This study examined the relationships among behavior-specific cognitions and oral health behaviors using Pender's revised health promotion model. Subjects were 300 preuniversity students from 6 high schools in the Yazd district in central Iran. Suitable instruments were designed to measure concepts in the model through validity testing with an expert health panel, and reliability testing with a small sample of students (n = 30). Instruments then were administered to students. Model testing was conducted to identify factors affecting students' practice of oral health behaviors. The results from structural equation modeling indicated that behavior-specific cognitions and affect had a direct effect on oral health behaviors, except activity-related affects. Self-efficacy had an indirect effect on oral health behaviors through perceived barriers. Self-efficacy mediated the effects of behaviors-specific cognitions and affect on oral health behaviors. Together, the variables accounted for 32% of the variance in oral health behaviors. Results of this study can be used to design and evaluate interventions to promote oral health behaviors among students.
Unintentional injuries are the leading cause of morbidity and mortality among children in the United States. This report uses data from the National Vital Statistics System and the National Electronic Injury Surveillance System - All Injury Program to provide an overview of unintentional injuries related to drowning, falls, fires or burns, transportation-related injuries, poisoning, and suffocation, among others during the period 2000 - 2006. Results are presented by age group and sex, as well as the geographic distribution of injury death rates by state.
This article was adapted from a speech presented at the Extension-Research Skill Session, 31st National Conference on Rural Health (AMA) April 5-7, 1978, Denver. Colorado. The author acknowledges the review comments and helpful suggestions provided by Peggy Ross, Jim Cantwell, Frank Fratoe. Jeannette Fitzwilliams. Calvin Beale and other friends. Dr. Jim Hildreth, Farm Foundation, provided guidance and support; and the Farm Foundation was a cosponsor of the conference.
This study examined the breast and cervical cancer screening practices of Hispanic and non-Hispanic women (n = 3,568) in counties that approximate the US southern border region. According to the Health Resources Services Administration (HRSA), border counties are those in which any part of the county is within 100 kilometers (62.14 miles) of the border. The study used data from Behavioral Risk Factor Surveillance System (BRFSS) surveys of adults aged > or = 18 years conducted in 1999 and 2000. The study looked at recent use of mammography and the Papanicolaou (Pap) test. Hispanic women were less likely to have had a recent mammogram or Pap test as compared with non-Hispanic women in border counties, and as compared with Hispanic and non-Hispanic women in nonborder counties of Texas, New Mexico, Arizona, and California combined, and with other women in the United States. Results underscore the need for continued efforts to ensure that medically underserved women who live in the border region have access to cancer screening services.
Exposure to adverse natural and environmental events (eg, extreme temperatures and disasters) poses a public health burden when resulting in injuries requiring emergency care. We examined the incidence and characteristics of persons with environmental exposure-related injuries treated in US-based hospital emergency departments during 2001 to 2004 by using the National Electronic Injury Surveillance System-All Injury Program. An estimated 26 527 (95% CI = 18 664-34 390) injuries were treated annually-78% were heat-related. People with heat-related conditions were men (P < 0.001) and had a median age of 34 years (range = <1 month-94 years). Targeting vulnerable populations in community-wide response measures may reduce injuries from adverse environmental exposures, especially heat.
Rural Healthy People 2010 represented the first effort to specifically include small and rural communities in the Healthy People movement to improve the health of Americans. Rural Healthy People 2010 set rural-specific health priority areas, documented what is known about health in rural areas, identified rural best practice programs/interventions, and promoted rural health services research and researchers. Over the last decade Rural Healthy People 2010 has provided policy makers, rural providers, and rural communities with a valuable resource for planning and policy making. Sustaining the Rural Healthy People project in collaboration with the broader Healthy People 2020 effort will provide an important infrastructure for improving rural health.
We recruited a community-based sample of 261 parents bereaved by the violent deaths of their 12- to 28-year-old children. Parents were observed over time, and data were collected from several sources. The findings showed that of six individual, family, and community resources examined, none of the resources seemed to improve parents' outcomes either 1 or 5 years later. Implications of the findings are discussed.
A significant portion of the US population has serious problems with both literacy and understanding how to effectively use and understand health-related information. An understanding of the breadth and significance of this problem and its impact on health outcomes is now clear. Interventions and strategies for effectively working with patients with limited literacy must be developed and evaluated. An agenda for medical and public health workers, health educators, and researchers is suggested.
