Showing papers in "International public health journal in 2015"

Building a co-created citizen science program with gardeners neighboring a superfund site: The Gardenroots case study.

Abstract: IntroductionTypically community members living in contaminated communities are the ones who initially identify adverse ecological and health outcomes associated with toxic exposures (1), although a state agency, regional US Environmental Protection Agency (USEPA) office, or the responsible party may make this discovery The USEPA may add the site to the Comprehensive Environmental Response, Compensation, and Liability Information System, which can lead to a cascade of regulatory and/or remedy events Typically at National Priorities List (NPL) sites with groundwater contamination, the time from discovery to remedy implementation can go beyond 20 years, and long-term management (ie decades to centuries) is needed at many sites (2) As time passes, site managers are responsible for monitoring the progress of remediation and engaging the community to inform them of the cleanup progress and describe potential risks associated with the siteTraditionally, site managers engage the community in a one-way communication model that solely aims to inform, change behavior, and assure populations that the determined risk is acceptable and that cleanup is underway (3, 4) This communication strategy has a low rate of success, primarily because it excludes those most affected (3) and fundamentally does not aim to increase environmental education or involve the community in the decisions about their risk Historically, because communities were not involved in the decision-making process, mistrust often eroded the relationships between scientists, regulatory officials, and the affected communities (5, 6)The lack of public participation at contaminated sites is a great loss, as community members have been contributing to science since the 17th century (7, 8) and in general, volunteerism is considered critical to civic life in the United States (9, 10) Volunteers have monitored watershed health in more than 700 programs in the US, involving over 400,000 local stakeholders (11) and most ecological research once fostered public participation in most or all of the steps in the scientific process (8) However, due to the professionalization of science, the role of the amateur scientist has diminished (8) The value of public participation in addressing environmental and health issues has received renewed attention in the past couple of decades through efforts such as public participation in scientific research (PPSR)/ citizen science (12), community based participatory research (CBPR) (13), popular epidemiology (14), and street science (15)Public participation in scientific research, often termed citizen science, is a form of informal science education, and is broadly defined as a partnership between scientists and non-scientists in which authentic data are collected, shared, and analyzed (12, 16, 17) Citizen science projects are meant to increase a participant's scientific literacy (12), to collect field data to monitor a variety of environmental conditions (7), and as a framework to support and enhance decision-making in modern society (17, 18) Previous research in science education and sociology has demonstrated the need to engage communities in scientific research and that this level of engagement can be successfully facilitated via community-academic partnerships Members of a community neighboring a contaminated site are typically intrinsically motivated to learn more about the issues regarding the contaminated site in their community and in most cases, have already begun to gather additional scientific data hypothesize other potential routes of exposure and areas that need additional monitoring Research related to inquiry-based education has elucidated how people have a greater motivation to engage and learn when the subject matter is directly related to their lives and if the learning process is interactive (19) Popular epidemiology, a community-driven practice, was proposed after observing the activities of communities experiencing contamination and entails community initiation of investigations, gathering of scientific knowledge, and, if necessary, recruiting of scientific professionals (14) …

Using concept mapping to mobilize a Black faith community to address HIV.

Abstract: IntroductionFaith communities, especially African American churches, have been suggested as a key partner to address HIV (1-3). HIV, or human immunodeficiency virus, can lead to a terminal condition known as AIDS (acquired immunodeficiency syndrome). African Americans are disproportionately affected by HIV (4). The Black church (evangelical congregations predominantly made up of African American members) has been a powerful voice in communities of color, but its role in shaping HIV-risk behaviors and HIV prevention/care has been mixed (1). A national study estimated that 5.6% of U.S. congregations provide programs or activities to people living with HIV (PLWH), which were facilitated by presence of PLWH in the congregation, formal community needs assessment activities, religious tradition (Black Protestantism), and openness to gays/lesbians (5). Another study has shown that only a third of Black Protestant congregations offer HIV prevention/counseling programs (2). The literature has identified stigma linked with religious doctrines and moral positions as a key barrier to effective HIV prevention/care (6). Even churches willing to address HIV in their communities defer from discussing specific HIV-risk behaviors (7). How to tackle doctrinal stances on HIV remains unclear, but mobilization and input directly from faith leaders and faith communities in specific local contexts are emerging as useful approaches (8).Involving community members in the process is considered as crucial to improving the success of health interventions (9). Research that partners with community stakeholders increases contextual relevance and community buy-in and therefore maximizes the chance for intervention success. As one strategy to HIV prevention, federal agencies have been funding Black churches as partners in HIV prevention (10). Most of this work has been capacity-building and HIV-related training. The development of community-based coalitions and partnerships is another effective strategy (11). Such connections have been seen as major opportunities for faith leaders to gain support and garner resources for faith communities' HIV involvement. Some faith institutions have been implementing HIV programs and services that they find acceptable within the context of their religious doctrine (12). Researchers have also begun engaging directly with faith leaders to learn about factors that facilitate or inhibit effective HIV prevention/care in at-risk communities (8).Unfortunately, data from such studies sometimes lack rigor because traditional research and evaluation methods are difficult to implement on a large scale and in "fluid" community settings. There are also several potential barriers to implementing health programs and in particular those addressing HIV within religious settings. These include the presence of mistrust and a reciprocal lack of understanding of the values, norms, and customs between religious organizations and their partners in science, public health, or academia (13). Therefore, innovative methodologies rooted in social sciences, not widely used within public health, are urgently needed. Furthermore, demonstrations and exploratory studies need to be repeated in a broad range of environments and might even be uniquely important in areas outside of epicenters in which relatively more motivations/resources are available. Finally, community mobilization with a focus on HIV can be effective, but such interventions are most effective when they occur spontaneously and emerge directly from communities (rather than being "implemented" by an outside agent) (14). There are few studies describing programs that emerge in such "organic" fashion.The purpose of the current study was to generate and then prioritize specific strategies to address HIV in a Black faith community. The intent was to inform the design of HIV intervention strategies based on the lived experience of the broader community of stakeholders - providers, faith-community stakeholders (faith leaders, health ministers, and congregants), community advocates, and health researchers. …

Reflections of Two-Screen Users: How People Use Information Technology While Watching Sports

Abstract: IntroductionSport fans frequently use more than one platform of information technology when they are watching sports (1). It is estimated that as many as 85% of people use another device while watching television (2). The spread of technology, combined with a reduction in its size, has made it possible for people to use technology while engaging in other activities. For example, the size of smart phones and tablets have made it easier for people to be online, while at a sporting event or watching one on television. People who use information technology while consuming other forms of entertainment are often referred to as two-screen users (3). They can also be said to be engaging in the second-screen experience (4). The use of multiple digital devices at once is an area within multitasking research that has seen a recent rise in interest. This interest is primarily rooted in the belief that the rapid spread of digital devices has created an information technology environment for today's young people, which is drastically different from previous generations (5). The second-screen experience can manifest in a number of different ways. Apps for smart phones and tablets can use audio from a television to sync with a television program. These apps then offer content related to the television program one is watching (4). The popular ABC show Grey's Anatomy offers an app that provides show watchers with an interactive experience while watching the show. As a viewer watches the show, content related to the show and its subject matter are displayed on the app (6). Popular apps such as GetGlue, IntoNow, and Viggle offer similar experiences for people. These apps also offer rewards for "checking-into" a show via the audio recognition software included on most smart phones (4). More importantly, two-screen users represent another way for broadcaster partners to generate revenue. Forbes estimated that CBS's online streaming of Super Bowl XLVII to second-screen users could generate between $10 and $12 million in extra revenue for the network. This online steam of the game contained extra features not available during the network broadcast of the 2013 Ravens versus 49ers Super Bowl. These features included additional camera angles and a user-designed Twitter feed that could appear along with the game broadcast (7).The two-screen experience also presents itself in the use of social media during sporting events. Social networks such as Twitter and Facebook help to facilitate conversations among fans as they watch a live sporting event (8). Social networks also allow this conversation to be unconstrained by geography and encompass many different voices. The broadcasts of many live sporting events incorporate various elements of social media. These include such things as designating a Twitter hashtag for the event and informing viewers that they can visit the network's official Facebook page for more information about the event (1).Nielsen, the firm that records and reports on television ratings, reported that in the second quarter of 2013, people tweeted about television 263 million times. This was a rise of 38% from one year before (9). People are tweeting about their television entertainment as they consume it and doing so in ever increasing numbers. For example, the series-finale of the popular show Breaking Bad generated 1.24 million tweets from 601,000 Twitter users during the show's airing. Nielsen estimates that these tweets reached an audience of 9.3 million people (9). The year 2013 marked the first year for which Nielsen tracked the social traffic and social rank of television broadcasts. Of importance for this research is that Nielsen's 2013: Year in Sports Media Report (10) reported that almost half of all tweets which were about television last year, referenced sports-49.7% to be exact. This is despite that the fact that sports accounts for only about 1.2% of all television programming. Nielsen also reported that in September 2013, 61. …

