Factors Influencing the Use of Domestic Violence Restraining Orders in Los Angeles

Domestic violence restraining orders (DVROs), although a widely used legal intervention in preventing future risk of intimate partner violence (IPV), there is a lack of documentation on the facilitators and barriers of utilization of DVROs among IPV survivors in Los Angeles County (LAC). We conducted 19 key informant interviews with various professionals working in domestic violence prevention in LAC. Factors such as survivors' motivation, ease of navigating the legal procedures, and availability of community resources facilitate the use of DVROs. Fear, ambivalence, structural barriers to access DVROs, and issues with the criminal justice system make it harder for survivors to obtain DVROs.

Measuring impact of storyline engagement on health knowledge, attitudes, and norms: A digital evaluation of an online health-focused serial drama in West Africa

Background

"Cest la Vie!" (CLV) is a serial drama that entertains, educates, and promotes positive health behaviors and social change for West African audiences. The purpose of this study was to evaluate if watching the CLV Season 2 series online had an impact on people's health knowledge, attitudes, and norms, focusing on populations in francophone West Africa.

Methods

Between July 2019 and October 2019, viewers of CLV and non-viewers were recruited from Facebook and YouTube. We conducted an online longitudinal cohort study that assessed changes in health knowledge, attitudes, and norms (KAN) between these groups. Participants completed a baseline survey prior to the online airing and up to three follow-up surveys corresponding to specific health stories in the series, including sexual violence, emergency contraception, and female circumcision. We used descriptive statistics to describe viewers and non-viewers, and an item response theory (IRT) analysis to identify the effect of viewing CLV on overall KAN.

Results

A total of 1674 respondents participated in the study. One in four participants (23%, n = 388) had seen one of the three storylines from CLV Season 2 (ie, CLV viewers). At follow-up, viewers were more likely than non-viewers to know when to correctly use emergency contraception (P < 0.001) and to believe that the practice of female circumcision should end (P = 0.001). Compared to people who did not see CLV, viewers of the series had 26% greater odds of answering pro-health responses at follow-up about sexual assault, emergency contraception, and female circumcision. Further, the level of engagement with specific storylines was associated with a differential impact on overall outcome questions.

Conclusions

As internet access continues to grow across the globe and health education materials are created and adapted for new media environments, our study provides a novel approach to examining the impact of online entertainment-education content on health knowledge, attitudes, and norms.

Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health

The opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. We review scientific evidence from promising interventions focused on the social determinants of health and discuss how such interventions can improve population health and reduce health disparities. We found sufficient evidence of successful outcomes to support disparity-reducing policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. Cost-effectiveness evaluations show that these interventions lead to long-term societal savings, but the interventions require more routine attention to cost considerations. We discuss challenges to implementation, including the need for long-term financing to scale up effective interventions for implementation at the local, state, and national levels.

Community Residents' Beliefs About Neighborhood Corner Stores in 2 Latino Communities: Implications for Interventions to Improve the Food Environment

We assessed community residents' perceptions of corner stores to better understand what facilitates and deters patronage at these food outlets. Data came from 978 household interviews in 2 Latino communities undergoing corner store interventions. Chi-square tests, an independent sample t test, and a multivariate logistic regression were conducted to assess the relationship between residents' perceptions about corner stores and their reported patronage at these food outlets. Residents reported that corner stores do not sell a variety of fruits and vegetables and are not places where one can get information about healthy eating. Convenience, cleanliness, positive customer service, availability of culturally appropriate items, and availability of quality fresh fruit increased the odds of store patronage. Simply providing healthy foods will not incentivize patrons to purchase them. Corner store interventions can be more effective if they address the characteristics that community residents prioritize.

Understanding where and why Senegalese adolescents and young adults access health information: A mixed methods study examining contextual and personal influences on health information seeking

Background

Adolescent and young adult years are critical to the development of behaviors that influence health across the life course. To reveal which health communication channels should be used to effectively reach and influence younger populations in Senegal, we used a mixed methods approach to identify and interpret the multifaceted influences surrounding where and why this population accesses health information.

Methods

We conducted 16 focus group discussions among adolescents and young adults in Senegal in September 2012. We then collected survey data from a larger, more diverse sample of Senegalese youth in October-November 2014.

Results

Our results demonstrate that information sources vary by health topic, differential access, age, and other demographics. While there is a greater perception of credibility and usefulness in information received from health professionals, stigma remains a barrier for obtaining information about HIV/AIDS from health centers. Older youth are also less likely to seek health information from adults, which may be influenced by preferred use of information technologies, especially for information about taboo health topics.

Conclusions

Our findings support multi-pronged, targeted approaches to health communication efforts. We recommend that doctors continue to provide actionable information about preventing or treating specific diseases, whereas teachers should educate youth about general health topics and health promotion behaviors. The results suggest that traditional mass media, such as radio and television, are the best communication channels for information about HIV and sexual/reproductive health, especially for older adolescents and young adults.