In an effort to understand what is happening in the United States as a result of legalizing abortion 3 major aspects of the issue must be examined: the legal question the health aspects and the psychological and sociological consequences. The legal question in terms of the cases Roe v. Wade and Doe v. Bolton are reviewed. Antichoice advocates do continue to enjoy limited success in the legislative sphere but prochoice advocates have managed to preserve the cause of reproductive freedom in the courts. In making appropriate referrals of abortion clients it is important to be aware of several medical issues: 1) legal abortion is safe; 2) the earlier a patient is diagnosed and has an abortion the safer is the procedure; 3) vaginal procedures are safer than instillation procedures or hysterectomy or hysterotomy; 4) 96 % of the women who have a medically competent vaginal procedure prior to the 12th gestational week have no complications; 5) most diseases seen in women who apply for abortion do not interfere with ambulatory performance of a vaginal abortion; 6) the counselor or referring agency needs to be aware of the competence and skill of the physicians at the factility to which patients are referred; and 7) most postabortal complications are minor and can be dealt with on an outpatient basis by skilled and sympathetic medical personnel. Whatever negative consequences may result from a legal abortion they are substantially less than those resulting from an illegal abortion. There are several factors affecting to varying degrees a womans emotional reactions to an abortion. Grieving and a sense of loss are quite common natural reactions.
The incidence of abortion and general characteristics of women obtaining legal abortions in the US, and the trends and effects of abortion during the 1970s are described. Statistics on the abortion ratio and abortion rate for the US by year from 1969 to 1978 are presented. Sociodemographic characteristics of women obtaining abortions (age, marital status, parity, gestational age and previous abortions) are described. The availability of abortion services and facilities and the types of procedures used and their safety are discussed. Factors which have contributed to the increasing number of legal abortions are discussed. The benefits of epidemiological data on abortion are noted.
This article compares the values and attitudes of two groups of 7th and 8th grade adolescents toward premarital sexual activity. One group received state-funded, abstinence-only education; the other group did not receive that education. Abstinence-only education did not significantly change adolescents' values and attitudes about premarital sexual activity, nor their intentions to engage in premarital sexual activity. The majority of both the treatment and control group subjects expressed disagreement with the statement: "It is okay for people my age to have sexual intercourse," and they did not intend to have sexual intercourse while an unmarried teenager.
Childhood sexual abuse is a major public health problem affecting thousands of children and adolescents in the United States each year. For more than 20 years, researchers, healthcare professionals, and policymakers have had considerable disagreements about various aspects of child sexual abuse. Although everyone agrees that sexual abuse is a harmful thing for children to experience, there is a lack of consensus on a definition of sexual abuse, investigation of allegations, long-term consequences, what constitutes appropriate psychotherapy, and what public health policies should be developed to prevent sexual abuse. The purpose of this article is to explore advances that have been made in understanding and treating child sexual abuse, to look at the implications for further research, and to address the public health policies that exist for preventing child sexual abuse.
Sexual abuse researchers are faced with many challenges. This article begins with a discussion of the theoretical underpinnings of topic sensitivity and describes difficulties specific to the study of childhood sexual abuse among adolescent mothers. In the last part of this article, suggestions for diminishing the difficulties and factors to consider when planning future studies are discussed. The aim of this article is to prepare novice researchers for the challenges that may occur while studying childhood sexual abuse among adolescent mothers and provide them with solutions to consider when they encounter such challenges.
In 1990, the US Advisory Board declared a national emergency in the child protection system, which was nothing short of a disaster. In calling for a new approach to child protection, the Board argued that only a universal system of family support, grounded in the creation of caring communities, could provide an effective foundation for ensuring children's safety. Strong Communities for Children is the first initiative to attempt a comprehensive, large-scale implementation of the Board's proposed strategy. Using a public health approach, Strong Communities blends research about the causes and correlates of child abuse and neglect with public health concepts of community-wide prevention and intervention. Strong Families, the direct service component of Strong Communities, relies heavily on the health sector for the engagement of families.
The Interprofessional Care Access Network is an innovative model for academic-practice partnership providing care coordination for vulnerable and underserved clients and populations in identified neighborhoods. Interprofessional student teams, including health professions students from nursing, medicine, pharmacy, and dentistry, collaborate with community service organizations and primary care clinics to address social determinants of health identified as barriers to achieving health care outcomes and Triple Aim goals. Teams are supervised by a nursing faculty in residence and address issues such as housing, health insurance, food security, and lack of primary care. Two case studies demonstrate the potential impact of the project.
African Americans have a substantially increased mortality rate compared to Whites in many cancers, including breast and cervix. The Deep South Network for Cancer Control (the Network) was established to develop sustainable community infrastructure to promote cancer awareness, enhance participation of African Americans and other special populations in clinical trials, recruit and train minority investigators, and develop and test innovative community-based cancer control measures to eliminate cancer mortality disparities in special populations. This article describes the steps necessary to form the network and the process and activities required to establish it as an effective infrastructure for eliminating disparities between Whites and African Americans in the United States.