Food Choices and Eating Patterns of International Students in the United States: A Phenomenological Study

Abstract: IntroductionThe international student population in the United States has steadily grown for more than half a century and has increased more than 25 times, with current enrollment at 764,495 students (1). Throughout the past decades, many studies have examined international college students' cultural adjustment issues such as culture shock, confusion about role expectations, lack of social support, social selfefficacy, and language barriers, collectively referred to as acculturative stress (2). Individuals experiencing significant amounts of acculturative stress typically encounter a deterioration of overall health status (3).The transitional period between adolescence and adulthood is known as a critical time for adopting and developing health behaviors related to prevention and wellness (4).Living independently in new environments, such as those for undergraduate college students, further make this transition an important time. International college students of all ages may face similar issues related to cultural assimilation and stress of transitional periods (5). International student health, particularly nutritional health, is not well known and warrants exploratory and in-depth study.One of the numerous health related changes that often occurs with immigration is change in diet. It is well known that undesirable changes in diet can lead to lifestyle-related diseases such as obesity, and obesity-related conditions such as heart disease, diabetes, and certain forms of cancer (6). The nutritional health and wellbeing of international students in institutions of higher education in the US is understudied despite the fact that it supports the goal of academic success.A study by Pan et al (7) discovered that changes in eating behaviors identified by Asian students living in the US involved skipping breakfast, increased frequency of consumption of salty and sweet snack items, and decreased frequency of consumption of vegetables. Another study in Belgium examined the change in dietary habits of international students from 60 different countries and concluded that healthier choices were hindered by a perceived unavailability of healthy food products (8).It is necessary to understand the process by which international students adopt or blend the dietary practices of the US to their everyday lives. Dietary acculturation and nutrition transition are concepts that refer to the process that occurs when individuals of a minority group adopt eating patterns and food choices representative of the host country (9,10). Dietary acculturation often focuses on large shifts in diet to more energy-dense foods that can impact nutritional outcomes such as increases in body weight (9,10). However, it is important to note that dietary acculturation can also result in healthful dietary changes.The exposure of international college students to a new food supply potentially changes the way food is chosen, acquired, stored and prepared. Often the unavailability of what these international college students consider traditional food and ingredients, results in increased intake of host country foods. Researches done on dietary acculturation often report an overall improvement in nutritional health when traditional healthful eating patterns are retained (9, 10).Given the above literature on dietary issues, this study examined the shifts in dietary patterns and health status of international students living and studying in the US.MethodsThe study took place at a large mid-western public university in the spring of 2103 and was designed for both undergraduate and graduate international students. The criteria for selection to participate in the study included being an immigrant and a full-time college student. Twenty-five participants from five continents representing 13 different countries were recruited using a snowballing and purposeful sampling technique (11). Specifically, students known to one of the authors through personal contacts were identified and asked to provide contact information for other students they knew of who met participant eligibility. …

Parents of Children with Autism: Issues Surrounding Childhood Vaccination

Abstract: IntroductionDespite increasing evidence of genetic causes of autism spectrum disorder (ASD) (1-3) and an authoritative review rejecting a causal association between MMR vaccination and ASD (4), fear that childhood vaccines play a key role in the etiology of ASD persists (5). In fact, a review by Brown and colleagues (6) identified a significant association between parents' belief that vaccines cause autism and lower vaccine uptake. The controversy continues to attract media attention and many parents remain skeptical about the safety of childhood vaccines (7,8). The issue is particularly salient for parents of children with autism (PCA) and, with an estimated ASD prevalence of one in 88 (9), vaccine uptake among this group could have a substantive impact on public health.Online surveys of parents involved with autism organizations in the US and Canada revealed that 40% of parents believed that vaccines were among the most significant contributory factors involved in their child's autism (10). Many factors play a role in producing these beliefs, including the temporal proximity of childhood vaccination and the manifestation of autism, distrust of governmental agencies, perceptions of the risks posed by vaccine-preventable diseases (VPDs), and information from popular media sources (11). Several studies have suggested that the latter, especially web-based sources, may fuel distrust in childhood vaccinations (12-15); yet, given limitations in extant research, developing interventions to address these influences would be challenging (16).Healthcare providers are on the frontlines in the debate about vaccines and autism, and can have a substantial influence on decisions about childhood vaccination (17-21). Therefore, it remains critical that healthcare providers offer information to caregivers, and to PCA, as early after diagnosis as possible (17). The purpose of this study was to examine attitudes toward childhood vaccination among PCA. The association between various dimensions of healthcare satisfaction, vaccine attitudes, and child autism severity and cognitive ability was explored, as was exposure to media sources portraying a link between vaccines and autism.Our studyA convenience sample of PCA were recruited through their participation in randomized controlled trials of a parent-teacher consultation intervention in Kentucky and Indiana (22,23). All children met the diagnostic and statistical manual IV-TR definition of autistic disorder (24) as confirmed by professionally-administered Autism Diagnostic Observation Schedule Modules 1 or 2 (25). Parents (n=79) were mailed two self-administered surveys assessing their attitudes toward childhood vaccines and their satisfaction with their child's medical care. Fifty parents completed the Parent Satisfaction with Care Questionnaire and 49 completed the Vaccine Attitude Questionnaire (described below). Respondents were not significantly different than non-respondents in terms of child's age, parental education level, income, or race. All study procedures were approved by the University's Institutional Review Board.Demographic information including child age, gender, race, household income, number of siblings, and parent education level was collected (described in table 1). Measures assessing children's severity of autism (Childhood Autism Rating Scale; CARS) and cognitive ability (Differential Abilities Scale; DAS) were administered by the research team (23). The CARS is a valid and reliable, observational scale comprised of 15 items evaluating behaviors such as social relating, resistance to change, communication, and body use (26). The General Conceptual Ability subscore of the DAS, which has strong internal and test-retest reliability (27), was used to assess children's cognitive ability.Participants also completed questionnaires assessing their satisfaction with their child's primary healthcare provider (PCP); Table 2 provides example items and coefficient alphas for subscales. …

A novel financial education program for single women of low-income and their children

Abstract: IntroductionTraditional risk factors for heart disease include hypertension, hypercholesterolemia, diabetes, obesity, sedentary behavior, smoking and family history (1). Financial stress, however, has also been implicated in cardiovascular disease risk. In the Framingham heart study, financial stress was associated with coronary heart disease and was shown to predict myocardial infarction and cardiac death in women (2,3). Additionally, lower socioeconomic status is associated with impaired well-being and biologic risk factors for heart disease including hyperlipidemia, metabolic syndrome and diabetes (4-6). Low socioeconomic status and financial stress also have deleterious effects on the health of children, including a greater rate of childhood obesity and subsequent development of diabetes and cardiovascular disease (7-10).Financial stress is not uncommon. Up to 40% of American households report living paycheck to paycheck (11). Single-mother families may be especially affected by financial strain. A report from 2012 found that 63% of single mother families met the poverty rate in the United States versus a 17% rate of poverty in two-parent families (poverty rate based on the 50% of median income poverty standard) (12). Due to its prevalence and association with poor health outcomes, financial stress presents a novel target for public health interventions, especially in the single-mother family population.Program historyIn an effort to reduce financial stress and improve money management skills in low income, single mother families, the Financial Success Program (FSP) was created. The FSP was initially funded by a grant from the Financial Industry Regulatory Authority (FINRA) Investor Education Foundation in 2010 to explore what financial education program components are most effective in creating behavior change for low income single mothers. The FSP focuses on three core components: an outstanding trainer, financial coaching, and an easy to use money management system.To be eligible for participation in the FSP, women must be earning a minimum of $12,000 annually, cannot be involved in a domestic violence situation or have an active addiction to alcohol or illicit drugs. They must also be willing to participate in both nine weeks of training and one year of financial coaching. The initial nine-week curriculum was created to address the immediate financial issues in a group of employed women who are struggling financially. The curriculum includes tracking expenses, saving for emergencies, and repairing credit reports. Information on taxes, insurance, predatory lending, legal issues, and the psychology of money are also provided. The nine-week curricular outline is described below (see table 1). The classes are offered once a week for two-three hours in a local community meeting space. Program participants receive free dinner and daycare with each weekly class. Participants are also paired with a financial coach, with whom they work with for a year following the initial classes. Financial coaches review and assess saved receipts, expense tracking forms, pay stubs and credit reports with the women.From this evaluation, spending habits are discussed and women participants make plans for change. Frequency of interaction with the coach is agreed upon by the participant and coach and may vary throughout the year depending on needs. This may include face to face meetings, phone calls, or email interaction. To date 196 women have completed the FSP.Program methodologyThe FSP is a two-phase program. Phase One involves the nine-week didactic curriculum in which women and their children receive a healthy dinner and live interactive educational sessions with an experienced trainer. Free childcare is available during these meetings. Phase Two occurs after graduation from the educational classes and involves one-on-one financial coaching from an assigned FSP representative, as well as monthly graduate follow-up meetings. …