Comparing Lay Community and Academic Survey Center Interviewers in Conducting Household Interviews in Latino Communities

BACKGROUND

The employment of professional interviewers from academic survey centers to conduct surveys has been standard practice. Because one goal of community-engaged research is to provide professional skills to community residents, this paper considers whether employing locally trained lay interviewers from within the community may be as effective as employing interviewers from an academic survey center with regard to unit and item nonresponse rates and cost.

METHODS

To study a nutrition-focused intervention, 1035 in-person household interviews were conducted in East Los Angeles and Boyle Heights, 503 of which were completed by lay community interviewers. A chi-square test was used to assess differences in unit nonresponse rates between professional and community interviewers and Welch's t tests were used to assess differences in item nonresponse rates. A cost comparison analysis between the two interviewer groups was also conducted.

RESULTS

Interviewers from the academic survey center had lower unit nonresponse rates than the lay community interviewers (16.2% vs. 23.3%; p < 0.01). However, the item nonresponse rates were lower for the community interviewers than the professional interviewers (1.4% vs. 3.3%; p < 0.01). Community interviewers cost approximately $415.38 per survey whereas professional interviewers cost approximately $537.29 per survey.

CONCLUSIONS

With a lower cost per completed survey and lower item nonresponse rates, lay community interviewers are a viable alternative to professional interviewers for fieldwork in community-based research. Additional research is needed to assess other important aspects of data quality interviewer such as interviewer effects and response error.

Human papillomavirus (HPV) awareness and vaccine receptivity among Senegalese adolescents

OBJECTIVE

To examine HPV vaccine awareness and receptivity among adolescents and young adults in Senegal.

METHODS

Participants from six high schools and five community centres across five regions of Senegal (n = 2286) completed a self-administered questionnaire in October and November 2014. The study assessed HPV awareness and receptivity towards receiving the HPV vaccine. Multivariable logistic regression explored statistically significant relationships between the predictor variables and both outcomes.

RESULTS

Twenty-seven percent had heard of HPV. Among those who had heard of HPV (n = 616), only 28% indicated willingness to vaccinate. Multivariable analysis showed that respondents from rural areas had 63% higher odds (95% CI: 1.24, 2.12) of having heard of HPV than those in urban areas. Respondents with fathers who had completed higher education had 41% higher odds (95% CI: 1.04, 1.92) of being aware of HPV (P < 0.05); however, every level of father's education (as compared to no education at all) was negatively associated with willingness to vaccinate. Respondents who had previously spoken to a healthcare professional about the HPV vaccine had 80% higher odds (95% CI: 1.16, 2.81) of willingness to vaccinate than those who did not speak to a provider about the vaccine.

CONCLUSIONS

Healthcare providers and parents are important stakeholders in disseminating HPV vaccine information. Given the overall low levels of awareness, there is a great opportunity for public health communication efforts to craft health messaging and information in a way to maximise receptivity, outlining benefits and providing information on the minimal risks associated with the vaccine.

Integrating Qualitative and Quantitative Survey Techniques

An “educational diagnosis,” which targetted the health behaviors of mothers with regards to malaria and diarrhea in their young children, was carried out over a three-week period in November 1985 in Rwanda, East Africa. The study used the methodological technique of triangulation, in which both quantitative and qualititative data collection efforts are used to find answers to the same or similar sets of questions. Findings include estimates of health care utilization and medication usage and illustrate how multiple methods of data collection can maximize both the amount of usable data and the degree of confidence in the validity of data obtained, even with relatively small samples. In particular, the qualitative technique of focus group interviewing, which provided information on the sociocultural, economic, and historical contexts of the Rwandese health care system, provided an explanation of why there is relatively little self-care or home treatment for these diseases in Rwandese society.

Training the Next Generation of Latino Health Researchers: A Multilevel, Transdisciplinary, Community-Engaged Approach

Reducing health disparities is a national public health priority. Latinos represent the largest racial/ethnic minority group in the United States and suffer disproportionately from poor health outcomes, including cardiovascular disease risk. Academic training programs are an opportunity for reducing health disparities, in part by increasing the diversity of the public health workforce and by incorporating training designed to develop a skill set to address health disparities. This article describes the Training and Career Development Program at the UCLA Center for Population Health and Health Disparities: a multilevel, transdisciplinary training program that uses a community-engaged approach to reduce cardiovascular disease risk in two urban Mexican American communities. Results suggest that this program is effective in enhancing the skill sets of traditionally underrepresented students to become health disparities researchers and practitioners.

Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health

The opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. We review scientific evidence from promising interventions focused on the social determinants of health and discuss how such interventions can improve population health and reduce health disparities. We found sufficient evidence of successful outcomes to support disparity-reducing policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. Cost-effectiveness evaluations show that these interventions lead to long-term societal savings, but the interventions require more routine attention to cost considerations. We discuss challenges to implementation, including the need for long-term financing to scale up effective interventions for implementation at the local, state, and national levels.

