case Study Beth Hayhoe and Ruth Ewert Introduction: Access to health care in Canada requires either the correct documentation or money.

Street youth have neither. In addition, health services in Canada are designed by adults for adults. Youth in general are often wary of having trust in adults with respect to their health concerns and frequently feel misunderstood. Street Youth are even more mistrustful of adults and public organizations, making their contact with health care professionals minimal. This combined with their risky behaviours and dangerous environment creates a population at risk for numerous health issues but with no place to have them investi· gated. At our non-government, not for profit health service designed specifically to provide a broad range of health care to street youth, professional services are provided almost entirely by volunteers.

Methods: Using a retrospective analysis of the 11 years of data gathered from this organization and reviewing the initial reasons gathered from youth about their needs, the success of the Health Centre was examined.

Results: All the things youth had listed as being important in a Health Centre have been implemented, and even more things have been added to improve the breadth and quality of services offered. The use of the health centre has increased by more than six times since its opening in 1994. In addition, tens of thousands of visits have been paid to the Health Centre, costing the government and taxpayers nothing. As far as we know there is nothing else in Canada that offers so many diverse and innovative services to youth in need.

Conclusion: It is clear from this case, that health care targeted at the needs of specific disadvan· taged populations can successfully provide them with appropriate health care. A model of accessible health care for marginalized populations can easily be developed for high impact and low cost from this successful case.

Toronto is one of the most ethno-racially diverse cities in the world Of the estimated 2,529,280 Toronto residents, 24% (597,218) live in Scarborough Population growth in Scarborough is faster than Toronto. Scarborough's population increased by 6% from 1996 to 2001 while Toronto increased only by 4%. Toronto's population is projected to increase by 10% (252 000) in 2011 while Scarbor· ough's will increase by 12%. (Census Canada 2001) Low income, pove;ty, seniors, hidden homeless, new~omers to Canada, the uninsured, are just a few of the issues concerning health care in our community. Health care needs in Scarborough are greatly impacted by diversity of ethnic and racial groups, poverty and settlement issues. This paper will share how The Scarborough Hospital (TSH) an Urb~n Communir_y Hospital cares f~~ it~ community. TSH recognizes: •The changing community• B_arriers t~ accessing care • lnequalmes m health care The hospital in caring for its community pro· v1~es services that '!'e~e cu~turally, racially, and linguistically sensitive to our community. The paper will share the hospitals unique program on access and equity. The paper will share the needs in Scar· borough and TSH's response to these needs: working in partnership with the Local Health Committee, i:ne Scarborough Homeless Co.mminee, The Scarborough Network of Immigrant Services Organiza· nons a~d others. 1:'1e paper will also share the many initiatives this urban community hospital has taken viz. community and home programs in service areas such as mental health, haemodialysis day care, t~~ home oxyg~n program, the palliative at-home program, and above all support for the volunteer clinic for the uninsured. J"'"1tllu:lion: In Canada's universal health care system it is generally assumed that everyone has equal access to health care. However, some immigrant groups in Canada have historically been uninswed. These groups include failed refugee claimants, those overstaying their visas, and new immigrants in tranSition who are waiting to become eligible for health insurance. Some estimates have suggested that at the present time there may be as many as one hundred thousand undocumented and thus uninsured immigrants in Toronto alone. Understandably, information on the characteristics of this marginalized population is very limited, since undocumented immigrants tend to have little contact with formal institutions. Knowledge of the demographic characteristics of this population may aid in the development of health and social programs to better identify and meet the needs of undocumented immigrants in Toronto.

We conducted a review of all undocumented, uninsured patients, 15 years of age or older at Access Alliance Multicultural Community Health Centre (AAMCHC) between 1994 and 2004. Demographic information such as age, gender, preferred language, length of time living in Canada, selfreported education level and household income were recorded.

Rmdts: 72% of all adult patients at Access Alliance were undocumented and uninsured. 80% were under40years of age (with a median age of 30 years), 72% were women and only 19% spoke English. This group lived in Canada for an average period of 2.2 years before they were first seen at AAMCHC. 74% of undocumented clients reported having completed at least a secondary or post-secondary education. 81% had self-reported household incomes of less than 20,000$/year, while 97% of households reported earning less than $30,000/year. The mean income per person in an average household was 425$/month. Conchuions: Uninsured individuals at AAMCHC were predominantly young females with limited knowledge of the English language. Despite having attained a high level of education most were living well below the poverty line. Recognition of these characteristics may assist in the development of health and social programs that are better adapted to meet the needs of undocumented immigrants.

P4-23 (C) Sharing Expertise: A Role for the Hospital Lactation Consultant in the Community.

Badrgrmuul: St. Michael's Hospital is a tertiary care hospital that serves a large inner city population in downtown Toronto. In order to provide care to this population, the hospital has developed a number of unique outreach roles. One such role was developed to work with pregnant and breastfeeding women living in Regent Park, a social housing complex located near the hospital. The population of Regent Park includes new immigrants, refugees and the socially disadvantaged.

Approach: The Outreach Lactation Consultant provides care, as part of the Canada Prenatal Nutrition Program, in the community prenatally, in the hospital during their inpatient stay and postnatally when they return to the community. The continuity of care enhances the probability of long term successful breastfeeding. Aside from the health benefits of breastmilk, breastfeeding is especially important for women who are financially needy and must depend on food banks for formula. . . Lason Learned: Aher two years of partnership, the relationship between the an-hospital ~stpar tum experience for breastfeeding mothers and the community postpartum support, the breastfeeding rate ~thin this community is high. The professional support and visibility of the 1:8ctation Consultant, both m the hospital and in the community, contributes to the support of breastfee~m~.. .

In light of ongoing funding constraints, this ha1son between hospital and community could be at risk and discontinued. In light of the benefits to the mother/baby dyad, the lactation consultant as a community partner in the Canada Prenatal Nutrition Program should be safeguarded. . lldPodiu:tion: Although the importance of adequate health care in pregna~cy is well recognised, ethnic disparities in utilization of prenatal care still exist in many Western coun~~es. A fun~amental factor in these disparities may be language proficiency, as it influences women's ab1hty. to ob~m and understand health information, to find the way in the health care system and to communicate with health care v78 POSTER SESSIONS providers. We investigated the role of language proficiency in use and knowledge of folic acid as aspect of prenatal care in an urban multi-ethnic pregnancy c?hort.

. .

Design: Prospective cohort study. Setting and parnc1pants: Amsterdam ~regnant women attending obstetric care providers for their first antenatal visit (N= 8050). Country of birth defined ethnicity: the Netherlands, Surinam, Antilles, Turkey, Morocco, Ghana, other non-~est~m (NW) and other Western (W) country. Main outcome measures: Knowledge about and use of.fohc a~d (FA) supplements in pregnancy, and determinants of these in diffe~~t ethnic ~~ups. Deterrrunants mcl~ded age, ed~ tion, parity, pregnancy intention and Dutch prof1c1ency. Stansncs: ~2 to co~p~re e~c groups, stranfied logistic regression (forward stepwise method) to explore determmants "'.'thm ethmc groups ..

Use of FA supplements was significantly lower among Ghanaian, Moroccan, Turkish and other NW women (21%to41 %) than among Dutch (86%) or other W women (78%). Use amongSurinames and Antillean women was intermediate (51%and60%). Ethnic differences in FA knowledge were similar. Knowledge was the strongest determinant of use in all ethnic groups, with odds ratios (ORs) ranging from 10.9 to 42.0. Language proficiency was the strongest determi~a~t of kno~ledge in ethnic groups with a mother tongue different from Dutch (ORs good vs. low proficiency ranging from 3.2 ro 16.0). Educational level had a modifying role, as shown by an interaction effect between education and language proficiency in the NW group. Here, the odds of having FA knowledge given a high education and good Dutch proficiency was 20 times the odds given a good proficiency but low education.

Conclusions: Appropriate periconceptional use of folic acid supplements in non-Western ethnic groups is low, reflecting an absence of knowledge that is largely determined by the inability to speak and understand the language of the habitual country. Tailored interventions using communication channels most likely to address (pregnant) women from ethnic minority groups are necessary. Apan from specific interventions, our results are in support of strong incentives on language education despite current political debate.

Introduction: Recent research suggests living in an economically disadvantaged neighborhood is asso· ciated with decreased likelihood of undergoing mammography and increased risk of late-stage breast can· cer diagnosis. Long distances and travel times to facilities offering low-or no-cost mammography may be imponant barriers to adherence to mammography screening recommendations for residents of economically disadvantaged neighborhoods. The purpose of this study was to examine whether facilities providing low-and no-cost screening mammography were less spatially accessible in low-income neighborhoods in Chicago, and the extent to which the relationship between neighborhood income and the spatial accessibility of facilities varied by the proponion of African-American residents in the neighborhood.

Methods: The sample consisted of 343 Chicago neighborhoods. For each neighborhood, we con· structed three measures of the spatial accessibility of facilities: street network distance to the nearest facility, public transportation travel time to the nearest facility, and shortest automobile travel time to a facility. Using 2000 decennial census data, we characterized the neighborhoods according to proportion of residents with incomes below the poverty line, proportion of residents in each of four raciaVethnic groups (African-American, Latino, White, and Other), and population density. We used ordinary least squares (OLS) and spatial exogenous lag regression to examine relationships. Model 1 estimated the relationship between neighborhood poverty and the spatial accessibility of facilities, adjusting for raciaVeth· nic composition and population density. Model 2 added a multiplicative interaction term between neighborhood poverty and African-American.

Restllts: We identified deven facilities that provided low-or no-cost screening mammography to Chicago residents in 2004. We found that the distance and travel times via automobile and public trans· portation to facilities generally decreased as neighborhood poveny increased. However, we also found that the ~egative associations between neighborhood poverty and two of the spatial accessibility mea· sures -distance and public transportation travel time -were less strong in neighborhoods with the highest proponions of African-American residents. Among neighborhoods in the highest tertile for poveny, th~ mean distance and mean public transportation travel time to facilities were over twice as long in neighborhoods in the highest tertile than in those in the lowest tenile of African-American residents.

. ~ Persistent socioeconomic and racial/ethnic disparities in breast cancer stage at diagno-s11 ~nd su~1val suggest that ensuring an equitable distribution of affordable mammography is a worth-w~e policy .goal. The ~~dy sugges~ that ~ture investigations should consider both neighborhood soc1oecono1D1c charactensbes and rac1aVethmc composition when examining the spatial distribution of health resources. , 2004) . Epidemiological data suggest tha~ HIV prevalence among MSM is over 1 % in some metropolitan cities, such .as Beijing (ibid.). Due to widespread homophobia in Chinese society, however, this population remains invisible within current health/social services. Lack of research on sexuality, specifically homosexuality, has impaired our understanding of health and health practices of Chinese MSM. Focusing on the illness experiences of Chinese MSM with HIV/AIDS, this paper explores the socio-cultural impacts of HIV/ AIDS on this group.

The data used for this paper were collected through semi-constructed in-depth face-toiace interviews with 21 adult PLWHAs (including 11 MSM) in Beijing, China. With the permission of the participants, the interviews were audio-taped or recorded in notes. The transcribed interviews and interview notes were analyzed by using N-vivo, a software program for qualitative data analysis. This phenomenological study aimed to understand the experiences Chinese PLWHAs (including MSM) from their own perspectives.

Results: It is found that the illness experiences of Chinese MSM with HIV/AIDS are profoundly shaped by the socio-cultural meanings of homosexuality, which are further complicated by the dominant discourses on HIV/AIDS in China. At a macro level, homophobia in the larger society has decreased the capability of this group to respond to this epidemic in a more efficient way. At a meso level, AIDS-phobia within the Chinese MSM circuits has prevented this group from openly confronting this disease and offering support to those who are already affected by it. At a micro level, however, these HIV-infected/ affected MSM have tried their best to locate spaces to live and to construct hope for their future lives despite various barriers within family, community, and the larger society.

This study suggests that facilitating Chinese MSM's response to the AIDS crisis urgently requires bridging awareness, commitment, knowledge and resources both within and without this group. It also illustrates the importance of understanding homosexuality in the local context of HIV I AIDS, which will be helpful for developing culturally sensitive HIV/AIDS programs for this population on the community, national and international levels. Introduction: Having a regular family doctor (RFD) is known to be positively correlated with a good medical follow up, including access to preventive and/or chronic care. Inversely, a lack of primary care may lead to high rates of avoidable hospitalizations, especially among poor people and/or in underserved neighbourhoods. In such a matter, a recent comparative study showed that Paris was better ranged than other cities, such as NYC, Tokyo or London. Nevertheless, despite a quasi universal health insurance and a high density of general practitioners, a noticeable fraction of the Paris population does not have any regular physician and we aimed to understand who they are and for what reasons rhey don't have any RFD.

Mdbods: Cross sectional population survey among a random sample of households in 2 ~nderpriv ileged neighbourhoods in Paris inner city, performed in 2003, using a face-to-face quest10nna1re collecr-1ng more than 400 social and health characteristics.

Ruults: A quarter (26.3 %) of rhe study popularion did not have any RFD. This proporrion was iignificantly higher among male (OR= 2.00, 95%CI = [ 1.41-2.781), younger (e.g. OR 18 -29/> .S l _= 4._oo, 95"1.CI = (2.13-7.69)), and/or unemployed (OR =2.01, 95%CI = IJ .21-3.3411_ people. In multtvanate analysis, after a full adjustment on gender, age, health status, health insura~ce, income, occupat10n and tducation level, we observed significant associations between having no RFD and: ~arrtal and_ pare~t hood status (e.g. OR single no kids/in couple+kids = 2.12, 95%CI = ( 1.26-3.59()~ quality of relattonsh1ps with neighbours (OR bad/good= 3 .82, 95%CI = [ 1.84-7.94)), and length of residence m the neighbourhood (with a dose/effect statistical relationship). . Co11clusion: Gender, age, employment status, mariral and parenthood stat~s as well as ~e1gh bourhood anchorage seem to be major predictors of having a RFD, even when um.versa! health i~sur ance has reduced most of financial barriers. In urban contexts, where residential migrattons and single lift (or family ruptures) are frequent, specific information may be conducted to encourage people to Ket RFD. :tu~y tries to assess the health effects and costs and also analyse the availability and accessibility to health care for poor.

. Methods: Data for this study was collected by a survey on 300 households of the local community living near the factories and 100 households where radiation hazard w~s n?~ present. ~~art from mor· bidity status and health expenditure, data was collected ~n access, a~ail~b1.hty and eff1c1ency of healrh care. A discriminant analysis was done to identify the vanables that d1scnmmate between the study and control group households in terms of health care pattern. A contingent valuation survey was also undertaken among the study group to find out the factors affecting their willingness to pay for health insurance and was analysed using logit model.

Results: The health costs and indebtedness in families of the study group was high as compared to control group households and this was mainly due to high health expenditure. The discriminant analysis showed that expenditure incurred by Private hospital inpatient and outpatient expenditure were significant variables, which discriminated between the two types of households. The logit analysis showed !hat variables like indebtedness of households, better health care and presence of radiation induced illnesses were significant factors influencing willingness to pay for health insurance. The study showed that study group households were dependent on private sector to get better health care and there were problems with access and availability at the public sector.

Conclusion: The study found out that the quality of life of the local community is poor due to health effects of radiation and the burden of radiation induced illnesses are so high for them. There is an urgent need for government intervention in this matter. There is also a need for the public sector to be efficient to cater to the needs of the poor. A health insurance or other forms of support to these households will improve the quality for health care services, better and fast access to health care facilities and reduces the financial burden of the local fishing community.

The prevalence of substance abuse is an increasing problem among low-income urban women in Puerto Rico. Latina access to treatment may play an important role in remission from substance abuse. Little is known, however, about Latinas' access to drug treatment. Further, the role of social capital in substance abuse treatment utilization is unknown. This study examines the relative roles of social capital and other factors in obtaining substance abuse treatment, in a three-wave longitudinal study of women ages 18-35 living in high-risk urban areas of Puerto Rico, the Inner City Latina Drug Using Study (ICLDUS). Social capital is measured at the individual level and includes variables from social support and networks, familism, physical environment, and religion instruments of the ICDUS. The study also elucidates the role of treatment received during the study in bringing about changes in social capital. The theoretical framework used in exploring the utilization of substance abuse treatment is the social support approach to social capital. The research addresses three main questions: ( t) does social capital predict parti~ipating in treatment programs? (2) does participation in drug treatment programs increase social capital?, and (3) is there a significant difference among treatment modalities in affecting change in ~ial capital? The findings revealed no significant association between levels of social capital and gettmg treatment. Also, women who received drug treatment did not increase their levels of social capital. The findings, however, revealed a number of significant predictors of social capital and receiving drug ~buse treatment. Predictors of social capital at Wave III include employment status, total monthly mcoi:rie, and baseline social capital. Predictors of receiving drug abuse treatment include perception of physical health and total amount of money spent on drugs. Other different variables were associated to treatment receipt prior to the ICLDUS study. No significant difference in changes of social capital was found among users of different treatment modalities. This research represents an initial attempt to elucidate the two-way relationship between social capital and substance abuse treatment. More work is necessary to unden~nd. ~e role of political forces that promote social inequalities in creating drug abuse problems and ava1lab1hty of treatment; the relationship between the benefits provided by current treatment POSTER SESSIONS v81 sctrings and treatment-seeking behaviors; the paths of recovery; and the efficacy and effectiveness of the trtaanent. and Alejandro Jadad Health professionals in urban centres must meet the challenge of providing equitable care to a population with diverse needs and abilities to access and use available services. Within the Canadian health care system, providers are time-pressured and ill-equipped to deal with patients who face barriers of poverty, literacy, language, culture and social isolation. Directing patients to needed supportive care services is even more difficult than providing them with appropriate technical care. A large proportion of the population do not have equitable access to services and face major problems navigating complex systems. New approaches are needed to bridge across diverse populations and reach out to underserved patients most in need. The objective of this project was to develop an innovative program to help underserved cancer patients access, understand and use needed health and social services. It implemented and evaluated, a pilot intervention employing trained 'personal health coaches' to assist underserved patients from a variety of ethno-linguistic, socio economic and educational backgrounds to meet their supportive cancer care needs. The intervention was tested with a group of 46 underserved cancer patients at the Princess Margaret Hospital, Toronto. Personal coaches helped patients identify needs, access information, and use supportive care services. Triangulation was used to compare and contrast multiple sources of quantitative and qualitative evaluation data provided by patients, personal health coaches, and health care providers to assess needs, barriers and the effectiveness of the coach program. Many patients faced multiple barriers and had complex unmet needs. Barriers of poverty and language were the easiest to detect. A formal, systematic method to identify and meet supportive care needs was not in place at the hospital. However, when patients were referred to the program, an overwhelming majority of participants were highly satisfied with the intervention. The service also appeared to have important implications for improved technical health care by ensuring attendance at appointments, arranging transportation and translation services, encouraging adherence to therapy and mitigating financial hardship -using existing community services. This intervention identified a new approach that was effective in helping very needy patients navigate health and social services systems. Such programs hold potential to improve both emotional and physical health out· comes. Since assistance from a coach at the right time can prevent crises, it can create efficiencies in the health system. The successful use of individuals who were not licensed health professionals for this purpose has implications for health manpower planning. Needle Exchange Programs (NEPs) have been distributing harm reduction materials in Toronto since 1990. COUNTERfit Harm Reduction Program is a small project operated out of a Community Health Centre in south-east Toronto. The project is operated by a single full-time coordinator, one pan-rime mobile outreach worker and two peers who work a few hours each week. All of COUNTERfit's staff, peers, and volunteers identify themselves as active illicit drug users. Yet the program dis~rib utes more needles and safer crack using kits and serves more illicit drug u~rs t~an the comb1~e~ number of all NEPs in Toronto. This presentation will discuss the reasons behind this success, .s~1f1cally the extended hours of operation, delivery models, and the inclusion of an. extremely marg1~ahzed community in all aspects of program design, implementation and eva.luat1?n. ~OUNTERfit was recently evaluated by Drs. Peggy Milson and Carol Strike, two leading ep1dem1olog1st and researchers in the HIV and NEP fields in Toronto and below are some of their findings: "The Program has experienced considerable success in delivering a high quality, accessible and well-used program .... The pro· gram has allowed (service users) to become active participants in providing. services to others and has resulted in true community development in the best sense. " ... COUNTERf1t has ~~n verr succe~sful attracting and retaining clients, developing an effective peer-based model an.d assisting chen~s ~1th a vast range of issues .... The program has become a model for harm red~ctmn progr~ms withm the province of Ontario and beyond." In June 2004, the Association of ?ntano Co~mumty Heal~~ <:en· Ires recognized COUNTERfit's acheivements with the Excellence m Community Health Initiatives Award.

In Kenya, health outcomes and the performance of government health service~ have det~riorated since the late 1980s, trends which coincide with a period of severe resource constramts necessitated by macro-economic stabilization measures after the extreme neo-liberalism of the 1980s. When the govern· ment withdrew from direct service provision as reform trends and donor advocacy suggested, how does it perform its new indirect role of managing relations with new direct health services providers in terms of regulating, enabling, and managing relations with these health services providers? In this paper therefore, we seek to investigate how healthcare access and availability in the slums of Nairobi has been impacted upon by the government's withdrawal from direct health care provision. The methodology involved col· leering primary data by conducting field visits to 8 health institutions located in the slum areas of Kibera and Korogocho in Nairobi. Purposive random sampling was utilized in this study because this sampling technique allowed the researcher(s) to select those health care seekers and providers who had the required information with respect to the objectives of the study. In-depth Interviews using a semi-structured ques· tionnaire were administered ro key informants in health care institutions. This sought to explore ways in which the government and the private sector had responded and addressed in practical terms to new demands of health care provision following the structural adjustment programmes of the 1990s. This was complemented by secondary literature review of publications and records of key governmental, bilateral and multilateral development partners in Nairobi. The study notes a number of weaknesses especially of Kenya's Ministry of Health to perform its expected roles such as managing user fee revenue and financial sustainability of health insurance systems. This changing face of health services provision in Kenya there· fore creates a complex situation, which demands greater understanding of the roles of competition and choice, regulatory structures and models of financing in shaving the evolution of health services. We rec· ommend that the introduction of user fees, decentralization of service provision and contracting-out of non-clinical to private and voluntary agencies require a new management culture, and new and clear insri· tutional relationships. Experience with private sector involvement in health projects underlines the need not only for innovative financial structures to deal with a multitude of contractual, political, market and risks, but also building credible structures to ensure that health services projects are environmentally responsive, socially sensitive, economically viable, and politically feasible.

Purpose: The purpose of this study is to examine the status of mammography screening utilization and its predictors among Muslim women living in Southern California.

Methods: We conducted a cross-sectional study that included 202 women aged ::!: 40 years. We col· leered data using a questionnaire in the primary language of the subjects. The questionnaire included questions on demography; practices of breast self-examination (BSE) and clinical breast examination (CBE); utilization of mammography; and family history of breast cancer. Bivariate and multiple logistic regression analyses were performed to estimate the odds ratios of mammography use as a function of demographic and other predictor variables.

. Results: Among the 202 women, 78% were married, 68% were 40-50 years old, and 20% had family h1Story of breast cancer. Thirty-two percent of the participating women never practiced BSE and 32% had not undergone CBE during the past two years. The data indicated that 46% of the women did not have mammography in the last two years. Logistic regression analysis showed that age (0R=5.1, 95% Confi· dcnc~ Interval (Cl)=l.8-14.2), having clinical breast examination (0R=24.9, 95% Cl=8.4-73.7), and practtce of self-breast examination (0R=2.6, 95% Cl= 1.1-6.2), were strong predictors of mammography use .

. Conclusions: The data point to the need for intervention targeting Muslim women to inform and motivate th.cm a~ut practices for early detection of breast cancer and screening. Further studies are needed to investigate the factors associated with low utilization of mammography among Muslim women population in California. 

We conducted a review of the scientific literature and° government documents to describe ditnational health care program "Barrio Adentro" (inside the neighborhood). We also conducted qualiurivt interviews with members of the local health committees in urban settings to descrihe the comm unity participation component of the program.

RtsMlts: Until recently, the Venezuelan public health system was characterized by a lack or limited access w health care (70% of the population) and long waiting lists that amounted to denial of service.

MOit than half of the MDs worked in the five wealthiest metropolitan areas of the country. Jn the spring oi2003, a pilot program hired 50 Cuban MDs to live in the slums of Caracas to provide health care to piople who had previously been marginalized from social programs. The program underwent a massive expansion and in only two years 20,000 Cuban and 6,500 Venezuelan health care providers were working acmss the country. They provide a daily average of 20-40 medical consultations and home visits, C1llY out neighborhood rounds, and deliver health prevention initiatives, including immunization programs. They also provide generic medicines at no cost to patients, which treat 80% of presenting ill-IJ!M, Barrio Adentro aims to build 8,000 clinics (primary care), 1,200 diagnostic and rehabilitation ctnrres (secondary care), and upgrade the current hospital infrastructure (tertiary care). Local Health Committees survey the community to identify needs and organize a variety of lobby groups to improve dit material conditions of the community. Last year, Barrio Adentro conducted 3.5 times the medical visits conducted by the Ministry of Health. The philosophy of care follows an integrated approach where btalrh is related to housing, education, employment, sports, environment, and food security.

Conclusions: Barrio Adentro is a unique collaboration between low-middle income countries to provide health care to people who have been traditionally excluded from social programs. This program shows that it is possible to develop an effective international collaboration based on participatory democracy. Low-income Americans are at the greatest risk of being uninsured and often face multiple health concerns. This evaluation of the Neighborhood Health Initiative (NH!), an organization which uses multiple programmatic approaches to meet the multiple health needs of clients, reflected the program's many activities and the clients' many service needs. NH! serves low-income, underserved, and hard-to-reach residents in the Des Moines Enterprise Community. Multiple approaches (fourth-generation evaluation, grounded theory, strengths-and needs-based) and methods (staff and client interviews, concept mapping, observations, qualitative and quantitative analysis) were used to achieve that reflection. Results indicate good targeting of residents in the 50314 ZIP Code and positive findings in the way of health insurance coverage and reported unmet health needs of clients. Program activities were found to match client nttds, validating the organization\'s assessment of clients. Important components of NHI were the staff composition and that the organization had become part of both the formal and informal networks. NHI 1 1 positioned as a link between the target population and local health and social sc:rvice agencies, working to connect residents with services and information as well as aid local agencies in reaching this underserved population.

P4-36 (C) Welfare: Definition by New York City Maribeth Gregory

For an individual who resides in New York City, to obtain health insurance under the Medicaid policy one must fall under certain criteria .. (New York City's Welfare Programs 2003) If the individual _is on SSI or earns equal to or less than $934 per month, he is entitled to receive no more than $5,600 m resources. A family the size of two would need to earn less than $942 per month to qualify for no greater than SS,650 worth of Medicaid benefits. A family of three would qualify for $5,650 is they earned less than $942 per month and so on. Introduction: The Vancouver gay communiry has a significant number of Asian descendan!l. Because of their double minority status of being gay and Asian, many Asian men who have sex with men (MSM) are struggling with unique issues. Dealing with racism in both mainstream society and the gay communiry, cultural differences, traditional family relations, and language challenges can be some of their everyday srruggles. However, culturally, sexually, and linguistically specific services for Asian MSM are very limited. A lack of availability and accessibiliry of culturally appropriate sexual health services isolates Asian MSM from mainstream society, the gay community, and their own cultural communities, deprives them of self-esteem, and endangers their sexual well-being. This research focuses on the qualita· tive narrative voices of Asian MSM who express their issues related to their sexualiry and the challenges of asking for help. By listening to their voices, practitioners can get ideas of what we are missing and how we need to intervene in order to reach Asian MSM and ensure their sexual health.

Methods: Since many Asian MSM are very discreet, it is crucial to build up trust relationships between the researcher and Asian MSM in order to collect qualitative data. For this reason, a community based participatory research model was adopted by forming a six week discussion group for Asian MSM. In each group session, the researcher tape recorded the discussion, observed interactions among the participants, and analyzed the data by focusing on participants' personal thoughts, experiences, and emotions for given discussion topics.

Ra11lts: Many Asian MSM share challenges such as coping with a language barrier, cultural differ· ences for interpreting issues and problems, and Westerncentrism when they approach existing sexual health services. Moreover, because of their fear of being disclosed in their small ethnic communities, a lot of Asian MSM feel insecure about seeking sexual health services when their issues are related to their sexual orientation.

ConclflSion: Sexual health services should contain multilingual and multicultural capacities to meet minority clients' needs. For Asian MSM, outreach may be a more effective way to provide them with accessible sexual health services since many Asian MSM are closeted and are therefore reluctant to approach the services. Building a communiry for Asian MSM is also a significant step toward including them in healthcare services. A communiry-based panicipatory approach can help to build a community for Asian MSM since it creates a rrust relationship between a worker and clients. P4-38 (C) Identifying Key Techniques to Sustain Interpretation Services for Assisting Newcomers Isolated by Linguistic and Cultural Barriers from Accessing Health Services S. Gopi Krishna lntrodaetion: The Greater Toronto Area (GTA) is home to many newcomer immigrants and other vulnerable groups who can't access health resources due to linguistic, cultural and systemic barriers. Linguistic and cultural issues are of special concern to suburbs like Scarborough, which is home to thousands of newcomer immigrants and refugees lacking fluency in English. Multilingual Community ~nterpreter. Service~ (MCIS) is a non-profit social service organization mandated to provide high quality mterpretanon services. To help newcomers access health services, MCIS partnered with the Scarborough Network of Immigrant Serving Organizations (SNISO) to recruit and train volunteer interpreters to accompany clienrs lacking fluency in English and interpret for them to access health services at various locati?ns, incl~~ing communiry ~C:-lth centres/social service agencies and hospitals. The model envisioned agencies recruin~ and MCIS ~.mm.g and creating an online database of pooled interpreter resources. This da.tabase, acces&1bl~ to all pama~~g ?rganization is to be maintained through administrative/member · ship fees to. be ~1d by each parnapanng organization. This paper analyzes the results of the project, defines and identifies suc:cases before providing a detailed analysis for the reasons for the success .

. Methods:. This ~per~ q~ntitative (i.e. client numben) and qualitative analysis (i.e. results of key •~ormant m~rv1ews with semce ~sers and interpreters) to analyze the project development, training and 1mplementanon phases of the proJect. It then identifies the successes and failures through the afore· mentioned analysis. POSTER SESSIONS vss ReslJts: The results of the analysis can be summarized as: • The program saw modest success both ia l?llllS of numbers of clients served as well as sustainability at various locations, except in the hospital iririog. o The success of the program rests strongly on the commitment of not just the volunteer interprmr, but on service users acknowledgments through providing transponation allowance, small honororia, letter of reference etc. • The hospital sustained the program better at the hospital due to the iolume and nature of the need, as well as innate capacity for managing and acknowledging volunceers.

Collc/llsion: It is possible to facilitate and sustain vulnerable newcomer immigrants access to health !Ul'ices through the training and commitment of an interpreter volunteer core. Acknowledging volunteer commitment is key to the sustenance of the project. This finding is important to immigration and health policy given the significant numbers of newcomer immigrants arriving in Canada's urban communities. nity Program was established in 1993 to provide support to people dying at home, especially those who were waiting for admission to the resi<lential hospice. With the advent of HAART and corresponding challenges for people living with HIV/AIDS in the community, the Community Program has developed a unique case management approach. This model features an interdisciplinary team providing a clientdrivcn service. The Case Manager provides continuity of care to clients in a variety of settings both within and outside of the health care system. A case study is used to demonstrate how formal and informal netWorks of support facilitate efficient and appropriate resource utilization to promote client health. This case study demonstrates the value of consistent coordination with a client who has complex physical, spiritual, substance use and mental health needs. The authors will show how they liaised with the housing authority, police, social services as well as the family physician, clinic staff and a hospital emergtncy room to ensure this client did not fall between the cracks.

Tarek Hussain

Recognition of the importance of community involvement and sectoral cooperation in health and !OCial services, formalized in Alma-Ata Declaration in 1978, was reinforced at Riga meeting held at the mid·point between Alma-Ata and the year 2000. Then at the 20th Anniversary of Alma-Ata Declaration, ir was declared that 'Primary Health Care is Everybody's Business'. Health does not exist in isolation. Health cannot be defined only as an outcome of 'medical care' but also as one of 'social action'; the responsibility of disease prevention and health promotion rests not only on governments, but also with DOn·govemmentorgan izations, the community, and individuals. The major accomplishment to date may be that rhere is growing realization in the health sector that community involvement is more than a political right-it is absolute necessary. Lessons have learned during the implementation of disease-specific l'Cltical programmes, such as CDD, ARI, and EPI; first, integrated and holistic approaches to childcare art needed, and second, the need for community involvement has become evident. IMC! is a broad inte-gra1ed strategy with an overall objective contributing to reducing child morbidity and mortality in developing countries. And one of the IMCI components, 'Community !MCI', which is now broadening ~s an entry point for child-focused community development initiatives. Community JMCl/c~1ld health is ~n mtcgrated approach to the promotion of key family and community practices that have impact on: child growth and development, disease prevention, home care for sick, malnourished child~en, a.nd care-seekmg behavior and compliance with advice and treatment. The presentation addres~es, m brief, the ~evel opinent of community !MCI, operational aspect of community/IM Cl, key strategies and tools ava1la~le for implementation of C/IMCI. The paper draws some successful programme examples on working logether for IMC! with the community in various countries which had substantial benefns on programme outcomes.

P4-4 t (C) Healthy Child Screening: An Innovative Service Initiative Ann-Marie Marcolin and Joyce Allen . Introduction: With mounting attention for creative and integrated models of c~re .that are populallon and community focused, the Healthy Child Screening initiative achiev.es t~ese pnncipl~s and more! . • Parkdale High Park Rotary (sponsorship) The Heal~h ~h1ld Scree?1?g is a ~opl~-centred model of care. Agency and professional sector-specific silos are ehmmated, ~rov1dmg f~~1hes wit~ one-sto~ access to primary prevention services in a local school gym! Children at nsk are rece1vmg early mtervent10n and appropriate referrals to the right care provider, at the right time a~d in t~e right place. Further, with a complimentary focus on prevention, the program serves to keep at nsk children healthy.

Healthy Child Screening Results: The service model is developed around four distinct phases: 1) planned outreach; 2) coordinated intake and registration; 3) interdisciplinary screening; and 4) targeted referral. Since the fall 2003 and through six collaborative Healthy Child Screenings 158 children ranging in age from 2 to 6 have benefited from this unique service model of care.

Conclusion: The presentation will provide practical information on the development and implementation of the model. There will also be a focus on lessons learned in building community service provider-hospital relationships. According to Statistics Canada (2001) 49% of the Toronto population was born outside of Canada and 21 % were new immigrants. Immigrants often arrive in Canada in superior health compared to the Canadian born population, but they lose this health advantage over time. Changes in immigrant health status over time may be attributed to a variety of factors including barriers to accessing and receiving care as well as limitations in the mainstream health service organizations and their approaches to health care delivery (Hyman, 2001 ) . For example, immigrant women are less likely to receive pap tests, which places them at a greater risk for developing cervical cancer. Similarly, immigrant women receive less mammography screening than their Canadian counterparts. The Immigrant Women's Health Centre Mobile Health Unit (MHU) was created as an alternative care delivery model to address the need for increased accessibility as well as culturally and linguistically appropriate reproductive health care. Toronto Western Hospital and the Immigrant Women's Health Centre have formed a collaborative partnership which incorporates a primary care nurse practitioner and lay ethnocultural counselors providing care on the MHU. Currently, a qualitative ethnonursing study is underway to understand the unique experiences of women using the MHU for their reproductive health care as well as the perspectives of the MHU health care providers. Based on a literature review and preliminary findings from provider and participant interviews, the proposed presentation will address the themes of health status for immigrant and refugee women, accessibility issues as well strategies to improve their reproductive health care. We will discuss benefits as well as limitations to health care provision using this alternative service delivery model.

Michael Carden, Brian Edlin, Andrew Talal, Elizabeth Getter, and Marla Shu lntrod.ction: To date most active drug users have not had access to treatment for hepatitis C virus (HCV) infection and substantial barriers continue to exist that interfere with treatment availability for this population.

Methods: Active illicit drug users interested in pursuing HCV care and treatment were recruited in partnership w~th co~munity-based organizations (CBO's) in New York City. Baseline data were collected on quahty of hfe, substance use patterns, depression, health care utilization, HCV health beliefs and other relev.ant variables. Medical evaluations were conducted, including liver biopsy when indicated, an~ treatment ts ~ffered when no contraindications are present. Participants also receive psychiatric evaluahons to determme the appropriateness of interferon treatment.

Renlts: Fifteen individuals have been recruited to date and received an initial medical evaluation. The mean age was 40 years and _the average age of initial heroin or cocaine use was 16.8. Eight (53%) ha~ been homeless at least once m the last 6 months and S (33%) were homeless for most or all of this penod. Fourteen (93%) had a history of injection drug use with the mean age at first injection being 21 111S1fRSEWONS v87 ,an. Elrven persc.!ns (79%) reported inje~~ng .heroin or cocaine within the last 30 days while the .Wing four (21 l'o) reported regular non-m1ect1on use of cocaine and street-obtained benzodiazepines. SiJIY seven percent of the sample (n= 10) reported ever being referred to HCV treatment while 2 ( t 3 % ) ftPOneddiattreann~nt had been offered by~ ~e.dical provider. None had ever received a liver biopsy or araanent. Most believed that HCV was a s1gmf1cant threat to their health (80%) and that there was a pM)dchance they would eventually die if their hepatitis C was not treated (67%). Though 7 individuals 147%1 believed that there was no cure for HCV, 13 (87%) reported that they would initiate treatment if i was recommended by their doctor. Thirteen (87%) had a current psychiatric diagnosis including «pmsion, anxiety disorder, schizophrenia, schizoaffective disorder, and borderline and antisocial persooaliry disorders. Among eight individuals who had the Beck Depression Inventory administered, the mean score was 29.75. Attendance rates were 83% (83/100) at scheduled medical and psychiatric 1pPOintments and 50% (2/4) at liver biopsy.

<Andtuions: Active drug users, despite experiencing multiple psycho-social problems, can be mgaged in HCV care using a multidisciplinary approach, but require intensive follow-up support. HCV aunnent of active drug users should not be dismissed.

N-44 (C) Antiretroviral Therapy in mv Infected Infants: When to Initiate Therapy an African Experience Kingsley Okonkwo, Ademola Adeyemo, Israel Sokeye, and Nwaife Umeike /""°""ction: As technology for early diagnosis of human immunodeficiency virus [HIV] improves, m to commence highly active antiretroviral therapy [HAARn is yet to be fully evaluated. This prospective study describes our initial experience with early HAART in HIV infected Nigerian infants and rqions the outcome. We also analyzed the socioeconomic implications of early HAART therapy in infants in the African setting.

Method: HIV infected Infants were started on HAART before 6 months and followed up at 4 mkly intervals.We monitored baseline and 3 monthly CD4 . Conclusion: Initial results suggest early HAART before 6 months resulted. in improv~d out~ome in African children. Treatment appears to be as effective as in developed counmes. In. A~nca as. m most developing countries with limited resources it is possible and effective to use HAART m 1~~ants if p~oper lllOniroring facilities are available. However the occurrence of long-term drug related tox1c1ty and mk of emergence of resistant viral strains create need for further evaluation of HAART in infants. Background: Most risk factors for cardiovascular disease (CVD) can be mitigated through ~th clinical interventions and lifestyle change. We used data from a telephone survey of New York City (NYC) adults to characterize health care access and healthy behavior among those with three or more CVD risk factors.

Methods: The study population included respondents to the NYC Community Health Survey 2002 (N= 9,674) self-reporting~ 3 of the following: smoking, diabetes, high cholesterol level, high blood pres· sure, body mass index >25, and age >45 (males) or >55 (females) (n=2,439).

Results: Based on self-report, an estimated 1.447,000 (24%) of NYC adults have~ 3 or more CVD risk factors. This population is 51 % male, 47% white, 25% black, and 53% with S 12 years of education. Most report good access to health care, indicated by having health insurance (95%), regular doctor (89%), their blood pressure checked within last 6 months (91 %), and their choles· terol checked within the past year (90% ). Only 29% reported getting at least 20 minutes of exercise ~ 4 times per week and only 9% eating ~ 5 servings of fruits and vegetables the previous day. Among current smokers, 59% attempted to quit in past 12 months, but only 32% used medication or counseling.

Implications: These data suggest that most NYC adults known to be at high risk for CVD have access to regular health care, but most do not engage in healthy lifestyle or, if they smoke, attempt effective quit strategies. More clinic-based and population-level interventions are needed to support lifestyle change among those at high risk of CVD.

Introduction: Recently, much interest has been directed at "obesogenic" (obesity-promoting) (Swinburn, Egger & Raza, 1998) built environments, and at Geographic Information Systems (GIS) as a tool for their exploration. A major geographical concept is accessibility, or the ease of moving from an origin to a destination point, which has been recently explored in several health promotion-related stud· ies. There are several methods of calculating accessibility to an urban feature, each with its own strengths, drawbacks and level of precision that can be applied to various health promotion research issues. The purpose of this paper is to describe, compare and contrast four common methods of calculating accessibility to urban amenities in terms of their utility to obesity-related health promotion research. Practical and conceptual issues surrounding these methods are introduced and discussed with the intent of providing health promotion researchers with information useful for selecting the most appropria1e accessibility method for their research goal~ ~ethod: This paper describes methodological insights from two studies, both of which assessed the neighbourhood-level accessibility of fast-food establishments in Edmonton, Canada -one which used a relatively simple coverage method and one which used a more complex minimum cos1 method.

Res.Its: Both methods of calculating accessibility revealed similar patterns of high and low access to fast-food outlets. However, a major drawback of both methods is that they assume the characteristics of the a~e~ities and of the populations using them are all the same, and are static. The gravity potential method is introduced as an alternative, since it is ·capable of factoring in measures of quality and choice. A n~mber of conceptual and pr~ctical iss~es, illustrated by the example of situational influences on food choice, make the use of the gravity potential model unwieldy for health promotion research into sociallydetermined conditions such as obesity.

Co.nclusions: I~ ~ommended that geographical approaches be used in partnership with, or as a foun~ation for, ~admonal exploratory methodologies such as group interviews or other forms of commumty consultation that are more inclusive and representative of the populations of interest.

Qilhl in Los Angeles County ,,..ia Shaheen, Richard Casey, Fernando Cardenas, Holman Arthurs, and Richard Baker ~The Retinomax autorefractor has been used for vision screening of preschool age childien. Ir bas been suggested to be used and test school age children but not been validated in this age poup.

Ob;taiw: To compare the results of Retinomax autorefractor with findings from a comprehensive I!' examination using wet retinoscopy for refractive error.

Mllhods: Children 5-12 years old recruited from elementary schools at Los Angeles County were iaml with Snellen's chart and the Retinomax autorefractor and bad comprehensive eye examination with dilation.

The proportion of children with abnormal eye examination as well as diesensitiviry and specificity of the screening tools using Retinomax autorefractor alone and in combinalion wirh snellen's chart. Results Of the 258 children enrolled in the study (Average age= 8.5± 2.1 years; age range, 5-12 years), 6?% had abnormal eye examination using retinoscopy with dilation. For the lerinomax, the sensitivity was 85% (95% confidence interval [CI] 78%-90%), and the specificity was 31% (95% CI, 22%-41 o/o). Simultaneous testing using Snellen's chart and Retinomax resulted in gain in 111Sitiviry (94%, 95% Cl= 89, 97), and loss in specificity (28%, 95% Cl= 19%-38%).

The study showed that screening school age children with Retinomax autorefractor could identify most cases with abnormal vision but would be associated with many false-positive results.

Simuhaneous resting using Snellen's chart and Retinomax maximize the case finding but with very low specificiry. MdhotJs: A language-stratified, random sample of 2366 members of the College of Family Physicians of Canada received a confidential survey. The questionnaire collected data on socio-demographic characteristics, medical training, practice type, setting and HCV-related care practices. The self-adminisratd questionnaire was also made available to participants for completion on the Internet.

