Differences in the attitudes towards the opioid crisis between metropolitan and rural counties in Central Texas: Secondary data analysis using cross-sectional data

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Poorer access to opioid use disorder care reported in rural than in urban areas.

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Less supports for syringe exchange programs in rural than in urban areas.

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Important to tailor efforts to address opioid use disorder in rural and urban areas.

This study examined metropolitan and rural differences regarding concerns about opioid misuse and support for different strategies to reduce opioid use disorder risk in areas not designated as high-risk. This study used cross-sectional data from a regional community health assessment, which was collected in 2019 using a combination of stratified random sampling and clinic-based purposive sampling in Central Texas. The secondary data included 430 and 270 respondents from metropolitan and rural (not metropolitan) counties, respectively. The primary outcomes were perceived concern about the opioid crisis, perceived likelihood of getting addiction treatment, and support for strategies to reduce opioid use disorder risks. Multiple multivariable regression models were used to examine metropolitan and rural differences in the outcome variables after adjusting for age, sex, ethnicity, race, marital status, education, and household income. Respondents were about 58 years old on average. A majority were female (60%), non-Hispanic (88%), and White (83%). About 60% of rural and metropolitan respondents were concerned about opioid use and misuse in their community. After adjusting for respondents’ demographic characteristics, rural respondents were significantly less likely to perceive that individuals are getting the needed opioid use disorder treatment (aOR = 0.69, P = 0.031). Rural respondents were also significantly less supportive for legalizing syringe service programs in their communities (aOR = 0.71, P = 0.044) than metropolitan respondents. Differing attitudes by respondents from metropolitan and rural areas indicate the importance of tailoring prevention and mitigation efforts to address opioid use disorder in advance of an impending public health crisis.

Global research on syndemics: a meta-knowledge analysis (2001-2020)

BACKGROUND

Syndemics or synergies of cooccurring epidemics are widely studied across health and social sciences in recent years.

METHODS

We conducted a meta-knowledge analysis of articles published between 2001 to 2020 in this growing field of academic scholarship.

RESULTS

We found a total of 830 articles authored by 3025 authors, mostly from high-income countries. Publications on syndemics are gradually increasing since 2003, with rapid development in 2013. Each article was cited more than 15 times on average, and most (n = 604) articles were original studies. Syndemics research focused on several areas, including HIV/AIDS, substance abuse, mental health, gender minority stressors, racism, violence, chronic physical and mental disorders, food insecurity, social determinants of health, and coronavirus disease 2019. Moreover, biopsychosocial interactions between multiple health problems were studied across medical, anthropological, public health, and other disciplines of science.

CONCLUSIONS

The limited yet rapidly evolving literature on syndemics informs transdisciplinary interests to understand complex coexisting health challenges in the context of systematic exclusion and structural violence in vulnerable populations. The findings also suggest applications of syndemic theory to evaluate clinical and public health problems, examine the socioecological dynamics of factors influencing health and wellbeing, and use the insights to alleviate health inequities in the intersections of synergistic epidemics and persistent contextual challenges for population health.

Global research on syndemics: a meta-knowledge analysis (2001-2020)

BACKGROUND

Syndemics or synergies of cooccurring epidemics are widely studied across health and social sciences in recent years.

METHODS

We conducted a meta-knowledge analysis of articles published between 2001 to 2020 in this growing field of academic scholarship.

RESULTS

We found a total of 830 articles authored by 3025 authors, mostly from high-income countries. Publications on syndemics are gradually increasing since 2003, with rapid development in 2013. Each article was cited more than 15 times on average, and most (n = 604) articles were original studies. Syndemics research focused on several areas, including HIV/AIDS, substance abuse, mental health, gender minority stressors, racism, violence, chronic physical and mental disorders, food insecurity, social determinants of health, and coronavirus disease 2019. Moreover, biopsychosocial interactions between multiple health problems were studied across medical, anthropological, public health, and other disciplines of science.

CONCLUSIONS

The limited yet rapidly evolving literature on syndemics informs transdisciplinary interests to understand complex coexisting health challenges in the context of systematic exclusion and structural violence in vulnerable populations. The findings also suggest applications of syndemic theory to evaluate clinical and public health problems, examine the socioecological dynamics of factors influencing health and wellbeing, and use the insights to alleviate health inequities in the intersections of synergistic epidemics and persistent contextual challenges for population health.

