Risky sex, quality of children's medical care - Journal of Urban Health

Jan 5 2006

The newest issue of the Journal of Urban Health: Bulletin of The New York Academy of Medicine includes a host of compelling research findings regarding risky sexual behavior in the vacation hotspot of Miami, racial influences on the quality of children's medical care, and willingness of blacks to use the Internet to manage their diabetes. These studies are summarized below.

As the winter vacation scene in South Florida heats up, new research in the Journal shows that risky sexual behaviors among gay men who live and vacation there is quite prevalent and that interventions are needed. South Florida annually hosts over 1.8 million gay and bisexual visitors and is home approximately 145,000 men who have sex with men (MSM).

Researchers conducted a cross-sectional study of recreational drug use and risky sexual behaviors among more than 400 MSM who live in or were vacationing in ten diverse locations in Miami-Dade and Broward counties in winter of 2004. They were approached on weekends and asked to complete a questionnaire. One-third of the men surveyed reported using one or more "club drugs" in the past year, a habit highly associated with unprotected anal intercourse. MSM who live outside of south Florida most often reported using cocaine and ketamine (a date rape drug also known as "Special K") and engaging in unprotected receptive anal intercourse in the past month.

"Tourists may be even more likely than residents to engage in risky sexual behaviors and use certain recreational drugs," said lead author William W. Darrow, PhD, of the Robert R. Stempel School of Public Health at Florida International University. "Interventions must be developed, implemented, and evaluated that take into account the unique characteristics of international resort areas."

Children whose pediatricians are of a different race/ethnicity do not receive lesser quality care, according to a new study in the current issue of the Journal. What is most important is that the child has a regular doctor, and this study finds that more than half of all young children do not. Past research has shown that adults receive better-quality care when their physicians are of the same race/ethnicity, but it was unknown whether this held true for children. The authors found the answer by examining data from the 2000 National Survey of Early Childhood Health, a telephone survey of about 2,000 Latino, white and African-American parents of children ages 4 months to 35 months.

No statistically significant difference was found in the basic preventive services received by children and their parents based on whether their pediatrician did, or did not, hail from the same racial/ethnic background. However, children who lacked a regular care provider had less "family-centered care," in which a physician has a continuous relationship with the child and parents and therefore knows and understands them. Blacks and Latinos were most likely to lack a family pediatrician, the researchers found.

"Efforts to improve these aspects of well-child care might focus less on linking children with a pediatrician of the same race/ethnicity, and more on changing the social, cultural, and linguistic factors that keep children from having a regular provider," said lead author Gregory D. Stevens, PhD, MHS, of the Division of Community Health at the University of Southern California Keck School of Medicine. "Without continuity of care, there may be more potential for parents and providers to rely on stereotypes and snap judgments during well-child care visits."

Interestingly, blacks and Latinos were found to be significantly less likely than whites to see a pediatrician from their racial/ethnic background, in part because of availability. Only 10 percent of pediatricians nationally were black or Latino as of 2004.

Although blacks have been shown to use the Internet much less frequently than whites, a new study in the Journal documents that those with no computer skills are quite willing to learn. Those with Type 2 diabetes say they would be eager to use a computer program to manage their diabetes if it were provided free. This is an important finding because blacks suffer disproportionately from Type 2 diabetes, which usually strikes in adulthood and can cause severe disabilities and even death if not properly controlled.

Researchers surveyed 457 black adults with Type 2 diabetes (predominantly low-income women) via telephone to determine their frequency of Internet use. Forty percent of the participants reported having a computer at home and 46 percent reported knowing how to use one. The research team found that participants with less than a high school education were less likely to have a computer. Older participants, men, and non-high-school-graduates were least likely to know how to use a computer.

The good news is that two-thirds of those with no computer skills said they are willing to learn, and nearly all participants (89 percent) said they would use a computer program to manage their diabetes if it were offered free of charge. In addition, 82 percent of non-users reported that they had friends or family in the neighborhood who would probably let them use a computer. Furthermore, 38 percent of non-users said they would feel comfortable using a computer in a community center to search for health information. This suggests that adding computers in community settings can help reduce the digital divide between minorities and whites, said senior author Tiffany L. Gary, PhD, Assistant Professor in the Department of Epidemiology at Johns Hopkins University's Bloomberg School of Public Health. "The health status of Americans with chronic diseases such as Type 2 diabetes will depend upon the self-management capability of the patient, not solely the care of their doctors," Gary said. "These data show promise for the willingness of African-Americans, an underserved population, to use computers and access health information using the Internet."