4How Well Do You Know Your Environment? 

Understanding	your	program	area’s	environment	will	help	you	to	anticipate	and	 

minimize	potential	challenges	to	TB	prevention	and	control.	It	will	also	help	you	to	 

identify	new	sources	of	support. 

Demographic Information on Your 

Program Area 

Demographic	information	refers	to	the	vital	 

statistics	of	your	program	area’s	population.	 

These	statistics	include	birth	rates,	death	 

rates,	country	of	origin,	ethnicity,	and	 

age.	Monitoring	your	program	area’s	 

demographic	trends	allows	you	to	identify	 

and	prepare	for	population	changes	that	are	 

likely	to	impact	your	TB	program.	 

Demographic	information	is	often	easily	 

obtained	from	specific	county	and	state	 

Six Categories of Effective TB 

Environmental Monitoring and 

Analysis 

•	 Demographic information on your 

program area 

•	 TB epidemiological profile of your 

program area 

•	 Information on your program area’s 

at-risk populations 

•	 Understanding primary care providers in 

your program area 

•	 Comparing your data to your TB program 

•	 Identifying and understanding additional 

stakeholders 

agencies	tasked	with	monitoring	demographics,	school	districts,	and	refugee	and	 

immigration	programs.	Information	can	also	be	obtained	from	the	United	States	Census	 

Bureau.	The	U.S.	Census	Bureau	Website	contains	information	by	state	and	county	and	 

can	be	accessed	electronically	at	www.census.gov.	 

Epidemiological Profile of Your Program Area 

Using	your	surveillance	data	to	create	a	comprehensive	epidemiological	profile	of	 

your	program	area	is	an	essential	first	step	toward	effectively	addressing	TB.	Your	 

epidemiological	profile	tells	you	how	TB	is	manifesting	itself	in	your	program	area	by	 

categorizing	TB	disease	trends	by 

• Age 

• Ethnicity 

• Country	of	origin 

• Length	of	time	in	the	United	States 

• Geographic	location 

• Treatment	completion	rates 

• Drug	resistance 

• DNA	fingerprinting 

• Latent	TB	infection	 

	 rates	of	at-risk	populations 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit  

Chapter 4: How Well Do You Know Your Environment? 
In	low-caseload,	low-incidence	states,	analyses	of	annual	trends	can	be	inconclusive.	 

These	states	may	find	it	helpful	to	review	changes	over	5-year	spans	and	undertake	 

the	ongoing	systematic	review	of	TB	cases	with	the	following	features:	<15	years	of	 

age;	drug-resistant	M. tuberculosis	isolates;	extensive	or	advanced	TB	disease,	which	is	 

suggestive	of	delays	in	diagnosis;	or	deaths	before	patients	complete	treatment.41	 

What an Epidemiological Profile Revealed: 

Immigrants & Refugees 

Subject	 African Immigrants and Refugees, Based on Active Disease Data Collected 

from 1998 through 2001 

Location Seattle-King County Source MMWR October 4, 2002. 

Significant Findings 

The overall rate of TB in Seattle-King County was 8 cases per 100,000 population during the 

period studied. The annual rate of TB for African immigrants in Seattle-King County was 262 per 

100,000, a figure matching the WHO estimates for the African nations involved. 

TB cases among African immigrants and refugees rose annually, with this population accounting 

for 20% of TB cases in Seattle by 2001. The majority of TB cases (85%) were among individuals 

from the African Horn countries of Eritrea, Ethiopia, and Somalia. Of known TB cases in Seattle 

among persons from Africa, 45% occurred within the first year of arrival in the United States, and 

65% within the first 5 years, a much higher figure than for other at-risk immigrant populations. 

The median age of African immigrants with TB was 27 years; 53% had extrapulmonary disease. 

Characteristics of patients and of TB disease were similar for all immigrants from Africa. 

Response 

Programs Worked with primary health care providers and civil surgeons to raise 

Implemented	 awareness of the high TB rates among African immigrants, especially 

within the first 5 years of arrival, and of the severe extrapulmonary forms of 

TB present in the population 

In 1999, a flexible community-based approach to TB prevention and 

control was implemented. It includes partnerships with immigrant 

service systems, engages groups of immigrants in an exchange of TB 

information, and employs immigrants to serve as outreach workers in their 

communities. The outreach workers visit patients undergoing treatment 

for both LTBI and TB disease, serve as mediators between patients and 

their health-care providers, and assist with resettlement issues such as 

education, housing, and overall health care. 