Batdti: Response proportion was 33%. Median age was 41 years (47% female) and the proporlionoffrench questionnaires was 26%. Approximately 88% had completed family medicine residency lllining in Canada; median year of training completion was 1995. Sixty-seven percent, 38% and 29% work in private offices/clinics, community hospitals and emergency departments, respectively. Regarding ~practices, 94% had ever requested a HCV test and 87% of physicians had screened for HCV iafrction in rhe past 12 months· median number of tests was 10. While 17% reported having no HCV-Uaed patients in their practic~, 44% had 1-5 HCV-infected patients. Regarding the level of HCV care provided, 4.3% provide ongoing advanced HCV care including treatment and dose monitoring for Ctmduions: In this sample of Canadian family physicians, most had pro~ided HCV screening. to •least one patient in the past year. Less than half had 1-5 HCV-infected patients and 41 % provide ~:relared care The role of socio-demographic factors, medical training as wel_I as HCV ca~e percep-llDas 10 rhe provision of appropriate HCV screening will be examined and described at the time of the canference.

'4-50 (C) Healthcare Services: The Context of Nepal Meen Poudyal Chhetri """1tl.ction Healthcare service is related with the human rights and fundamental righ~ of the ci~ ciaaiuntry. However, the growing demand foi health care services, quality heal~care service, accessib1b~ ID die mass population and paucity of funds are the different but interrelated issues to .be ~ddressed. m Nepat.1n view of this context, public health sector in Nepal is among other sectors, which IS struggling -.i for scarce resources.

. . .

Nepal, the problems in the field of healthcare servic~s do not bnut ~o the. paucity of faads and resources only, but there are other problems like: rural -urban imbalance, regional unbalance, POSTER SESSIO~ f the ll ·m1 ·ted resources poor healthcare services, inequity and inaccessibility of the poor management o , . poor people of the rural, remote and hilly areas for the healthcare services and so on.. . . .

· . I f ct the best resource allocation is the one that max1m1zes t e sum o m ivi ua s u11 · ea t services. n a , · h d' ·b · · · H . ·t effi.ciency and efficient management are correlated. It might be t e re istn utmn of mes. ence, equi y, . . . . 1 . income or redistribution of services. Moreover, maximizanon of available resources, qua tty healthcare services and efficient management of them are the very important and necessary tools and techmques to meet the growing demand and quality healthcare services in Nepal.

P4-51 (A) An Jn-Depth Analysis of Medical Detox Clients to Assist in Evidence Based Decision Making Xin Li, Huiying Sun, Ajay Puri, David Marsh, and Aslam Anis Introduction: Problematic substance use represents an ever-increasing public health challenge. In the Vancouver Coastal Health (VCH) region, there are more than 100,000 individuals having some probability of drug or alcohol dependence. To accommodate this potential demand for addiction related services, VCH provides various services and treatment, including four levels of Withdrawal Management Services (WMS). Clients seeking WMS are screened and referred to appropriate services through a central telephone intake service (ACCESS I). The present study seeks to rigorously evaluate one of the services, Vancouver Detox, a medically monitored 24-bed residential detox facility, and its clients. Doing so will allow decision makers to utilize evidence based decision-making in order to improve the accessibility and efficiency of WMS, and therefore, the health of these clients.

Methods: We extract one-year data (October 1, 2003 -September 30, 2004 from an efficient and comprehensive database. The occupancy rate of the detox centre along with the clients' wait time for service and length of stay (LOS) are calculated. In addition, the effect of seasonality on these variables and the impact of the once per month welfare check issuance on the occupancy rate are also evaluated.

Results: Among the 2411 clients (median age 40, 65% male) who were referred by ACCESS! to Vancouver Detox over the one-year period, 1448 were admitted. The majority (81 %) of those who are not admitted are either lost to follow up (i.e., clients not having a fixed address or telephone) or declined service at time of callback. The median wait time was 1 day [Q3-Ql: 3-1], the median LOS was 5 days IQ3-Qt: 6-3], and the average bed occupancy rate was 83%. However, during the threeday welfare check issue period the occupancy rate was lower compared to the other days of the year 175% vs. 84%, p

Conclusion: Our analysis indicates that there was a relatively short wait time at Vancouver Detox, however 40% of the potential clients were not served. In addition, the occupancy rate declined during the welfare check issuance period and during the summer. This suggests that accessibility and efficiency at Vancouver Detox could be improved by specifically addressing these factors.

Background: Intimate partner violence (IPV) is associated with acute and chronic physical and men· tal health outcomes for women resulting in greater use of health services. Yet, a vast literature attests to cultural variations in perceptions of health and help-seeking behaviour. Fewer studies have examined differences in perceptions of IPV among women from ethnocultural communities. The recognition, definition, and understanding of IPV, as well as the language used to describe these experiences, may be different in these communities. As such, a woman's response, including whether or not to disclose or seek help, may vary according to her understanding of the problem.

Methods: This pilot study explores the influence of cultural factors on perceptions of and responses to IPV among Canadian born and immigrant young women. In-depth focus group interviews were con· ducted with women, aged 18 to 24 years, living in Toronto. Open-ended and semi-structured interview questions were designed to elicit information regarding how young women socially construct JPV and where they would go to receive help. Interviews were transcribed, then read and independently coded by the research team. Codes were compared and disagreements resolved. Qualitative software QSR N6 was used to assist with data management.

. Ruu~ts_: Res~nses_abo~t what constitutes IPV were similar across the study groups. When considering specific ab.us1ve ~1tuanons and types of relationships, participants held fairly relativistic views about IPV, especially with regard to help-seeking behaviour. Cultural differences in beliefs about normaive m;ile/femal~ relations. familial.roles, and customs governing acceptable behaviours influenced partictpants perceptions about what 1n1ght be helpful to abused women. Interview data highlight the social l05TER srnfONS v91 11111 suucrural _impact these factors ha:e on you?g women and provide details regarding the dynamics of cibnocUltur~ m~uences on help-~eekmg behav10ur: T~e ro~e of such factors such as gender inequality within rtlaoo?sh1ps and t_he ~erce1ved degree of ~oc1al 1solat1on and support nerworks are highlighted.

COllC~ The~ findmgs unde~score the _1mporta_nc_e of understanding cultural variations in percrprions of IPV ~ relanon to ~elp-seekmg beha~1':'ur. Th1s_mformation is critical for health professionals iodiey may connnue developmg culturally sensmve practices, including screening guidelines and protorol s. ln addition, _this study demonstr~tes that focus group interviews are valuable for engaging young romen in discussions about IPV, helpmg them to 'name' their experiences, and consider sources of help when warranted.

P4-S3 (A) Health Problems and Health Care Use of Young Drug Users in Amsterdam .Wieke Krol, Evelien van Geffen, Angela Buchholz, Esther Welp, Erik van Ameijden, and Maria Prins /11trod11ction: Recent advances in health care and drug treatment have improved the health of populations with special social and health care needs, such as drug users. However, still a substantial number dots not have access to the type of services required to improve their health status. In The Netherlands, tspccially young adult drug users (YAD) whose primary drug is cocaine might have limited access to drugrreatment services. In this study we examined the history and current use of (drug associated) treatmmt services, the determinants for loss of contact, and the current health care needs in the Young drug mm Amsterdam Study (YODAM).

Methods: YODAM started in 2000 and is embedded in the Amsterdam Cohort Study among drug mm. Data were derived from Y AD aged < 30 years who had used cocaine, heroin, ampheramines and I or methadone at least 3 days a week during the 2 months prior to enrolment.

Res11lts:Of 195 YAO, median age was 27 years (range: 18-30 years), 72% was male and 83% had 1Dutch nationality at enrolment. Nearly all participants (97%) reported a history of contact with drug llt.lnnent services (methadone maintenance, rehabilitation clinics and judicial treatment), mental health car? (ambulant mental care and psychiatric hospital) or general treatment services (day-care, night-care, hdp for living arrangements, work and finance). However, only 61 % reported contact in the past six l!Xlllths. This figure was similar in the first and second follow-up visit. Among Y AD who reported no current contact with the health care system, 87% would like to have contact with general treatment serl' icts. Among participants who have never had contact with drug treatment services, 67% used primarily cocaine compared with 22% and 8% among those who reported past or current contact, respectively.

Saied on the Addiction Severity Index, 70% reported at least one mental health problem in the past 30 days, but only 11 % had current contact with mental health services. Concl11Sion: Results from this study among young adult drug users show that despite a high contact rm with health care providers, the health care system seems to lose contact with YAO. Since 87% indicatt the need of general treatment services, especially for arranging house and living conditions, health M services that effectively integrate general health care with drug treatment services and mental health care might be more successful to keep contact with young cocaine users. Mtthods: Respondents included adults aged 18 and over who met DSM-IV diagn?snc criteria for an anxiety or depressive disorder in the past 12 months. We performed two sets of logisnc regressmns.

Thtdichotomous dependent variables for each of the regressions indicated whether rhe respondenr_vis-Ud a psychiatrist, psychologist, family physician or social worker in the _past_ 12 months. no relationship for income. There was no significant interaction between educatmn an mco~:· r:

::or respondents with at least a high school education to seek help ~rom any of the four servic P were almost twice that for respondents who had not completed high school.

Th . d ec of analyses found che associacion becween educacion and use of MD-provided care e secon s · · be d · · ·f· ly 1 ·n che low income group For non-MD care, the assoc1anon cween e ucatlon and was s1gm icant on -· . . . . use of social workers was significant in both income groups, but significant only for use of psychologists in che high-income group.

. . . Conclusion: We found differences in healch service use by education level. Ind1v1duals who have nor compleced high school appeared co use less mental he~lt~ servi~es provided ~y psyc~iatrists, psycholo· gists, family physicians and social workers. We found limited e.v1dence _suggesting the influence of educa· tion on service use varies according to income and type of service provider.

Results suggesc there may be a need to develop and evaluate progr~ms.designe~ to deliver targeted services to consumers who have noc completed high school. Further quahtanve studies about the expen· ence of individuals with low education are needed to clarify whether education's relationship with ser· vice use is provider or consumer driven, and to disentangle the interrelated influences of income and education.

System for Homeless, HIV-infected Patients in NYC? Nancy Sahler, Chinazo Cunningham, and Kathryn Anastos Introduction: Racial/ethnic disparities in access to health care have been consistently documented. One potential reason for disparities is that the cultural distance between minority patients and their providers discourage chese patients from seeking and continuing care. Many institucions have incorporated cultural compecency craining and culturally sensicive models of health care delivery, hoping co encourage better relacionships becween patients and providers, more posicive views about the health care system, and, ulcimacely, improved health outcomes for minority patients. The current scudy tests whether cultural distance between physicians and patients, measured by racial discordance, predicts poorer patient attitudes about their providers and the health care system in a severely disadvantaged HIV-infected population in New York City that typically reports inconsistent patterns of health care.

Methods: We collected data from 396 unscably housed black and Latino/a people with HIV who reported having a regular health care provider. We asked them to report on their attitudes about their provider and the health care system using validated instruments. Subjects were categorized as being racially "concordant" or "discordant" with their providers, and attitudes of these two groups were compared.

Results: The sample consisted of 256 (65%) black and 140 (35%) Latino/a people, who reported having 80 (20%) black physicians, 49 (12%) Latino/a physicians, 167 (42%) white physicians, and 100 (25%) physicians of another/unknown race/ethnicity. Overall, 260 (75%) subjects had physicians of a different race/ethnicity than their own. Racial discordance did not predict negative attitudes about rela· tionship with providers: the mean rating of a I-item trust in provider scale (lO=high and O=low) was 8.0 for both concordant and discordant groups, and the mean score in 13-icem relationship with provider scale (4=high and !=low) was 3.5 for both groups. However discordance was significantly associated with distrust in che health care syscem: che mean score on a 7-icem scale (5=high discrust and l=low distrust) was 3.4 for discordant group and 3.0 for che concordant group (t= 2.66, p= 0.008). We further explored these patterns separacely in black and Lacino/a subgroups, and using different strategies ro conceptualize racial/ethic discordance.

Conclusions: In this sample of unscably housed black and Latino/a people who receive HIV care in New York City, having a physician from the same racial/ethnic background may be less important for developing a positive doctor-patient relationship than for helping the patients to dispel fear and distrust about the health care system as a whole. We discuss the policy implications of these findings.

Ilene Hyman and Samuel Noh .

.Abstract Objectiw: This study examines patterns of mental healthcare utilization among Ethiopian 1mm1grants living in Toronto.

Methods: A probability sample of 342 Ethiopian adults ( 18 years and older) completed structured face-to-face interviews. Variables ... define, especially who are non-health care providers. Plan of analysis.

Results: Approximately 5% of respondents received memal health services from mainstream healthcare providers and 8% consulted non-healthcare professionals. Of those who sought mental health services from mainstream healthcare providers, 3.1 % saw family physicians, 2.1 % visited a psychiatrist. and 0.6% consulted other healthcare providers. Compared with males, a significantly higher proportion 1GSfER SESSIONS v93 ri ftlnales consulted non-healthcare_ professionals for emotional or mental health problems (p< 0.01 ).

tlbile Ethiopian's overall use of mamstream healthcare services for emotional problems (5%) did not prlydiffer from the rate (6%) of the general population of Ontario, only a small proportion ( 12.5%) rJErhiopians with mental health needs used services from mainstream healthcare providers. Of these, !OJ% received family physicians' services, 4.3 % visited a psychiatrist, and 2.2% consulted other healthll/C providers. Our data also suggested that Ethiopian immigrants were more likely to consult tradioooal healers than health professionals for emotional or mental health problems ( 18.8% vs. 12.5% ). Our bivariate analyses found the number of somatic symptoms and stressful life events to be associated with an increased use of medical services and the presence of a mental disorder to be associated with a dfcreased use of medical services for emotional problems. However, using multivariate methods, only die number of somatic symptoms remained significantly associated with use of medical services for emooonal problems.

Diu#ssion: Study findings suggest that there is a need for ethnic-specific and culturally-appropriate mrcrvention programs to help Ethiopian immigrants and refugees with mental health needs. Since there ~a strong association between somatic symptoms and the use family physicians' services, there appears robe a critical role for community-based family physicians to detect potential mental health problems among their Ethiopian patients, and to provide appropriate treatment and/or referral.

The authors acknowledge the Centre of Excellence for Research in Immigration and Settlement (CERIS) in Toronto and Canadian Heritage who provided funding for the study. We also acknowledge Linn Clark whose editorial work has improved significantly the quality of this manuscript. We want to thank all the participants of the study, and the Ethiopian community leaders without whose honest contributions the present study would have not been possible.

This paper addresses the impact of the rationalization of health-care services on the clinical decision-making of emergency physicians in two urban hospital emergency departments in Atlantic Canada.

Using the combined strategies of observational analysis and in-depth interviewing, this study provides a qualitative understanding of how physicians and, by extension, patients are impacred by the increasing ancmpts to make health-care both more efficient and cost-effective. Such attempts have resulted in significantly compromised access to primary care within the community. As a consequence, patients are, out of necessity, inappropriately relying upon emergency departments for primary care services as well as access to specialty services. Within the hospital, rationalization has resulted in bed closures and severely rmricted access to in-patient services. Emergency physicians and their patients are in a tenuous position having many needs but few resources. Furthermore, in response to demands for greater accountability, physicians have also adopted rationality in the form of evidence-based medicine. Ultimately, ho~ever, rationality whether imposed upon, or adopted by, the profession significantly undermines physu.:1ans' ability to make decisions in the best interests of their patients.

JohnJasek, Gretchen Van Wye, and Bonnie Kerker Introduction: Hispanics comprise an increasing proportion of th.e New York City (NYC) populanon !currently about 25%). Like males in the general population, H1spamc males (HM) have a lower prrval,nce of healthcare utilization than females. However, they face additional access barriers such as bnguage differences and high rates of uninsurance. They also bear a heavy burden of health problems lllehasobesity and HIV/AIDS. This paper examines patterns of healthcare access and ut1hzat1on by HM compared to other NYC adults and identifies key areas for intervention.

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. 148 9 01 5 8 9 01 and older are significantly lower than the NHM popu anon . 10 v.

. 10, p<.05), though HI\' screening and immunizations are comparable between the two groups.

Conclusion: Findings suggest that HM have less access t? healthcare than HF or NHM. Hown1r, HM ble to obtain certain discrete medical services as easily as other groups, perhapsdueto!Rtor are a HM. I I . subsidized programs. For other services, utilization among 1s ower. mprovmg acc~tocareinthis group will help ensure routine, quality care, which can lead to a greater use of prevennve services Iii! thus bener health outcomes.

Introduction: Cancer registry is considered as one of the most important issues in cancer epidemiology and prevention. Bias or under-reporting of cancer cases can affect the accuracy of the results of epidemiological studies and control programs. The aim of this study was to assess the reliability of the regional cancer report in a relatively small province (Yasuj) with almost all facilities needed for C3llCll diagnosis and treatment.

Methods: Finding the total number of cancer cases we reviewed records of all patients diagnoicd with cancer (ICD 140-239) and registered in any hospital or pathology centre from1999 until 2001 i n Yasuj and all (5) surrounding provinces.

Results: Of 504 patients who were originally residents of Yasui province, 43.7% wereaccoulll!d for Yasuj province. The proportion varies according to the type of cancer, for exarnplecancetsofdiglstive system, skin and breast were more frequently reported by Yasuj's health facilities whereas cancmoi blood, brain and bone were mostly reported by neighbouring provinces. The remaining cases (56.3%1 were diagnosed, treated and recorded by neighbouring provinces as their incident cases. This is partly because of the fact that patients seek medical services from other provinces as they believed that the facil. ities are offered by more experienced and higher quality stuffs and their relative's or temporary acOOIII' modation addresses were reported as their place of residence.

Conclusion: Measuring the spatial incidence of cancer according to the location of report ortht current address affected the spatial statistics of cancer. To correct this problem recording the permanm! address of diagnosed cases is important.

P4-60 (C). Providing Primary HealthCare to a Disadvantaged Population at a University-Run Commumty Healthcare Facility Tracey Rickards

The. C:ommuni~y .H~alth ~linic (CHC) is a university sponsored nurse-managed primary bealthwt (P~C:l clime. The clm1c is an innovative model of healthcare delivery in Canada that has integrated tht principles of PHC ser · · h' .

vices wit ma community development framework. It serves to provide access to PHC services for members of th · · illi · dru is II be . . e community, particularly the poor and those who use or gs, we mg a service-learning facil'ty f d · · · · · · d rionll h . . .,m.:. · t · . meet c ient nee s. Chmc nursing and social work staff and srudents r·--· ipa em various PHC activities and h .L.hont" less I . f . outreac services in the local shelters and on the streelS to'"" popu auon o Fredericton As well th CHC · model Iii fosterin an on oi :

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• e promotes and supports a harm reduction . · local d!or an~ h ng ~art:ersh1p with AIDS New Brunswick and their Needle Exchange program, w1tha

ing condoms and :xu:t h:~~~e e~aint~nance Therapy clients, and with the clie~ts themselves ~_r;

benefits of receiving health f ucation, a place to shower, and a small clothing and food oai~· care rom a Nurse p · · d d · --""~'I"· are evidenced in th r research that involved needsaans mvo ves clients, staff, and students. To date the CHC has unacn-1 · sessment/enviro I . d ; •• '""""1ll eva uanon. The clinic has also e . d nmenta scan, cost-benefit analysis, an on-go...,,1"".'I'~ facility and compassionate lea x~mme the model of care delivery' focusing on nursing roles wi~ cJ rmng among students. Finally, the clinic strives to share the resU•P v95 .

-arch with the community in which it provides service by distributing a bi-monthly newsletter, and plllicipating in in-services and educational sessions in a variety of situations. The plan for the future is coolinued research and the use of evidence-based practice in order to guide the staff in choosing how much n~ primary healthcare services to marginalized populations will be provided.

N-61 (C) Tuming Up the Volume: Marginalized Women's Health Concerns Tckla Hendrickson and Betty Jane Richmond bdrotbu:tion: The marginalization of urban women due to socio-economic status and other determinants negatively affects their health and that of their families. This undermines the overall vitaliry of urban communities. For example, regarding access to primary health care, women of lower economic surus and education levels are less likely to be screened for breast and cervical cancer. What is not as widely reported is how marginalized urban women in Ontario understand and articulate their lack of access to health care, how they attribute this, and the solutions that they offer. This paper reports on the rnults of the Ontario Women's Health Network (OWHN) focus group project highlighting urban women's concerns and suggestions regarding access to health care. It also raises larger issues about urban health, dual-purpose focus group design, community-based research and health planning processes.

Mdhods: Focus group methodology was used to facilitate a total of 30 discussions with 55 urban and 54 rural women across Ontario from 2003 to 2005. The women were invited to participate by local women's and health agencies and represented a range of ages, incomes, and access issues. Discussions focussed on women's current health concerns, access to health care, and information needs. Results were analyzed using grounded theory. The focus groups departed from traditional focus group research goals and had two purposes: 1) data collection and dissemination (representation of women's voices), and 2) fostering closer social ties between women, local agencies, and OWHN. The paper provides a discussion and rationale for a dual approach. Rax/ts: The results confirm current research on women's health access in women's own voices:

urban women report difficulty finding responsive doctors, accessing helpful information such as visual aids in doctors' offices, and prohibitive prescription costs, in contrast with rural women's key concern of finding a family doctor. The research suggests that women's health focus groups can address access issues by helping women to network and initiate collective solutions.

The study shows that marginalized urban women are articulate about their health conctrns and those of their families, often understanding them in larger socio-economic frameworks; howtver, women need greater access to primary care and women-friendly information in more languages and in places that they go for other purposes. It is crucial that urban health planning processes consult directly with women as key health care managers, and turn up the volume on marginalized women's voices.

Women: An Evaluation of Awareness, Attitudes and Beliefs

Introduction: Nigeria has one of the highest rates of human immunodeficiency virus IHIVI seroprrvalence in the world. As in most developing countries vertical transmission from mother to child account for most HIV infection in Nigerian children. The purpose of this study was ro. determine the awareness, attitudes and beliefs of pregnant Nigerian women towards voluntary counseling and testing IVCT! for HIV.

Mnbod: A pre-tested questionnaire was used to survey a cross section '.>f.240 pregnant women ~t 2 (lrlleral antenatal clinics in Awka, Nigeria. Data was reviewed based on willingness to ~c~ept or re1ect VCT and the reasons for disapproval. Knowledge of HIV infection, routes of HIV transm1ssmn and ant1rnroviral therapy IART) was evaluated.

hsults: 72% of the women had good knowledge of HIV, I 5% had fair knowledge while 1.1% had poor knowledge of HIV infection.48% of the women were not aware of the association of hreast milk feeding and transmission of HIV to their babies. Majority of the women 87% approved V~T while 13% disapproved VCT, 93% of those who approved said it was because VCT could ~educe risk of rransmission of HIV to their babies. All respondents, 100% who accepted VC.I ~ere willing to be tnted if results are kept confidential only 23% accepted to be tested if VC.T results w.111 be s~ared w1.th Pinner and relatives 31 % attributed their refusal to the effect it may have on their marriage whale 69 '-gave the social 'and cultural stigmatization associated with HIV infection for their r~fusal.S 9 % wall accept VCT if they will be tested at the same time with their partners.81 ~0 of ~omen wall pref~r to breast feed even if they tested positive to HIV. Women with a Higher education diploma were 3 times v96 more likely to accept VCT. Knowledge of ART for HIV infected pregnant women as a means of pre. vention of maternal to child transmission [PMTCT) was generally poor, 37% of respondents wm aware of ART in pregnancy.

Conclusion: The acceptance of VCT by pregnant women seems to depend on their understanding that VCT has proven benefits for their unborn child. Socio-cultur al factors such as stigmatizationof HIV positive individuals appears to be the maj_or impedi~ent towards widespread acceptanee of ycr in Nigeria. Involvemen t of male partners may 1mpro~e attitudes t~wa~ds VCT:The developmentofm novative health education strategies is essential to provide women with mformanon as regards the benefits of VCT and other means of PMTCT.

P4-63 (C) Ethnic Health Care Advisors in Information Centers on Health Care and Welfare in Four Districts of Amsterdam Arlette Hesselink, Karien Stronks, and Arnoud Verhoeff Introduction : In Amsterdam, migrants report a "worse actual health and a lower use of health care services than the native Dutch population. This difference might be partly caused by problems migrants have with the Dutch language and health care and welfare system. To support migrants finding their way through this system, in four districts in Amsterdam Information Centers on Health Care and Welfare were developed in which ethnic health care advisors were employed. Their main task is to provide infor· mation to individuals or groups in order to bridge the gap between migrants and health care providers.

Methods: The implementat ion of the centers is evaluated using a process evaluation in order to give inside in the factors hampering and promoting the implementat ion. Information is gathered using reports, attending meetings of local steering groups, and by semi-structu red interviews with persons (in)directly involved in the implementat ion of the centers. In addition, all individual and groupcontaetS of the health care advisors are registered extensively.

Results: Since 2003 four Information Centers, employing 12 ethnic health care advisors, are implemented. The ethnicity of the health care advisors corresponds to the main migrant groups in the different districts (e.g. Moroccan, Turkeys, Surinamese and African). Depending on the local steering groups, the focus of the activities of the health care advisors in the centers varies. In total, around 2000 individual and 225 group educational sessions have been registered since the start. Most participants were positive about the individual and group sessions. The number of clients and type of questions asked depend highly on the location of the centers (e.g. as part of a welfare centre or as part of a housing corporation). In all districts implementa tion was hampered by lack of ongoing commitment of parties involved (e.g. health care providers, migrant organization s) and lack of integration with existing health care and welfare facilities.

Discussion: The migrant health advisors seem to have an important role in providing information on health and welfare to migrant clients, and therefore contribute in bridging the gap between migrants and professionals in health care and welfare. However, the lack of integration of the centers with the existing health care and welfare facilities in the different districts hampers further implementation . Therefore, in most districts the Information Centres will be closed down as independent facilicities in the near future, and efforts are made to better connect the position of migrant health advisor in existing facilities. The 2005 WHO Report ranks the Philippines as ninth among 22 countries with a high TB prevalence. About a fourth of the country's population is infected, with majority of cases coming from the lower socioeconomic segments of the community. Metro Manila is not only the economic and political capital of the Philippines but also the site of major universities and educational institutions. Initial interviews with the school's clinicians have established the need to come up with treatment guidelines and protocols for students and personnel when TB is diagnosed. These cases are often identified during annual physical examinations as part of the school's requirements. In many instances, students and personnel diagnosed with TB are referred to private physicians where they are often lost to follow-up and may have failure of treatment due to un monitored self-administered therapy. This practice ignores the school clinic's great potential as a TB treatment partner. Through its Single Practice Network (SPN) Initiative, the Philippine Tuberculosis Initiatives for the Private Sector (Philippine TIPS), has established a model wherein school clinics serve as satellite treatment partners of larger clinics in the delivery of the Directly Observed Treatment, Short Course (DOTS) protocol. This "treatment at the source" allows school-based patients to get their free government-suppl ied TB medicines from the clinic each day. It also cancels out the difficulty in accessing medicines through the old model where the patient has to go to the larger clinic outside his/her school to get treatment. The model also enables the clinic to monitor the treatment progress of the student and assumes more responsibility over their health. This experience illustrates how social justice in health could be achieved from means other than fund generation. The harnessing of existing health service providers in urban communities through standardized models of treatment delivery increases the probability of treatment success, not only for TB but for other conditions as well.

P4-66 (C) Voices for Vulnerable Populations: Communalities Across CBPR Using Qualitative Methods Martha Ann Carey, Aja Lesh, Jo-Ellen Asbury, and Mickey Smith Introduction: Providing an opportunity to include, in all stages of health studies, the perspectives and experiences of vulnerable and marginalized populations is increasingly being recognized as a necessary component in uncovering new solutions to issues in health care. Qualitative methods, especially focus groups, have been used to understand the perspectives and needs of community members and clinical staff in the development of program theory, process evaluation and refinement of interventions, and for understanding and interpreting results. However, little guidance is available for the optimal use of such information.

Methods: This presentation will draw on diverse experiences with children and their families in an asthma program in California, a preschool Latino population in southern California, a small city afterschool prevention program for children in Ohio, HIV/AIDS military personnel across all branches of the service in the United States, and methadone clinic clients in the South Bronx in New York City. Focus groups were used to elicit information from community members who would not usually have input into problem definitions and solutions. Using a fairly common approach, thematic analysis as adapted from grounded theory, was used to identify concerns in each study. Next we looked across these studies, in a meta-synthesis approach, to examine communalities in what was learned and in how information was used in program development and refinement.

Results: While the purposes and populations were diverse, and the type of concerns and the reporting of results varied, the conceptual framework that guided the planning and implementation of each study was similar, which led to a similar data analysis approach. We will briefly present the results of each study, and in more depth we will describe the communalities and how they were generated.

Conclusions: While some useful guidance for planning future studies of community based research was gained by looking across these diverse studies, it would be useful to pursue a broader examination of the range of populations and purposes to more fully develop guidance.

Background: The majority of studies examining the relationship between residential environments and cardiovascular disease have used census derived measures of neighborhood SES. There is a need to identify specific features of neighborhoods relevant to cardiovascular disease risk. We aim to 1) develop Methods· Data on neighborhood conditions were collected from a telephone survey of S,988 feSI· dents in Balth:.ore, MD; Forsyth County, NC; and New York, NY. A sample of 120 of the i.ni~~l l'elpondents was re-interviewed 2-3 weeks after the initial interview t~ measure the tes~-~etest rebab1~1ty of ~e neighborhood scales. Information was collected across seven ~e1ghborho~ cond1~ons (aesth~~ ~uah~, walking environment, availability of healthy foods, safety, violence, social cohesion, and acnvmes with neighbors). Neighborhoods were defined as census tracts or homogen~us census tra~ clusters. ~sycho metric properties.of the neighborhood scales were accessed by ca~cu~~.ng Chronba~h s alpha~ (mtemal consistency) and intraclass correlation coefficients (test-r~test reliabilmes) .. Pear~n s .corre~anons were calculated to test for associations between indicators of neighborhood SES (tncludmg d1mens1ons of race/ ethnic composition, family structure, housing, area crowding, residential stability, education, employment, occupation, and income/wealth) and our seven neighborhood scales. .

Chronbach's alphas ranged from .73 (walking environment) to .83 (Violence). Intraclass correlations ranged from .60 (waling environment) to .88 (safety) and wer~ high~~~ .7~ for ~urout of the seven neighborhood dimensions. Our neighborhood scales (excluding aChv1hes with neighbors) were consistently correlated with commonly used census derived indicators of neighborhood SES.

The results suggest that neighborhood attributes can be reliably measured. Further development of such scales will improve our understanding of neighborhood conditions and their importance to health.

Childhood to Young Adulthood in a National U.S. Sample Jen Jen Chang lntrodfldion: Prior studies indicate higher risk of substance use in children of depressed mothers, but no prior studies have followed up the offspring from childhood into adulthood to obtain more precise estimates of risk. This study aimed to examine the association between early exposure to maternal depl'elsive symptoms (MDS) and offspring substance use across time in childhood, adolescence, and young adulthood.

Methods: Data were obtained from the National Longitudinal Survey of Youth. The study sample includes 4,898 mother-child/young adult dyads interviewed biennially between 1992 and 2002 with children aged 4 to 16 years old at baseline. Data were gathered using a computer-assisted personal interview method. MDS were measured in 1992 using the Center for Epidemiologic Studies Depression Scale. Offspring substance use was assessed biennially between 1994 and 2002. Logistic and passion regression models with Generalized Estimation Equation approach was used for parameter estimates to account for possible correlations among repeated measures in a longitudinal study.

Rnlllta: Most mothers in the study sample were Whites (42%), urban residents (79%), had a mean age of 31 years with at least a high school degree (82%). The mean child age at baseline was 9 years old.

Offspring cigarette and alcohol use increased monotonically across childhood, adolescence, and young adulthood. Differential risk of substance use by gender was observed. Early exposure to MDS was associated with increased risk of cigarette (adjusted odds ratio (aOR) = 1.52, 95% confidence interval (0): 1.12, 2.08) and marijuana use (aOR = 1.46, 95% CI: 1.02, 2.08), but not with alcohol use across childhood, adolescence, and young adulthood, controlling for a child's characteristics, socioeconomic statuS, ~ligiosity, maternal drug use, and father's involvement. Among the covariates, higher levels of father's mvolvement Condluion: Results from this study confirm previous suggestions that maternal depressive symptoms are associated with adverse child development. Findings from the present study on early life experi-e~ce have the potential to inform valuable prevention programs for problem substance use before disturbances become severe and therefore, typically, much more difficult to ameliorate effectively. The ~ACT (~r-City Men~ Health Study Predicting filV/AIDS, Club and Other Drug Transi-b~) Study 15 a multi-level study aimed at determining the association between features of the urban enYJrOnment mental health, drug use, and risky sexual behaviors. The study is randomly sampling FOSTER SESSIONS v99 neighborhood residents and assessing the relations between characteristics of 36 ethnographically defined urban neighborhoods and the health outcomes of interest. A limitation of existing systematic methods for evaluating the physical and social environments of urban neighborhoods is that they are expensive and time-consuming, therefore limiting the number of times such assessments can be conducted. This is particularly problematic for multi-year studies, where neighborhoods may change as a result of seasonality, gentrification, municipal projects, immigration and the like. Therefore, we developed a simpler neighborhood assessment scale that systematically assessed the physical and social environment of urban neighborhoods. The IMPACT neighborhood evaluation scale was developed based on existing and validated instruments, including the New York City Housing and Vacancy Survey which is performed by the U.S. Census Bureau, and the NYC Mayor's Office of Operations Scorecard Cleanliness Program, and modified through pilot testing and cognitive testing with neighborhood residents. Aspects of the physical environment assessed in the scale included physical decay, vacancy and construction, municipal investment and green space. Aspects of the social environment measured include social disorder, social trust, affluence and formal and informal street economy. The scale assesses features of the neighborhood environment that are determined by personal (e.g., presence of dog feces), community (e.g., presence of a community garden), and municipal (e.g., street cleanliness) factors. The scale is administered systematically block-by-block in a neighborhood. Trained research staff start at the northeast corner of an intersection and walk around the blocks in a clockwise direction. Staff complete the scale for each street of the block, only evaluating the right side of the street. Thus for each block, three or more assessments are completed. We are in the process of assessing psychometric properties of the instrument, including inter-rater reliability and internal consistency, and determining the minimum number of blocks or street segments that need to be assessed in order to provide an accurate estimate of the neighborhood environment. These data will be presented at the conference.

Obj«tive: To describe and analyze the perceptions of longterm injection drug users (IDUs) about their initiation into injecting.

Toronto. Purposive sampling was used to seek out an ethnoculturally diverse sample of IDUs of both genders and from all areas of the city, through recruitment from harm reduction services and from referral by other study participants. Interviews asked about drug use history including first use and first injecting, as well as questions about health issues, service utilization and needs. Thematic analysis was used to examine initiation of drug use and of injection.

Results: Two conditions appeared necessary for initiation of injection. One was a developed conception of drugs and their (desirable) effects, as suggested by the work of Becker for marijuana. Thus virtually all panicipants had used drugs by other routes prior to injecting, and had developed expectations about effects they considered pleasureable or beneficial. The second condition was a group and social context in which such use arose. No participants perceived their initiation to injecting as involving peer pressure. Rather they suggested that they sought out peers with a similar social situation and interest in using drugs. Observing injection by others often served as a means to initiate injection. Injection served symbolic purposes for some participants, enhancing their status in their group and marking a transition to a different social world.

Concl111ion: Better understanding of social and contextual factors motivating drug users who initiate injection can assist in prevention efforts. 10 ma!onty of them had higher educational level (57%-highschool or higher).About 20.2 Yo adffiltted to have history of alcohol & another 12.4% had history of smoking. Only 3.2% people were on HRT & 3.1 % were receiving steroid. Majority of them (81.2) did not have history of osteoporosis. 13.6% have difficulty in ambulating. Only 8.8% had family history of osteoporosis. BMD measurements as me~sured by dual xray absorptiometry (DEXA) were used for the analysis. BMD results were compare~ w1~ RBC folate & serum vitamin B12 levels. No statistical significance found between BMD & serum v1taffiln B12 level but high levels of folate level is associated with normal BMD in bivariate and multivariate analysis.

Conclusion: In the studied elderly population, there was no relationship between BMD and vitamin B12; but there was a significant association between folate levels & BMD.

Introduction: Adolescence is a critical period for identity formation. Western studies have investigated the relationship of identity to adolescent well-being. Special emphasis has been placed on the influence of ethnic identity on health, especially among forced migrants in different foreign countries.

Methodology: This study asses by the means of an open ended question identity categorization among youth in three economically disadvantaged urban communities in Beirut, the capital of Lebanon. These three communities have different histories of displacement and different socio-demographic makeup. However, they share a history of displacement due to war.

Results and Conclusion: The results indicated that nationality was the major category of identification in all three communities followed by origin and religion. However, the percentages that self-identify by particular identity categories were significantly different among youth in the three communities, perhaps reflecting different context in which they have grown up.

Mechanical Heart Valve Replacement Amanda Hu, Chi-Ming Chow, Diem Dao, Lee Errett, and Mary Keith Introduction: Patients with mechanical heart valves must follow lifelong warfarin therapy. War· farin, however, is a difficult drug to take because it has a narrow therapeutic window with potential seri· ous side effects. Successful anticoagulation therapy is dependent upon the patient's knowledge of this drug; however, little is known regarding the determinants of such knowledge. The purpose of this study was to determine the influence of socioeconomic status on patients' knowledge of warfarin therapy.

Methods: A telephone survey was conducted among 100 patients 3 to 6 months following mechan· ical heart valve replacement. A previously validated 20-item questionnaire was used to measure the patient's knowledge of warfarin, its side effects, and vitamin K food sources. Demographic information, socioeconomic status data, and medical education information were also collected.

Results: Sixty-one percent of participants had scores indicative of insufficient knowledge of warfarin therapy (score :s; 80%). Age was negatively related to warfarin knowledge scores (r= 0.27, P = 0.007). In univariate analysis, patients with family incomes greater than $25,000, who had greater. than a grade 8 education and who were employed or self employed had significantly higher warfarm knowledge scores (p= 0.007, p= 0.002 and p= 0.001 respectively). Gender, ethnicity, and warfar~n therapy prior to surgery were not related to warfarin knowledge scores. Furthermore, none of t~e. m-hospital tea~hing practices significantly influenced warfarin knowledge scores. However, panic1~ants who _rece1v~d post discharge co~unity counseling had significantly higher knowledge scores tn comp~r1son with those who did not (p= 0.001 ). Multivariate regression analysis revealed that und~r~tandmg the ~oncept of 1?ternational Normalized Ratio (INR), knowing the acronym, age and receiving ~ommum1!' counseling after discharge were the strongest predictors of warfarin kn~wledge. S~1oeconom1c status was not an important predictor of knowledge scores on the multivanate analysis. POSTER SESSIONS v101 ~The majority of patients at our institution have insufficient knowledge of warfarin therapy.Post-discharge counseling, not socioeconomic status, was found to be an important predictor of warfarin knowledge. Since improved knowledge has been associated with improved compliance and control, our findings support the need to develop a comprehensive post-discharge education program or, at least, to ensure that patients have access to a community counselor to compliment the in-hospital educatiop program.

Brenda Stade, Tony Barozzino, Lorna Bartholomew, and Michael Sgro lntTotl#ction: Due to the paucity of prospective studies conducted and the inconsistency of results, the effects of prenatal cocaine exposure on functional abilities during childhood remain unclear. Unlike the diagnosis of Fetal Alcohol Spectrum Disorder, a presentation of prenatal cocaine exposure and developmental and cognitive disabilities does not meet the criteria for specialized services. Implications for public policy and services are substantial.

Objective: To describe the characteristics of children exposed to cocaine during gestation who present to an inner city specialty clinic.

Mnbods: Prospective cohort research design. Sample and Setting: Children ages 5 to 15 years old, referred to an inner city Prenatal Substance Exposure Clinic since November, 2003. Data Collection: Data on consecutive children seen in the clinic were collected over an 18 month period. Instrument: A thirteen (13) page intake and diagnostic form, and a detailed physical examination were used to collect data on prenatal substance history, school history, behavioral problems, neuro-psychological profile, growth and physical health of each of the participants. Data Analysis: Content analysis of the data obtained was conducted.

Results: Twenty children aged 6 to 14 years (mean= 9.8 years) participated in the study. All participants had a significant history of cocaine exposure and none had maternal history or laboratory (urine, meconium or hair) exposure to alcohol or other substances. None met the criteria of Fetal Alcohol Spectrum Disorder. All were greater than the tenth percentile on height, weight, and head circumference, and were physically healthy. Twelve of the children had IQs at the 19th percentile or less. For all of the children, keeping up with age appropriate peers was an ongoing challenge because of problems in attention, motivation, motor control, sensory integration and expressive language. Seventy-four percent of participants had significant behavioral and/or psychological problems including aggressiveness, hyperactivity, lying, poor peer relationships, extreme anxiety, phobias, and poor self-esteem.

Conclusion: Pilot study results demonstrated that children prenatally exposed to cocaine have significant learning, behavioural, and social problems. Further research focusing on the characteristics of children prenatally exposed to cocaine has the potential for changing policy and improving services for this population. Methods: Trained interviewers conducted anonymous quantitative surveys with a random sample (n= 148) of female detainees upon providing informed consent. The survey focused on: sociodemographic background; health status; housing and neighborhood stability and social resource availability upon release.

Results: Participants were 70% African-American, 16% White, 9% Mixed Race and 5% Native American. Participants' median age was 37, the reported median income was <S2,000 year, and 53% reported receiving a high school diploma or equivalent. Women reported a number of health conditions rypical of underserved populations, including asthma (42%), sexually transmitted infections (39%), high blood pressure (19%), HCV (14%), diabetes (5%) and HIV (4%). Nearly half (46%) did not anticipate having a place to stay for at least 30 days upon release. Factors significantly associated housing stability upon release were: high Family Support Score (Adjusted Odds Ratio [AOR) 6.15; 95% Confidence Interval (95% Cl) 1.76, 21.61), high Neighborhood Stability Score (AOR 4.41; 95% Cl 1.25, 15.52), wanting a commercial sex worker (CSW) support group (AOR 0.25; 95% Cl 0.10, 0.62); and identifying as bisexual (AOR 0.24; 95% Cl 0.07, 0.75). Women desired employment (95%), housing (84%), education (77%), drug treattnent (74%), help with custody of children (31 %), childcare (28%), and domestic violence suppon (20%) services. Conclusions: Female detainees represent one of urban centers' most marginalized PCJPWatioos. Short periods of detention represent a unique opportunity for _interven?~ns bri~ CO~s and public health institutions. Service providers should collaborate ~1th local ~ails to .P~de a con1111uwnof care for female detainees upon release that includes transportation , housing, residential drug treallllCnt, employment, education, family reunification, childcare and domestic viol~nce su~rt. ~pecial attenlion is warranted to lesbian and bisexual women and CSWs, who may be especially margmalized &om family and service-based support networks.

Introduction: "Health Care and Ethnic Minority Immigrants" examines how health care policy dil· ferences between Canada and the United States impact the health-related hardships, access and use of preventative care, and health outcomes of urban ethnic minority immigrants in both countries.

Methods: The findings of this paper build on the results of my qualitative comparative study of hotel workers in Vancouver, BC and Seattle, WA that revealed greater health related hardships for similarly matched employees in Seattle compared to Vancouver. In this paper, I examine the generalizability of these findings at the cross-national level for similar ethnic minority immigrant groups. I compare the impact of health care policy differences on specific groups that have emigrated to cities in both Canada and the United States. These include immigrants from China, Viemam, Philippines, West Indies, Africa, Sri Lanka, Pakistan, and Latin America. Comparative statistical analysis -utilizing rel· evant data from Statistics Canada and the U.S. Census -reveal the extent to which health policy differ· ences help explain how current health policy in the United States disadvantages urban ethnic minority immigrants.

Results: Many ethnic minority immigrants are a part of the working poor, a group which disproportionately lacks health insurance coverage in the United States. Their position in the labour market makes them most vulnerable to exclusion from health care services. The data reveals how current U.S. health policy creates barriers for recently arrived ethnic minority immigrants to access health insurance and care. It remains difficult to ascribe health outcome differences directly to policy differences because of the challenge in disentangling the complex interacting interventing variables, including income inequality, that determine health outcomes. Yer suggestive evidence suggests that health policy in the United States is harming the health of urban ethnic minority immigrants.

The current health policy regime in the United States harms the health access, care, and outcomes of urban ethnic minority immigrants. Comparing the fortunes of similar immigrants in Cana· dian and U.S. cities reveals these patterns of disadvantage and some of their consequences. These barriers are an understudied factor in the sociological literature on "segmented assimilation" and social exclu· sion. The paper ends with policy recommendatio ns to improve access to health care among ethnic minor· ity immigrants in both countries, with the goal of reducing health related hardships, and improving health outcomes.

