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Baltimore Highlands, MD, United States

Economic strengthening through entrepreneurial and microenterprise development has been shown to mitigate poverty-based health disparities in developing countries. Yet, little is known regarding the impact of similar approaches on disadvantaged U.S. populations, particularly inner-city African-American male youth disproportionately affected by poverty, unemployment, and adverse health outcomes. A systematic literature review was conducted to guide programming and research in this area. Eligible studies were those published in English from 2003 to 2014 which evaluated an entrepreneurial and microenterprise initiative targeting inner-city youth, aged 15 to 24, and which did not exclude male participants. Peer-reviewed publications were identified from two electronic bibliographic databases. A manual search was conducted among web-based gray literature and registered trials not yet published. Among the 26 papers retrieved for review, six met the inclusion criteria and were retained for analysis. None of the 16 registered microenterprise trials were being conducted among disadvantaged populations in the U.S. The available literature suggests that entrepreneurial and microenterprise programs can positively impact youth’s economic and psychosocial functioning and result in healthier decision-making. Young black men specifically benefited from increased autonomy, engagement, and risk avoidance. However, such programs are vastly underutilized among U.S. minority youth, and the current evidence is insufficiently descriptive or rigorous to draw definitive conclusions. Many programs described challenges in securing adequate resources, recruiting minority male youth, and sustaining community buy-in. There is an urgent need to increase implementation and evaluation efforts, using innovative and rigorous designs, to improve the low status of greater numbers of African-American male youth. © 2014, The New York Academy of Medicine. Source

Winch P.,Social and Behavioral Interventions Program | Stepnitz R.,Center for Injury Research and Policy
American Journal of Public Health

Peak oil refers to the predicted peak and subsequent decline in global production of petroleum products over the coming decades. We describe how peak oil will affect health, nutrition, and health systems in low-and middle-income countries along 5 pathways. The negative effects of peak oil on health and nutrition will be felt most acutely in the 58 low-income countries experiencing minimal or negative economic growth because of their patterns of sociopolitical, geographic, and economic vulnerability. The global health community needs to take additional steps to build resilience among the residents of low-and middle-income countries and maintain access to maternal and other health services in the face of predicted changes in availability and price of fossil fuels. Source

Poulsen M.N.,Social and Behavioral Interventions Program
Agriculture and Human Values

Civic agriculture is an approach to agriculture and food production that—in contrast with the industrial food system—is embedded in local environmental, social, and economic contexts. Alongside proliferation of the alternative food projects that characterize civic agriculture, growing literature critiques how their implementation runs counter to the ideal of civic agriculture. This study assesses the relevance of three such critiques to urban farming, aiming to understand how different farming models balance civic and economic exchange, prioritize food justice, and create socially inclusive spaces. Using a case study approach that incorporated interviews, participant observation, and document review, I compare two urban farms in Baltimore, Maryland—a “community farm” that emphasizes community engagement, and a “commercial farm” that focuses on job creation. Findings reveal the community farm prioritizes civic participation and food access for low-income residents, and strives to create socially inclusive space. However, the farmers’ “outsider” status challenges community engagement efforts. The commercial farm focuses on financial sustainability rather than participatory processes or food equity, reflecting the use of food production as a means toward community development rather than propagation of a food citizenry. Both farms meet authentic needs that contribute to neighborhood improvement, though findings suggest a lack of interest by residents in obtaining urban farm food, raising concerns about its appeal and accessibility to diverse consumers. Though not equally participatory, equitable, or social inclusive, both farms exemplify projects physically and philosophically rooted in the local social context, necessary characteristics for promoting civic engagement with the food system. © 2016 Springer Science+Business Media Dordrecht Source

Fonner V.A.,Social and Behavioral Interventions Program
Cochrane database of systematic reviews (Online)