Integrating Qualitative and Quantitative Survey Techniques

As “educational diagnosis,” which targeted the health behaviors of mothers with regards to malaria and diarrhea in their young children, was carried out over a three-week period in November 1985 in Rwanda, East Africa. The study used the methodological technique of triangulation, in which both quantitative and qualitative data collection efforts are used to find answers to the same or similar sets of questions. Findings include estimates of health care utilization and medication usage and illustrate how multiple methods of data collection can maximize both the amount of usable data and the degree of confidence in the validity of data obtained, even with relatively small samples. In particular, the qualitative technique of focus group interviewing, which provided information on the sociocultural, economic, and historical contexts of the Rwandese health care system, provided an explanation of why there is relatively little self-care or home treatment for these diseases in Rwandese society.

The association between self-rated eating habits and dietary behavior in two Latino neighborhoods: Findings from Proyecto MercadoFRESCO

OBJECTIVE

Latinos are the largest racial and ethnic minority group in the United States and bear a disproportionate burden of obesity related chronic disease. Despite national efforts to improve dietary habits and prevent obesity among Latinos, obesity rates remain high. The objective of this study is to explore the relationship between self-rated dietary quality and dietary behavior among Latinos and how this may vary by socio-demographics to help inform future public health efforts aiming to improve eating habits and obesity rates.

DESIGN

Cross-sectional study using a series of chi-square tests, the non-parametric Wilcoxon-Mann-Whitney test and logistic regression to explore self-rated eating habits.

SETTING

Two urban, low-income, predominantly Latino neighborhoods in Los Angeles County.

SUBJECTS

1000 adults who self-identified as their household's primary food purchaser and preparer were interviewed from 2012 to 2013. Households were randomly selected based on their proximity to corner stores participating in a project to improve the food environment.

RESULTS

Most respondents (59%) report "good" eating habits. Significant associations between "good" eating habits and overall health, fruit and vegetable consumption were observed (p < 0.001). Despite these promising findings, we also find high levels of regular soda and energy-dense food consumption.

CONCLUSION

This study revealed a general understanding that healthy dietary habits are associated with fruit and vegetable consumption among Latinos in two urban neighborhoods. However, there is a need for more targeted health promotion and nutrition education efforts on the risks associated with soda and energy-dense food consumption to help improve dietary habits and obesity levels in low-income Latino communities.

Substantial improvements not seen in health behaviors following corner store conversions in two Latino food swamps

Background

The effectiveness of food retail interventions is largely undetermined, yet substantial investments have been made to improve access to healthy foods in food deserts and swamps via grocery and corner store interventions. This study evaluated the effects of corner store conversions in East Los Angeles and Boyle Heights, California on perceived accessibility of healthy foods, perceptions of corner stores, store patronage, food purchasing, and eating behaviors.

Methods

Household data (n = 1686) were collected at baseline and 12- to 24-months post-intervention among residents surrounding eight stores, three of which implemented a multi-faceted intervention and five of which were comparisons. Bivariate analyses and logistic and linear regressions were employed to assess differences in time, treatment, and the interaction between time and treatment to determine the effectiveness of this intervention.

Results

Improvements were found in perceived healthy food accessibility and perceptions of corner stores. No changes were found, however, in store patronage, purchasing, or consumption of fruits and vegetables.

Conclusions

Results suggest limited effectiveness of food retail interventions on improving health behaviors. Future research should focus on other strategies to reduce community-level obesity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3074-1) contains supplementary material, which is available to authorized users.

Access to and Use of Health Care Services Among Latinos in East Los Angeles and Boyle Heights

This study examined differences in access, utilization, and barriers to health care by nativity, language spoken at home, and insurance status in East Los Angeles and Boyle Heights, California. Data from household interviews of neighborhood residents conducted as part of a corner store intervention project were used. Binary and multinomial logistic regression models were fitted. Results showed that uninsured and foreign-born individuals were differentially affected by lack of access to and utilization of health care. While the Affordable Care Act may ameliorate some disparities, the impact will be limited because of the exclusion of key groups, like the undocumented, from benefits.

Proyecto MercadoFRESCO: a multi-level, community-engaged corner store intervention in East Los Angeles and Boyle Heights

Urban food swamps are typically situated in low-income, minority communities and contribute to overweight and obesity. Changing the food landscape in low income and underserved communities is one strategy to combat the negative health consequences associated with the lack of access to healthy food resources and an abundance of unhealthy food venues. In this paper, we describe Proyecto MercadoFRESCO (Fresh Market Project), a corner store intervention project in East Los Angeles and Boyle Heights in California that used a multi-level approach with a broad range of community, business, and academic partners. These are two neighboring, predominantly Latino communities that have high rates of overweight and obesity. Located in these two communities are approximately 150 corner stores. The project used a community-engaged approach to select, recruit, and convert four corner stores, so that they could become healthy community assets in order to improve residents' access to and awareness of fresh and affordable fruits and vegetables in their immediate neighborhoods. We describe the study framework for the multi-level intervention, which includes having multiple stakeholders, expertise in corner store operations, community and youth engagement strategies, and social marketing campaigns. We also describe the evaluation and survey methodology to determine community and patron impact of the intervention. This paper provides a framework useful to a variety of public health stakeholders for implementing a community-engaged corner store conversion, particularly in an urban food swamp.