Mass Index Deyu Pan, Richard Baker, and Keith Norris Badtgrou~ Over the past 3 decades, there has been dramatic increase in prevalence of obesity in the US population. However, the relationship between obesity and the prevalence of cardiovascular dis· ease (CV~) risk factors in different race/ethnic groups over time is not well known.

. Ik~rgn: _We use 2 cross-sectional , nationally representative surveys: National Health and Nutri· t10nal Examination Survey (NHANES III 1988 -1994 (n= 14 029) and NHANES 1999 NHANES -2002 , including white, black, and Hispa~ic races who were no~preg~ant, aged 20 to 74 years.

Res11lt1: The preval~nce of high cholesterol level (~ 240 mg/dL), untreated high blood pressure (2: l40/90 mm Hg) an~ diabetes were calculated according to BMI group (lean, <25; overweight, 25-29; and obese, 2: 30) for different race/ethnicity groups. Over the approximately 10 years period (from 1988l ~94 ~o [1999] [2000] [2001] [2002] , reducrion in 3 CVD risk factors in non-Hispanic white has been observed. For mmonty race/~hnicity groups, black and Hispanic, there had been increases in prevalence in high blood fa pressure and diabetes. The lean group experienced larger increase in prevalence of those CVD risk ctors.

. fo~~ The prevalence in CVD risk factors over time had reduced in most of the BMI ca1egoes r t e w ~~e population. However, for black and Hispanic, prevalence of 2 of 3 CVD risk factors ave generaUy uncreased, especially in overweight and obese groups. Methods: Strategies identified to achieve these goals include: developing meaningful neighbourhood and district boundaries for comparing health information, providing free access to neighbourhood health profiles (including relevant data at the smallest level for which valid rates could be calculated); mapping relationships of inequality at a variety of nested levels; providing a range of formats (maps, tables) to meet the needs of users; providing technical support; seeking user input to advance and improve the site; and conducting workshops to foster access and use of data for decision-making , advocacy and collaboration. An evaluation strategy is being developed to assess the efforts and impact of these strategies. A preliminary assessment of the results of the first six months of activity will be completed in October 2005.

Results: Significant differences in health are shown at all the geographic levels indicating success in developing the boundaries. Results tabulated for the first six months use of the site include: site visits; media use; reference/acknow ledgement of the site in other documents; number of contacts through presentations and workshops; feedback from users identifying strengths and limitations; and, response from health decision makers. Members of the partnership are identifying additional tools and services to further support actions that reduce health inequalities. The assessment will be used to develop more specific goals, targets and monitoring mechanisms.

Conclusions: Our experience with paper-based health profiles indicates that they have been used extensively for program planning and advocacy. The greater availability of information in a publiclyavailable web-based format is expected to translate into even greater usefulness and wider application. The web site has had considerable usage to date, extensive media coverage. Site users and workshop participants have provided positive feedback and suggestions for next steps. The six month review will be available in October 2005.

In India, more than 4 and a half people are HIV-positive and half a million have AIDS. India currently has the largest number of positive people in the world, oumumbering South Africa and accounting for nearly one tenth of the global HIV/AIDS prevalence. The World Bank predicts that by 2015, there will be 35 million HIV/AIDS cases in India. The central challenge facing HIV prevention efforts in South Asia today is learning how to respond to the societal determinants of vulnerability to HIV. HIV/AIDS is an issue largely engulfed by social stigma. Stigma and discrimination are often considered the foremost barriers to effective POSTER SESS10Ns v104 prevention and care initiatives. Stigma can make a person afraid of disclosing their status~ ~yone el se, and may make them feel depressed or alone. Stigma can .also le~d to poor adherence to medicanon, ~ likelihood to access health and social services, and less desire to hve. HIV+ men and women may beafraidtotd! their co-workers that they have HIV for fear of their reactions or for fear of losing their jobs. In a study 1 conducted of people living with HIV/AIDS in Delhi, India ov~r. 2003-~, many respo~ts shared their experiences of discrimination in their families, in their communmes, an~ m health ~e settmgs. These findings will be shared in the workshop, and will be compa~ed to m~ ex~nences workmg as an ~ co~l~ at the Center for AIDS Prevention Studies in San Francisco, Cahforma and Congreso de Lannos Unidos m Philadelphia, Pennsylvania. The workshop will include an overview of HIV/AIDS in urban contexts in tht United States (Los Angeles, San Francisco, New York, Philadelphia) and South Asia (Delhi, Hyderabad, Chennai). Differences in methods for outreach, prevention and treatment efforts between devdoped world and developing world contexts will be discussed. A large portion of the workshop will be centered on discussion. Participants will engage in an exercise to categorize their ideas of stigma. The workshop will also include a powerpoint presentation on the quantitative data gathered from the survey.

The number of homeless and runaway youth is increasing in Toronto, which is currently home to 3 out of 4 youth in the GT A who live alone, and it is the preferred locale for the street-involved and homeless youth. The city's youth population is expected to grow by nearly 20% by 2011, the school dropout rate is rising, and there are is a paucity of empirical data on what works with these at-risk youth. Over a two-year period, (2002) (2003) (2004) , YOUTHLINK-Inner City, conducted an evaluation of the impact of a harm reduction program aimed at reducing street youth's risk of contracting/infecting others with the HEP C virus, which has both short-term and long-term deleterious effects. Demographic data from 102 street-youth, along with resources/services used, employment methods, type and frequency of drug use, health status, police contacts, and their views of program impact were analyzed using a standardized sur· vey. Additionally, focus groups with youth, agency staff and community key informants were conducted, as well as in-depth interviews with three youth, over a sixth-month period. This paper details study results, which both inform both practice and future study about what works, why it works, and how best to work with these vulnerable youth. sho~ed .that the wasteland in this area was contaminated by As Cd Zn Pb Cu simultaneously. The con-ta~matton of As ~d was quit significant. The contamination problems and environmental issues in this region are very. serious. The awareness on environmental and health issues was investigated by spot survey and analysis. Overall awareness among the residents in the region is very poor. The Measures must be taken to assu~e t~e .sustainable economy development by local and central gorvernments. Keywords Nandan Guangx1; mmmg area; environmental awareness. concern like, epileptic fits, vision problems, earache, cough of more than 3 weeks and urinary problems. Ninety-five subjects did not take bath regularly and 42 were exposed to sex.

The health problems identified are only of a particular point of time and it may be difficult to interpret the depth of "iceberg" of the street children's world also draw the health-illness continuum. Periodic interaction and follow-up is very difficult as they generally disappear from the research setting due to their frequent mobility for survival measures. As per the prediction of the iceberg theory, only some problems may have been identified, larger problems in respect to their health may not have been identified. In spite of various limitations, this attempt had proven that, it is possible to enter the street children world, explore the iceberg of illnesses, and establish data of health-illness continuum through an effective nursing agency. It is recommended to deworm these children, provide nutritional education, establish "condom corners" and "street children help line" in the city and urban slum areas and undertake action research on their health.

Malnutrition is a serious problem in developing countries like Bangladesh. Malnutrition causes a great deal of child suffering. Malnutrition is one of the major causes of morbidity and mortality among the child. The aim of present study was to investigate the nutritional status and its relation to socioeconomic conditions of urban disadvantaged child of under five years age. Nutritional status was determined by anthropoemetric measurement(Heig ht, Weight, Mid-arm circumference etc.). Determination of total protein and serum albumin were done for biochemical examination. Haematological examination was done by blood haemoglobin profile estimation by cynmethhaemoglob in method and determination of haematocrit value or packed cell volume (PCV). Stool examination for ova of Hook Worm, round worm, trichuris species and other species were also done. Relevant information on socioeconomic characteristics was recorded by interviewing the house hold head using pretested questionnaire. our study demonstrated that nutritional status of the children are positively correlated with family income, parents level of formal education and negatively related to the family size. The effect of family income on the nutritional status, haematological and biochemical indices of urban disadvantaged child under five will be discussed in detail which will help us to determine proper way of utilization of health care facilities exists in developing countries. Introduction: With the increase in morbidity and reduction in mortality and with the introduction of highly active antiretroviral therapy (HAART), there is increasing focus on the determinants of healthrelated quality of life (HRQOL) in HIV-infection. The focus on the present study is to examine the relationship between social support, depression, and HIV disease severity, and the extent to which these variables impact on HRQOL in adult men with HIV-infection.

Methods: As part of a larger ongoing natural history study focusing on the neurobehavioural complications of HIV and AIDS, we administered questionnaires to assess depression (Beck Depression Inventory), social support, and HRQOL (MOS-HIV) to 366 adult men with HIV-infection. A structured interview was used to collect health information and data on HIV disease severity. Physical and Mental Health summary scores (PHS and MHS) were derived through Principal Components Analysis. Participants were grouped according to level of social support: "well supported" (n= 180), "moderately supported" (n=90), "little or ineffective support" (n=96). Analysis of variance was conducted to assess the effects of three levels of perceived social support, depression status (present vs absent), and HIV disease severity (AIDS vs non-AIDS) on mental and physical health dimensions of HRQOL. Potential interaction effects were also evaluated.

Results: Social support was found to have a significant effect on both MHS and PHS. Presence of depression was found to have a significant effect on MHS but not PHS. HIV disease severity (presence of AIDS diagnosis) was found to have a significant effect on PHS but not MHS. MANOV A analyses revealed no significant interactions effects.

Conclusions and Implications: Level of social support, presence of depression and HIV disease severity were shown to have independent effects on HRQOL. Feeling "well supported" appears to have significant benefits for mental and physical health. Biological indicators of HIV disease appear to have a selective impact on physical health while presence of depression is related to significant reductions in mental health. The development and evaluation of behavioural interventions to improve perceived social support network and depression will likely result in significant improvements in health outcomes of adults with HIV and AIDS. 

Introduction: Ongoing medical advances have greatly enhanced the longevity of Penons Living With AIDS (PLWA). However, for certain subgroups living with HIV/AIDS, including, members of minority groups, women and the economically underprivilege d, AIDS outcomes have not changed so favorably. One obvious factor to consider when explaining disparities in AIDS outcomes is the environ· ment within which an individual resides. Few studies of AIDS outcomes have focused on how commu· nity setting influences the effectiveness of care delivery. The principle research questions were: 1) What is the relationship between the locations of areas with concentrations of PL WA and the distribution of both primary and ancillary service providers? 2) How has the widespread availability of HAART (after 1996) impacted AIDS outcomes at the community level? 3) How do AIDS mortality and fatality rates vary when related community characteristics, such as household income, ethnic mix, and geographic access to primary and ancillary HIV/AIDS services are considered? We examine this issue across residential communities in the Los Angeles area.

Methods: Los Angeles County's comprehensive AIDS service providers database (compiled and maintained by AIDS Project Los Angeles) was geo-referenced and distances between weighted mean population centers and the nearest HIV/AIDS service providers were calculated to provide a measure of access which was then merged with AIDS diagnosis and mortality data along with relevant socioeconomic and population indicators and for analysis using bivariate and multivariate statistics at the zip code level.

Results: There is a growing disparity in HIV/AIDS outcomes between low-income minority areas and affluent non-minority areas in the post-HAART era (P = 0.002). Ancillary AIDS services such as case management and counseling and testing are located near the places where low income HIV/AIDS service consumers are likely to live (P =.000). In spite of having more access to ancillary services low income areas continue to be associated with smaller decreases post-HAART AIDS mortality rates (P=0.301).

Conclusions: Given the increasing disparities in AIDS outcomes between lower and upper income communities in the Post -HAART era, more specific research into the capacities of AIDS services providers and the efficiency of their interventions is required. Although it is clear that ancillary services are operating in the areas of greatest need, their effectiveness remains limited. Understanding the reasons for t~is, be they lack of adequate resources for inner city service providers, failure to reach target popula· tmns or other causes, requires additional research. In 20?3, Y.out~ who were able to speak either French or English and had been absent from their parent's/ c~regivers ~es.1dence for at least three consecutive nights took part in the survey which consisted of inter· viewer-adm1ms tered question~aires. P.arti~i~an~s were recruited from drop in centres in 7 cities across <?-nada.Y~uth self-report as either using in1ect1on or non-injection drugs. Statistical analyses were car· r1ed out using SAS version 8. The 'home' is a contested site for many women living in urban areas. Women living in poverty and using illicit drugs are largely excluded from participation in dominant 'home-base' gender roles of wife and mother because of economic disadvantage. They thus 'make home' in ways that are specific to their everyday experiences. While research has established links between housing, health and drug use, this literature does not tend to consider the meanings that home may have within the lives of women who lack access to adequate tenured living spaces. This presentation reports the findings of my Master's thesis work. Using grounded theory methodology within a poststructuralist feminist conceptual framework, I conducted in-depth, open-ended interviews with 11 women living in the Toronto area. The women were recruited from within the community through posters at different social service agencies (e.g., drop-in centres, community health centres). They were asked to describe their housing experiences and what home meant to them over the course of their lives. Through the data analysis process, a substantive theory of 'making home' for women living in poverty and using illicit drugs emerged. The central concept of making home is a continual process of learning about and interacting with the environment. The process of making home entails different subprocesses: finding home (knowing what is available and accessible, and accessing home), adaptation, and leaving home. The different meanings of home that women developed from their experiences and knowledge emerged as critical components for the process of making home. The women I interviewed were very mobile and experienced constant change with regards to home. Home was not considered only in relation to physical living space. Home could be made within a relationship or with regards to a possession. While dominant meanings of home relation to tenured living spaces are generally positive, my research indicated that home could also be a negative context. The presentation will describe my research process and findings as well as the theoretical and policy implications of my results. In the western democracies, social citizenship bundles the right to social provision (defined as a share of the social good, not necessarily proportionate to the market value of a citizen's contribution) with participation in the paid labour force. For this reason, social citizenship rights, which usually involve some kind of redistributive measures, are a key mechanism by which states ensure economic equality, or at least, economic equality of opportunity, but are also a mechanism of social exclusion. Social rights are inscribed around a single kind of relationship, that which exists between a male family breadwinner and the paid labor market; those who make economic contributions that fall outside this relationship -such as unpaid care-work, or, work that occurs in shadow or underground economiesare to a greater or lesser degree barred from accessing citizen-based social provisions. Furthermore, social provision that occurs outside of the breadwinner/market-eco nomy dyad is very often meanstested and is accompanied by regulatory state apparatuses (this includes a range of social services, from welfare payments, to child-care subsidies, to disability pensions). Social citizenship is thus stratified; the legal relationship that is at the heart of social citizenship acts as a form of social closure against claims for a share of the social good made by those who are 'lesser' citizens than others. Of particular interest in this paper is how citizenship inequalities translate into inequalities in the social provisions that emerge from economic participation: the right to safety on the job, protection from employer harassment, protection from the vagaries of the market as well the right to adequate, comprehensive, and appropriate health services. Drawing on mixed methods, longitudinal data from adult sex workers (n= 170) located in two research sites with different social welfare regimes -one in Canada and one in the U.S. -we examine the consequences of working in a "shadow" or "underground" economy on various facets of health and access to health services, taking into consideration the mediating role that citizenship constructs and social welfare regimes play in accessing other key social and economic determinants of health. Methods: The study population included methadone patients (re)admitted at the MHS in the period from 1/1/1996 to 31/1/2002, born in the Netherlands, Morocco, Surinam, Dutch Antilles or Turkye, and officially registered in the population register of Amsterdam. The population register was used to ascer· rain the vital status. Causes of death were provided by the Central Bureau of Statistics. Mortality was categorised as HIV related, directly drug related (overdose) and other.mortality.

Results: The methadone patients had the following characteristics: 38 years of age at entry; 81% male; 37% ethnic minority; 37% ever injected. In total, 9558 personyear (py) of observation time and 173 deaths (18% HIV related, 14% overdose; 57% other) were observed. Hence, the crude mortality rate was 18/1000 py (95% CI 16-21/1000 py). The percentage of (ever) injectors was higher among the native Dutch than among the ethnic minorities, 51 % and 14 % respectively. Higher rates were observed among native Dutch drug users compared to those belonging to an ethnic minority (age adjusted Hazard ratio (HR) 1.9 (95% CI 1.4-2.7). The age adjusted HR of (ever) injecting drug users versus non injecting users was 3.0 (95% Cl 2.2-4.1 ). After additional adjustment for route of administration a non significant difference between the Dutch and ethnic minorities remained (HR 1.3, 95% Cl 0.9-1.9, p-value 0.151.

Conclusion: The mortality rate among the heroin users in Amsterdam is strongly affected by the high prevalence of non-injecting drug use. Moreover, this study confirms that differences in mortality between the native Dutch and the ethnic minorities is related to differences in route of administration. The ongoing reduction of injecting drug use (due tot selctieve mortality, and switching route ofadministration and popularity of crack cocaine) may lead to a further reduction of mortality rates among heroin users in Amsterdam. Interventions preventing the initiation of injecting should be encouraged. . Introduction: Food insecurity is an inequality that is central in the lives of many low-income Cana· d1ans. People lack food security when regular access to nutritious food is limited or variable due to high prices'. low income, lack of transportation or inadequate food distribution, or they become disadvan· taged m other w~ys through the acquisition of food. A group comprising academics, health profession· als, and commumty workers who have experience in food insecurity, developed a pilot study in Ottawa that sought to und~rstand the lived experience of food insecurity. The study also used the United States Department of Agriculture (USDA) Community Food Security Module.

Methods: A series of group meetings determined the best research approaches; questionnaires and consent forms were developed by a working group. Twenty-three self-identified food insecure respon· dents were interviewed. The data were analysed using frequency distributions· the Food Security Module was coded according to the USDA coding guide, and open-ended responses w~re coded using a grounded approach.

Renlts: Preliminary results from our pilot study have given the research team cause for considerable concern. Out of 14 households without children, 11 experienced food insecurity with hunger; 5 ~ere at the severe l~vel. Out of 9 households with children, 7 experienced food insecurity with hunger. ~•rst person reflecnons commonly featured feelings of depression low self-esteem and despair. Participants' account tha d . an 1 cu ty gettmg to the store, severely limited putting knowledge and skills mto practice. l'OSTER SESSIONS v109 Conclusion: Based on these early findings, our research team is looking to challenge what appear to be assumptions about poverty and food insecurity and for best ways to use this information. Some policy approaches and interventions that encourage people to eat better and exercise more, may be missing the mark for low-income individuals, and may serve to maintain food insecurity. Future research will build on this pilot. With methods augmentation, and a comprehensive knowledge dissemination plan, we hope co contribute to research and policy frameworks at all levels.

PS-25 (A) Mental Health and the Corrections System: Population-Based Analyses in Urban, Semi-Urban, and Rural Settings Julian Somers, Robert Watts, and Michelle Patterson Introduction: According to recent epidemiological research, rates of mental disorders vary considerably across countries and across regions within countries. Nevertheless, rates of mental disorders (including substance use disorders) are consistently higher in populations involved in the corrections sys-1em. Courts have long recognized the heavy burden of mental illness within their purview, and have developed innovative programs to better manage the needs of such individuals. The majority of these innovations (e.g., specialized courts) exist in urban settings. However, few studies have examined the degree of variability in rates of different mental disorders between courts in urban and other settings (e.g., semi-urban, rural). Variability between courts in different settings, if present, holds implications for needs-based resource planning.

The present study was conducted as part of a long-term Inter-Ministerial collaboration in British Columbia (BC). Analyses were conducted on linked administrative data regarding population health and correctional services. A database was constructed including all individuals sentenced in BC in a single year (n=49,142). Corrections records were matched to records of health services utilization (hospital and outpatient services) for mental disorders and substance use disorders in the years preceding sentencing. Services for mental health and substance-related problems were aggregated into three groups: severe mental illness (SMI); less-severe mental illness (LSMI); alcohol/other drug (AD). Courts were grouped, based on their annual volumes, inro three categories: "Urban"; "Semi-Urban" and "Rural." Rates of service use for mental disorders were compared between groups for 1-year and 5-years preceding sentencing.

Results: There were significant differences in the rates of mental disorders in courts of different size (urban, semi-urban, rural) . However, differences between the rates of disorders within each of these groups exceeded the discrepancies between groups. Comparatively high and low rates of disorders were observed in courts of each size. Moreover, the courts with the highest rates of certain disorders (e.g., AD) did not have the highest rates of other types of mental disorders (e.g., SMI).

Conclusions: Rates of mental disorders differed significantly among the annual populations sentenced across courts in BC. Urban courts (which process comparatively large numbers of people) have implemented services to address the needs of the mentally ill. The present analyses strongly suggest that program development should be closely linked to the demonstration of need. The results caution that a uniform approach to court programs for the mentally ill is likely to be inefficient, over-supplying services in some settings and underestimating need in others. Results: Public settings used for injection are characterized by highly unhygienic conditions, the presence of unsafely disposed syringes, limited availability of sterile syringes and a lack of sterile water for injecting. A number of unsafe injection practices observed were common among public injectors. The presence of police officers nearby and the potential of assault by street predators fostered rushed injecting among those consuming drugs in public spaces. The ecological features of these environments encourage unhygienic and unsafe injecting practices, heighten risk for overdose and the transmission of blood borne viruses. Introduction: Approximately 13% of women experience depression in the first weeks or months after giving birth. Although it has been argued that postpartum depression (PPD) is a culture-bound P~ nomenon, experienced only in Western, industrialized countries, recent international research studies have confirmed that the prevalence of PPD is similar around the world. However, little is known about variables that may influence the experience of PPD in women from diverse cultures and immigrant women. Research is needed to identify the role culture may play in the presentation of PPD (i.e., types of symptoms most commonly reported), how women from various racial, ethnic and cultural backgrounds perceive and attribute their symptoms of PPD, and finally, how culture can be appropriately addressed in PPD treatment programs.

Method: To examine the role of culture in PPD, semi-structured interviews and self-report question· naires were administered to clients of the Women's Health Centre of St. Joseph's Health Centre, Tor· onto. Participants were identified as either first generation Canadians (relative newcomen) (N=8) or second generation Canadian (parents were immigrants to Canada) (N=6). Data were collected QD these two groups of women based on: severity of depression, symptom presentation, perceived role of social supports and culturally-specific traditions, and barriers and responses to treatment.

The interview data were analyzed using qualitative methods (thematic content analysis), and the following themes were identified: 1) stress about passing on their culture to their children, 2) lack of social support and feelings of isolation, 3) perceived importance or lack of importance of cultural based tra· ditions, 4) conflicts with family members. about cultural traditions and beliefs, 5) mental health stigma within ethnic communities and beyond, 6) race-and sex-based discrimination, and 7) language barriers.

Conclrllion: Identifying the role culture plays in the presentation of PPD, and how women from diverse backgrounds perceive and attribute their symptoms of PPD, is critical in order to establishcultur· ally appropriate guidelines for treatment options. Furthermore, information gathered from this study can be used to develop policies and resources for delivering culturally competent care for newcomer wo~ who are dealing with PPD as well as the issues around acculturation (i.e., language barriers, racism). llus is of particular importance for urban health centers which provide postpartum care to diverse groups of women, and particularly recent immigrants or newcomers.

PS-~8 (Al. Contaminated 'Therapeutic Landscape': Perceptions of the Aamjiwnaang Fint Nation KeYln Smith and Isaac Luginaah . In~: This. paper pres;ents the findings of an ongoing study among the Aamjiwnaang F!rst Nanon. Aam11wnaang is located m the heart of Samia's 'Chemical Valley', surrounded by cherrucal ~(ants such as Esso, Imperial Oil, Shell, Suncor Energy, and Canada's largest hazardous waste disposal sate. Safety Kleen. This Fint Nation community is located within the St. Clair River •Area of Concem'. as destgna~ by Health Canada for the population of Samia and the surrounding region. Although this comm_umty, by way of. its proximity to the numerous chemical plants is already exposed to high levels pollu~on, recent che?Ucal dumping in ~mjiwnaang, as well as a failed proposal for another ethanol plant m the community, only helped to mtensify community concerns about potential health impactS of exposure. Research on the cultural beliefs and traditions of First Nation communities has established that th~ ~isting rel~tionship between First Nations people and 'Mother Earth' is not only physical, but also_ spmtual. In this study we explore how the complex relationship between the Aamjiwnaang First Naaon and 'Mother Earth' be ha · · · I .. may c ngmg 111 a contammated 'therapeutic' landscape. The study a so ~lores h?w Aam11wnaang residents are coping with these changes and with the probable conramina· boa of their community. Ra!Jts: Aamjiwnaang residents acknowledge that they are living in a contaminated environment and are being impacted by emissions from the surrounding 'Chemical Valley' especially for future generations, and have expressed concerns that members of the community and Mother Earth are 'sick' as a result of this exposure. While moving from that 'place' has been discussed, residents have strong personal and generational connections to the land and insist however, that Aamjiwnaang is their 'home' and will remain that way despite growing community concerns about the impact from industry.

The contribution of this study lies in the direct involvement of community leadership in designing and conducting this research and distributing the results to further local policy development regarding community concerns on the reserve.

Background: Truck driver are at very high risk for drug abuse because the factor contributing to drug abuse among driver are multiple. It is important to gain an understanding of the key factors that contributing to drug abuse among truck drivers.

Methods: seventy-truck driver aged 25-35 years were conveniently selected from the population. All the participants were male. An interview schedule was developed in the light of literature data and data were collected by personal interview with informed consent in selected urban area of Eastern part of Nepal.

Results: A considerable percentage of truck driver have less knowledge about drug abuse, its effect on body and their complication. Majority of the participants (90%) explained that lack of education, financial crisis were leading factors of drug abuse. The average numbers of respondents were believed that lack of meaning in life, marital disharmony. Friendship with drug abuser, stress, tiredness, modernization of life pattern and freedom from the home pressure were the influencing risk factors to drug abuse.

Conchuion: This study reveals those truck drivers are at risk in urban area for developing drugs abuse, mostly influenced by social and environmental factors. Hence, these groups should undergo certain educational programme to prevent not only drug abuse, but also prevent transmission of infectious disease among these groups. Introduction: Food insecurity is an inequality that is central in the lives of many low-income Canadians. Our group of university researchers, health professionals, and community developers conducted a study in Ottawa with community workers who work with people identified as food insecure. The purpose of the study was to understand the nature of their work, and their perspectives, perceptions and experiences of the causes and consequences of food insecurity. (A parallel study was conducted with food insecure participants).

Methods: Sampling was through local knowledge of organizations involved in the provision of food to community members. Written permission for the researchers to contact workers in confidence was obtained from each organization. Thirteen in-depth interviews were conducted. The interviews consisted of a number of open-ended questions. The data were collated, and analysed using a grounded approach.

Results: Workers interviewed represented organizations that offered diverse programming and methods of food distribution intended to address the needs of the community. The provision of food was seen as a necessary response to address hunger that arose for the majority from poverty caused by low income, or levels of government income support and safety nets that were insufficient to support food requirements. Workers reported that food requirements varied according to different. ethnic backgrounds, ages of recipients and family configurations, and with food preferences, and d'.etary (health) requirements. Workers' observations of the effects of insufficient food on adults and children such as depression, low energy and non-participation or social disengagement matched those of food insecure respondents. Food insecurity was cited as "another srressor among the mountain of problems." Overall, workers presented a picture of a silent, stigmatized, poor population including children, and a lack of advocacy to address the issues. be tha th · ·ty the results suggest that workers and organizations, like the commuruty mem rs t ey msecun • · · · · f ilab'l' f food · t d ·n thei·r ab1'l1'ty to address food insecurity. L1m1tanons m terms o ava 11ty o , serve, are restnc e 1 . .

funding, and donations appeared to set the para?1eters of pr~g:am r.espon~ to commuruty food msecurity. Workers were concerned with program des1g": and a~m1mstranon that m general addr~d hunger on an emergency short-term basis, although food msecunty was long-ter_m for ~any. Sustainable solutions that include knowledge translation strategies, and health and social pohcy responses were suggested and will be explored in future research that hopes to build on this pilot. Background: Socioeconomic deprivation as well as low levels of soc!al s.uppoi:r have .been associated with poor outcomes following cardiac surgery. Pre-operative depression m ~anents with coron~ry artery disease awaiting CABG ranges from 27-47% and is an independent predictor of post-operanve mortality. Since St. Michael's Hospital has a large inner city population, this study was designed to determine the both the prevalence of depressive symptomatology (DS) in patients awaiting CABG as well as its relationship with socioeconomic status (SES) and social support.

Methods: Consecutive patients referred for isolated CABG were invited to complete the Centre for Epidemiological Studies Depression Scale (CES-D) as well as a social support scale and a life streSsors inventory. A CES-D score of 2: 16 represents mild DS and a score of 2:27 represents moderate to severe DS. Participants also recorded information on functional status, perceived progression of heart failure, demographic and SES variables. All participants with CES-D scores 2: 16 were considered to have DS. Results: Of the 75 patients (75%) who returned the survey, 22 (29.3%) of participants had a CES-D score 2: 16 with 8 (10.7%) of those having scores suggestive of severe depression. Females and those with ongoing medical concerns tended to have more DS (p= 0.06 and p= 0.07 respectively). Age was not related to DS. Perceived worsening of symptoms and increased CCS angina class were significantly related to the presence of DS (p= 0.03 and p= 0.03 respectively) but not the number of diseased heart vessels. Satisfaction with personal relationships including having someone to confide in (p=0.01), feeling lonely (p= 0.04) and not having a partner (p= 0.007) were significantly related to DS. Being very upset by a recent breakup in the immediate family was also significantly related to DS (p= 0.02). Having greater than a grade 9 education was the only SES variable related to DS (p=0.06). Multivariate logistic regression suggested that not being partnered and having low education were the most significant predictors of DS.

ConclNSion: Pre-operative depression is present in at least one quarter of patients referred for CABG. Since DS is related to poor outcomes following CABG, single patients with few social supports and low education should be considered at high risk for DS. These findings support the need for the development of supportive interventions in patients at risk in order to decrease post-operative morbidity.

This study examines the relationship between childhood sexual abuse, sexual assault during adolescence, and HIV-Risk-Related behaviours in a sample of 919 homeless youths. Over the past decade, there has been increasing research devoted to the impact of childhood sexual abuse. Some studies have suggested that the experience of childhood sexual abuse is associated with substance use and abuse, at· risk sexual behaviour and subsequent higher rates of HIV infection (Ompad et al., 2005; Cinq-Mars et al., 2003; Brown et al., 1997) . Other studies have found that childhood abuse, especially sexual abuse, is c_o~n among stree~ youth (Noell et al. 1999 ). This study compares sexually abused males and females livtng on the street ~th non-sexually abused street youth, with regards to unsafe sexual behaviours and e~ures to potmnal t:DV sources (e.g., tattooing, body piercing and injection drug use). The hypothe-SIS oft~ ~nt study IS that the prevalence of HN-risk-related behaviours will be higher among street youth vtctuns of sexual abuse than those who have not been sexually abused. The sample includes 919 youths aged 13 to 25 who met specific criteria's for itinerancy (649 male and 270 female, with a mean ~of 19.4 Y· and a standard deviation of 2.9). They were recruited through five organisations working ~th~ you~ and were~ of an ongoing cohort study. All youth completed a 45 to 60 minute ques· ~onnaue on their sexual behaviours, use of drugs and alcohol and other HIV risk behaviours. Oral spec· unens for HIV testing were. also collected. A total of 357 (38.9%) youth reported at least one incident of ~I •~use/assault (1~1 girls (67.0% of all the girls) and 176 boys (27.2% of all the boys]). Preliminary descnpnve analyses pomt to sexually abused/assaulted youth showing the highest prevalence of sexual POSTER SESSIONS v113 at-risk behaviours. For example, 43.3% of sexual abuse/assault victims have engaged in prostitution in their lives compared with 13.4% in the non-sexually abused/assaulted group. In addition, 42.6% of sexual abuse/assault victims reported having injected drugs, compared with 32.0% in the non-sexually abused/assaulted group. More statistical analyses will bring other significant factors to light, especially when we analyze separately those victim of childhood sexual abuse as compare to those victim of sexual assault after childhood. Elucidating the risk factors for getting involved in HIV-Risk-Related behaviours is important for the development of comprehensive and appropriate prevention and treatment intervention strategies. Introduction: New immigrants and refugees to Canada frequently emigrate from regions of the world where intestinal parasitic infections with worms are endemic. Of note, some of these parasites area capable of surviving for years to decades within a given host and can have life threatening consequences many years after initial infection. Thus, early diagnosis and treatment of intestinal parasitic worms is considered important in high risk immigrant populations, however there remains a lack of consensus regarding the best method of accomplishing this. Diagnosing worm infections through stool examinations is costly and has limited sensitivity, while presumptive treatment of all immigrants, although advocated by some, is expensive and results in healthy individuals being unnecessarily treated. Herein, we examine the utility of a hematologic marker (i.e. peripheral blood eosinophilia) as a screening instrument to identify parasitic worm infections in new immigrants to Toronto.

We identified 192 adults, 15 years of age or older, who were screened for intestinal parasitic infections by stool examination as part of a recently developed screening protocol at a downtown Toronto community health centre. We examined the prevalence of infections with worms and subsequently evaluated the impact of several demographic factors on the presence of worm infections. We also determined the sensitivity and specificity of peripheral blood eosinophilia (defined as greater than 500 eosinophils per ml) as a marker for intestinal parasitic worm infections.

Results: Overall, 21 % of the 192 immigrants tested had evidence of at least one worm infection on a single stool examination, while 4% of such individuals bad infections with multiple worms concurrently. Age did not appear to be associated with the presence of worms, however 29% of males had evidence of worm infections compared with 16% of females (p= 0.03). Immigrants from Asia, sub-Saharan Africa, and Central America had the highest burden of overall infection. The sensitivity and specificity of peripheral blood eosinophilia for worm infections was 24% and 92% respectively.

Conclusions: One in five recent immigrants presenting to a community health centre in downtown Toronto had evidence of at least one intestinal parasitic worm infection. The highest burden of illness was in men and in those emigrating from less developed regions of the world. Peripheral blood eosinophilia is a poor screening test for worm infections however its presence is highly suggestive of the existence of worms in new immigrants.

More than a decade ago, the Journal of American College Health recommended that a national study be conducted to measure the health status of African American college students, 'both health disparities and [their] positive healthful behaviors' (Fennell, 1994) . It was later decided that when exploring the level of health risk behaviors for African American students, gender is an important variable and should be included in the research (Fennell, 1997) . At historically Black college and universities (HBCUs) college health researchers must tackle gender disparities through highly-effective health promotion and disease prevention programs. The purpose of this review is to examine the literature that addresses the overarching health behaviors (i.e. risky sexual behavior, poor diet, smoking, physical inactivity, etc.) of African American men who attend HBCUs. Despite the various social, cultural, and academic benefits of African American students who attend HBCUs, the number of research studies that adequately address their health and health behaviors is limited. Studies indicate that African American men who attend HBCUs are actively engaged in poor health behaviors. Compared to females at HBCUs, African American men are more likely to behave in ways that could result in injuries and the use tobacco, alcohol, and ~ther dru~. 

The City of Toronto has recently proposed to conduct a street count of the homeless. Like proposals that have come before, this most recent proposal is controversial among many homeless advocates and service providers because it is perceived as intrusive, likely to undercount the target population, and unnecessary for addressing the problem. Advocates of the count view it as necessary to gauge the scope of the problem and advise city leaders about how to most effectively direct resources ro.the various homeless services. This paper first reviews the history of efforts to count homeless populat10ns m Toronto, describing the motivations and arguments of people on both sides of the issue. Second, the paper reviews the methodological complexities of counting homeless populations, describing approaches that use shelter-counts, administrative data and street observations. Those interested in counts for Toronto and elsewhere can benefit from this review of approaches that have been proposed and carried out in other municipalities. Third, the paper proposes a new community-base d strategy that joins the skills of methodologists, local experts, and service providers to ensure a fair and accurate count. The method of systematic social observation avoids some of the problems of early counts by utilizing a repeated identification approach to minimize undercount bias. The method also has the advantage of involving and compensating homeless individuals for assisting with the street count estimates. The estimation approach can be implemented on a rolling basis throughout the year.

Drug Transitions) is a multi-level study aimed at examining the associations between features of the urban environment and mental health, drug use, and risky sexual behaviors. Research participants are being recruited in 36 New York City (NYC) neighborhoods. An essential first step in the implementation of this study was to delineate boundaries for each target neighborhood that could then be used to establish sampling frames and as key units of analytic interest. Although many neighborhood studies rely on pre-established definitions (e.g. those used for the census or administrative purposes), such definitions do not always reflect contemporary settlement patterns. We felt that street level observations were a neces· sary component of the definition process.

Methods: The procedures used to delineate neighborhoods were: (1) development of census block maps of targeted areas; (2) review of land use maps and census tract data to ensure, prior to going into the field, tha.t particular blocks are residential and likely to have sufficient population for recruitment purposes; and (3) field VISltS and observation in each of the targeted areas. Field observations focused on: housing characteristics, including housing type and condition; characteristics of commercial areas, such as likely customer base (e.g. local or no~, socio-economic status and ethnicity of customers); pedestrian volume (including con· gregauons of people m parks and outside stores or residences); obstructions to pedestrian traffic (e.g. ma1or thoroughfares, multi-block industry or institutions); and maintenance and use of open spaces.

Results: In making the final decisions regarding neighborhood boundaries and the inclusion or exclusion of particular. blocks, we considered a broad range of factors including evidence of homogeneity an~ heterogeneity (socmeconomic, ethnic, housing type, environmental) across blocks within and blocks ad1acent to a nei.ghborhood, and across the 36 sample neighborhoods; the potential for efficient recruit· ment of appropriate particip.ants (i.e. sufficient local pedestrian traffic); and boundaries used in reporting census data (s? that population data can be used in our analysis). .

Altho~gh utilization of field observations for neighborhood definitions is relatively time consuming (ap~~ox1mately 2 hours for a 12 block area, with more diverse neighborhoods taking even longer), we annc1p~t~ that it will substantially improve the quality and consistency of our data gath· ~rmg ~nd analyse~. Spec1f1c e?'amples from neighborhoods defined through this process will be given dur· m~ this presentatmn. We will also discuss the merits and limitations of characterizing neighborhoods usmg street level observations. has been no consideration for how social networks are associated with SSE. The objective of this study was to identify personal and social network characteristics associated with being a recipient of SSE.

In this cross-sectional study, IDUs who injected in the past 6 months were recruited from syringe exchange programs in Montreal, Canada, between April 2004 and January 2005. Information on each participant and on the persons with whom contact had occurred in the past month were elicited using a structured, interviewer-administe red questionnaire. Participants provided detailed demographic and drug use information on up to 5 IDU members with whom drugs or injecting materials were shared. Using logistic regression, personal and network characteristics were examined in relation to receipt of sterile syringes.

Res.Its: Of 277 IDUs, 39% reported receiving sterile syringes in the past month from another IDU. The sample mean age was 33 years (range 18-55), 73% male, 91 % Caucasian, and 85% cocaine injectors. In multivariate analyses adjusted for age and gender, recipients of sterile syringes were more likely than non-recipients to share drugs after preparation (0R=2.39(1.06-5.42 )), to require help or to have helped inject another IDU (OR= 3.48(1.60-7.60)), to have asked someone to get sterile syringes from a syringe exchange program (OR=2.54[1.20-5.40 )), to lend syringes (OR=2.44[1.16-5.16) ) and to use drug preparation water that was previously used by another IOU (0R=2.46(1.42-4.28) ) during the past 6 months. Recipients also had a higher rate of change (p=0.01) of IDUs in their drug injecting network during the past month. With respect to social networks, 45% ( 171/348) of IDU network members were providers of sterile syringes and were more likely than non-providers to inject everyday (OR= 2.50( 1.51-4.15)). When stratified by their role as a sexual partner or as someone who provides support (e.g. friend, family member), further risk behaviours were observed in relation to sharing injecting materials with the participant.

Conclusion: Recipients of sterile syringes and their IDU network members had several high-risk behaviours for infection with bloodborne diseases. SSE may afford an opportunity for the dissemination of other salutary behaviours such as information sharing on safe injecting practices between recipients and distributors. Furthermore, drug injecting networks may be an avenue to reach IDUs who may not otherwise be exposed to preventive measures.

There are numerous sources of stigma and labelling of mental and physical illness. First, the sociocultural dimension to stigma and labelling clearly influences patients, families, health care professionals and society's perception and treatment of illness. This creates multiple challenges related to illness identification and recovery, particularly in culturally diverse societies. Second, the media is a major source of stigma and stereotyping with regard to a variety of mental and physical illnesses. Despite increased public knowledge of many illnesses, studies have shown that stigma has intensified over the years in certain cases. A third element of stigma and labels appears with the use of diagnosis as a solution to human problems with the result that difficult to treat patients are repudiated and social issues are unaddressed. This presentation will serve to outline the development of stigma, various expressions of stigma, and consequences of stigma. It will provide some practical recommendations for the reduction of stigma related to mental and physical illness.

Purpose: To assess the knowledge, attitude, and practice about immunization for parent of 2-3 years old Hispanic and African American children in Los Angeles County (LAC).

Methods: We conducted two cluster surveys in LAC. The sample was selected with probability proportionate to estimated size at the first stage and simple random sample of children at the second stage. Data were collected through interview. We absuacted vaccine coverage data from immunization record card (IRC) at home or from clinic records. The participation was 81 % in Hispanics and 83% in African Americans populations. IRC was not available at home for 26% of African American and 16% of Hispanic children.

Results: All parents perceived their children got all necessary vaccine~. Fa~orable attitudes to.w~rd immunization were reported by 82 % of African American and 90% of H1s?amc parents. '.he m~1ority of the parents (90% African American and 95% Hispanic) agreed that vaccines prevent senous d1se~ses among children. Regarding vaccine safety, significantly more Hispanic parents (91 %) than African American parents (75%) mentioned that vaccines are safe. 

Introduction: Cervical cancer has been shown to be preventable by Papanicolau tests in heterosexual women; however, the utility of Papanicolau test in lesbians is controversial. Cervical cancer is caused by the human papillomavirus (HPV) which is transmitted by sexual _intercourse; howev_er, its' transmission by homosexual intercourse is also controversial. The goal of this study was to review the evidence for Papanicolau tests in lesbians.

Methods: A Pub Med, OVID ( 1996 OVID ( to 2005 , and Cochrane library search was performed using the MeSH headings "Homosexuality , Female," "Vaginal Smears," and "Papillomavirus, Human." In Pub Med, the Clinical Queries feature was used with "diagnosis" and "broad, sensitive" filters. A Google Advanced Search of the internet was conducted with the terms "lesbian," "cervical cancer," and "pap rest." The url was limited to ".ca," ".edu," or ".gov."

Results: The search yielded 8 original articles and 4 reviews, but no Cochrane reviews. None of the publications were Canadian. 111 website hits were found and selected websites were reviewed. Studies showed that lesbians have fewer Papanicolau tests than heterosexual women; however, many reported risk factors for cervical cancer, including multiple past or current sexual partners (male and female), early age of first coitus, history of sexually transmitted diseases, and cigarette smoking. HPV has been detected in 13-30% of lesbians and 6-19% of lesbians who have never had sex with men. Case studies of abnormal Papanicolau tests in lesbians who have never had sex with men have also been reponed. Sexual transmission of HPV among lesbians can be explained by several factors: 1) 53-99% of lesbians have had sex with men and 21-30% of lesbians continue to have sex with men. 2) HPV may be transmitted by sexual behaviours among women, like digital-vaginal sex, digital-anal sex, oral sex, and the use of insertive sex toys. 3) HPV transmission requires only skin-to-skin contact. Genital HPV has been identified on human fingers. Some professional organizations, like the Society of Obstetricians and Gynecologists of Canada and the American Cancer Society, recognize the need for Papanicolau tests in lesbians. Other organizations, like the Canadian Cancer Society, do not have official policy statements. The current Ontario Cervical Screening Program does not specifically address lesbians.

Conclusion: Although the data was limited, most studies recommended that lesbians should receive Papanicolau tests. The frequency of these tests was controversial. Policy makers and professional organizations should address the needs of this special population and make specific recommendations .

Monique Chaaya, Ahia Sibai, Hiam Chemaitelly, and Zana El Roueiheb .

Literature concerning the mental and physical effect of work at an old age is contradictory. In addinon, urban environments are physically and socially harsh with reduced potential for income generation and employment and increased potential for depression. The present paper is an attempt to study how do work, or lack of work, link to the experience of depression among older adults in underprivileged Lebanese urban communities. The data comes from a cross-sectional survey, where 740 elderly residing in 3 underprivileged communities in Beirut, including a Palestinian refugee camp, were successfully inter-v1ewed through face-to-face interviews. Logistic regression was performed to assess the effect of work on depression ad_justing for many other covariates. Data showed that 17.5% of people aged 60 years and more were still workmg. There was a highly protective effect of work on depression in elderly males (OR= 0.342, 95% Cl= 0.128-0.909). The current study is the first of its kind in the Arab region and more work shou_ld be _don_e in this area. It is important for the Lebanese government to consider elderly rights for social mclus10n m terms of employment opportunities.