Program Outcomes	 TB treatment acceptance among targeted refugees increased from 51% to 

86% within 2 years. 

TB treatment completion rates increased from 50% to 87% within 2 years. 

41CDC. Progressing	toward	tuberculosis	elimination	in	low-incidence	areas	of	the	United	States: recommendations	 

of	the	Advisory	Council	for	the	Elimination	of	Tuberculosis.	MMWR 2002;	51	(No.	RR-5:10). 

0 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter 4: How Well Do You Know Your Environment? 
What an Epidemiological Profile Revealed: 

Multidrug-Resistant Tuberculosis 

Subject MDR TB 

Location St. Louis, MO Source TB Notes No. 2, 2001 

Significant Findings 

From 1998 to 2001, nine cases of MDR TB were found in St. Louis. The Missouri Department of 

Health invited the CDC to assist with identifying the MDR TB Cluster. Significant findings included: 

The CDC investigators were able to link six cases in the cluster. Seven of the cases were part of 

the same social network. Prior to the arrival of the CDC, only three cases had been linked. 

An index case was identified with risk factors that included homelessness, alcohol dependence, 

and other drug use. 

The contact and social networking investigations directly linked this index case to five secondary 

cases. Two contacts to one of the secondary cases also developed active TB. 

Four cases were quite advanced when identified and appeared to have had extended periods of 

illness. 

Two of the patients in this outbreak made multiple visits to physicians before their TB was 

accurately diagnosed. 

Response 

Programs CDC staff participated in Grand Rounds of key St. Louis area hospitals to 

Implemented educate physicians and emergency room staff. 

All of the MDR patients were housed at the Missouri Rehabilitation Center 

for at least part of their treatment. Some patients were under court order to 

remain at the facility for the duration of treatment. 

The New Jersey Medical School and the National Jewish Medical and 

Research Center provided consultation to the Missouri Rehabilitation 

Center staff, most of whom had limited TB experience. 

Program Housing MDR patients at the Missouri Rehabilitation Center eliminated the 

Outcomes risk of nonadherence to isolation and treatment. 

The medical staff at the Missouri Rehabilitation Center gained expertise 

and experience with state-of-the-art TB treatment and are now a statewide 

resource for MDR TB cases. 

To date, no reactivation of disease has occurred in these patients. 

Additional MDR cases linked to this outbreak are likely to occur due to the 

delay in diagnosis of several of these cases and the transient population 

with whom they had contact. 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit  

Chapter 4: How Well Do You Know Your Environment? 
Information on Your Program Area’s At-Risk Populations 

Better	understanding	the	at-risk	populations	in	your	program	area	will	help	you	to	 

address	stigma,	as	well	as	the	language	and	cultural	issues	impacting	your	program	area’s	 

TB	prevention	and	control	efforts.	In	addition,	these	at-risk	populations	are	a	source	of	 

valuable	insights,	leadership,	and	support.	 

What Information about an At-Risk Population Revealed: 

Cultural Differences Interfere with TB Prevention and Control 

Subject Knowledge, Attitudes, Beliefs and Behaviors: Selected TB Information Associated 

with Patients from Somalia 

Country of Somalia Source www.ethnoMed.org 

Origin 

Significant Findings 

The extreme social isolation and stigma associated with TB in Somalia are at least as severe as 

those associated with AIDS in the United States. 

Diagnosis of TB has traditionally led to a lifetime of social isolation, stigma, and illness. 

Patients may deny sharing housing or may fail to provide names of contacts when they believe 

their TB diagnosis will be revealed to these contacts. 

Persons with severe symptoms may fail to seek medical care and deny their illness to themselves 

and others. 

Response 

Recommendations Treat the diagnosis of TB with sensitivity and maintain strict confidentiality, 

to Providers similar to that of HIV diagnoses. 

Educate your patient about the curable nature of TB. 

Take time to discuss the social ramifications of the disease with the patient. 

