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New York City's immigrant minorities. Reducing cancer health disparities.

One million newcomers arrive in the United States every year; 11.7% of the total U.S. population is foreign-born. Immigrants face cancer care and research access barriers, including economic, immigration status, cultural, and linguistic. In 2000, the Center for Immigrant Health, NYU School of Medicine, launched the Cancer Awareness Network for Immigrant Minority Populations (CANIMP), a network comprising community- and faith-based organizations, local and national government health institutions, clinical service providers, researchers, and immigrant-service and advocacy organizations. This community-based participatory program chose as its priorities high- incidence cancer sites in the overall immigrant community (colorectal, lung, breast, cervical, prostate), as well as sites with strikingly high incidence in specific immigrant groups (gastric, liver, oral). CANIMP has developed successful outreach, education, screening, survivorship, training, and research programs to decrease cancer disparities. Over 2500 at-risk community members have been reached, 25 junior minority researchers trained, 60 minority interns mentored, numerous cancer disparities research projects funded and conducted, and vital partnerships to improve cancer data developed. These initiatives serve as models to address community, systems, physician, and cancer research gaps in immigrant communities. Cancer 2006. (c) 2006 American Cancer Society.

Community Networks↗

Annual report to the nation on the status of cancer, 1975-2003, featuring cancer among U.S. Hispanic/Latino populations.

BACKGROUND: The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate annually to provide U.S. cancer information, this year featuring the first comprehensive compilation of cancer information for U.S. Latinos. METHODS: Cancer incidence was obtained from 90% of the Hispanic/Latino and 82% of the U.S. populations. Cancer deaths were obtained for the entire U.S. population. Cancer screening, risk factor, incidence, and mortality data were compiled for Latino and non-Latino adults and children (incidence only). Long-term (1975-2003) and fixed-interval (1995-2003) trends and comparative analyses by disease stage, urbanicity, and area poverty were evaluated. RESULTS: The long-term trend in overall cancer death rates, declining since the early 1990s, continued through 2003 for all races and both sexes combined. However, female lung cancer incidence rates increased from 1975 to 2003, decelerating since 1991 and breast cancer incidence rates stabilized from 2001 to 2003. Latinos had lower incidence rates in 1999-2003 for most cancers, but higher rates for stomach, liver, cervix, and myeloma (females) than did non-Latino white populations. Latino children have higher incidence of leukemia, retinoblastoma, osteosarcoma, and germ-cell tumors than do non-Latino white children. For several common cancers, Latinos were less likely than non-Latinos to be diagnosed at localized stages. CONCLUSIONS: The lower cancer rates observed in Latino immigrants could be sustained by maintenance of healthy behaviors. Some infection-related cancers in Latinos could be controlled by evidence-based interventions. Affordable, culturally sensitive, linguistically appropriate, and timely access to cancer information, prevention, screening, and treatment are important in Latino outreach and community networks.

Adolescent↗

The meshing of youth development and community building.

Practitioners, policymakers, residents, workers, researchers, and even funders have an opportunity to merge their many practices into a more comprehensive and focused approach to change communities substantially. People are affiliated with a number of communities, and not just those with geographical definitions. There are communities based on gender, sexual orientation, physical ability, race, ethnicity, and institutions such as family and school. Building the bridges between youth development and community building and merging their principles and practices will create a force of change. This chapter lays the foundation for meshing the worlds of youth development and community building to make powerful connections that will be important to the community of youth and bring them into wider circles and forces that ultimately will be important to the adult community as well.

Adolescent↗

Comprehensive community building initiatives--ten years later: what we have learned about the principles guiding the work.

Community building places emphasis on resident engagement, collaboration, and other elements of a more community-driven approach. For the past ten years, we have learned a lot about how to value the principles of community building and have become more strategic about how to make them work. The chapter offers a brief look at this learning and what community building should focus on as we move forward.

Adolescent↗

Using the coproduction principle: no more throwaway kids.

Youth development does not take place only in institutions or even primarily in institutions. It takes place in the core economy-the economy of family, neighborhood, and community. Major challenges include rebuilding the kind of village it takes to raise a child and enabling a child to be part of that rebuilding. Another challenge is to make sure that any external incentives that are provided to youth are linked to activities that build self-esteem and convey a definition of value that is different from that established by money and market price. This chapter provides an introduction to time banking and to coproduction, approaches to youth development that enable youth to participate as major players, as opposed to recipients, in the reshaping of their lives and communities.

Adolescent↗

University-assisted community school program of West Philadelphia: democratic partnerships that make a difference.

