bluuebunny/crossref_metadata_2025 huggingface dataset:
Neighborhoods on the Move: A Community-Based Participatory Research Approach to Promoting Physical Activity
Authors: Suminski Richard R. , Petosa Rick L. , Jones Larry , Hall Lisa , Poston Carlos W.S.C.
Published: July 2012

Background : There is a scientific and practical need for high-quality effectiveness studies of physical activity interventions in “real-world” settings.
Objective : To use a community-based participatory research (CBPR) approach to develop, implement, operate, and evaluate an intervention for promoting physical activity called Neighborhoods on the Move .
Methods : Two communities with similar physical and social characteristics participated in this study. One community was involved in Neighborhoods on the Move; the other (comparison community) participated only in the assessments. Academic personnel and residents/organizations in the Neighborhoods on the Move community worked together to create a community environment that was more conducive for physical activity. Pre- and posttest data on new initiatives promoting physical activity, existing physical activity initiatives, and business policies supporting physical activity were collected simultaneously in both communities.
Results : The success of the CBPR approach was evidenced by several developments, including substantial resident involvement and the formation of a leadership committee, marketing campaign, and numerous community partnerships. The number of businesses with policies promoting physical activity and breadth of existing physical activity initiatives (participants, activities, hours) increased substantially more in the Neighborhoods on the Move community than in the comparison community. A total of sixty new initiatives promoting physical activity were implemented in the Neighborhoods on the Move community during the intervention.
Conclusion : The CBPR approach is an effective strategy for inducing environmental changes that promote physical activity. Additional research is needed to assess the portability and sustainability of Neighborhoods on the Move.
A Culturally Adapted Drug and Alcohol Abuse Prevention Program for Aboriginal Children and Youth
Authors: Baydala Lola T. , Sewlal Betty , Rasmussen Carmen , Alexis Kathleen , Fletcher Fay , Letendre Liz , Odishaw Janine , Kennedy Merle , Kootenay Brenda
Published: July 2012

Background: In response to substance abuse within their community, the Alexis Nakota Sioux Nation invited the University of Alberta (UofA) to partner in a collaborative effort to establish a school-based substance abuse prevention program.
Objectives: An evidence-based substance abuse prevention program was reviewed and adapted by the community to ensure that it incorporated their cultural beliefs, values, language, and visual images. The adapted program was delivered to students at Alexis Nakota Sioux Nation School and changes in student participants’ knowledge, attitudes, refusal skills, and self-beliefs were measured. Benefits and challenges of adapting the program were documented.
Methods: The principles of community-based participatory research (CBPR) and the Canadian Institute for Health Research, Guidelines for Research Involving Aboriginal People, provided a frame of reference for the work throughout the research process. A pre-/posttest questionnaire was used to measure changes in student participants’ drug and alcohol refusal skills, self-beliefs, and knowledge of the negative effects of drug and alcohol use. Focus groups (FGs) documented community members’ experiences of and responses to the program adaptations and delivery.
Results: Results included (1) positive changes in students’ drug and alcohol refusal skills, self-beliefs, and knowledge of the negative effects of drug and alcohol use, (2) ownership of and investment in the program by the community, (3) teaching approaches that correspond with the learning contexts, worldview, and relationships of the community, and (4) participation of community Elders.
Conclusion: Quantitative and qualitative measures provide evidence for the importance, benefits, and challenges of employing a culturally adapted evidence-based substance abuse prevention program with Aboriginal students attending a First Nations school.
The Rise of the Community-Based Participatory Research Initiative at the National Institute for Environmental Health Sciences: An Historical Analysis Using the Policy Streams Model
Authors: Felix Holly C
Published: July 2012

Background: Community-based participatory research (CBPR) is an approach to research that seeks equitable and collaborative involvement of community members and researchers in all aspects of the research process. It has moved slowly into the areas of health and public health research. In 1995, the National Institute for Environmental Health Sciences (NIEHS) launched the first research initiative at NIH specifying the use of the CBPR approach. Objectives: The purpose of this paper is to provide the historical record and to identify factors and events that led to the development of the policy creating the CBPR initiative at NIEHS. Methods: The study used Kingdon's policy streams model as an analysis framework. The policy streams model explains that policies are developed when three "streams" (problem, policy and political) come together at a point called the policy window. Information collected from key informant interviews and document analyses were coded to the components of the policy streams model. Results: The study documented factors and events in each of the three streams of the model. All these occurred about the same time to bring together the three streams, causing the opening of a policy window. This analysis demonstrates an importance of problem awareness and changes in leadership positions or ideology/mood to bring a policy option to the attention of policymakers, and the importance of a policy entrepreneur to advocate for a particular policy when the opportunity arises. Conclusions: Policy entrepreneurs should be alert for opportunities to take advantage of the open policy windows when they emerge, thereby achieving success in moving policy ideas forward.
A Qualitative Examination of Heterosexual Consciousness Among College Students
Authors: Mueller John A. , Cole Jennifer C.
Published: July 2012