At-risk	population	information	can	be	divided	into	two	parts:	General	background	 

information,	and	information	specific	to	your	program	area. 

General Background Information 

General	background	information	can	increase	your	awareness	of	and	sensitivity	to	 

cultural	issues.	At	the	same	time,	be	careful	not	to	stereotype	and	assume	that	every	 

individual	will	exhibit	all	characteristics	of	the	larger	group	norms. 

General	background	information	includes	 

• Values	and	culture 

• Health	care	priorities	 

 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter 4: How Well Do You Know Your Environment? 
•	 Factors	influencing	when	and	where	medical	attention	is	sought 

•	 Knowledge,	attitudes,	beliefs,	and	behaviors	associated	with	TB,	illness,	and	 

medical	treatment	 

•	 Fears	and	beliefs	associated	with	receiving	public	health	services	and	interacting	 

with	government	agencies 

Gathering	this	information	is	a	critical	first	step	toward	partnering	effectively	with	 

at-risk	populations	and	those	that	serve	them,	and	gathering	it	is	much	easier	than	 

it	seems.	Much	of	it	can	be	obtained	through	an	initial	one-hour	investment	of	your	 

time	on	the	Internet.	Information	that	can	be	found	on	the	Internet	includes 

•	 Social	stigma	associated	with	TB At-Risk Population Findings •	 Common	misconceptions	associated	with	TB	 

In Los Angeles County, information disease,	skin-testing,	and	treatment	 gathered from patients with active •	 Common	acculturation	issues	faced	by	the	 TB revealed that unemployment 

population	 and not knowing where to obtain 

care were more closely associated •	 General	etiquette	 with delays of treatment in excess •	 Norms	associated	with	touch	and	personal	 of 60 days, than was severity of TB 

space	 disease symptoms (TB Notes No. 

•	 Gender	roles 2, 2001). 

•	 Family	and	kinship	structure 

•	 Religious	beliefs	and	practices 

•	 Community	structure 

•	 Traditional	medical	practices 

•	 How	the	culture	views	and	deals	with	illness 

•	 How	medical	decisions	are	made	and	by	whom	 

•	 How	medical	news	is	managed 

Among	the	sites	on	which	information	like	this	can	be	found	is		 

www.ethnomed.org.	This	site	makes	specific	recommendations	to	health	care	 

providers	and	provides	information	about	cultural	beliefs	and	health-related	issues. 

Information Specific to Your Program Area 

The	following	information	will	help	you	to	access	and	work	with	your	at-risk	 

populations: 

•	 Local	population	structures	such	as	faith-based,	cultural,	and	community	 

organizations	that	are	respected	and	have	influence 

•	 Gathering	places,	cultural	events,	and	festivals	 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit  

Chapter 4: How Well Do You Know Your Environment? 
•	 Common	sources	of	employment 

•	 Respected	influential	leaders	 

•	 Primary	care	providers	serving	the	 

population 

•	 Respected	community-based	 

organizations	serving	the	population 

•	 Trusted	communication	channels,	 

such	as	community	newspapers,	 

media	outlets,	organizational	 

newsletters,	and	word	of	mouth 

Leaders Provided Effective Strategy 

for Reaching At-Risk Populations 

Stigma associated with TB and 

misinformation about the BCG vaccine kept 

Filipino-born patients from requesting TB 

services from their primary care physicians. 

Filipino leaders revealed that stigma made 

public forums, such as community meetings, 

a poor first choice for reaching this 

population. Instead, they recommended that 

newspaper articles providing TB information 

and encouraging individuals to seek 

services from their providers be placed in 

Filipino community newspapers. The leaders 

offered key messages addressing TB that 

were included in the articles. 

To	ensure	your	information	is	comprehensive	and	accurate,	it	is	important	to	identify	 

and	speak	directly	with	respected	influential	individuals	from	at-risk	populations	in	 

your	program	area,	not	just	those	providing	services	to	the	population.	Meeting	with	 

these	leaders	 

•	 Helps	you	develop	a	deeper	 

understanding	of	current	assets,	 

stigma,	and	issues	that	will	impact	 

your	TB	work; 

•	 Creates	an	opportunity	to	develop	 

trust	and	honest	dialogue	about	 

effective	strategies	to	address	these	 

issues	and	priorities;	and	 

Working One on One 

Some program areas have experienced 

positive results by working directly with 

individual clinics, hospitals, universities, and 

private practice physicians to provide them 

with epidemiological information and clinical 

training. Sample slide set presentations and 

training materials are available through the 

CDC at www.cdc.gov/tb. 