The university-assisted community school model is showing results for children and youth in West Philadelphia. The University of Pennsylvania's (Penn's) Center for Community Partnerships has coordinated universitywide efforts, in partnership with the community, in order to create and develop community school programs. The Sayre program aims to become a university-assisted community school, with a comprehensive community problem-solving curriculum and communitywide program that is fully integrated across both the Sayre curriculum and the curriculum of a number of Penn's schools. The Penn-Sayre project demonstrates that higher education can be a permanent anchor for revitalizing schools and communities if the vast resources it possesses, particularly its faculty, students, and staff, are brought to bear in a coordinated fashion.

Adolescent↗

Aligning systems to create full-service schools: the Boston experience, so far.

Leaders of full-service schools in Boston seek to expand the number and increase the impact of Boston's full-service schools, catalyzing a realignment of public resources and an expansion of private investment. The Full-Service Schools Roundtable, led by a dynamic staff and supported by the mayor and the superintendent of schools, is a steadily growing coalition of educators, public agencies, human service providers, and community leaders. Challenges for the Roundtable are to build the public will to invest in full-service schools; secure leadership from stakeholders; share accountability across sectors so that schools prioritize youth development and health, and service providers share responsibility for school success; and become a political force, championing the strategic realignment of public investments based on child outcomes.

Adolescent↗

Families as full research partners: what's in it for us?

This article describes a children's managed mental health care program that incorporates both a family participation service model and a family-initiated evaluation model. The authors begin by tracing the evolution of the family support and the participatory research movements leading to current developments in children's mental health services research. In the King County Blended Funding Project, three service systems pool funds that are spent flexibly by child and family teams. Family advocates have led efforts to design and implement the project evaluation. During this process, many tensions have arisen between meeting the demands of both scientific rigor and multiple community stakeholders. Examples are given of the issues raised by family advocates and research scientists as together they established a theory of change, identified meaningful outcomes, selected measurement tools, and implemented the evaluation protocol. Guidelines are given for how services research partnerships can be successfully built to better address community needs. This article was selected as a distinguished research paper based on a presentation by the authors at the 1998 11th annual research conference titled "A system of Care for Children's Mental Health: Expanding the Research Base." This conference is sponsored annually by the Research and Training Center for Children's Mental Health, Department of Child and Family Studies, Louis de la Parte Florida Mental Health Institute, University of South Florida, Tampa.

Child↗

Using empowerment theory in collaborative partnerships for community health and development.

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalization. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development.

Adolescent↗

Empowerment praxis in community coalitions.

Community coalitions address a wide variety of community problems, espousing a community development processes that promotes individual and collective self-determination. They offer a promising venue for the study of empowerment of individuals and organizations. This study utilizes data from members of 35 community coalitions organized for the prevention of alcohol and other drug problems to address the following questions: What individual characteristics are related to the psychological empowerment of coalition members? What organizational characteristics are related to the collective empowering of members? What organization characteristics are related to a coalition being organizationally empowered to succeed in achieving its objectives? At the individual level, psychological empowerment was most strongly related to individuals' participation levels, sense of community, and perceptions of a positive organizational climate. At the group level, the strongest predictors of collective empowering (our operationalization of the empowering organization) were net benefits of participation, commitment, and positive organization climate. Psychological empowerment and positive organizational climate were the two predictors of organizational effectivenes (the empowered organization). Implications and limitations of these findings are discussed.

Adolescent↗

Speaking truth to power: empowerment ideology as social intervention and policy.

The popularity, and subsequent ambiguity, in the use of the term "empowerment" has created an even greater need for reassessment in the applied context than in the theory and research literatures. This paper outlines some of the areas of community, organizational, and societal level social intervention and policy ostensibly based on the concept of empowerment. These include neighborhood voluntary associations (for environmental protection, community crime prevention, etc.), self-help groups, competence-building primary prevention, organizational management, health care and educational reforms, and national and international community service and community development policies. Issues in applying social research to community organizations and to legislative and administrative policy making are reviewed. Ten recommendations are offered, including the value of a dialectical analysis, for helping researchers and policy makers/administrators make more effective use of empowerment theory and research.

Community Networks↗

Empowerment meets narrative: listening to stories and creating settings.

Comments on and summarizes some of the themes of a special issue on empowerment. Extends empowerment theory with the suggestion that both research and practice would benefit from a narrative approach that links process to practice and attends to the voices of the people of interest. Narrative theory and method tends to open the field to a more inclusive attitude as to what counts as data and to cross-disciplinary insights as well as citizen collaboration. Communal narratives are defined at various levels of analysis, including the community, the organizational, and the cultural. A definition of empowerment that includes a concern with resources calls attention to the fact that communal narratives and personal stories are resources. Implications for personal and social change are suggested.

Community Networks↗

An ecological assessment of community-based interventions for prevention and health promotion: approaches to measuring community coalitions.

