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PubMed2006

A national survey of tobacco cessation programs for youths.

OBJECTIVES: We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics. METHODS: We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified. RESULTS: We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was 2000 dollars. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment. CONCLUSIONS: There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths' smoking prevalence.

Adolescent↗
PubMed2004

An evaluation of substance abuse aftercare program for homeless women with children using confounding variable-control design.

An outcome evaluation of a substance abuse aftercare program for homeless women with children was conducted using confounding variable-control evaluation design. The confounding variables are chosen from pre-treatment and other contextual variables of the clients that are known to have significant influence on the program outcome, but those that could not have been influenced a priori by the client involvement in in-treatment program activity at Transition House (TH). The latter is the independent variable of this evaluation design. The pre-treatment variables are measured by severity of alcohol and other drug (AOD) problems of the clients, their mental health status, age, and their job status before enrollment in the program. The contextual confounding variables are composed of family and social support available to the clients before and during recovery. While applying multiple regression analysis, we were able to explain 50.8% of the total variance in program outcome by four pre-treatment variables. By adding two contextual variables of family and social support, the total variance in program outcome explained is increased to 64.1%. Finally, by adding the degree of client involvement in in-treatment program activity, we were able to augment the total variance of the program outcome to 69.7%. By estimating the changed variance of program outcome by the in-treatment program activity during the final step, controlling for all other variables previously entered, we were able to establish that client involvement in in-treatment program had unique and positive impact on the program outcome distinct from those explained by the confounding variables. The additional variance uniquely added by in-treatment program activity is 5.6% (p < .001). It has been determined that the degree of client involvement in in-treatment program had positive and systematic impact on the program outcome.

Adult↗
PubMedDate not supplied

Assessment of the integration of the ecological approach in health promotion programs.

PURPOSE: This article proposes a model of the ecological approach in health promotion programs. Based on system theory, the model identifies intervention settings and targets as two independent dimensions for assessing the integration of this approach in programs. Additional objectives are to present and pretest an analytical procedure that allows the assessment of integration of the ecological approach in programs. DESIGN: This was a descriptive study of the integration of the ecological approach in a sample of health promotion programs. SUBJECTS: Subjects were 44 health promotion programs drawn from the population of Canadian federally funded programs. MEASURES: Descriptions of programs were obtained by telephone interviews. A coding scheme was applied to the data to identify intervention settings and targets for each program. Using this information, a summative score of the integration of the ecological approach was estimated for each program. RESULTS: Single-setting programs were the dominant pattern in the sample. Individuals whose health was of concern were very frequently the direct targets of the programs. However, organizational and interpersonal environments were also often directly targeted. Single-setting or single-intervention strategy programs outnumbered ecological programs. CONCLUSION: The proposed model and analytical procedure is a useful framework for the assessment of integration of the ecological approach in health promotion programs. The pilot test having been conducted on a convenience sample, future work should replicate the study in a representative sample of programs.

Canada↗
PubMedDate not supplied

A program for successful integration of international medical graduates (IMGs) into U.S. surgical residency training.

OBJECTIVE: U.S. surgery residency programs have traditionally attracted international medical graduates (IMGs). However, the qualifications and performance of IMGs are variable and difficult to predict. Poor performance negatively affects patient care, the residency program, and the IMGs. We sought to identify causes of poor performance and to develop a program to identify those with chances to succeed. DESIGN: Longitudinal study. Retrospective analysis. Description of a new program. SETTING: University of Washington, a tertiary care teaching hospital. PARTICIPANTS: Performance of former IMG residents was reviewed to define the most common reasons for failure. In August 2002, we developed an IMG Certificate Program that enrolls IMGs into a formal 8-week clinical experience with duties, responsibilities, and evaluations similar to fourth-year medical students. A final global score is given for potential for success as a resident in our program. RESULTS: Poor performance in past IMG residents could be attributed to: credential problems and poor performance. Performance problems were further subdivided to include knowledge issues and personal/cultural issues. Since August 2002, our Certificate Program enrolled 15 IMGs. Fourteen graduated, and 10 were offered preliminary spots in our program: 4 are successful interns, 1 returned to Italy, and 5 will start in 2004. One entered the 2004 match in Anesthesiology, and 1 was counseled to not be a candidate for a U.S. program. Three had above average performance and were felt to be better suited to a smaller program (1-2 hospitals). The mean "potential for success" global score was 3.9 (all grads), 4.6 (current interns), 1.0 (nongraduate), and 3.0 for the above average performers better suited to a smaller U.S. program. CONCLUSIONS: We developed a program that provides IMGs an 8-week clinical experience in a busy U.S. training program; it provides them with enough experience to successfully integrate into a U.S. residency and identifies those with better chances to succeed. Wide application of this program and exchange of information among program directors may facilitate recruitment and the successful completion of training of IMGs and provide the number of residents needed to fill critical positions in the United States.