Innovations in Continuing Professional Education: A Model to Impact Interprofessional Collaboration

Abstract: IntroductionChallenges exist for public health workforce development in both developing countries and wealthier countries alike. Beaglehole and Dal Poz (1) relate this challenge to the traditional emphasis on formal academic and didactic training with very limited attention being paid to training methods that are field-based continuing education where the workforce can participate in work group training that addresses the diversity and complexity of the healthcare team from a wide range of occupational backgrounds (1). Patients today have complex medical issues requiring more than one healthcare professional which calls for interprofessional collaboration (2). In 2001, acknowledging the medically challenging needs of patients, the Institute of Medicine (IOM) Committee on Quality of Health Care in America recommended that healthcare professionals be able to work in interprofessional (IP) teams (3). The research of Schofield et al. demonstrated that, especially for complex, chronic conditions, a multidisciplinary, or IP, team offers many advantages for patients and their families (4). Bringing an interprofessional focus to the development of innovative care delivery models requires collaboration among the health professions to increase learning about, from and with each other, as well as incorporation of a patient centered perspective (5). A growing consensus exists that interprofessional (IP) team- based care offers the potential to improve quality of care and lower costs (6). However, Varda et al. emphasize that even though there is growing interest in collaborative practice in public health, there is still little empirical evidence within the public health literature to support and inform this practice (7). According to Gebbie and Turnock, public health is especially challenged due to the multidisciplinary nature of services provided (8), and there is often very limited opportunities for workforce training and continuing education interventions that address the need for interprofessional collaboration. In November 2012 the Global Health Forum on Innovation in Health Professional Education convened in Washington, D.C. One of the obstacles identified for implementing IP education was "knowing how to weave IP content into meaningful clinical and community experiences" (9). Such obstacles, while challenging for students, become even more daunting when the learners are practicing clinicians where continuing education programs need to be relevant to current practice needs, and delivered in ways that encourage professional development. This study provides a model for continuing education that addresses the need to engage learners in ways that use authentic tasks to develop interprofessional collaboration.Collaborative partnerships in practiceBringing an interprofessional focus to the development of innovative care delivery models requires collaboration among the health professions to increase learning about, from and with each other (10), as well as incorporation of a patient centered perspective. Continuing professional education research emphasizes that educating working professionals must use authentic projects that have relevance in practice. To date, there is very limited research addressing knowledge translation or continuing professional education within the interprofessional context (11). Further, the World Health Organization (WHO) supports the development of evidence to inform best approaches to public health workforce development (1).Interprofessional teams develop through interprofessional collaboration. Interprofessional collaboration is a "partnership between a team of health providers and a client in a participatory collaborative and coordinated approach to shared decision making around health and social issues" (12). These collaborations "create an interprofessional practice team where healthcare providers from different professional backgrounds work together with patients, families, and communities to deliver the best quality of care. …

Significance of Race in College Athletics: Comparing Mission Statements across Racial Boundaries

Abstract: IntroductionThe racial classifications used in the process of attaching a meaning to a group of individuals producing group identity can be viewed as the determinants toward the "racial practices of opposition ("we" versus "them") at the economic, political, social, and ideological levels" (1). The United States has historically been a nation encompassed of various ethnic immigrant groups, with the white race establishing dominance in the nation's early history through slavery over phenotypically African individuals. The white hegemony and systemic discrimination of race has been a cornerstone within race relations in the U.S. deeming white Americans stereotypically 'true' Americans and black Americans as inferior (2). According to dominant racial theory, society is able to identify groups and individuals in racial terms to place them in categories (3). Essentially, the white identity has sat atop the racial hierarchy throughout time in the United States and, in turn, its development and growth can be linked to the structure of slavery implemented prior to the civil war (2,4). Prior to the1954s Brown v. Board of Education decision that ruled racially segregated schools unconstitutional, black college students in the U.S. attended historically black colleges and universities (HBCU) for their academics and athletics. Nevertheless, as much as the upper-class, white decision makers in predominately white institutions (PWI) were reluctant to embrace the idea of black students attending their universities, they were equally open to the idea of recruiting black athletes to compete on their athletic teams to improve the already commercialized collegiate athletics (2, 5).Issues and controversiesMoney is generated within the National Collegiate Athletic Association (NCAA) from the men's basketball tournament commonly known as March Madness. In 2010, the NCAA agreed to a 14 year $10.8 billion dollar broadcasting agreement to cover the men's basketball tournament consisting of 68 teams playing for a national championship (6, 7). The Bowl Championship Series (BCS), separate from the NCAA, reportedly held a four year deal between the years 2011 and 2014 worth $125 million dollars per year to structure a playoff system for football (8,9). After existing for 16 years, the BCS shifted to the College Football Playoff (CFP), separate from the NCAA, adding a final four aspect to the college football scene similar to the way the men's basketball playoff champion is decided. The new system still includes contracts with the five high-major conferences similar to the BCS system (ACC, SEC, Big Ten, Big 12, PAC12) with another spot being awarded to one of the mid-major conferences' (American, Mountain West, Mid-American, Sun Belt and Conference USA) highest-ranking team (10). The salaries for college football coaches range from Nick Saben for the University of Alabama at the top of the list receiving a total compensation in 2013 of just over $5.54 million, and Steve Sarkisian for the University of Washington as the #25 highest paid coach in college football receiving just over $2.57 million in total compensation in 2013 (11). The salaries for college basketball coaches in the 2013 men's basketball tournament ranged from Mike Krzyzewski for Duke University at the top of the list receiving a total pay for the 2013-14 season of just over $9.68 million, to Sean Miller for the University of Arizona as the #10 highest paid coach in college basketball receiving just over $2.62 million, and finally to Gregg Marshall for Wichita State University as the #25 highest paid coach receiving just over $1.79 million in total pay (12). The top earning athletic directors of institutions within the NCAA receive salaries of just over $3.23 million, $1.41 million, and $1.23 million for David Williams for Vanderbilt University, Tom Jurich for the University of Louisville, and Jeremy Foley for the University of Florida respectively (13).The significance of race comes into question when addressing the 2012 Racial and Gender Report Card within college sports reported by The Institute for Diversity and Ethics in Sport. …