Voluntary counseling and testing (VCT) continues to play a critical role in HIV prevention, care and treatment. In recent years, different modalities of VCT have been implemented, including clinic-, mobile- and home-based testing and counseling. This review assesses the effects of all VCT types on HIV-related risk behaviors in low- and middle-income countries. The primary objective of this review is to systematically review the literature examining the efficacy of VCT in changing HIV-related risk behaviors in developing countries across various populations. Five electronic databases - PubMed, Excerpta Medica Database (EMBASE), PsycINFO, Sociological Abstracts, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) - were searched using predetermined key words and phrases. Hand-searching was conducted in four key journals including AIDS, AIDS and Behavior, AIDS Education and Prevention, and AIDS Care; the tables of contents of these four journals during the included time period were individually screened for relevant articles. The reference lists of all articles included in the review were screened to identify any additional studies; this process was iterated until no additional articles were found. To be included in the review, eligible studies had to meet the following inclusion criteria: 1) Take place in a low- or middle-income country as defined by the World Bank, 2) Published in a peer-reviewed journal between January 1, 1990 and July 6, 2010, 3) Involve client-initiated VCT, including pre-test counseling, HIV-testing, and post-test counseling, and 4) Use a pre/post or multi-arm design that compares individuals before and after receiving VCT or individuals who received VCT to those who did not, and 5) Report results pertaining to behavioral, psychological, biological, or social HIV-related outcomes. All citations were initially screened and all relevant citations were independently screened by two reviewers to assess eligibility. For all included studies data were extracted by two team members working independently using a standardized form.  Differences were resolved through consensus or discussion with the study coordinator when necessary. Study rigor was assessed using an eight point quality score and through the Cochrane Collaboration's Risk of Bias Assessment Tool. Outcomes comparable across studies, including condom use and number of sex partners, were meta-analyzed using random effects models. With respect to both meta-analyses, data were included from multi-arm studies and from pre/post studies if adequate data were provided. Other outcomes, including HIV-incidence, STI incidence/prevalence, and positive and negative life events were synthesized qualitatively. For meta-analysis, all outcomes were converted to the standard metric of the odds ratio. If an outcome could not be converted to an odds ratio, the study was excluded from analysis.  An initial search yielded 2808 citations. After excluding studies failing to meet the inclusion criteria, 19 were deemed eligible for inclusion. Of these studies, two presented duplicate data and were removed. The remaining 17 studies were included in the qualitative synthesis and 8 studies were meta-analyzed.  Twelve studies offered  clinic-based VCT, 3 were employment-based, 1 involved mobile VCT, and 1 provided home-based VCT.  In meta-analysis, the odds of reporting increased number of sexual partners were reduced when comparing participants who received VCT to those who did not, unadjusted random effects pooled OR= 0.69 (95% CI: 0.53-0.90, p=0.007). When stratified by serostatus, these results only remained significant for those who tested HIV-positive. There was an insignificant increase in the odds of condom use/protected sex among participants who received VCT compared to those who did not, unadjusted random effects pooled OR=1.39 (95% CI: 0.97-1.99, p=0.076). When stratified by HIV status, this effect became significant among HIV-positive participants, random effects pooled OR= 3.24 (95% CI: 2.29-4.58, p<0.001). These findings add to growing evidence that VCT can change HIV-related sexual risk behaviors thereby reducing HIV-related risk, and confirming its importance as an HIV prevention strategy. To maximize the effectiveness of VCT, more studies should be conducted to understand which modalities and counseling strategies produce significant reductions in risky behaviors and lead to the greatest uptake of VCT. Source

Surkan P.J.,Social and Behavioral Interventions Program | Ettinger A.K.,Family and Reproductive Health | Ahmed S.,Family and Reproductive Health | Minkovitz C.S.,Family and Reproductive Health | Strobino D.,Family and Reproductive Health

OBJECTIVE: The aim of our study was to examine whether maternal depressive symptoms at 9 months postpartum adversely affect growth in preschool- and school-aged children. METHODS: We used data from the US nationally representative Early Childhood Longitudinal Study, Birth Cohort. We fit multivariable logistic regression models to study maternal depressive symptoms at 9 months postpartum (using the Center for Epidemiologic Studies Depression Scale) in relation to child growth outcomes, ≤10% height-for-age, ≤10% weight-for-height, and ≤10% weight-for-age at 4 and 5 years. RESULTS: At 9 months, 24% of mothers reported mild depressive symptoms and 17% moderate/severe symptoms. After adjustment for household, maternal, and child factors, children of mothers with moderate to severe levels of depressive symptoms at 9 months' postpartum had a 40% increased odds of being ≤10% in height-for-age at age 4 (odds ratio = 1.40, 95% confidence interval: 1.04-1.89) and 48% increased odds of being ≤10% in height-for-age at age 5 (odds ratio = 1.48, 95% confidence interval: 1.03-2.13) compared with children of women with few or no depressive symptoms. There was no statistically significant association between maternal depressive symptoms and children being ≤10% in weight-for-height and weight-for-age at 4 or 5 years. CONCLUSIONS: Maternal depressive symptoms during infancy may affect physical growth in early childhood. Prevention, early detection, and treatment of maternal depressive symptoms during the first year postpartum may prevent childhood height-for-age ≤10th percentile among preschool- and school-aged children. Copyright © 2012 by the American Academy of Pediatrics. Source

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