Certification↗
PubMed1999

Assessment of asthma patients' willingness to pay for and give time to an asthma self-management program.

Despite the success of health education programs for patients with asthma, several researchers have found that patients are reluctant to enroll in and complete a program designed to help them manage their condition. The purpose of this study was to identify factors that influence asthma patients' willingness to pay (WTP) for and willingness to give time (WTGT) to an asthma self-management program. The patient sample consisted of 116 adult asthma patients (age range, 18 to 34 years) from 2 affiliated sites: a county teaching hospital with ambulatory clinics and a staff-model health maintenance organization. To determine WTP and WTGT, patients were presented with a scenario in which the components of an 8-week asthma management program were described. Patients were then asked how much they would be willing to pay for and how much time they would be willing to spend on the program. Regression analyses were used to determine what effect the following factors had on WTP and WTGT with respect to an asthma self-management program: sociodemographic factors; predisposing, enabling, and reinforcing factors; level of asthma self-management; and health care utilization. Mean patient WTP was $29.50 for an 8-week asthma education program. Several factors appeared to influence this amount. Patients who were willing to pay more for a program that would help them manage their asthma exhibited suboptimal behaviors during asthma attacks, had greater perceived access to health care resources, received less educational information from health care providers, had previously participated in a self-management program, and had indicated an interest in participating in a self-management program. This model was statistically significant (P < 0.0001), with 35% of the variation in WTP scores explained by the independent variables. Patients reported that they were willing to spend a mean of 5.8 hours per week on an 8-week asthma self-management program. Patients who were willing to spend more time on an asthma self-management program had indicated an interest in participating in such a program, had a higher number of comorbidities, or had more emergency department visits. This model was statistically significant (P = 0.0018), with 18% of the variance explained. This study identified several factors that may affect WTP and WTGT in relation to an asthma self-management program. This information may be helpful in identifying candidates for educational programs.

Adolescent↗
PubMedDate not supplied

The community orientation of social model and medical model recovery programs.

This paper examines the extent to which two social model programs and one medical model program operating in the same county were able to establish links between their programs and the community at large. Emphasis on community and environment is a hallmark of social model programs, suggesting that more effective links will have been established at those programs than at the medical model program. Items from the community orientation subscale of the Social Model Philosophy Scale provide a guide for this qualitative analysis. Community resources considered include self-help 12-step programs, as well as community agencies chartered to address employment, education, family counseling, and housing. All three programs were found to have a strong emphasis on Alcoholics Anonymous (AA)/Narcotics Anonymous (NA). At the medical model program (MMP), patients were exposed to three to five AA or NA meetings per week during their 10-day stay, although for the most part, meetings in the MMP had few, if any, outsiders. The social model programs exposed residents to a number of different AA and NA meetings, both at the program and in the community over a period of months. The MMP program was found to have minimal links with the community for employment, education, or other services. The MMP program counselors did try to make referrals to other substance abuse programs upon release from the hospital, and to insure that patients had somewhere to go for shelter after being discharged. In contrast, social model programs encouraged residents to utilize community resources for health, education, and social service needs.

Community Health Services↗
PubMed2005

The growth of palliative care programs in United States hospitals.

BACKGROUND: Palliative care programs are becoming increasingly common in U.S. hospitals. OBJECTIVE: To quantify the growth of hospital based palliative care programs from 2000-2003 and identify hospital characteristics associated with the development of a palliative care program. DESIGN AND MEASUREMENTS: Data were obtained from the 2001-2004 American Hospital Association Annual Surveys which covered calendar years 2000-2003. We identified all programs that self-reported the presence of a hospital-owned palliative care program and acute medical and surgical beds. Multivariate logistic regression was used to identify characteristics significantly associated with the presence of a palliative care program in the 2003 survey data. RESULTS: Overall, the number of programs increased linearly from 632 (15% of hospitals) in 2000 to 1027 (25% of hospitals) in 2003. Significant predictors associated with an increased likelihood of having a palliative care program included greater numbers of hospital beds and critical care beds, geographic region, and being an academic medical center. Compared to notfor- profit hospitals, VA hospitals were significantly more likely to have a palliative care program and city, county or state and for-profit hospitals were significantly less likely to have a program. Hospitals operated by the Catholic Church, and hospitals that owned their own hospice program were significantly more likely to have a palliative care program than non- Catholic Church-operated hospitals and hospitals without hospice programs respectively. CONCLUSIONS: Our data suggest that although growth in palliative care programs has occurred throughout the nation's hospitals, larger hospitals, academic medical centers, not-for-profit hospitals, and VA hospitals are significantly more likely to develop a program compared to other hospitals.

