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PubMed2002

Report of the WHO Commission on Macroeconomics and Health: a critique.

The World Health Organization has been able to interest some of the world's top economists in joining the Commission on Macroeconomics and Health, to study macroeconomics of health services for the poor peoples of the world. The commission has been ahistorical, apolitical, and atheoretical. It has adopted a selective approach to conform to a preconceived ideology. It has ignored earlier work done in this field. And it has pointedly ignored such major developments in the health services as the Alma-Ata Declaration. These failings have brought the quality of the scholastic work to an almost rock-bottom level. The commission's tunnel vision in its recommendations on so important a subject is not surprising. Its emphatic recommendations for perpetuating vertical programs against major communicable diseases (tuberculosis, AIDS, and malaria) on the grounds that such programs have proved convenient to "donors" reveals the real motivations for an almost openly ideology-driven agenda. This is a serious danger signal for scholars who wish to take a scientific attitude toward program formulations for the poor that provide maximum returns from limited resources. The concept of DALYs (disability adjusted life years) is bristling with gross infirmities. The WHO-generated data used for DALY calculations, converted into dollar terms, are patently invalid, unreliable, and not comparable between and even within countries.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Smoking initiation prevention among youths: implications for community health nursing practice.

Cigarette smoking among youths has long been documented as a national problem affecting health and economic status in the United States. A number of studies have documented that cigarette-smoking initiation occurs primarily between late childhood and young adolescence. This evidence has brought about the need for awareness among community health nurses to find and deliver effective antismoking programs to reduce the prevalence of youth smoking initiation. Generally, community health nurses are in an excellent position to help the nation achieve its goals in terms of reducing the incidence of youth smoking initiation. However, current knowledge about community health nursing practice and smoking initiation interventions is limited. This article raises awareness about smoking initiation prevention in youth and the need to implement effective smoking prevention programs in practice settings and encourages community health nurses to increase their involvement in antismoking initiation research and interventions.

Adolescent↗
PubMedDate not supplied

Screening and community outreach programs for priority populations: considerations for oncology managers.

The goals of screening and community outreach efforts are to translate knowledge into relevant interventions to enhance health, prevent disease and manage chronic illness. Despite recent progress in the fight against cancer, a disproportionate share of the cancer burden is observed among ethnic minorities and medically underserved populations. Studies consistently link low socioeconomic status to low survival rates for nearly all types of cancer. Cultural differences, low literacy skills, language barriers and limited access to health care pose additional barriers to preventative health care for priority populations. Reaching priority populations with effective, appropriate and measurable ways to reduce cancer morbidity and mortality are key considerations for oncology managers seeking to provide comprehensive screening and community outreach care. This article addresses the importance of culture and literacy when developing screening and community outreach programs for at-risk populations, highlights the value of community partnerships to achieve programmatic goals, and outlines key considerations for creating successful breast screening and community outreach among Hispanic farmworker and rural women.

Agriculture↗
PubMed2006

HIV risk reduction among young minority adults in Broward County.

We examined changes in perceptions of HIV risk, abstinence, condom use, and intentions to use condoms for disease protection among African American, Hispanic, Haitian, and Afro-Caribbean unmarried and married men and women living in Broward County, Florida. Data were collected through computer-assisted telephone interview surveys conducted during 2001, 2002, and 2003 with cross-sectional probability samples of 18-39 year old residents of 12 high AIDS incidence ZIP code areas. Perceptions of HIV risk increased over time for men, but not for women. Unmarried Haitian women 18-22 years old were most likely to report abstinence. Condom use during the last 12 months increased among sexually active respondents. Among residents reporting exposure to project interventions, condom use increased from 53.6% in 2001 to 64.7% in 2002 and 71.6% in 2003. HIV-prevention programs should (1) consider locally collected data; (2) take into account cultural, living situation, and other significant differences; and (3) be evaluated to assess differentiated impact.

Adult↗
PubMed2005

Beyond the physical examination: the nurse practitioner's role in adolescent risk reduction and resiliency building in a school-based health center.