Access to Care and Cardiovascular Disease Prevention: A Cross-Sectional Study in 2 Latino Communities

Cardiovascular disease (CVD) is the leading killer of Americans. CVD is understudied among Latinos, who have high levels of CVD risk factors. This study aimed to determine whether access to health care (ie, insurance status and having a usual source of care) is associated with 4 CVD prevention factors (ie, health care utilization, CVD screening, information received from health care providers, and lifestyle factors) among Latino adults and to evaluate whether the associations depended on CVD clinical risk/disease.Data were collected as part of a community-engaged food environment intervention study in East Los Angeles and Boyle Heights, CA. Logistic regressions were fitted with insurance status and usual source of care as predictors of the 4 CVD prevention factors while controlling for demographics. Analyses were repeated with interactions between self-reported CVD clinical risk/disease and access to care measures.Access to health care significantly increased the odds of CVD prevention. Having a usual source of care was associated with all factors of prevention, whereas being insured was only associated with some factors of prevention. CVD clinical risk/disease did not moderate any associations.Although efforts to reduce CVD risk among Latinos through the Affordable Care Act could be impactful, they might have limited impact in curbing CVD among Latinos, via the law's expansion of insurance coverage. CVD prevention efforts must expand beyond the provision of insurance to effectively lower CVD rates.

Reliability and validity of the Assessment for Disaster Engagement with Partners Tool (ADEPT) for local health departments

OBJECTIVE

This study presents reliability and validity findings for the Assessment for Disaster Engagement with Partners Tool (ADEPT), an instrument that can be used to monitor the frequency and nature of collaborative activities between local health departments (LHDs) and community-based organizations (CBOs) and faith-based organizations (FBOs) for disaster preparedness, response, and recovery.

METHODS

We used formative research to develop the instrument by ranking LHDs according to their disaster outreach and engagement activities. We validated the scale through a 2011 national survey of disaster preparedness coordinators (n=273) working in LHDs. We reduced the original measure of 25 items to a final measure comprising 15 items with four dimensions: (1) communication outreach and coordination, (2) resource mobilization, (3) organizational capacity building, and (4) partnership development and maintenance. We used internal consistency reliability m correlation and factor analysis to validate the measure.

RESULTS

Using internal consistency reliability, we found reasonable inter-item reliability for the four hypothesized dimensions (Cronbach's alpha: 0.71-0.88). These four dimensions were confirmed through correlation and factor analysis (Varimax rotation).

CONCLUSION

Higher scores on all four dimensions of ADEPT for organizational respondents suggest that more activities were conducted for inter-organizational preparedness in those organizations than in organizations whose respondents had lower scores. This finding implies that organizations with higher ADEPT scores have more active relationships with CBOs/FBOs in the realm of preparedness, a key element for creating community resilience for emergencies and disaster preparedness.

Planning for chronic disease medications in disaster: perspectives from patients, physicians, pharmacists, and insurers

BACKGROUND

Recent US disasters highlight the current imbalance between the high proportion of chronically ill Americans who depend on prescription medications and their lack of medication reserves for disaster preparedness. We examined barriers that Los Angeles County residents with chronic illness experience within the prescription drug procurement system to achieve recommended medication reserves.

METHODS

A mixed methods design included evaluation of insurance pharmacy benefits, focus group interviews with patients, and key informant interviews with physicians, pharmacists, and insurers.

RESULTS AND DISCUSSION

Most prescriptions are dispensed as 30-day units through retail pharmacies with refills available after 75% of use, leaving a monthly medication reserve of 7 days. For patients to acquire 14- to 30-day disaster medication reserves, health professionals interviewed supported 60- to 100-day dispensing units. Barriers included restrictive insurance benefits, patients' resistance to mail order, and higher copay-ments. Physicians, pharmacists, and insurers also varied widely in their preparedness planning and collective mutual-aid plans, and most believed pharmacists had the primary responsibility for patients' medication continuity during a disaster.

CONCLUSIONS

To strengthen prescription drug continuity in disasters, recommendations include the following: (1) creating flexible drug-dispensing policies to help patients build reserves, (2) training professionals to inform patients about disaster planning, and (3) building collaborative partnerships among system stakeholders.

The association between nutrition facts label utilization and comprehension among Latinos in two east Los Angeles neighborhoods

BACKGROUND

The Nutrition Facts label can facilitate healthy dietary practices. There is a dearth of research on Latinos' utilization and comprehension of the Nutrition Facts label.

OBJECTIVE

To measure use and comprehension of the Nutrition Facts label and to identify correlates among Latinos in East Los Angeles, CA.

DESIGN

Cross-sectional interviewer-administered survey using computer-assisted personal interview software, conducted in either English or Spanish in the participant's home.

PARTICIPANTS/SETTING

Eligibility criteria were: living in a household within the block clusters identified, being age 18 years or older, speaking English or Spanish, identifying as Latino and as the household's main food purchaser and preparer. Analyses were based on 269 eligible respondents.