Amam Nuru-Jeter, Nancy Adler, and Burton Singer . l~u~on:_ The Socioeconomic gradient is perhaps the most persistent and significant finding in social epidem1ological research. The insistent nature of the SES effect is evidenced by its significance after acc?untmg for ~umerous confounds. The significance and magnitude of the effect, however, varies by ::•al group. Evidence_ o_f the relative effect of race and SES is inconclusive. Further, less attention has f ~ ptid to the specific interactions of race and SES than to examinations of which is a better predictor 0 d ~ th. ~sues are further complicated by the explanatory complexity of the various measures of SES anl . owht ey relate to the health of various social groups. Understanding the specific nature of these re a11ons ips 1s necessary for guiding he Ith d · I 1· · h a an soc1a po mes and programs aimed at improving t e POSTER SESSIONS v117 health of our most disadvantaged groups, and therefore population health, overall. This study examines the synergistic effects of SES with both race and gender in predicting group differences in mortality.

Methods: Analyses use data from the National Longitudinal Mortality Survey (N= 559, 715) for the years 1979, 1980, and 1981-85; and were linked to the National Death Index for deaths occurring through 1985. Results were confirmed using data from the National Mortality Followback Survey for people who died in 1986 (N= 13,491) and the 1986 National Health Interview Survey (denominator). We used correlation analysis and the standardized mortality ratio to examine SES (education and income), race, and gender as predictors of group differences in changes in mortality.

Results: For the total population, analyses support the income gradient showing significant declines in mortality ratios from low to high income along the income strata. Education shows a significant drop in mortality with completion of high school and completion of college, exhibiting a threshold rather than a gradient effect. Compared to whites, Blacks receive diminishing health returns for each subsequent level of income and education; with whites closely mirroring the total population in SES thresholds.

Similarly, compared to men, women do not experience the same health gains at comparable SES levels. For education, Black men and women only show significant mortality declines upon completion of high school.

The SES gradient operates differently among race and gender subgroups. Threshold effects suggest resource gains in life opportunities at particular milestones along the SES gradient. Further, SES matters less for Blacks and women compared to whites and men suggesting differing implications for health and social policy aimed at reducing disparities.

Objective: We assessed the impact of diabetes in a large Puerto Rican community of Chicago by measuring the prevalence of diagnosed diabetes and calculating the diabetes mortality rate.

Methods: We analyzed data from a comprehensive health survey conducted in randomly selected households in community areas. Questions on diagnosed diabetes and selected risk factors were asked. In addition, mortality data were analyzed in order to calculate the age-adjusted diabetes mortality rate. When possible, rates were compared to those found in other studies.

Results: The diabetes prevalence located in this community (20.8%: 95% Cl= 10.1 %-38.0%) is one of the highest ever reported for Puerto Ricans. For instance, it is more than three times higher than the prevalence for the US (6.1 %) and twice the prevalence for Puerto Ricans in New York ( 11.3%) and Puerto Rico (9.3%-9.6%). Diagnosed diabetes was found to be significantly associated with obesity (p=0.023). The prevalence was particularly high among older people, females, those horn in the US, and those with a family history. The diabetes mortality rate (67.6 per 100,000 population) was more than twice the rate for all of Chicago (31.2) and the US (25.4).

Conclusions: Understanding why the diabetes and mortality rates for Puerto Ricans in this commu· nity are so much higher than those of other communities is imperative. Collaboration between researchers, service providers and community members can help address the issues of diabetes education, early screening and diagnosis and effective treatment needed in this community.

Introduction: SARS is a respiratory illness that is spread from person to person through dose contact. This infectious disease outbreak was unusual due to the high rate of infection among health care workers. The aim of the study is to explore the demographic and attitudinal determinants of psychological distress due to SARS among health care workers of a Toronto Hospital.

Methods: A total of 997 adult participants completed questionnaires co assess psychological distress (Impact of Event Scale -JES) and attitudes to SARS. Of these, 845 participants completed the questionnaire during the SARS I outbreak, and 152 participants completed the questionnaire during the SARS II outbreak. Participants also provided information on demographic variables, including occupation and exposure to SARS. Principal components analysis was used to derive eight attitudinal scales: Fear: system, protection, prevention, job stress, stigma, instrumental coping, and psychological copm~. L111ear regression analyses were applied to evaluate the associations of the demographic and amtudmal variables, as well as time, with psychological distress.

. .

Regression analyses showed that time and higher scores on fear, 1ob stress, stigma'. and instrumental coping were associated with a higher total IES score: (R2 =.30). Contrary to expectations, none of the demographic variables was associated with total IES score. Conclusion: The presence of psychological distress in health care workers is indicative of intrusive or avoidant responses to thoughts, feelings, and memories associated with the SARS outbreak. This study shows that ( 1) fear for one's health and the he~lth of.others, (2) ex~erien~in~ job stress, (3)_tbe per· ception of stigma, (4) usage of instrumental copmg skills, ~n~ (5) t1m_e s1grufi~an~ly c~nmb~te to increased psychological distress in health care workers. Potential mterventmns during mfecttous diseaie outbreaks in health care settings should be targeted to minimize the impact of these factors.

Purpose: The purpose of this study was to expand knowledge regarding feeding practices, know!· edge and nutritional beliefs of mothers currently residing in the Dominican Republic (DR). The rising incidence of obesity in children is a major national health concern and obesity in first and second-generation immigrant children also continues to rise. We know that parents (particularly mothers) shape children's early diet patterns and that immigrant mothers experience additional challenges related to acculturation and assimilation into a new culture, however there is a paucity of literature concerning the effect of immigrant adaptation to American culture on the nutrition of children. In addition, new immigrant knowledge about the causes of obesity and the resulting health implications for childhood obesity has not been assessed and reported. This qualitative study used focus group methodology to discuss views and practices related to the introduction of food for infants and feeding practices for young children, along with a discussion on knowledge and beliefs related to the causes and health implications of child· hood obesity. Ten Dominican Mothers' of young children (birth to 6 years old) who reside in a small town in the western frontier area of the DR were participants in the focus group. Results from this srudy will be compared to results from an identical study that will be conducted in Fall 2005 with new immi· grant mothers from the DR to the Boston area. We will compare feeding practices, beliefs and knowledge about nutrition for young children between these two groups.

Methods: Using participatory principles, a focus group design was used to interview a group of mothers in the DR. The investigator along with a bilingual translator conducted the focus group. The session was tape recorded and is currently in the process of being transcribed and translated. Transcribed data will be systematically analyzed themes will be identified. A qualitative data analysis software will be used to organize and code the data according to the specific aims of the study. Supporting quotations will be selected to substrate each theme.

lmpli~tions for Urban Health Practice: An ultimate goal of this study is to lay a foundation for understanding the process of acculturation on feeding practices of mothers when they immigrate to the US. Understanding beliefs, knowledge and feeding practices that mothers use with young children will help m ~he ~evelopment of culturally and linguistically appropriate educational strategies and materials for use m primary prevention of pediatric obesity.

In Canada more than seventy-five percent of immigrants choose to stay in three major urban centers of Toronto, Montreal and Vancouver. Approximately fifty percent of the immigrants eventually set· tie m ~~e greater Tor<_>nto area. There is mounting evidence that the increasing immigrant population has a_ sigmfic~nt health disadvantage over Canadian-born residents. This health disadvantage manifests particularly m the ma1"ority of 1"mm1"gr t h h d be · · h .

. . . an s w o a en m Canada for longer than ten years. This group as ~n associ~te~ with higher risk of chronic disease such as cardiovascular diseases. This disparity twccb n ma1onty of the immigrant population and the Canadian-born population is of great importance to ur an health providers d" · I I · b

as isproporttonate Y arge immigrant population has settled in the ma1or ur an centers. Generally the health stat f · · · · · · h h been .

us 0 most 1mm1grants 1s dynamic. Recent 1mm1grants w o av_e ant •;ffca~ada _for less ~han ~en years are known to have a health advantage known as 'healthy imm1• ~ants r::r · ~:s eff~ 1~ defined by the observed superior health of both male and female recent immi- immigrant participation in Canadian society particularly the labour market. A new explanation of the loss of 'healthy immigrant effect' is given with the help of additional factors. lt appears that the effects of social exclusion from the labour market leading to social inequalities first experienced by recent immigrant has been responsible for the loss of healthy immigrant effect. This loss results in the subsequent health disadvantage observed in the older immigrant population.

A study on Patients perspectives regarding tuberculosis treatment By S.j.Chander, Community Health Cell, Bangalore, India.

Introduction: The National Tuberculosis Control Programme was in place over three decades; still Tuberculosis control remains a challenge unmet. Every day about 1440 people die of tuberculosis in India. Tuberculosis affects the poor more and the poor seek help from more than one place due to various reasons. This adversely affects the treatment outcome and the patient's pocket. Many tuberculosis patients become non-adherence to treatment due to many reasons. The goal of the study was to understand the patient's perspective regarding tuberculois treatment provided by the Bangalore City Corporation. (BMC) under the RNTCP (Revised National Tuberculosis Control Programme) using DOTS (Directly Observed Treatment, Short course) approach.

BMC were identified. The information was collected using an in-depth interview technique. They were both male and female aged between 4-70 years suffering from pulmonary and extra pulmonary tuberculosis. All patients were from the poor socio economic background.

Results: Most patients who first sought help from private practitioners were not diagnosed and treated correctly. They sought help form them as they were easily accessible and available but they. Most patients sought help later than four weeks as they lacked awareness. A few of patients sought help from traditional healers and magicians, as it did not help they turned to allopathic practitioners. The patients interviewed were inadequately informed about various aspect of the disease due to fear of stigma. The patient's family members were generally supportive during the treatment period there was no report of negative attitude of neighbours who were aware of tuberculosis patients instead sympathetic attitude was reported. There exists many myth and misconception associated with marriage and sexual relationship while one suffers from tuberculosis. Patients who visited referral hospitals reported that money was demanded for providing services. Most patients had to borrow money for treatment. Patients want health centres to be clean and be opened on time. They don't like the staff shouting at them to cover their mouth while coughing.

Conclusion: Community education would lead to seek help early and to take preventive measures.

Adequate patient education would remove all myth and conception and help the patients adhere to treatment. Since TB thrives among the poor, Poverty eradiation measures need to be given more emphasis. Mere treatment approach would not help control tuberculosis.

lntrod#ction: The main causative factor in cervical cancer is the presence of oncogenic human papillomavitus (HPV). Several factors have been identified in the acquisition of HPV infection and cervical cancer and include early coitarche, large number of lifetime sexual partners, tobacco smoking, poor diet, and concomitant sexually transmitted diseases. It is known that street youth are at much higher risk for these factors and are therefore at higher risk of acquiring HPV infection and cervical cancer. Thus, we endeavoured to determine the prevalence of oncogenic HPV infection, and Pap test abnormalities, in street youth.

~tbods: This quantitative study uses data collected from a non governmental, not for profit dropin centre for street youth in Canada. Over one hundred females between the ages of sixteen and twentyfour were enrolled in the study. Of these females, all underwent Pap testing about those with a previous history of an abnormal Pap test, or an abnormal-appearing cervix on clinical examination, underwent HPV-deoxyribonucleic (DNA) testing with the Digene Hybrid Capture II.

Results: Data analysis is underway. The following results will be presented: 1) number of positive HPV-DNA results, 2) Pap test results in this group, 3) recommended follow-up. .

The results of this study will provide information about the prevalence of oncogemc HPV-DNA infection and Pap test abnormalities in a population of street youth. The practice implic~ tions related to our research include the potential for improved gynecologic care of street youth. In addition, our recommendations on the usefulness of HPV testing in this population will be addressed. Methods: A health promotion and disease prevention tool was developed over a period of several years to meet the health needs of recent immigrants and refugees seen at Access Alliance Multicultural Community

Health Centre (AAMCHC), an inner city community health centre in downtown Toronto. This instrument was derived from the anecdotal experience of health care providers, a review of medical literature, and con· sultations with experts in migration health. Herein we present the individual components of this instrument, aimed at promoting health and preventing disease in new immigrants and refugees to Toronto. Results: The health promotion and disease prevention tool for immigrants focuses on three primary health related areas: 1) globally important infectious diseases including tuberculosis (TB), HIV/AIDS, syphilis, viral hepatitis, intestinal parasites, and vaccine preventable diseases (VPD), 2) cancers caused by infectious diseases or those endemic to developing regions of the world, and 3) mental illnesses includiog those developing among survivors of torture.

The health needs of new immigrants and refugees are complex, heterogeneous, and ohen reflect conditions found in the immigrant's country of origin. Ideally, the management of all new immigrants should be adapted to their experiences prior to migration, however the scale and complexity of this strategy prohibits its general use by healthcare providers in industrialized countries. An immigrant specific disease prevention instrument could help quickly identify and potentially prevent the spread of dangerous infectious diseases, detect cancers at earlier stages of development, and inform health care providers and decision makers about the most effective and efficient strategies to prevent serious illness in new immigrants and refugees.

lntrodMction: As poverty continues to grip Pakistan, the number of urban street children grows and has now reached alarming proportions, demanding far greater action than presently offered. Urbanization, natural catastrophe, drought, disease, war and internal conflict, economic breakdown causing unemployment, and homelessness have forced families and children in search of a "better life," often putting children at risk of abuse and exploitation.

Objectives: To reduce drug use on the streets in particular injectable drug use and to prevent the transmission of STDs/HIV/AIDS among vulnerable youth.

Methodology: Baseline study and situation assessment of Health problems particularly HIV and STDs among street children of Quetta, Pakistan.

The program launched a peer education program, including: awareness o_f self and body protection focusing on child sexual abuse, STDs/HIV/AIDS , life skills, gender and sexual rights awareness, preventive health measures, and care at work. It also opened care and counseling center for these working and street children ar.d handed these centers over to local communities. Relationships among AIDS-related knowledge and bt:liefs and sexual behavior of young adults were determined. Rea.sons for unsafe sex included: misconception about disease etiology, conflicting cultural values, risk demal, partner pressur~, trust and partner significance, accusation of promiscuity, lack of community endorsement of protecnve measures, and barriers to condom access. In addition socio-economic pressure, physiological issues, poor community participation and anitudes and low ~ducation level limited the effectiveness of existing AIDS prevention education. According to 'the baseline study the male children are ex~ to ~owledge of safe sex through peers, Hakims, and blue films. Working children found sexual mfor~anon through older children and their teachers (Ustad).

Recommendation s: It was found that working children are highly vulnerable to STDs/HIV/AIDS, as they lack protective meas":res in sexual abuse and are unaware of safe sexual practices. Conclusion: Non-fatal overdose was a common occurrence for IDU in Vancouver, and was associated with several factors considered including crystal methamphetamine use. These findings indicate a need for structural interventions that seek to modify the social and contextual risks for overdose, increased access to treatment programs, and trials of novel interventions such as take-home Naloxone programs.

Background: Injection drug users (IDUs) are at elevated risk for involvement in the criminal justice system due to possession of illicit drugs and participation in drug sales or markets. The criminalization of drug use may produce significant social, economic and health consequences for urban poor drug users. Injection-related risks have also been associated with criminal justice involvement or risk of such involvement. Previous research has identified racial differences in drug-related arrests and incarceration in the general population. We assess whether criminal justice system involvement differs by race/ethnicity among a community sample of IDUs.

We analyzed data collected from IDUs (N = 1,084) who were recruited in San Francisco, and interviewed and tested for HIV. Criminal justice system involvement was measured by arrest, incarceration, drug felony, and loss/denial of social services associated with the possession of a drug felony.

Multivariate analyses compared measures of criminal justice involvement and race/ethnicity after adjusting for socio-demographic and drug-use behaviors including drug preference, years of injection drug use, injection frequency, age, housing status, and gender.

The six-month prevalence of arrest was highest for Whites (32%), compared to African Americans (25%) and Latinos (27% ), in addition to the mean number of weeks spent in jail in the past 6 months (7.0 vs. 5.8 and 4.2 weeks). These differences did not remain statistically significant in multivariate analyses. Latinos reported the highest prevalence of a lifetime drug felony conviction (48%) and mean years of lifetime incarceration in prison (13.3 years), compared to African Americans (48%, 10.7 years) and Whites (34%, 6.9 years). Being African American was independently associated with having a felony conviction and years of incarceration in prison as compared to Whites.

The history of involvement in the criminal justice system is widespread in this sample.

When looking at racial/ethnic differences over a lifetime including total years of incarceration and drug felony conviction, the involvement of African Americans in the criminal justice system is higher as compared to Whites. More rigorous examination of these data and others on how criminal justice involvement varies by race, as well as the implications for the health and well-being of IDUs, is warranted.

Homelessness is a major social concern that has great im~act on th~se living.in urban commu?ities.

Metro Manila, the capital of the Philippines is a highly urbanized ar~ w.1t~ the h1gh~st concentration of urban poor population-an estimated 752,229 families or 3,005,857 md1v1duals. This exploratory study v122 is the first definitive study done in Manila that explores the needs and concerns of street dwdlent\omc.

less. It aims to establish the demographic profile, lifestyle patterns and needs of the streetdwdlersindit six districts City of Manila to establish a database for planning health and other related interventions.

Based on protocol-guid ed field interviews of 462 street dwellers, the data is useful as a template for ref!!. ence in analyzing urban homelessness in Asian developing country contexts. Results of the study show that generally, the state of homelessness reflects a feeling of discontent, disenfranchisem ent and pow!!· lessness that contribute to their difficulty in getting out of the streets. The perceived problems andlar dangers in living on the streets are generally associated with their exposure to extreme weather condiriOll! and their status of being vagrants making them prone to harassment by the police. The health needs of the street dweller respondents established in this study indicate that the existing health related servias for the homeless poor is ineffective. The street dweller respondents have little or no access to social and health services, if any. Some respondents claimed that although they were able to get service from heallh centers or government hospitals, the medicines required for treatment are not usually free and are beyond their means. This group of homeless people needs well-planned interventions to hdp them improve their current situations and support their daily living. The expressed social needs of the sucet dweller respondents were significantly concentrated on the economic aspect, which is, having a perma· nent source of income to afford food, shelter, clothing and education. These reflect the street dweller' s need for personal upliftment and safety. In short, most of their expressed need is a combination of socioeconomic resources that would provide long-term options that are better than the choice of living on the streets. The suggested interventions based on the findings will be discussed. . Methods: IDU~ aged I 8 and older who injected drugs within the prior month were recruited in 2005 usmg RDS which relies on referral networks to generate unbiased prevalence estimates. A diverse and mon· vated g~o~p of IDU "seeds." were given three uniquely coded coupons and encouraged to refer up to three other ehgibl~ IDU~, for which they received $5 USD per recruit. All subjects provided informed consent, an anonymous 1~t erv1ew and a venous blood sample for serologic testing of HIV, HCV and syphilis anti~!· Results. A total of 213 IDUs were recruited in Tijuana and 206 in Juarez, of whom the maion!)' were .male < 9 .l.4% and 92.2%) and median age was 34. Melhotls: Using the data from a multi-site survey on health and well being of a random sample of older Chinese in seven Canadian cities, this paper examined the effects of size of the Chinese community and the health status of the aging Chinese. The sample (N=2,272) consisted of aging Chinese aged 55 years and older. Physical and mental status of the participants was measured by a Chinese version Medical Outcome Study Short Form SF-36. One-way analysis of variance and post-hoc Scheffe test were used to test the differences in health status between the participants residing in cities representing three different sizes of the Chinese community. Regression analysis was also used to examine the contribution of size of the Chinese community to physical and mental health status.

Rmdts: In general, aging Chinese who resided in cities with a smaller Chinese population were healthier than those who resided in cities with a larger Chinese population. The size of the Chinese community was significant in predicting both physical and mental health status of the participants. The findings also indicated the potential underlying effects of the variations in country of origin, access barriers, and socio-economic status of the aging Chinese in communities with different Chinese population size.

The study concluded that size of an ethnic community affected the health status of the aging population from the same ethnic community. The intra-group diversity within the aging Chinese identified in this study helped to demonstrate the different socio-cultural and structural challenges facing the aging population in different urban settings. 

Urban Health and Demographic Surveillance System, which is implemented by the African Population & Health Research Center (APHRC) in two slum settlements of Nairobi city. This study focuses on common child illnesses including diarrhea, fever, cough, common cold and malaria, as well as on curative health care service utilization. Measures of SES were created using information collected at the household level. Other variables of interest included are maternal demographic and cultural factors, and child characteristics. Statistical methods appropriate for clustered data were used to identify correlates of child morbidity.

Preliminary Ratdts: Morbidity was reported for 1,087 (16.1 %) out of 6,756 children accounting for a total of 2,691 illness episodes. Cough, diarrhoea, runny nose/common cold, abdominal pains, malaria and fever made up the top six forms of morbidity. The only factors that had a significant associ· ation with morbidity were the child's age, ethnicity and type of toilet facility. However, all measures of socioeconomic status (mother's education, socioeconomic status, and mother's work status) had a significant effect on seeking outside care. Age of child, severity of illness, type of illness and survival of father and mother were also significantly associated with seeking health care outside home.

The results of this study have highlighted the need to address environmental conditions, basic amenities, and livelihood circumstances to improve child health in poor communities. The fact that socioeconomic indicators did not have a significant effect on prevalence of morbidity but were significant for health seeking behavior, indicate that while economic resources may have limited effect in preventing child illnesses when children are living in poor environmental conditions, being enlightened and having greater economic resources would mitigate the impact of the poor environmental conditions and reduce child mortality through better treatment of sick children.

Inequality in human life chances is about the most visible character of the third world urban space. F.conomic variability and social efficiency have often been fingered to justify such inequalities. Within this separation households exist that share similar characteristics and are found to inhabit a given spatial unit of the 'city. The residential geography of cities in the third world is thus characterized by native areas whose core is made up of deteriorated slum property, poor living conditions and a decayed environment; features which personify deprivation in its unimaginable ma~t~de. There are .eviden~es that these conditions are manifested through disturbingly high levels of morbidity and mortality. ban · h h d-and a host of other factors (corrupt10n, msens1t1ve leaders 1p, poor ur 1ty on t e one an ,

. · 1 f · 1 · · Th t ) that Suggest cracks in the levels and adherence to the prmc1p es o socta 1usnce. ese governance, e c . . . . .

PS £factors combine to reinforce the impacts of depnvat10n and perpetuate these unpacts. By 1den· grou o . ·1 "Id . . bothh tifying health problems that are caused or driven by either matena _or soc1a e~nvanon or , t e paper concludes that deprivation need not be accepted as a way. of hfe a~d a deliberate effon must be made to stem the tide of the on going levels of abject poverty m the third world. To the extent that income related poverty is about the most important of all ramifications of po~erty, efforts n_iu_st include fiscal empowerment of the poor in deprived areas like the inner c~ty. This will ~p~ove ~he willingness of such people to use facilities of care because they are able to effectively demand 1t, smce m real sense there is no such thing as free medical services. ). There were 322 men with HIV-infection included in the present study (mean age and education of 41.8 (SD=8.4) and 13.9 (SD=2.7), respectively). A series of multiple regressions were used to examine the unique contributions of symptom burden (depression, cognitive, pain, fatigue), neuropsychologic al impairment (psychomotor efficiency), demographics (age and education) and HIV disease (CDC-93 staging) on IIRS total score and JIRS subscores: ( 1) Activities of daily living (work, recreation, diet, health, finances); (2) Psychosocial functioning (e.g., self-expression, community involvement); and (3) Intimacy (sex life and relationship with partner).

ResNlts: Total IIRS score (R 2 "0.43) was associated with AIDS diagnosis (Ii= 0.11, p <0.01) and symptoms of pain (Ii= -0.14, p < 0.01 ), fatigue (ji = -0.34, p < 0.001) and cognitive difficulties (p =0.30, P < 0.001 ). For the three dimensions of the IIRS, multiple regression results revealed: ( 1) activities of daily living (R2=0.42) were associated with AIDS diagnosis (Ii =0.17, p < 0.01) and symptoms of pain <P =-0J6, P < 0.01 ), fatigue (ji = -0.31, p < 0.001) and cognitive difficulties (ji =0.32, p < 0.001 ); (2) Psychosocial functioning (R2=0.31) was associated with was associated with symptoms of fatigue (Ii= -0.25, p <0.001) and cognitive difficulties <Ii =0.19, p <0.001); and (3) Intimacy (R2=0.17) was related to was associated with symptoms of fatigue (IJ = -0.17, p < 0.01) and cognitive difficulties (Ii= 0.19, p < 0.001 ). Methods: The SIF evaluation methodology involves a comprehensive database located at the SIF, a randomly selected p~o.spective coh~rt of SIF users, and two pre-existing external control cohorts. . . ~ts: In addmon to reporting process data and descriptions of the SIF users, we report on data indicating that the establishment of the SIF has been independently associated with reductions in public ~':°g ~ (p <?.001), and syringe sharing (AOR =0.3[95%CI: 0.1 _ 0.7); p =0.013) and other unsafe m1ecnon pract1_ces_ (p ~ 0.010), and increased uptake of detox services (log-rank p =0.017). As well, we report on da~ md1cat1ng that the SIF has not prompted adverse changes in community drug use patterns.

The Vancouver SIF has been well accepted by the target population, and while adve~ events s~c~ as overdoses have occurred, these events have been successfully managed. Externally compiled data indicate that the SIF has been associated with substantial declines in public disorder !'OSTER SESSIONS v125 associated with injection drug use, syringe sharing, and increased uptake of detox services. As well, the establishment of the SIF has not exacerbated community drug use patterns. Ongoing evaluation activities wiU involve assessing the impact of the SIF on a variety of outcomes, including infectious disease transmission, fatal overdose, and utilization of health and social services. City, Brazil, 1996 -2002 Maria Cristina Almeida, Waleska Caiaffa, Renato Assum;iio, and Fernando Proietti Dengue cases were described according to time, space, intensity, age, gender, onset of symptoms, residence address and census tract. Spatial distribution of two groups (children and women over 64 years old and men aged 20-59) were compared, under assumption that they have distinct behaviors regarding their displacement around the city. Analysis included local Moran index, Ripley\\'s K function and recurrence of census areas over time. About 99,559 cases were identified in seven epidemic waves. Concentration of cases in small areas, followed by a spread either in space or time suggested endemic patterns. Regarding age-gender groups, distinct patterns suggested that residence might not be a good proxy in determining the local of infection for men aged 20-59. Dengue is shifting to endemic pattern in this city and transmission may not be sole related to home environment, suggesting that additional spatial information must be coUected aiming efficient control measures.

Murukan Kandamuthan and Subodh Kandamuthan lnl7Uduction: Illness or disablement of a child may affect the economic functioning of a family as it alters the employment pattern and earnings of parents This paper tries to assess the health status and the quality of life of disabled children, and how generally, severe disablement in a child affected their fami-lies\' finances, and to quantify any such effects the problems faced by children in their home and to provide information relevant to the formation of criteria for new or increased cash support.

Methods: A case-control study was done in the Thiruvananthapuram district, capital city of Kerala by selecting a random sample of 300 families with severely disabled children below 15 years and a random sample of 300 normal children matched for age and occupation of the parents. Comparative and subjective data were collected. Money spent on children\'s medical care, loss of earnings of the parents, and other economic burden to the family due to the disability of the child in the family. A discriminant analysis along with univariate analysis was done to assess the factors that mostly differentiate the disabled and normal children.

The mean expenditure of the families with a disabled child was Rs. 852/-per month, which is significantly higher than the corresponding expenditure of Rs. 389/-per month of families with normal child, (t= 16.86, P <.00001). Of the disabled children, 81 % were not getting any social security payments and 90% had no special concessions for medical and other educational purposes. The analysis of income and expenditure pattern indicated that financial impact of disablement in a child on the family is significant. The discriminant model results revealed that medical expenditure was a significant variable that differentiated the disabled and normal child.

The study found that the health status and quality of life of the disabled children were far from satisfactory. This in fact affected the economic status of the disabled children. In addition to reduced earnings, there are extra costs for disabled children for travel, domestic help, medical care, and health care expenditures (hospital care, physician services, dentistry, drugs and others) for disabled individuals. A strong case can be made for their long-term care by improving the financial support to such families possibly through the introduction of an allowance specially to compensate for the earnings lost by parents due to the disability of their children.

Widows in India are considered disadvantage group of population. Because they are characterized by pangs of separation from spouse, and consequently they go through mental agony, social ~s?lation, and economic dislocation. In addition to these, poverty, landlessness, homelessness, malnutr1non etc. endure serious deterioration of their health. According to census 2001, there are 44 million women are widowed and one fourth live in urban areas. There is a noticeable increase of urban widows from the previous census (almost half). The paper examines the type of disability and chronic ailment borne among elderly widows (60 years and above). Fifty second round of National Sample Survey aske~ the individuals three sets of questions regarding their health: their status of health, whether they are physically POSTER SESSIONS v126 immobile, and whether or not they have had any specific chronic illnesses. Although health infrastruc-1 1 ·1 ble 1 ·n urban setting in India as compared to rural counterpart, prevalence of tures are arge y ava1 a . . . . . h · ·11 · h h"gher 1 "n urban areas Analysis shows 1omt problems m old age qmte common c romc 1 ness is muc 1

• . . and nearly 44 percent elderly widows are suffering from this ail'.11ent in urban areas. One-fifth of widows are suffering from high/low BP. Heart disease, diabetes and urinary problems are much ~ore pre~alent in urban areas though disabilities is comparatively lower in urban areas. However, the d~fference is not statistically significant. Disability with respect to vision is more pronounced and one third_ of the total respondents have problems regarding eyesight. One fifths ofdderly widows are _ha.rd of hearing. Though disability increases with age, similar trend is not observed with respect to chr~mc illness. The percepnon of self-health among elderly becomes poorer as their age increases. The perceived health status need not be always corrected to objective indicators of health. It is noted that around 27 per~en~ of those perceived their health as "excellenr" or "very good" are found to be suffering from chrome disease of1omts and 17 percent have visual disability. To conclude an elderly widow living in urban areas have similar health problems as she Jives in rural areas. This can be easily explained, as they were not made aware to seek treatment from health facility. In addition, the study shows that the economic conditions are deterrent factors for their illness. It is essential that intervention should be taken up improving their economic conditions so that wellbeing of this most vulnerable group of the society can be taken care of.

Heart failure is a disease that affects nearly 15 million people world wide. The United States alone accounts for one third of this population. Blacks are stricken with heart failure twice as often as whites. Men are more likely to develop CHF than women, however since the majority of the CHF population are seniors, there are actually more women than men. Congestive heart failure (CHF) has become a pandemic. As the baby boomer generation ages, the number of CHF cases will rise dramatically. (Young, J. & Mills, R.,2004). After the age of 45, each proceeding decade doubles the incidence level of CHF. The average person has a 1 in 5 chance of developing heart failure within their lifespan according to the Framingham study (NIH.gov). Individuals aging 65 or older compose over half of the entire documented heart failure population. In this age group, CHF is the leading cause of hospitalization. Many patients are continuously readmitted. It is estimated that the CHF population will increase by one million within the next 25 years. Mortality was at 50% for a two year period and 70% for five years (Young, J. & Mills, R.,2004 ). data from: AHA As technology evolves, the understanding of the nature of heart failure has become clearer. In the beginning of the 20th century heart failure was diagnosed as a condition that presented with edema (swelling) in the extremities caused by water retention. Treatment in the beginning of the past cenrury was limited to abdominal drainage and diuretics. The discovery of the heart's insufficient pumping ability in heart failure patients lead to new surgeries and devices such as heart transplants and ventricular assist devices (bridge until transplant is available). Ventricular hypertrophy often occurs before the development of heart failure. Hypertrophy is the term given for cardiac remodeling. Cardiac remodeling also includes chamber dilation (Young, J. & Mills, R.,2004) . CHF financial burden The US Healthcare Financing administration has ranked CHF as the highest cost illness in the diagnose-related area. Direct costs related to CHF in the US for 2004 were nearly $26 billion. These costs included hospital admissions, physician fees, home health aids and medications. Indirect costs were over $2 billion in 2004. Loss of jobs or death due to CHF was the criteria for this category (Young, J. & Mills, R., 2004).

. Introduction: The Injection Drug User Quality of Life Scale (IDUQOL) is a relatively new scale ~es1gned to capture the unique and individual circumstances that determine quality of life among injection drug users (IDUs). The 20 life areas comprising the instrument were based on the research literature an~ ~ocus group discussions with IDUs. The purpose of the present study was to evaluate the content validity of t.h~ IDUQOL using judgmental methods based on subject matter experts' (SMEs) ratings. Content vah~1ty refers to the de~ee to which elements of an assessment tool are representative of the construct of interest and appropnate for a given population.

Methods: Data were obtained from six SMEs, from the field of IDU research and practice, who ~ere. asked t.o evaluate various aspects of the IDUQOL, including the title of the instrument, administraon instruchons, clarity of the names and descriptions of each life area, response format, scoring instruc-no~s and examples, record form and whether each life area should be included in the instrument. SME ratings were made using either 3 or 4 point scales. SM Es were also given the opportunity to comment on POSTER SESSIONS v127 each section and to suggest whether important life areas had been overlooked, were redundant, not relevant, or in need of revision.

(CVI) and the ~v.erage ~eviation Index (AD) were used to evaluate SMEs' agreement on ratings of the content vahd1ty vanables. Both measures provided support for the content validity of various aspects of the IDUQOL, although results from the stricter AD index noted some areas of disagreement, including the description of particular life areas (e.g., being useful, drugs, sex), the inclusion of some life areas (e.g., drug treatment, education, independence and free choice), and the ease of the scoring instructions.

The findings from this study provide (a) content validity evidence to support the use of the IDUQOL as well as (b) recommendations to suengthen both the instrument (e.g., improved descriptions for some items) and the accompanying administration and scoring manual (e.g., an easier scoring template). Changes made to the instrument and its manual make the IDUQOL even easier for researchers, practitioners, and program evaluators to use as a way of assessing, and tracking changes over time or as a result of interventions in, quality of life in injection drug users. Introduction: Strict adherence to prescribed regimens is required to derive maximal benefit from highly active antireuoviral therapy (HAART) in persons living with HIV/AIDS (PHAs). Adherence is a key determinant of the degree and durability of viral suppression. Adherence is also essential in reducing the spread of HIV and ensuring that today's treatments remain effective for as long as possible. The objective of this study is to conduct a systematic review of the research literature on the effectiveness of education and patient support strategies for improving adherence to HAART.

Methods: A systematic search of the core databases was performed from January 1996 until May 2005. Randomized Controlled Trials examining the effectiveness of education and patient support interventions to improve the adherence to HAART were considered for inclusion. Only those studies that measured adherence at a minimum of six weeks were included. Study selection, quality assessments, and data abstraction were performed independently by two reviewers.

Results: Study heterogeneity with respect to differing populations, interventions, outcomes, and length of follow-up did not allow for meta-analysis. We included 19 studies involving 2, 159 PH As. Sample sizes ranged from 22 to 367. Study duration ranged from a single session to a variable number of sessions delivered over one year. Many of the interventions involved the provision of an educational component to improve adherence and often addressed strategies to overcome barriers to adherence and the development of problem-solving skills. They ranged from simple interventions (e.g., the provision of reminder devices) to complex interventions (e.g., cognitive-behavioural therapy delivered by licensed psychologists). Eleven of the 19 studies demonstrated a statistically significant advantage associated with the described adherence intervention. The advantage associated with adherence outcomes does not seem to translate into the more clinically relevant outcome of viral suppression. Only 4 out of 12 studies that reported virological or immunological results found a significant effect associated with the intervention. The studies had several methodological shortcomings.

Conclusions: There is a need for standardization and methodological rigour in the conduct of adherence trials. Some interventions may have a significant impact on improving adherence. Further research is required before any specific adherence improving strategy can confidently be incorporated into standard clinical practice. 

Focus groups were used to collect data from a purposive sample of treatmentexperienced participants. focus group data were analyzed using a grou~ded t~eory appr~ach. i:ne themes identified from the interviews were used to identify the effects of ant1rerrov1rals on quality of hfe. The content of the MOS-HIV was appraised against the themes identified from our analysis. Participants also completed the MOS-HIV survey and were asked whether the survey covered all important aspects of quality of life on antiretroviral medications.

Results: Five key informant interviews and five focus groups with 38 participants were used to identify effects on quality of life that are not directly ~aptu~ed by_ the MOS-HIV Health Survey. Our~~ showed that our participants described quality of hfe as mvol~mg_ a set of ~rsonal trad~ffs ~stay alive. In most cases, worsened quality of life was traded-off for gams 1~ longeVlty from ~~canon use. These eff~'ts or tradeoffs included: ( 1) Downstream Consequences of Side effects and toXlanes; (2) Loss of lrufe.

pende~t Decision-Making Privileges, (3) Having to Choose Drugs over ~areer; (~)Burden of Medication-Taking Responsibilities; and (5) Living Life Under a Pretense and Havmg to Hide-The net effect of the tradeoffs, or "prices" to pay led to what was described as "longevity with HN without hope and future~.

Conclusion: Our study highlights five major themes summarizing the impact of HAART on quality on life, and suggests that currently used scales for measuring quality of life do not a~atd~ cap~e these findings and the associated consequences. The conceptual framework for measuring quality of bfe in HIV should be reconsidered in order to better capture the important effects of the medications on quality of life. This may involve widening the boundaries of the definition of health-related quality oflife to include aspects such as finances, employment, and housing. We should further consider the development of a HAART adverse effect specific instrument, using a broad definition of adverse effect in order to capture all types of adverse impacts of HIV treatments on quality of life.

Introduction: Measles (rubeola) is the most contagious vaccine preventable disease of humans. While cases of measles are uncommon in Canada today, the disease continues to be a leading cause of morbidity and death in the developing world. As a result of human migration, measles cases still occur in Canada, primari~ among immigrants, returning travelers, and other susceptible groups. Canada's National Advisory Council on Immunizations (NACI) recommends that immigrants without records of measles immunization be considered for vac:cination since these individuals may not have been appropriately vaccinated in their native country. On rhe other hand, natural immunity to measles in immigrants is likely to be high given the high incidence of disease in developing parts of rhe world. Thus it remains unclear if the most efficient strategy to achieve high levels of measles immunity in immigrants should entail initial serologic screening followed by vaccination of susceptible individuals or preemptive vaccination of all persons lacking immunization records. Understanding the epidemiology of measles immunity in immigrant populations could help guide such decisions.

. Methods: We identified 527 adults, 15 years of age or older, who were screened for serologtc immunity to measles as part of a recently developed screening protocol at a downtown Toronto community health centre. We subsequently determined if these individuals had any immunization records from their native country or from within Canada. We then examined the relationship between several demographic factors and immunity to measles.

Results: 93% of immigrants had no prior immunization records. Overall, 93% of the 527 immigrants rested for immunity to measles were found to be immune; 88% of those under the age of 20, 93% of those between 20 and 39 years of age, 99% of those between 40 and 59 years of age, and 100% of those 60 years of age or older. Gender, education status, household income, and immigration status were nor ~ssoc1ated wirh immunity to measles. Immunity to measles was lowest among immigrants from Eastern Europe (8~%), whil~ immigrants from other regions of the globe had greater than 90% immunity.

C~lusrons: Immigrants and refugees appear to have reasonably high levels of immunity to mea· sics, possibly related to natural infection wirh the measles virus. Immigrants from Eastern Europe appear to have slightly. lower l~vel~ of immunity to the measles virus. Universal screening for immunity to meales or preemptive vac:cmauon may both be inefficient public health strategies, however further research IS needed to corroborate these findings.

Nancy R~ss, Stephane Tremblay, Saeeda Khan, Daniel Crouse, Mark Tremblay, and jean-Marie Berrhelor

O~ve: The speed of the rise in obesity in places like Canada suggests that rather than a shift in the gcncnc_ com~sirion of the population, the root of the obesity pandemic is an environment that suprrs ~besity. This paper examines the influence of neighbourhood and metropolitan characteristics. bour~lts:. While accounting. for individual socio-demographics and behaviours, residents of neighs with a large proportmn of poorly educated individuals had higher BMis than those living in POSTER SESSIONS v129 neighbourhoods with more highly educated individuals (p <.01 ). Residing in a neighbourhood with a high proportion of recent immigrants was associated with lower BMI for men (p<.01), but not women. Neighbourhood dwelling density, a proxy for walkability, was not associated with BM! for either sex. Metropolitan sprawl was associated with higher male BMI (p=.02) but the effect was negligible for women (p=.09). BMI was significantly lower for women (p<.01) living in a city in the province of Quebec, even after accounting for the influence of individual and neighbourhood covariates. Conclusions: BM! was strongly patterned by individual-level social position in urban Canada. The incremental influence on BMI of neighbourhood related to the neighbourhood's social conditions and not to their physical form. Metropolitan sprawl was associated with higher BM! for men, a group with longer car-dependent commutes than women. The findings suggest that both individuals and their environments (both social and physical) influence the distribution of BMI in urban populations.

Introduction: Urban environments have been linked to a range of human health issues. In Singapore, Prevalence of End Stage Renal Disease (ESRD) is predicted to rise (2633 in 1999 to 6000 in 2010 , Kidney International, Vol.67, 2005 . The clinical and economic burden of ESRD has promoted development of strategies aimed at preventing the development and progression of chronic kidney disease. These include population based screening programs such as the National Kidney Foundation, Sin-gapore\'s (NKFS) "Partnership for Prevention."The program, aims to reduce incidence of ESRD through comprehensive intervention and screening for early detection of urinary abnormalities, blood pressure (BP), and random blood glucose (RBG). Objective of this study is to examine gender, race and age wise prevalence of elevated BP, RBG and proteinuria.

Methodology: This current analysis includes 575,438 subjects, age 18 to 86 years, who underwent screening during September 1999 and December 2004. Participants were asked to give demographic information and the history of diseases. Tests were given to get clinical information such as proteinuria, blood glucose, SBP, and DBP. Blood pressure abnormalities were defined according to ]NC VI criteria. Proteinuria was defined as the presence of 1 plus or greater protein (equivalent to> 30 mg/di) on dipstick analysis.

Results: There were 296, 116 (51.5%) males. Racial distribution was Chinese (78.8% ), Malay (8.8% ), Indians (8. 7%) and others (3. 7% ).Among participants, who were apparently "healthy" (asymptomatic and without history of DM, HT, or KD), gender and race wise % prevalence of elevated (BP> 140/90), RBG (> 140 mg/di) and positive urine dipstick for protein was as follows Male: (20.5;6.9; 3.5) Female:(13.6;5.0;3. 2) Chinese:( 17.1;6.0;3) Malay: (19.4;7.3;5.6) Indian:( 15.9;7.5;3.0) Others: (15.4;4.5;2.9) Total:(l 7.1, 6.1,3.2). Percentage of Participants with more than one abnormality were as follows. Those with BP> 140/90mmHg, 14% also had RBG> 140mg/dl and 6.4% had Proteinuria> I. Those with RBG> 140mgldl, 11 % also had Proteinuria> 1 and 35% had BP> 140/90mmHg. Those with Proteinuria> 1, 18% also had RBG> 140mg/dl, and 38% had BP> 140/90mmHg.

Conclusion: We conclude that sub clinical abnormalities in urinalysis, BP and RBG readings are prevalent across all genders and racial groups in the adult population. The overlap of abnormalities, point towards the high risk for ESRD as well as cardiovascular disease. This indicates the urgent need for population based programs aimed at creating awareness, and initiatives to control and retard progression of disease.

