Ann F. Brunswick

What Happened in Harlem? Analysis of a Decline in Heroin Use among a Generation Unit of Urban Black Youth:

The annual prevalence of heroin use among a cross-section of black adolescents and young adults from Harlem fell from eight percent in 1970–71 to less than three and a half percent in 1975–76. The most important component of this change was a sharp decline in the rate of heroin initiation among younger birth cohorts. Controlling for differential opportunity based on age of cohorts, twenty-two percent of this sample who were born in 1952 initiated use of heroin by age 18, compared to three percent of those born in 1957. The explanation that appears most plausible for these findings is that, for most individuals, the actions of initiating and continuing heroin use appear to be a product of rational choice. And the context within which that choice was made was appreciably altered in this generation unit of Harlem youth.

HIV risk behavior and the health belief model: An empirical test in an African American community sample

The increasing prominence of minority groups, particularly African Americans, in the growing rates of HIV infection and AIDS underscores the urgency for developing ethno-gender specific models for changing behaviors that are placing those groups at risk. To this end, HIV-related knowledge, attitudes, and perceptions reported by an urban community sample of African Americans (N = 364) and formulated as components of the Health Belief Model (HBM) have been tested against HIV avoidance practices, using both structural equation and OLS regression analysis. Both multivariate approaches identified perceived vulnerability as a significant negative predictor and, additionally for women, a positive relationship with generalized sense of personal efficacy. The results suggest an inverted causal sequence from what the HBM assumes: risk behavior leading to or predicting perceptions. Some implications of this critical reversed ordering are suggested.

HIV-1 seroprevalence and risk behaviors in an urban African-American community cohort

OBJECTIVES Previous attempts at obtaining population estimates of human immunodeficiency virus type 1 (HIV-1) seroprevalence have been beset by problems of cooperation bias. As part of the fourth round of study with an urban African-American community cohort, the following investigation was aimed at assessing HIV-1 prevalence and the relative importance of sex and drug injection as risk factors in infection. METHODS Personal interviews were conducted in the home with 364 respondents, followed by voluntary blood sample collection from 287 of these individuals. RESULTS Blood assays showed a point prevalence of 8.4% HIV-1 seropositivity in this community cross section, with a higher female-to-male ratio than appears among acquired immunodeficiency syndrome (AIDS) case reports. Most infected persons were unaware and unsuspecting of their infection. CONCLUSIONS First, findings underscore the need to focus on risk behaviors rather than on risk groups. Second, the smaller than 2:1 ratio of infected men to women suggests that current AIDS case reports seriously underestimate HIV-1 infection among certain cohorts of African-American women. Finally, widespread ignorance of own infected status and inaccurate risk assessment signal the substantial task for community health educators in reaching inner-city African-American men and women at risk.

A life span perspective on drug use and affective distress in an african-american sample

Data from the second and third waves of an ongoing study of inner-city African Americans (N = 411) were used to assess the relationship between substance use and affective distress. Involvement with eight substances was examined individually and collectively over a 7-year interval, during which time the study cohort moved from ages 18 to 23 years to 26 to 31 years. Regression analysis indicated that substance use was associated directly with deleterious change in affective distress. Important gender differences were evident in the magnitude, related substances, and timing of these drug effects. Further analysis showed that the introduction of life-style controls for social integration and social attainment did not substantially alter the observed drug effect.

Who sees the doctor? a study of urban black adolescents?

Abstract By means of structured personal home interviews, health problems and physician care obtained for those problems were studied in an area probability sample of 562 non-Hispanic, black adolescents, drawn from a single health district in a major city in the Northeastern U.S. Physician care was represented by a ratio score: the number of health problems for which the adolescent had seen a physician divided by the total number of health problems he reported. On the basis of these scores, adolescents were separated into “high” and “low” physician care groups and compared with regard to: kinds of health problems, general health status, demographic and family background characteristics, health attitudes and behavior and psychosocial attitudes. Bivariate and then multivariate analyses were performed. A major finding indicated a relationship between lack of medical care and activity limitation or chronic impairment as early as the adolescent years. In multivariate analysis, the variable which accounted more than any other for the difference between black adolescents with “high” and “low” physician care scores was the combination of having a private physician and a mother born outside the southern U.S. Generally the findings supported the model of significant psycho-sociocultural influences, over and above need for care and availability of services, in explaining medical utilization.