The purpose of this study was to explore how heterosexual college students understand and make meaning of their life experiences and how they incorporate those into their sexual orientation consciousness. We interviewed 14 undergraduate and graduate self-identified heterosexual students, ten women and four men, ranging in age from 20 to 24. Students discussed the sources of and mechanisms for learning about their sexual orientation, the role of faith in their views on sexuality, distancing themselves from homophobia, and the invisibility of heterosexuality. Implications for theory, research and practice are presented.
The Influence of Parenting Styles, Achievement Motivation, and Self-Efficacy on Academic Performance in College Students
Authors: Turner Erlanger A. , Chandler Megan , Heffer Robert W.
Published: July 2012

Parenting styles have consistently been shown to relate to various outcomes such as youth psychopathology, behavior problems, and academic performance. Building on the research in the parenting style literature, along with examining components of self-determination theory, the present study examined the relations among authoritative parenting style, academic performance, self-efficacy, and achievement motivation using a sample of college students ( N = 264) . Results indicated that authoritative parenting continues to influence the academic performance of college students, and both intrinsic motivation and self-efficacy predicted academic performance. Additionally, the study tested the interaction between self-efficacy and authoritative parenting, but the interaction was not significant. Implications for future research and applications are discussed.
Perceptions of Multiple Identities Among Black College Students
Authors: Stewart Dafina Lazarus
Published: July 2012

A qualitative study of 13 self-identified Black and African American college students across three institutions revealed important findings relevant for understanding the multifaceted and complex ways in which these students both perceived and made meaning of the multiple facets of their identities. Implications for the ways in which social identity factors are seen as cooperative and coherent are discussed. Also, provocative findings related to the incorporation of non-unitary facets of identity are shared.
Tradition Meets Technology: Cuban Film Animation Enters the Global Marketplace
Authors: Stock Ann Marie
Published: July 2012

La producción y distribución de los dibujos animados cubanos han experimentado una dramática transformación en los años recientes. Durante la pasada década, las imágenes generadas por computadora—o CGIs, por sus siglas en ingles—han remplazado en gran parte al dibujo y la pintura hechos a mano, y el estudio de animación Instituto Cubano de Arte e Industrias Cinematográficos (ICAIC) ha incrementado los esfuerzos dirigidos a su inserción en la esfera internacional—participando en más festivales, penetrando nuevos mercados y ofreciendo sus servicios a clientes de todo el mundo. Sin embargo, esta transformación no ha significado una ruptura total con el pasado de la institución. La misión original de los estudios—contribuir a la creación de una cultura únicamente cubana—se mantiene intacta y su compromiso con la revolución no ha disminuido. Los artistas del dibujo animado siguen considerando que su función principal es servir a sus compatriotas, especialmente a los niños, y resistirse a la dominación de los Estados Unidos, ofreciendo una alternativa a los dibujos animados de Disney. Por lo tanto, aunque la tecnología digital y las fuerzas del mercado internacional han tenido un impacto importante en la animación cubana de los años recientes, la industria global no ha usurpado la tradición nacional de la isla; sino que, por el contrario, en Cuba la animación autóctona está en pleno florecimiento. Este ensayo reúne las reflexiones de numerosos artistas de la animación, a fin de analizar la forma en que la animación cubana ha balanceado cuidadosamente los propósitos políticos con los aspectos estéticos, las metas nacionales con las influencias globales y lo tradicional con lo innovador.
El Hijo de Guillermo Tell: Carlos Varela Confronts the Special Period
Authors: Nasatir Robert
Published: July 2012

Para las dos generaciones de la nueva trova, el período especial fue una época prolífica notable por una creatividad que solamente se acerca a la de los últimos años de la década de los sesenta y de los setenta. De hecho, muchas de las canciones compuestas durante el período especial son comentarios —o sutiles o explícitos—de los primeros años de la revolución. No obstante, el presente no evita la crítica. Aunque las dos generaciones expresan su decepción y rabia, las expresiones toman formas muy distintas. Para la primera generación de la nueva trova, especialmente Silvio Rodríguez y Pablo Milanés, las críticas del presente muestran una nostalgia por la promesa inacabada de la revolución. En el caso de la novísima trova, hay poca nostalgia. Al contrario, y específicamente en las canciones de Carlos Varela, su experiencia se presenta como un drama familiar en que su generación demuestra un enojo edípico hacia la generación anterior que sacrificó la generación menor sin permiso.
Arbitrary Cause
Authors: Falco Raphael
Published: July 2012

This essay introduces the term arbitrary cause as a precise description of the contingent structural relationship of figurative language to social reality. At the present time our critical vocabulary lacks a term that characterizes that relationship. The aim of the present essay is to establish the importance of the notion of arbitrary cause in understanding the process of figurative representation. The essay examines Saussurean linguistics, structuralist and poststructuralist revisions of Saussure, and provides a detailed set of examples demonstrating the instability of the concept of the arbitrary in common usage. The essay concludes with a discussion of literary expression.
Against Theory Beside Romanticism: The Sensation of the Signifier
Authors: Wang Orrin Nan Chung
Published: July 2012