Substance Abuse and Adolescent Girls

Abstract: IntroductionThis paper considers recent trends, risk factors, and consequences for substance abuse in adolescent females. The rate of substance abuse is on the rise in US youth. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), substance abuse trends are changing dramatically with initiation rates highest in young age and a dramatic shift in gender trends (1, 2). The most recent data collected in 2009 showed that 730, 228 patients twelve years and older reported using alcohol and other drugs requiring an admission to an alcohol or drug treatment program.Alcohol remains the most commonly abused substance in adolescents with the highest use among 19 year olds; in this group about 15% reported using alcohol. The rates starts declining from there to 12.8 percent in persons aged 18 to 25 years of age (1, 2).Out of these, about 23% were only using alcohol while 39% reported using other drugs without alcohol, and about 37% reported using both alcohol and at least one other drug at the time of admission (3). Figure 1 depicts the recent trends in choice of substances in US adolescents.Gender differences in substance abuseTraditionally, substance abuse is considered to be a more common problem in male adolescents but in the last decade or so young girls slowly approached the same level. According to the SAMSHA 2000 report, when looking at the gender distribution in all age groups, males were more than twice as likely (7.7 %) compared to their female counter parts (3.3%) to be abusing or being dependent on alcohol (1). While this may appear to support the general assertion that substance abuse is mainly a disease afflicting men, once one sifts through these data and breaks it out by age group, the picture changes considerably. For instance, in adolescents 12-17 years of age, the rate of alcohol abuse and dependence were very similar in both genders-5.2% in boys versus 5.1% in girls (1).The majority of new substance users, however, were younger and 56.2% of new initiators were female (1). Moving 5 years forward on this timeline, and in 2005, SAMSHA reported that -for the first time- adolescent girls age 12- 17 years admitting to current alcohol use surpassed their male peers at the rate of 17.2% females versus 15.9% of males (2). The same pattern was seen in adolescents who started using illicit drugs other than alcohol. Over 55% were younger than age 18 when they first used, and 56.2% were female (2).Risk factors for substance abuse in female adolescentsNon-gender specific risk and protective factors have been identified that affect substance abuse predisposition in adolescents. The literature shows, in addition, that young adolescent girls have factors specific to their gender and age (see figure 2). Early identification of these risk and protective factors is important because continuation of risks can worsen prognosis and enhancement of protective aspects can improve the course of illness. Figure 2 gives a brief overview of some of these risk factors.Puberty status and timingAttainment of puberty has been associated with a significant rise in smoking tobacco and cannabis, drinking alcohol, and abusing other substances independent of other variables such as school grade and age (4). Several researchers have suggested a role of pubertal changes and their possible link to this behavior. The age of menarche has been declining at a rate of 1-3 months per decade for more than last 175 years. For instance, in the United States in recent years, puberty has generally been occurring between the ages of 8 and 13 years of age in girls (5). It is well known that adolescents seldom start abusing substances before puberty (4). It has also been established that the earlier the onset of substance abuse, the worse the prognosis (4). The relationship between onset of puberty and initiation of substance abuse has been studied closely (5).Puberty in this context is examined in two different developmental stages: Pubertal status and pubertal timing. …

College Students, Prescription Stimulant, and Other Substance Abuse

Abstract: IntroductionSubstance abuse among college students requires specific attention because of the unique circumstances and characteristics of drug-taking behavior in this population. In 20ll, the rate of illicit substance use among full-time college students was 22% (1). In addition to frank substance abuse, there are significantly higher rates of binge alcohol use among full-time college students as opposed to others aged 18-22 years. The risk of substance use in the college population is potentiated by decreased parental supervision, a new and complex social structure that often includes communal living, and a view of substance intoxication as being relatively normative.Consequences of substance use can have a profound impact on young adults, and are a major public health concern in the United States. Alcohol related deaths alone in college students reached 1,825 in 2005. In 2001, 10.5% of college students reported being injured because of drinking, 12% were hit or assaulted by another college student, and 2% reported sexual assault related to alcohol. Furthermore, 28.9% of college students reported driving while under the influence of alcohol, suggesting there is a significant risk of alcohol-related motor vehicle accidents (2). Another significant aspect of substance abuse in college students is its relation to comorbid mental health disorders and suicide. One study found that suicidal ideation was higher in students with nicotine dependence, alcohol related problems, and illicit drug use (3). Prevention and treatment of substance use disorders in college students may help to diminish these adverse outcomes and reduce the public health burden from this population.Certain trends highlight the environmental influences of college life and their role in substance use. For example, college-bound 12th graders were found to have a lower than average use of all illicit substances while they were in high school compared to those who did not attend college. However, the eventual use of illicit substances by this group when they reached college was found to equal or in some cases exceed the use of their non-college peers. This "catching up" effect may in part be related to important contextual issues; the fact that college students often leave the parental home for the first time and tend to defer marriage leaves them more independent than they were in high school, but also not grounded in either their family of origin or a new family (4).Increased academic demands and pressure to succeed may drive some college students to use substances as a coping mechanism, or even to misuse substances in an attempt to enhance academic performance. Of note, a national health survey found that college students reported the highest use in the past year of Adderall (i.e., mixed amphetamine salts, a stimulant medication prescribed for attention-deficit/hyperactivity disorder; see below) compared to several other demographic groups. This increased use among college students may be attributable to the desire to stay awake and focused during study time, as well as completion of course work (Johnston, 2011). Issues related to abuse of prescription stimulants will be covered in detail below.The goals of this chapter are to discuss use of various licit and illicit substances of abuse by the college student population, including demographics and recent trends of use, relationship to use of other substances, co-occurrence of psychiatric disorders, consequences of using specific substances, and implications for prevention and treatment.AlcoholIn addition to the types of alcohol abuse seen in other populations, binge drinking is particularly common in the college age population. Binge drinking is usually defined as having 5 or more drinks in a row on a single occasion for men, or 4 or more drinks for women (5). As this type of drinking is one of the main forms of alcohol use during the college years, it should be specifically queried in clinical assessment. …

Immigrant College Students' Experiences with Their American Physicians

Abstract: IntroductionPreventative healthcare, which includes screening and regular check-ups, are an integral part of health. The Centers for Disease Control and Prevention (CDC) states that routine visits to the one's healthcare provider can extend life expectancy and decrease the cost of medical care (1). Immigrants in the United States (US) are from diverse backgrounds (2-5). Hispanic and Asian Americans make up the fastest growing sector of the US population (6). Often times immigrants are unable to access, seek, or receive health care due to barriers. A study that examined responses of a nationally representative database of recent immigrants found that those who migrate to the US frequently experience a lack of access, high costs, and difficulty obtaining medical insurance along with barriers such as access to information, cultural or linguistic obstacles, and an inability to understand the US healthcare system (6). Gaining a better understanding of the experiences that immigrants undergo in the healthcare system is thus important.The period when individuals enter college marks a period of transition from adolescence to adulthood. For many university students, college may be the first time away from home where they must independently make decisions. College students are regarded as a vulnerable population who are susceptible to many health problems. Research has illustrated that the period of adolescence is a stage when risky behavior is most common (7). Therefore, access to care is imperative for this subpopulation. The disposition of an international college student is vastly different from that of the traditional native college student. International students go through the federal process of applying and being granted a visa before entry into the country. Beyond this procedure, the acculturation process is expected immediately from international students. These students are expected to cross cultural, and at times, bilingual lines fairly quickly in addition to becoming accustomed to the policies at the higher educational institution.Acculturation is defined as the process of incorporating and understanding behaviors, beliefs, and values of a culture; however, current research has focused on changes of a cultural group (8-10). Getting accustomed to the healthcare system is a form of acculturation for immigrants, including international college students. Therefore, information about healthcare access, utilization, and health informational sources is needed and should be available for incoming international studies. There is need for further investigation regarding acculturation of the healthcare system among international students, especially regarding the mental health concerns that may accompany it.A meta-analysis revealed that international students face various stressors such as language barriers, educational stress, sociocultural difficulties, discrimination, practical stressors, and acculturative stress (11). Another study that sampled Asian International students' found that racial identity status, Asian values, ethnic identity affirmation and belonging were predictors of wellbeing (12). Even though international students tend to have a strong sense of identity, they are less likely to utilize medical facilities for healthcare and mental health services (13, 14). In a study that examined trends in health information utilization, in comparison to native students, international students reported a least likelihood of utilizing the medical center's health staff, health educators, faculty or coursework as a source of health information, but were more likely to utilize their parents as a health informational source (15).Doctor-patient relationship is an important aspect to the adequate care. A qualitative study that interviewed 22 individuals (10 participates who saw their regular healthcare practitioner and 12 who saw an unfamiliar practitioner), found that patients preferred to create a personal relationship with their practitioner, and reported that it was difficult to change practitioner even if the care was poor (16). …

Effect of a financial education program on the health of single, low-income women and their children

