Julia M. Fleckman

Bio: Julia M. Fleckman is an academic researcher from Tulane University. The author has contributed to research in topics: Medicine & Psychology. The author has an hindex of 7, co-authored 13 publications receiving 144 citations.

Intercultural Competency in Public Health: A Call for Action to Incorporate Training into Public Health Education

Abstract: Due to increasing national diversity, programs addressing cultural competence have multiplied in U.S. medical training institutions. Although these programs share common goals for improving clinical care for patients and reducing health disparities, there is little standardization across programs. Furthermore, little progress has been made to translate cultural competency training from the clinical setting into the public health setting where the focus is on population-based health, preventative programming, and epidemiological and behavioral research. The need for culturally relevant public health programming and culturally sensitive public health research is more critical than ever. Awareness of differing cultures needs to be included in all processes of planning, implementation and evaluation. By focusing on community-based health program planning and research, cultural competence implies that it is possible for public health professionals to completely know another culture, whereas intercultural competence implies it is a dual-sided process. Public health professionals need a commitment toward intercultural competence and skills that demonstrate flexibility, openness, and self-reflection so that cultural learning is possible. In this article, the authors recommend a number of elements to develop, adapt, and strengthen intercultural competence education in public health educational institutions.

Role of Direct and Indirect Violence Exposure on Externalizing Behavior in Children.

Abstract: The objective of this study was to examine the association between externalizing behaviors and indirect violence exposure, assessed both within the household and at the community level, as well as the interaction effect of indirect and direct violence exposure. A sample of parents of children ages 4–15 who have not been referred or enrolled in child welfare (n = 82) were recruited from the greater New Orleans community. Externalizing behavior was assessed with the Child Behavior Checklist (CBCL). The child’s indirect exposure to violence included witnessing community violence, witnessing physical assault, and witnessing fighting or domestic violence at home. Direct exposure to violence included the child experiencing physical aggression from a caregiver. All assessments were based on caregiver reports. To decrease potential for confounding, children were matched for analysis based on age, Hurricane Katrina exposure, and their propensity to be exposed to high indirect violence. Cumulative indirect exposure to violence was significantly positively correlated with CBCL scores. After controlling for key covariates, CBCL externalizing T score increased significantly by approximately 1.25 points for each level increase in indirect violence exposure (β = 1.25, SE = 0.57, p = 0.027). There also was a significant interaction between indirect and direct exposure to violence in the association with CBCL score (β = −0.08, SE = 0.03, p = 0.002). These findings extend previous research by demonstrating that exposure to both direct and cross-contextual indirect violence influences externalizing behaviors in children. Additionally, the findings suggest that community and household social environments are both important targets for interventions designed to decrease externalizing behaviors and improve long-term outcomes for youth at risk of exposure to violence.

Impact of a community popular opinion leader intervention among african american adults in a southeastern united states community

Abstract: We examine the impact of an adapted community popular opinion leader (C-POL) intervention targeting alcohol-using social networks in Southeast Louisiana. A pre-post C-POL was conducted between October 2009 and April 2013, targeting alcohol users. A total of 65 popular opinion leaders were recruited, trained, and deployed into their social networks to diffuse intervention messages. Anonymous community surveys conducted within the venues among 99 male and female participants at baseline and 197 at 6 months to 1 year later revealed significant behavioral and knowledge changes. Average sexual risk score based on 7 sexual risk items declined from 15.3 to 11.9 (p < 0.001); the number of vaginal and anal sex partners in the last year decreased from 11.3 to 7.7 and 3.9 to 2.3, respectively (p < 0.01); and HIV knowledge score (based on % correct) increased from 67.2 to 76.8% (p < 0.001). Findings add to the evidence base surrounding peer interventions.

Internationalisation, intercultural communication and intercultural competence

Abstract: This article assumes that the internationalization of higher education demands more elaborate pedagogical approaches to utilise the experiences of multiethnic student groups and to facilitate every student’s acquisition of intercultural competencies. Drawing from three internationalisation ideologies embedded in the educational discourse, it is argued that intercultural communication – as a field of study or a discipline – can play a key role in this endeavour. Twelve fields of consideration, when international educators work with students, are also identified.