Navigating healthcare systems before and after resettlement: Exploring experiences and recommendations for improvement from the perspectives of a Bhutanese refugee community

Background

Though refugees often survive in refugee camps for many years, little is known about the impact of their interactions within the healthcare system during that time and how it may affect current concerns with the healthcare system after resettlement. Guiding our analysis was the Community Health Development model, which emphasizes the importance of understanding the impact of historical experiences on a community's health to identify specific current health needs, and plan solutions alongside the community to address and improve health concerns.

Objective

To better understand the healthcare system related experiences of Bhutanese refugees before and after resettlement, and describe potential solutions based on their perspectives to improve their health status.

Methods

This study used an explorative qualitative research design. Four focus group discussions were conducted with 40 female participants to examine their experiences within the healthcare system in Nepal (e.g. before resettlement) and the US (after resettlement). Focus group data were audio-recorded, translated, coded, and reported based on qualitative thematic analysis.

Results

Findings revealed that Bhutanese refugees were mistreated in the Nepalese healthcare system, often neglected from healthcare access and services because of their refugee status. Upon arrival to the United States after resettlement, study participants also reported experiencing challenges within the US health care system including cultural and linguistic barriers when interacting with medical interpreters during visits with their providers, as well as having inadequate time during the visit to fully express their concerns. Respondents’ recommendations to improve their overall health centered on their experiences with the US health care system including initiatives developing leadership skills for building community capacity towards advocating for the refuges, while increasing access to external resources.

Conclusion

The result of this study outlines an account of Bhutanese refugees’ experiences and recommendations for improving their community's health based on such past experiences and their current needs. These findings provide a starting point for future research with underserved refugee migrant groups and indicate a need for health programs to be historically and culturally sensitive in order to be more effective. Further, the understanding of refugees’ collective history should inform the development of collaborative interventions with community members in order to be effective.

Rural-urban differences in estimated life expectancy associated with neighborhood-level cumulative social and environmental determinants

Diverse neighborhood-level environmental and social impacts on health are well documented. While studies typically examine these impacts individually, examining potential health impacts from multiple sources as a whole can provide a broader context of overall neighborhood-level health impacts compared to examining each component independently. This study examined the association between cumulative neighborhood-level potential health impacts on health and expected life expectancy within neighborhoods (census tracts) across Texas using the Neighborhood Potential Health Impact Score tool. Among urban census tract neighborhoods, a difference of nearly 5 years was estimated between neighborhoods with the least health promoting cumulative health impacts compared to neighborhoods with the most health promoting cumulative health impacts. Differences were observed between rural and urban census tract neighborhoods, with rural areas having less variability in expected life expectancy associated with neighborhood-level cumulative potential health impacts compared to urban areas.

The effect of health-related information seeking and financial strain on medication nonadherence among patients with diabetes and/or hypertension in central Texas

Objective

To assess self-reported financial strain and persistence in asking treatment- and medication-related questions in relation to medication nonadherence.

Method

Data were analysed from a cross-sectional study of adults with diabetes, hypertension or both in central Texas in 2013. Measures of medication nonadherence in the past 12 months, financial strain and patients' persistence in asking treatment- and medication-related questions were identified. Medication nonadherence resulting from cost, transportation or work was compared with medication nonadherence resulting from other reasons. Binary and multinomial regression models were fitted to identify factors associated with medication nonadherence among the respondents.

Key findings

In the bivariate model, medication nonadherence from any cause was significantly associated with financial strain, not asking questions about treatments or medications, and all demographic characteristics. However, in the multinomial model, medication nonadherence resulting from cost, work or transportation was only associated with not asking medication-related question about financial strain, lack of health insurance, age and gender. This was true for nonadherence resulting from other reasons except that ethnicity was significant while gender was not.

Conclusions

While removing financial strain could aid medication adherence, clinicians should also encourage patients to be persistent in asking questions about their medications until they understand the purpose for taking them. Our findings have implications for empowering patients to be more proactive in enhancing their adherence to medications.