Abstract: IntroductionIn 2012, 40% of households reported living paycheck to paycheck, a trend more common in women than men, 36% versus 44% (1). The same survey demonstrated that 20% of workers were unable to make ends meet, which can lead to significant financial and socioeconomic stress. Increases in perceived life stress and impairments in well-being have been documented in individuals enduring financial strain (2-6).Persons under stress can be more socially isolated and report elevated depressive and psychosomatic symptoms (7). They also engage in unhealthy behaviors such as smoking, alcohol consumption, overspending, and poor diet and exercise (8). This has been recently explained by the limited-resource model of self-control (8). Because the poor have less money, food, and expendable time, they are challenged to control behavior and resist urges more than others which exhaust self-control resources. Over time, people under stress are at a greater risk for chronic illness, particularly cardiovascular disease. Financial stress was shown to predict myocardial infarction and cardiac death in women in the Framingham Study and has been associated with coronary heart disease (9, 10).While lifestyle factors can contribute to the development of chronic illness, lower socioeconomic status is also associated with biologic risk factors including hyperlipidemia, obesity, metabolic syndrome, diabetes, elevations in fibrinogen, cardiac rhythm abnormalities, and procoagulant blood profiles (11-13). Many researchers have postulated that the link between stress and poor health outcomes is sustained activation of autonomic and neuroendocrine responses (14). Increased activation of the hypothalamic-pituitary-adrenal axis leading to increased levels of cortisol is a major component of the stress pathway. Chronic cortisol elevations may contribute to insulin resistance, muscle atrophy, diabetes, abdominal fat, immune impairment, and hypertension (7,15). Furthermore, increased sympathetic nervous system activity, specifically elevations in catecholamines, epinephrine and norepinephrine, has been shown in those of lower socioeconomic status (16). Poverty, low socioeconomic status, and financial stress can also affect health outcomes in children. Financial stress during childhood has been associated with increased childhood obesity and the development of diabetes and cardiovascular disease later in life (17-20).The Financial Success Program (FSP), founded in 2010 at Creighton University, was developed to explore which financial education program components are most effective in creating behavior change for low-income single mothers. The FSP focuses on three core components: an outstanding trainer, one-on-one financial coaching, and an easy to use money management system. The program serves women in the Omaha, Nebraska metropolitan area who are predominantly African American. Participants have significantly more cardiovascular risk factors than other women in Nebraska including obesity, smoking, diminished exercise, hypertension, and diabetes (21).During the FSP, participants meet weekly for nine weeks followed by monthly group meetings for one year. Participants are also assigned a coach for long-term financial advice. Based on anecdotally-reported positive health changes in prior graduates of the FSP, this study was designed to evaluate the effect of the FSP on cardiovascular risk health indicators and financial outcomes in participants and their children. Figure 1 depicts a conceptual model to describe the relationship between financial education and health indicators. To date, there are no published studies assessing the effect of financial education interventions on health indicators.MethodsThis study was approved by the Creighton University Institutional Review Board (#11-16171). All participants provided written informed consent/assent as applicable. The study was registered on clinicaltrials.gov as "Impact of a Financial Success Education Program in Women and Children", NCT01409291, on July 29, 2011. …

An Inter-Governmental Approach to Childhood Obesity in Chicago, Illinois

Abstract: IntroductionOver the last three decades, childhood obesity (1-3) has emerged as a significant public health crisis in the United States (4) and around the world (5). Almost 35 million of the 42 million children under the age of five who are overweight are located in developing countries (6). In the United States, childhood obesity is a major concern, with researchers there predicting that this generation of American children will be the first to have a shorter lifespan than the preceding generation (4, 7). Although some age groups (8) and localities, such as New York City and Los Angeles (9), are beginning to demonstrate decreases in childhood obesity rates, disparities still exist; especially for children in lower-income, African American, and Latino communities (10).According to data analyzed by the Consortium to Lower Obesity in Chicago Children (CLOCC), in Chicago, Illinois, young children in this city have had considerably higher obesity rates than children in the rest of Illinois and across the US. However, there are signs of improvement. Data analyzed by CLOCC show a decrease in obesity prevalence among 3-7 year olds over a five year period. A recent report indicates declines in obesity exclusively among Chicago Public School students (11). These improvements cannot be attributed to one intervention but are, in part, the result of significant coordination of obesity efforts in Chicago since 2002 (3). One important aspect of this coordination is the City of Chicago's InterDepartmental Task Force on Childhood Obesity (IDTF).The purpose of this work is to align and coordinate Chicago governmental agency efforts to plan, implement, and evaluate policy, systems, and environmental change (PSE) strategies to address the childhood obesity epidemic in Chicago. The task force prioritizes children between the ages of 0-18. However, the IDTF acknowledges that early intervention is critical and thus interventions tailored for the early childhood years of 0-5 are emphasized.Background of government collaboration on childhood obesity preventionPublic health experts widely acknowledge that government has an essential role to play in protecting the public's health (12, 13). In the United States, state and local governments are authorized to protect the public's health, a concept known as "police power," and there is well-established precedent for government to exercise this power for childhood obesity prevention. For example, state and local governments have exercised this power to require the posting of nutritional information in restaurants, regulate the sale of junk food in schools, and impose zoning restrictions to limit the location of fast food establishments (14). Government is in a unique position to assess public health problems and coordinate implementation of policies, programs, and services to alleviate these issues (1, 13). Additionally, public health experts recognize the importance of an interdisciplinary approach with non-health governmental agencies' participation in the protection of the public's health (1).Through Internet research and discussions with health departments across the US, the authors found that other obesity-focused government coalitions and task forces, such as those in the cities of New York, Boston, Baltimore, and Columbus, tend to convene for a delimited time to develop an agenda and work on specific topics on an as-needed basis. Some are created formally by legislation and others are developed based upon a call from a local government entity. Although other childhood obesity prevention task forces may exist, the authors believe that the City of Chicago's Inter-Departmental Task Force on Childhood Obesity is unique given the length of time it has been operational, its multi-pronged and multisector approach, and the city's ongoing commitment to its existence.Background of Chicago's intergovernmental approach to childhood obesity preventionThe City of Chicago, situated in Northern Illinois, with a population of over 2. …

Establishing Partnerships between Public Health and Academic Partners to Address Infant Mortality

Abstract: IntroductionInfant mortality, in a public health sense, serves as a gauge of overall community health and is defined as the death of an infant before his or her first birthday. The national infant mortality rate per one thousand births in the United States is 6.06 - a rate much higher than that in other developed countries (1). Although infant mortality in the United States has declined in recent years (1), infant death in the Cincinnati-Hamilton County region of Ohio is nearly triple the Healthy People 2010 goal and double the national average (1, 2). Infant mortality has recently evolved to epidemic status in Cincinnati, although the issue has not affected all racial groups equally. At a rate of 17.8 deaths per 1000 births, African Americans have more than double the infant mortality rate of White residents (3-5). Considering the elevated overall infant mortality rate and the striking racial disparity in infant deaths, social and medical scientists are trying to untangle the web of factors that contribute to negative birth outcomes. Given the complexity of such disparities, interdisciplinary collaboration between public health and academic partners provides a unique way to dissect health concerns with greater rigor and objectivity.Social determinants of infant mortalityThe Cincinnati Health Department and its partnering social service agencies and community organizations have prioritized infant mortality as the key public health issue in our area and have started to investigate the unique social determinants of infant mortality in Cincinnati. Perhaps partially due to the fragmented landscape of health services for women in our area, understanding the perinatal risks for both women and their babies is multifaceted and therefore quite complicated. Unintended pregnancy, for instance, is documented as an indicator of poor birth outcomes (6). However, in a largely Catholic hospital delivery system, few post-partum women are discharged from the delivery hospital with contraception, thereby increasing the chances that these women might become pregnant before the recommended time of at least eighteen months post-delivery.Pregnancy intention has been documented as a correlate of infant mortality, in that family planning can reduce infant mortality (7). Teen mothers are more likely to experience unintentional pregnancies, thereby increasing risks for adverse health outcomes. Proper prevention of unwanted pregnancy is also affected by the sociopolitical landscape. Research shows that young mothers with unwanted pregnancies are more likely to miss important prenatal visits (8), engage in risky behavior such as smoking or illicit drug use during pregnancy (9), and are more likely to suffer from postpartum depression than adult mothers who plan pregnancy (10). It has also been found that teen mothers often have poorer physical and mental health outcomes later in life than women who did not experience teen motherhood (11).When attempting to promote optimal infant health and avoid mortality, social service agents and healthcare professionals tend to focus on those factors in which they have expertise. Primary care physicians may be more concerned with weight gain and hypertension as correlates of poor birth outcomes. Social workers may be more likely to contribute high infant mortality rates to domestic issues or access to social services. Obstetricians might focus on participation in prenatal healthcare as the primary target for intervention. In order to address the complex problem of infant mortality, collaboration among diverse stakeholders with varying skill sets and subjectivities is essential. Essentially, untangling the web of human behaviors that led to a pregnancy and ultimately a birth involves both social and medical perspectives.University-public health department partnershipA truly successful partnership is considered to be a pooling of resources where each partner exercises power in decision-making (12). …