Walter Benn Michaels's The Shape of the Signifier: 1967 to the End of History makes the ostensive cul-de-sac of identity politics the dominant symptom of postmodernism per se. The Shape connects its argument to the controversy over intention and interpretation created by Steven Knapp and Walter Benn Michaels's twenty-year-old essay "Against Theory." This very connection, however, highlights the not-quite-acknowledged presence of a certain type of romanticism in both works that each also wants to attack. Misunderstanding Paul de Man's notion of materiality, Michaels becomes the latest thinker hoping to free us from the inchoateness of romantic sensation, both as the indulgence of sensory experience and the cognitive sloppiness (from Michaels's perspective) of nonmeaning as the sense of meaning. Far from a Fukuyama-inspired postmodern condition, Michaels's scenario actually adumbrates a basic problem between romanticism and modernism-as-modernity.
Katrina vanden Heuvel
Authors: vanden Heuvel Katrina
Published: July 2012

Some questions are really not worth asking, even as they nag. What relationship should American intellectuals have
toward mass culture: television, films, mass-market books, popular music, and the Internet may be one of them.
Before answering it, let me first attack
any effort to do so. I don’t think we have a recognizable group of American intellectuals of real political weight, at least not intellectuals of the
sort celebrated by and occasionally inhabiting the old Partisan Review. That is, we don’t have an identified bunch of
very smart and socially interconnected people—of course, often neurotic, passionate, and sometimes
delusional—who judge their life by its contribution to human
science or art and who see themselves as the guardians of its standards...
Leon Wieseltier
Authors: Wieseltier Leon
Published: July 2012

“I am human and I consider nothing human alien to me”: this statement has always struck me as preposterous. Of
course there are human creations and activities that are alienating, or worse. (The famous sentence in Terence’s
comedy is in fact spoken in bad faith, as an excuse for an obtrusive neighbor to intervene in a matter that is none of
his business.) And to the inventory of alienating human productions one must add a good deal of American mass
culture—for its transformation of a citizenry into an audience; for its hardening of an entire population toward the most
obscene representations of violence, which we call entertainment; for its grotesque sexualization of an entire society,
which has the effect not least of degrading sex, even dirty sex; for the mental passivity inculcated in millions of people
who are helpless before its big and little screens...
Why Tatian Never "Apologized" To The Greeks
Authors: McGehee Michael
Published: July 2012

Tatian's "To the Greeks" ( Pros Hellenas ) has usually been classified as either an apology or a harangue. Yet neither of these genres can explain the work's vituperative style, denigration of Tatian's rivals, frequent digressions, and intent. If we classify the work as a protrepticus , however, we can see it as an integrated whole which was given with the intent of attracting people to study the "barbarian philosophy" with Tatian. The use of this genre implies that Tatian understood Christianity to be a philosophy and himself to be an independent teacher who could work without ecclesiastical oversight.
Theological Identity Making: Justin's Use of Circumcision to Create Jews and Christians
Authors: Livesey Nina E.
Published: July 2012

This essay contributes to the current scholarly view that in his Dialogue with Trypho , Justin is centrally concerned with the creation of distinct Christians and Jews. By using treatments of circumcision as a test case and engaging Justin's Dialogue rhetorically and stylistically-by commenting upon not only the structure of his arguments including aspects pertaining to sound such as breath-measures, but also upon his choice of words and biblical references-it documents the distinction-making process and provides supporting material often lacking in the scholarship on Justin. Justin creates Christians and Jews by forcing differences between them, differences that would not and do not exist in the socio-historical sphere. While circumcision provides a literal or physical, though unseen, difference between the two groups, Justin's primary interest is in making distinctions that hold sway in the theoretical and theological realm.
A Culture of Trees: The Politics of Pruning and Felling in Late Eighteenth-Century France
Authors: Pacini Giulia
Published: July 2012

Before the French revolutionaries adopted the tree as a symbol of freedom, artists used arboreal images to discuss issues of royal policy and reform. Hubert Robert, Peyraud de Beaussol, Jacques Delille, Michel-Paul de Chabanon, and Adélaïde de Souza drew scenes of felling and pruning to comment upon the solidity of a cultural and political system—the ancien régime—that seemed to be vacillating at their feet. Their work was inspired by the monarchy's involvement in the management of forests, by the construction of the gardens of Versailles under Louis XIV, and the dramatic event of their replanting in 1774–5.
Pierre and the Non-Transparencies of Figuration
Authors: Snediker Michael D.
Published: July 2012

" Pierre and the Non-Transparences of Figuration" argues that many critical readings of Herman Melville's 1852 novel depend on a non-necessary subordination of Pierre 's extravagant style to questions of characterology and plot to which the text seems at best ancillary and nonconventionally attached. My essay suggests that characterological volatility or depletion might more profitably be understood in terms of Melville's own movement away from imagining characters as mimetic instantiations of persons, and toward an account of aesthetic personhood resonant with recent psychoanalytic and queer-theoretical investigations of ontology itself as a particularly aesthetic phenomenon and predicament.
Playing the Lord: Tudor Vulgaria and the Rehearsal of Ambition
Authors: Sullivan Paul
Published: July 2012

