Joys and tribulations of faith-based youth tobacco use prevention: a case study in Mississippi

Faith-based health promotion initiatives are resurging in popularity among health promoters and providers, but few programs are systematic, large-scale, and funded at the state level. One exception is an initiative by the Partnership for a Healthy Mississippi (PHM), a nonprofit organization funded by tobacco settlement monies. PHM funded churches and other faith-based organizations to implement a grassroots youth tobacco use prevention program to coincide with other community- and school-based efforts. In the 2-year evolution of this faith-community health partnership, PHM experienced both successes and challenges. This article outlines the history of tobacco use prevention and control programs within Mississippi's faith community, provides a brief case study of two churches, and makes 10 recommendations based on lessons learned.     

Quantifying the impact of participation in local tobacco control groups on the psychological empowerment of involved youth.

A core component of Legacy's Statewide Youth Movement Against Tobacco Use is the ability of state and local initiatives to empower youth to effect change in their communities. The authors' conceptual framework proposes that youth empowerment is an outcome of the process by which youths become active participants in local efforts. Youths are proposed to attain specific skills (e.g., assertiveness, advocacy), attitudes (e.g., domain-specific self-efficacy, perceived sociopolitical control, participatory competence), and knowledge of relevant resources. All are proposed outcomes of their individual participation in these local efforts. Data collected in fall 2002 through a tested survey instrument designed to obtain data on key components of empowerment are presented. Regression modeling was used to examine the extent to which characteristics of empowerment are an outcome of individual participation in these groups. A summary of lessons learned pertaining to effectively measuring empowerment and enhancing the empowerment process through local initiatives is provided.     

The elimination of anonymous HIV testing: a case study in North Carolina.

In May 1997, anonymous human immunodeficiency virus testing in publicly funded clinics was eliminated throughout North Carolina. There were concerns that this decision would disenfranchise testers with certain behavioral profiles. North Carolina's counseling and testing system was used to evaluate the effect of this policy change. A 10.3 percent decline in overall testing and a 21.7 percent decline among men who had sex with other men were identified in the year following the policy change. However, between 13 and 24 months after the policy change, the number of tests administered returned to near pre-policy levels. Understanding North Carolina's experience can assist others considering similar policy changes.     

Who benefits from community-based participatory research? A case study of the Positive Youth Project.

Community-based participatory research (CBPR) has evolved as a popular new paradigm in health research. This shift is exciting, yet there is still much to discover about how various stakeholders are affected. This article uses a critical social science perspective to explore who benefits from these changes through an analysis of a CBPR case study (The Positive Youth Project). Two major categories of beneficiaries emerged: the research itself and the partner-stakeholders. The benefits, however, were not gained without substantial human resource investment, nor were they necessarily equitably spread. Participation costs included heavy demands of time, an added burden of work, frustration with the process, missing other opportunities, risking loss of anonymity, and loss of control. Care needs to be taken to ensure that concrete benefits accrue for all project partners and costs are minimized. Another way of framing benefits is to look at the community capacities built to address future health and social issues.     

Prevention of non-communicable diseases: Risk factors in youth: The North Karelia Youth Project (1984-88)

The North Karelia Youth Project is based on the results of previouspilot studies in North Karelia and forms part of the North Kareliaintegrated programme for non-communicable diseases prevention,co-ordinated by the WHO and conducted by the Finnish NationalPublic Health Institute. The project is designed to test thefeasibility and effects of a largescale health programme among12–16 year old schoolchildren. The educational programmeaims to prevent cigarette smoking and alcohol use mainly bytraining pupils to resist social pressures and by modifyingperceived social norms which may lead to smoking and alcoholuse. The dietary intervention aims to improve dietary habitsto decrease serum cholesterol and blood pressure level. Theprogramme also aims to promote positive decision-making andcoping skills and to increase social support for coping withstress. The study, which began in the autumn of 1984 provides a comprehensivethree-year programme for all seventh graders (ages 12–13)and succeeding age cohorts in North Karelia (24 schools) andin selected schools in the county of Kuopio (eight schools),including approximately 4 000 students in the first year and12 000 over the entire study period. Simultaneously successivemeasurements are implemented in all the intervention schoolsand in eight randomized reference schools, which will allowus to evaluate the programme and to test a number of hypothesesabout programme effects. The preventive programme is designedto make the best possible use of existing resources (teachers,parents, community) and will require only relatively modestnew expenditure so that, if proved effective, it can be continuedon a permanent basis. A baseline survey of the schools was carried out in the springof 1984 among ninth-graders. Twenty-four per cent of the boysand 18% of the girls reported smoking daily and 13% and 9% respectivelywere occasional smokers. About 20% had used alcohol during thepast week, 7% reported "passing out" because of drinking duringthe last year and 12% had been deeply drunk. The mean serumcholestrol level was 4.7 mmol/l and the mean blood pressure130/66 mmHg. At this baseline survey, the levels of these variableswere generally comparable in the different randomly assignedstudy groups, although there was a trend towards less smokingand alcohol use at baseline in the schools in North Kareliathan in those in the county of Kuopio.     