STATISTICAL ANALYSES PERFORMED

χ(2) test and multivariate logistic regression analysis assessed the associations among the main outcomes and demographics. Multiple imputations addressed missing data.

RESULTS

Sixty percent reported using the label; only 13% showed adequate comprehension of the label. Utilization was associated with being female, speaking Spanish, and being below the poverty line. Comprehension was associated with younger age, not being married, and higher education. Utilization was not associated with comprehension.

CONCLUSIONS

Latinos who are using the Nutrition Facts label are not correctly interpreting the available information. Targeted education is needed to improve use and comprehension of the Nutrition Facts label to directly improve diet, particularly among males, older Latinos, and those with less than a high school education.

Using the Precaution Adoption Process model to describe a disaster preparedness intervention among low-income Latinos

Only 40-50% of households in the United States are currently disaster prepared. In this intervention study, respondent-driven sampling was used to select a sample (n = 187) of low income, Latino residents of Los Angeles County, randomly assigned into two treatment conditions: (i) household preparedness education received through 'promotora' (community health worker) led small group meetings, and (ii) household preparedness education received through print media. Weinstein's Precaution Adoption Process, a stage model appropriate for risk communication guided the intervention. Outcomes are conceptualized as stages of decision making linked to having disaster supplies and creating a family communication plan. Quantitative results showed a significant shift over time from awareness to action and maintenance stages for disaster communication plans and supplies in both study arms; however, the shift in stage for a communication plan for those in the 'platica' study arm was (P < 0.0001) than for those in the media arm. For changes in stage linked to disaster supplies, people in both media and 'platica' study arms improved at the same rate. Simple media-based communications may be sufficient to encourage disadvantaged households to obtain disaster supplies; however, adoption of the more complex disaster family communication requires interpersonal education.

Substance use recovery outcomes among a cohort of youth participating in a mobile-based texting aftercare pilot program

Project ESQYIR (Educating & Supporting Inquisitive Youth in Recovery) is a pilot study examining the feasibility of a 12-week mobile-based aftercare intervention for youth (ages 12 to 24) transitioning out of community-based substance abuse treatment programs. From January 2012 through July 2013, a total of 80 youth were recruited from outpatient and residential treatment programs, geographically dispersed throughout Los Angeles County, California. Results revealed that youth who participated in the texting mobile pilot intervention were significantly less likely to relapse to their primary compared to the aftercare as usual control condition (OR=0.52, p=0.002) over time (from baseline throughout the 12-week aftercare pilot program to a 90-day follow-up). Participants in the texting aftercare pilot program also reported significantly less substance use problem severity (β=-0.46, p=0.03) and were more likely to participate in extracurricular recovery behaviors (β=1.63, p=0.03) compared to participants in the standard aftercare group. Collectively, findings from this pilot aftercare study suggest that mobile texting could provide a feasible way to engage youth in recovery after substance abuse treatment to aid with reducing relapse and promoting lifestyle behavior change.

Exploring the feasibility of text messaging to support substance abuse recovery among youth in treatment

This exploratory study examined treatment involved youth opinions about (i) the utility of using text messaging to support recovery behaviors after treatment; (ii) important types of text messages that could help youth self-manage their substance use behaviors after treatment; and (iii) programmatic or logistical areas associated with text messaging programs. Eight focus groups were conducted with 67 youth (aged 12-24) enrolled in outpatient and residential publicly funded substance abuse treatment programs around Los Angeles County, California. Results highlight that 70% of youth positively endorsed text messaging as a viable method of intervention during aftercare, 20% expressed ambivalent feelings, and 10% conveyed dislike. Thematic data exploration revealed seven themes related to the types of text messages youth recommend for helping youth avoid relapse after treatment, including positive appraisal (90%), lifestyle change tips (85%), motivational reinforcing (80%), coping advice (75%), confidence boosters (65%), inspiration encouragement (55%), and informational resources (50%). Youth opinions about key logistical features of text messaging programs, including frequency, timing, sender, and length are also examined. Findings offer insight for the development and enhancement of recovery support interventions with substance abusing youth. Results imply text messaging may serve as a promising opportunity for recovery support for young people with substance abuse problems.

Perceptions about recovery needs and drug-avoidance recovery behaviors among youth in substance abuse treatment

OBJECTIVE

This study used mixed methods to explore youth attitudes about recovery-related needs and important drug-avoidance behaviors after treatment.

METHOD

Focus groups were conducted with 118 substance using youth in treatment (four residential and 10 outpatient settings) throughout Los Angeles County.

RESULTS

The average age was 17.4 (SD = 2.9); 78.3% were male, 66.1% Latino; and most were in treatment for primary marijuana (40.9%) or methamphetamine (30.4%) abuse. Quantitatve results from the drug-avoidance activity survey identified the following factors youth rated as important to their recovery after treatment: lifestyle improvement activities (95.7%); changing personal drug behaviors (89.6%); drug environment/culture change activities (82.5%); with the least important being therapeutic activities (78.5%). Qualitative findings from focus groups that asked what youth think are important for recovery programs to address after treatment revealed the following four areas: (1) recovery promotion to developmentally appropriate activities (95%); (2) facilitating the use of coping skills to deal with stress (85%); (3) offering alternative recovery support options (not just abstinence only) (75%); and (4) continuing to provide substance use education (65%).