Anxiety and depressive symptoms and missing breast cancer and cervical screening: results from Brazos valley community health survey

Breast and cervical cancer screening are associated with dramatically reduced cancer mortality. Mental illnesses have been demonstrated to influence preventative behaviours. This study aims to explore whether anxiety or depressive symptoms is associated with breast and cervical cancer screening. We analyzed data (n = 3104) from the 2013 Brazos Valley Community Health Assessment. The GAD-7 Scale was used to assess the anxiety level, and PHQ-2 was used to assess the depressive symptoms. Stata 15.0 statistical software was used to perform descriptive and logistic regression analysis. Overall, 80.61% of women in each sample met breast cancer or cervical cancer screening guidelines, respectfully. Anxiety was associated with missing breast and cervical cancer screening, but the association was only significant for cervical cancer (OR = 1.430, CI = 1.009, 2.026), not for breast cancer (OR = 1.406, CI = .952, 2.078). Depressive symptom was significantly associated with missing breast (OR = 1.502, CI = 1.051, 2.149) and cervical (OR = 1.689, CI = 1.208, 2.362) cancer screening after controlling for demographics. Women with depressive symptoms and anxiety had higher odds of missing breast and cervical cancer screening. Health promotion programs should consider targeting individuals with anxiety and depression to improve cancer-screening rates..

Factors that influence the intention to use mobile phone caller tunes for patient reporting of adverse drug reactions: a qualitative study

Background:

Patient reporting of adverse drug reactions (ADRs) is low in low- and middle-income countries, in part because of poor awareness to report. With the increase in mobile subscription, mobile phones can be used as a platform to disseminate information on ADRs. The aim of this study was to qualitatively assess the potential of using mobile phone caller tunes (the message or sound the caller hears before the receiver answers the call) to encourage patient reporting of ADRs.

Methods:

A total of 38 key informant interviews and 12 focus group discussions (57 participants in groups of 4–5) were conducted in Accra, Ghana. The transcripts were analysed using key constructs of the Technology Acceptance Model (TAM) including perceived usefulness, perceived ease of use, and behavioural intention to use caller tunes for patient reporting of ADRs.

Results:

Respondents mentioned lack of knowledge on reporting ADRs, and their willingness to use mobile phone caller tunes to promote patient reporting of ADRs. Many respondents pointed out how ADRs usually led to discontinuity in medication use, usually without consultation with health professionals. Caller tunes were regarded an innovative, accessible and convenient platform to disseminate information on ADRs. Most respondents intended to use caller tunes with drug safety information to promote ADR reporting, particularly to help their friends and family members. Simplicity of the message, use of songs or messages in local languages and price of downloading the caller tunes were important considerations.

Conclusion:

There is a need for the creation and testing of caller tunes on ADRs in Ghana to promote patient or consumer reporting of ADRs. Further studies are needed to assess factors that could influence the creation and use of caller tunes to disseminate information on drug safety.

Determinants of Intention to Use Mobile Phone Caller Tunes to Promote Voluntary Blood Donation: Cross-Sectional Study

Background

Voluntary blood donation rates are low in sub-Saharan Africa. Sociobehavioral factors such as a belief that donated blood would be used for performing rituals deter people from donating blood. There is a need for culturally appropriate communication interventions to encourage individuals to donate blood. Health care interventions that use mobile phones have increased in developing countries, although many of them focus on SMS text messaging (short message service, SMS). A unique feature of mobile phones that has so far not been used for aiding blood donation is caller tunes. Caller tunes replace the ringing sound heard by a caller to a mobile phone before the called party answers the call. In African countries such as Ghana, instead of the typical ringing sound, a caller may hear a message or song. Despite the popularity of such caller tunes, there is a lack of empirical studies on their potential use for promoting blood donation.

Objective

The aim of this study was to use the technology acceptance model to explore the influence of the factors—perceived ease of use, perceived usefulness, attitude, and free of cost—on intentions of blood or nonblood donors to download blood donation-themed caller tunes to promote blood donation, if available.

Methods

A total of 478 blood donors and 477 nonblood donors were purposively sampled for an interviewer-administered questionnaire survey at blood donation sites in Accra, Ghana. Data were analyzed using descriptive statistics, exploratory factor analysis, and confirmatory factory analysis or structural equation modeling, leading to hypothesis testing to examine factors that determine intention to use caller tunes for blood donation among blood or nonblood donors who use or do not use mobile phone caller tunes.