Comorbidity and Treatment in Substance Use Disorders

Abstract: IntroductionSubstance use disorders (SUDs) are fairly common among adolescents and young adults in the United States, with prevalence rates ranging from approximately 8% (1) to approximately 35% (2). Not only are SUDs common, but they also frequently co-occur with other psychiatric disorders. The National Survey on Drug Use and Health reported that in 2010, 22.1% of adolescents aged 12 to 17 (N = 379,000) with substance dependence or abuse in the past year also had a major depressive episode during the same time period (3). Additionally, the most recent practice parameter from the American Academy of Child and Adolescent Psychiatry reported that up to 50% of adolescents with SUDs in clinical populations have a comorbid psychiatric disorder (4).Common comorbid psychiatric conditionsStudies of community-based samples of children and adolescents generally report attention-deficit/hyperactivity disorder and disruptive behavior disorders as the most commonly occurring comorbid psychiatric conditions in SUDs, at rates just under 70% (5, 6). In addition, ADHD complicated by co-occurring oppositional defiant disorder or conduct disorder is associated with significant risk for developing SUDs (7). The next most frequently reported comorbid psychiatric conditions at approximately 20-30% are mood disorders (both depressive disorders and bipolar disorders) (5, 8). Anxiety disorders occur at a rate of approximately 20% in children and adolescents with SUDs (5).Clinical samplesSimilar to data from community samples, clinical samples of children and adolescents report rates suggesting that ADHD and disruptive behavior disorders are the most common conditions comorbid with SUDs (9-12). Approximately 40-50% of young patients diagnosed with an SUD meet diagnostic criteria for comorbid ADHD (9, 10, 12). It has been suggested that ADHD during childhood/adolescence is a significant risk factor for developing an SUD (13). Further, longitudinal assessments of the relationship of ADHD in adolescence to later SUD have found that not only are co-occurring oppositional defiant disorder or conduct disorder significant predictors of SUD (13,14), but also that comorbid conduct disorder predicts SUD in pediatric ADHD (15,16). Conduct disorder has been reported to co-occur in approximately 50% of children and adolescents with an SUD (10-12).Mood disorders also are commonly comorbid with juvenile SUDs in clinical settings (9, 12). Approximately 20% to more than 50% of children and adolescents with SUDs suffer from major depressive disorder (4, 11, 17, 18). Bipolar disorders (BPD) occur in 15% to 30% of juvenile SUD cases (19, 20). Further, juvenile BPD has been found to be a predictor of later SUD (21), and preliminary data suggest that co-occurring BPD and post-traumatic stress disorder increase the risk of subsequent SUD (22). Post-traumatic stress disorder and other anxiety disorders occur at rates of approximately 10% to 40% in juvenile SUD in clinical settings (4,12,18).While psychotic disorders are not uncommonly comorbid with SUDs, the onset of the psychotic disorder generally occurs in late adolescence to early adulthood (23). Thus, clinical sample data are generally limited to adults. Of note, substance use and SUDs, particularly cannabis use, are associated with earlier age of onset of psychotic symptoms (24-28). Accordingly, adolescents with SUDs may be at increased risk for developing a comorbid psychotic disorder.General principles of assessment and diagnosisConsidering the serious risks associated with SUDs and co-occurring psychiatric conditions, and high rates of comorbid individuals, proper assessment is critical. Although validated psychometric instruments are used frequently in scientific investigations, research has shown that only a small number of treatment providers report using formal assessment measures (e.g., self-reports, structured interviews, etc.) when determining proper treatment referrals (29). …

Measurements of Social Isolation and Social Support for Rare Lung Disease Patients: An Integrative Review

Abstract: IntroductionAn estimated 30 million Americans live with a diagnosis of one of the 6,000 to 8,000 known rare diseases (1) and such conditions affect approximately 30 million individuals in the EU (2). EURORDIS (Rare Diseases Europe) has identified the need to address the social aspects of the rare diseases as one component of living well within the context of a rare condition (3). Such social aspects include, but are not limited to, social support, extent of social network, and perceptions of loneliness and social isolation. Social isolation has been anecdotally reported in individuals suffering from various rare diseases (4, 5). Few studies have identified how social isolation affects people with rare diseases, despite the National Research Council's call for investigations into the linkages between social isolation and health (6). The impact of social isolation and social support has been explored in other populations. In their seminal work, House, Landis and Umberson (7) reviewed prospective epidemiological studies of social isolation in humans, and found that that social isolation was a significant risk factor for broad-based morbidity and mortality.Operationally, social isolation is defined as the perception of a stigmatized environment, societal indifference, a personal-societal disconnection, or personal powerlessness (8). It is characterized by a lack of support system or a small/nonexistent social network. Few published studies have explored the experiences of living with a rare disease; no studies identified have investigated social isolation in rare lung diseases such as AATD or sarcoidosis.Sarcoidosis is a rare, complex, granulomatous disease of unknown etiology. The incidence of sarcoidosis varies throughout the world, with 10-40 per 100,000 persons in the US and northern Europe developing this condition (9). Many organ systems can be affected, although lung involvement is most common, occurring in greater than 75% of all patients (10). Depression has been documented in these individuals (11), and more recently, social isolation has been identified as a concern (12). However, no published studies of social isolation have been identified to date.Alpha-1 antitrypsin deficiency (AATD) is an uncommon genetic disease which that affects approximately 1 in 2,000 to 1 in 5,000 individuals and predisposes to liver disease and early-onset emphysema (13). Previous studies have confirmed adverse psychosocial effects related to an AATD diagnosis (14). Social isolation has been explored in individuals with COPD (15, 16) but no published studies were identified that investigated social isolation in AATD patients specifically.Recognition of the importance of research into rare lung diseases is growing (17). Many studies have adopted a population-based approach to rare diseases, but the patients' viewpoint on having such a disorder has remained unattended (18). Despite the number of people affected by rare diseases, resources are lacking. Patients often feel isolated, unable to get the information and support they need (19). Delays in diagnosis and/or misdiagnosis may promote distrust of health care providers and counselors. Information on the psychosocial burden of these diseases is needed, of which social isolation is one component of the continuum.Social isolation as a conceptThe term "social isolation" has multiple meanings. Carpenito-Moyet succinctly defined social isolation as 'the state in which the individual or group expresses a need or desire for contact with others but is unable to make that contact' (20). Individuals at risk for such states include ethnic/cultural minorities, persons with chronic physiological and psychological illnesses or deformities, and elderly persons (8), such as individuals grappling with living with rare conditions.In his concept analysis of social isolation in older adults, Nicholson (21) suggested that determinants of isolation include 'number of contacts, feelings of belonging, fulfilling relationships, engagement with others, and quality of network members' (p. …

Community-Engaged Research and Homeless Adolescents: Capturing Perceptions of Health Care and Building Lasting Relationships with the Community