CONCLUSION

Findings highlight essential aspects of recovery in terms of need and drug-avoidance behaviors considered important to youth in treatment. Such information will help to better address clinical and recovery support models aimed at relapse prevention to ensure that the perceived problems of substance-abusing youth are adequately met.

School-based HIV prevention in Dakar, Senegal: findings from a peer-led program

This evaluation study examines the effectiveness of a peer-led technology-focused HIV prevention program targeting in-school youth in Dakar, Senegal. A quasi-experimental design was used to examine differences in knowledge, attitudes, and behavioral intentions related to HIV testing among students at three intervention schools and a comparison school. Findings at the school level vary; however, results suggest that students exposed to intervention activities had a 1.5 greater odds of intending to get HIV tested compared with students not exposed to the program. As access to and use of digital technologies continue to increase throughout parts of sub-Saharan Africa, programs will continue to leverage this medium to diffuse effective health education and promotion messages for intervention.

Contextualizing an expanded definition of health literacy among adolescents in the health care setting

The current emphasis on preventive health care and wellness services suggests that measures of skills and competencies needed to effectively navigate the health care system need to be better defined. We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and practices relevant when managing one's health environment. It is an emerging area of inquiry especially among adults and those with chronic conditions; however, it has been less studied among adolescent populations. To begin operationalizing this concept in a manner appropriate for teens in a health systems context, we explored knowledge, attitudes and practices related to health and preventive health care in 12 focus groups with publicly insured adolescents (N = 137), aged 13-17 years, as well as eight key informant interviews with physicians who serve publicly insured teens. Five dimensions emerged that provide a preliminary framework for an expanded definition of health literacy among adolescents. These include: (i) navigating the system, (ii) rights and responsibilities, (iii) preventive care, (iv) information seeking and (v) patient-provider relationship. This robust definition of health literacy contextualizes the concept in a health environment where individuals must be informed and skilled health care consumers.

Understanding recovery barriers: youth perceptions about substance use relapse

OBJECTIVE

To qualitatively explore how treatment-involved youth retrospectively contextualize relapse from substance use.

METHODS

Fourteen focus groups were conducted with 118 youth (78.3% male; 66.1% Latino) enrolled in participating substance abuse treatment programs (4 young adult and 10 adolescent) throughout Los Angeles County. Transcripts were analyzed for relapse perception themes.

RESULTS

Dominant relapse themes include emotional reasons (90%), life stressors (85%), cognitive factors (75%), socialization processes (65%), and environmental issues (55%).

CONCLUSIONS

Youth perceptions about relapse during treatment should be used to better inform clinical approaches and shape early-intervention recovery agendas for substance-abusing youth.

Perceptions of chronicity and recovery among youth in treatment for substance use problems

PURPOSE

To explore how youth contextualize substance use problems and recovery, in general and for themselves, in relation to the commonly accepted chronicity framework.

METHODS

Fourteen focus groups were conducted with 118 youth in substance abuse treatment settings (aged 12-24 years; 78.3% male; 66.1% Latino) located throughout diverse areas of Los Angeles County. Transcribed qualitative focus group data were analyzed for major substance use and recovery themes.

RESULTS

Most (80%) youth do not accept a chronicity framework that conceptualizes substance use problems as recurring and constituting a lifelong illness. Most (65%) view substance use problems as a function of poor behavioral choices or a developmental/social lifestyle phase. Youth perceptions of recovery tend to parallel this view, as most define recovery to mean having an improved or changed lifestyle that is achieved through making better behavioral choices (67%) and exerting personal control over one's behavior (57%) through willpower, confidence, or discipline. Other recovery themes identified by youth were substance use related (47%), wellness or well-being related (43%), and therapeutic or treatment related (14%).

CONCLUSIONS

Findings highlight the importance of considering youth perceptions about substance use chronicity and recovery in making improvements and promoting new developments in clinical and recovery support approaches to better meet the needs of youth with substance use problems. Findings are discussed under a theoretical context of behavior change to provide insights for the treatment and recovery communities.

Point-of-Purchase Alcohol Ads in One Low-Income Community in Central California

This study explores the occurrence of point-of-purchase (POP) alcohol ads in one low-income community Central California, identifies their target audience and themes, and obtains their perspective on how the ads influence women’s alcohol consumption. Methods included observation of POP alcohol ads in local supermarket and convenience stores that sell alcohol products, content analysis of a selection of these POP alcohol ads, and focus group discussions with young women who are mostly in their twenties from both Latina and non-Latina backgrounds. A total of 2,021 POP alcohol ads were observed in 164 retail establishments that sell alcohol. Of these ads, we took photos of 64 different ads for content analysis. Our content analysis indicated that most POP alcohol poster ads appealed both to men and women, with themes mainly related to sex and sports. Focus group interviews indicated that sex and sports-themed alcohol ads, coupled with the presence of peers and family members that drink alcohol, are influential in women’s decisions to drink. The influence of alcohol ads on norms regarding alcohol consumption warrant stronger anti-alcohol policies, such as the banning alcohol ads in places frequented by minors, and the implementation of anti-alcohol marketing campaigns with a health consequences focus.