Introduction: Various theories have been proposed that link differential psychological vulnerability to health outcomes, including developmental theories about attachment, separation, and the formation of psychopathology. Research in the area of psychosomatic medicine suggests an association between attachment style and physical illness, with stress as a mediator. There are two main hypotheses explored in the present study: ( t) that individuals living with HIV who were upsychologically vulne~able" at study entry would be more likely to experience symptoms of depression, anxiety and phys1ca! illness over. the course of the 9-month study period; and (2) life stressors and social support would mediate the relat10nship between psychological vulnerability and the psychological ~nd physical outcomes. . (RSLES), State-Trait Anxiety Inventory (STAI), Beck Depr~ssi~n lnvento~ (BDI), and~ _21-item pbys~I symptoms inventory. We characterized participants as havmg psychological vulnerability and low resilience" as scoring above 35 on the RAAS (insecure attachment) or above 120 on the DAS (negative expectations about oneself). . . . . . " . . ,, . Results: At baseline, 55% of parnc1pants were classified as havmg low resilience. Focusmg on anxiety, the average cumulative STAI score of the low-resilience group was significandy hi~e~ than that of the high-resilience group ( 18.45 SD= 10.6 versus 9.57 SD= 8.6; F(l,80)= 16.74, P <.001). Similar results were obtained for BDI and physical symptoms (F( 1,80)= 14.65, p<.001 and F( 1,80)= 5.50, p<.05, respec· tively). After controlling for resilience, the effects of variance in life stres".°rs averaged over time wa~ a_sig· nificant predictor of depressive and physical symptoms, but not of anxiety. Ho~e_ver, these assooan~s became non-significant when four participants with high values were removed. S1ID1larly, after controlling for resilience, the effects of variance in social support averaged over time became insignificant.

Conclusion: Not only did "low resilience" predict poor psychological and physical outcomes, it was also predictive of life events and social support; that is, individuals who were low in resilience were more likely to experience more life events and poorer social support than individuals who were resilient. For individuals with vulnerability to physical, psychological, and social outcomes, there is need to develop and test interventions to improve health outcomes in this group.

Rajat Kapoor, Ruby Gupta, and jugal Kishore Introduction: Young people in India represent almost one-fourth of the total population. They face significant risks related to sexual and reproductive health. Many lack the information and skills neces· sary to make informed sexual and reproductive health choices.

Objective: To study the level of awareness about contraceptives among youth residing in urban and rural areas of Delhi.

Method: A sample of 211 youths was selected from Barwala (rural; N= 112) and Balmiki Basti (urban slums; N= 99) the field practice areas of the Department of Community Medicine, Maulana Azad Medical College, in Delhi. A pre-tested questionnaire was used to collect the information. When/(calen· dar time), By 2, fisher exact and t were appliedxwhom (authors?). Statistical tests such as as appropriate.

Result: Nearly 9 out of 10 (89.1 %) youth had heard of at least one type of contraceptive and majority (81.5%) had heard about condoms. However, awareness regarding usage of contraceptives was as low as 9.4% for terminal methods to 39.3% for condom. Condom was the best technique before and after marriage and also after childbirth. The difference in rural and urban groups was statistically signif· icant (p=.0001, give confidence interval too, if you provide the exact p value). Youth knew that contra· ceptives were easily available (81 %), mainly at dispensary (68.7%) and chemist shops (65.4%). Only 6.6% knew about emergency contraception. Only advantage of contraceptives cited was population con· trol (42.6%); however, 3.8% believed that they could also control HIV transmission. Awareness of side effects was poor among both the groups but the differences were statistically significant for pills (p=0.003). Media was the main source of information (65%). Majority of youth was willing to discuss a~ut contraceptive with their spouse (83.4%), but not with others. 51.2% youth believed that people in their age group use contraceptives. 35% of youth accepted that they had used contraceptives at least once. 81 % felt 2 children in family is appropriate, but only 59.7% believed in 3 year spacing.

. Conclusion: Awareness about contraceptives is vital for youth to protect their sexual and reproduc· tive health .. Knowledge about terminal methods, emergency contraception, and side effects of various contraceptives need to be strengthened in mass media and contraceptive awareness campaigns. Mdbot:ls: 740 elderly aged 60+ were interviewed in 3 poor communities in Beirut the capital of f:ebanon, ~e of which is a Palestinia~. refugee camp. Depression was assessed using the i 5-item Geriat· nc Depressi~n Score (~l?S-15). Specific q~estions relating to the 3 aspects of religiosity were asked as well as questions perta1rung to demographic, psychosocial and health-related variables.

Results: Depression was prevalent in 24% of the interviewed elderly with the highest proportion being in the Palestinian refugee camp (31 %). Mosque attendance significantly reduced the odds of being depressed only for the Palestinian respondents. Depression was further associated, in particular communities, with low satisfaction with income, functional disability, and illness during last year.

Condiuion: Religious practice, which was only related to depression among the refugee population, is discussed as more of an indicator of social cohesion, solidarity than an aspect of religiosity. Furthermore, it has been suggested that minority groups rely on religious stratagems to cope with their pain more than other groups. Implications of findings are discussed with particular relevance to the populations studied.

Nearly thirty percent of India's population lives in urban areas. The outcome of urbanization has resulted in rapid growth of urban slums. In a mega-city Chennai, the slum populations (25.6 percent) face greater health hazards due to overcrowding, poor sanitation, lack of access to safe drinking water and environmental pollution. Amongst the slum population the health of Women and Children are most neglected, resulting in burden of both communicable and non-communicable diseases. The focus of the paper is to present the epidemiology profile of children (below 14 years) in slums of Chennai, their health status, hygiene and nutritional factors, the social response to health, the trends in child health and urbanization over a decade, the health accessibility factors, the role of gender in health care and assessment impact of health education to Children. The available data prove that child health in slums is worse than rural areas. Though the slum population is decreasing there is a need to explore the program intervention and carry out surveys for collecting data on some specific health implications of the slum children.

Objective: During the summer of 2003 there was a heat wave in central Europe, producing an excess number of deaths in many countries including Spain. The city of Barcelona was one of the places in Spain where temperatures often surpassed the excess heat threshold related with an increase in mortality. The objective of the study was to determine whether the excess of mortality which occurred in Barcelona was dependent on age, gender or educational level, important but often neglected dimensions of heat wave-related studies.

Methods: Barcelona, the second largest city in Spain (1,582,738 inhabitants in 2003) , is located on the north eastern coast. We included all deaths of residents of Barcelona older than 20 years that occurred in the city during the months of June, July and August of 2003 and also during the same months during the 5 preceding years. All the analyses were performed for each sex separately. The daily number of deaths in the year 2003 was compared with the mean daily number of deaths for the period 1998-2002 for each educational level. Poisson regression models were fitted to obtain the RR of death in 2003 with respect to the period 1998-2002 for each educational level and age group.

Results: the excess of mortality during that summer was more important for women than for men and among older ages. Although the increase was observed in all educational groups, in some age-groups the increase was larger for people with less than primary education. For example, for women in the group aged 65-74, the RR of dying for 2003 compared to 1998-2002 for women with no education was 1.30 (95%CI: 1.04-1-63) and for women with primary education or higher was 1.19 (95%CI: 0.90-1.56). When we consider the number of excess deaths, for total mortality (>=20 years) the excess numbers were higher for those with no education ( 17 5. 7 for women and 46. 7 for men) and those with less than primary education (112.5 for women and 11-2 for men) than those with more than primary edm:ation (75.0 for women and -10.3 for men).

Conclusion: Age, gender and educational level were important in the 2003 Barcelona heat wave. It is necessary to implement response plans to reduce heat morbidity and mortality. Policies should he addressed to all population but also focusing particularly to the oldest population of low educational level.

Introduction: Recently there has been much public discourse on homelessness and its imp~ct on health. Measures have intensified to get people off the street into permanent housing. For maximum v132 POSTER SESSIONS success it is important to first determine the needs of those to be housed. Their views on housing and support requirements have to be considered, as th~y ar~ the ones affected. As few res.earch studies mclude the perspectives of homeless people themselves, httle IS known on ho~ they e~penence the 1mpacrs on their health and what kinds of supports they believe they need to obtain housing and stay housed. The purpose of this study was to add the perspectives of homeless people to the discourse, based in the assumption that they are the experts on their own situations and needs. Housing is seen as a major deter· minant of health. The research questions were: What are the effects of homelessness on health? What kind of supports are needed for homeless people to get off the street? Both questions sought the views of homeless individuals on these issues.

Methods: This study is qualitative, descriptive, exploratory. Semi-structured interviews were conducted with homeless persons on street corners, in parks and drop-ins. Subsequently a thematic analysis was carried out on the data.

Results: The findings show that individuals' experiences of homelessness deeply affect their health. Apart from physical impacts all talked about how their emotional health and self-esteem are affected. The system itself, rather than being useful, was often perceived as disabling and dehumanizing, resulting in hopelessness and resignation to life on the street. Neither welfare nor minimum wage jobs are sufficient to live and pay rent. Educational upgrading and job training, rather than enforced idleness, are desired by most initially. In general, the longer persons were homeless, the more they fell into patterned cycles of shelter /street life, temporary employment /unemployment, sometimes addictions and often unsuccessful housing episodes.

Conclusions: Participants believe that resources should be put into training and education for acquisition of job skills and confidence to avoid homelessness or minimize its duration. To afford housing low-income people and welfare recipients need subsidies. Early interventions, 'housing first', more humane and efficient processes for negotiating the welfare system, respectful treatment by service providers and some extra financial support in crisis initially, were suggested as helpful for avoiding homelessness altogether or helping most homeless people to leave the street.

This study is a National Homelessness Initiative funded analysis examining the experiences and perceptions of street youth vis-a-vis their health/wellness status. Through in-depth interviews with 140 street youth in Halifax, Montreal, Toronto, Calgary, Ottawa and Vancouver, this paper explores healthy and not-so healthy practices of young people living on the street. Qualitative interviews with 45 health/ social service providers complement the analysis. More specifically, the investigation uncovers how street youth understand health and wellness; how they define good and bad health; and their experiences in accessing diverse health services. Findings suggest that living on the street impacts physical, emotional and spiritual well·being, leading to cycles of despair, anger and helplessness. The majority of street youth services act as "brokers" for young people who desire health care services yet refuse to approach formal heal~h care organizational structures. As such, this study also provides case examples of promising youth services across Canada who are emerging as critical spaces for street youth to heal from the ravages of ~treet cultur~. As young people increasingly make up a substantial proportion of the homeless population in Canada, it becomes urgent to explore the multiple ways in which we can support them to regain a sense of wellbeing and "citizenship." P5-77 (C) Health and Livelihood Implications of Marginalization of Slum Dwellers in Provision of Water and Sanitation Services in Nairobi City Elizabeth Kimani, Eliya Zulu, and Chi-Chi Undie . ~ntrodfldion: UN-Habitat estimates that 70% of urban residents in Kenya live in slums; yet due to their illegal status, they are not provided with basic services such as water sanitation and health care.

~nseque~tly, the services are provided by vendors who typically provide' poor services at exorbitant prices .. This paper investigates how the inequality in provision of basic services affects health and livelihood circumstances of the poor residents of Nairobi slums .

. Methods: This study uses qualitative and quantitative data collected through the ongoing longitudmal .health and demographic study conducted by the African Population and Health Research Center m slum communities in N ·rob" W d · · · · ai 1. e use escnpnve analytical and qualitative techmques to assess h~w concerns relating to water supply and environmental sanitation services rank among the c~mmumty's general and health needs/concerns, and how this context affect their health and livelihood circumstances.

Results: Water (32%) and sanitation (20%) were the most commonly reported health needs and also key among general needs (after unemployment) among slum dwellers. Water and sanitation services are mainly provided by exploitative vendors who operate without any regulatory mechanism and charge exorbitantly for their poor services. For instance slum residents pay about 8 times more for water than non-slum households. Water supply is irregular and residents often go for a week without water; prices are hiked and hygiene is compromised during such shortages. Most houses do not have toilets and residents have to use commercial toilets or adopt unorthodox means such as disposing of their excreta in the nearby bushes or plastic bags that they throw in the open. As a direct result of the poor environmental conditions and inaccessible health services, slum residents are not only sicker, they are also less likely to utilise health services and consequently, more likely to die than non-slum residents. For instance, the prevalence of diarrhoea among children in the slums was 31 % compared to 13 % in Nairobi as a whole and 17% in rural areas, while under-five mortality rates were 151/1000, 62/1000 and 113/1000 respectively.

The results demonstrate the need for change in governments' policies that deprive the rapidly expanding urban poor population of basic services and regulatory mechanisms that would protect them from exploitation. The poor environmental sanitation and lack of basic services compound slum residents' poverty since they pay much more for the relatively poor services than their non-slum counterparts, and also increase their vulnerability to infectious diseases and mortality.

Since 1991 IEPAS've been working in Harm Reduction becoming the pioneer in Latin America that brought this methodology for Brazil. Nowadays the main goal is to expand this strategy in the region and strive to change the Drug Policy in Brazil. In this way Harm Reduction: health and citizenship Program work in two areas to promote the Citizenship of !DU and for people living with HIV/AIDS offering law assistance for this population and outreach work for Needle Exchange to reduce damages and dissemination of HIV/AIDS/Hepatit is. The methodology used in Outreach work is peer education, Needle Exchange, condoms and folders distribution to reduce damages and the dissemination of diseases like HIV/AIDS/Hepatitis besides counseling to search for basic health and Rights are activities in this Program. Law attendance for the target population at IEPAS headquarters every week in order to provide law assistance that includes only supply people with correct law information or file a lawsuit. Presentations in Harm Reduction and Drug Policy to expand these subjects for Police chiefs and governmental In the last year attended 150 !DU and 403 NIDU reached and 26.364 needles and syringes exchanged. In law assistance 740 (420 people living with Aids, 247 drug users, 43 inject drug users, 30 were not in profile) people attended. 492 lawsuits filed 218 lawsuits in current activity. Broadcasting of the Harm Reduction strategies by the press helps to move the public opinion, gather supporters and diminish controversies regarding such actions. A majority number of police officer doesn't know the existence of this policy. It's still polemic discuss this subject in this part of population.

Women remain one of the most under seviced segments of the Nigerian populationand a focus on their health and other needs is of special importance.The singular focus of the Nigerian Family welfare program is mostly on demographic targets by seeking to increase contraceptive prevalence.This has meant the neglect of many areas of of women's reproductive health. Reproductive health is affected by a variety of socio-cultural and biological factors on on e hand and the quality of the service delivery system and its responsiveness on the other.A woman's based approach is one which responds to the needs of the adult woman and adolescent girls in a culturally sensitive manner.Women's unequal access to resources including health care is well known in Nigeria in which stark gender disparities are a reality .Maternal health activities are unbalanced,focusi ng on immunisation and provision of Iron and folic acid,rather than on sustained care of women or on the detection and referral of high risk cases.

A cross-sectional study of a municipal Government -owned Hospitalfrom each of the 6 Geo-Political regions in igeria was carried out (atotal of 6 Ce~ters) .. As _part ~f t~e re.search, the H~spital records were uesd as a background in addition to a 3-week mtens1ve mvesuganon m the Obstemc and Gynecology departments.

. . .

: Little is known for example of the extent of gynecological morbtdtty among women; the little known suggest that teh majority suffer from one or more Reproductive tr~ct Infect~ons. Although abortion is widespread, it continues to be performed under ilegal and unsafe condmons. With the growing v134 POSTER SESSIONS HIV pandemic, while high riskgroups such asComn;iercial Sex workers and their clients have been studied, little has been accomplished in the large populat10ns, and particularly among women, regardmgSTD an HIV education.

. . Conclusions: Programs of various Governmentalor Non-Governmental agen,c1es to mvolve strategies to broaden the narrow focus of services, and more importan~, to put wo~en s reproducnve health services and information needs in the forefront are urgently required. There IS a n~d to reonent commuication and education activities to incorprate a wider interpretation of reproducnve health, to focus on the varying information needs of women, men, and youth and to the media most suitable to convey information to these diverse groups on reproductive health.

Introduction: It is estimated that there are 250-300 youths living on the streets, on their own with the assistance of social services or in poverty with a parent in Ottawa. This population is under-serviced in many areas including health care. Many of these adolescents are uncomfortable or unable to access the health care system through conventional methods and have been treated in walk-in clinics and emergency rooms without ongoing follow up. In March 2004, the Ontario government provided the CT Lamont Institute with a grant to open an interdisciplinary and teaching medical/dental clinic for street youth in a drop-in center in downtown Ottawa. Bringing 5 community organizations together to provide primary medical care and dental hygiene to the streetyouths of Ottawa ages 12-20, it is staffed by a family physician, family medicine residents, a nurse practitioner, 2 public health nurses, a dental hygienist, dental hygiene students and a chiropodist who link to social services already provided at the centre including housing, life skills programs and counselling.

Project Objectives: 1. To improve the health of high risk youth by providing accessible, coordinated, comprehensive health and dental care to vulnerable adolescents. 2. To model and teach interdisciplinary adolescent care to undergraduate medical students, Family Medicine residents and dental hygiene students.

Methods: Non-randomized, mixed method design involving a process and impact evaluation. Data Collection-Qualitative:a) Semi-structured interviews b) Focus groups with youth Quantitative:a) Electronic medical records for 12 months b) Records (budget, photos, project information).

Results: In progress-results from first 12 months available in August 2005. Early results suggest that locating the clinic in a safe and familiar environment is a key factor in attracting the over 130 youths the clinic has seen to date. Other findings include the prevalence of preventative interventions including vaccinations, STD testing and prenatal care. The poster presentation will present these and other impacts that the clinic has had on the health of the youth in the first year of the study.

Conclusions: 1) The clinic has improved the health of Ottawa streetyouth and will continue beyond the initial pilot project phase. 2) This project demonstrates that with strong community partnerships, it is possible meet make healthcare more accessible for urban youth.

Right to health care campaign By S.J.Chander, Community Health Cell, Bangalore, India. Introduction: The People's Health Movement in India launched a campaign known as 'Right to Health care' during the silver jubilee year of the Alma Ata declaration of 'Health For All' by 2000 AD in collahoration with the National Human Rights Commission (NHRC). The aim of the campaign was to establish the 'Right to Health Care' as a basic human right and to address structural deficiencies in the pubic health care system and unregulated private sector .

. Methods: As part of the campaign a public hearing was organized in a slum in Bangalore. Former chairman of the NHRC chaired the hearing panel, consisting of a senior health official and other eminent people in the city. Detailed documentation of individual case studies on 'Denial of access to Health Care' in different parts of the city was carried out using a specific format. The focus was on cases where denial of health services has led to loss of life, physical damage or severe financial losses to the patient.

Results: _Fourte_en people, except one who had accessed a private clinic, presented their testimonies of their experiences m accessing the public health care services in government health centres. All the people, e_xcept_ one person who spontaneously shared her testimony, were identified by the organizations worki_ng with the slum dwellers. Corruption and ill treatment were the main issues of concern to the people. Five of the fourteen testimonies presented resulted in death due to negligence. The public health cen· n:s not only demand money for the supposedly free services but also ill-treats them with verbal abuse. Five of these fourteen case studies were presented before the National Human Right Commission. The POSTER SESSIONS v135 NHRC has asked the government health officials to look into the cases that were presented and to rectify the anomalies in the system. As a result of the public hearing held in the slum, the NHRC identified urban health as one of key areas for focus during the National Public Hearing.

Cond#Sion: A campaign is necessary to check the corrupted public health care system and a covetous private health care system. It helps people to understand the structure and functioning of public health care system and to assert their right to assess heath care. The public hearings or people's tribunals held during the campaign are an instrument in making the public health system accountable.

PS-82 (A) Violence Among Women who Inject Drugs Nadia Fairbairn, Jo-Anne Stoltz, Evan Wood, Kathy Li, Julio Montaner, and Thomas Kerr Background/Object ives: Violence is a major cause of morbidity and mortality among women living in urban settings. Though it is widely recognized that violence is endemic to inner-city illicit drug markets, little is known about violence experienced by women injection drug users (!DU). Therefore, the present analyses were conducted to evaluate the prevalence of, and characteristics associated with, experiencing violence among a cohort of female IDU in Vancouver.

Methods: We evaluated factors associated with violence among female participants enrolled in the Vancouver Injection Drug User Study (VIDUS) using univariate analyses. We also examined self-reported relationships with the perpetrator of the attack and the nature of the violent attack.

Results: Of the 346 active IOU followed between December 1, 2003 and May 6, 2005, 73 (21.1 %) had experienced violence during the last six months. Variables positively associated with experiencing violence included: homelessness (OR= 3.46, 95% CI: 1.66-7.21, p < 0.01), public injecting (OR= 3.45, 95% CI: 1.43 -8.35, p < 0.01 ), frequent crack use (OR= 2.99, 95% CI: 1. 72 -5.17, p < 0.01 ), recent incarceration (OR =2.81, 95% Cl: 1.38 -5.72, p < 0.01), receiving help injecting (OR =2.77, 95% Cl: 1.54-5.00, p < 0.01 ), shooting gallery attendance (OR =2.46, 95% CI: 1.22 -4.93, p < 0.01 ), sex trade work (OR =2.30, 95% Cl: 1.35 -3.93, p < 0.01 ), frequent heroin injection (OR= 1.96, 95% Cl: 1.13 -3.40, p < 0.02), and residence in the Downtown Eastside (odds ratio [OR] = 1.85, 95% CI: 1.09 -3.13, p < 0.02). Variables negatively associated with experiencing violence included: being married or common-law (OR =0.47. 95% CI: 0.25 -0.87, p < 0.02) and being in methadone treatment (OR =0.53, 95% CI: 0.31 -0.91, p < 0.02). The most common perpetrators of the attack were acquaintances (48.0%), strangers (27.4%), police (9.6%), or dealers (8.2%). Attacks were most frequently in the form of beatings (65.8%), robberies (21.9%), and assault with a weapon (13.7%).

Conclusion: Violence was a common experience among women !DU in this cohort. Being the victim of violence was associated with various factors, including homelessness and public injecting. These findings indicate the need for targeted prevention and support services, such as supportive housing programs and safer injection facilities, for women IOU.

Introduction: Although research on determinants of tobacco use among Arab youth has been carried out at several ecologic levels, such research has included conceptual models and has compared the two different types of tobacco that are most commonly used among the Lebanese youth, namely cigarette and argileh. This study uses the ecological model to investigate differences between the genders as related to the determinants of both cigarette and argileh use among youth.

Methodology: Quantitative data was collected from youth in economically disadvantaged urban communities in Beirut, the capital of Lebanon.

Results: The results indicated that there are differences by gender at a variety of ecological levels of influence on smoking behavior. For cigarettes, gender differences were found in knowledge, peer, family, and community influences. For argileh, gender differences were found at the peer, family, and community l.evels.

The differential prevalence of cigarette and argileh smoking between boys and girls 1s therefore understandable and partially explained by the variation in the interpersonal and community envi.ronment which surrounds them. Interventions therefore need to be tailored to the specific needs of boys and girls.

Introduction: The objective of this study was to assess the relationship between parents' employment status and children' health among professional immigrant families in Vancouver. Our target communmes v136 POSTER SESSIONS included immigrants from five ethnicity groups: South Korean, Indian, Chine~e, ~ussian, and Irani~ with professional degrees (i.e., MDs, Lawyers, Engineers, Ma?~ger~, and Uru~ers1ty Professors) w11h no relevant job to their professions and those who had been hvmg m the studied area at least for 36 months.

Methodology: The participants were recruited by collaboration from three local community agencies and were interviewed individually during the fall of 2004.

Ra#lts: Totally, 109 complete interviews were analyzed: 33 from South-East Asia, 59 from South Asia, 17 from Russia and other Eastern Europe. Overall, 14.5% were employed, 38.5% were underemployed, 46% indicated they were unemployed. Overall, 58.5% were not satisfied with their current job.

Russians and other Eastern Europeans were most likely satisfied with their current job, while South-east Asians were most satisfied from their life in Canada. About 53% indicated that their spouses were not satisfied with their life in Canada, while 55% believed that their children are very satisfied from their life in Canada. In addition, around 30% said they were not satisfied from their family relationship in Canada. While most of the responders ranked their own and their spouses' health status as either poor or very poor, jut 3% indicated that their first child's health was very poor. In most cases they ranked their children's health as excellent or very good.

The results of this pilot study show that there is a need to create culturally specific Child Health and Behavioral Scales when conducting research in immigrant communities. For instance, in many Asian cultures, it is customary for a parent either to praise their children profusely, or to condemn them. This cultural practice, called "saving face," can affect research results, as it might have affected the present study. Necessary steps, therefore, are needed to revise the current standard health and behavioral scales for further studies by developing a new scale that is more relevant and culturally sensitive to the targeted immigrant families. Metboda: Database: 2003 National Health Survey (Ministry of Health www.msc.es). Two thousand interviews were performed among Madrid population (0.04% of the whole); 593 corresponded to older adults (0.04% of the 1. 7 million aged 50 years and over). Study sample constitutes 95.3% (565 out of 593) of those older adults, who live in urban areas. Demographic structure (by age and gender) of this population in relation to health services use (medical consultations, dentist visits, emergence services, hospitalisation) was studied using General Linear Model Univariate procedure. A p0.005), while age was associated with emergence services use (26% of the population: 21 %, 28% and 45% of each age group) and hos~italisation (17% .oft~~ population: 13%, 20% and 31%, of each age ~oup) (p0.005) was fou~d with respect to dennst v1s1ts (18% vs 20%), medical consultations (29% vs 36%), and emergence services use (26% vs 26%), while an association (p= 0.005) was found according to hospitalisation (20% vs 16%). Age. an~ g~der interaction effect on health services use was not found (p> 0.005), but a trend towards bosp1tal1sanon (p=0.04) could be considered.

Concl.uions: Demographic structure of urban older adults is associated with two of the four health se~ices use studi~. A relation.ship ber_ween age. and hospital services use (emergence units and hospitalisanon), but not with ~ut-hosp1tal sei:vices (medical and dentist consultations), was found. In addition ro age, gender also contnbutes to explam hospitalisation. . sexua experiences. We exammed the prevalence expenences 10 relation to ethnic origin and other sociodemographic variables as wc1I as Y1J7 die relation between unwanted sexual experiences, depression and agreuion. We did so for boys and prts separately.

Mdhods: Data on unwanted sexual expcric:nces, depressive symptoms (CE.S-D), aggrc:uion (BOHi-Di and sociodemographic facron were collected by self-report quescionnairc:s administettd to 35 31 students in the: 2nd grade (aged 12-16) of secondary schools in Amsterdam, the Netherlands. Data on the nature ol unwanted sexual experiences were collected during penonal interviews by trained schoolnursn.

ltaiJtJ: Overall prevalences of unwanted sexual experiences for boys and girls were 6.5% and 5.7% respectively. Unwanted sexual experiences were more often ttported by Turkish ( 17.1 %), Moroc· an (10.4%) and Surinamese/Anrillian boys (7.4%) than by Dutch boys (2.2%). Moroccan and Turkish girls, however, reported fewer unwanted sexual experiences (respectively 2.3 and 2.7%) than Durch girls did (6.9%). Depressive symptoms(OR=4.6, Cl=3.1-7.0) covert agression (0R•4.9, Cl•3.2-7.7) and cmrt aggression (OR= 2.6, Cl• 1.6-4.4) were more common in girls with an unwanted sexual experi· met. Boys with an unwanted sexual experience reported more depressive symptoms (OR= 2.2; Cl• I . .l· 3.9) and oven agression (OR= 1.5, Cl= 1.0-2.4) . Of the reported unwanted sexual experiences rnpec· timy 17.5% and 73.5% were confirmed by male and female adolescents during a personal interview.

Cond11Sion: We ..:an conclude that the prevalence of unwanted sexual experiences among Turkish and Moroccan boys is disturbing. It is possible that unwanted sexual experiences are more reported hy boys who belong to a religion or culture where the virginity of girls is a maner of family honour and talking about sexuality is taboo. More boys than girls did not confirm their initial disdosurc of an lllWalltc:d sexual experience. The low rates of disclosure among boys suggcsu a necd to educ.:atc hcahh care providen and others who work with migrant boys in the recognition and repomng of 1exu.il ... ICtion. Viramin A aupplc:tMntation i1 at .H'Yo, 1till far from tafl'eted 100%. Feedinit pracn~:n panKu· lerty for new born earn demand lot of educatton ernpha111 a• cxdu11ve hrealt fecdtnit for dnared rcnoJ of 6 months was observtd in only 6.S% of childrrn thoulh colcKturm w.11 givm 1n rn% of MWly horn ct.ildrm. The proportion of children hclow-2 WAZ (malnounshrdl .con" a• h!Jh •• 42.6% anJ "rt'I· acimy tc.. 11 compared to 1998 data. Mother's ~alth: From all IS 10 womm in ttprod~uvr •Ill' poup, 83% were married and among marned w~ .\9% only W\"rt' u1mic wmr cnntr.-:cruve mt1h· odL 44% were married bdorc thc •Ar of 18 yean and 27% had thnr ftnc prcicnancy hcftitt dlt' •icr nf 21 yean. The lt'f'Vicn are not uutfactory or they arc adequate but nae unh1ed opumally. Of thote' l'H mothen who had deliverrd in last one year, 80% had nailed 11ntmaral eum1nat1on 11 Ira" oncc, .~o-... bad matt rhan four ttmn and ma1ortty had 1heir tetanus toxotd tnin,"t1or"'" nlht "'"'"· lJn1r11ned rn· Win ronductrd 12.4% dchvcnn and 26% had home deh\'t'OC'I. ~Md~: The tervtcn unbud or u111led are !tu than dnaraMe. The wr· l'Kft provided are inadequate and on dechM reprcwnttng a looun1t ~P of h11hnto good coYtti\#' ol wr· ncn. l!.ckground chanpng pnoriry cannoc be ruled out u °"" of thc coatnbutory bc10f.

PS-II IA) Dcpn:wioa aad AnUccy ia Mip'mu ia Awccr._ Many de Wn, Witco Tui~bmjer. jack Dekker, Aart·Jan lttkman, Wim GonMc:n. and Amoud Verhoeff ~ A Dutch commumry-bucd ICUdy thawed 12-moarh•·prc:Yalm«I al 17 .44'1. kw anx1· ay daorden and 13. 7% fOI' dqrasion m Anmttdam. nm .. 11p1tficantly hlllhn than dwwhrft .. dw ~Thew diffamca m pttYalcnca att probably rdarcd to tlK' largr populanoa of napaan 111 ..\mturdam. <Turkish 5%, Moroccan 9%, and Surinam 10%1. lndttd. IC'Wt'll ltudla hatt ~ ~ high prevalena rata among migrant poupi in rbe Ncdwrlands. HowC'Ytt aU ttlluchn IUffenod from wry low raporne rara, or med screnung talel thac lack a ~Y Yabdarcd ~

In order to study the prevalence of depression and anxiety, and the (barriers to) use of mental health care among the different ethnic groups the following study was recently conducted: .

The study consisted of a two-step approach. The first step was mcl~ded m the ~ H Ith Survey of 2004 (AHS), and consisted of three screening scales for depression and aruaety (KlO, G::Q-12 and MHl-5). In this survey all respondents were asked_ permission for~ second app~ 1:' 18t consisted of a structured interview containing the CIDI for aruaety and depression, and questtollllalres on health care seeking, amongst others. All respondents who gave permission for a second approachwere invited by Jetter for a suuctured interview with multilingual interviewers at home at a preset date and time in the following week. .

In total, 439 Dutch, 317 Turkish, 322 Moroccan and 124 Surinam respondents took part in the AHS and gave permission for a second approach. In the second step, fo~ 21~ Tur~h, 184M~roc

can 87 Surinamese and 320 Dutch respondents, information from the extensive interview was available (res~nse rates between 60 and 70% ). Since the data collection was completed only recently (june 2005), prevalence estimates can be presented at the conference for the first time.

We have shown that with this approach it is feasible to achieve an acceptable response rate in a study on mental health among migrants. Therefore we expect that this study will provide reli· able estimates of depression and anxiety in the Turkish, Moroccan and Surinam migrants in Amstw!3~· for the first time. In addition, insight into mechanisms underlying the differences between and within ethnic groups and into barriers to mental health care will provide pretexts for the improvement of pre· vention and mental health care for migrant groups. This study aimed to determine spatial patterns of mortality and morbidity of five major health problems in an urban environment: homicides, pregnancy among adolescents ((<20 years old), asthma hospitalization among young children(< 5 years old) and two mosquito-borne diseasesdengue and visceral leishmaniasis, during 1999-2003. All events were obtained through the City Health database and, subsequently, geoproccsscd using the address of residence and the geographical and administrative division of the municipality, composed by 80 unit of planning (UP), which in tum were formed, each one, by census tract units. Two research questions were investigated: are there spatial patterns to the events dis· tribution, and moreover, are these patterns overlapping across space? We use thematic maps, index of comparative mortality/morbidity by UP and the overlapped rank of the 20th worse UP rates for each event. A spatial pattern of high rates of homicides, proportion of young mothers and hospitalization of asthma were overlapping in areas social and economically disadvantaged. For mosquito-borne diseases, high rates with great dispersion were found in unprivileged areas in contrast with very low rares among privileged ones. These results pointed toward a coexistence of heavier burden of diseases for those living in areas of the city where misery, poverty, lack of political public health may be modulating social health problems. A possible environmental intervention in one mosquito•bome disease might be playing a role in the occurrence of other. Although with limitations, this study may provide useful information for a joint urban planning under the public perspective, articulated for use in health impact assessment.

Jalil Safaei bdrod#aion: The association of socioeconomic status (SES), usually measured by income, and health status is an established result in bcalth studies. The poor and low income individuals have lower health sta· tus then_ those with higher incomes. in general. Such finding has been usually obtained from sample surveys on speafic populations. A problem with many sample survey$ is that their results are not comparable aaoss ~ndaries as they may use different sampling methods, ask different questions, categorize the answers differently, or define groups differently. Moreover, the sample data need to be standardized using the demographic: katurea of a ~ population. This study, however, uses the National Population Health Survey (NPHS) Cycle 3 Public Use Mictodata Files which is based on a common survey template ·~~three~ area in Canada, namely Montreal, Toronto, and Vancouver. It also utili7.es the built-m stanclatdizaaon of the NPHS data which accounts for its complex survey design. . ~:The Stu~ USC:S two well-known measures of health inequalitythe relative index of meqaality and die concentranon indexto capture the extent of income related health inequality among POSTER SESSIONS v139 urban female and male populations in each of the three metropolitan areas. Personal income is classified into ten groups by the NPHS with "no income" as the first group and "more than $60,000" as the last. Health status is measured by three variables -Having a chronic condition (CHC), Self Assessed Health (SAH), and Health Utility Index (HUI) -using appropriate indices. Alternative formulations are used to calculate the standard deviations of the estimated or calculated measures.

The findings of the study suggest that the measured health inequality depends on the health measure used. For CHC and HUI the measured inequality indices do indicate poorer health for lower income individulas, however, they are not statistically insignificant. Health inequalities are more pronounced when health is measured by SAH. The results do not support any systematic ranking of the three metropolitan areas in terms of health inequalities. They do not reveal any systematic pattern of inequality between men and women, either.

Conclusions: Despite the use of highly aggregated NPHS data, income related health disparities are observed in the three metropolitan areas in Canada. This is more the case with self perceived (SAH) health. Such disparities are preventable and call for broader health policies that address poverty and low income among other social determinants of health. Introduction: The analysis of health indicators under the spatial perspective is configured as an important instrument in the detection of intra-urban differentials. This study aimed to examine the spatial distribution of the births occurred in Belo Horizonte, in 2001, analyzing the presence of spatial clusters of health indicators for newborns (RN) and their mothers, using data from the Information System on Live Birth Database (SINASC).

Method: For each covered area of the Basic Units of Health (UBS), we calculated the proportion of: adolescent mothers, mothers with less than 8 years of schooling, first pregnancy, mothers with four or more pregnancies, dead babies born on previous pregnancies, stillbirths, cesarean section, less than four prenatal care attendance, moderate and severe hypoxemia in the 1st and 5th minutes of life, low or very low birth weight. We used empiric Bayesian methods for smoothing the estimates. For spatial analysis, the indicators obtained from the global Moran (I) index and Local Indicators of Spatial Association (LISA) were used. Maps were built to allow the visualization of the spatial clusters. In all analysis, significance statistics was considered p~ 0.05.

Results: A total of 36, 12 7 births of residents in Belo Horizonte were registered in 200 I. The estimated Bayesian proportions for the entire municipality was close to the one observed for all variables. Analysis using LISA showed the presence of relevant spatial clusters for adolescent and low educated mothers, dead babies form previous pregnancies, cesarean section, low attendance to the prenatal care especially in area with low socio-demographic characteristics. Three areas presented consistent clusters, with important spatial auto-correlation for almost all studied indicators.

Conclusion: The used methodology was configured as a great instrument of detection risk areas where clustering occurs. It can easily be incorporated in any surveillance system as a mechanism for controlling events related to births in the municipality. Moreover, it can be applied to discriminate target areas for prompt public health interventions, such as improving health services access and the consolidation of better obstetric practices.

Introduction: Gentrification, the displacement of low income and non-majority people out of longtime neighborhoods and residences is a global phenomenon. It has been identified as occurring in both developed and less developed countries and as inequality persists or increases, many communities are vulnerable to disruption and loss. While there may be some benefits to gentrification, these benefits are less likely to impact those who have been forced to move out of a gentrifying community or those who remain but economically stressed.

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This paper lays out a theoretical framework for 1dent1fymg and ~ddressm~. the_ health consequences of gentrification on residents living in a community prior .to o.r durmg gent~1~1cat.10n. By drawing on the literature of housing, sociology, health and urban plannmg, 1t places genmf1catt~n and neighborhood change into the context of other forces affecting th~ .hea.lth of vulnerable populations. It then proposes solutions to prevent or mitigate the impacts of genmf1cat1on.

Results: Four main categories of consequences potentiallr re~ult from ~entr~fica~~n: !'°°r housing· related issues, spatial effects, mental health impacts and contr1bunons to racial ~spanttes m heal~. The housing issues include increased susceptibility to asthma, lead exposure, allergiesl~topy an~. acetdents/ injuries. Spatial effects include reduced access to health ~are, reduce~ access to 1obslttadinonal food sources, decreased physical activity, and increased obesity. The __ pnmary mental health effects_ :ire increased stress increased risk of depression and disruption of trad1t1onal support networks. In addinon to the above he~lth issues, gentrification has the potential to increase racial disparities in health by reduc· ing access to long term and multi-culturally experienced health care provide~s.

Conclusions: Public health practice provides a framework for addressmg the health consequences of gentrification. In this context primary prevention would involve preventing gentrification in the first place along with a renewed commitment to helping distressed communities a~~ im_proving the quality ~f life for long term residents. The next layer of meeting the challenges of gentrification would be to aSSJst long rime residents to stay in a community and thus potentially allowing them to participate in the bene~ts of gentrification (such as better public services). Only if all these efforts fail -and these other prevennon strategies must be a priority, public policy should then work to help people and instirutions move to other communities through grants and the provision of alternative safe affordable housing and neighborhoods.

Sarah Romans, Marsha Cohen, and Tonia Forte lnh'odlletion: There has been sustained interest in urban rural (UR) differences in mental health over the last 50 years of epidemiological research, with most studies reporting higher urban rates of mor· bidity, particularly when psychotic disorders have been studied. Most recently, in Britain, urban rates of non-psychotic disorder were greater than rural and semi-rural rates, both before and after the more adverse circumstances of urban dwellers were considered (Paykel et al 2003) . Surprisingly, there were no UR differences in help seeking. In Canada, Wang (2004) found greater urban rates for major depression only after he controlled for the confounding effects of race, immigration, employment and marital status, a result reminiscent of work from the US (Blazer et 1985) . Rural participants were less likely to have sought help for their mental health problems. In this study, we sought to examine urban/rural differences in rates of depression and help seeking in Canada.

Method; data came from the 2000 Canadian Community Health Survey 1.2, a community survey conducted by Statistics Canada of people aged 15 and older, with the total sample size of 36,984 respon· dents, 77% response. Analyses used weighted data; differences were assessed by chi-squared.

Ra.Its: bivariate cross-tabulations showed a modest increase in 12 month depression rates for urban (5.4%) over rural (4.3%, p= 0.03) dwellers; there were no UR differences when the sample was examined separately by gender and age group ( 15-29, 30-44, 45-69) . In general, more urban (10.6%) than rural people (8. 7%, p= 0.002) had sought mental health treatment in the past year. There was no UR difference in helping seeking amongst those with depression (U 58.9%, R 50.1 % ns). Amongst the whole population, helping seeking was gendered with more urban men accessing help (7.4%) than rural men (5.4%, p=0.004); this did not apply for women (13.7% vs 12.1% p=0.1).

~ons: The urban-rural demographic continues to generate intriguing findings, even recently when internal migration is common and people can seek out the environment most conducive to their health, ~th physical and mental. People with depression are a disadvantaged, frequently stigmatized group, with ~r quality of life a_nd often impaired function. Unlike many other factors associated wi~h urban or rural hfe per se, depression can be treated. The low help seeking rates is a cause for concern, m both the ur~n and_ rural populations. It behooves researchers, policy makers and service planners to ensutt effective services are available for both humane and economic reasons. Methods: Using United States 2000 census income data, we assigned the 12 Manhattan community districts to two major socioeconomic groups, Manhattan I and II. Manhattan I is composed of community districts with average household incomes above the median for New York City; Manhattan II is those below. With public New York City Department of Health 1999 death records and 2000 US census data, we calculated a "standard" New York City population and estimated mortality rate distributions for Manhattan I and II. We then compared these age-adjusted actual mortality distributions with a standard t-test.

Results: We explored premature deaths using several cut-off points (before the ages of 65, 70, and 75), and with subcomparisons for males and females. Every comparison showed the wealthier area, Manhattan I, to have significantly lower premature mortality rates than the lower income Manhattan II. Further, we compared age-adjusted mortality rates among the city's five boroughs, and found no significant differences based on local geography alone.

Conclusions: These findings suggest that in Manhattan, characterized by its extremes of wealth and poverty, health status, as measured by premature mortality, does vary significantly with the local income level. In Manhattan, the relative average income by community district varies as much as 4: 1. This ratio is greater than that found in the other cities we have studied: for example, the range among Tokyo's kus is half that in Manhattan, or about 2: 1. Paris has shown the longest life expectancy and changing premature mortality rates. From our preliminary work, we expect to find less variation in premature mortality rates in comparable cities. This study will continue to explore the relationship of premature mortality rates and life expectancy to income levels and different health systems among WCP cities with a view to measuring health policy options.

Introduction: According to the World Health Organization (WHO), smoking-related illness is currently the world's second major cause of death, currently responsible for one out of ten adult deaths worldwide. The WHO's Framework Convention on Tobacco Control (FCTC) aims to reduce tobaccorelated disease and deaths by changing national public policies. Mexico, which, according to the WHO, had smoking prevalences of 32% among adults in 1998 and 23% among health care providers (HCPs) in 1997, ratified the FCTC in 2004.

Objective: To examine knowledge of and attitudes towards cigarette smoking and smoking cessation among HCPs, and clinical practices regarding smoking cessation.

Methods: In June 2005, a convenience sample of HCPs from one public clinic in urban Oaxaca, Mexico, part of Mexico's national network of public health care clinics, were interviewed in Spanish using a verbally administered questionnaire that was standard among all participants. During primary care outpatient visits, HCPs were observed treating patients to assess the relative importance of smoking cessation as a health care priority.

Results: Of the 18 HCPs interviewed, including ten physicians, three nurses, and five medical students, 67% reported smoking regularly. All HCPs reported assessing patients' history of smoking, knowledge of the health risks associated with smoking, and feeling qualified to discuss these risks with patients. All HCPs reported counseling patients who currently smoked to quit. All HCPs reported recommending nicotine replacement therapy (eg., patch and/or gum) and/or behavioral therapy (eg., psychologist, support groups) to patients who smoked. All HCPs reported that there was no government funding for smoking cessation, and that all costs associated with smoking cessation were patients' out-of-pocket expenses. Observation of HCP interaction with patients revealed that HCPs always inquired about smoking history with new patients and rarely inquired about smoking history with returning patients. HCPs were not observed counseling patients who reported current smoking on smoking cessation methods and its benefits. Observation of the clinical environment suggested a focus on preventative child health (eg., immunization, water-borne illnesses), family planning, and chronic diseases (eg., diabetes, hypertension).

Conclusions: While the Mexican government has made smoking cessation a public health priority and HCPs report addressing smoking cessation, observation of HCPs suggests: 1) smoking status is assessed only in new patients; and 2) smoking cessation methods are not addresse~. Observ_atio~ of HCPs and the clinical environment in a public clinic in Oaxaca suggests that smoking cessation 1s of lower priority than other heath care issues.

P6-04 (A) Urban Agriculture and Food and Nutrition Security in Kampala, Uganda Fiona Yeudall, Renee Sebastian, Abdelrahman Lubowa, Selahadin Ibrahim, and Donald Cole Introduction: Urban agriculture is an important livelihood strategy contributing to household food security by increasing access and availability to food in urban settings (Koc et al., 1999) . The purpose of POSTER SESSIONS v142 rhis study was to examine relationships between child nutritional securiry outcomes, household food security, and urban agriculture activiries in Kampala, Uga~da.