Data Collection↗
PubMed2004

Outcomes of states' scholarship, loan repayment, and related programs for physicians.

CONTEXT: Many states attempt to entice young generalist physicians into rural and medically underserved areas with financial support-for-service programs-scholarships, service-option loans, loan repayment, direct financial incentives, and resident support programs-with little documentation of their effectiveness. OBJECTIVE: The objective of this study was to assess outcomes of states' support-for-service programs as a group and to compare outcomes of the 5 program types. DESIGN: We conducted a cross-sectional, primarily descriptive study. PARTICIPANTS: We studied all 69 state programs operating in 1996 that provided financial support to medical students, residents, and practicing physicians in exchange for a period of service in underserved areas; federally funded initiatives were excluded. We also surveyed 434 generalist physicians who served in 29 of these state programs and a matched comparison group of 723 nonobligated young generalist physicians. DATA COLLECTION: Information on eligible programs was collected by telephone, mail questionnaires, and from secondary sources. Obligated and nonobligated physicians were surveyed, with 80.3% and 72.8% response rates, respectively. MAIN OUTCOME MEASURES: Levels of socioeconomic need of communities and patients served by physicians, programs' participant service completion and retention rates, and physicians' satisfaction levels. RESULTS: Compared with young nonobligated generalists, physicians serving obligations to state programs practiced in demonstrably needier areas and cared for more patients insured under Medicaid and uninsured (48.5% vs. 28.5%, P <0.001). Service completion rates were uniformly high for loan repayment, direct incentive, and resident-support programs (93% combined) but lower for student-targeting service-option loan (mean, 44.7%) and scholarship (mean, 66.5%) programs. State-obligated physicians were more satisfied than nonobligated physicians, and 9 of 10 indicated that they would enroll in their programs again. Obligated physicians also remained longer in their practices than nonobligated physicians (P = 0.03), with respective group retention rates of 71% versus 61% at 4 years and 55% versus 52% at 8 years. Retention rates were highest for loan repayment, direct incentive, and loan programs. CONCLUSIONS: States' support-for-service programs bring physicians to needy communities where a strong majority work happily and with at-risk patient populations; half stay over 8 years. Loan repayment and direct financial incentive programs demonstrate the broadest successes.

Adult↗
PubMed1984

A comparison of controlled feeding programs for maximizing returns of white Leghorn layers.

Three controlled feeding programs initiated after peak egg production and a full feeding program were evaluated for their effects on production and income performance of White Leghorn layers. Program 1 consisted of full feeding from 20 to 64 weeks of age. Controlled feeding programs were initiated at 36 weeks and consisted of feeding approximately 105 g/bird/day to 64 weeks (Program 2), a phase reduction feeding program consisting of feeding approximately 105 g/bird/day to 53 weeks of age followed by feeding approximately 95 g/bird/day to 64 weeks (Program 3), and feeding approximately 95 g/bird/day continuously from 36 weeks (Program 4). Controlled feeding programs resulted in significant (P less than .05) reductions in total feed usage compared to full fed birds. Eggs per hen, however, were significantly (P less than .05) reduced only for feeding Programs 3 and 4, and egg weights were reduced only with feeding Program 4. Egg mass production and body weights were significantly affected by controlled feeding programs. Egg grade distributions were not significantly (P greater than .05) different among Programs 1, 2, or 3; however, Program 4 produced a significant (P less than .05) increase in the percentage of medium grade eggs obtained. Egg incomes over pullet and feed costs favored all controlled feeding programs, demonstrating that maximum production levels do not always mean maximum returns.

Animal Feed↗
PubMed1996

Resident research in internal medicine training programs.