Quality of life among treatment seeking methamphetamine-dependent individuals

As the number of men and women entering treatment for substance use disorders continues to increase across the country, it becomes vitally important to understand their quality of life (QOL) or perceived health status, in order to inform treatment efforts for improving such outcomes. To date, QOL assessments among methamphetamine (MA) dependent users are limited. This paper examines QOL health status among a sample of 838 treatment seeking MA users at admission. Using regression analysis, predictors of QOL are examined among MA users. Predictors of poor QOL among MA users at treatment admission included being female, white, high school educated or more, married, experiencing psychosocial dysfunction (lifetime trauma, suicide, social conflict), reporting a high frequency of both MA and polydrugs for 15 days or more in the past month, chronicity of MA and polydrug use, injection use, and having co-morbid medical and psychiatric impairment. Employment status was the only factor related to better health status perceptions. This study expands the scope of scholarly examination of MA-dependent users entering treatment, as there has not been a development of coherent profiles of QOL among representative samples of clinical MA-abusing populations to date.

Risk communication for public health emergencies

This review defines crisis risk communication, traces its origins to a number of applied fields, and then shows how basic principles have become incorporated into emergency preparedness and risk communication for public health. Literature from four different disciplines that inform crisis risk communications are reviewed. These are (a) environmental risk communication, (b) disaster management, (c) health promotion and communication, and (d) media and communication studies. Current curricula and training materials are briefly reviewed. Although this literature review suggests much progress has been made to incorporate and disseminate crisis risk communication principles into public health practice, and case studies suggest that public health workers have gained skills and experience, this emerging field still lacks in-depth evaluation of the effectiveness of event-specific crisis risk communication efforts.

Acceptance of HIV testing and counseling among unmarried young adults in Northern Thailand

A cluster randomized trial was used to assess the effect of an active group intervention in promoting utilization of voluntary HIV testing and counseling (HIV-TC). Villagers from 40 clusters were sampled to represent the premarital age population and assigned into two groups, intervention and comparison. The intervention was designed to enhance risk perception and increase knowledge about HIV testing. Interviews were performed before and after the intervention. At baseline, 23% of 398 participants had been tested for HIV at least once and 90% reported testing positive. Most participants perceived that they had no chance of being infected with HIV. Among the intervention group, 71% participated in the intervention activities. The risk ratio of HIV-TC acceptance among the intervention group was 2.92, but the risk difference was only 8.11%. Factors associated with HIV-TC acceptance were ever having had a sexually transmitted disease, being previously married, intention to get tested, and having partici pated in AIDS-related activities.

Cognitive and Behavioral Factors in Community-Based Malaria Control in Malawi

Monitoring of preventive health behaviors and their determinants at the level of households is an important component in field research for malaria control programs. Household members in twelve rural villages in south central Malawi participated in a study to show change over time in perceptions and behaviors in an area undergoing multiple malaria control interventions. Focus group interviews were used initially to elicit the major concepts villagers used to define and respond to the threat of malaria. A longitudinal household survey (T1: n = 2460; T2: n = 2149) measured biomedical or traditional knowledge about malaria causation and control, attitudes toward mosquitoes, barriers to taking preventive actions, and preventive behaviors defined as sanitation, traditional, or commercial methods to control mosquitoes. While adherence to traditional beliefs and behaviors was found among some, the majority of respondents also had adopted many biomedical beliefs and attitudes about malaria causation. Changes reflected both national and local initiatives to improve health status and control malaria. Behaviors changed over time and were associated with a village level intervention and with structural, situational, and cognitive attributes of respondents.

A multi-disciplinary curriculum for 11- to 13-year-olds: immunization, plus!

A sixth grade curriculum entitled "Immunization, Plus!" Was developed to promote adolescent immunization. This targeted immunization curriculum utilized contemporary learning theory and innovative teaching approaches and styles to maximize acceptability among educators. Because instructional time in school was limited, a thematic curriculum was created to embed immunization and communicable disease content within mathematics, science/health, and language arts units. The curriculum, which reflected the theory of multiple intelligences among students, offered an array of different learning formats, including linguistic, logical-mathematical, spatial, and bodily-kinesthetic. The curriculum was made available free of charge to school districts in California, and its evaluation was planned to track distribution, utilization, and changes in students' knowledge, attitude, and behavior.