In early Tudor grammar schools, the use of vulgaria , or English-Latin phrase books, linked literary instructin and dramatic play as rehearsals for social self-advancement. Schoolmasters composed several remarkable collections of these "vulgars" to inform the practice of colloquial Latin and to season schoolboy conversation with ludic pleasure. The earliest printed vulgaria include vivid expressions of school life, but they also thrust boys into speaking in a broad variety of roles well beyond their own experience and social circumstances. Recent criticism has tended to emphasize the regulatory functions of humanist pedagogy, but the vulgaria provide impressive evidence for emancipatory possibilities. From these daily acts of impersonation, a schoolboy learned to regard social rank as the performance of roles. Moreover, the vulgaria arguable contributed to the development of English drama: first, as they conditioned a relatively sophisticated audience of readers and writers, practiced in impersonation and in performing the language of social striving; second, as they introduce into English monologue and dialogue a rich and various rhetoric of worldly ambition.
Peindre le toucher: la leçon de continence de Rubens mise en mots par Roger de Piles
Authors: Gaudin-Bordes Lucile
Published: July 2012

Les notices rédigées par Roger de Piles sur Susanne avec les deux vieillards, La Madeleine chez Simon le Pharisien et La Continence de Scipion permettent de croiser les regards du théoricien et du peintre pour aborder la question du toucher en peinture, de ses figures, de ses effets, de ses enjeux. Cet article articule l'art de toucher, tel qu'il est décrit par les lexicographes du 17ème siècle et exploité par les théoriciens, et l'art du toucher dont témoignent à la fois les œuvres de Rubens et le texte de de Piles.
Corps-Caméra : The Evocation of Touch in the Dardennes' La Promesse (1996)
Authors: Mai Joseph
Published: July 2012

Without the universalizing political ideologies of the European Left, the Dardenne brothers focus their cinema on creating a sense of touch between audience and the film. Their "haptic" cinema disrupts viewers' subjectivities and gives them a sensuous experience of other worlds, leading to an ever-shifting ethical bricolage.
"Cet ignoble trafic": The Kidnapping and Sale of Vietnamese Women and Children in French Colonial Indochina, 1873-1935
Authors: Lessard Micheline
Published: July 2012

Le trafic des femmes et des enfants au Viêt Nam représente un fléau qui n'est ni récent, ni contemporain. Pendant la période coloniale française (1858-1954) l'administration coloniale, les consuls de France en Chine, les militaires et d'autres colons se rendirent compte que les rapts de femmes et de fillettes vietnamiennes étaient non seulement fréquents mais faisaient aussi souvent partie de réseaux criminels bien organisés. De nombreuses bandes armées sillonnant les régions côtières et les villages frontaliers entre la Chine et le Viêt Nam capturaient ou enlevaient des femmes et des enfants vietnamiens afin de les vendre dans de nombreux marchés chinois. Ces femmes et enfants, destinés au concubinage, au travail domestique ou à la prostitution, parfois permirent à des bandes vietnamiennes anticoloniales de les échanger contre des armes. Malgré de nombreuses mesures mises en place pour mettre fin à ce trafic, le commerce des femmes et des enfants vietnamiens demeura constant pendant la période coloniale française et devint un phénomène embarrassant pour les autorités coloniales.
A Truth-functional Non-modal Interpretation of Ockham's Theory of Consequences
Authors: Beierle John
Published: July 2012

Philotheus Boehner, in his paper of 1951 demonstrated that Ockham knew of material implication, and his book of 1952 translated many of Ockham's rules for simply valid consequences as tautologies (hence theorems) of PC (propositional calculus). E. A. Moody, in his book of 1953, gave a conflicting interpretation, identifying Ockham's simply valid consequences with Lewis and Langford's CSI (calculus of strict implication) and Ockham's consequences valid ut nunc with PC. It is demonstrated here that Moody was wrong and Boehner right. It is also shown that PC with propositional constants provides a framework for a truth-functional interpretation of Ockham's consequences without modal adverbs '□' and '◊' ('necessarily' and 'possibly' where '□' = df '~◊~').
Nehanda and Gender Victimhood in the Central Mashonaland 1896–97 Rebellions: Revisiting the Evidence
Authors: Charumbira Ruramisai
Published: July 2012

In 1998 David N. Beach revisited the 1896-97 central MaShonaland rising in colonial Zimbabwe in an article titled “An Innocent Woman Unjustly Accused? Charwe, Medium of the Nehanda Mhondoro Spirit, and the 1896-97 Central Shona Rising in Zimbabwe.” Beach's main thesis was that, contrary to conventional wisdom that placed Nehanda-Charwe (and other leaders) at the center of those anti-European settler rebellions, Nehanda-Charwe might have been “an innocent woman unjustly accused.” For Beach, upstart Kaguvi-Gumboreshumba (a male spiritual leader) might have been the real hero, for he was to be found in all the sources and his tracks were better traceable than Nehanda-Charwe, who had a sporadic presence in the same sources.