The quality of the new birth certificate data: a validation study in North Carolina.

A random sample of 395 December 1989 North Carolina birth certificates and the corresponding maternal hospital medical records were examined to validate selected items. Reporting was very accurate for birth-weight, Apgar score, and method of delivery; fair to good for tobacco use, prenatal care, weight gain during pregnancy, obstetrical procedures, and events of labor and delivery; and poor for medical history and alcohol use. This study suggests that many of the new birth certificate items will support valid aggregate analyses for maternal and child health research and evaluation.     

Coalition building for prevention: lessons learned from the North Carolina Community-Based Public Health Initiative.

This article examines the four-year development of the North Carolina Community-Based Public Health Initiative consortium (NC CBPHI). The NC CBPHI consisted of four separate county coalitions and differed in both its agenda and membership from the many examples of coalitions described in the literature. This article presents and describes evaluation findings that identify six factors as important in coalition functioning and success in the CBPHI coalitions. These factors are: participation, communication, governance and rules for operation, staff/coalition member relationships, technical assistance and skills training, and conflict recognition and containment. Selected CBPHI coalition activities are also described and implications for public health practitioners are presented.     

A multilevel analysis examining the association between school-based smoking policies, prevention programs and youth smoking behavior: evaluating a provincial tobacco control strategy

This paper examined how smoking policies and programs are associated with smoking behavior among Grade 10 students (n = 4709) between 1999 and 2001. Data from the Tobacco Module from the School Health Action Planning and Evaluation System were examined using multilevel logistic regression analyses. We identified that (i) attending a school with smoking prevention programs only was associated with a substantial risk of occasional smoking among students with two or more close smoking friends and (ii) attending a school with both smoking prevention programs and policies was associated with substantial risk of occasional smoking among students who did not believe there were clear smoking rules present. Students attending schools where year of enrollment in high school starts in Grade 9 were more likely to be regular and occasional smokers. Each 1% increase in Grade 12 smoking rates increased the odds that a Grade 10 student was an occasional smoker. It appears that grade of enrollment, senior student smoking behavior, close friend's smoking behavior and clear rules about smoking at school can impact school-based tobacco control programming. These preliminary study findings suggest the need for further research targeting occasional smoking behavior and the transition stage into high school.     

Examination of the relationship between community support and tobacco control activities as a part of youth empowerment programs.

Through the American Legacy Foundation's Statewide Youth Movement Against Tobacco Use (SYMATU), programs aimed at empowering youths to take action against tobacco use were funded. It is believed that the activities these groups undertake result in changes at the community level. This article examines the relationships between community support of tobacco control and the number and types of tobacco control-related activities these local youth groups conduct. Regression analyses examine the influence that different levels and sources of community support have on the quantity and focus of a group's activities. The influences of community support are briefly explored to understand if certain group characteristics have an impact on the quantity or sources of support for tobacco control. A deeper understanding of the importance and impact of community support will help groups understand the need for building community support networks and how these networks can assist them with implementation of program activities.     

Longitudinal patterns of cigarette smoking and smokeless tobacco use in youth: the Bogalusa Heart Study.

Tobacco use was studied during 1977-76 (n = 2880) and 1981-82 (n = 2158) in a total biracial community of children, aged 8-17 years, in Bogalusa, Louisiana. White males were the early adopters of tobacco products in both surveys. Cigarette smoking decreased in all race and gender groups while smokeless tobacco use increased in White males. Studies which find a decline in male adolescent smoking should investigate a possible concurrent increase in smokeless tobacco.     

Using community-based participatory research (CBPR) to develop a community-level HIV prevention intervention for Latinas: a local response to a global challenge

Introduction and BackgroundThe arsenal of interventions to reduce the disproportionate rates of HIV and sexually transmitted disease (STD) infection among Latinos in the United States lags behind what is available for other populations. The purpose of this project was to develop an intervention that builds on existing community strengths to promote sexual health among immigrant Latinas.MethodsOur community-based participatory research (CBPR) partnership engaged in a multistep intervention development process. The steps were to (1) increase Latina participation in the existing partnership, (2) establish an intervention team, (3) review the existing sexual health literature, (4) explore health-related needs and priorities of Latinas, (5) narrow priorities based on what is important and changeable, (6) blend health behavior theory with Latinas’ lived experiences, (7) design an intervention conceptual model, (8) develop training modules and (9) resource materials, and (10) pretest and (11) revise the intervention.ResultsThe MuJEReS intervention contains five modules to train Latinas to serve as lay health advisors (LHAs) known as “Comadres.” These modules synthesize locally collected data with other local and national data, blend health behavior theory with the lived experiences of immigrant Latinas, and harness a powerful existing community asset, namely, the informal social support Latinas provide one another.ConclusionThis promising intervention is designed to meet the sexual health priorities of Latinas. It extends beyond HIV and STDs and frames disease prevention within a sexual health promotion framework. It builds on the strong, preexisting social networks of Latinas and the preexisting, culturally congruent roles of LHAs.     