Safety behaviors of mothers of young children: impact of cognitive, stress and background factors

We explore the relative contribution of cognitive, stress, and background variables as factors that explain safety behaviors of parents of young children. The data set was a probability sample of mothers of young children ( N= 1247). The focus of survey questions was predominantly home safety, a setting where young children are at highest risk for injury. We tested hypotheses using structural equations models. Our analyses indicate that stress and coping are important mediating factors between cognitive factors of perceptions of risk and safety behaviors practiced by parents of young children. Use of both cognitive and situational variables may be particularly important in understanding preventive health behaviors of mothers with young children. We also explore differences in models between African-American and white parents. We view this research as representing the continued development of health behavior research, extended to include parents and their children, since most health behavior research has not examined parental health behavior linked to protection of young children.

Observation evaluation to assess race and educational bias in state-mandated standard testing of nurse aides in nursing homes

This article presents an assessment of whether race, education, gender, or other testing bias was present in a state-mandated nurse aide competency test. This assessment was carried out with data from two sources: (a) a statewide standardized test for all nurse aides that was given by a nationally known testing company, (b) an independent observational evaluation with a Behaviorally Anchored Rating Scale (BARS) for nurse aides' performance that was carried out by the investigators. The results show that race and education level were predictors of performance on written and manual portions of the standardized test. Gender, age, and years of experience were also shown to predict test success. Comparing data from the two sources suggests that a possible bias in the standardized nurse aid test. The independent observation of performance on the job with the BARS is shown to be less biased.

Safety hazards in households with young children

Interviewed 230 mothers of young children concerning in-home observations of safety hazards related to burns, poisoning, and falls, and self-reported measures of maternal supervision, locus of control, social support, and safety attitudes. These were supplemented by measures of mothers' risk perceptions, stress and coping, their child's previous injury experience, and indicators of the family's socioeconomic status (SES) collected by telephone survey. SES was an important predictor of observed home hazards. Child-related variables, risk perceptions, and domain-specific attitudes had little influence on home hazards. Maternal supervisory style, rated on dimensions of protectiveness, was an important correlate of all types of household hazards. Results suggest that residential injury prevention strategies for young children should stress active as well as passive countermeasures.

Application of multiple methods to study the immunization programme in an urban area of Guinea

During 1988-89, studies were conducted to evaluate the immunization system in Conakry, Guinea. The first, a health facility survey, found that health staff screened the vaccination status of only 30% of children who presented for curative care. A sterile syringe and needle were used for less than half of the injections. In the second survey, key informant interviews with vaccinators and health centre chiefs showed that there were minimal lines of communication between health workers and the community, but that health workers did not perceive this to be a problem. Focus group discussions in the community revealed a high level of general knowledge about vaccine-preventable diseases. However, mothers did not know how many vaccinations their children should receive or by what age they should be completed. They complained of long waiting times in health centres, the high costs of vaccination, poor rapport with health workers, and the occurrence of abscesses after vaccination. The final study, a "knowledge, attitudes, and practice" community survey, showed that missed immunization opportunities and inappropriately timed vaccinations reduced potential vaccine coverage by almost 30% among children with vaccination cards. Higher socioeconomic status, delivery in hospital, and whether mothers perceived the vaccinations to be affordable affected whether the child began the immunization series. Once a child had entered the immunization system, completion of the series was determined by the mother's education level, employment status, and experience with vaccination services.

Symbolic, ritual and social dynamics of spiritual healing

Participant observation among white, middle class spiritual healing groups in the Baltimore area (1981-1983) revealed distinct sociocultural and interpersonal patterns of action and influence among two types of groups found. Types of groups were (1) Christian, Pentecostal, neo-Pentecostal or 'charismatic' healing groups and (2) 'New Age', or 'metaphysical' healing groups. Qualitative findings highlight similarities and differences between these two types of groups through examination of organizational characteristics, leadership patterns, ideological systems, and ritual processes. Illness and social characteristics of participants are also compared. Analysis of characteristics of groups and participants shows how the incorporation of explanatory models, social roles, myths, and symbols into the social, ideational, and ritual context of spiritual healing is essential to its therapeutic effect, and that spiritual healing exemplifies a symbolic healing system. Finally, a substantive theoretical model for healing research is suggested.

Psychosocial wellness among spiritual healing participants

The findings reported are based on an exploratory, comparison group study of participants in spiritual healing practices carried out over a 2-year period (1981-1983) in Baltimore, Md. In this study, participation in such forms of healing, which generally occurs in small groups, is related to various measures of psychosocial wellness defined as the emic construct of 'subjective health'. Interview data from regular participants in two types of healing group, charismatic (n = 83) and metaphysical (n = 93), were compared with regular utilizers of primary care (n = 137), using the same data collection procedures. Members of the two types of healing group differ on some social attribute data. Members of charismatic healing groups tend to be of slightly lower SES overall than members of metaphysical healing groups. Members of both types of healing groups, however, had significantly more positive scores on wellness measures than primary care patients, even when sex, age, marital status, illness severity and religiosity were controlled statistically. Findings suggest that such groups play a social support function among regular participants, and that participation in specific healing systems can be seen as a contextual variable which has an effect on subjective self-reports of health or, as defined here, wellness.