Since Beach's 1998 study, I have not come across any other original study that has extended or disputed his arguments; to that end, I consider this study a response to Beach's study and an invitation to revisit the historiography of early colonial Zimbabwe through feminist lenses. My main aim is to revisit two major issues Beach raised in his study, and to look at them through a feminist lens in order to understand whether Nehanda-Charwe was indeed an “innocent woman unjustly accused” or whether something else was at play. After giving a brief background to the rebellion in MaShonaland, I will look at the issue of the credibility of evidence given by Africans to colonial officials about those who were up in arms against the colonial authority, the British South Africa Company (BSAC), with a focus on women's testimonies.
Finding Bosutswe: Archeological Encounters with the Past
Authors: Denbow James , Mosothwane Morongwa , Ndobochani Nonofho Mathibidi
Published: July 2012

Bi-lingual, Bi-cultural

able to slip from “How's life”

to M'estan volviendo loca,

able to sit in a paneled office

drafting memos in smooth English,

able to order in fluent Spanish

at a Mexican restaurant,

American but hyphenated,

viewed by Anglos as perhaps exotic,

perhaps inferior, definitely different,

viewed by Mexicans as alien

(their eyes say, “You may speak

Spanish but you're not like me”)

an American to Mexicans

a Mexican to Americans

a handy token

sliding back and forth

between the fringes of both worlds

by smiling

by masking the discomfort

of being pre-judged

Bi-laterally.

This paper presents a micro-scale examination of archeological field praxis and its impact on archeologists, students (foreign and indigenous), and the local communities that both host and labor for them. It is a reflexive journey that attempts to bring coherence to the multiple and changing registers of meaning, contradiction, and transformation that have taken place during excavations at Bosutswe in “post-colonial” Botswana. We discuss our interactions with one another and our encounters with “the past” as we sought to validate, transform, or escape the contemporary entanglements of multilateral “pre-judgments” that have their roots deep in the soil of colonial encounter.

Pat Mora in her short poem, Two Worlds, captures some of the contradictions inherent in a post-modern, post-colonial, transnational world, where one is sometimes offered the possibility of inhabiting multiple universes, with multiple cultural and linguistic positionalities, and sometimes even trans-ethnic or transnational identities as possible choices.
Peirce's Modal Shift: From Set Theory to Pragmaticism
Authors: Lane Robert
Published: July 2012

For many years, Charles Peirce maintained that all senses of the modal terms "possible" and "necessary" can be defined in terms of "states of information." But in 1896, he was motivated by his work in set theory to criticize that account of modality, and in 1905 he characterized that criticism as a return "to the Aristotelian doctrine of a real possibility ... the great step that was needed to render pragmaticism an intelligible doctrine." But since Peirce was a realist about modality before 1896, and since he continued defining "possibility" in terms of "states of information" after that date, it is not clear exactly what he changed his mind about. In this essay I explain what it was that Peirce changed his mind about and why, in retrospect, he viewed that change as a decisive step in the development of pragmaticism.
Berkeley et les métaphysiques de son temps
Authors: Bardout Jean-Christophe
Published: July 2012

La contribution de Berkeley à l'histoire de la métaphysique n'a que rarement été étudiée par ses commentateurs français ou anglo-saxons. La présente étude se propose de revenir sur la définition berkeleyenne de la métaphysique, sur la place qu'elle occupe dans l'économie de sa pensée, et tente ainsi d'éclairer la contribution de Berkeley à l'histoire de la notion de métaphysique à l'époque moderne. Nous montrons que la critique berkeleyenne de la métaphysique n'empêche pas Berkeley de maintenir sa pertinence théorique, si l'on rapporte sa conception de la métaphysique à la transformation qui affecte celle-ci après Descartes, et qui en fait la science des principes de la connaissance humaine. Cette étude entend donc réévaluer la place de la métaphysique dans l'oeuvre de Berkeley, et, simultanément, de mesurer l'apport de Berkeley à l'histoire de la métaphysique.
Nutrition Education: A Computer-Based Education Program
Authors: Goodman Jennifer , Blake JoAnn
Published: July 2012

African Americans have higher than average rates of morbidity and mortality for numerous health conditions despite the improvements in overall health in the United States over the past century. Despite the proliferation of material on health promotion and health disparities concerns related to diet and health care for African Americans persist. In the present paper, the authors describe a computer-based nutrition education program designed for use with African American adults. Specific features of the program that qualify it as culturally-tailored are presented and preliminary results demonstrating success in improving nutrition in a church-based sample of 82 adults are provided.
Effect of acculturation and income on Hispanic women's health
Authors: Leybas-Amedia Velia , Nuno Thomas , Garcia Francisco
Published: July 2012