Effective Discipline to Raise Healthy Children.

Abstract: Pediatricians are a source of advice for parents and guardians concerning the management of child behavior, including discipline strategies that are used to teach appropriate behavior and protect their children and others from the adverse effects of challenging behavior. Aversive disciplinary strategies, including all forms of corporal punishment and yelling at or shaming children, are minimally effective in the short-term and not effective in the long-term. With new evidence, researchers link corporal punishment to an increased risk of negative behavioral, cognitive, psychosocial, and emotional outcomes for children. In this Policy Statement, the American Academy of Pediatrics provides guidance for pediatricians and other child health care providers on educating parents about positive and effective parenting strategies of discipline for children at each stage of development as well as references to educational materials. This statement supports the need for adults to avoid physical punishment and verbal abuse of children.

Aging and health among migrants in a European perspective.

Abstract: Population aging and the associated changes in demographic structures and healthcare needs is a key challenge across Europe Healthy aging strategies focus on ensuring the ability to maintain health, quality of life and independent living at old age Concurrent to the process of population aging, the demographics of Europe are affected by increased migration resulting in substantial ethnic diversity In this paper, we narratively review the health profile of the growing proportion of aging migrants in Europe, outline key factors shaping health among this diverse group and consider ways of addressing their healthcare needs Although factors shaping aging processes are largely similar across populations, migrant-specific risk factors exist These include exposure to health risks before and during migration; a more disadvantaged socioeconomic position; language barriers and low health literacy; cultural factors influencing health-seeking behaviours; and psychosocial vulnerability and discrimination affecting health and quality of life Overall, migrants experience the same morbidity and mortality causes as the native populations, but with different relative importance, severity and age of onset and with substantial differences within and between migrant groups Little is known regarding health behaviours among aging migrants, although differences in cancer screening behaviours have been identified Indications of widening health differentials between migrants and native populations with age and informal barriers to quality healthcare for aging migrants are causes of concern In conclusion, there is a need for attention to migration alongside other determinants of healthy aging The diversity in individual characteristics, life course processes and contextual factors shaping aging processes among migrants point to the need for a sensitive and comprehensive approach to policies, practices and research within the field of healthy aging This is important to accommodate for the needs of the growing number of aging migrants in Europe and counter inequities in health and well-being at old age

Peer education for HIV prevention among high-risk groups: a systematic review and meta-analysis

Abstract: Peer education has become a strategy for health promotion among high-risk groups for HIV infection worldwide. However, the extent to which peer education could have an impact on HIV prevention or the long-term effect of this impact is still unknown. This study thus quantifies the impact of peer education over time among high-risk HIV groups globally. Following the PRISMA guidelines, a systematic review and meta-analysis was used to assess the effects and duration of peer education. A thorough literature search of PubMed, Web of Science, Embase and Cochrane Library was performed, and studies about peer education on high-risk HIV groups were reviewed. Pooled effects were calculated and the sources of heterogeneity were explored using meta-regression and subgroup analysis. A total of 60 articles with 96,484 subjects were identified, and peer education was associated with 36% decreased rates of HIV infection among overall high risk groups (OR: 0.64; 95%CI: 0.47–0.87). Peer education can promote HIV testing (OR = 3.19; 95%CI:2.13,4.79) and condom use (OR = 2.66, 95% CI: 2.11–3.36) while reduce equipment sharing (OR = 0.50; 95%CI:0.33,0.75) and unprotected sex (OR = 0.82; 95%CI: 0.72–0.94). Time trend analysis revealed that peer education had a consistent effect on behavior change for over 24 months and the different follow-up times were a source of heterogeneity. Our study shows that peer education is an effective tool with long-term impact for behavior change among high-risk HIV groups worldwide. Low and middle-income countries are encouraged to conduct large-scale peer education.