School-based health centers in high schools provide a unique setting in which to deliver risk-reduction and resilience-building services to adolescents. The traditional health care system operating in the United States focuses on the treatment of illness and disease rather than on preventing problems originating from health risk behaviors. Nurse practitioners can promote healthy behavior in adolescents through linkages to parents, schools, and community organizations; by conducting individual risk assessments; and by providing health education and access to creative health programs that build resilience and promote protective factors. With a focus on wellness, nurse practitioners as advanced practice nurses and specialists in disease prevention and health promotion can establish students' health priorities in the context of the primary health care they deliver on a daily basis.

Adolescent↗
PubMed2007

Creating a successful school-based mobile dental program.

BACKGROUND: Dental disease is one of the leading causes of school absenteeism for children. This article describes the creation and evolution of the St. David's Dental Program, a mobile school-based dental program for children. METHODS: The dental program is a collaboration of community partners in Central Texas that provides free dental care to low-income children in schools without relying on reimbursements or government funding. RESULTS: Since 1998, the program has provided 132,791 screenings for oral health treatment needs and 38,634 encounters for sealants or treatment. In 2005, the program provided $2.1 million worth of services at a cost of $1.2 million (not including donated services). Factors important to the program's success included sustained funding for general operating costs; well-compensated clinicians to deliver care and experienced human service workers to manage program operations; the devotion of resources to maximize consent form return rates; and the development of strong relationships with school district and individual school staff. CONCLUSIONS: By removing cost, time, transportation, and bureaucratic barriers, the program was able to reach more children than fixed-site clinics. The program was a merging of private and public health dentistries. This model can be useful to other communities in light of the unmet need for dental care and tighter federal, state, and local government budgets.

Adolescent↗
PubMed2003

Promoting safe walking and biking to school: the Marin County success story.

Walking and biking to school can be an important part of a healthy lifestyle, yet most US children do not start their day with these activities. The Safe Routes to School Program in Marin County, California, is working to promote walking and biking to school. Using a multipronged approach, the program identifies and creates safe routes to schools and invites communitywide involvement. By its second year, the program was serving 4665 students in 15 schools. Participating public schools reported an increase in school trips made by walking (64%), biking (114%), and carpooling (91%) and a decrease in trips by private vehicles carrying only one student (39%).

Adolescent↗
PubMed2004

Wellness Within REACH: mind, body, and soul: a no-cost physical activity program for African Americans in Portland, Oregon, to combat cardiovascular disease.

Wellness Within REACH (WWR) aims to saturate the heart of the African-American community in Portland, Oregon, with culturally appropriate physical activity opportunities. The purpose of this project is to develop and implement no-cost physical activities to increase the number of African Americans leading active lifestyles, while shifting the community norm. Certified African-American instructors conduct exercise classes at community venues. A pre- and post-questionnaire is administered to participants attending exercise classes each quarter, to assess frequency of attendance, lifestyle changes, and attitudes over time. To date, more than 700 individuals have participated in the WWR classes. Participants (58%) in a recent sample (N=75) reported exercising more now than in the 6 months prior to joining the program. Community members are bringing members of their social networks to try classes otherwise not available or affordable to them. By centering classes around the culture of this specific community, WWR has become a "movement" of healthy, active living.

Adult↗
PubMed2004

Exploring access to cancer control services for Asian-American and Pacific Islander communities in Southern California.

During the last 25 years, numerous studies have been conducted to promote breast cancer and cervical cancer screening. Most of these studies focused on individual-level factors predicting screening, but we are unaware of any that directly examined community and ecological influences. The goal of this project, Promoting Access to Health for Pacific Islander and Southeast Asian Women (PATH for Women), was to increase community capacity for breast and cervical cancer screening and follow up in Los Angeles and Orange counties. We focused on Southeast Asian and Pacific Islander women because, although they have the lowest rates for cancer, compared to all other ethnic groups, relatively few programs have specifically targeted Asian-American and Pacific Islander (AAPI) women to promote and sustain screening practices. The PATH for Women project involved a partnership between 5 community-based organizations and 2 universities, and included 7 Asian-American and Pacific Islander communities: Cambodians, Chamorros, Laotians, Thais, Tongans, Samoans, and Vietnamese. In this paper, we share our experiences in developing a Geographic Information System (GIS)-mapping evaluation component that was used to explore availability and accessibility to culturally responsive breast and cervical cancer screening services for Southeast Asian and Pacific Islander women in all 7 communities. We describe the methods used to develop the maps, and present the preliminary findings that demonstrate significant geographic and language barriers to accessing healthcare providers, services for breast and cervical cancer screening, and follow up, in each of the communities. Finally, we discuss implications for programs designed to promote breast and cervical screening and policy education.