OBJECTIVE: To determine how well medical residency programs are prepared to meet the new Accreditation Council of Graduate Medical Education (ACGME) accreditation guidelines for resident scholarly activity. DESIGN: Cross-sectional study using a mailed survey. PARTICIPANTS: Program directors of all ACGME-accredited internal medicine residency programs. MEASUREMENTS: Program directors were asked to list the scholarly activities and products of their residents and their programs' minimal expectations for resident research; available academic, faculty, technical, and personnel support for resident research; perceived barriers to resident research; and the desired educational and skill outcomes of resident research. The responses of university-based training programs were compared with those of non-university-based programs. RESULTS: 271 program directors returned the survey, yielding a response rate of 65%. Ninety-seven percent of all programs have established scholarly guidelines consistent with accreditation requirements. Although only 37% of programs reported having an organized, comprehensive research curriculum, 70% taught skills important to research. Technical support and resources were generally available for resident research; the most frequently cited barrier to resident research was lack of resident time. University-based and non-university-based training programs differed in important ways. Generally, non-university-based programs had more research activity and structure, and they exceeded university-based programs in the number of oral and poster presentations given at local, state, and national professional meetings. CONCLUSIONS: Most programs have in place the basic elements conducive to resident research. Program directors have identified and teach educational outcomes and skills that are likely to have lifelong benefits for most of their graduates.

Accreditation↗
PubMed1999

Residents' exposure to aboriginal health issues. Survey of family medicine programs in Canada.

OBJECTIVE: To determine whether Canadian family medicine residency programs currently have objectives, staff, and clinical experiences for adequately exposing residents to aboriginal health issues. DESIGN: A one-page questionnaire was developed to survey the details of teaching about and exposure to aboriginal health issues. SETTING: Family medicine programs in Canada. PARTICIPANTS: All Canadian family medicine program directors in the 18 programs (16 at universities and two satellite programs) were surveyed between October 1997 and March 1998. MAIN OUTCOME MEASURES: Whether programs had teaching objectives for exposing residents to aboriginal health issues, whether they had resource people available, what elective and core experiences in aboriginal health were offered, and what types of experiences were available. RESULTS: Response rate was 100%. No programs had formal, written curriculum objectives for residency training in aboriginal health issues, although some were considering them. Some programs, however, had objectives for specific weekend or day sessions. No programs had a strategy for encouraging enrollment of residents of aboriginal origin. Eleven programs had at least one resource person with experience in aboriginal health issues, and 12 had access to community-based aboriginal groups. Core experiences were all weekend seminars or retreats. Elective experiences in aboriginal health were available in 16 programs, and 11 programs were active on reserves. CONCLUSIONS: Many Canadian family medicine programs give residents some exposure to aboriginal health issues, but most need more expertise and direction on these issues. Some programs have unique approaches to teaching aboriginal health care that could be shared. Formalized objectives derived in collaboration with other family medicine programs and aboriginal groups could substantially improve the quality of education in aboriginal health care in Canada.

Adult↗
PubMedDate not supplied

Community pharmacy residency programs, 1997-1998.

OBJECTIVE: To obtain a descriptive "snapshot" of community pharmacy residency programs active in 1997-1998. DESIGN: Survey (telephone interview) of community pharmacy residency program directors. METHODS: An advance letter to residency directors stated the purpose of the study and requested written information on their residency program. Using a scripted questionnaire, telephone interviews were conducted with each residency director. RESULTS: Descriptive statistics were used to portray the data. There were 13 active community pharmacy residency programs with 20 filled residency sites nationwide at the time of the study. Results revealed that 9 (69%) programs were funded by multiple sources, 3 programs were funded solely by the affiliated college, and 1 program was funded solely by the affiliated pharmacy. Of the 10 residency programs that had been in existence for longer than 1 year, 7 (70%) had the same funding source as they did the first year. Respondents provided descriptions of the residency programs, along with insight into the challenges of creating such programs. At the time of publication (November 1999), there were 50 active community residency sites within the 21 active community pharmacy residency programs. Several other programs are planned for implementation in July 2000. CONCLUSION: In general, community pharmacy residency programs continue to grow in number, and funding has been sustained due to the programs' successful outcomes. The results of this study provide a framework for the improvement of existing community pharmacy residency programs and the development of additional ones.

Community Pharmacy Services↗
PubMed2000

Medicare premium buy-in programs: results of SSA demonstration projects.