•	 Establishes	a	communications	link	with	a	respected	and	influential	member	of	 

your	high-risk	population.	 

One	way	to	identify	respected	influential	leaders	is	to	ask	people	you	know	for	 

suggestions,	and	then	ask	each	suggested	person	for	additional	recommendations.	If	 

this	sort	of	contact	is	not	possible,	a	cold	call	(e.g.,	a	contact—phone	call,	e-mail,	or	 

visit—made	without	prior	introduction	or	interaction)	to	a	religious	organization	or	 

a	service	agency	working	with	the	population	is	likely	to	provide	you	with	names	to	 

pursue.	 

In	addition	to	meeting	with	leaders	of	at-risk	populations,	you	may	find	that	 

conducting	one	or	more	focus	groups	or	discussion	groups	with	members	of	at-risk	 

communities	will	yield	valuable	information	about	the	populations	at	risk	in	your	 

program	area. 

4 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter 4: How Well Do You Know Your Environment? 
 

 

 

 

 

 

 

 

 

 

The	At-Risk Population Information Worksheet	and	information	provided	in	Chapter	5:	 

Determining Your Purpose and Choosing Partners,	will	help	you	to	gather	the	information	 

you	need	and	to	recruit	effective	partners	from	at-risk	populations.	 

Understanding Primary Care Providers in Your Program Area 

A	comprehensive	understanding	of	your	TB	environment	includes	information	about	 

the	primary	care	providers	(PCPs)	serving	your	at-risk	populations.	Identify	the	 

emergency	and	non-emergency	health	care	providers	attending	the	majority	of	at-risk	 

population	members.	Understand	them	by 

•	 Evaluating	their	 Associations of Health Care Professionals understanding	of	TB	 

Organizations of health care professionals are potential epidemiology	and	 partners in reinforcing TB awareness by including TB on patient	risk	factors	in	 their agendas for specialty training and certification, and in 

your	program	area,	as	 conferences for continuing medical education. 

well	as	of	screening	and	 Many of your colleagues have identified and developed 

relationships with associations and networks of primary care treatment	protocols providers, including regional or state hospital associations, 

medical societies, HMOs, associations of emergency

•	 Assessing	their	 department physicians, associations of infectious disease 

willingness	to	work	 practitioners, and health clinic networks. 

The following organizations have been active in TB control cooperatively	with	 on a national level and may have affiliates in your program public	health	agencies area: 

• American Academy of	 • Infectious Diseases 

•	 Evaluating	their	cultural	 Pediatrics	 Society of America 

• American College of Chest	 • American Academy of competency	levels Physicians	 Family Physicians 

• American College of	 • National Health Care •	 Identifying	their	 Physicians-American for the Homeless Society

perceived	barriers	to	 of Family Medicine Council 

early	diagnosis	of	TB	and	 • Migrant Clinicians’ Network • American Thoracic 

Society treatment	completion	 

•	 Identifying	individuals	and	organizations	they	respect 

Research	indicates	that	as	TB	cases	decline,	PCPs	become	less	aware	of	who	their	high-risk	 

patients	are	and	thus	are	less	likely	to	consider	TB	in	their	differential	diagnosis	of	at-risk	 

patients.	Meeting	with	PCPs	to	better	understand	their	perceptions	of	TB	is	a	first	step	 

toward	raising	TB	awareness.	These	meetings	can	lead	to	 

•	 Increased	cooperation	with,	and	support	for,	your	TB	program 

•	 Sponsorship	of	TB	education	and	training	programs 

•	 Consistent	and	ongoing	information	sharing	about	changing	epidemiological	 

trends	 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit  

Chapter 4: How Well Do You Know Your Environment? 
The	Associations of Primary Care Providers and Professional Associations Worksheet	can	help	 

you	gather	the	information	you	need.	 