Results

Perceived usefulness had a significant effect on intention to use caller tunes among blood donors with caller tunes (beta=.293, P<.001), blood donors without caller tunes (beta=.165, P=.02, nonblood donors with caller tunes (beta=.278, P<.001), and nonblood donors without caller tunes (beta=.164, P=.01). Attitudes had significant effect on intention to use caller tunes among blood donors without caller tunes (beta=.351, P<.001), nonblood donors with caller tunes (beta=.384, P<.001), nonblood donors without caller tunes (beta=.539, P<.001) but not among blood donors with caller tunes (beta=.056, P=.44). The effect of free-of-cost caller tunes on the intention to use for blood donation was statistically significant (beta=.169, P<.001) only in the case of nonblood donors without caller tunes, whereas this path was statistically not significant in other models.

Conclusions

Our results provide empirical evidence for designing caller tunes to promote blood donation in Ghana. The study found that making caller tunes free is particularly relevant for nonblood donors with no caller tunes.

Depression and health-related quality of life among persons with sensory disabilities in a health professional shortage area

OBJECTIVE

The authors examined depression and health-related quality of life among individuals with self-reported sensory impairments living in a health professional shortage area.

RESEARCH METHOD

Health surveys of residents were conducted in 2006 and 2010. Responses were analyzed by groups of residents reporting vision loss, hearing loss, dual hearing and vision loss, and no sensory loss. In 2006, the total sample size was n = 2,591, and in 2010, it was n = 3,955.

MAIN OUTCOME MEASURES

The CESD-5 scale (Shrout & Yager, 1989) was included in 2006, and the PHQ-9 (Kroenke, Spitzer, & Williams, 2001) was included in 2010. Rates of depression on the CESD-5 were determined by the recommended cut-off scores and on the PHQ-9 by the recommended algorithm. The Centers for Disease Control (CDC) Healthy Days instrument (Moriarty, Zack, & Kobau, 2003) was used in both surveys to assess health-related quality of life.

RESULTS

In both surveys, individuals who reported sensory loss had higher rates of depression and lower health-related quality of life than individuals with no reported sensory loss.

CONCLUSIONS

Individuals reporting sensory loss had high rates of depression and a compromised quality of life compared to respondents without these impairments. These data imply strategic community-based health care services, including mental health initiatives, may be indicated for individuals with sensory loss living in underserved regions. Implications for rehabilitation psychology research, service, and policy are discussed as innovations in these areas are needed to better understand and address the disparities that may compromise the overall well-being of residents of underserved communities. (PsycINFO Database Record

Community Health Needs Assessment: Potential for Population Health Improvement

Derived from various health care policies and initiatives, the concept of population health has been newly adopted by health care and medicine. In particular, it has been suggested that the Patient Protection and Affordable Care Act provision that requires nonprofit hospitals to conduct a community health needs assessment (CHNA) and implement strategies to address health priorities has the potential to improve population health. A mixed methods study design was used to examine the potential for population health improvements to occur through the Internal Revenue Service (IRS)-mandated nonprofit hospital CHNA and planning processes. Methods involved a 2-phased approach composed of (1) content analysis of 95 CHNA/implementation strategies reports and (2) interviews with key informants, consultants, and community stakeholders involved in CHNA and planning processes. Although this is a great opportunity for the nonprofit hospital assessment and planning processes to influence population health outcomes, the findings from the first 3-year assessment and planning cycle (2011-2013) suggest this is unlikely. As nonprofit hospitals begin the second 3-year assessment and planning cycle, this article offers recommendations to increase the potential for nonprofit hospitals to improve population health. These recommendations include clarifying the purpose of IRS CHNA regulations, engaging community stakeholders in collaborative assessment and planning, understanding disease etiology and identifying and addressing broader determinants of health, adopting a public health assessment and planning model, and emphasizing population health improvement. (Population Health Management 2016;19:178-186).

Nonprofit hospitals' approach to community health needs assessment

OBJECTIVES

We sought a better understanding of how nonprofit hospitals are fulfilling the community health needs assessment (CHNA) provision of the 2010 Patient Protection and Affordable Care Act to conduct CHNAs and develop CHNA and implementation strategies reports.

METHODS

Through an Internet search of an estimated 179 nonprofit hospitals in Texas conducted between December 1, 2013, and January 5, 2014, we identified and reviewed 95 CHNA and implementation strategies reports. We evaluated and scored reports with specific criteria. We analyzed hospital-related and other report characteristics to understand relationships with report quality.