Three programs known collectively as the Medicare buy-in programs are available to pay Medicare Part B premiums and, in some cases, other medical expenses for certain low-income individuals. The Health Care Financing Administration administers those programs, with most functions performed by the states. The Social Security Administration (SSA) plays an indirect role in the buy-in programs: with certain exceptions, people who qualify for Medicare and hence for buy-in are beneficiaries of Social Security retirement or disability programs. SSA is often cited as an agency that might be able to increase enrollment in the buy-in programs through outreach to its beneficiaries and by acting as an intermediary in the enrollment process. The three buy-in programs have different requirements for eligibility. The Qualified Medicare Beneficiary (QMB) program includes individuals who have Part A Medicare benefits and whose income does not exceed 100 percent of federal poverty guidelines. People in the Specified Low-Income Medicare Beneficiary (SLMB) program are individuals who would otherwise be QMBs but whose income is more than 100 percent but less than 120 percent of poverty guidelines. People in the Qualified Individual (QI) program are those who meet the other criteria but whose income is less than 175 percent of poverty guidelines. Various reports and studies by government agencies and advocacy organizations conclude that the buy-in programs are not reaching many of the people who are eligible. Low enrollment appears to be a particular issue for the SLMB and QI programs. States have tried various outreach efforts, but the effectiveness of those efforts has not been adequately assessed. In 1998, Congress mandated that SSA conduct a demonstration project to determine how to increase participation in the buy-in programs. The project tested six different administrative models in which outreach letters were sent to potential beneficiaries asking them to contact SSA and then be screened for eligibility and referred for enrollment. SSA was able to screen about 7.1 percent of letter recipients for buy-in eligibility: 4.2 percent were potentially eligible for the programs based on income and resources, and 3.7 percent enrolled in a buy-in program. An evaluation of the probability that letter recipients would contact SSA to be screened found that: Among the elderly, older individuals were less likely to be screened but more likely to enroll. Among the disabled, older individuals were more likely to be screened but less likely to enroll. The disabled were less likely to be screened but more likely to enroll. Individuals with higher Social Security benefits were more likely to be screened but less likely to enroll. Women were more likely to be screened and to enroll. Being married did not appear to affect screening but negatively affected enrollment. Individuals with a preference for materials in Spanish were much more likely to be screened and enrolled. In some of the demonstration sites, enrollment in a Medicare+Choice plan increased the probability of being both screened and enrolled. SSA conducted a survey of some people who did not respond to the outreach letter. Most of those from whom explanations of the nonresponse were obtained had not responded because they were not eligible on the basis of their income or resources. If SSA were to reproduce the demonstrations in a nationwide outreach effort, a national mailing would include nearly 20 million individuals. If response rates were similar to those seen in the 1999 demonstrations, outreach would produce over 740,000 new buy-in enrollees. That number might be increased modestly by conducting additional outreach efforts in conjunction with the mailing.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2005

Lessons learned from employee fitness programs at the Marshfield Clinic.

PURPOSE: To describe and evaluate employee fitness programs at the Marshfield Clinic. METHODS: A 16-week program was offered to employees from April-July 2004, and a 12-week program was offered from August-November, 2004. Weekly e-mails included suggestions to increase physical activity and eat a healthy diet. Incentives were offered for meeting program goals. RESULTS: A total of 1129 employees signed up for the first program (approximately 18% of all employees) and 610 for the second program. More than 95% of the participants in both programs were female. The activity program goal was met by 231 (20.5%) participants in the first program and 31% (n = 190) of participants in the second program. There was a significant increase in the percent of people with good or excellent fitness levels from baseline (46.4%, 95% CL = 40.5, 52.3) to follow-up (70.7%, 95% CL = 65.3, 76.0) in the first program. In the second program, there was a significant association between the number of program goals met and self-report of having increased energy, better weight control, and feeling better overall and about body image. CONCLUSION: Emphasis in future programs should be placed on increasing employee participation. Program evaluation could be expanded to include health care costs and employee absenteeism.

Adult↗
PubMed2005

Canadian rural family medicine training programs: growth and variation in recruitment.