Subject	 Identification of cross-cultural competency levels among outreach workers, 

public health nurses, and clinicians in Minnesota. 

Location Minnesota	 Source TB Notes No.3, 2002 

What a Survey of Health Care Providers Revealed: 

Addressing Primary Care Providers’ Cultural Competencies in TB Control 

Key Findings from a Statewide Survey 

The cultural competency needs expressed by health-care professionals in urban and suburban 

areas differed significantly from those in rural areas. 

All providers wanted to improve their skills, knowledge, and expertise in communicating with 

culturally diverse patients and involving them in their own health-care decisions. 

Rural areas were more likely to work exclusively with Hispanic and Latino populations, while urban 

areas worked more with African and Southeast Asian TB clients. 

Response 

Programs 

Implemented 

Program 

Outcomes 

Collaborated with the Minnesota-based Center for Cross-Cultural Health to 

present two half-day workshops titled “Cross-Cultural Issues in TB Prevention 

and Control in Minnesota.” One workshop was designed to meet the needs 

of urban and suburban professionals. The other was designed to serve rural 

professionals and was simultaneously broadcast live to 11 videoconference 

sites around the state. The conference was videotaped and free copies are 

available. 

Physicians, public health nurses, and outreach workers, as well as nurses 

from businesses employing large numbers of immigrants, attended both 

workshops. 

Additional collaboration opportunities are being explored with the Center 

for Cross-Cultural Health, including the possibility of including members of 

high-risk populations in future forums to share cultural information aimed at 

identifying and implementing mutually acceptable TB prevention and control 

strategies. 

Comparing Your Data to Your Area’s TB Program 

Part	of	understanding	your	environment	includes	analyzing	how	closely	your	TB	 

program	goals,	objectives,	and	resources	are	aligned	with	your	epidemiological	profile	 

and	your	environment.	 

Your	TB	program	analysis	will	help	you	to: 

•	 Obtain	data	on	program	inputs	(e.g.,	funding	and	equipment)	and	outputs	(e.g.,	 

the	percentage	of	patients	completing	therapy),	and	review	your	program	goals	and	 

objectives.	 

 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter 4: How Well Do You Know Your Environment? 
•	 Analyze	the	TB	program’s	current	results,	comparing	them	with	existing	program	 

goals	and	objectives	and	taking	into	consideration	changing	environmental	trends. 

•	 Recognize	and	delineate	successes,	as	well	as	problem	areas	and	gaps	in	services. 

•	 Determine	possible	strategies	for	 

improving	performance	by	building	 

on	strengths	and	competencies	and	by	 

addressing	problem	areas. 

•	 Estimate	the	additional	resources	and	 

competencies	needed	to	help	implement	 

those	strategies	and	meet	new	program	 

objectives. 

Identifying and Understanding 

Additional Stakeholders 

For	the	purposes	of	this	guide,	a	TB	 

Formation of the Kansas TB Control 

Coalition 

The Kansas TB Control Program created a 

statewide TB coalition that includes public 

health entities, private providers, government 

entities, nonprofits, associations of medical 

professionals, religious groups serving atrisk populations, schools, the department of 

corrections, and a university. One of the many 

benefits was the Kansas Association for the 

Medically Underserved asking the TB Control 

Program to join forces with them to reach 

providers with TB education and information. 

(TB Notes No. 3, 2000) 

stakeholder	is	any	group	or	individual	impacted	by	TB;	thus,	TB	stakeholders	have	 

a	stake	in	preventing	and	controlling	the	disease.	In	reality,	everyone	in	society	is	a	 

potential	TB	stakeholder.	Our	challenge	is	to	awaken	an	interest	in,	and	commitment	 

to,	TB	prevention	and	control	among	more	and	more	stakeholders.	You	can	use	the	 

specific	needs,	opportunities,	and	issues	identified	in	your	epidemiological	profile	and	 

your	information	on	primary	care	providers,	at-risk	populations,	and	your	program	to	 

prioritize	your	identification	and	recruitment	of	new	TB	stakeholders	as	partners	(see	 

Chapter	5:	Determining Your Purpose and Choosing Partners).	Information	you	will	want	 

to	know	about	new	stakeholders	includes: 

•	 The	mission,	vision,	and	values	of	the	stakeholder	group 

•	 Membership	characteristics,	including	geographic	distribution	of	members	 

•	 Key	organizational	contacts 

•	 Organizational	structure	and	decisionmaking	procedures 

•	 Respected	members	and	leaders 

•	 Communications	channels,	such	as	newsletters,	broadcast	e-mail	lists,	and	websites 

•	 Current	activities,	including	volunteer	or	service	efforts 

•	 Regional	or	annual	gatherings 

Much	of	this	information	is	easily	obtained	from	the	stakeholder	organization’s	website.	 