RESULTS

There was wide-ranging diversity in CHNA approaches and report quality. Consultant-led CHNA processes and collaboration with local health departments were associated with higher-quality reports.

CONCLUSIONS

At the time of this study, the Internal Revenue Service had not yet issued the final regulations for the CHNA requirement. This provides an opportunity to strengthen the CHNA guidance for the final regulations, clarify the purpose of the assessment and planning process and reports, and better align assessment and planning activities through a public health framework.

Science reporting in Accra, Ghana: sources, barriers and motivational factors

In Ghana, as in many other developing countries, most science reporting is done by general reporters. However, few studies have investigated science reporting in such a situation. To understand better the dynamics of science reporting in such context, we surveyed 151 general reporters in Ghana. Respondents' demographic characteristics resembled those found in studies elsewhere. Respondents perceived health professionals and scientists as very important sources of information for reporting science. There was an inverse correlation between journalism experience and the number of science feature stories reported in the past 12 months (p=.017). Most respondents indicated that science journalism training would motivate them to report science more. Likewise, most reported that easier access to research findings would do so. We identify characteristics of reporters, media, scientific, and training institutions that are important influences of Ghanaian reporters' coverage of science. We provide recommendations for advancing science reporting in Ghana.

Utilization of an interorganizational network analysis to evaluate the development of community capacity among a community-academic partnership

BACKGROUND

Following a community health assessment the Brazos Valley Health Partnership (BVHP) organized to address fragmentation of services and local health needs. This regional partnership employs the fundamental principles of community-based participatory research, fostering an equitable partnership with the aim of building community capacity to address local health issues.

OBJECTIVES

This article describes changes in relationships as a result of capacity building efforts in a community-academic partnership. Growth in network structure among organizations is hypothesized to be indicative of less fragmentation of services for residents and increased capacity of the BVHP to collectively address local health issues.

METHODS

Each of the participant organizations responded to a series of questions regarding its relationships with other organizations. Each organization was asked about information sharing, joint planning, resource sharing, and formal agreements with other organizations. The network survey has been administered 3 times between 2004 and 2009.

RESULTS

Network density increased for sharing information and jointly planning events. Growth in the complexity of relationships was reported for sharing tangible resources and formal agreements. The average number of ties between organizations as well as the strength of relationships increased.

CONCLUSION

This study provides evidence that the community capacity building efforts within these communities have contributed to beneficial changes in interorganizational relationships. Results from this analysis are useful for understanding how a community partnership's efforts to address access to care can strengthen a community's capacity for future action. Increased collaboration also leads to new assets, resources, and the transfer of knowledge and skills.

Residential rurality and oral health disparities: influences of contextual and individual factors

The purposes of the study were (a) to identify disparities between urban and rural adults in oral health and (b) to examine contextual (i.e., external environment and access to dental care) and individual (i.e., predisposing, enabling, and lifestyle behavioral) factors associated with oral health problems in a community population. Study data were derived from a two-stage, telephone-mailed survey conducted in 2006. The subjects were 2,591 adults aged 18 years and older. Cochran-Mantel-Haenszel statistics for categorical variables were applied to explore conditional independence between both health access and individual factors and oral health problems after controlling for the urban or rural residence. Logistic regression was used to investigate the simultaneous associations of contextual and individual factors in both rural and urban areas. Approximately one quarter (24.1%) of the study population reported oral health problems. Participants residing in rural areas reported more oral health disparities. Oral health problems were significantly associated with delaying dental care. These problems also were more common among those who were less educated, were African American, skipped breakfast every day, and currently smoked. The study findings suggest that oral health disparities persist for people in rural areas, and improving oral health status is strongly related to better access to oral health care and improved lifestyles in both rural and urban areas.