The goal of this study was to examine the relationship between maternal acceptance-rejection and children's social competence and the role that maternal acculturation (ie, American orientation, Korean orientation) played in this relationship in a sample of 53 Korean American mothers. Self-report data were analyzed using Pearson correlations and multiple hierarchical regressions. Low maternal acceptance-rejection was positively related to children's low social competence. Mothers' American orientation had a moderating effect on the relationship between maternal acceptance-rejection and children's social competence. Findings indicate the importance of providing parenting guidelines to mothers who are low on both acceptance-rejection and American orientation.
Compared to non-Hispanic women, Hispanic women have disproportional mortality rates due to breast cancer. Mammographic screening detects breast cancer in its early stages and reduces mortality. We examined data obtained from the 2002 Behavioral Risk Factor Surveillance System questionnare using logistic regression analyses to study the relationships between demographic and healthcare factors and mammography use among Hispanic and non-Hispanic White women 40 years and older. Overall, the odds of ever having had a mammogram were similar among Hispanic and non-Hispanic White women (odds ratio = 1.2; 95% confidence interval = 0.9, 1.6), when adjusted for age, employment status, and other demographic variables. Having a personal physician and the type of healthcare facility typically used were associated with mammography use, regardless of Hispanic ethnicity. Although associations between mammography use and demographic factors were similar between ethnic groups, larger proportions of Hispanics had demographic characteristics that were negatively associated with mammography use. Establishing policies and mechanisms to provide all women with regular access to a personal physician or healthcare professional for their preventive and nonemergency healthcare needs may improve mammography use among both Hispanic and non-Hispanic White women. Similarly, reaching out to women who are uninsured and who use facilities other than physicians' offices for their healthcare needs may increase the use of mammography among both ethnic groups.
Comparisons in the health status of rural dwellers and care access have not traditionally considered culturally defined areas such as Appalachia. This study examined differences in parent health status, child health status, and access to care between those living in Ohio's 29 Appalachian counties and those living in Ohio's 30 rural counties. We analyzed data from the 2008 Ohio Family Health Survey including Bayesian hierarchical modeling. Child health differed by gender and ethnicity. Parent health status differed by region. Parent and child health status were related to care access. Health and access disparities exist within rural and Appalachia Ohio.
The aims of this project were to minimize organizational barriers and increase access to immunizations for children aged 6 months to 21 years in a multiethnic community health center in Honolulu. The intervention consisted of opening a "walk-in" shot clinic (WISC), run by a nurse practitioner, 2 evenings per week and Saturdays. Between January and July 2005, 351 clients accessed the clinic, with 774 immunizations administered. Clinic satisfaction measures were excellent. Up-to-date immunization status for all clients improved significantly. The WISC is an effective and customer-friendly way to improve childhood and adolescent immunization rates in a community health center setting.
The Leon County Health Resource Commission sought to increase access to mental health services for their rural community. The commission formed a network of partners who collaborated to increase free transportation to mental health services outside the community and developed a telehealth-based counseling program through a counseling psychology training program. Learning opportunities emerged during the development and implementation of these activities for both the students and the community in how to successfully utilize and sustain this service. This article describes the telehealth counseling model, presents lessons learned in the process, and presents recommendations for others interested in utilizing similar strategies.
Using a national dataset, the influence of the community and individual provider characteristics on the availability of healthcare resources in rural areas was evaluated. Disparities continue to exist in the availability of providers including organizational types of providers such as Community Health Centers and Community Mental Health Centers. A lower percentage of nonmetropolitan counties have such centers, and more rural counties within the general grouping of nonmetropolitan counties have fewer of these organizational resources. A case study on the Southwestern region of Virginia is presented to highlight the impact on health outcomes and an innovative community response to the lack of availability of needed healthcare services.
Despite their high vulnerability to depression, a majority of low-income, homebound older adults face multiple barriers to accessing psychologic services. These older adults require both social services for managing their multiple financial and functional needs and psychologic services for managing their depression. Mental health needs of these older adults may be better met if aging service providers provide both social services and psychotherapy. This study outlines the rationale for integrating the social and psychologic services for homebound older adults and the need for research evidence on the feasibility, efficacy, and replicability of implementing such an integrated model.
This article presents a large body of qualitative material on healthcare access and barriers for unauthorized immigrants living in the US-Mexico borderlands. The focus is on active sequences of health-seeking behavior and barriers encountered in them. Barriers include direct legal mandates, fear of authorities, obstacles to movement by immigration law enforcement, interaction of unauthorized legal status with workplace and household relations, and hierarchical social interactions in healthcare and wider social settings. At the same time, important resilience factors include community-oriented healthcare services and the learning/confidence-building process that enable the unauthorized to connect to such services. An important finding is that barriers are not discrete factors but rather occur as webs that make solution of challenges more difficult than individual barriers alone. Outcomes include incomplete sequences of care, especially breakdowns in complex diagnoses, long-term treatment, and monitoring of chronic conditions.