Additional	information	can	be	gathered	through	a	phone	conversation	with	staff,	 

organizational	brochures,	and	annual	reports. 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit  

Chapter 4: How Well Do You Know Your Environment? 
Following	is	a	partial	listing	of	TB	stakeholder	groups	that	are	partnering	with	TB	 

prevention	and	control	programs	around	the	nation: 

•	Cultural	and	ethnic	organizations	 

•	Refugee	and	immigration		 

organizations 

•	Native	American	Nations	and		 

organizations	 

•	Citizens	or	residents	associations 

•	Business	and	trade	associations 

•	Financial	institutions 

•	Employers 

•	Public	and	private	schools	 

•	Media 

•	Clinics	and	HMOs	 

•	Private	health	care	providers 

•	Correctional	facilities	and	probation		 

officers	advocacy	groups 

•	Long-term	residential	facilities 

•	Substance	abuse	programs 

•	Shelters	and	low-income	housing	programs 

•	Professional	societies	 

•	Lung	associations	and	other	voluntary	 

groups	 

•	Schools	of	medicine,	nursing,	and	public	 

health	 

•	HIV/AIDS	service	organizations	 

•	Government	health	care	providers,	such	as	 

Indian	Health	Services	and	the	Department	 

of	Veterans	Affairs 

•	Immigration	and	border	officials 

•	Faith-based	organizations 

To	locate	possible	stakeholders	groups	in	your	program	area,	visit	the	CDC	National	 

Prevention	Information	Network	(NPIN)	Website	(www.cdcnpin.org)	and	select	“Search	 

for:	Organizations.”	You	will	find	descriptions	of	more	than	19,000	national,	state,	and	 

local	organizations	that	provide	resources	and	services	related	to	HIV/AIDS,	STDs,	and	 

TB.	Services	include	case	management,	counseling	and	testing,	prevention,	education	 

and	outreach,	health	care,	support	services,	housing	assistance,	and	treatment. 

Related Resources 

Cultural and Linguistic Competence Tools and Resources 

•	 The Bureau of Primary Health Care (BPHC) of the Health Resources and Services 

Administration (HRSA) 

BPHC	offers	tools	and	resources	addressing	cultural	competence	that	can	be	 

accessed	at	www.bphc.hrsa.gov/quality/Cultural.htm.	 

•	 Center for Immigrant Health 

The	mission	of	the	Center	for	Immigrant	Health	is	to	facilitate	the	delivery	of	 

linguistically,	culturally,	and	epidemiologically	sensitive	health	care	services	to	 

newcomer	populations.	Access	their	website	at	www.med.nyu.edu/cih/. 

•	 Cultural Competency Resource List 

	 This	resource	list	was	developed	and	is	maintained	by	the	Cultural	Competency	 

Subcommittee	of	the	TB	Education	and	Training	Network	(TB	ETN).	The	list	 

8 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter 4: How Well Do You Know Your Environment? 
contains	names,	contact	information,	and	descriptions	of	over	75	organizations	 

worldwide.	A	copy	of	the	Cultural Competency Resource List	is	available	by	 

sending	an	e-mail	to	tbetn@cdc.gov	or	by	visiting	the	TB	Education	and	Training	 

Resources	Website	at	www.findtbresources.org. 

•	 Linguistic and cultural aspects of tuberculosis screening and management for refugees 

and immigrants 

	 This	transcript	of	a	talk	presented	at	the	International	Union	Against	Tuberculosis	 

and	Lung	Disease	Conference	in	March	1996	discusses	some	strategies	for	 

managing	TB	treatment	and	prevention	in	a	multicultural,	multilingual	setting.	 