Community health development: a strategy for reinventing America's health care system one community at a time

The purpose of this article is to propose a set of ideas for reinventing America's health care system, one community at a time. Community health development is proposed as a strategy and approach to population health improvement, the ultimate goal of health care reform. The practice of community health development, particularly the partnership approach, provides guidance about how this approach might be employed as a national health care reform strategy. Examples of two communities successfully using the partnership approach illustrate the methods described. Six specific recommendations for policy makers and public administrators in the new administration resulting from our experience with community health development are presented. First, adopt and apply community health development (CHD) as the American approach for facilitating population health improvement and building community capacity. Second, the partnership approach should be promoted as a model for communities to use in implementing CHD. Third, make the community-level the focus for planning, implementing, evaluating, and sustaining a full continuum of health and human services. Fourth, formally recognize the social determinants of health as a key component of a new population/community health status model and as a public policy driver for health care reform, marketplace issues, and population health status improvement at all levels of society. Fifth is a call for a national strategy for the recruitment, training, education, and support of individuals to facilitate this community movement. Sixth, Congress and the Obama Administration adopt and apply CHD as a national strategy and utilize American community-based experiences to bring about a national plan.

Sociodemographic and healthcare characteristics of Colonia residents: the role of life stage in predicting health risks and diabetes status in a disadvantaged Hispanic population

An assessment of the risk or diagnosis of diabetes in a random sample of 386 adult border residents found 46% obese, 12% at risk for diabetes, and 18% diagnosed with diabetes. While obesity was associated with greater diabetes risk, > 50% of obese adults reported not being told of their diabetes risk. Independent of other characteristics, boomers were at increased risk (OR 3.88) for diabetes. Comorbidities increased the risk for actual diabetes diagnosis (OR 4.79). Skipping medications increased risk of developing diabetes (OR 2.98). Disadvantaged obese boomers are at particular risk, warranting culturally appropriate interventions before onset of chronic illnesses.

The impact of a communitywide smoke-free ordinance on smoking among older adults

INTRODUCTION

Clean-air and smoke-free ordinances have been shown to reduce the prevalence of smoking among the overall population, but their effects on the smoking prevalence among older adults deserves further attention. We examined changes in self-reported cigarette smoking and in attitudes toward smoking after the implementation of such ordinances in Fort Collins, Colorado, in 2003.

METHODS

Communitywide health status surveys were mailed out to northern Larimer County residents recruited via random-digit dialing in 2001 and 2004. Secondary data analysis was conducted for respondents living in Fort Collins, comparing the entire sample with a subsample of adults aged 50 years or older. Univariate analyses were used to determine differences in self-reported cigarette smoking between the groups across the 2 surveys. Multivariate logistic regression models estimated differences in smoking status and in attitudes toward acceptability of public smoking between the 2 survey administrations, controlling for demographic correlates.

RESULTS

Smoking rates among older respondents failed to change, despite significant decreases in smoking rates in the entire adult population. Furthermore, attitudes toward smoking in public did not change between the 2 surveys for either of the groups.

CONCLUSION

Different factors may influence the decision to stop smoking for older adults and younger adults. We recommend the use of multiple approaches on different ecological levels to ensure that communitywide antismoking intervention efforts reach all population segments.

Health-related quality of life among Mexican Americans living in colonias at the Texas-Mexico border

Understanding influences on health-related quality of life (HRQL) is critical in order to track and improve the health of poor, vulnerable populations and reduce health disparities. However, studies assessing HRQL of minorities are relatively scarce. The purpose of this study was to document personal and socioenvironmental correlates to HRQL. The study population is Mexican Americans in the Texas-Mexico border region living in colonias - unincorporated, impoverished settlements with substandard living conditions along the U.S.-Mexico border. Mexican Americans living in colonias are one of the most disadvantaged, hard-to-reach minority groups in the United States. We used data from the Integrated Health Outreach System Project collected in 2002 and 2003. Our sample included 386 participants randomly selected and interviewed face-to-face with a structured survey. We measured HRQL and examined personal and socioenvironmental correlates. Unadjusted and adjusted (multivariate) logistic regression models were used for data analyses. We found that border Mexican Americans living in colonias were of similar mental health status compared to the general population of the United States, but worse off in terms of physical health. Poor education and long-term residency in colonias were predictors of lower physical health. Women reported worse mental health than men. Length of time living in a colonia, co-morbidity status, and perceived problems with access to healthcare was associated with poorer mental health status. This study provides information for health professionals and policymakers and underscores the need to provide better preventive and medical services for underserved populations. Major findings indicate the need for additional research centered on further exploration of the impact of economic, cultural, and social influences on HRQL among severely disadvantaged populations.

Levels and correlates of exercise in a border mexican american population

OBJECTIVE

To examine personal and environmental correlates of exercise among Mexican Americans living in the Texas-Mexico border region.