Abstract: IntroductionAccording to the most recent US federal data, nearly 1.7 million adolescents annually experience a "runaway/thrown away" episode, resulting in homelessness or placing them "at risk" for homelessness (1). It is well established that homelessness is associated with poorer health, with homeless adolescents exhibiting disproportionately higher rates of illegal substance abuse, sexually transmitted infections, unwanted pregnancies, mental illness, and insufficient access to health care than housed adolescents (2-6).Many of such poor health outcomes are a logical consequence of the conditions of homelessness, such as poor nutrition and hygiene, crowding, violence, and the need for survival sex (3, 5).The social and environmental determinants of poor health for homeless adolescents are complex, with comprehensive solutions being a matter of public policy beyond what can be affected solely in clinical settings. Nevertheless, despite the seemingly intransigent barriers to good health for homeless adolescents, we believe there is room for health care providers to mediate the impact of these barriers by creating better models of health care delivery. Our goal with our current effort was to use community engaged research to develop a testable theory on the relationship between the perceptions of homeless adolescents of health care delivery and the impact of those perceptions on homeless adolescents' health seeking behavior. Our goal was to create transferable principals that can be used by other practitioners in the development improved models of health care delivery uniquely suited for homeless adolescents.MethodsWe employed a community-engaged research model to engage homeless adolescents in contributing to the development of a new program for health care delivery to meet their unique needs. Community-engaged research has been championed as a method to further reduce health inequalities, (7) through emphasizing the development of lasting relationships between researchers and the community of interest (8, 9). To that end, we spent time throughout the research process cultivating a lasting relationship with the staff and clients of a street outreach program of a local social services agency. Our goal from our community engaged approach was not simply to collect data; while data collection was important, we also wanted to simultaneously demonstrate our commitment to addressing health issues of the local homeless adolescent population through the development of programs that arose directly from our research. Thus, our data were intended to serve not only academic purposes, but to provide an immediate benefit to the homeless adolescents we sampled.SamplingStudy participants included clients (ages 16-24 years) receiving services from the homeless adolescent program of a social services agency in medium-sized city in the south-central United States. All participants were identified by the partnering agency as either homeless or "at risk" for homelessness. Potential participants were informed of the nature of the study and invited to participate in either focus groups or individual interviews based on individual preference. Participants were provided a consent information sheet that explained the the purpose of the study was to gauge the perceptions of homeless adolescents regarding health care for their community. Participants were offered a $10 gift card for their time and modest refreshments. Consent was expressed through their participation in either a focus group that lasted 60-90 minutes or an individual interview that ranged from 30-60 minutes. The study protocol was approved by the Institutional Review Board of the University of Oklahoma Health Sciences Center.Focus groups and individual interviews were semi-structured to promote conversational, two-way communication (10). Researchers followed question guidelines based on community- and health-related themes, but were free to follow conversation trajectories based on topics that participating adolescents deemed significant. …

Exercise Culture among Immigrants Living in the Midwestern United States

Abstract: IntroductionPhysical inactivity/exercise is a priority health risk behavior and a leading contributor to morbidity and mortality in the United States (US). It has been mentioned as a risk factor for cardiovascular disease (2), obesity (3) and other chronic conditions that reduce individuals' quality of life and place huge financial burden on families (3). Healthy People 2020 lists increasing the proportion of children, adolescents, and adults participating in physical activity as one of its four overarching goals (4).Few physical activity/exercising research studies have been done on immigrants from Africa residing in the US. Existing research mainly focuses on socioeconomic facilitators and barriers to physical activity in a segment of African immigrants in the US (5-8), but is mostly silent on salient cultural issues surrounding exercising in the population. Our study explores the role of culture in influencing exercise behavior among recent immigrants from Africa who reside in the US Midwest. Such an investigation, we believe, is important given Kreuter et al (9) argument that culture is a shared group characteristic (seen in its norms, values, practices, and other social regularities) that has passed on to future generations and directly or indirectly influences a group's health-related behavior. Secondly, immigrants are the fastest growing segment of the U.S. population (10) and immigrants from Africa represent one of the fastest growing groups resettling in the US (5). The population's health status therefore impacts the overall health standing of the country.New immigrants tend to present better health indicators in general and weigh less than native-born individuals in the US. With increasing duration of residence in the country, however, exhibited health and weight advantages diminish (10-12). Several studies (13-15) indicate that migration to Western countries is significantly associated with weight gain among immigrants from some parts of the world; with obesity being more prevalent among Africans who migrate to Western countries than among their counterparts in Africa (16, 17). Studies also find significantly elevated risks of developing obesity among children from communities with a high proportion of immigrants (14). These changes in health and weight among immigrants are attributed in-part to a combination of dietary and exercise factors. In a process referred to as diet acculturation, migration often makes individuals change their food habits (14). Empirical evidence indicates that migrants from Africa to Western countries usually change their dietary habits from a consumption of traditional staple foods low in fat and rich in fiber to processed and refined foods high in saturated fats and sugar (14, 15). Additionally, consistent with studies on adult immigrants from other Western countries, (18) foreign-born individuals in the US have been found to be more often sedentary than the host population (10). According to the Center for Disease Control and Prevention (CDC) (19), physical activity levels and dietary behaviors among immigrants and refugees to high income nations are usually less healthy than the non-immigrant majority populations. Little is known about exercise culture among African immigrants in the US. Qualitative studies among segments of African men (6), women (7) and youth (8) originally from Somalia suggests inadequate levels of physical activity after resettlement in the US. It is also not clear if the population's cultural perceptions concerning obesity/overweight changes when they settle in the US, and whether that is reflected in the population's exercise culture. In several parts of Africa, attitudes toward overweight and obesity are positive (20) and people generally associate fatness with good health and beauty. (21-23) CDC guidelines recommend obesity prevention through exercise and diet (24).The purpose of this study was therefore to explore shared lived exercise experiences of immigrants by investigating the phenomena as described by recent immigrants from Africa living in the US Midwest. …

Building Interprofessional Cultural Competence: Reflections of Faculty Engaged in Training Students to Care for the Vulnerable

Abstract: IntroductionScholars, educators and health care organizations all agree: interprofessional education (IPE) and collaborative health care practice are essential to provide quality, holistic care for patients across health care settings (1). Health care providers today are faced with challenges including complex diagnoses and limited resources along with providing care in a diverse team environment to maximize care. The importance of team care becomes more evident when working with patients who are vulnerable. Collaborative care and team-based practice are now being recognized as skills that need to be taught and enhanced (1). Health care team interactions that are negative or ineffective can profoundly impact patient outcomes and the overall success of a health care organization (2). Team development, both for the individual health care practitioner and the health care team, is also critical to the success of collaborative care (2). Interprofessional education (IPE) has emerged as a pedagogical approach to train health care students to be prepared for health care practice. Within the context of IPE, a variety of pedagogies have been shown to teach collaborative, team skills. The overall intent of IPE is to move students beyond thinking within one's own health care discipline and to expand clinical reasoning to a team-based approach (3).Accreditation bodies have now included interprofessional practice as a core skill for many health care professions (4, 5). Students from across the health sciences will now be learning skills including collaborative ethical decision making, how to engage in successful team interactions, appropriate team communication and team problem solving (1). Pecukonis, Doyle, and Bliss (6) propose that the best way to prepare students to build the skills necessary for collaborative care in practice is to develop interprofessional cultural competence. Despite an effort in IPE to build team-based care skills, health care education is largely "profession-centric" which leads to the development of ethnocentrism held by professionals creating barriers to collaborative health care practice (6).According to Pecukonis et al (6), even the social construction of the term "professionalism" does not promote collaboration but instead leads to competition among health care providers. Due to the social construct of being part of a profession, collaborative care faces challenges and requires health professions educators to alter their thinking to develop and implement appropriate IPE. In order to break down existing social constructs to promote increased collaborative care, Pecukonis et al proposed that educators follow the concept of IDEA: Interaction, Data, Expertise and Attention (6). The authors of this manuscript will use the mnemonic of IDEA to describe the development of an IPE course focused on preparing students, both as individuals and as part of a team, to provide care to vulnerable populations and/or individuals. The premise of IDEA provides a foundation for building interprofessional cultural competence not just among students but professionals and educators as well. Experts in interprofessional education have long argued the importance of faculty development for successful IPE (7).Any team of educators implementing IPE need to develop their own interprofessional cultural competence in order to be effective in designing and implementing successful IPE for students.This manuscript will describe the journey of a team of educators in developing interprofessional cultural competence while facing the challenges of developing an IPE course focused on vulnerable populations.Intersecting interprofessional education and vulnerabilitySimulation centers, service-learning, case analysis, and patient safety have all been exemplars in teaching health professions students the skills necessary to engage in collaborative health care practice (3, 4, 10). However, as identified by Dow et al (9), one area of interprofessional education still in need of development is the preparation of the interprofessional team for working with vulnerable and/or underserved populations. …

Sero-Prevalence of Rubella-Specific Immunoglobulin G Antibodies and Its Correlates among Blood Donors in Zambia