OBJECTIVE: To document the proliferation of rural family medicine residency programs and to note differences in design as they affect rural recruitment. DESIGN: Descriptive study using semistructured telephone interviews. SETTING: All family medicine residency programs in Canada in 2002. PARTICIPANTS: Directors of Canadian family medicine residency programs. MAIN OUTCOME MEASURES: Number of rural training programs and positions; months of rural exposure, degree of remoteness, and specialist support of rural communities within rural training programs. RESULTS: The number of rural training programs rose from one in 1973 to 12 in 2002. Most medical schools now offer dedicated rural training streams. From 1989 to 2002, the number of rural residency positions quadrupled from 36 to 144; large jumps in capacity occurred from 1989 to 1991 and then from 1999 to 2001. Rural positions now represent 20% of all family medicine residency positions. Among rural programs, minimum rural exposure ranged from 4 to 12 months, and the median distance between rural training communities and referral sites ranged from 50 to 440 km (median 187 km). Rotations in communities with no hospital were mandatory in five of 12 rural programs, optional in five, and unavailable in two. The proportion of training communities used by rural programs that had family physicians only (ie, no immediate specialty backup) ranged from 0 to 78% (mean 44%). Most training communities (78%) used by rural programs had fewer than 10 000 residents. Four of 12 rural programs offered various specialty medicine rotations in small communities. CONCLUSION: Rural residency programs have proliferated in Canada. The percentage of residency positions that are rural now equals the proportion of the general population in Canada living in rural areas. National guidelines for rural programs recommend at least 6 months of rural rotations and at least some training in communities without hospitals. Major variations among programs exist, and most program designs differ from designs recommended in national guidelines in at least one aspect.

Canada↗
PubMedDate not supplied

[Efficiency of a gambling prevention program for youths: results from the pilot study].

UNLABELLED: A meta-analysis of North American studies indicates that the prevalence rate of pathological gambling varies between 4.4% and 7.4% among adolescents. Pathological gambling is thus not a phenomenon that suddenly appears once youths reach an adult age. On the contrary, significant contact with gambling occurs in childhood adolescence. For this reason, it is important to develop an effective gambling prevention program that will reduce the risk that youths will develop gambling problems. The information promoted in the prevention program our research team created and evaluated here teaches youths to recognize the traps of gambling activities, while enabling them to make an informed decision as to their eventual participation in those activities. The program is based on knowledge and recognition of key indices that can be easily identified as warning signs of a loss of control. It is predicted that youths who participate in this prevention program will improve their knowledge of gambling activities and will develop a more realistic attitude towards those activities than youths from a control group. The experimental group's problem-solving skills are also expected to improve. An experimental design (pre-test, post-test and follow-ups with control group) was used to evaluate the program's effectiveness. Overall, 1193 youths participated in this study. The prevention program involves three 60-minute meetings. The objectives of these meetings are the following: (meeting #1) improve youths' knowledge of gambling activities and help them acquire a more realistic attitude towards these activities; (meeting #2) teach a structured problem-solving approach to resist to peer-pressure; (meeting #3) inform youths of the consequences that may be associated with abusive participation in gambling and teach them to recognize warning signs of a loss of control over gambling habits. DEPENDENT VARIABLES: (a) knowledge of and attitudes towards gambling and gambling activities; (b) problem-solving skills; (c) frequency of participation in gambling activities; (d) discussion with relatives, friends and teachers regarding gambling activities and attention paid towards gambling habits among close friends and family. Participation in the gambling prevention program significantly improves youths' knowledge of the real probabilities of winning and the pitfalls included in gambling activities and favours the development of a more realistic attitude towards these activities. However, the participation in the prevention program does not help to improve their problem-solving skills. Nonetheless, it leads more youths to talk about gambling with their parents and teachers, and enables them to be more aware of the gambling habits of their friends and family. Finally, note that it was impossible to verify any decrease in gambling habits as the majority of participants (62%) were non or very occasional gamblers. However, no iatrogenic effect was observed on the frequency of participation in gambling activities. Aside the positive impact of the program on the attitudes and knowledge of students, participation in the preventive sessions contributed to create a dialogue with adults and increased youths' interest in the gambling habits of their friends and family. These discussions enabled the youths to validate the information they received during class, to consolidate what they learned during the prevention sessions, and favour the dissemination of this knowledge beyond the scope of the academic environment. The results obtained regarding youths' attitudes and knowledge demonstrate that attitude modification takes place progressively. However, once well assimilated, these new attitudes seem to take hold in a fairly durable way. On the other hand, acquisition of knowledge seems to take place immediately after the theoretical concepts are taught. Yet, they slightly decreased before stabilising a few months later. This suggests that assimilation of new knowledge may be optimized by the addition of an intervention session a couple of months after the end of the intervention. Even if it was impossible to verify any decrease in participants' gambling habits, it is possible to think that the impact of participation in the gambling prevention program could be observable and measurable within a few years. However, only a long-term follow-up study would make it possible to assess whether participation in the program does indeed contribute to decreasing gambling habits and the number of youths who regularly participate in gambling activities. Despite the non-significant results observed for problem-solving skills, it seems nonetheless important to include this component, which benefits from great theoretical support, especially within the framework of prevention programs targeting youths. However, the teaching method must be changed in order to maximize the intervention's effectiveness. Despite some methodological limitations observed during the evaluation of this program, the results obtained clearly demonstrate that participation in the prevention program significantly improves youths' attitudes and knowledge regarding gambling activities. The teaching of accurate knowledge and realistic attitudes towards gambling should help youths to recognize the cognitive traps inherent to gambling activities and thus contribute, over the long run, to decrease the number of youths with gambling problems.