Adult↗
PubMed2003

Tribal benefits counseling program: expanding health care opportunities for tribal members.

American Indian tribal clinics hired benefits counselors to increase the number of patients with public and private insurance coverage, expand the range of health care options available to tribal members, and increase third-party revenues for tribal clinics. Benefits counselors received intensive training, technical assistance, and evaluation over a 2-year period. Six tribal clinics participated in the full training program, including follow-up, process evaluation, and outcomes reporting. Participating tribal sites experienced a 78% increase in Medicaid enrollment among pregnant women and children, compared with a 26% enrollment increase statewide during the same period. Trained benefits counselors on-site at tribal clinics can substantially increase third-party insurance coverage among patients.

Counseling↗
PubMed2003

State Medicaid coverage for tobacco-dependence treatments--United States, 1994-2001.

Tobacco use is the leading preventable cause of death in the United States. One of the national health objectives for 2010 is to increase insurance coverage of evidence-based treatment for nicotine dependence (i.e., total coverage of behavioral therapies and Food and Drug Administration [FDA]--approved pharmacotherapies) in Medicaid programs from 36 states to all states and the District of Columbia (DC) (objective 27.8). To increase both the use of treatment by smokers attempting to quit and the number of smokers who quit successfully, the Guide to Community Preventive Services recommends reducing the "out-of-pocket" cost of effective tobacco-dependence treatments (i.e., individual, group, and telephone counseling, and FDA--approved pharmacotherapies) for smokers. The 2000 Public Health Service (PHS) Clinical Practice Guideline supports expanded insurance coverage for tobacco-dependence treatments. In 2000, approximately 32 million low-income persons in the United States received their health insurance coverage through the federal-state Medicaid program; 11.5 million (36%) of these persons smoked (CDC, unpublished data, 2000). The amount and type of coverage for tobacco-dependence treatment offered by Medicaid has been reported for 1998 and 2000 from state surveys conducted by the Center for Health and Public Policy Studies (CHPPS) at the University of California, Berkeley. All states and DC were re-surveyed in 2001 about amount and type of coverage, and level of coverage since 1994. This report summarizes the results of the survey, which indicate that the number of Medicaid programs providing some coverage for tobacco-dependence counseling or medication increased from 34 in 2000 to 36 in 2001, but only one state offered coverage for all the counseling and pharmacotherapy treatments recommended by the 2000 PHS guideline. If the 2010 national health objective is to be achieved, Medicaid coverage for treatment of tobacco dependence should be increased dramatically.

Healthy People Programs↗
PubMed2007

Early adolescents perceptions of health and health literacy.

BACKGROUND: Health illiteracy is a societal issue that, if addressed successfully, may help to reduce health disparities. It has been associated with increased rates of hospital admission, health care expenditures, and poor health outcomes. Because of this, much of the research in the United States has focused on adults in the health care system. This study investigated the effect of aspects of health literacy on the motivation to practice health-enhancing behaviors among early adolescents. METHODS: Measures were generally based on 3 National Health Education Standards for grades 5-8. Data were obtained from 1178 9- to 13-year-old students visiting 11 health education centers in 7 states. Students responded via individual electronic keypads. RESULTS: Multivariate logistic regression revealed that, in addition to age, difficulty understanding health information and belief that kids can do little to affect their future health, decreased the likelihood for interest in and desire to follow what they were taught about health. Further, low interest independently decreased motivation to follow what was taught. Girls were more likely to turn to school, parents, and medical personnel for health information. Older students were more likely to turn to school and to the Internet. CONCLUSIONS: Programs and curricula should be designed to increase student interest in health issues and their self-efficacy in controlling their own health destinies. Educators should also teach students to more effectively use nonconventional health information sources such as the Internet, parents, and medical professionals.

Adolescent↗
PubMed2005

History and overview of school-based health centers in the US.

SBHCs are filling a gap in health care needs for many of our nation's children. They provide services to an underserved population of children and adolescents, focusing on provision of health services and the promotion of health through population-based education programs. Schools with SBHCs are finding that significant physical, mental, and dental health issues are being addressed during the school day, allowing children to remain in school. The mission of SBHCs to contribute to the health of children by providing access to primary health care and preventive health care services is being actualized.