It	reviews	management	strategies	and	frequent	areas	of	miscommunication	that	 

require	special	attention,	explores	why	translation	and	patient	education	is	a	 

complicated	process,	and	describes	a	system	for	negotiating	cultural	differences. 

	 Access	this	talk	at	www.ethnomed.org/ethnomed/clin_topics/tb/tb.html	 

•	 The National Center for Cultural Competence of the Georgetown University Center 

for Child and Human Development 

The	center	offers	tools	and	resources	associated	with	cultural	and	linguistic	 

competence,	including	self-assessment	checklists.	The	center	can	be	accessed	by	 

calling	1-800-788-2066	or	at		 

www.georgetown.edu/research/gucdc/nccc/index.html. 

TB Program Assessment and Training Resources 

•	 The Public Health Training Network (PHTN) of the Centers for Disease Control 

and Prevention 

PHTN	is	a	distance	learning	system	that	takes	training	to	the	learner.	The	 

network	uses	a	variety	of	instructional	media,	ranging	from	print-based	to	 

videotape	and	multimedia,	to	meet	the	training	needs	of	the	public	health	 

workforce	nationwide.	PHTN	can	be	accessed	at	www2.cdc.gov/phtn.	 

•	 The TB Education and Training Network (TB ETN) of the Centers for Disease 

Control and Prevention 

TB	ETN	was	formed	to	bring	TB	professionals	together	to	network,	share	 

resources,	and	build	education	and	training	skills.	Currently,	membership	 

includes	representatives	from	TB	programs,	correctional	facilities,	hospitals,	 

nursing	homes,	federal	agencies,	universities,	American	Lung	Associations,	 

Regional	Training	and	Medical	Consultation	Centers,	and	other	U.S.	and	 

international	organizations	interested	in	TB	education	and	training	issues.	 

Additional	information	about	TB	ETN	can	be	accessed	at		 

www.cdc.gov/tb/TBETN. 

Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit  

Chapter 4: How Well Do You Know Your Environment? 
Additional Publications 

•	 TB-Related	News	and	Journal	Items	Weekly	Update	(TB-Update).	A	compilation	 

of	TB-related	articles	published	for	the	benefit	and	information	of	people	 

interested	in	TB.	To	subscribe	to	the	list,	or	to	change	your	subscription	options,	 

visit:	www.cdcnpin.org/scripts/subscribe.asp#journal. 

•	 CDC. Progressing	toward	tuberculosis	elimination	in	low-incidence	areas	of	the	 

United	States: recommendations	of	the	Advisory	Council	for	the	Elimination	of	 

Tuberculosis.	MMWR 2002;	51	(No.	RR-5).		 

www.cdc.gov/mmwr/preview/mmwrhtml/rr5105a1.htm 

•	 CDC.	Recommendations	for	prevention	and	control	of	tuberculosis	among	 

foreign-born	persons:	report	of	the	Working	Group	on	Tuberculosis	Among	 

Foreign-Born	Persons.	MMWR	1998;	47	(No.	RR-16).		 

www.cdc.gov/mmwr/preview/mmwrhtml/00054855.htm 

•	 CDC.	The	role	of	the	BCG	vaccine	in	the	prevention	and	control	of	tuberculosis	 

in	the	United	States:	a	joint	statement	by	the	Advisory	Council	for	the	 

Elimination	of	Tuberculosis	and	the	Advisory	Committee	on	Immunization	 

Practices. MMWR	1996;	45	(No.	RR-4).		 

www.cdc.gov/mmwr/preview/mmwrhtml/00041047.htm 

•	 CDC.	Division	of	Tuberculosis	Elimination.	TB Elimination, Now Is the Time.	 

Atlanta,	GA.	www.cdc.gov/tb/pubs/nowisthetime/.	 

•	 CDC.	Division	of	Tuberculosis	Elimination.	TB	Facts	for	Health	Care	Workers.	 

www.cdc.gov/tb/pubs/TBfacts_HealthWorkers/default.htm 

	 

0 Forging Partnerships to Eliminate Tuberculosis: A Guide and Toolkit 

Chapter 4: How Well Do You Know Your Environment?