WHAT GENERATION GAP?: A Comparison of Some Generational Differences Among Blacks and Whites

Data from seven national surveys were examined for age differences in black and white populations regarding three kinds of attitudes: 1) outlook on life; 2) interracial tolerance and hostility; 3) attitudes toward the advocacy of violence. In each of these attitude areas, populations showed differences by education as well as by age. But the interaction between education and age was not always the same in the black and white populations. This analysis indicated that education may be at least as important a determiner of generations as age is; introducing education as a variable interacting with age adds precision to the discussion of generational differences.

Drug use and stress: Testing a coping model in an urban African‐American sample

Opposing functions have been attributed to substance use — as causal of distress and as buffering agent to reduce distress. These opposing roles were modeled with longitudinal data from an urban community sample of African Americans. With enduring unemployment formulated as the predictor stressor, three levels of drug use were tested for direct versus multiplicative effects on strain. Findings did not support the buffering or stress-relief hypothesis. Further, strongly gender-differentiated processes appeared in the unemployment-drug-distress relationship. For men, unemployment strain was increased under the condition of moderate to heavy drug use (i.e., an interactive or multiplicative relationship). For women, moderate to heavy drug use increased strain independently of unemployment (additive effect). But light (less than weekly) use exacerbated strain for women under the condition of regular employment although showing no effect for women when unemployed.

Health through three life stages: A longitudinal study of urban black adolescents

This is a study of life stage coherence and change in perceived health status and morbidity reports over a 15 year interval bounding adolescence. Data were obtained through personal home interviews with a representative sample (N = 426) of urban black youths who were interviewed at three successive life stages: first when they were adolescents ages 12-17, 6-8 years later when they were ages 18-23, and 7-8 years after that when they were ages 26-31. Results showed that health decline was neither continuous nor progressive over the three life stages. Instead, a dramatic increase in morbidity reports occurring between adolescent and post adolescent measurement was succeeded by stabilization in the following 7 year interval. One interpretation of these findings is that they reflect the stressfulness of the adolescent life stage in the urban black youth cohort. The congruence of this interpretation with Mechanic and Angels theory of differential health synchrony over the life course and also with Antonovskys theory of sense of coherence in explaining variations in perceived health is discussed. The study, finally, pointed up a serious methodological impediment to attempting comparative life span health studies such as this, namely, the difficulty in arriving at equivalently comprehensive and sensitive health symptom indicators at different life stages.

Dealing with Drugs: Heroin Abuse as a Social Problem

Reported here are attitudes and perceptions regarding heroin control, prevention, and treatment obtained in a survey of community leaders in four high drug traffic and drug use neighborhoods in New York City. Studies in the past have focused on the causes and consequences of heroin use primarily from the standpoint of the drug user. Operationalizing the tenet that heroin abuse is a social problem, this study develops an ecological paradigm for analyzing the effects on neighborhoods of illicit drugs and of prevention, intervention, and treatment policies. The research was undertaken in 1981 for the New York State Heroin and Alcohol Study Commission. It demonstrates the importance of including community perspectives in policy decisions and the usefulness of a study group of community leaders as a reliable source of this information.

Health services for adolescents with impairment, disability, and/or handicap: An ecological paradigm

The purpose of this paper is to formulate a set of measures that can be used to monitor and evaluate health services for disabled adolescents. In attempting to meet this goal, two other objectives will also be served: 1) the examination of the meaning of adolescent disability in functional terms; 2) the design of a framework that can guide the selection of services into a comprehensive community health program for disabled adolescents. The ideas developed here are derived from my review of recent work concerned with the problems of chronically ill and/or handicapped children in the United States (1-3); from my own and others work in health-status measurement (4-8); and from my longitudinal research into the biopsychosocial health of young people from Harlem, New York City (9-14). These concepts of adolescent disability and proposals regarding community health services build on some of the important issues raised in the other papers of this symposium. Examining adolescent disability in functional or behavioral terms identifies adolescence as an optimal point in the life span for providing habilitative services to those with disabilities. A behavioral or functional view of adolescence leads us to formulate the goal of community services as that of reducing limitations in mobility, especially in access to the opportunity structure. These limitations may have been imposed either by uncorrected physical, sensory,