Presented an ecological assessment of a community coalition to prevent alcohol, tobacco, and other drug abuse, and related risks. Ecological assessment is defined as occurring at multiple social levels and along a continuum of stages of coalition readiness. The assessment is aided by the triangulation, or combining of assessment methods and strategies. Measures used to assess the coalition's formation, implementation of community initiatives, and production of community impacts are described, along with the triangulation strategies used to enhance the assessment findings.

Alcoholism↗

Using methods that matter: the impact of reflection, dialogue, and voice.

In recent years, the field of community psychology has given considerable attention to how research and evaluation methods should be designed to support our goals of empowerment and social justice. Yet, as a field, we have given much less attention to whether the use of our methods actually achieves or supports our empowerment agenda. With the primary purpose of beginning to establish the norm of reporting on the impacts of our methods, this paper reports on the findings from interviews of 16 youth and adults who had participated in one participatory evaluation method (Photovoice). Two specific questions were examined: (1) What is the impact of participating in a Photovoice effort; and (2) How does the method of Photovoice foster these impacts? Overall, participants noted that they were significantly affected by their experiences as photographers and through their dialogue with neighbors during Photovoice group sessions. Impacts ranged from an increased sense of control over their own lives to the emergence of the kinds of awareness, relationships, and efficacy supportive of participants becoming community change agents. According to participants, Photovoice fostered these changes by (a) empowering them as experts on their lives and community, (b) fostering deep reflection, and (c) creating a context safe for exploring diverse perspectives. The implications of these findings for the science and practice of community psychology are discussed.

Adolescent↗

A description of the process of recruitment for research studies investigating the genetics of psychotic illness.

Collecting biometric data on probands and family members is pivotal for advancing the understanding and treatment of any medical disorder with genetic contributions. The process of recruiting probands with psychosis and their family members for genetic studies has proven to be challenging. We present the recruitment strategies of two sites that are collaborating in genetic studies. We review details of referral sources at these sites. Of 69 participants recruited from the University of Pittsburgh, 23% were self-referrals, 30% were encouraged by family, and 47% were encouraged by clinicians. Of 48 probands from the University of Pennsylvania, 6% were self-referrals, 21% were encouraged by family, and 73% were encouraged by clinicians. Qualitative data from focus groups are reviewed. Strategies that helped to facilitate recruitment and foster community networking are discussed. This preliminary study has broad implications as a potential model for collaboration among patient support groups, family groups, clinicians, and researchers.

Humans↗

Dynamics of participation in a community health project.

Although the term 'participation' is widely used in discussing community development strategies, there has been relatively little said about the characteristics of 'participatory relationships', i.e. the interactions between community developers and those who stand to benefit from community development initiatives. There is seen to be a need for case studies which attempt to understand the relational and communicative processes involved in participatory development. The paper presents an analysis of the participatory dynamics of a community health development project. The principal source of data is interviews conducted with thirteen selected participants in the project. Analysis of interview data using a structured hermeneutic method led to a description of the meaning of participation for each of the participants interviewed. Further interpretation led to the identification of a number of modes of participation in the project as a whole. For each mode of participation descriptions were developed of how it was perceived by others not participating from that mode. An attempt was made to understand the dynamics of the project in terms of the relationship between the different modes of participation and in terms of the discrepancies between how participants saw themselves and how others saw them. Finally, these problems were discussed at a general theoretical level and suggestions were made about how such problems might be alleviated.

Communication Barriers↗

Nuclear accidents, consumers' perspectives and demands.

The public's reaction to life threatening situations is determined by a variety of factors. In the case of nuclear accidents, the panic experienced by citizens may be reasonably justified. This paper briefly describes the parameters that cause panic reactions from a consumer's point of view and summarizes citizen's demands concerning nuclear crisis management.

Community Networks↗

Community-based research: barriers to recruitment of African Americans.

The elimination of health disparities for African Americans requires culturally relevant, empirical knowledge, which in turn requires including African Americans in research studies. However, power-difference barriers and conceptual barriers continue to inhibit the recruitment of African Americans. The purpose of this article is to define and discuss certain barriers to the recruitment of African Americans into research studies and to present culturally and contextually sensitive strategies to overcoming these barriers. Power-difference barriers reflect unequal authority and often generate mistrust. Conceptual barriers reflect researchers' need for better understanding about African Americans. Effective strategies include collaboration with the community through a community advisory board and conducting community-based participatory action research. Also, integrating alternative conceptual frameworks with mainstream frameworks may reduce researchers' ideological assumptions about African Americans. To promote optimal recruitment of African Americans, researchers must be aware of power-difference barriers and conceptual barriers and move toward active collaboration with African American communities.

Black or African American↗