Intimate partner violence (IPV) screening and referral are routinely practiced by various healthcare providers. Although facilitators and barriers to IPV disclosure have been previously explored, healthcare providers' role in linking patients to longer-term IPV-related resources has received only superficial attention. This focus group study explored IPV survivors' service seeking experiences, using the complementary perspectives of advocates from a national domestic violence hotline (n = 24) and survivors from a domestic violence program (n = 30). Both advocates and survivors identified key service needs and access barriers. Advocates also shared successful strategies for "coaching" survivors that increased the likelihood of receiving services.
Many schools throughout the United States are mandated to hold drills, or operational exercises, to prepare for fires, earthquakes, violence, and other emergencies. However, drills have not been assessed for their effectiveness in improving preparedness at schools. This mixed-methods study measures the quantity and the quality of drills in an urban school district in Los Angeles. Compliance with California mandates was fair; most schools barely met requirements. Drills were not used as opportunities to improve procedures. Sites neither conducted any self-assessments nor made changes to procedures on the basis of performance. Suggestions include developing realistic simulated exercises, debriefing, and better school accountability for drills.
The field of health promotion has yet to acknowledge the unique needs of women with disabilities, a population representing approximately 1 of 5 women in the United States. Compared with women without disabilities, women with disabilities have critical needs for evidence-based health promotion services. Women with disabilities face a lack of access to multitudinous opportunities for maintaining and improving their overall health. Inaccessible exercise equipment and other disability-related barriers discourage women with physical disabilities from engaging in health-promoting behaviors. This article identifies 10 essential elements for achieving effective health promotion research and interventions for women in this population.
In response to a lack of information related to girls' health in a low-income community, an initiative was developed to create a community-wide vision for girls' health. A forum was conducted following a photovoice project to generate sustainable action steps. Forty-four participants attended the forum. Key action steps included decreasing barriers to participation in girls' programs, offering leadership roles and interpersonal communication skills for girls in the community, and engaging girls in community organizations. Integral to the forum's success were the initial photos, which provided a bridge from understanding the issues of girls' health to the development of the action steps.
This article discusses the process of developing collaborative relationships for a community-based health promotion project. A partnership was established among the university, the city where the intervention took place, and the community senior center. A community advisory board was created to identify the strengths, diversity, and needs of each partner. The community advisory board guided the partnership to recruit 1,277 older adults to participate in the intervention study. A sample was deemed representative after comparison with Census 2000 data, with gender and educational attainment being similar.
Methicillin-resistant Staphylococcus aureus has been commonly known to be found in hospital or healthcare settings; however, increased prevalence within the community has posed a concern to providers with treatment management and costs. Community-acquired methicillin-resistant Staphylococcus aureus infections typically present as skin and soft tissue infections but do not respond to typical skin and soft tissue infection treatment. Methicillin-resistant Staphylococcus aureus can also lead to more serious systemic infections, even in the healthy individual. With this, the healthcare provider must be aware of the prevalence and populations with increased risk and the recommended treatment and education. Assessment, diagnosis, education, and treatments must be appropriate and meet the needs of the individual. Therefore, this article provides current assessment and treatment recommendations through a typical case study.
Is health promotion a White middle-class phenomenon that people from other cultures and classes do not regard as important? When implementing health-promotion initiatives, are healthcare providers making assumptions that are not valid for other cultural or socioeconomic groups? How do people of various cultures and classes perceive health and health promotion? To explore these questions, this article reviews some of the relevant literature on culture and class in relation to health promotion, exploring issues foundational to the effectiveness of health-promotion programs and pertinent to delivering health-promotion interventions to ethnic, racial, and cultural minorities and poor populations. Health promoters are encouraged to consider the social determinants of their patients' health and tailor programs on the basis of their patients' motivations and resources.
Sustaining community-based obesity interventions for families represents an ongoing challenge. Many initially grant-funded initiatives lack a sustainable model to continue. After initial grant funding ended, we continued a partnership between Seattle Children's Hospital and YMCA of Greater Seattle to enhance and expand a community-based family obesity program, "ACT! Actively Changing Together." We used principles of continuous process improvement, community-based participatory research, and the RE-AIM framework to successfully transition from a grant-funded to a community-supported program. Our pilot evaluation demonstrated promising results in parent behaviors, youth quality of life, ongoing family participation at the Y, and youth body mass index.