METHODS

The study was based on data from a community health assessment conducted in 2 counties at the Texas-Mexico border region. A random-digit-dialed community survey was used in this cross-sectional study (n=933).

RESULTS

A majority of border Mexican Americans (52%) did not exercise at all. Gender, age, and self-rated health were statistically significant correlates to exercise.

CONCLUSIONS

Understanding personal and environmental factors that influence physical activity and exercise in this minority population is critical for the development of culturally sensitive health interventions.

Assessing healthful eating among community dwelling rural older adults using self-reported fruit and vegetable consumption via a community-wide mail-out health status assessment

This project assessed fruit and vegetable intakes among rural older adults on a regional mail-out community health assessment. Over 95% of respondents answered questions regarding fruit and vegetable consumption. Rural older adults in this sample were willing to respond to questions regarding their fruit and vegetable intake; yet they were not likely to be meeting minimum recommended intakes of these foods. Including questions about dietary healthfulness on such an assessment may provide key stakeholders and policymakers a clearer understanding of their community's overall health status.

The evolving role of partnerships in addressing community public health issues: policy and ethical implications

The current state of health insurance coverage in the United States is deteriorating. Historically, efforts to address access at the federal level have met with insurmountable opposition. This article describes a model utilizing the Partnership Approach to Community Health Improvement to engage communities in developing creative ways of addressing local health issues, discusses the policy implications of such a model, and explores ethical issues inherent in the discussion of universal access. An argument is presented for a national dialogue seeking societal agreement to approach access and health from a perspective of solidarity.

The political and policy implications of a rating system of community capacity to improve population health

This article discusses the political and policy implications of a potential rating system of community capacity for health improvement. Evidence suggests that such a rating system will have little effect in the current health care environment unless it is directly related to the health care dollar. Community change agents and stakeholders, including the growing population of older adults, will perceive a rating system to have value only if the defined purpose meets their interests and needs, and if the rating system results prove useful for decisions that affect the bottom line in working on issues like health improvement and capacity.

Aggregate Health Status: a benchmark index for community health

A qualitative review of population health assessment models used throughout the United States and Canada indicate both individual and community-level domains of health. Individual-level domains of health include health habits, education, public safety, environment, social, government, culture, and mobility. Community-level domains include the same general health domains but aggregated to the community level Aggregate Health Status (AHS). In the development of the AHS portion of our model, the dependent variable was the general health question from the Medical Outcomes Study. The remainder of the survey was partitioned into mutually exclusive individual measure subsets. A linear combination of these global variables then produces a single estimate relating the multiple domains of the broader determinants of health to health status. This global variable uniquely discriminates between the five categories of general health. This model serves as a framework and benchmark indicator that (1) provides a summary indicator of the overall health status of the population, (2) is broadly representative of populations rather than individuals, (3) is a population perspective rather than a provider perspective, and (4) emphasizes outcomes versus inputs and processes.

The SF-12 as a population health measure: an exploratory examination of potential for application

OBJECTIVE

To describe the relationships among functional health status measures (SF-12 physical and mental components summary scores), traditional measures of community health status, and social determinants of health among respondents to community health status surveys conducted in nine different communities.

DATA SOURCES/STUDY SETTING

Data collected as part of comprehensive community health status assessments conducted in each of nine communities (in seven states) between 1992 and 1997. The purpose of each assessment was to gather data to plan and evaluate population health improvement initiatives.

STUDY DESIGN AND DATA COLLECTION

This is an opportunistic study drawing on the universe of community health survey data collected by the authors to support local health improvement initiatives. Both community-level as well as an aggregate of individual-level measures are used in the analysis. Within each locality, survey respondents were randomly selected using a telephone-facilitated, mailed survey methodology.

PRINCIPAL FINDINGS

The key variables reported here are functional health status measures (SF-12) and social determinants of health variables. SF-12 physical and mental component scales correlated with two of four traditional measures of community health status. At the aggregate level of analysis, significant relationships were found for seven of nine social determinants of health measures when compared with SF-12 component summary scores. Relationships between social determinants measures and PCS-12 and MCS-12 scores suggest both application possibilities and the need for additional analysis in order to understand the nature of those relationships.