This research examines how acculturation and income affect health care access, utilization, and prevention knowledge among a population of Hispanic women living along the U.S.-Mexico border in Yuma, Arizona, a rural agricultural county. A cross-sectional survey was conducted among 417 Hispanic women with mean age 61.3 years (s.d.=9.2). Most were long-term residents of Yuma County with some elementary and middle school education. Respondents had low monthly household incomes (average: $927.77, s.d.=550.40) and 10% reported current employment. The results show that income may be a more important predictor of actual utilization of health care services while acculturation may play a more prominent role with respect to provider preferences. A better understanding of the complex interplay between the individual and the society she inhabits is required in order to develop a meaningful public health intervention that will affect disease risk.
Homeless, Mentally Ill and Addicted: The Need for Abuse and Trauma Services
Authors: Christensen Richard C , Hodgkins Candace C , Garces Lorrie , Estlund Kathleen L , Miller M. David , Touchton Reginald
Published: July 2012

This paper examines an empirical investigation of the lifetime prevalence of trauma (defined as sexual and/or physical abuse) in a cohort of adults enrolled in a federally funded initiative that provides treatment for homeless persons suffering the effects of comorbid substance use and serious mental illness, and considers the impact of this information on clinical programming. Data collected from homeless individuals with co-occurring disorders admitted to the Seeking Treatment and Recovery (STAR) Program during a one year period (n=78) were analyzed for a history of trauma events. Of those individuals evaluated, 79.5% (62/78) acknowledged a history of either physical and/or sexual abuse at some time in their lifetimes. Of this population, 100% of the homeless women (27/27) with co-occurring disorders had experienced a life-altering traumatic event while 68.6% (35/51) of the homeless men also reported trauma histories.
We describe the trauma-based interventions made in the STAR Program that have the potential for replication in other initiatives committed to serving homeless individuals with co-occurring disorders.
Community's Voice in Managing Childhood Asthma: The Assessment Phase of Research
Authors: Peterson Jane W , Dobie Sharon
Published: July 2012

This study was designed to investigate community beliefs about caring for childhood asthma and to elicit suggestions for interventions to improve asthmatic children's health. Focus groups were conducted with parents of children with asthma, children with asthma, school staff, and health care and childcare professionals. Data were analyzed for themes, such as disruption of normal living and having to work in a chaotic system, enabling researchers to posit a core belief for each group. These core beliefs, together with encompassed other, related beliefs held by group members, guide attitudes and actions about asthma. Interventions recommended by focus group participants included creating an asthma play, asthma education, and developing a clinic-based registry to standardize asthma documentation. The community's voice is important in assessment and design of health improvement projects. Incorporating the community's suggestions gives the community a sense of contributing to the health care of their children with asthma.
Care System Assessment Demonstration Project, Palm Beach County, Florida: Methodology, Findings, and Recommendations
Authors: Dodge Karen , Potocky-Tripodi Miriam
Published: July 2012

Palm Beach County, Florida was one of three sites selected nationally for the Care System Assessment Demonstration Project. The special focus of the Palm Beach project was Black women (both U.S.-born and foreign-born). The CSAD consists of two complementary components: (1) Rapid Assessment, Response, and Evaluation (RARE), which examines the research topic from the perspectives of the affected population (i.e., HIV-positive Black women who are not in care); and (2) Care System Assessment, which examines the research topic from the perspectives of people within the HIV/AIDS care system (e.g., health care providers, planners, HIV-positive Black women in care). This article presents the methods, findings, and recommendations from the Palm Beach County site.
CARE Act Planning for Unmet Need
Authors: Hopson Deborah Parham , Morgan Douglas H , Gray Sonya Hunt , Conviser Richard
Published: July 2012

The Ryan White CARE Act, a safety net program first enacted in 1990, provides health and support services to people living with HIV (PLWH) in the U.S. through several Titles. Recipients of CARE Act funds—particularly metropolitan areas and States under Titles I and II, respectively—prioritize and allocate funds to cover unmet service needs. In the 2000 reauthorization of the CARE Act, Title I and II grantees were directed to determine unmet needs for services. This paper describes a process by which the HIV/AIDS Bureau of the Health Resources and Services Administration of the U.S. Department of Health and Human Services has assisted grantees in developing tools to make quantitative estimates of the unmet need for HIV primary care services. The process enables grantees to identify underserved populations and implement strategies to bring them into regular primary care. The Care System Assessment Demonstration Project supplements these tools.
Twin Cities Care System Assessment: Process, Findings, and Recommendations
Authors: Othieno Joan
Published: July 2012