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Questionnaires assessing socio-demographic, farmmg and household food secunry (HFSI characreristics were administered to 270 households. Food diversiry was ~lculate~ from ~e number of foods consumed over 24 hours for one child (2-5 years) per household. Heigh~ weight,. nud-upper·ann· circumference (MUAC) and tricep skinfolds (TSF) were measured for the mdex child. Z-sc.ores for height-for·age (HAZ), weighr-for-age (WAZ) and body mass index (ZBMI) were ~~ulated usmg Cen· rres for Disease Control and Prevenrion reference data. Z-scores for body composition measures were calculated using NHANES I and II data for African Americans. The LMS method was used to c~.t for skewed z·score indices. All dara was checked for normaliry and univariable and backward mulnvanablc linear regression analysis conducted.

Ruwlts: Household food securiry was significantly associated with wealth (B= 0. 71, p< 'A acre were more dependenr on assets for HFS. Although sex of head of household was ~ot related to J-:IFS, it modi· fied relationships in rhar female headed households had greater food securtry when fai:mmg less than 1,4 acre compared ro male headed households, and vice versa. HFS was significantly associated with food diversiry (S=0.15, p).

Urbanization, especially in developing countries, has substantially increased the vulnerability of rhe mass of low-income urban dwellers. The livelihoods and quality of life for many of the poor espe· cially in Larin America, Asia, and Africa, have deteriorated significantly over the years. Urban areas are increasingly unable to provide for their populations, resulting in poverry, massive unemploymenr, job cuts, poor housing, lack of or poor public services, and a compromised health status. Botswana, a country rhat lies in the sourhern parr of Africa, has had its share of urban problems such as rhe mush· rooming of squarters and low-income urban sertlements. Despite efforts to address the substandard living conditions in low-income urban areas, these problems have continued to grow. These living con· diuons are porenrially stressful to rhe residenrs and likely affects their health. The primary aim of the 11udy wa1 to examine the complex relationship between communiry-level stressors and interveners and health-related quality of life among residents of low-income neighborhoods in Francistown, Botswana. U1i"" a croa1-iCCtional quantitative design (both descriptive and explanatory) and using primarily cloae-mded interview• with a random sample of 388 residents, this study examined the role of chrome life 1trnson and environmental quality on overall health status qualiry of life) and the physical, psy· chological and level of independence domains of health. The major hypothesis of the study was that community-levrl stre1Sor1 would influence health-related quality of life and that social capital would moderate these relationships. Findings indicate that neighborhood quality is a powerful predictor of healrh 1tatu1 rhan socioeconomic status and individual life stressors. Social capital was also found to he a 11111ificant positive predictor of healrh and also moderator of structural factors. Social capital moderated the effects of low environmental quality on level of indrpendence and on physical health outcomn, but nor on psychological and global health outcomes. These findings suggest that as the environment get1 betttr. stresson are reduced, hence promoting berter health outcomes. The study ends with implication• for social justice, public health and social work practice, and research, focusing mostly on the ~ole of social capital and the environmental quality in predicting health outcomes. Spt· cafically • anenhon should be focused on political and civic society's commitment for social justice and poveny alleviation, ~uction of the threat of insecuriry and violence; cultivating social capital and good governance; and improving the health and social environments, especially housing and environ· mental 1aiutanon to name a few. urban and other uprisings by non-elites that lead to transitions, can disrupt sexual and injection "risk" networks that transmit infectious diseases by changing mixing patterns. They can also weaken urban social networks, their associated protective norms and their informal social control mechanisms which can lead to increased sexual and drug risk behaviors and violence (Fullilove 2004; Wallace & Wallace1998, Aral 2002 , Friedman & Reid 2000 Hankins et al 2002) . For example, the 1979 revolution and transition to theocratic rule, and subsequent urban and national conflicts, have been followed by many urban youth in Iran engaging in clandestine high-risk sexual and drug behaviors. In Palestine, conflicts and restrictions on movement have led to increased fatalities from chronic diseases due to limited access to hospitals and modern medical facilities (Union of Palestinian Medical Relief Committees); and heroin use and violence-related blood exposure have also increased. Social movements "from below" that are rooted both in urban social network dynamics and in underlying patterns of injustice can have both protective and risky effects. For example, the social movements that led to the collapse of the USSR and its dependent governments in other countries-with subsequent increases in sex trade, alcoholism, drug use, tuberculosis, HIV, STis, and mortality in many localities-were based originally on such city-based movements in Eastern Europe. Their impacts on health were mediated by urban social dynamics and structures. Some urban social movements have improved health by prevent· ing the spread of HIV, hepatitis and other diseases. Examples include movements of (a) gays and lesbians and (b) drug users. These have been rooted in social networks that overlap with risk networks. Theories of urban health should include social conflict as a core concept. Mechanisms that generate conflicts and the pathways by which conflicts affect health should be a major part of Urban Health research agendas.

P6-07 (C) Demographic Characteristics of People seen with Tuberculosis in Lagos State University Teaching Hospital (LASUTH) Chest Clinic John Bako, Adewale Akeredolu, and Wale Alabi Tuberculosis has become a resurgent Public Health problem in recent times in the world. Because resources are limited, control programmes frequently must target population at greatest risk. The purpose of this study was to study the Demographic Characteristics of people seen with Tuberculosis in Lagos State University Teaching Hospital. A total of 76 patients who have been both radiologically and bacteriologically confirmed tuberculosis patients were used for this study between January and March. 57 (75%) were males, while 19 (25%) were females. Notable risk factors among patients with tuberculosis were overcrowding (46.1 % ), homelessness ( 11.8%) cigarette smoking (22.4% ), alcoholism (30.3%), Non vaccination (25%), secondary contact (36.8%) and poor knowledge (92. l 'X,). Man· agement history patterns among the patients were herbs ( 13.2 'Yo), orthodox medicine ( .H . .l'X.). Intervention targeting early-identified groups may be an effective way to reduce the incidence of tuber· culosis. Such intervention should focus on health education, modification of life style and improvement of standard of living.

P6-08 (C) Profiles in Urban Health in 9 Cities of the Americas

In the countries of the Americas, there is an increasing migration of national and international populations to urban centers. This presentation will focus on some of the issues created by this influx of populations, the ways that 9 cities in 8 countries are dealing with them, and the efforts to promote local participation and solutions in management and decision-making. The methodology used to collect this information has been to draw upon and analyze information produced by the mayor's and Ministry of Health and Development offices in each of the cities under consideration. An analysis of the impact of urbanization on health and health determinants will be presented. The information covers issues such as health status by geographic areas within the cities, highlighting issues such as marginality, barriers and physical, economic and cultural constructs and inequities in the delivery of and access to essential services (such as health, education, water, and basic sanitation). Issues of governance and citizen participation will be highlighted to provide insight in~o the balance of power and mechanisms for decision-making at the local level. Part of the analysis will show the relationship between democratic processes and social participation. Public ~olicies will be reviewed to indicate those that are most beneficial in promoting health and overcoming barriers to it, as well as ways of capitalizing on local assets and resources. Final~y, evidence of effectiveness of various strategies will be indicated. The presentation will conclude wuh suggesuons for future strategic directions to improve the quality of life and the promotion of health in large urban centers of the Americas. Introduction: Much of the illicit drug in Mexico is concentrated in northern border areas. The 2000 mile border between the U.S. and Mexico is also characterized by migration; the border crossing between Tijuana, Baja California, Mexico and San Diego, California, U.S.A. is rep~rt~dl~ the busiest land border crossing in the world. We attempt to describe the migration scene among m1ect1on drug users (IDUs) m Tijuana and investigate service needs.

Methods: Migration trends were investigated in a cross-sectional study conducted from February to June 2005 among IDUs in Tijuana. Enrollment criteria included informed consent, being 18 years or older, and having injected drugs within the prior month. Subjects were recruited by respondent-dnven sampling and were administered a quantitative survey and serology for HIV, HCV, and syphilis. Logistic regression was used to compare IDUs who had migrated to the U.S. versus those who had not.

Results: Of 222 IDUs enrolled, 91 % were male and median age and age at first injection were 35 and 20, respectively. Drug combinations injected most frequently in the past 6 months were heroin (35%1 and crystal methamphetamine mixed with heroin (53%). Of those enrolled, 212 responded to quesnons on migration and drug treatment and were included in this analysis. Although 76% had resided in Tijuana for at least 5 years, 70% of users were born outside of Baja California. Working outside of Mexico was common, with 38% working abroad in the last 10 years (94% in U.S.), and 17% in the past year. In the last 6 months, 10% of IDUs had crossed the border to the U.S., with 57% crossing at least once per month. Those working outside of Mexico in the past year were less likely to have ever received substance abuse treatment, [29% vs. 53%, OR 0.38, ] and were marginally less likely to have received drug treatment in the past 6 months [6% vs. 18 %, OR 0.28, 95% CI (0.06-1.2)]. Drug use patterns, age and gender did not differ between migrants and non-migrants, although migrants were more likely to report being in need of substance abuse treatment (68% vs. 57%, respectively).

Conclusions: Migration is common among IDUs in Tijuana. Maintaining drug treatment regimens and determining how to best target education and services to a highly mobile population pose challenges to officials on both sides of the border. These data underscore the need to develop coordinated binational prevention and treatment efforts.

Introduction: Despite the expanding literature on the important role public policy plays in influencing the broader determinants of the public\'s health, profound differences exist among jurisdictions in rhe attention placed upon such activities. We take an international perspective on health by examining rhe d?minant public _health paradigms of Canada, USA, UK, and Sweden and exploring how these paradigms shape public health practice. _Method: We carefully analyze governmental and public health agencies documents to discern ~he dommant para~igms driving public health approaches and practices. We also consider the unique paht1· cal and economic contexts within each nation and consider how these contexts drive public health pahcY and approaches.

. . ~u~: The Canadian and USA public health communities -with some exceptions --focus upOn m~ividuahzed approaches to risk management. In contrast, the UK and Swedish public health scenes are oriented toward broader approaches to health determinants. We find that the extent to which govern· ments, public health agencies and public health workers concern themselves with public policY approaches £<_> ~ddress ~ro.ad~r .determinants of health depends upon the particular health parad'.~ adhered. ~o withm each 1urisd1ctton. And whether a paradigm is adopted depends upon the ideologi~a and pol~ncal context of each nation. Nations such as Sweden that have a long tradition of public policies promonng social jus~ce an~ equity are naturally receptive to evolving population health concepts. '[he USA represen~ a ~bey en~ro~~t where such is~ues are clear!~ subordinate.

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Our findings mdicate that there 1s a strong political component that influences pubh ~ealth a~proaches and practi~ within the jurisdictions examined. The implications are that those seek· m~ to raise the broader detennmants of the public's health should work in coalition to raise these issueS with non-health organizations and age · Ca d d th · - Badrgrollnd: In developed countries, social inequalities in health have endured or even worsened comparatively throughout different social groups since the 1990s. In France, a country where access to medical and surgical care is theoretically affordable for everyone, health inequalities are among the high· est in Western Europe. In developing countries, health and access to care have remained critical issues. In Madagascar, poverty has even increased in recent years, since the country wenr through political crisis and structural adjustment policies. Objectives. We aimed to estimate and compare the impact of socio· economic status but also psychosocial characteristics (social integration, health beliefs, expectations and representation, and psychological characteristics) on the risk of having forgone healthcare in these 2 dif· fercnt contexts.

Methods: Population surveys conducted among random samples of households in some under· served Paris neighbourhoods (n= 889) and in the whole Antananarivo city (n= 2807) in 2003, using a common individual questionnaire in French and Malagasy.

Reslllts: As expected, the impact of socioeconomic status is stronger in Antananarivo than in Paris.

But, after making adjustments for numerous individual socio-economic and health characteristics, we observed in both cities a higher (and statically significant) occurrence of reponed forgone healthcare among people who have experienced childhood and/or adulthood difficulties (with relative risks up to 2 and 3.S respectively in Paris and Antananarivo) and who complained about unhealthy living conditions. In Paris, it is also correlated with a lack of trust in health services. Coneluions: Aside from purely financial hurdles, other individual factors play a role in the non-use of healthcare services. Health insurance or free healthcare seems to be necessary hut not sufficienr to achieve an equitable access to care. Therefore, health policies must not only focus on the reduction of the financial barriers to healthcare, but also must be supplemented by programmes (e.g. outreach care ser· vices, health education, health promotion programmes) and discretionary local policies tailored to the needs of those with poor health concern .. Acknowledgments. This project was supported by the MAl>IO project and the National Institute of Statistics (INSTAT) in Madagascar, and hy the Development Research Institute (IRD) and the Avenir programme of the National Institute of Health and Medical Research (INSERM) in France.

For the cities of developing countries, poverty is often described in terms of the living standard~ of slum populations, and there is good reason to believe that the health risks facing these populations are even greater, in some instances, than those facing rural villagers. Yet much remains to be learned ahour the connections between urban poverty and health. It is not known what percentage of all urban poor live in slums, that is, in communities of concentrated poverty; neither is it known what proportion of slum residents are, in fact, poor. Funhermore, no quantitative accounting is yet available that would sep· arare the health risks of slum life into those due to a househoid•s own poverty and those stemminic from poveny in the surrounding neighborhood. If urban health interventions are to be effectively targeted in developing countries, substantial progress must be made in addressing these cenrral issues. This paper examines poverty and children's health and survival using two large surveys, one a Demographic and Health Survey fielded in urban Egypt (with an oversampling of slums) and the other a survey of the slums of Allahabad, India. Using multivariate statistical methods. we find, in both settings: ( 11 substan· rial evidence of living standards heterogeneity within the slums; (21 strong evidence indicating that household-level poverty is an imponant influence on health; and (3) staristically significant (though less strong) evidence that with household living standards held constant, neighborhood levels of poverty adversely affect health. The paper doses with a discussion of the implications of these findings for the targeting of health and poverty program interventions.

P6-13 (A) Urban Environment and the Changing Epidemiological Surfacr. The Cardiovascular ~ &om Dorin, Nigeria

The emergence of cardiovascular diseases had been explained through the concomitants o_f the demographic transition wherein the prevalent causes of morbidity and monality ~hangr pr~mmant infectious diseases to diseases of lifestyle or chronic disease (see Deck, 1979) . A ma1or frustration m the v146 POSTER SESSIONS case of CVD is its multifactural nature. It is acknowledged that the environment, however defined is the d · f · t' b tween agents and hosts such that chronic disease pathogenesis also reqmre a me 1an o mterac ion e .

spatio-temporal coincidence of these two parties. What is not clear is which among ~ever~( potennal fac· · h b pace exacerbate CVD risk more· and to what extent does the ep1dem1olog1cal trans1· tors m t e ur an s ' . . . . tion h othesis relevant in the explanation of urban disease outlook even the developmg cities like Nigeri~: Thesis paper explorer these within a traditional city in Nigeria.

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The data for the study were obtained from two tertiary level hospitals m the metropolis for 10 years (1991) (1992) (1993) (1994) (1995) (1996) (1997) (1998) (1999) (2000) . The data contain reported cases of CVD in the two facilities for the period. Adopting a series of parametric and non-parametric statistics, we draw inferences between the observed cases of CVDs and various demographic and locational variables of the patients.

Findings: About 28% of rhe cases occurred in 3 years (1997) (1998) (1999) coinciding with the last year of military rule with great instability. 55.3% occurred among male. 78.8% also occurred among people aged 31-70 years. These are groups who are also likely to engage in most stressful life patterns. ~e study also shows that 63% of all cases occurred in the frontier wards with minor city areas also havmg their •fair' share. Our result conformed with many empirical observation on the elusive nature of causation of CVD. This multifactoral nature had precluded the production of a map of hypertension that would be consistent with ideas of spatial prediction. CVD -Cardiovascular diseases.

Mumbai is the commercial capital of India. As the hub of a rapidly transiting economy, Mumbai provides an interesting case study into the health of urban populations in a developing country. With high-rise multimillion-dollar construction projects and crowded slums next to each other, Mumbai presents a con· trast in development. There are a host of hi-tech hospitals which provide high quality care to the many who can afford it (including many westerners eager to jump the queue in their healthcare systems-'medical tour· ism'), at the same time there is a overcrowded and strained public healthcare system for those who cannot afford to pay. Voluntary organizations are engaged in service provision as well as advocacy. The paper will outline role of the voluntary sector in the context of the development of the healthcare system in Mumbai. Mumbai has distinct upper, middle and lower economic classes, and the health needs and problems of all three have similarities and differences. These will be showcased, and the response of the healthcare system to these will be documented. A rising HIV prevalence rate, among the highest in India, is a challenge to the Mumbai public healthcare system. The role of the voluntary sector in service provision, advocacy, and empowerment of local populations with regards to urban health has been paramount. The emergence of the voluntary sector as a major player in the puzzle of urban Mumbai health, and it being visualized as voices of civil society or communiry representatives has advantages as well as pitfalls. This paper will be a unique attempt at examining urban health in India as a complex web of players. The influence of everyday socio·polirical-cultural and economic reality of the urban Mumbai population will be a cross cutting theme in the analysis. The paper will thus help in filling a critical void in this context. The paper will thus map out issues of social justice, gender, equiry, effect of environment, through the lens of the role of the voluntary sector to construct a quilt of the realiry of healthcare in Mumbai. The successes and failures of a long tradi· tion of the active advocacy and participation of the voluntary sector in trying to achieve social justice in the urban Mumbai community will be analyzed. This will help in a better understanding of global urban health, and m how the voluntary sector/NGOs fir into the larger picture.

Ba~und: O~er. half _of N~irobi's 2.5 million inhabitants live in illegal informal settlements that compose 5 Yo of the city s res1dent1al land area. The majority of slum residents lack access to proper san· iranon and a clean and adequate water supply. This research was designed to gain a clearer understand· mg of what Kappr · · · H f . . opnate samtanon means or the urban poor, to determine the linkages between gender, hvehhoods, and access to water and sanitation, and to assess the ability of community sanitation blocks to meet water and sanitation needs in urban areas.

M~tboJs_: _A household survey, gender specific focus groups and key informant interviews were conducted m Maih Saba, a peri-urban informal settlement. Qualitative and quantitative research tools were u~ to asses~ the impact and effectiveness of community sanitation blocks in two informal settlements.

Results

ropna e samtarmn me u es not only safe and clean latrines, but also provision ° adequate drainage and access to water supply for cleaning of clothes and homes. Safety and cleanliness POSTER SESSIONS v147 were priorities for women in latrines. Levels of poverty within the informal settlements were identified and access to water and sanitation services improved with increased income. Environmental health problems related to inadequate water and sanitation remain a problem for all residents. Community sanitation blocks have improved the overall local environment and usage is far greater than envisioned in the design phase. Women and children use the blocks less than men. This is a result of financial, social, and safety constraints.

The results highlight the importance a need to expand participatory approaches for the design of water and sanitation interventions for the urban poor. Plans need to recognize "appropriate sanitation" goes beyond provision of latrines and gender and socioeconomic differences must be taken into account. Lessons and resources from pilot projects must be learned from, shared and leveraged so that solutions can be scaled up. Underlying all the challenges facing improving water and sanitation for the urban poor are issues of land tenure. P6-16 (C) Integrating TQM (Total Quality Management), Good Governance and Social Mobilization Principles in Health Promotion Leadership Training Programmes for New Urban Settings in 12 Countries/ Areas: The Prolead Experience Susan Mercado, Faren Abdelaziz, and Dorjursen Bayarsaikhan Introduction: Globalization and urbanization have resulted in "new urban settings" characterized by a radical process of change with positive and negative effects, increased inequities, greater environmental impacts, expanding metropolitan areas and fast-growing slums and vulnerable populations. The key role of municipal health governance in mitigating and modulating these processes cannot be overemphasized. New and more effective ways of working with a wide variety of stakeholders is an underpinning theme for good governance in new urban settings. In relation to this, organizing and sustaining infrastructure and financing to promote health in cities through better governance is of paramount importance. There is a wealth of information on how health promotion can be enhanced in cities. Despite this, appropriate capacity building programmes to enable municipal players to effectively respond to the challenges and impacts on health of globalization, urbanization and increasing inequity in new urban settings are deficient. The WHO Kobe Centre, (funded by the Kobe Group( and in collaboration with 3 Regional Offices (EMRO, SEARO, WPRO) with initial support from the Japan Voluntary Contribution, developed a health promotion leadership training programme called "Prolead" that focuses on new and autonomous structures and sustainable financing for health promotion in the context of new urban settings.

Methodology: Country and/or city-level teams from 12 areas, (China, Fiji, India, Japan, Lebanon, Malaysia, Mongolia, Oman, Philippines, Republic of Korea, Tonga and Viet Nam) worked on projects to advance health promotion infrastructure and financing in their areas over a 9 month period. Tools were provided to integrate principles of total quality management, good governance and social mobili1.ation.

Results: Six countries/areas have commenced projects on earmarking of tobacco and alcohol taxes for health, moblization of sports and arts organizations, integration of health promotion and social health insurance, organizational reforms, training in advocacy and lobbying, private sector and corporate mobilization and community mobilization. Results from the other six areas will be reported in 01..;obcr.

Conclusions: Total quality management, good governance and social mobilization principles and skills are useful and relevant for helping municipal teams focus on strategic interventions to address complex and overwhelming determinants of health at the municipal level. The Prolead training programmes hopes to inform other processes for building health promotion leadership capacity for new urban settings.

The impact of city living and urbanization on the health of citizens in developing countries has received increasing attention in recent years. Urban areas contribute largely to national economies. However, rapid and unplanned urban growth is often associated with poverty, environmental degradation and population demands that outstrip service capacity which conditions place human health at risk. Local and national governments as well as multi national organizations are all grappling with the challenges of urbanization. With limited data and information available, urban health characteristics, including the types, quantities, locations and sources in Kampala, are largely unknown. Moreover, there is n? basis for assessing the impact of the resultant initiatives to improve health ~onditions amo~g ~o":1":1um ties settled in unplanned areas. Since urban areas are more than the aggregation ?f ~?pie w~th md_1v1dual risk factors and health care needs, this paper argues that factors beyond the md1V1dual, mcludmg the POSTER SESSIONS v148 · I d h · I · ment and systems of health and social services are determinants of the health soc1a an p ys1ca environ .

of urban populations. However, as part of an ongoing study? ~s pape~ .addresses the basic concerns of urban health in Kampala City. While applying the "urban hvmg conditions and the urban heal~ pen· alty" frameworks, this paper use aggregated urban health d~ta t~ explore the role of place an~ 111st1tu· tions in shaping health and well-being of the population m Kampala by understanding how characteristics of the urban environment and specific features of the city are causally related to health of invisible and forgotten urban poor population: Results i~dica~e that a .range o~ urb~n he~l~h hazards m the city of Kampala include substandard housing, crowdmg, mdoor air poll.ut1on, msuff1c1ent a~d con· taminated water, inadequate sanitation and solid waste management services, vector borne .diseases, industrial waste increased motor vehicle traffic among others. The impact of these on the envtronment and community.health are mutually reinforcing. Arising out of the withdra"'.al of city pl~nning systems and service delivery systems or just planning failure, thousands of people part1cularl~ low-mc~me groups have been pushed to the most undesirable sections of the city where they are faced with ~ va_r1ety ~f enVJ· ronmental insults. The number of initiatives to improve urban health is, however, growing mvolVJng the interaction of many sectors (health, environment, housing, energy, transportation and urban planning) and stakeholders (local government, non governmental organizations, aid donors and local community groups).

Key words: urban health governance, health risks, Kampala.

Introduction: The viability of urban communities is dependent upon reliable and affordable mass transit. In particular, subway systems play an especially important role in the mass transit network, since they provide service to vast numbers of ridersseven of the 95 subway systems worldwide report over one billion passenger rides each year. Surprisingly, given the large number of people potentially affected, very little is known about the health and safety hazards that could affect both passengers and transit workers; these include physical (e.g., noise, vibration, accidents, electrified sources, temperature extremes), biological (e.g., transmission of infectious diseases, either through person-to-person spread or vector-borne, for example, through rodents), chemical (e.g., exposure to toxic and irritant chemicals and metals, gas emissions, fumes), electro-magnetic radiation, and psychosocial (e.g., violence, workstress). More recently, we need to consider the threat of terrorism, which could take the form of a mass casualty event (e.g., resulting from conventional incendiary devices), radiological attack (e.g., "dirty bomb"), chemical terrorist attack (e.g., sarin gas), or bioterrorist attack (e.g., weapons grade anthrax). Given the large number of riders and workers potentially at risk, the public health implications are considerable.

Methods: To assess the hazards associated with subways, a structured review of the (English) litera· ture was conducted.

Ruults: Based on our review, non-violent crime, followed by accidents, and violent crimes are most prevalent. Compared to all other forms of mass transit, subways present greater health and safety risks. However, the rate of subway associated fatalities is much lower than the fatality rate associated with automobile travel (0.15 vs. 0.87 per 100 million passenger miles), and cities with high subway ridership rates have a 36% lower per capita rate of transportation related fatalities than low ridership cities (7.5 versus 11.7 annual deaths per 100,000 residents). Available data also suggest that subway noise levels and levels of air pollutants may exceed recommended levels.

. ~: There is a paucity of published research examining the health and safety hazards associated with subways. Most of the available data came from government agencies, who rely on passively reported data. Research is warranted on this topic for a number of reasons, not only to address important knowled~ gaps, but also because the population at potential risk is large. Importantly, from an urban perspecnve, the benefits of mass transit are optimized by high ridership ratesand these could be adversely affu:ted by unsafe conditions and health and safety concerns.

Veena Joshi, Jeremy Lim. and Benjamin Chua ~ ~rban health issues have moved beyond infectious diseases and now centre largely on chrome diseases. Diabetes is one of the most prevalent non-communicable diseases globally. 9 % of adult ¥151 benefit in providing splash pads in more parks. Given the high temperature and humidity of London summers, this is an important aspect and asset of parks. Interviewed parents claimed to visit city parks anywhere between 1 to 6 days per week.

Corrduion: Given that the vast majority of Canadian children are insufficiently active to gain health benefits, identifying effective qualities of local parks, that may support and foster physical activity is essential. Strategies to promote activity within children's environments are an important health initiative. The results from this study have implications for city planners and policy makers; parents' opinions of, and use of city parks provides feedback as to the state current local parks, and modifications that should be made for new ones being developed. This study may also provide important feedback for health promoters trying to advocate for physical activity among children. Introdt1clion: A rapidly increasing proportion of urban dwellers in Africa live below the poverty line in overcrowded slums characterized by uncollected garbage, unsafe water, and deficient sanitation and overflowing sewers. This growth of urban poverty challenges the commonly held assumption that urban populations enjoy better health than their rural counterparts. The objectives of this study are (i) to compare the vaccination status, and morbidity and mortality outcomes among children in the slums of Nairobi with rural Kenya, and (ii) to examine the factors associated with poor child health in the slums.

We use data from demographic and health survey representative of all slum settlements in Nairobi City carried out in 2000 by the African Population & Health Research Center. A total of 3,256 women aged 15-49 from 4,564 households were interviewed. Our sample consists of 1,210 children aged 0-35 months. The comparison data are from the 1998 Kenya Demographic and Health Survey. The outcomes of interest include child vaccination status, morbidity (diarrhea, fever and cough) and mortality, all dichotomized. Socioeconomic, environmental, demographic, and behavioral factors, as well as child and mother characteristics, are included in the multivariate analyses. Multilevel logistic regression models are used.

l'Nlimin11ry Rest1lts: About 32 % of children in the slums had diarrhea in the two weeks prior to the survey, compared to 16% of rural children. These disparities between the urban poor anJ the rural residents are also observed for fever (64% against 42%), cough (46% versus 20%), infant mortality (91/ 1000 against 76/1000), and complete vaccination (48% against 64%). Preliminary multivariate results indicate that health service utilization and maternal education have the strongest predictive power on child morbidity and mortality in the slums, and that household wealth has only minor, statistically insignificant effects.

Conclruion: The superiority of health of urban children, compared with their rural counterparts, masks significant disparities within urban areas. Compared to rural residents, children of slum dwellers in Nairobi are sicker, are less likely to utilize health services when sick, and stand greater risk to die. Our results suggest policies and programs contributing to the attainment of the millennium development goal on child health should pay particular attention to the urban poor. The insignificance of socioeconomic status suggests that poor health outcomes in these communities are compounded by poor environmental sanitation and behavioral factors that could partly be improved through female education and behavior change communication.

Introduction: Historic trade city Surat with its industrial and political peace has remained a center of attraction for people from all the comers of India resulting in to pop.ulatio~ explosio~ a~d stressed social and service infrastructure. The topography,dimate and demographic profile of the city 1s threat to the healthy environment. Aim of this analysis is to review the impact of managemt'nt reform on health indicators.

Method: This paper is an analysis of the changing profile of population, sanitary infr~s~rucrure, local self Government management and public health service reform, secondary health stat1st1cs data, health indicator and process monitoring of 25 years.

. . health of entire city and challenge to the management system. Plague outbr~ak (1994) was the turning point in the history of civic service management including p~blic ~e~lth service management. ~ocal self government management system was revitalized by reg~lar_ field v1s1ts o~ al~ cadre~, _decentraltzanon of power and responsibility, equity, regular vigilant momtormg, commumcanon facility, ream_approach and people participation. Reform in Public health service management was throu_gh stan~~rd1Zed intervention protocol, innovative intervention, public private partnership, community part1c1panon, academic and service institute collaboration and research. Sanitation service coverage have reached nearer to universal. Area covered by safe water supply reached to 98%(2004) from 40% (1991) and underground drainage to 97% (2004) from 17% ( 1991) The overhauling of the system have reflected on health indicators of vector and water born disease. Malaria SPR declined to 1.23 (2004) from 23.06'Yo(!991) and diarrhea case report declined to 1963(2004) from 3431 (2004). Except Dengue fever in 2002 no major disease outbreaks are reported after 1991. City is recipient of international/national awards/ranking for these achievements. The health department have developed an evidence and experience based intervention and monitoring system and protocol for routine as well as disaster situation. The health service and management structure of Surat city have emerged as an urban health model for the country.

Introduction: The Center for Healthy Communities (CHC) in the Department of Family and Com· munity Medicine at the Medical College of Wisconsin developed a pilot project to: 1) Assess the know· ledge, attitudes, and behaviors of female Milwaukee public housing residents related to breast cancer; 21 Develop culturally and literacy appropriate education and screening modules; 3) Implement the developed modules; 4) Evaluate the modules; and 5) Provide follow-up services. Using a community-based participatory research model the CHC worked collaboratively with on-site nurse case management to meet these objectives.

Methods: A "breast health kick off event" was held at four separate Milwaukee public housing sites for elderly and disabled adults. Female residents were invited to complete a 21-item breast health survey, designed to accommodate various literacy levels. Responses were anonymous and voluntary. The survey asked women about their previous physical exams for breast health, and then presented a series of state· ments about breast cancer to determine any existing myths. The final part gathered information about personal risk for breast cancer, the highest level of education completed, and whether the respondents h;td ever used hormone replacement therapy and/or consumed alcohol. Responses were collected for descriptive analysis.

Results: A total of 45 surveys (representing 18% of the total female population in the four sites) were completed and analyzed. 89% reported that they had a physical exam in the previous rwo years. 96% of respondents indicated they never had been diagnosed with breast cancer. 85% reported having had a mammogram and 87% having had a clinical breast exam. Those that never had a mammogram reported a fear of what the provider would discover or there were not any current breast problems ro warrant an exam. 80% agreed that finding breast cancer early could lower the chance of dying of cancer. Over 92% reported that mammograms were helpful in finding cancer. However, 27% believed that hav· ing a mammogram actually prevents breast cancer. 14% indicated that mammograms actually cause cancer and 16% reported that a woman should get a mammogram only if there is breast cancer in her family.

Conclusion: This survey indicates that current information about the importance of mammograms and clinical breast exams is reaching traditionally underserved women. Yet there are still critical oppor· tunities to provide valuable education on breast health. This pilot study can serve as a tool for shaping future studies of health education messages for underserved populations. Located in a yourh serv· ~ng agency m downtow~ Ottawa, the clinic brings together community partners to provide primary medical care. and dent~I hygiene t? the street youths of Ottawa aged 12-20. The primary goal of the project is to provide accessible, coordinated, comprehensive health and dental care to vulnerable adolescents.

These efforts respond to the pre-existing body of evidence suggesting that the principle barrier in accessing such care for these youths are feelings of intimidation and vulnerability in the face of a complex healthcare system. The Bruyere FHN Satellite Clinic is located in the basement of a downtown drop-in and brings together a family medicine physician and her residents, a dental hygienist and her 2nd year students, a nurse practitioner, a chiropodist and 2 public health nurses to provide primary care. The clinic has been extremely busy and well received by the youth. This workshop will demonstrate how five community organizations have come together to meet the needs of high risk youths in Ottawa. This presentation will showcase the development of the clinic from its inception through its first year including reaction of the youths, partnerships and lessons learned. It will also focus on its sustainability without continued funding. We hope to have developed a model of service delivery that could be reproduced and sustained in other large cities with Faculties of Medicine.

Methods: Non-randomized, mixed method design involving a process and impact evaluation. Data

Collection-Qualitative-a) Semi structured interviews with providers & partners b)Focus groups with youth Quantitative a)Electronic medical records for 12 months Records (budget, photos, project information).

Results: 1) Successfully built and opened a medicaUdental clinic which will celebrate its 1 year anniversary in August. 2) Over 140 youths have been seen, and we have had over 300 visits.

Conclusion: 1) The clinic will continue to operate beyond the 18 month project funding. 2) The health of high risk youth in Ottawa will continue to improve due to increased access to medical services.

P7-11 (A) Health Services -for the Citizens of Bangalore -Past, Present and Future Savita Sathyagala, Girish Rao, Thandavamurthy Shetty, and Subhash Chandra Bangalore city, the capital of Karnataka with 6.5 million is the 6th most populous city in India; supporting 30% of the urban population of Karnataka, it is considered as one of the fastest growing cities in India. Known as the 'silicon valley of India', Bangalore is nearly 500 years old. Bangalore City Corporation (BMP), is a local self government and has the statutory commitment to provide to the citizens of Bangalore: good roads, sanitation, street lighting, safe drinking water apart from other social obligations, cultural development and poverty alleviation activities. Providing preventive and promotive heahh services is also a specific component. The objective of this study was to review the planning process with respect to health care services in the period since India independence; the specific research questions being what has been the strategies adopted by the city planners to address to the growing needs of the population amidst the background of the different strategies adopted by the country as a whole. Three broad rime ranges have been considered for analysis: the 1950s, 1970s and the 1990s. The salient results are: major area of focus has been on the maternal and child care with activities ranging from day-care to in-patient-care; though the number of institutions have grown from 5 to the current day 79, their distribution has been far from satisfactory; Obtaining support from the India Population projects 3 and 8 major upgradarions have been undertaken in terms of infrastructure; Over the years, in addition to the dispensaries of modern system of medicine, local traditional systems have also been initiated; the city has partnered with the healthy cities campaign with mixed success; disease surveillance, addressing the problems related to the emerging non-communicable diseases including mental health and road traffic injuries are still in its infancy. Isolated attempts have been made to address the risks groups of elderly care and adolescent care. What stands out remarkably amongst the cities achievements is its ability to elicit participation from NGOs, CBOs and neighbourhood groups. However, the harnessing of this ability into the health sector cannot be said totally successful. The moot question in all the above observed development are: has the city rationally addressed it planning needs? The progress made so far can be considered as stuttered. The analysis and its presentation would identify the key posirive elements in the growth of Banglore city and spell a framework for the new public health.

Introduction: Anaemia associated with pregnancy is a major public health problem all over the world. Different studies in different parts of India shown prevalence of anaemia between 60-90%. Anaemia remains a serious health problem in pregnancy despite of strong action taken by the Government of India through national programmes. In the present study we identified th~ social beha~iors, responsible for low compliance of IF A tablets consumption in pregnancy at community level and intervention was given with new modified behaviors on trial bases. . in Vadodara urban. 60 anganwadies out of 289 were selected from the list by random sampling for TIPS (Trials of Improved Practices) study. . . Participants: 266 pregnant women (132, intervention group+ 134, control. group) registered m the above 60 anganwadies. Study was conducted in to three phases: Phase: 1. Formative research and baseline survey (FRBS). Data was collected from all 266 pregnant women to identify behaviors that are responsible for low compliance of IFA tablets. Both qualitative and quantitative data were collected. Haemoglobin was estimated of all pregnant women by Haemo-Cue. Phase: 2. Phase of TIPS. Behaviors were identified both social & clinical for low compliance of IFA tablets consumption in pregnancy from FRBS and against those, modified behaviors were proposed to pregnant women in the intervention group on trial bases by health education. Trial period of 6 weeks was given for trial of new behaviors to pregnant women in the interven· tion group. Phase: 3. In this phase, feedbacks on behaviors tried or not tried were taken from pregnant women in intervention group. Haemoglobin estimation was carried out again in all 266 pregnant women. At the end of the study, messages were formulated on the bases of feedbacks from the pregnant women.

Results: All pregnant women in the intervention group had given positive feedback on new modified behaviors after intervention. Mean Haemoglobin concentration was higher in intervention group (10.04±0.11 gm%) than control group (9.60±0.14 gm%). IFA tablets compliance was improved in intervention group (95.6%) than control group (78.6%).

Conclusion: All pregnant women got benefits after trial of new modified behaviors in the intervention group. Messages were formulated from the new modified behaviors, which can be used for longterm strategies for anaemia control in the community.

Introduction: In order to develop a comprehensive MCH handbook for pregnant women and to assess its effect among them, a pilot study was carried out at the Maternal and Child Health Training Institute (MCHTI), in Dhaka, Bangladesh.

Methods: From MCHTI a sample of 600 pregnant women was selected and all subjects were women who were attending the first visit of their current pregnancy by using a random sampling method. Of the 600 subjects, 240 women were given the MCH handbook as case and 360 women were not given the handbook as control. Data on pre and post intervention of the handbook from the 240 cases and 360 controls were taken from data recording forms between the 1st of November 2002 and 31st of October, 2003 and data was analysed by using a multilevel analysis approach. This was a hospital-based action (case-control) research, and was applied in order to measure the outcome of pre and post intervention following the introduction of the handbook. Data was used to assess the effects of utilisation of the handbook on women's knowledge, practice and utilisation of MCH services.

Results: This study showed that the change of knowledge about antenatal care visits was 77.1% among case mothers. Knowledge of danger signs improved 49.2 %, breast feeding results 31.5%, vaccination 32.0% and family planning results improved 60.3% among case. Results showed some positive changes in women's attitudes among case mothers and study showed the change of practice in antenatal care visits was .U.5% in the case. Other notable changes were: change of practice in case mother's tetanus toxoid (TI), 55.2%; and family planning 41.2%. In addition, handbook assessment study indicated that most women brought the handbook on subsequent visits (83.3%), the handbook was highly utilised (i.e. it was read by 84.2%, filled-in by 76.1 %, and was used as a health education tool by 80.4%). Most women kept the handbook (99.5%) and found it highly useful (78.0%) with a high client satisfaction rate of 88.0%.

Conclusion: Pregnant women in the case group had higher knowledge, better practices, and higher utilisation of MCH services than mothers in the control groups who used alternative health cards. If the handbook is developed with a focus on utilising a problem-oriented approach and involving the recomendations .of end~users, it is anticipated that the MCH handbook will contribute significantly to ensuring the quahry of hfe of women and their children in Bangladesh. After several meetmgs to identify the needs of the community, a FASO clinic was opened at NCfS. Health care professionals from SMH joined with developmental and social service workers from NCFS to implement the FASO diagnostic process and to provide culturally appropriate after-care. The clinic is unique in that its focus is the high risk urban aboriginal population of Toronto. It accepts referrals of not only children and youth, but also of adults.

Lessons Learned: Response to the FASO clinic at Native Child and Family Services has been overwhelming. Aboriginal children with F ASD are receiving timely diagnosis and interventions. Aboriginal youth and adults who have been struggling with poveny, substance abuse, and homelessness are more willing to enter the NCFS centre for diagnosis and treatment. Aboriginal infants prenatally exposed to alcohol born at St. Michael's Hospital or referred by other centres have access to the developmental programs located in both of the partnering agencies. The presentation will describe the clinic's development, and will detail the outcomes described, including interventions unique to the Aboriginal culture.

P7-15 (C) Seeds, Soil, and Stories: An Exploration of Community Gardening in Southeast Toronto Carolin Taran, Sarah Wakefield, Jennifer Reynolds, and Fiona Yeudall Introduction: Community gardens are increasingly seen as a mechanism for improving nutrition and increasing food security in urban neighbourhoods, but the evidence available to support these claims is limited. In order to begin to address this gap in a way that is respectful of community knowledge and needs, the Urban Gardening Research Opportunities Workgroup (UGROW) project explored the benefits and potential risks of community gardening in Southeast Toronto.

The project used a community-based research (CBR) model to assess community gardens as a means of improving local health. The research process included interviews, focus groups, and participant observation (documented in field notes). We also directly engaged the community in the research process, through co-learning activities and community events which allowed participants to express their views and comment on emerging results. Most of the research was conducted by a community-based research associate, herself a community gardener. Key results were derived from these various sources through line-by-line coding of interview transcripts and field note review, an interactive and iterative process which involved both academic and community partners.

Results: These various data sources all suggest that enhanced health and access to fresh produce are important components of the gardening experience. They also highlight the central importance of empowering and community-building aspects of gardening to gardeners. Community gardens were thought to play a role in developing friendships and social support, sharing food and other resources, appreciating cultural diversity, learning together, enhancing local place attachment and stewardship, and mobilizing to solve local problems (both inside and outside the garden). Potential challenges to community gardens as a mechanism for communiry development include bureaucratic resistance to gardens, insecure land tenure and access, concerns about soil contamination, and a lack of awareness and under· standing by community members and decision-makers of all kinds.

Conclusion: The results highlight many health and broader social benefits experienced by commu· nity gardeners. They also point to the need for greater support for community gardening programs, par· ticularly ongoing the ongoing provision of resources and education programs to support gardens in their many roles. This research project is supported by the Wellesley Central Health Corporation and the Centre for Urban Health Initiatives, a CIHR funded centre for research development hased at the Univer· sity of Toronto.

P7-16 (C) Developing Resiliency in Children Living in Disadvantaged Neighbourhoods Sarah Farrell, Lorna Weigand, and Wayne Hammond

The traditional idea of targeting risk reduction by focusing on the development of eff~ctive coping strategies and educational programs has merit in light of the research reportmg_ that_ ~10lupl.e forms of problem behaviour consistently appear to be predicted by increasing exposure to 1den_uf1able risk factors. As a result, many of the disadvantaged child and youth studies have focused on trymg to better _unde.r· stand the multiple risk factors that increase the likelihood of the development of at nsk behaviour m ch1ldren/youth and the potential implications for prevention. This in turn has led t_o. the conclus1on that community and health programs need to focus on risk reduction by helpm~ md1v1duals develop more effective coping strategies and a better understanding of the limitations of cenam pathologies, problematic v156 POSTER SESSIONS coping behaviours and risk factors potentially inheren~ in high needs co~unities. ~owever, another ai:ea of research has proposed that preventative interventions should cons1de~ .~rotecnve fa~ors alo~~ with reducing risk factors. As opposed to just emphasizing problems, vulnerab1ht1es, and deficits, a res1liencybased perspective holds the belief that children, youth and their families. have strengths, reso~ce.s and the ability to cope with significant adversity in ways that are not only effective, but tend to result m mcreased ability to constructively respond to future adversity. With this in mind, a participatory research project sponsored by the United Way of Greater Toronto was initiated to evaluate and determine the resiliency profiles of children 8 -12 years (n = 500) of recent immigrant families living in significantly disadvantaged communities in the Toronto area. The presentation will provide an overview of the identified protective factors (both intrinsic and extrinsic) and resiliency profiles in an aggregated format as well as a summary of how the children and their parents interpreted and explained these strength-based results. As part of the focus groups, current community programs and services were examined by the participants as to what might be best practices for supporting the development and maintaining of resiliency in children, families and communities. It was proposed that the community model of assessing resiliency and protective factors as well as proposed best strength-based practice could serve as a guide for all in the community sector who provide services and programs to those in disadvantaged neighbourhoods.