Abstract: IntroductionRubella is an acute, contagious viral infection caused by rubella virus, a member of the Togaviridae family. The virus is an enveloped single-stranded RNA genome (1). It is transmitted through the respiratory system, replicating in the nasopharynx and lymph nodes. The virus is found in the blood 5 to 7 days after infection and spreads throughout the body, and can be shed for even up to one year in children with CRS (2). Rubella disease affects both children and adult with common signs and symptoms including rash, low fever (Rubella continues to be a disease of public health concern globally. In the Americas, rubella virus infection during pregnancy was estimated to have caused 30,000 still births and 20,000 children were born impaired or disabled as a result of CRS (9). The number of rubella cases reduced from the pre vaccine to vaccine era in the Americas and Europe where an elimination goal was set for 2010 and 2015, respectively. WHO estimates that in 1996, 22,000 children were born with CRS in Africa, 46,000 in Southeast Asia and almost 13,000 in the Western Pacific (10). Literature review by Goodson et al (5) revealed 22 reports on studies conducted on rubella sero-prevalence between 1963 and 2009 from 14 out of the 46 countries in the Africa region. Seventeen of the 22 studies reported rubella sero-positivity of between 68 and 98%. Of the 22 studies, 17 reported sero-positivity results in the range of 71-99% and varied between study populations and age groups among persons aged older than 12 years or described as "women of reproductive age".Socio-demographic factors such as age, sex and residency and socio-economic factors such as education and wealth have been associated with rubella infection (7, 11, 12). Factors associated with rubella vary among populations and it is important that they be determined in a population so that population-specific interventions may be tailored accordingly.Rubella infections are prevented by active immunisation programs using live, disabled virus vaccines. Most countries in Africa have not introduced routine vaccination against rubella partly because studies on the burden of the disease, seroprevalence of rubella or CRS have not been conducted (2, 13). The majority of studies that have been conducted to determine the sero-prevalence of rubella on populations or sub populations are in the developed world (7, 11, 12).Mazaba-Liwewe et al (14) confirmed the presence of rubella disease among suspected measles cases in persons aged below 5 years in Zambia. However, there is limited documentation on the burden of disease in older age groups in Zambia. A study by Watts (13) on sero-prevalence of rubella among mothers, though with a number of limitations including a small sample size of 100 respondents and limited geographical area (Lusaka) indicated at least 12% of this study population was vulnerable to rubella infection. …

Healthcare Workers' Breastfeeding Practices and Beliefs in Ghana

Abstract: IntroductionAccording to a World Health Organization document, breastfeeding is the best source of nutrients for infants for the first six months of an infant's health (1). Majority of mothers with good information and good skills on breastfeeding will be able to nurse their babies for healthy development (1).Scholarships on Healthcare workers demonstrates that healthcare professionals' competence to help breastfeeding mothers depends on their breastfeeding skills, knowledge and attitudes towards breastfeeding and that some health care professionals have negative beliefs, and wrong information about human breast milk (2- 4). Research has also shown that new mothers' attempt to breastfed their infants can be swayed by the information and skills they receive from their healthcare professionals (doctors and nurses), since they are the first people to be with the mother and the child (2-7)Many scholars and mothers around the globe reported professional healthcare workers making mistakes that had impacted the breastfeeding efforts of mothers leading to frustration by a mother and her child (8-13).Many scholars studied breastfeeding education on healthcare providers and came to the conclusion that breastfeeding education helped healthcare workers' clinical performance and positive health results for mothers and their children (14-16)Concerning breastfeeding world-wide, according to the World Health Organization's Infant and Young Child Feeding, only 38% of babies receive breastfeeding for 6 months, and that about 800, 000 children's lives will be saved if they are exclusively breastfed (17).In view of the above-mentioned research findings, this research aims to investigate the breastfeeding beliefs, knowledge and skills among healthcare workers in Ghana with the view to learning more about what influences this group of healthcare workers' knowledge and skill about breastfeeding practice.MethodsThis study uses an interpretative phenomenological perspective to examine the breastfeeding experiences of healthcare workers in Cape Coast (Ghana). An interpretative phenomenological perspective was used in order to find out the ways in which participants make sense of their experiences. The study was conducted in the summer of 2013 by the lead author. Surveys were used to collect the data. The survey included open-ended questions that allowed the participants the opportunity to respond as they saw (it) fit. Open-ended questions were used since they require researchers to careful select words in order for the respondent to understand what is being asked (18). Also, open-ended questionnaires were used since they have the potential to gather information from a wider sample than can be reached by personal interviews. The questionnaire investigated participants' beliefs about breastfeeding and how such beliefs influence their profession. The questions also touched on problems that they could potentially come across as healthcare providers on breastfeeding, and their knowledge and opinion about skin-to-skin. Finally participants were asked about some ways that they believe will encourage mothers to breastfeed for at least 6 months or one year.ParticipantsThe target population was healthcare workers. This population was chosen because they are the first people to work with mothers if babies are born at the hospital and great target audience for giving breastfeeding information and skills. Knowing the beliefs and breastfeeding knowledge, and skills of health care workers in Ghana practices would provide information to tailor future educational training and interventions of this group.Participants were recruited through a healthcare worker who assisted with the data collection. Criteria for participating included: being a healthcare worker and over 18 years old. Potential participants were encouraged to notify and refer other workers who fit the above criteria. Indiana University's Institutional Review Board approved this research project. …

Bridge to Care for Refugee Health: Lessons from an Interprofessional Collaboration in the Midwest

Abstract: IntroductionAccording to the United Nations High Commissioner for Refugees (UNHCR), a refugee is defined as someone who "owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself to the protection of that country" (1). "Secondary Migrants" are those refugees who have originally resettled in one part of the country and have subsequently moved to another location. There are approximately 15 million refugees around the world (1).Refugees begin the process of seeking resettlement after fleeing their home countries to seek safety in neighboring nations. When refugees arrive at the nation providing asylum or temporary residence, they face three possible endpoints, one of which is resettlement in a third country such as the United States (1). This process often times takes more than 5 years while refugees live in harsh conditions within the refugee camps (1). The President of the United States sets the ceiling for refugee admission to the United States (U.S.) each fiscal year (2), for which the U.S. averages more than 50,000 refugee resettlements per year (1). Many of these refugees choose to resettle in mid-sized Midwestern cities given low costs of living and low rates of unemployment (2). Refugees are also placed in locations where existing family ties are already established (2).Refugee resettlement in NebraskaCurrently, there are an estimated 25,000 refugees in Nebraska, with 15,000 in Omaha alone, according to Omaha resettlement agencies (personal communica-tions) and federal resettlement reports (2, 3). In fiscal year 2013, there was a record high of 1,006 refugees resettled, and the number is expected to increase in 2014 (4). Over the years, refugees from Sudan, Somalia, Burma, Bhutan, Nepal, Iraq, Afghanistan, Ethiopia, Liberia, Congo, and Burundi have been resettled in Nebraska. As of 2006, it is estimated that over 50% of the Sudanese population in the U.S. settled in Nebraska (5, 6). In more recent years, the majority of resettled refugees are those who have fled to camps in Thailand from nearby Burma (Myanmar) (7).The three primary refugee resettlement agencies that provide services to these refugees in Nebraska are Lutheran Family Services (LFS), Southern Sudan Community Association (SSCA), and Catholic Charities (4). The agencies provide various services such as: English classes, cultural orientation, employment assistance, fair housing education, financial literacy and household budgeting, as well as training programs for churches and civic organizations that wish to sponsor refugees and immigration legal assistance. Agencies also help coordinate access to healthcare services while in the U.S (8).Refugee health issuesPrior to arrival in the U.S., the refugee receives inadequate preparation regarding health and health-related issues (3). Refugees also lack basic understanding about navigating the healthcare system, Western hygiene practices, preventive practices, and Western disease management (9). As a result of their circumstances, it is not unusual to find individuals with complicated health issues upon arrival and for years following resettlement. Past history of poor nutrition, poor sanitation, exposure to on-going violence and lack of adequate medical care also contribute to poor health (1).One particular area of concern is the high rates of undiagnosed infectious conditions such as tuberculosis, malaria, hepatitis C, Human Immuno-deficiency Virus (HIV), as well as skin and intestinal parasites (9-11). Mental health disorders also affect a large portion of the population including a high prevalence of depression, drug and alcohol abuse (7, 11). Individuals who experienced persecution, terrorization by violent groups, imprison-ment, and torture, may suffer from somatization disorders, psychosocial distress, post-traumatic stress disorder, anxiety and depression (1,9-11). …