The Twin Cities Care system lacks services that are most needed in the later stages of HIV disease. Services in highest demand included housing, transportation, and translation; available translations services are generally limited to Somali, Oromo, and Amharic, the languages most widely spoken by the three largest African immigrant and refugee groups in the Twin Cities. The care system is not well-integrated, and most of the work of moving clients within the system is done by case managers and care advocates. The main technical competencies identified by providers as lacking are understanding mental health from the perspective of African-born people living with HIV/AIDS (PLWH) and addressing sexual issues, especially with women. African providers with foreign certifications not recognized in the United States are not able to use their professional skills. African clients are not well-informed about HIV, and African women are more likely than men to seek and stay in care.
Care System Assessment Findings in Orange County, California
Authors: Watson Mary M
Published: July 2012

This article describes how the Care System Assessment Demonstration (CSAD) was applied to the Ryan White Care System in Orange County, California. Data were collected for the project using the Rapid Assessment, Response and Evaluation (RARE) assessment methods plus document reviews. The RARE methods were used to gather data from people living with HIV/AIDS (PLWH), cultural experts and service providers. Information from the contextual assessment and the system assessment were combined and presented to a group of community stakeholders representing PLWH and their families and service providers. Three recommendations were forwarded to the HIV Planning Council for implementation.
Challenges Faced by Minority Children in Obtaining Dental Care
Authors: Dasanayake Ananda P , Li Yufeng , Chhun Nok , Bronstein Janet M. , Childers Noel K
Published: July 2012

Deaths of children due to neglected dental diseases have put the issue of access to care by minorities at the forefront of dental public health discussions. We evaluated the trends in dental service utilization in relation to racial disparities and other factors using Medicaid enrollment and claims data from 1990 to 1997 for Alabama children 19 years of age and younger (N=512,049). Alabama Medicaid children visited the dentist at a low and declining rate. The number of participating providers gradually declined over time and the racial disparities in service utilization were related to the availability of a local provider. Lower service utilization, however, was not a simple function of race, but a complex interaction of race with age and gender. Identification of these complex interactions and removal of barriers to service utilization in race, age, and gender sub-groups will help the U.S. meet the year 2010 oral health objectives.
Culturally Sensitive Oral Health Educational Materials for Older African Americans
Authors: Slaughter Ann , Evans Lois K
Published: July 2012

Abstract: Oral diseases disproportionately affect older Americans from minority populations. Approaches to reducing such disparities include increasing community-based interventions that target vulnerable older adults. To help in developing and implementing such programs, the U.S. Department of Health and Human Services suggests using the MAP-IT technique, from a strategic planning guide to address public health issues in the community. This approach served as the method of investigation for the Take Charge of Your Oral Health educational program, a health promotion initiative targeting older African Americans. This paper describes the development and evaluation of the program. A total of 111 African American elders from 7 senior sites in Philadelphia participated in the program. A 6-item pre-test and post-test indicated a significant improvement in mean test scores from baseline (p,.001). The program demonstrated merit in improving oral health knowledge among community-residing, inner city, older African Americans.
Children First: The Need to Reform Financing of Health Care Services for Children
Authors: Diekema Douglas S.
Published: July 2012

Many children in the United States live in poverty, lack health insurance, and receive inadequate health care. Current methods of financing health care fail to adequately provide for the needs of children. On the basis of the moral principles of beneficence and justice, adult members of society have a duty to assure that all children receive at least a basic level of health care. Any reorganized health care system should assure health care coverage for all children, health insurance plans must guarantee access and adequate coverage for important medical needs of children, and out-of-pocket expenditures must not discourage the use of effective health care for children.
Investigating the Relationship Between Economic Status and HIV Risk
Authors: Murrain Michelle , Barker Thomas
Published: July 2012

Although anecdotal information suggests that there is a relationship between socioeconomic status and HIV risk, there have been few investigations of that possible relationship. Understanding that relationship can have important implications for designing and implementing prevention programs. This study investigated the relationship between indicators of socioeconomic status and HIV prevalence in Massachusetts using seroprevalence data from publicly funded test sites. HIV seroprevalence was found to differ depending on demographic groups and the health care insurance/provider. Those who had no insurance or were Medicaid recipients had higher rates of HIV infection. Homeless individuals were also at higher risk. Further, low-income ZIP codes in Massachusetts were four times more likely to have high seroprevalence rates among residents voluntarily testing for HIV. Thus, HIV seroprevalence appears to be associated with socioeconomic status in this group of voluntarily tested individuals.
Principles for Forging a National Health Plan
Authors: Enochs Richard , Cato Amy , Jillson-Boostrom Irene , Bonnyman Gordon , Braithwaite Ronald , Cebrun Anthony , Kirkland-Essien Joyce D. , Evans Therman , Hardy Robert , Scott Veronica , Nabrit-Stephens Barbara , Hodge Cynthia
Published: July 2012

At the conclusion of this conference, a group of practitioners representing diverse specialties but united in their concern for the underserved met to discuss lessons gleaned from the conference. Inasmuch as the debate over health care reform at the federal and state levels frequently fails to consider the implications for reform on underserved populations, one of the goals of the group was to formulate recommendations which, if adopted by policymakers, will ensure greater equity. These recommendations, and a summary statement from the conference, follow.
Role Burdens: The Impact of Employment and Family Responsibilities on the Health Status of Latino Women
Authors: Rivera Ralph , Torres M. Idali , Carré Françoise J.
Published: July 2012