P7-17 (C) Naloxone by Prescription in San Francisco, CA and New York, NY Emalie Huriaux

The Harm Reduction Coalition's Overdose Project works to reduce the number of fatal overdoses to zero. Located in New York, NY and San Francisco, CA, the Overdose Project provides overdose education for social service providers, single-room occupancy hotel (SRO) residents, and syringe exchange participants. The Project also conducts an innovative naloxone prescription program, providing naloxone, an opiate antagonist traditionally administered by paramedics to temporarily reverse the effects of opiate overdose, to injection drug users (IDUs). We will describe how naloxone distribution became a reality in New York and San Francisco, how the Project works, and our results. The naloxone prescription program utilizes multiple models to reach IDUs, including SRO-and street-based trainings, and office-based trainings at syringe exchange sites. Trainings include information on overdose prevention, recognition, and response. A clinician conducts a medical intake with participants and provides them with pre-filled units of naloxone. In New York, funding was initially provided by Tides Foundation. New York City Council provides current funding. New York Department of Mental Health and Hygiene provides program oversight. While the New York project was initiated in June 2004, over half the trainings have been since March 2005. In San Francisco, California Endowment, Tides Foundation, and San Francisco Department of Public Health (SFDPH) provide funding. In addition, SFDPH purchases naloxone and provides clinicians who conduct medical intakes with participants. Trainings have been conducted since November 2003. To date, nearly 1000 individuals have been trained and provided with naloxone. Approximately 130 of them have returned for refills and reported that they used naloxone to reverse an opiate-related overdose. Limited episodes of adverse effects have been reported, including vomiting, seizure, and "loss of friendship." In New York, 400 individuals have been trained and provided with naloxone. Over 30 overdose reversals have been reported. Over half of the participants in New York have been trained in the South Bronx, the area of New York with the highest rate of overdose fatalities. In San Francisco, 570 individuals have been trained and provided with naloxone. Over 96 overdose reversals have been reported. The majority of the participants in San Francisco have been trained in the Tenderloin, 6th Street corridor, and Mission, areas with the highest rates of overdose fatalities. The experience of the Overdose Project in both cities indicates that providing IDUs low-threshold access to naloxone and overdose information is a cost-effective, efficient, and safe intervention to prevent accidental death in this population.

P7-18 (C) Successful Strategies to Regulate Nuisance Liquor Stores Using Community Mobilization, Law Enforcement, City Council, Merchants and Researchers Tahra Goraya

Presenta~ion _will discuss ~uccessful environmental and public policy strategies employed in one Southen:1 Cahf?rmna commumty to remedy problems associated with nuisance liquor stores. Participants ~111 be given tools to understand the importance of utilizing various substance abuse prevention str~tegi~ to change local policies and the importance of involving various sectors in the community to a~_1st with and advocate for community-wide policy changes. Recent policy successes from the commultles of Pa~ad~na and Altad~na will highlight the collaborative process by which the community mobilized resulnng m several ordmances, how local law enforcement was given more authority to monitor POSTER SESSIONS v157 nonconforming liquor stores, how collaborative efforts with liquor store owners helped to remove high alcohol content alcohol products from their establishments and how a community-based organiz,uion worked with local legislators to introduce statewide legislation regarding the regulation of nuisance liquor outlets.

P7-19 (C) "Dialogue on Sex and Life": A Reliable Health Promotion Tool Among Street-Involved Youth Beth Hayhoe and Tracey Methven Introduction: Street involved youth are a marginalized population that participate in extremely risky behaviours and have multiple health issues. Unfortunately, because of previous abuses and negative experiences, they also have an extreme distrust of the adults who could help them. In 1999, Toronto Public Health granted funding to a non governmental, nor for profit drop-in centre for Street Youth aged 16-24, to educate them about how to decrease rhe risk of acquiring HIV. Since then the funding has been renewed yearly and the program has evolved as needed in order to target the maximum number of youth and provide them with vital information in a candid and enjoyable atmosphere.

Methods: Using a retrospective analysis of the six years of data gathered from the "Dialogue on Sex and Life" program, the researchers examined the number of youth involved, the kinds of things discussed, and the number of youth trained as peer leaders. Also reviewed, was written feedback from the weekly logs, and anecdotal outcomes noted by the facilitators and other staff in the organization.

Results: Over the five year period of this program, many of youth have participated in one hour sessions of candid discussion regarding a wide range of topics including sexual health, drug use, harm reduction, relationship issues, parenting, street culture, safety and life skills. Many were new youth who had not participated in the program before and were often new to the street. Some of the youth were given specific training regarding facilitation skills, sexual anatomy and physiology, birth control, sexually transmitted infections, HIV, substance use/abuse, harm reduction, relationships and discussion of their next steps/future plans following completion of the training. Feedback has been overwhelmingly positive and stories of life changing decisions have been reported.

Conclusion: Clearly, this program is a successful tool to reach street involved youth who may otherwise be wary of adults and their beliefs. Based on data from the evaluation, recommendations have been made to Public Health to expand the funding and the training for peer leaders in order ro target between 100-200 new youth per year, increase the total numbers of youth reached and to increase the level of knowledge among the peer leaders.

P7-20 (C) Access to Identification and Services Jane Kali Replacing identification has become increasingly more complex as rhe government identification issuing offices introduce new requirements rhar create significant barriers for homeless people to replace their ID. New forms of identification have also been introduced that art' not accessible to homekss peoplt-(e.g. the Permanent Resident card). Ar rhe same time, many service providers continue to require identifi· cation ro access supports such as income, housing, food, health care, employment and employmt·nt training programs. Street Health, as well as a number of other agencies and Community Health Centres, h,1, been assisting with identification replacement for homeless peoplt· for a number of years. The rnrrt·nr challenges inherent within new replacement requirements, as well as the introduction of new forn1' of identification, have resulted in further barriers homeless people encounter when rrring to access t:ssential services. Street Health has been highlighting these issues to government identification issuing offices, as well as policy makers, in an effort to ensure rhar people who are homeless and marginalized have aC'ess to needed essential services.

Bandar is a Somali word for •·a safe place." The Bandar Research Project is the product of the Regent Park Community Health Centre. The research looks ar the increasing number of Somali and Afri· can men in the homeless and precariously house population in the inner city core of down~own Toronto.

In the first phase of the pilot project, a needs assessment was conducted to 1dennfy barners and issues faced by rhe Somali and other African men who are homeless and have add1cr10ns issues. Th_e second phase of rhe research project was to identify long rerm resources and service delivery mechamsms that v158 POSTER SESSIONS would enhance the abiity of this population to better access detox, treatment, and post treatment ser· vices. The final phase of the project was to facilitate the development of a conceptual model of seamless continual services and supports from the STREETS to DETOX to TREATMENT to LONG TERM REHABILITATION to HOUSING. "Between the pestle and Mortar" -safe place.

P7-22 (C) Successful Methods for Studying Transient Populations While Improving Public Health Beth Hayhoe, Ruth Ewert, Eileen McMahon, and Dan Jang Introduction: Street Youth are a group that do not regularly access healthcare because of their mis· trust of adults. When they do access health care, it is usually for issues severe enough for hospitalization or for episodic care in community clinics. Health promotion and illness prevention is rarely a part of their thinking. Thus, standard public health measures implemented in a more stable population do not work in this group. For example, Pap tests, which have dearly been shown to decrease prevalence of cer· vical cancer, are rarely done and when they are, rarely followed up. Methods to meet the health care needs and increase the health of this population are frequently being sought.

Methods: A drop-in centre for street youth in Canada has participated in several studies investigating sexual health in both men and women. We required the sponsoring agencies to pay the youth for their rime, even though the testing they were undergoing was necessary according to public health stan· dards. We surmised that this would increase both initial participation and return.

Results: Many results requiring intervention have been detected. Given the transient nature of this population, return rates have been encouraging so far.

Conclusion: It seems evident that even a small incentive for this population increases participation in needed health examinations and studies. It is possible that matching the initial and follow-up incentives would increase the return rate even further. The fact that the youth were recruited on site, and not from any external advertising, indicates that studies done where youth trust the staff, are more likely to be successful.

The presentation will share the results of the "Empowering Stroke Prevention Project" which incor· porated self-help mutual aids strategies as a health promotion methodology. The presentation will include project's theoretical basis, methodology, outcomes and evaluation results. Self-help methodology has proven successful in consumer involvement and behaviour modification in "at risk," "marginalized" settings. Self-Help is a process of learning with and from each other which provides participants oppor· tunities for support in dealing with a problem, issue, condition or need. Self-help groups are mechanisms for the participants to investigate existing solutions and discover alternatives, empowering themselves in this process. Learning dynamic in self-help groups is similar to that of cooperative learning and peertraining, has proven successful, effective and efficient (Haller et al, 2000) . The mutual support provided by participation in these groups is documented as contributory factor in the improved health of those involved. Cognizant of the above theoretical basis, in 2004 the Self-Help Resource Centre initiated the "Empowering Stroke Prevention Project." The project was implemented after the input from 32 health organizations, a scan of more than 300 resources and an in-depth analysis of 52 risk-factor-specific stroke prevention materials indicated the need for such a program. The project objectives were:• To develop a holistic and empowering health promotion model for stroke prevention that incorporates selfhelp and peer support strategies. • To develop educational materials that place modifiable risk factors and lifestyle information in a relevant context that validates project participants' life experiences and perspectives.• To educate members of at-risk communities about the modifiable risk factors associated with stroke, and promote healthy living. To achieve the above, a diverse group of community members were engaged as "co-editors" in the development of stroke prevention education materials which reflected and validated their life experiences. These community members received training to become Lay Health Promoters (trained volunteer peer facilitators). In collaboration with local health organizations, these trained lay Health Promoters were then supported in organizing their own community-based stroke prevention activities. In addition, an educational booklet written in plain language, entitled Healthy Ways to Prevent Stroke: A Guide for You, and a companion guide called Healthy Ways to Pre· vent Stroke: A Facilitator's Guide were produced. The presentation will include the results of a tw<>tiered evaluation of the program methodology, educational materials and the use of the materials beyond the life of the project. This poster presentation will focus on the development and structure of an innovative street outreach service that assists individuals who struggle mental illness/addictions and are experiencing homelessness. The Mental Health/Outreach Team at Public Health and Community Services (PHCS) of Hamilton, Ontario assists individuals in reconnecting with health and social services. Each worker brings to the ream his or her own skills-set, rendering it extremely effective at addressing the multidimensional and complex needs of clients. Using a capacity building framework, each ream member is employed under a service contract between Public Health and Community Services and a local grassroots agency. There are Public Health Nurses (PHN), two of whom run a street health centre and one of Canada's oldest and most successful Needle Exchange Programs, mental health workers, housing specialists, a harm reduction worker, youth workers, and a United Church Minister, to name a few. A Community Advisory Board, composed of consumers and professionals, advises the Program quarterly. The program is featured on Raising the Roors 'Shared Learnings on Homelessness' website at www.sharedlearnings.ca. Through our poster presentation participants will learn how to create effective partnerships between government and grassroots agencies using a capacity building model that builds on existing programs.

This study aims to assess the effects of broadcasting a series of documentary and drama videos, intended to provide information about the BC HealthGuide program in Farsi, on the awareness about and the patterns of the service usage among Farsi-speaking communities in the Greater Vancouver Area. The major goals of the present study were twofold; ( 1) to compare two methods of communications (direct vs. indirect messages) on the attitudes and perceptions of the viewers regarding the credibility of messengers and the relevance of the information provided in the videos, and (2) to compare and contrast the impact of providing health information (i.e., the produced videos) via local TVs with the same materials when presented in group sessions (using VCR) on participants' attitudes and perceptions cowards the BC HealrhGuide Services.

Results: Through a telephone survey, 545 Farsi-speaking adults were interviewed in November and December 2004. The preliminary findings show that 53% of the participants had seen the aired videos, from which, 51 % watched at least one of the 'drama' clips, 8% watched only 'documentary' clip, and 41% watched both types of video. In addition, 27% of the respondents claimed that they were aware about the program before watching the aired videos, while 73% said they leaned about the services only after watching the videos. From this group, 14% said they called the BCHG for their own or their "hildren's health problems in the past month. 86% also indicated that they would use the services in the future whenever it would be needed. 48% considered the videos as "very good" and thought they rnuld deliver relevant messages and 21 % expressed their wish to increase the variety of subjects (produ\:e more videos) and increase the frequency of video dips.

Conclusion: The results of this study will assist public health specialists in BC who want to choose the best medium for disseminating information and apply communication interventions in multi\:ultural communities.

Introduction: Many theorists and practitioners in community-based research (CBR) and knowledge transfer (KT) strongly advocate for involvement of potential users of research in the development of research projects, yet few examples of such involvement exist for urban workplace health interventions. We describe the process of developing a collaborative research program.

Methods: Four different sets of stakeholders were identified as potential contributors to and users of the research: workplace health policy makers, employers, trade unions, and health and safety associations. Representatives of these stakeholders formed an Advisory Committee which met quarterly. Over the 13 month research development period, an additional 21 meetings were held between resc:ar~h~rs and stakeholders. In keeping with participant observation approaches, field notes of group and md1v1~ ual meetings were kept by the two co-authors. Emails and telephone calls were also documented. Qu~h tative approaches to textual analysis were used, with particular attention paid to collaborattve v160 POSTER SESSIONS relationships established (as per CBR), indicators of stakeholders' knowledge utilization (as per KT), and transformations of the proposed research (as per CBR).

Results: Despite initial strong differences of opinion both among stakeho~ders .an~ between stakeholders and researchers, goodwill was noted among all involved. Acts of rec~proc1ty included mu.rual sharing of assessment tools, guidance on data utilization to stakeho~der orga~1zat10ns, and suggestions on workplace recruitment to researchers. Stakeholders demonstrated mcreases m concep~ual. un~erstand ing of workplace health e.g. they more commonly discussed more complex,. psychosocial md1cators of organizational health. Stakeholders made instrumental use of shared materials based on research e.g. adapting their consulting model to more sophisticated dat~ analysis. Sta~ehol?~rs recogni_zed the strategic use of their alliance with researchers e.g., transformational leadership trainmg as a~ inducement to improve health and safety among small service franchises. Stakeholders helped re-define the research questions, dramatically changed the method of recruitment from researcher cold call to stakeholderbased recruitment, and strongly influenced pilot research designs. Owing a great deal to the elaborate joint development process, the four collaboratively developed pilot project submissions which were all successfully funded.

Conclusion: The intensive process of collaborative development of a research program among stakeholders and researchers was not a smooth process and was time consuming. Nevertheless, the result of the collaborative process was a set of projects that were more responsive to stakeholder needs, more feasible for implementation, and more broadly applicable to relevant workplace health problems.

Introduction: Environmental groups, municipal public health authorities and, increasingly, the general public are advocating for reductions in pesticide use in urban areas, primarily because of concern around potential adverse health impacts in vulnerable populations. However, limited evidence of the relative merits of different intervention strategies in different contexts exists. In a pilot research project, we sought to explore the options for evaluating pesticide reduction interventions across Ontario municipalities.

Methods: The project team and a multi-stakeholder Project Advisory Committee (PAC), generated a list of potential key informants (Kl) and an open ended interview guide. Thirteen KI from municipal government, industry, health care, and environmental organizations completed face to face or telephone interviews lasting 30-40 minutes. In a parallel process, a workshop involving similar representatives and health researchers was held to discuss the role of pesticide exposure monitoring. Minutes from PAC meetings, field notes taken during KI interviews, and workshop proceedings were synthesized to generate potential evaluation methods and indicators.

Results: Current evaluation activities were limited but all Kls supported greater evaluation effons beginning with fuller indicator monitoring. Indicators of education and outreach services were imponant for industry representatives changing applicator practices as well as most public health units and environmental organizations. lndictors based on bylaw enforcement were only applicable in the two cities with bylaws, though changing attitudes toward legal approaches were being assessed in many communities. The public health Rapid Risk Factor Surveillance System could use historical baseline data to assess changes in community behaviour through reported pesticide uses and practices, though it had limited penetration in immigrant communities not comfortable in English. Pesticide sales (economic) data were only available in regional aggregates not useful for city specific change documentation. Testing for watercourse or environmental contamination might be helpful, but it is sporadic and expensive. Human exposure monitoring was fraught with ethical issues, floor effects from low levels of exposure, and prohibitive costs. Clinical episodes of pesticide exposure reported to the Regional Poison Centre (all ages) or the Mother Risk program (pregnant or breastfeeding women) are likely substantial underestimates that would be need to be supplemented with sentinel practice surveillance. Focus on special clinical populations e.g., multiple chemical sensitivity would require additional data collection efforts .

. Conc~ons: Broad support for evaluation and multiple indicators were proposed, though con-s~raints associate~ with access, coverage, sensitivity and feasibility were all raised, demonstrating the difficulty of evaluating such urban primary prevention initiatives. interVentionists.

An important aim of the Youth Monitor is to learn more about the health development of children and adolescents and the factors that can influence this development. Special attention is paid to emo· tional and behavioural problems. The Youth Monitor identifies high-risk groups and factors that are associated with health problems.

At various stages, the Youth Monitor chancrs the course of life of a child. The sources of informa· tion and methods of research are different for each age group. The results arc used to generate various kinds of repons: for children and young persons, parents, schools, neighbourhoods, boroughs and the municipality of Rotterdam and its environs. Any problems can be spotted early, at borough and neigh· bourhood level, based on the type of school or among the young persons and children themselves.

Together with schools, parents, youngsters and various organisations in the area, the municipal health service aims to really address these problems. On request, an overview is offered of potentially suitable interventions. The authors will present the philosophy, working method, preliminary effects and future developments of this instrument, which serves as the backbone for the Rotterdam local youth policy.

Social Workers to be Leaders in Response to Aging Urban Populations: The Practicum Partnership Program Sarah Sisco, Alissa Yarkony, and Patricia Volland 1"'"1tliu:tion: Across the US, 77.5% of those over 65 live in urban areas. These aging urban popu· lations, including the Baby Boomers, have already begun encounter a range of heahh and mental hcahh conditions. To compound these effects, health and social service delivery fluciuates in cities, whit:h arc increasingly diverse both in their recipients and their systems. Common to other disciplines (medicine, nursing, psychology, etc.) the social work profession faces a shortage of workers who are well-equipped to navigate the many systems, services, and requisite care that this vast population requires. In the next two decades, it is projected that nearly 70,000 social workers will be required to provide suppon to our older urban populations. Social workers must be prepared to be aging-savvy leaders in their field, whether they specialize in gerontology or work across the life span.

MllhotU: In 2000, a study conducted at the New York Academy of Medicine d<>1:umcntcd the need for improved synchroniciry in two aspects of social work education, classroom instruction and the field experience. With suppon from the john A. Hanford foundation, our team created a pilot proj~"t entitled the Practicum Pannership Program (PPP) in 11 master's level schools of social work, to improvt" aginR exposure in field and classroom content through use of the following: I) community-university partnrr· ships, 2) increased, diverse student field rotations, ll infusion of competcn1."}'·drivm coursework, 41 enhancement of field instructors' roles, and 5) concentrated student recruitment. We conductt"d a prr· and post-teSt survey into students' knowledge, skills. and satisfaction.

ICarlJa: Surveys of over 400 graduateS and field inltnK."tors rcflected increased numlK-n of .1Rrm:y· univmity panncrships, as well as in students placed in aging agencin for field placements. There wa1 11 marked increase in student commitments to an aging specialization. Onr year por.t·gradu:nion rcvealrd that 93% of those surveyed were gainfully employed, with 80% employed in the field of aginic. By com· bining curricular enhancement with real-world experiences the PPP instilled a broad exposurr for llU· dents who worked with aging populations in multiple urban settings.

Coltdtuion: Increased exposure to a range of levels of practicr, including clinical, policy/aJvocaq, and community-based can potentially improve service delivery for older adulh who live in elfin, and potentially improve national policy. The Hanford Foundation has now elected to 1uppon cxpantion of the PPP to 60 schools nationwide (urban and rural) to complement other domntic initiatives to cnhalk"C" holistic services for older adults across the aging spectrum. Bodrgnn.ntl: We arc a team of rcscarcbcn and community panncn working tCJ8C(her to develop an in"itepth understanding of the mental health needs of homeless youth ~ages 16 to 24) (using qualiutivc and quantitative methods 8' panicipatory rncarch methods). It is readily apparmt that '-neless youth cxpcricnce a range of mental health problems. For youth living on the street, menul illnew may be either a major risk factor for homelessnal or may frequently emcsge in response to coping with rhe multitudinous stressors associated with homclCSlllCSI including exposure to violence, prasutt to pamaplte in v162 POSTER SESSIONS survival sex and/or drug use. The most frequent psychiatric diagnoses amongst the homeless gencrally include: depression, anxiety and psychosis.

. . .

The ultimate ob1ective of the pr~am of rei:e~ IS to ~evelop a plan for intervention to meet the mental health needs of street youth. Prior t_o pl~nnmg mtervenbOns, .it is necessary to undertake a comprehensive assessment ~f mental health needs m this ~lnerable populanon. Thus, the immediate objective of this research study is to undertake a comprehensive assessment of men· tal health needs. . . Melbotlology: A mixed methodology triangulating qualitative, participatory acnon and quantitative methods will capture the data related to mental health needs of homeless youth. A purposive sample of approximately 60-80 subjecrs. ages 16 to 24, is currently being ~ted ~participate from the commu.nity agencies Covenant House, Evergreen Centre fo~ srrc;et Youth, Turning P?1?t and Street ~ Serv~. Youth living on the street or in short -term residennal programs for a mmimum of 1 month pnor to their participation; ages 16 to 24 and able to give infonned consent will be invited to participate in the study.

O..tcomes: The expected outcome of this initial survey will be an increased understanding of mental health needs of street youth that will be used to develop effective interventions. It is anticipated that results from this study will contribute to the development of mental health policy, as well as future programs that are relevant to the mental health needs of street youth.

Note: It is anticipated that preliminary quantitative data (25 subjects) and qualitative data will be available for the conference. The authors intend to present the identification of the research focus, the formation of our community-based team, relevance for policy, as well as preliminary results.

P7-31 (A) The Need for Developing a Firm Health Policy for Urban Informal Worken: The Case of

Despite their critical role in producing food for urban in Kenya, urban farmers have largely been ignored by government planners and policymakers. Their activity is at best dismissed as peripheral eveo, inappropriate retention of peasant culture in cities and at worst illegal and often some-times criminal· ized. Urban agriculture is also condemned for its presumed negative health impact. A myth that contin· ues despite proof to the contrary is that malarial mosquitoes breed in maize grown in East African towns. However, potential health risks are insignificant compared with the benefits of urban food production. Recent studies too rightly do point to the commercial value of food produced in the urban area while underscoring the importance of urban farming as a survival strategy among the urban poor, especially women-headed households. Since the Millennium Declaration, health has emerged as one of the most serious casualties consequent on the poverty, social exclusion, marginalisation and lack of sustain· able development in Africa. HIV/AIDS epidemic poses an unprecedented challenge, while malaria, tuber· culosis, communicable diseases of childhood all add to the untenable burden. Malnutrition underpins much ill-health and is linked to more than 50 per cent of all childhood deaths. Kenya's urban poor people ~ace ~ h~ge burde~ of preventable and treatable health problems, measured by any social and bi~ medical md1cator, which not only cause unnecessary death and suffering, but also undermine econonuc development and damage the country's social fabric. The burden is in spite of the availability of suitable tools and re:c=hnology for prevention and treatment and is largely rooted in poverty and in weak healah •rstems. This pa~ therefore challenges development planners who perceive a dichotomy instead of con· tmuum between informal and formal urban wage earners in so far as access to health services is con· cemed. It i~ this gap that calls for a need to developing and building sustainable health systemS among the urban mformal ~wellers. We recommend a focus on an urban health policy that can build and strengthen the capacity of urban dwellers to access health services that is cost-effective and sustainable. Such ~ health poli<=>: must strive for equity for the urban poor, displaced or marginalized; mobilise and effect1~ely use sufficient sustainable resources in order to build secure health systems and services. Special anenti_on. should ~ afforded HIV/AIDS in view of the unprecedented challenge that this epidemic poses to Africa s economic and social development and to health services on the continent. Methods: A review of the literature led us to construct three simple models and a composite model of exposure to traffic. The data were collected with the help of a daily diary of travel activities using a sample of cyclists who went to or come back from work or study. To calculate the distance, the length of journey, and the number of intersections crossed by a cyclist different Geographic Information Systems (GIS) were operated. Statistical analysis was used to determine the significance between a measure of exposure on the one hand, and the sociodemographic characteristics of the panicipants or their geographic location on the other hand. RestlltJ: Our results indicate that cyclists were significantly exposed to road accidents, no matter of where they live or what are their sociodemographic characteristics. We also stress the point that the fact of having been involved in a road accident was significantly related to the helmet use, but did not reduce the propensity of the cyclists to expose themselves to the road hazards.

Condlllion: The efforts of the various authorities as regards road safety should not be directed towards the reduction of the exposure of the vulnerable users, but rather towards the reduction of the dangers to which they could face.

Keywords: cyclist, daily diary of activities, measures of exposure to traffic, island of Montreal.

P7-33 (A) Intra Urban Disparities and Environmental Health: Some Salient Features of Nigerian Residential Neighbourhoods Olumuyiwa Akinbamijo

Intra Urban disparities and Environmental Health: Some salient features of Nigerian residential neighbourhoods Abstract Urbanization panicularly in Nigerian cities, ponends unprecedented crises of grave dimensions. From physical and demographic viewpoints, city growth rates are staggering coupled with gross inabilities to cope with the consequences. Environmental and social ills associated with unguarded rapid urbanization characterize Nigerian cities and threaten urban existence. This paper repons the findings of a recent study of the relationship between environmental health across inrraurban residential communities of Akure, South West Nigeria. It discuses the typical urbanization process of Nigerian cities and its dynamic spatial-temporal characteristics. Physical and socio-demographic attributes as well as the levels and effectiveness of urban infrastructural services are examined across the core residential districts and the elite residential layouts in the town. The incidence rate of cenain environmentally induced tropical diseases across residential neighborhoods and communes is examined. Salient environmental variables that are germane to health procurement in the residential districts, incidence of diseases and diseases parasitology, diseases prevention and control were studied. Field data were subjected to analysis ranging from the univariate and bivariate analysis. Inferential statistics using the chi-square test were done to establish the truthfulness of the guiding hypothesis. Given the above, the study affirms that there is strong independence in the studied communities, between the environment and incidence of diseases hence health of residents of the town. This assertion, tested statistically at the district levels revealed that residents of the core districts have very strong independence between the environment and incidences of diseases. The strength of this relationship however thins out towards the city peripheral districts. The study therefore concludes that since most of the city dwellers live in urban deprivation, urban health sensitive policies must be evolved. This is to cater for the urban dwellers who occupy fringe peripheral sites where the extension of facilities often times are illegally done. Urban infrastructural facilities and services need be provided as a matter of public good for which there is no exclusive consumption or access even for the poorest of the urban poor. Many suffer from low-self esteem, shame and guilt about their drug use. In addition, they often lack suppon or encounter opposition from their panners, family and friends in seeking treatment. These personal barriers are compounded by fragmented addiction, prenatal and social care services, inflexible intake systems and poor communication among sectors. The experience of accessing adequate care between services can be overwhelming and too demanding. The Toronto Centre for Substance Use in Pregnancy (T-CUP) is a unique program developed to minimize barriers by providing Kone-stop" comprehensive healthcare. T-CUP is a primary care based program located in the department of Family Medicine at St. Joseph\'s Health Centre, a community teaching hospital in Toronto. The interdisciplinary staff provides prenatal and addiction services, case management, as well as care of newborns affected by substance use. Regular care plan meetings are held between T-CUP, Labour and Delivery nurses and social workers in the Y164 POSTER SESSIONS Maternity and Child Care program. T-CUP also connects "'.omen with. inpatient treatment programs and community agencies such as Breaking the Cycle, an on-site counselmg group for pregnant substance users.

· f · d d h Ith

Method: Retrospective chart review, qualitative patient ~ans action stu ~· an ea care provider surveys are used to determine outcomes. Primary outcomes mclude changes m maternal su~tance use, psychosocial status and obstetrical complications (e.g. pre-rupture of membrane, pre-eclampsia, placen· ral abruption and hemorrhage). Neonatal measures ~~nsisted of .bir~h pa_rame~ers, length of h~spital st.ay and complications (e.g. feral distress, meconium stammg, resuscitation, 1aund1ce, hypoglycemia, seventy of withdrawal and treatment length). Chart review consisted of all T-CUP patients who met clinical cri· reria for alcohol or drug dependence and received prenatal and intra-partum care at St. Joseph's from October 2003 to June 2005. Participants in the qualitative study included former and current T-CUP patients. Provider surveys were distributed on-site and to a local community hospital.

Raulb: Preliminary evaluation has demonstrated positive results. Treatment retention and satisfaction rates were high, maternal substance use was markedly reduced and neonatal outcomes have shown to be above those reported in literature.

Conclusion: This comprehensive, primary care model has shown to be optimal in the management of substance use in pregnancy and for improving neonatal outcomes. Future research will focus on how this inexpensive program can be replicated in other health care settings. T-CUP may prove to be the optimal model for providing care to pregnant substance users in Canada.

lntrod11ction: Cigarette smoking is one of the most serious health problems in Taiwan. The prevalence of smoking in 2002 is 48.1 % in males 5.9% in females aged 18 years and older. Although the government of Taiwan passed a Tobacco Hazards Control Act in 1997, it has not been strongly enforced in many places. Therefore, community residents have often reported exposure of second hand smoke. The purpose of the study was to establish a device to build up more smoke-free environments in the city of Tainan.

Methods: Unique from traditional intervention studies, the study used a healthy city approach to help build up smoke-free environments. The major concept of the approach is to build up a healthy city platform, including organizing a steering committee, setting up policies and indicators, creating intersectoral collaboration, and increasing community participation. First, more than 80 enthusiastic researchers, experts, governmental officers, city counselors and community leaders in Tainan were invited in the healthy city committee. Second, smoke-free policies, indicators for smoke-free environments, and mechanisms for inter-departmen· tal inspections were set up. Third, community volunteers were recruited and trained for persuading related stakeholders. Lastly, both penalties and rewards were used for help build up the environments.

Raults: Aher two-year (2003 Aher two-year ( -2005 execution of the project, the results qualitatively showed that smoke-free environments in Tainan were widely accepted and established, including smoke-free schools, smoke-free workpla~es, smoke-free households, smoke-free internet shops, and smoke-free restaurants.

Smoke~s were. effectively educated not to smoke in public places. Community residents including adults and children m the smoke-free communities clearly understand the adverse effects of environmental tobacco smoke and actively participated anti-smoking activities.

Conclruions: Healthy city platform is effective to conquer the barrier of limited anti-smoking rc:sources. Nor. only can it enlar:ge community actions for anti-smoking campaigns, but also it can provide par_merships for collaboratJOn. By establishing related policies and indicators the effects of smoke· free environments can be susta1·ned a d th · · · ' · n e progression can be monitored m a commuruty. These issues are used ~· oi::c It~ goals, WEUHA identifies issues that put people's health at risk.

Presently, team com~u:C: ran ee~tion !earns. (IATs) that design integrative solutions ~teSJ'°~ g om six to fifteen members. Methods In order to establish WO-POSTER SESSIONS v165 projects for WEUHA, the following approach was undertaken: I. A project-polling template was created and sent to all members of the Alliance for their input. Each member was asked to identify thdr top two population groups, and to suggest a project on which to focus over a 12-18 month period for each identified population. 2. There was a 47% response to the poll and the top three population groups were identified. Data from the Toronto Community Health Profile database were utilized to contextualize the information supplied for these populations. A presentation was made to the Steering Committee and three population-based projects were selected, leaders identified and IATs formed. Three Population-Based Projects: The population-based projects and health care issues identified are: Newcomer prenatal uninsured women; This project will address the challenges faced by providers to a growing number of non-insured prenatal women seeking care. A service model where the barrier of "catchments" is removed to allow enhanced access and improved and co-ordinated service delivery will be pilot-tested.

Children/Obesity/Diab etes: Using a health promotion model this team will focus on screening, intervention, and promoting healthy lifestyles (physical activity and nutrition) for families as well as for overweight and obese children.

Seniors Health Promotion and Circle of Discharge: This team will develop an early intervention model to assist seniors/family unit/caregivers in accessing information and receiving treatment/care in the community. The Circle of Discharge initiative will address ways of utilizing community supports to keep seniors in the community and minimize readmissions to acute care facilities.

Results/Expected Outcomes: Coordinated and enhanced service delivery to identified populations, leading to improved access, improved quality of life, and health care for these targeted populations.

Introduction: Basic human rights are often denied to high-risk populations and people living with HIV/AIDS. Their rights to work and social security, health, privacy, non discrimination, liberty and freedom of movement, marriage and having a family have been compromised due to their sero-positive status and risk of being positive. The spread of HIV/AIDS has been accelerating due to the lack of general human rights among vulnerable groups. To formulate and implement effective responses needs dialogue and to prevent the epidemic to go underground barriers like stigma need to be overcome.

Objective: How to reduce the situation of stigma, discrimination and human rights violations experienced by people living with HIV/AIDS and those who are vulnerable to HIV/AIDS. Methodology and Findings: Consultation meetings were strm.-rured around presentations, field visits, community meetings and group work to formulate recommendations on how Govt and NGOs/CBOs should move forward based on objective. Pakistan being a low prevalence country, the whole sense of compl;u:enc.:y that individuals are not subject to situations of vulnerable to HIV is the major threat to an explosion in th•· epidemic, therefore urgent measures are needed to integrate human rights issues from the very start of the response. The protection and promotion of human rights in an integral component of ;tll responses to the HIV/AIDS epidemic. It has been recognized that the response to HIV/AIOS must he multi sectoral and multi faceted, with each group contributing its particular expertise. For this to occur along with other knowlcdg<" more information is required in human rights abuses related to HIV/ AIDS in a particular scenario. The ~·on sultarion meetings on HIV/AIDS and human rights were an exemplary effort to achieve the same ohj<..:tivc.

Recommendations: The need for a comprehensive, integrated and a multi-sectoral appro;u.:h in addressing the issue of HIV/AIDS was highlighted. The need social, cultural and religious asp•·ct' to he: prominently addressed were identified. It was thought imperative measures even in low prevalence countries. Education has a key role to play, there is a need for a code of ethics for media people and h<"alth care providers and violations should be closely monitored and follow up action taken.

P7-38 (C) How can Community-Based Funding Programs Contribute to Building Community Capacity and How can we Measure this Elusive Goal? Mary Frances Maclellan-Wright, Brenda Cantin, Mary Jane Buchanan, and Tammy Simpson Community capacity building is recognized by the Public Health Agency of Canada (PHAC) as an important strategy for improving the overall health of communities by enabling communities to addre~s priority issues such as social and economic determinants of health. In 2004/2005 PHAC.:, Alberta/NWf Region's Population Health Fund (PHF) supported 12 community-based projects to build community capacity on or across the determinants of health. Specifically, this included creating accessible and sup· portive social and physical environments as well as creating tools and processes necessary for healthy policy development and implementation. The objective of this presentation is to highlight how the Community Capacity Building Tool, developed by PHAC AB/NWf Region, can demonstrate gains in v166 POSTER SESSIONS · · the course of a pror· ect and be used as a reflective tool for project planning and community capacity over . . . . I · A art of their reporting requirements, 12 pro1ect sites completed the Community Caparny eva uanon. s p . . Th T I II I'd d . Building Tool at the beginning and end of their ~ne-year prorect. e oo ~o ects va 1 an reliable data in the context of community-based health prorects. Developed through a vigorous ~nd collabora11ve research process, the Tool uses plain languag~ to expl~re nine key f~atures o~ commuruty cap~city with 35 't ch with a section for contextual information, 26 of which also mdude a four-pomt raong 1 ems, ea f fu d · scale. Results show an increase in community capacity over the course o the nde prorects. Pre and post aggregate data from the one-year projects measure~ statistic.ally si~n~ficant changes for 17 of the 26 scaled items. Projects identified key areas of commumty capacity bmldmg that needed strengthemng, such as increasing participation, particularly among people with low incomes; engaging community members in identifying root causes; and linking with community groups. In completing the Tool, projects examined root causes of the social and economic determinants of health, thereby exploring social justice issues related to the health of their community. Results of the Tool also served as a reflec· cion on the process of community capacity building; that is, how the project outcomes were achieved. Projects also reported that the Tool helped identify gaps and future directions, and was useful as a project planning, needs assessment and evaluation tool. Community capacity building is a strategy that can be measured. The Community Capacity Building Tool provides a practical means to demonstrate gains in community capacity building. Strengthening the elements of community capacity building through community-based funding can serve as building blocks for addressing other community issues.

Needs of Marginalized Crack Users Lorraine Barnaby, Victoria Okazawa, Barb Panter, Alan Simpson, and Bo Yee Thom Background: The Safer Crack Use Coalition of Toronto (SCUC) was formed in 2000 in response to the growing concern for the health and well-being of marginalized crack users. A central concern was the alarm· ing Hepatitis C rate ( 40%) amongst crack smokers and the lack of connection to prevention and health ser· vices. SCUC is an innovative grassroots coalition comprised of front-line workers, crack users, researcher! and advocates. Despite opposition and without funding, SCUC has grown into the largest crack specific harm reduction coalition in Canada and developed a nationally recognized sarer crack kit distribution program (involving 16 community-based agencies that provide outreach to users). The success of our coalition derives from our dedication to the issue and from the involvement of those directly affected by crack use.

Setting: SCUC's primary service region is Greater Toronto, a diverse, large urban centre. Much ofour work is done in areas where homeless people, sex trade workers and drug users tend to congregate. Recently, SCUC has reached out to regional and national stakeholders to provide leadership and education.

Mandate: Our mandate is to advocate for marginalized crack users and support the devdopmentof a com.p.rehensive harm reduction model that addresses the health and social needs facing crack users; and to fac1htare the exchange of information between crack users, service providers, researchers, and policy developers across Canada.

Owrview: The proposed workshop will provide participants with an overview of the devdopment of SCUC, our current projects (including research, education, direct intervention and consultation), our challenge~ and s~ccesses and the role of community development and advocacy within the coalition. Pre-senter~ will consist of community members who have personal crack use experience and front-line work· ers-, SC.UC conducted a community-based research project (Toronto Crack Users Perspectives, 2005) , in w~ich 1 S focus groups with marginalized crack users across Toronto were conducted. Participants iden· t1f1ed health and social issues affecti h b · · · d " red .

. ng t em, arrsers to needed services, personal strategies, an oue recommendations for improved services. Presenters will share the methodology, results and recommen· datmns resulting from the research project.

Conc/usio": Research, field observations and consultations with stakeholders have shown that cradck shmoke~s are at an. increased risk for sexually transmitted infections HIV/AIDS Hepatitis C, TB an ot er serious health issues Health · ff, · ' ' · · .

· issues a ectmg crack users are due to high risk behavmurs, socio· economic factors, such as homeless d. · · · · d · 1 . 1 .

ness, 1scrsmmat1on, unemployment, violence incarceraoons, an soc1a 1so at1on, and a lack of comprehe · h I h · ' ns1ve ea t and social services targeting crack users. · · sinCt · s, owever arge remains a gross underesurnaoon.

POSTER SESSIONS v167 these are Hospital-based reports and many known cases go unreported. However teh case, young age at first intercourse, inconsistent condom use and multiple partnersplace adolescents at high risks for a diverse array of STls, including HIV. About 19% of female Nigerian Secondary School Students report initiating Sexual intercourse before age 13 years. 39% of Nigerian female Secondary School students report not using a condom the last time they had sexual intercourse. More than 60% of Urban Nigerian teens report inconsistent condom use.

Methods: 371 adolescents were studied, ages 12 to 19, from Benin City in Edo State. The models used were Mother-Daughter(119), Mother -Son(99), Father -Son (87), and Father-Daughter(66). The effect of Parent-Child sexual communicationat baseline on Child\'s report of sexual behavior, 6 to 12 months later were studied. Greater amounts of sexual risk communication were asociated with markedly fewer episodes of unprotected sexual intercourse, reduced number of sexual partners and fewer episodes of unprotected sexual intercourse.

Results: This study proved that Parents can exert more influence on the sexual knowledge attitudes and practise of their adolescent children through desired practises or rolemodeling, reiterating their values and appropriate monitoring of the adolescents\' behavior. They also stand to provide information about sexuality and various sexual topics. Parental-Child sexual communication has been found to be particularly influential and has been associated with later onset of sexual initiation among adolescents, less sexual activity, more responsible sexual attitudes including greater condom use, self efficacy and lower self -reported incidence of STis.

Conclusions: Parents need to be trained to relate more effectively with their Children/Wards about issues related to sex and sexuality. Family -based programs to reduce sexual risk-taking need to be developed. There is also the need to carry out cross-ethnicaland cross-cultural studies to identify how Parent-Child influences on adolescent sexual risk behavior may vary in different regions or Countries, especially inthis era of the HIV pandemic.

Introduction: Public health interventions to identify and eliminate health disparities require evidence-based policy and adequate model specification, which includes individuals within a socioecological context, and requires the integration of biosociomedical information. Multiple public and private data sources need to be linked to apportion variation in health disparities ro individual risk factors, the health delivery system, and the geosocial environment. Multilevel mapping of health disparities furthers the development of evidence-based interventions through the growth of the Public Health Information Network (PHIN-CDC) by linking clinical and population health data. Clinical encounter data, administrative hospital data, population socioenvironmental data, and local health policy were examined in a three-level geocoded multilevel model to establish a tracking system for health disparities. NJ has a long established political tradition of "home rule" based in 566 elected municipal governments, which are responsible for the well-being of their populations. Municipalities are contained within Counties as defined by the US Census, and health data are linked mostly at the municipality level. Marika Schwandt Community organizers from the Ontario Coaliti~n Again~t Pove~, .along ":ith ~edical practitioners who have endorsed the campaign and have been mvolved m prescnbmg special diet needs for OW and ODSP recipients, will discuss the Raise the Rates campaign. The organizati~n has used a special diet needs supplement as a political tool, meeting the urgent needs o.f .poor ~ople m Toront~ while raising the issues of poverty as a primary determinant of health and nutrtnous diet as a preventative health mea· sure. Health professionals carry the responsibility to ensure that they use all means available to them to improve the health of the individuals that they serve, and to prevent future disease and health conditions. Most health practitioners know that those on social assistance are not able to afford nutritious foods or even sufficient amounts of food, but many are not aware of the extra dietary funds that are available aher consideration by a health practitioner. Responsible nurse practitioners and physicians cannot, in good conscience, ignore the special needs diet supplement that is available to all recipients of welfare and disabiliry (OW and ODSP). A number of Toronto physicians have taken the position that all clients can justifiably benefit from vitamins, organic foods and high fiber diets as a preventative health measure. We know that income is one of the greatest predictors of poor health. The special needs diet is a health promotion intervention which will prevent numerous future health conditions, including chronic conditions such as cardiovascular disease, cancer, diabetes and osteoporosis. Many Communiry Health Centres and other providers have chosen to hold clinics to allow many patients to get signed up for the supplement at one time. Initiated by the Ontario Coalition Against Poverty, these clinics have brought together commu· niry organizers, community health centers, health practitioners, and individuals, who believe that poverty is the primary determinant of poor health. We believe that rates must be increased to address the health problems of all people on social assistance, kids, elders, people with HIV/AIDS -everyone. Even in the context of understaffing, it could be considered a priority activity that has potentially important health promotion benefits. Many clients can be processed in a two hour clinic. Most providers find it a very interesting, rewarding undertaking. In 2004 the Ontario Coalition for Social Justice found that a Toronto family with two adults and two kids receives $14,316. This is $21,115 below the poverty line.

P7-43 (C) The Health of Street Youth Compared to Similar Aged Youth Beth Hayhoe and Ruth Ewert . lntrod~on: Street Youth are at an age normally associated with good health, but due to their risky ~hav1ours and th~ conditions in which they live, they experience health conditions unlike their peer~ an more stable env1r~nments. In addition, the majority of street youth have experienced significant physical, sexual ~nd em.ot1onal abuse as younger children, directly impacting many of the choices they make around their physical and emotional health. We examined how different their health really is.

. , Methodl: Using a retrospective analysis of the 11 years of data gathered from Yonge Street Mis· 510~ 5 • Evergreen Health Centre, the top 10 conditions of youth were examined and compared with national tren~s for similar aged youth. Based on knowledge of the risk factors present in the group, rea· sons for the difference were examined. d' ~Its: Street youth experience more illness than other youth their age and their illnesses can bt . irect t ·~kc~ to the. conditions in which they live. Long-term impacts of abus~ contribute to such signif· ~~nt t e t 0 d~slpl air that youth may voluntarily engage in behaviours or lack of self care in the hope at t cir 1ve~ w1 perhaps come to a quicker end.