Adolescent↗
PubMed2005

An examination of knowledge, attitudes and practices related to HIV/AIDS prevention in Zimbabwean university students: comparing intervention program participants and non-participants.

OBJECTIVES: This study represents a comprehensive assessment of differences between participants in an HIV/AIDS prevention program (SHAPE: Sustainability, Hope, Action, Prevention, Education) and non-participants in knowledge, attitudes and practices with a focus on cultural, sociological and economic variables. METHODS: We developed an eight-page questionnaire that was administered to 933 randomly selected students at the University of Zimbabwe. Survey items addressed sexual decision-making, condom use, limiting sexual partners, cultural power dynamics and access to HIV testing. RESULTS: Results show participants are statistically more likely to report being sexually abstinent, and understand the prevention benefits of condom use. SHAPE members had fewer sexual partners in the previous year than non-SHAPE members (1.4 vs. 2.2). SHAPE members were significantly more likely (67%) than non-SHAPE respondents (48%) to indicate that they knew their HIV sero-status and to state that they knew their status because they had been tested (85% vs. 71%). DISCUSSION: Though we found differences between the groups suggesting that program participation increases awareness concerning gender equity, there continue to be many intractable cultural attitudes in this age group. Findings suggest that the attitudes and practices of young men and women are changing, but that progress in some areas does not assure progress in all areas.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Community gardens: lessons learned from California Healthy Cities and Communities.

Community gardens enhance nutrition and physical activity and promote the role of public health in improving quality of life. Opportunities to organize around other issues and build social capital also emerge through community gardens. California Healthy Cities and Communities (CHCC) promotes an inclusionary and systems approach to improving community health. CHCC has funded community-based nutrition and physical activity programs in several cities. Successful community gardens were developed by many cities incorporating local leadership and resources, volunteers and community partners, and skills-building opportunities for participants. Through community garden initiatives, cities have enacted policies for interim land and complimentary water use, improved access to produce, elevated public consciousness about public health, created culturally appropriate educational and training materials, and strengthened community building skills.

California↗
PubMed2004

Reducing disparities in diabetes among African-American and Latino residents of Detroit: the essential role of community planning focus groups.

Diabetes is prevalent among African-American and Latino Detroit residents, with profound consequences to individuals, families, and communities. The REACH Detroit Partnership engaged eastside and southwest Detroit families in focus groups organized by community, age, gender, and language, to plan community-based participatory interventions to reduce the prevalence and impact of diabetes and its risk factors. Community residents participated in planning, implementing, and analyzing data from the focus groups and subsequent planning meetings. Major themes included: 1) diabetes is widespread and risk begins in childhood, with severe consequences for African Americans and Latinos; 2) denial and inadequate health care contribute to lack of public awareness about pre-symptomatic diabetes; 3) diabetes risks include heredity, high sugar, fat and alcohol intake, overweight, lack of exercise, and stress; and 4) cultural traditions, lack of motivation, and lack of affordable, accessible stores, restaurants, and recreation facilities and programs, are barriers to adopting preventive lifestyles. Participants identified community assets and made recommendations that resulted in REACH Detroit's multi-level intervention design and programs. They included development of: 1) family-oriented interventions to support lifestyle change at all ages; 2) culturally relevant community and health provider education and materials; 3) social support group activities promoting diabetes self-management, exercise, and healthy eating; and 4) community resource development and advocacy.

Adolescent↗
PubMed2003

Challenges to masculine transformation among urban low-income African American males.

In this article we describe and analyze the challenges faced by an intervention program that addresses the fatherhood needs of low-income urban African American males. We used life history as the primary research strategy for a qualitative evaluation of a program we refer to as the Healthy Men in Healthy Families Program to better understand the circumstances and trajectory of men's lives, including how involvement in the program might have benefited them in the pursuit of their fatherhood goals. A model of masculine transformation, developed by Whitehead, was used to interpret changes in manhood/fatherhood attitudes and behaviors that might be associated with the intervention. We combined Whitehead's model with a social ecology framework to further interpret challenges at intrapersonal, interpersonal, community, and broader societal levels.

Adult↗