This paper explores the relative effects of employment and family responsibility on the perceived health status of Latino women. The data source analyzed for this study was the 1990 Panel Study of Income Dynamics/Latino National Political Survey (PSID/LNPS) Early-Release File (n = 1,502). Regression analyses were used to investigate the contributions of variables associated with perceived health status, including sociodemographics, Latino ethnicity, language, employment, and family responsibility. The results suggest that annual employment hours, occupation, and family responsibilities, such as child care and weekly housework, significantly affect self-reported health status of employed Latinas. Both social causation and social selection may be underlying the associations found. The results suggest that there is need for the development of public policies that seek to increase Latinas' labor force participation rate since any expansion has the potential to have a positive impact on their health status.
Access to Primary Care for Patients with Diabetes at an Urban Public Hospital Walk-in Clinic
Authors: Schiff Robert L. , Ansell David , Goldberg David , Dick Stuart , Peterson Corinne
Published: July 2012

The purpose of this study was to determine the regular source of primary care, the content of care, and barriers to accessing primary care for 218 medically indigent adults with diabetes mellitus. Patients were surveyed at a public hospital walk-in clinic and were queried regarding demographics, regular source of care, and the content of care they received during the preceding year. Seventy percent of the patients were medically uninsured, and 60 percent had household incomes under $10,001. Forty-three percent reported no regular source of care, and 18 percent named an episodic care site as their regular source. Patients with a regular source of primary care had twice as many annual ambulatory visits as those without primary care. Patients with a regular source of primary care reported more diabetic-related services than those without. This patient population is largely poor and uninsured and has difficulty accessing primary care.
Developing and Evaluating an Integrated Substance-Abuse Curriculum for Implementation in a Primary Care Setting
Authors: Alario A , Riggs S , Dube C , Lewis D
Published: July 2012

Equipped with appropriate skills, the primary care provider can play a significant role in the detection, treatment, and prevention of potentially dangerous substance use. A program with specific goals to develop, test, and disseminate a new integrated substance-use curriculum has been designed especially for health care providers in the primary care setting. Three key, integrated educational methods provide the core curriculum material. The first method employs the use of video trigger tapes of interviews with substance users and nonusers of various ages. The tapes are designed to impart direct didactic knowledge about substance use, including epidemiology, developmental stages of use, clinical presentations, and comorbidities. The effectiveness of the tapes in enhancing knowledge in these areas is assessed through standardized question/answer tests administered before and after tape sessions. Perhaps most important, the tapes are designed to evoke explicit attitudes from the primary care providers about substance abuse. Review of the extent and content of the discussions following the tapes as well as scales measuring attitudes given both before and after viewing serve in evaluation. The second teaching method employed is the use of a skills checklist, part of which is illustrated in the videotaped interviews. The goals of the five subsections of the skills checklist are to: 1) create the appropriate setting for discussions substance use; 2) ensure confidentiality to the patient; 3) bring up the topic of drug and alcohol use; 4) assess risk/use; and 5) negotiate for treatment and follow-up. The effectiveness of the skills checklist is assessed by the third instructional method. This method fosters skill-building through the use of role play in clinical application exercises utilizing participants in the curriculum as well as trained, simulated patients. Assessment is provided quantitatively by direct scoring of the skills checklist and qualitatively through personal review and group discussion of a video-taped encounter. The research agenda of the project focuses on identifying specific measures to evaluate the effectiveness of these three teaching methods. With careful integration of teaching methods and evaluation tools, a focused approach to substance abuse education can be effectively administered and evaluated in the primary care setting.
Improving Access to the Underserved through Medicaid Managed Care
Authors: Goldman Bruce
Published: July 2012

New York City's Harlem community faces extraordinary health care needs that a failing economy has made more urgent. In an attempt to open lines of access to health care, the New York City Health and Hospitals Corporation has implemented a managed care program for Medicaid participants. The program is a team approach to link each Medicaid patient with a primary care physician responsible for coordinating medical services for the patient. We hope the managed care program will help us conserve our dwindling resources while better managing patients' services and improving access to care.
Access to Family Planning Services: Relationship With Unintended Pregnancies and Prenatal Outcomes
Authors: Mitchell Janet B. , McCormack Lauren A.
Published: July 2012

Family planning services are important because they can prevent unintended pregnancies and improve prenatal outcomes. This paper uses secondary data to analyze trends in access to family planning services, with a particular focus on poor women and young women. Trends from the 1980s showed a small decline in family planning visits and an upsurge in the percentage of births that were unwanted at the time of conception. These changes were particularly marked for poor women. Over the same decade, public expenditures for contraceptive services declined dramatically. The health insurance system with respect to family planning must be modernized to meet the needs of women and couples today. Future improvements in infant health and survival will depend in large part on ensuring that pregnancies are intended and not the result of lack of access to effective family planning services.