Adolescent↗
PubMed2005

The development of a Master of Public Health Program with an initial focus on urban and immigrant health at the State University of New York, Downstate Medical Center.

The State University Downstate Medical Center initiated a Master of Public Health (MPH) degree program in July 2001 following planning efforts that began in 1995. Twelve Students entered the program in June 2002. Currently, eighty students are enrolled in the program and eighteen have graduated from it in 2004 and 2005. With an initial focus on urban and immigrant health, the program aims to train public health professionals who can assist in addressing through population-based interventions the health issues of Brooklyn's 2,465,326 people, of whom 38.5% are immigrants to the United States. Starting with four courses in the summer 2002 semester, the program now offers twenty-four courses over the three semesters of the academic year. The program is housed in the Department of Preventive Medicine and Community Health of the College of Medicine and is part-time in nature for most students. In addition to completing required course work, students must also complete a 250-hour practicum experience in which they apply theoretical knowledge in a public health practice setting. Student practicum experiences play a vital role in linking the program to communities and serve as conduits for the initiation of further community based collaboratives. This article describes the challenges encountered in initiating an MPH program in an academic medical center, the importance of both intramural and community support to its success, and the vital role it plays in addressing the health issues of various communities. The program became a leading priority of the Strategic Plan of the Downstate Medical Center in 2000, and received the full support of Downstate's then new president, Dr. John C. LaRosa. This prioritization and support proved essential to the rapid development of the program. The Downstate MPH program offers a concurrent degree to medical students who are able to complete both degrees in a four year period. The Alumni Fund of the College of Medicine provides each MD/MPH student with a one-time scholarship which covers a quarter of the MPH tuition. Concurrent MPH degrees are also offered for graduate students enrolled in occupational therapy, nursing, and several other health programs. The Council on Education for Public Health (CEPH) conducted an accreditation site visit of the Downstate MPH program in December 2004. On June 10, 2005, the CEPH Board accredited the program for 5 years.

Academic Medical Centers↗
PubMed2003

Geriatric medicine curriculum consultations for family practice residency programs: american academy of family physicians residency assistance program/hartford geriatrics initiative.

Increasing the quality and quantity of geriatric medicine training for family practice residents is a particular challenge for community-based programs. These programs have an average of only seven full-time equivalent physician faculty. This report summarizes results of the Residency Assistance Program/Hartford Geriatric Initiative (RAP/HGI) geriatric medicine curriculum consultations for family practice (FP) residency programs conducted from 1996 to 2001. This project was developed as part of the RAP in family practice. Ten experienced FP educators were selected and trained as special consultants. Between 1996 and 2001, 39 FP residency programs participated in the 1- to 4-day RAP/HGI consultations. The programs were diverse in size and location. The consultations reached 308 family practice residency faculty members involved in training 807 residents. Program evaluations of the consultants were uniformly in the very good to excellent range, with a mean rating of 4.6 (5-point scale, with 5 indicating excellent). At the end of the initial consultation visit, the residency program faculty and the consultant developed short-term goals for geriatrics program development. Eighty-five percent (33/39) of the programs submitted their curriculum goals in writing. The mean number of goals per program was 4.8 (range = 3-11). Of the 33 programs with written goals, follow-up was documented for 29 programs. Seventy-nine percent of the programs' self-defined educational goals were met during the 6 to 12 months of follow-up (range 50-100%). Ten of the programs implemented all of their educational goals. The RAP/HGI project demonstrated that achievable geriatric medicine curriculum improvements could occur as part of an onsite consultation process.

Connecticut↗