CONCLUSIONS

Physical and mental health functioning summary scores as measured by the SF-12 are useful in describing overall community health status when compared with traditional measures such as total deaths, age-adjusted mortality, or physician to population ratio. The SF-12 can also be used to measure the relationship between physical and mental health functioning (as proxies for community health status) and the social determinants of health. This analysis can help to refine our understanding of how social determinants and health status interact in a community or population as a precursor to the development of models of community or population health.

Health education intervention strategies: recommendations for future research

While the ultimate goal of health education interventions is to positively influence health status, more proximal indicators of success are changes in intermediate outcomes, or impact. Because health education interventions work through intermediate outcomes, the linkage to health status is often assumed to be at a conceptual or theoretical level. The term health education intervention strategy is a heuristic device used to conceptualize and organize a large variety of activities. There is a wide range of studies and reports in the literature that either test specific intervention strategies or report on larger health education efforts combining several strategies. This article organizes the discussion to focus on individual-, community-, and policy-level interventions. Mass communications are also considered, and the authors comment on program planning issues that cut across specific interventions at the individual, community, and policy levels. Eleven recommendations are offered for future health education intervention research.

Taking the pulse of the community

In recent years, the technology and methodology have been developed to help you identify, collect, analyze, and apply health status information about the community you serve. Called a population-based community health status assessment, this tool is not intended to help you identify "needs"--you probably already know what many of them are in your community. Rather, it allows you to develop precise indicators of the health status of the community in general as well as of specific subgroups with particular health problems and risk factors. The assessment is useful both for the data and insights it provides and for organizing, implementing, and evaluating community health improvement interventions. Seven steps for the successful design and implementation of a population-based community health status assessment follow.

A community view of smoking cessation counseling in the practices of physicians and dentists

The practice norms of community physicians and dentists in the Lehigh Valley of Pennsylvania for counseling about smoking cessation were surveyed. In addition, 1,373 residents in the valley were interviewed by telephone about the smoking counseling behaviors of their dentists and physicians. These activities were conducted as part of the planning for an intervention by the Coalition for a Smoke-Free Valley, a coalition of 100 persons and organizations in the area. The survey response rate for 172 physicians was 77 percent, and for 103 dentists, it was 76 percent. More physicians than dentists advised patients to quit, counseled patients, provided materials, and helped the patient to set a quit date. However, there was a clear discrepancy between what physicians say they do and what smokers say they hear.

Practitioners' use of theory: examples from a workgroup

There is a continuing discussion within the field of health education about the relationship between theory and practice. Much of this discussion, particularly that which appears in professional journals, has been developed by academicians and is prescriptive. That is, it identifies ways in which theory should be used by practitioners. The purpose of this article is to facilitate this ongoing discussion by providing descriptive information on how theory is used by a group of health educators who work for the same organization. This information is used as a springboard for discussion more generally about the nature of theory in health education. This article represents the thinking and experiences of a dozen health professionals, in reaction to the question. "How do you use theory in your practice?" The authors believe this information will be useful in helping theoreticians develop more useful theory and helping practitioners increase their understanding of the utility of good theory. The division between theory and practice in the field of health education represents a significant opportunity and challenge to the discipline if energy can be redirected from criticism of the other "camp" to effective collaboration and enhanced effectiveness of health education efforts.

The business of health promotion: ethical issues and professional responsibilities

In the nine years since an entire issue of Health Education Quarterly (then Health Education Monographs) was devoted to considering ethical issues in health education, several important social changes have occurred which have substantially influenced the practice of that discipline. New practice contexts and ethical issues have resulted, which require a fresh look at both these new issues as well as those addressed in the earlier monograph. The importance of understanding the principles underlying the ethical dilemmas raised by the authors is emphasized as a concern for both the individual practitioner as well as the profession of health education itself. Recommendations for personal and professional action are made by the authors.

The effects of ethnicity, sex and father's occupation on heart health knowledge and nutrition behavior of school children: the Texas youth health awareness survey

The relationships of ethnicity, sex and father's occupation with heart health knowledge and nutrition behavior were studied in Texas seventh and eighth grade students. A questionnaire was administered to 2,695 children in schools chosen to represent the urban/rural and ethnic mix of the state population. The findings indicated a strong need for heart health education and for culturally-relevant nutrition education aimed at specific target groups defined by ethnicity, sex and leisure activity. Analysis of eating behavior at school and home confirmed the importance of school feeding programs on the health of minority and low income children.