Concl11non: Although it has Ion b k h th' dy clearly shows 3 d'fi . h g ee~ no~n t at poverty negatively affects health, ~SIU be used to make ; erence m t .e health of this particular marginalized population. The infonnanon can relates to th . ecommendatio.ns around public policy that affects children and youth, especially as it e1r access to appropriate health care and follow up.

P7-44 (Cl Why do Urban Children · B gt .

Tarek Hussain 10 an adesh Die: How to Save our Children?

The traditional belief that urban child alid.

A recent study (DHS d fr 17 r~n are better off than rural children might be no longer v urban migrants are highata th om h c~untn~s I demonstrates that the child survival prospects of rural· er an t ose m their r J · · ·grants.

In Bangladesh, currently 30 million 0 ~r~ 0~1gm and lower than those of urban non-IDI million. Health of the urban 1 ~ p~e are hvmg m urban area and by the year 2025, it would be SO the popu at1on 1s a key A eals that urban poor have the worse h 1 h . concern. recent study on the urban poor rev ea t situation than the nation as a whole. This study shows that infant POSTER SESSIONS v169 mortality among the urban poor as 120 per thousand, which are above the rural and national level estimates. The mortality levels of the Dhaka poor are well above those of the rest of the city's population but much of the difference in death rates is explained by the experience of children, especially infants. Analyzing demographic surveillance data from a large zone of the city containing all sectors of the population, research showed that the one-fifth of the households with the least possessions exhibited U5 child mortality almost three times as high as that recorded by the rest of the population. Why children die in Bangladesh? Because their parents are too poor to provide them with enough food, clean water and other basic needs to help them avoid infection and recover from illness. Researchers believed that girls are more at risk than boys, as mothers regularly feed boys first. This reflects the different value placed on girls and boys, as well as resources which may not stretch far enough to provide for everyone. Many studies show that housing conditions such as household construction materials and access to safe drinking water and hygienic toilet facilities are the most critical determinants of child survival in urban areas of developing countries. The present situation stressed on the need for renewed emphasis on maternal and child healthcare and child nutrition programs. Mapping Path for progress to save our children would need be done strategically. We have the policies on hand, we have the means, to change the world so that every child will survive and has the opportunity to develop himself fully as a healthy human being. We need the political will--courage and determination to make that a reality.

P7-45 (C) Sherbourne Health Centre: Innovation in Healthcare for the Transgendered Community James Read Introduction: Sherbourne Health Centre (SHC), a primary health care centre located in downtown Toronto, was established to address health service gaps in the local community. Its mission is to reduce barriers to health by working with the people of its diverse urban communities to promote wellness and provide innovative primary health services. In addition to the local communities there are three populations of focus: the Lesbian, Gay, Bisexual, Transgendered and Transexual communities (LGBTT); people who are homeless or underhoused; and newcomers to Canada. SHC is dedicated to providing health services in an interdisciplinary manner and its health providers include nurses, a nurse practitioner, mental health counsellors, health promoters, client-resource workers, and physicians. In January 2003 SHC began offering medical care. Among the challenges faced was how to provide responsive, respectful services to the trans community. Providers had considerable expertise in the area of counselling and community work, but little in the area of hormone therapy -a key health service for those who want to transition from one gender to another.

Method: in preparing to offer community-based health care to the trans community it was clear that SHC was being welcomed but also being watched with a critical eye. Trans people have traditionally experienced significant barriers in accessing medical care. To respond to this challenge a working group of members of the trans community and health providers was created to develop an overall approach to care and specific protocols for hormone therapy. The group met over a one year period and their work culminated in the development of medical protocols for the provision of hormone therapy to trans individuals.

Results: SHC is currently providing health care to 281 registered clients who identify as trans individuals (March 31 2005) through primary care and mental health programs. In an audit of SHC medical charts (January 2003 to September 2004) 55 female-to-male (FTM) and 82 male-to-female (MTF) clients were identified. Less than half of the FTM group and just over two-thirds of the MTF group presented specifically for the provision of hormones. Based on this chart audit and ongoing experience SHC continues to update and refine these protocols to ensure delivery of quality care.

Conclusion: This program is an example of innovative community-based health delivery to a population who have traditionally faced barriers. SHC services also include counselling, health promotion, outreach and education.

P7-46 (C) Healthy Cities for Canadian Women: A National Consultation Sandra Kerr, Kimberly Walker, and Gail Lush On March 4 2005, the National Network on Environment and Women's Health held a Pan-Canadian consultation to identify opportunities for health research, policy change, and action. This consultation also worked to facilitate information sharing and networking between Canadian women working as urban planners, policy makers, researchers, and service workers on issues pertaining to the health of women living in Canadian cities.

Methods: For this research project, participants included front-line service workers, policy workers, researchers, and advocates from coast to coast, including Francophone women, women with disabilities, racialized women, and other marginalized groups. The following key areas were selected as topics for

DU.bnes i1 alto kading .:aUK of end·sugr ieaal clileue ia Singapore, accounting for more than SO% of new can

Singapore (NKFS) to embark on a Prevention Program (PP) 10 empo~r d1ahc

1J1U1F dieir condition bttter, emphasizing education and disease sdf·managemen1 lkilla a. essennal camponenn of good glycaemic control. We sought 10 explore the effects of a 1pecialiJed edu.:a11on pro· pun OD glycacmic conuol, as indicated by, serum HbA IC values

Budine serum HbA IC values were determined before un<k-rgmng the education progr ;am, which couisted of comprehensive dietary advice, ideal weight goals, and improving lipid profiln. Serum HbAIC values were obtained ar 3,6,9 months later to determine impact of the program. Analy11• wu done Uling paired !·tests

Significant reduction in HbA le levels from 0 ro 9 month• was observed in females, Chinese race, older age group(> SO yean). ohew-IBMI ~ 27.nwm2, Wai11 Hip Ratio> l),up to primary and above secondary level education and those having OM

Urine IClt showed that increasing HbAlc levels (9) had increasing urmary protein (38.± 117; .18 ±I IH

SO± 136) and crearinine (S2.S ± 64

7S ± 71; IOI± 7S) levels

FBG rnults showed that the management nf d1abetn m the NKFS Preven· tion Programme is effec;rive. Results also indicated 1har HbA le leve11 have a linnr trend wnh unnary protein and creatinine which are imponant determinants of renal diseate

tal Family-Focused Cinical Palbway1 Promoce Politivc OutcOllln for ua Inner City Canu allicy

IPMAI JerrnJm1 care llCtivirits in preparation for an infanr'' dilchargr honlr, and art m1endnl lo improve effi.:k'fl.:tn of c.are. 11lere i11 paucity of tttran:h, and inconsi1trncy of rnulta on 1ht-•m!*-1 of f1m1ly·fc"-'UW d1nM

1a: To determinr whrthrr implrmentation of family.focuted C:Pt 1n 1 Ntnn.tt.tl Unit W"n mg an inner city 1;ommunity drcl't'aKI leftarh of lf•Y (I.OSI and rromclll'I family uo•fkllon and rt.1J1 nest for dikhargr. Md6odt: Family-focuK"d CPI

1041 data wm coll«ted for all infant• horn btrwttn 29 and 36 Wft"k• 1t"lal111MI atr who wrtt .1dm111ed to the Ntonatal Unit

Lmgdl of -.y 111. 9 n. 14.8 daY'o p c O.OSI ind PMA .11 d•Mr., ho.nr 137.3 t 1.3 n. 36.4 ± I. I wb, p < O.OS) wett N«01fiamly F.lfrt 1n the pre.(]' poup. ~11.fxtMon ICOfn for famihn wrre high. and families noctd thc:y wnr mott prepued to ah thrar t..lby "'-· Thett was .a cosi uving of S 1,814 (Cdn) per patient d1teharpd home 1n the pmi-CP poap c.-pated 10 the P"''lfOUP· CortclaioN· lmplrmrnr.rion of family·foanrd C:P. in a Nrona1.1I Umt tC"fYIDI an 1nnn an com· muniry decre.ned length of'"'" mft with a high dcgrft of family uuJamon, and wrre COll~nT

At least 35% percent of the Kathmandu population lives in slum like conditions with poor access to basic health services. In these disadvantaged areas, a large proportion of children do not receive treatment due to inaccessibility to medical services. In these areas, diarrhea, pneumonia, and measles, are the key determinants of infant mortality. Protein energy malnutrition and Vitamin A deficiency persists and communicable diseases are compounded by the emergence of diseases like HIV/AIDS. While the health challenges for disadvantaged populations in Kathmandu are substantial, the city has also experienced various forms of innovative and effective community development health programs. For example, there are community primary health centers established by the Kathmandu Municipality to deliver essential health services to targeted communities. These centers not only provide equal access to health services to the people through an effective management system but also educate them hy organizing health related awareness programs. This program is considered one of the most effective urban health programs. The Paper/Presentation This paper will review large, innovative, and effective urhan health programs that are operating in Kathmandu. Most of these programs are currently run by international and national NGOs

A) Early Detection of Emerging Diseases in Urban Settings Through Syndromic Surveillance: 911 Data Pilot Study Kate Bassil

of community resources, and without adequate follow-up. In November 2003 shelter pr.oviders ~et with hospital social workers and CCAC to strike a Working Group to address some of th~ issues by mcre.asing knowledge among hospital staff of issues surrounding homelessness, and to build a stro?g workmg relationship between both systems in Hamilton. To date the HSWG has conducted four w~lkmg to~ of downtown shelters for hospital staff and local politicians. Recently the HSWG launched its ·~ool.k1t for Staff Working with Patients who are Homeless', which contains community resources and gu1dehnes to help with effective discharge plans. A SCPI proposal has been submitted to incre~se the capacity of the HSWG to address education gaps and opportunities with both shelters and hospitals around homelessness and healthcare. The purpose of this poster presentation is to share Hamilton's experience and learnings with communities who are experiencing similar issues. It will provide for intera~tion around shared experiences and a chance to network with practitioners across Canada re: best practices.

Introduction and Objectives: Canadians view health as the biggest priority for the federal government, where health policies are often based on models that rely on abstract definitions of health that provide little assistance in the policy and analytical arena. The main objectives of this paper are to provide a functional definition of health, to create a didactic model for devising policies and determining forms of intervention, to aid health professionals and analysts to strategize and prioritize policy objectives via cost benefit analysis, and to prompt readers to view health in terms of capacity measures as opposed to status measures. This paper provides a different perspective on health, which can be applied to various applications of health such as strategies of aid and poverty reduction, and measuring the health of an individual/ community/country. This paper aims to discuss theoretical, conceptual, methodological, and applied implications associated with different health policies and strategies, which can be extended to urban communities. Essentially, our paper touches on the following two main themes of this conference: •Health status of disadvantaged populations; and •Interventions to improve the health of urban communities.Methodology: We initially surveyed other models on this topic, and extrapolated key aspects into our conceptual framework. We then devised a theoretical framework that parallels simple theories of physkal energy, where health is viewed in terms of personal/societal Health Capacities and Effort components.After establishing a theoretical model, we constructed a graphical representation of our model using selfrated health status and life expectancy measures. Ultimately, we formulated a new definition of health, and a rudimentary method of conducting cost benefit analysis on policy initiatives. We end the paper with an application example discussing the issues surrounding the introduction of a seniors program.Results: This paper provides both a conceptual and theoretical model that outlines how one can go about conducting a cost-benefit analysis when implementing a program. It also devises a new definition and model for health barred on our concept of individual and societal capacities. By devising a definition for health that links with a conceptual and theoretical framework, strategies can be more logically constructed where the repercussions on the general population are minimized. Equally important, our model also sets itself up nicely for future microsimulation modeling and analysis.Implications: This research enhances one's ability to conduct community-based cost-benefit analysis, and acts as a pedagogical tool when identifying which strategies provide the best outcome. P7-06 (A) Good Playgrounds are Hard to Find: Parents' Perceptions of Neighbourhood Parks Patricia Tucker, Martin Holmes, Jennifer Irwin, and Jason Gilliland Introduction: Neighbourhood opportunities, including public parks and physical activity or sports fields hav~ been. iden.tified as correlates to physical activity among youth. Increasingly, physical activity among children 1s bemg acknowledged as a vital component of children's lives as it is a modifiable determinant of childh~d obesity. Children's use of parks is mainly under the influence of parents; therefore, the purpose of this study was to assess parents' perspectives of city parks, using London Ontario as a case study.M~~: This qualitative study targeted a heterogeneous sample of parents of children using local parks w1thm London. Parents with children using the parks were asked for 5 minutes of their time and if willing, a s.hort interview was conducted. The interview guide asked parents for their opinion 'of city parks, particularly the one they were currently using. A sample size of 50 parents is expected by the end of the summer.Results: Preliminary findings are identifying parents concern with the current Jack of shade in local parks. Most parents have identified this as a limitation of existing parks, and when asked what would make the parks better, parents agree that shade is vital. Additionally, some parents are recognizing the v170 POSTER SESSIONS focused discussions during the consultation: 1. Women in _Poverty 2. Women with Disability 3. Immi· grant and Racialized Women 4. The Built and _Physica_l Environment. . . . . R Its· Participants voiced the need for integration of the following issues withm the research and policy :::na; t) The intersectional nature of urban women's health i~sues wh~ch reflects the reality of women's complex lives 2) The multisectional aspect of urban wo_m~n s health, 1ss~es, which reflects the diversity within women's lives 3) The interse~roral _dynamics within _womens hves and urban health issues. These concepts span multiple sectors -mdudmg health, educat10n, and economics -when leveraging community, research, and policy support, and engaging all levels of government.Policy Jmplicatiom: Jn order to work towards health equity for women, plans for gender equity must be incorporated nationally and internationally within urban development initiatives: • Reintroduce "Women" and "Gender" as distinct sectors for research, analysis, advocacy, and action. •Integrate the multisectional, intersectional, and intersecroral aspects of women's lives within the framework of research and policy development, as well as in the development of action strategies. • Develop a strategic framework to house the consultation priorities for future health research and policy development (for example, advocacy, relationship building, evidence-based policy-relevant research, priority initiatives}.Note: Research conducted by NNEWH has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.P7-47 (C) Drugs, Culture and Disadvantaged Populations Leticia Folgar and Cecilia Rado lntroducci6n: A partir de un proyecto de reducci6n de daiios en una comunidad urbana en situ· aci6n de extrema vulnerahilidad surge la reflexion sobre el lugar prioritario de los elementos sociocuhurales en el acceso a los servicios de salud de diferentes colectivos urbanos. Las "formas de hacer, pensar y sentir" orientan las acciones y delimitan las posibilidades que tienen los individuos de definir que algo es o no problema, asf como tambien los mecanismos de pedido de ayuda. El analisis permanenre del campo de "las culturas cotidianas" de los llamados "usuarios de drogas" aporta a la comprension de la complejidad del tema en sus escenarios reales, y colabora en los diseiios contextualizados de politicas y propuestas socio-sanitarias de intervenci6n, tornandolas mas efectivas.Mitodos: Esta experiencia de investigaci6n-acci6n que utiliza el merodo emografico identifica elementos socio estructurales, patrones de consumo y profundiza en los elementos socio-simb61icos que estructuran los discursos de los usuarios, caracterizandolos y diferenciandolos en tanto constitutivos de IDENTIDADES SOCIA LES que condicionan la implementaci6n del programas de reduccion de daiios.Resultados: Los resultados que presentaremos dan cuenta de las caracteristicas diferenciadas v relaciones particulares ~ntre los consumidores de drogas en este contexto espedfico. A partir de este e~tudio de caso se mtentara co1?1enzar a responder preguntas que entendemos significativas a la hora de pensar intcrvcnciones a la med1da de poblaciones que comparten ciertas caracteristicas socio-culturales. (Cuales serian las .motivaciones para el cambio en estas comunidades?, cQue elementos comunitarios nos ayudan a i:nnstnur dema~~a? • cQue tenemos para aprender de las "soluciones" que ellos mismos encuenrran a los usos problemat1cos? Methods: Our study was conducted by a team of two researchers at three different sites. The mapping consisted of filling in a chart of observable neighbourhood features such as graffiti, litter, and boarded housing, and the presence or absence of each feature was noted for each city block. Qualitative observations were also recorded throughout the process. Researchers analyzed the compiled quantitative and qualitative neighbourhood data and then analyzed the process of data collection itself.Results: This study reveals the need for further research into the effects of physical environments on individual health and sense of well-being, and perception of investment in neighbourhoods. The process reveals that perceptions of health and safety are not easily quantified. We make specific recommendations about the mapping methodology including the importance of considering how factors such as researcher social location may impact the experience of neighbourhoods and how similar neighbourhood characteristics are experienced differently in various spaces. Further, we discuss some of the practical considerations around the mapping exercise such as recording of findings, time of day, temperature, and researcher safety.Conclusion: This study revealed the importance of exploring conceptions of health and well-being beyond basic physical wellness. It suggests the importance of considering one's environment and one's own perception of health, safety, and well-being in determining health. This conclusion suggests that attention needs to be paid to the connection between the workplace and the external environment it is situated in. The individual's workday experience does not start and stop at the front door of their workplace, but rather extends into the neighbourhood and environment around them. Our procedural observations and recommendations will allow other researchers interested in the effect of urban environments on health to consider using this innovative methodology.

Introduction: Responding ro protests against poor medical attention for sexually assaulted women and deplorable conviction rates for sex offenders, in the late 1970s, the Ontario government established what would become over 30 hospital-based Sexual Assault Care and Treatment Centres (SACTCs) across the province. These Centres, staffed around the clock with specially trained heath care providers, have become the centralized locations for the simultaneous health care treatment of and forensic evidence collection from sexually assaulted women for the purpose of facilitating positive social and legal outcomes. Since the introduction of these Centres, very little evaluative research has been conducted to determine the impact of this intervention. The purpose of our study was to investigate it from the perspectives of sexually assaulted women who have undergone forensic medical examinations at these Centres.Method: Women were referred to our study by SACTC Coordinators across Ontario. We developed an interview schedule composed of both closed and open-ended questions. Twenty-two women were interviewed, face-to-face. These interviews were approximately one-to-two hours in length, and were transcribed verbatim. To date, 19 have been analyzed for key themes.Results: Preliminary findings indicate that most women interviewed were Canadian born (79'Yo), and ranged in age from 17 to 46 years. A substantial proportion self-identified as a visible minority ( 37'X.). Approximately half were single or never married (47%) and living with a spouse or family of origin (53%). Most were either students or not employed (68%). Two-thirds (68%) had completed high school and onethird (37%) was from a lower socio-economic stratum. Almost two-fifths (37%) of women perceived the medical forensic examination as revictimizing citing, for example, the internal examination and having blood drawn. The other two-thirds (63%) indicated that it was an empowering experience, as it gave them a sense of control at a time when they described feeling otherwise powerless. Most (68%) women stated that they had presented to a Centre due to health care concerns and were very satisfied ( 84 % ) with their experiences and interactions with staff. Almost all (89%) women felt supported and understood.Conclusions: This research has important implications for clinical practice and for appropriately addressing the needs of sexually assaulted women. What is apparent is that continued high-quality medical attention administered in the milieu of specialized hospital-based services is essential. At the same time, we would suggest that some forensic evidence collection procedures warrant reevaluation. 

The study will take an experiential, approach by chroruclmg the impa~ of the transition f m the streets to stabilization in a managed alcohol program through the techruque of narrative i~:uiry. In keeping with the shift in thinking in the mental health fie!~ ~his stu~y is based on a paradigm of recovery rather than one of pathology. The "inner views of part1c1pants hves as they portray their worlds, experiences and observations" will be presented (Charm~z, 1991, ~· 38~)-"I?e p~ of the study is to: identify barriers to recovery. It will explore the exJ?Cnence of ~n~t1zanon pnor to entry into the program; and following entry will: explore the meanmg ~nd defirutto~s of r~overy ~~d the impact of the new environment and highlight what supports were instrumental m movmg pan1apants along the recovery paradigm.P7-St (A) Treating the "Untreatable": The Politics of Public Health in Vancouver's Inner City

Introdudion: This paper explores the everyday practices of therapeutic programs in the treaDnent of HIV in Vancouver's Inner City. As anthropologists have shown elsewhere, therapeutic programs do not siinply treat physical ailments but they shape, regulate and manage social lives. In Vancouver's Inner City, there are few therapeutic options available for the treatment of 1-IlV. Public health initiatives in the Inner City have instead largely focused on prevention and harm reduction strategies such as needle exchange programs, safe injection sites, and safer-sex education. Epidemiological reports suggest that less than a quarter of those living with HIV in the Downtown Eastside (DTES) are taking antiretroviral therapies raising critical questions regarding the therapeutic economy of antiretrovirals and rights to health care for the urban poor.Methods: This paper is drawn from ethnographic fieldwork in Vancouver's OTES neighborhood focusing on therapeutic programs for HIV treatment among "hard-to-reach" populations. The research includes participant-observation at Inner City Health Clinics specializing in the treatment of HIV; semi· structured interviews with HIV positive participants, health care professionals providing HIV treatment, and administraton working in the field of Inner City public health; and, lastly, observation at public meetings and conferences surrounding HIV treatment.R.awlts: HIV prevention and treatment is a central concern in the lives of many residents living in the Inner City -although it is just one of many health priorities afflicting the community. Concerns about drug resistance, cost of antiretrovirals, and illicit drug use means that HIV therapy for most is characterized by the daily observation of their medicine ingestion at health clinics or pharmacies. Daily observed treatment (DOT) is increasingly being adopted as a strategy in the therapeutic management of "untreatable" populations. DOT programs demand a particular type of subject -one who is "compliant" to the rules and regimes of public health. Over emphasis on "risky practices," "chaotic lives," and "~dh~rence" preve~ts the public health system from meaningful engagement with the health of the marginalized who continue to suffer from multiple and serious health conditions and who continue to experience considerable disparities in health.~ The ~ffec~s of HIV in the Inner City are compounded by poverty, laclc of safe and affordable houamg, vanous 1llegal underground economies increased rates of violence and outbreaks of ~~~·~ly tr~nsmitted infections, Hepatitis, and tuberculosi: but this research suggests 'that public health uunauves aimed at reducing health disparities may be failing the most vulnerable and marginal of citiztl1s.

Margaret Malone 1~ Vi~lence that occurs in families and in intimate relationships is a significant urban, ~unity, and pu~hc health problem. It has major consequences and far-reaching effects for women, ~~--renho, you~ sen1on, and families. Violence also has significant effects for those who provide and uKllC w receive health care Violence · · I · · . all lasses, · is a soc1a act mvolvmg a senous abuse of power. It crosses : ' : ' ~ 11 s;nden, ag~ ~ti~, cultures, sexualities, abilities, and religions. Societal responsesHali ra y oc:used on identificatton, crisis intervention and services for families and individuaJs.promoten are only "-"--:-g to add h · ' · I in intimate relationshi with"-~"'.". ress t e issues of violence against women and VJoence lenga to consider i~ m families. In thi_s P~per, I analyze issues, propose strategies, and note c~· cannot be full -...L'-~ whork towards erad1canng violence, while arguing that social justice and equity Y -.1ucvcu w en thett are people wh Mnhod: Critical social theory, an analysis that addresses culturally and ethnically diverse communities, together with a population health promotion perspective frame this analysis. Social determinants of health are used to highlight the extent of the problem of violence and the social and health care costs.The Ottawa Charter is integrated to focus on strategies for developing personal skills, strengthening community action, creating supportive environments, devdoping healthy public policies, and re-orientating health and social services. Attention is directed to approaches for working with individuals, families, groups, communities, populations, and society.Ratdts: This analysis demonstrates that a comprehensive interdisciplinary, multisectoral, and multifaceted approach within an overall health promoting perspective helps to focus on the relevant issues, aitical analysis, and strategies required for action. It also illuminates a number of interacting, intersecting, and interconnecting factors related to violence. Attention, which is often focused on individuals who are blamed for the problem of violence, is redirected to the expertise of non-health professionals and to community-based solutions.

The challenge for health promoters working in the area of violence in families and in intimate relationships is to work to empower ourselves and the communities with whom we work to create health-promoting urban environments. Social justice, equiry, and emancipatory possibilities are positioned in relation to recommendations for future community-based participatory research, pedagogical practices for health care practitioners, and policy development in relation to violence and urban health.

The Mid-Main Community Health Center, located in Vancouver British Columbia (BC), has a diverse patient base reflecting various cultures, languages, abilities, and socio-economic statuses. Due to these differences, some Mid-Main patients experience greater digital divide barriers in accessing computers and reputable, government produced consumer health information (CHI) websites, such as the BC HealthGuide and Canadian Health Network. Inequitable access is problematic because patient empowerment is the basis of many government produced CHI websites. An Internet terminal was introduced at Mid-Main in the summer of 2005, as part of an action research project to attempt to bridge the digital divide and make government produced CHI resources useful to a broad array of patients. Multi-level interventions in co-operation with patients, with the clinic and eventually government ministries were envisioned to meet this goal. The idea of implementing multi-level interventions was adopted to counter the tendency in interactive design to implement a universal solution for the 'ideal' end-user [ 1 ), which discounts diversity. To design and execute the interventions, various action-oriented and ethnographic methods were employed before and during the implementation of the Internet terminal. Upon the introduction of the Internet terminal, participant observation and interviews were conducted using a motion capture software program to record a digital video and audio track of patients' Internet sessions. This research provided insight into the spectrum of patients' capacities to use technology to fulfil their health information needs and become empowered. At the Mid-Main clinic it is noteworthy that the most significant intervention to enhance the usefulness of CHI websites for patients appeared to be a human rather than a technological presence. As demonstrated in other ethnographic research of community Internet access, technical support and capacity building is a significant component of empowerment (2). The Mid-Main wired waiting room project indicates that medical practitioners, medical administrators, and human intermediaries remain integral to making CHI websites useful to patients and their potential empowerment. (1) Over the past 5 years the Environmental Yo~th Alliance has been of~ering a.youth As~t. Mappin~ program which trains young people in community research and evaluation. Wh1~st the positive expenenc~ and relationships that have developed over this time attest to the success of this program, no evaluations has yet been undertaken to find out what works for t.he youth, what ~ould be changed, and what long term outcomes this approach offers for the youth, their local community, and urban governance. These topics will be shared and discussed to help other community disorganizing and uncials governments build better, youth-driven structures in the places they live.P7-55 (A) The World Trade Center Health Registry: A Unique Resource for Urban Health Researchers Deborah Walker, Lorna Thorpe, Mark Farfel, Erin Gregg, and Robert Brackbill Introduction: The World Trade Center Health Registry (WfCHR) was developed as a public health response to document and evaluate the long-term physical and mental health effects of the 9/11 disaster on a large, diverse population. Over 71,000 people completed a WfCHR enrollment baseline survey, creating the largest U.S. health registry. While studies have begun to characterize 9/11 bealth impacts, questions on long-term impacts remain that require additional studies involving carefully selected populations, long-term follow-up and appropriate physical exams and laboratory tests. WTCHR provides an exposed population directory valuable for such studies with features that make ita unique resource: (a) a large diverse population of residents, school children/staff, people in lower Man· hattan on 9/11 including occupants of damaged/destroyed buildings, and rescue/recovery/cleanup work· ers; (b) consent by 91 % of enrollees to receive information about 9/11-related health studies; (c) represenration of many groups not well-studied by other researchers; (c) email addresses of 62% of enrollees; (d) 30% of enrollees recruited from lists with denominator estimates; and (e) available com· parison data for NYC residents. WfCHR strives to maintain up-to-date contact information for all enrollees, an interested pool of potential study participants. Follow-up surveys are planned.Methods: To promote the WTCHR as a public health resource, Guidelines for External Researcher.; were developed and posted on (www.wtcregistry.org) which include a short application form, a twopage proposal and documentation of IRB approval. Proposals are limited to medical, public health, or other scientific research. Researchers can request de-identified baseline data or have DOHMH send information about their studies to selected WfCHR enrollees via mail or email. Applications are scored by the WTCHR Review Committee, comprised of representatives from DOHMH, the Agency for Toxic Subst~nces and Disease Registry, and WTCHR's scientific, community and labor advisory committees. A data file users manual will be available in early Fall 2005.~suits: Three external applications have been approved in 2005, including one &om a non-U.S. ~esearcher, all requesting information to be sent to selected WTCHR enrollees. The one completed mail· mg~~ WTCHR enrollee~ (o 3,700 WfC tower evacuees) generated a positive survey response rate. Three additional researchers mtend to submit applications in 2005. WfCHR encourages collaborations between researchers and labor and community leaders.Conclusion: Studies involving WTCHR enrollees will provide vital information about the long· term health consequences of 9/11. WTCHR-related research can inform communities, researcher.;, policy makers, health care providers and public health officials examining and reacting to 9111 and other disasters. t .,. dp'"f'osed: Thi is presentation will discuss the findings of attitudes toward the repeat male client iden· 1 ie as su1e1 a and substance us'n p · · · · I · 'd . . -1 g. articipants will learn about some identified effective strategies or service prov1 ers to assist this group of I · f men are oft · d bl men. n emergency care settings, studies show that this group 0 en viewe as pro emaric patient d I r for mental health p bl h h 5 an are more ikely to be discharged without an assessmen 200!) Ea 1 1 rofr ems t. an or er, more cooperative patients (Forster and Wu 2002· Hickey er al., · r Y resu ts om this study suggest th · · ' ' l · d tel' mining how best to h 1 . d 1 at negative amtudes towards patients, difficu nes e · As well pathways L_e_ p patientsblan ~ck of conrinuity of care influence pathways to mental health care.

• UC\:Ome pro emat1c when p ti k · che system. M a ems present repeatedly and become "get stuc ID Methods: Semi-structured intervie d . · (n=5), ED nurses (n=5) other ED ;s were con ucted with male ED patients (n=25), ED phys1oans ' sta (n= 7) and family physicians (n= 7). Patients also completed a POSTER SESSIONS v175 diagnostic interview. Interviews were tape-recorded, transcribed verbatim and managed using N6. Transcripts were coded using an iterative process and memos prepared capture emergent themes. Ethics approval was obtained and all participants signed a detailed informed consent form.Introduction: Urban settings are particularly susceptible to the emergence and rapid spread of nt•w or rare diseases. The emergence of infectious diseases such as SARS and increasing concerns over the next influenza pandemic has heightened interest in developing and using a surveillance systt·m which detects emerging public health problems early. Syndromic surveillance systems, which use data b,1scd on symptoms rather than disease, offer substantial potential for this by providing near-real-rime data which are linked to an automated warning system. In Toronto, we are piloting syndromic data from the 911 · Emergency Medical Services (EMS) database to examine how this information can be used on an ongoing basis for the early detection of syndromes including heat-related illness (HRI), and influenza-like-illness (Ill). This presentation will provide an outline of the planned desi_gn of this system and proposed evaluation.

For one year, 911 call codes which reflect heat-related illness or influenza-like-illness will be selected and searched for daily using software with a multifactorial algorithm. Calls will he stratified by call code, extracted from the 911-EMS database and transferred electronically to Toronto Public Health. The data will be analyzed for clusters and aberrations from the expected with the Realtime Outbreak and Disease Surveillance (RODS) system, a computer-based public health tool for the early detection of disease outbreaks. This 911-EMS surveillance system will be assessed in terms of its specificity and sensitivity through comparisons with the well-established tracking systems already in place for HR! and Ill. Others sources of data including paramedic ambulance call reports of signs and . this study will introduce complementary data sources t~ the ED ch1e~ complamt an~ o~~rthe-counter pharmacy sales syndromic surveillance data currently bemg evaluated m ~ther Ontar~o cltles. .

Syndromic surveillance is a unique approach to proactive(~ dete~tmg early c.hangesm the health status of urban communities. The proposed study aims to provide evidence of differential effectiveness through investigating the use of 911-EMS call data as a source of syndromic surveillance information for HR! and ILi in Toronto. Introduction: There is strong evidence that primary care interventions, including screening, brief advi<:e, treatment referral and pharmacotherapy are effective in reducing morbidity and mortality caused by substance abuse. Yet physicians are poor at intervening with substance users, in part because of lack of time, training and support. This study examines the hypothesis that shared care in addictions will result in decreased substance use and improved health status of patients, as well as increased use of primary care interventions by Primary Care Practitioners (PCPs).

Methods: The Addiction Medicine Service (AMS) at St. Joseph's Health Centre's Family Medicine Department is in the process of being transformed from its current structure as a traditional consult service into a shared care model called Addiction Shared Care (ASC). The program will have three components: Education, office systems and clinical shared care. As opposed to a traditional consult service, the patient will be booked with both a Primary Care Liaison Worker (PCL) and Addictions Physician. Patients referred from community physicians, the emergency department and inpatient medical and psychiatric wards will be recruited for the study as well as PCPs from the surrounding community. The target sample size is 100-150 physicians and a similar number of patients. After initial consult, patient will be recruited into the study with their consent. The shared-case model underlines the interaction and collaboration with the patient's main PCP. ASC will provide them with telephone consults, advice, support and re-assessment for their patients, as well as educational sessions and materials such as newsletters and informational kits.Results: The impact of this transition on our patient care and on PCP's satisfaction with the ASC model is currently being evaluated through a grant provided by the Ministry of Health & Long Term Care. A retrospective chart review will be conducted using information on the patient's substance use, ER/clinic visits, and their health/mood status. PCP satisfaction with the program will be measured through surveys and focus groups. Our cost-effectiveness analysis will calculate the overall cost of the program per patient..Conclusion: This low-cost service holds promise to serve as an optimal model and strategy to improve outcomes and reduce health care utilization in addict patients.

The Inner City Public Health Project Introduction The Inner City Public Health Project (ICPHP) was desi.gned to explore new an~ innovative ways to reach marginalized inner city populations that par-t1c1pate m high health-nsk beha~1ors. Much of this population struggles with poverty, addictions, mental illness and homelessness, creatmg barriers to accessing health services and receiving follow-up. This pro1ect was de~igned to evaluat~ .~e success of offering clinics in the community for testing and followup of communicable diseases uuhzmg an aboriginal outreach worker to build relationships with individuals and agencies. v1n(demographics~ history ~f testi~g ~nd immunization and participation in various health-risk behaviors), records of tesnng and 1mmumzat1ons, and mterviews with partner agency and project staff after one year.. Results: T~e CHR ~as i~strumental in building relationships with individuals and partner agencies ' .° the c~mmun_1~ re_sultmg m req~ests for on-site outreach clinics from many of the agencies. The increase m parnc1pat10n, the CHR mvolvement in the community, and the positive feedback from the agen? staff de~onstrated that.the project was successfully creating partnerships and becoming increasingly integrated m the community. Data collected from clients at the initial visit indicated that the project was reaching its target populations and highlighted the unique health needs of clients, the large unmet need for health services and the barriers that exist to accessing those services. ~usion: The outreach clinics were successful at providing services to target populations of high health-nsk groups and had great support from the community agencies. The role of the CHR was critical to the success of the project and proved the value of this category of health care worker in an urban aboriginal population. The unmet health needs of this disadvantaged population support the need for more dedicated resources with an emphasis on reducing access barriers.

Building a Caring Community Old Strathcona's Whyte Avenue, a district in Edmonton, brought concern about increases in the population of panhandlers, street people and homeless persons to the attention of all levels of government. The issue was not only the problems of homelessness and related issues, but feelings of insecurity and disempowerment by the neighbourhood residents and businesses. Their concerns were acknowledged, and civic support was offered, but it was up to the community itself to solve the problem. Within a year of those meetings, an Adult Outreach Worker program was created. The Outreach worker, meets people in their own environments, including river valley camps. She provides wrap-around services rooted in harm reduction and health promotion principles. Her relationship-based practice establishes the trust for helping clients with appropriate housing, physical and/or mental health issues, who have little or no income and family support to transition from homelessness. The program is an excellent example of collaboration that has been established with the businesses, community residents, community associations, churches, municiple services, and inner-city agencies such as Boyle Street Community Services. Statistics are tracked using the Canadian Outcomes Research Institute HOMES database, and feedback from participants, including people who are street involved. This includes an Annual General Meeting for community and people who are homeless. The program's holistic approach to serving the homeless population has been integral, both in creating community awareness and equipping residents and businesses to effectively interact with people who are homeless. Through this community development work, the outreach worker engages Old Strathcona in meeting the financial and material needs of the marginalized community. The success of this program has been surprising -the fact is that homeless people's lives are being changed; one person at a time and the community has been changed in how they view and treat those without homes. Over two years, the program has successfully connected with approximately seventy-five individuals who call Old Strathcona home, but are homeless. Thirty-six individuals are now in homes, while numerous others have been assisted in obtaining a healthier and safer lifestyles by becoming connected with other social/health agencies. The program highlights the roots of homelessness, barriers to change and requirements for success. It has been a thriving program and a model that works by showing how a caring community has rallied together to achieve prosperous outcomes. The SPN has created models of TB service delivery to be used m part~ers~1p with phannaceunca compa-. · · -. t' ns cooperatives and health maintenance orgamzanons (HMOs). For example, the mes, c1v1c orgamza 10 , . · b TB d' · SPN has established a system with pharmaceutical companies that help patients to uy me 1cmes at a special discounted rate. This scheme also allows patients to get a free one-_month's worth of~ dru_g supply if they purchase the first 5 months of their regimen. The sy_s~e~s were ~es1gned to be cm~pattble with eXISting policies for recording and documentation of the Ph1hppme National Tuberculosis Program (NTP). Aside from that, stakeholders were also encouraged to be DOTS-enabled through the use of m~nual~ and on-line training courses. The SPN initiative offers an alternative in easing the burden of TB sc:rv1ce delivery from rhe public sector through the harnessing of existing private-sector (DSOs). The learnmgs from the SPN experience would benefit groups from other locales that _work no~ only on ~ but other health concerns as well. The SPN experience showcases how well-coordinated private sector involvements help promote social justice in health delivery in urban communities.P7-63 (C) Young People in Control; Doing It Safe. The Safe Sex Comedy Juan Walter and Pepijn v. Empelen Introduction: High prevalence of chlamydia and gonorrhoea have been reported among migrants youth in Amsterdam, originating from the Dutch Antilles, Suriname and Sub-Sahara Africa. In addition, these groups also have high rates of teenage-pregnancy (Stuart, 2002) and abortions (Rademakers 1995), indicating unsafe sexual behaviour of these young people. Young people (aged 12 -30) from the so· called Urban Scene (young trendsetters in R&B/hip hop music and lifestyle) in Amsterdam have been approached by the Municipal Health Service (MHS) to collaborate on a safe sex project. Their input was to use comedy as vehicle to get the message a cross. For the MHS this collaboration was a valuable opportunity to reach a hard-to-reach group.Mdhods: First we conducted a need assessment by means of a online survey to assess basic knowledge and to similtaneously examine issues of interest concerning sex, sexuality, safer sex and the opposite sex. Second, a small literature study was conducted about elements and essential conditions for succesful entertainment & education (E&E) (Bouman 1999), with as most important condition to ensure that the message is realistic (Buckingham & Bragg, 2003) . Third a program plan was developed aiming at enhancing the STl/HIV and sexuality knowledge of the young people and addressing communication and educational skills, by means of drama. Subsequently a safe sex comedy show was developed, with as main topics: being in love, sexuality, empowerment, stigma, STI, HIVand safer sex. The messages where carried by a mix of video presentation, stand up comedy, spoken word, rap and dance.Results: There have been two safe sex comedy shows. The attendance was good; the group was divers' with an age range between 14 and 50 year, with the majority being younger than 25 year. More women than men attended the show. The story lines were considered realistic and most of the audients recognised the situations displayed. Eighty percent of the audients found the show entertaining and 60% found it edm:arional. From this 60%, one third considers the information as new. Almost all respondents pointed our that they would promote this show to their friends.Con.clusion: The s.h<_>w reached the hard-to-reach group of young people out of the urban scene and was cons1d_ered entert~mmg, educational and realistic. In addition, the program was able in addressing important ISSues, and impacted on the percieved personal risk of acquiring an STI when not using condoms, as well as on basic knowledge about STl's. Introduction: Modernity has contributed mightily to the marginality of adults who live with mental illnesses and the subsequent denial of opportunities to them. Limited access to social, vocational, educational, and residential opportunities exacerbates their disenfranchisement, strengthening the stigma that has been associated with mental illness in Western society, and resulting in the denial of their basic human rights and their exclusion from active participation in civil society. The clubhouse approach tn recovery has led to the reduction of both marginality and stigma in every locale in which it has been implemented judiciously. Its elucidation via the prism of social justice principles will lead to a deeper appreciation of its efficacy and relevance to an array of settings.

Methods: A review of the literature on social justice and mental health was conducted to determine core principles and relationships between the concepts. In particular, Fondacaro and Weinberg's (2002) conceptualization of social justice in community psychology suggests the desirability of the clubhouse approach in community mental health practice. A review of clubhouse philosophy and practice has led to the inescapable conclusion that there is a strong connection between clubhouse philosophy-which represents a unique approach co recovery--and social justice principles. Placing this highly effective model of community mental health practice within the context of these principles is long overdue. Via textual analysis, we will glean the principles of social justice inherent in the rich trove of clubhouse literature, particularly the International Standards of Clubhouse Development.Results: Fondacarao and Weinberg highlight three primary social justice themes within their community psychology framework: prevention and health promotion; empowerment, and a critical pnsp<"<·tive. Utilizing the prescriptive principles that inform every detail of clubhouse development and th<" movement toward recovery for individuals at a fully-realized clubhouse, this presentation asserts that both clubhouse philosophy and practice embody these social justice themes, promote human rights, and empower clubhouse members, individuals who live with mental illnesses, to achieve a level of wdl-heing and productivity previously unimagined.Conclusion: A social justice framework is critical to and enhances an understanding of the clubhouse model. This model creates inclusive communities that lead to opportunities for full partic1pil!ion 111 civil society of a previously marginalized group. The implication is that clubhouses that an· based on the International Standards for Clubhouse Programs offer an effective intervention strategy to guarantee the human rights of a sizable, worthy, and earnest group of citizens. to a drastic increase in school enrollment from 5.9 million in 2002 to 7.5 million in 200.S. However, while gross enrollment rates increased to 104°/., in the whole country after the introduction of FPE, it remained conspicuously low at 62% in the capital city, Nairobi. Nairobi City's enrollment rate is lower .than thatof all regions in the country except the nomadic North-Eastern province. !h.e.d1sadvantage of children bas_ed in the capital city was also noted in Uganda after the introduction of FPE m the late 1990s_-Many_ education experts in Kenya attribute the City's poor performance to the high propornon of children hvmg m slums, which are grossly underserved as far as social services are concerned. This paper ~xammes the impact of FPE and explores reasons for poor enrollment in informal settlements m Na1rob1 City.

Methods: The study utilizes quantitative and qualitative schooling data from the longitudinal health and demographic study being implemented by the African Population and Health Research Center in two informal settlements in Nairobi. Descriptive statistics are used to depict trends in enrollment rates for children aged 5-19 years in slum settlements for the period 2000-2005. Results: The results show that school enrollment has surprisingly steadily declined for children aged 15-19 while it increased marginally for those aged 6-14. The number of new enrollments (among those aged 5 years) did not change much between 2001 and 2004 while it declined consistently among those aged 6-9 since 2002. These results show that the underlying reasons for poor school attendance in poverty-stricken populations go far beyond the lack of school fees. Indeed, the results show that lack of finances (for uniform, transportation, and scholastic materials) has continued to be a key barrier to schooling for many children in slums. Furthermore, slum children have not benefited from FPE because they mostly attend informal schools since they do not have access to government schools where the policy is being implemented.Conclusion: The results show the need for equity considerations in the design and implementation of the FPE program in Kenya. Without paying particular attention to the schooling needs of the urban poor children, the millennium development goal aimed at achieving universal primary education will remain but a pipe dream for the rapidly increasing number of children living in poor urban neighborhoods.PS-04 (C) Programing for HIV/AIDS in the Urban Workplace: Issues and Insights Joseph Kamoga HIV/AIDS has had a major effect on the workforce. according to !LO 35million persons who are engaged in some form of production are affectefd by HIV/AIDS. The working class mises out on programs that take place in communities, yet in a number of jobs, there are high risks to HIV infection. working persons sopend much of their active life time in workplaces and that is where they start getting involved in risky behaviour putting entire families at risk. And when they are infected with HIV, working people face high levels of seclusion, stigmatisation and some miss out on benefits especially in countries where there are no strong workplace programs. Adressing HIV/AIDS in the workplace is key for sucessfull responses. This paper presents a case for workplace programing; the needs, issues and recommendations especially for urban places in developing countries where the private sector workers face major challenges.