The use of participatory action research and ergonomics in the prevention of work-related musculoskeletal disorders in the newspaper industry

The newspaper industry is one of many in which employees are reported to be at risk for work-related musculoskeletal disorders of the upper extremities and low back. The purpose of this 18-month demonstration project was to assess the usefulness of a participatory ergonomics process as a strategy to reduce the risk factors associated with musculoskeletal disorders at a metropolitan newspaper company. The company involved had 455 employees and a daily circulation of 75,200. Employees from both office and production areas participated. The participatory action research approach utilized required investigators to work collaboratively with the study population. Using a five-step continuous improvement process, the ergonomics committee identified and evaluated jobs having ergonomic risk factors. This was followed by the development, implementation, and evaluations of interventions aimed at reducing risk factor exposure. The committee's productivity and participant feedback were used as measures of the committee's effectiveness. During the project period, interventions were implemented in 11 of 12 targeted departments. Participant ratings of effectiveness for different aspects of the ergonomics process were generally favorable. The mean and median cost for ergonomic interventions were $376 and $25, respectively. This project demonstrated that participatory action research could be used to develop and implement ergonomic solutions that reduce the risk factors associated with work-related musculoskeletal disorders.     

The healthcare experiences of Koreans living in North Carolina: a mixed methods study

This study examined the healthcare experiences of Korean immigrants aged 40–64 living in the North Carolina Triangle area of the Southeastern United States. Using a mixed methods design, we collected quantitative data via a questionnaire from 125 participants and conducted a focus group with 10 interviewees from December 2010 to February 2011. The quantitative data were analysed using t‐tests and chi‐square tests, and a thematic analysis was used for the focus group study. Questionnaire findings showed that only 27.2% had sufficient English skills to communicate adequately. Participants with insurance were significantly more likely to be employed (P < 0.001), had higher incomes (P = 0.011) and higher education (P < 0.001), and had greater English‐speaking ability (P = 0.011) than those without insurance. Participants who did not use healthcare services showed significantly less knowledge (P < 0.001) of and less satisfaction (P = 0.034) with the healthcare system than those using healthcare services. Sixty‐two participants (49.6%) reported having no health insurance for one or more of the following reasons: high costs (75.8%), medical tourism (22.6%) and lack of information or knowledge (6.5%). The following themes emerged from the data collected during the focus group: (i) barriers to utilisation of healthcare services; (ii) facilitators of utilisation of healthcare services; and (iii) social support seeking for health management. Our mixed methods study findings indicate that healthcare disparities exist among Korean immigrants and that a number of factors, including health literacy, may contribute to their poor health outcomes. Continued collaboration among community members, healthcare professionals and academicians is needed to discuss the community's health concerns and to develop sustainable programmes that will ensure meaningful access to care for those with limited English proficiency and medically underserved populations.     

Ethical dilemmas in participatory action research: a case study from the disability community.

Participatory action research (PAR) is a collaborative approach to inquiry for education and social change that is gaining increasing prominence in health education. This case study explores the use of PAR by and with a community of people with disabilities in addressing a polarizing issue in that community: death with dignity or physician-assisted suicide legislation. Following a brief review of the debate within the community about this issue and the goals, methods, and findings of this project, the authors examine four key ethical challenges. These are dilemmas in issue selection when the community is deeply divided over a problem area, inclusion and exclusion in study team makeup and sample selection, insider/outsider issues, and how best to use findings in ways that can unite and strengthen the community. The implications of these issues for health educators and others engaged in community-based PAR efforts are presented.     

The place of chiropractors in health care delivery: a case study of North Carolina

Three perspectives on the place of DCs in the United States health care delivery system were derived from the social science literature; system status, cultural congruence, and utilization patterns. North Carolina was used as a case study site to examine these perspectives from a geographical point of view. It was found that DCs were located in smaller places than MDs. DC/population ratios were associated with white populations and higher incomes, but were not associated with those aged 18-64, rural populations, and religious groups that used touch in healing. DCs were located in more rural and lower income areas than were MDs.     

The use of quantile regression in health care research: a case study examining gender differences in the timeliness of thrombolytic therapy

Investigators are frequently interested in determining patient and system characteristics associated with delays in the provision of essential medical treatment. Investigators have typically used either multiple linear regression or Cox proportional hazards models to assess the impact of patient and system characteristics on the timeliness of medical treatment. A drawback to the use of these two methods is that they allow, at best, a partial exploration of how a distribution of delays in treatment or of waiting times changes with patient characteristics. In contrast, quantile regression models allow one to assess how any quantile of a conditional distribution changes with patient characteristics. We illustrate the utility of quantile regression by examining gender differences in the delivery of thrombolysis in patients with an acute myocardial infarction. We demonstrate that richer inferences can be drawn through the use of quantile regression. Females were more likely to experience delays in treatment compared to males. Furthermore, gender had a greater impact upon those patients who had the greatest delays in treatment. Investigators who want to determine how a distribution of delays in treatment or of waiting times changes with patient or system characteristics should consider complementing their analyses with the use of quantile regression.