Medicine and Health Sciences Commons^™

The Community-Driven Approach To Environmental Exposures: How A Community-Based Participatory Research Program Analyzing Impacts Of Environmental Exposure On Lupus Led To A Toxic Site Cleanup, Julien A. Terrell, Edith M. Williams, Christine M. Murekeyisoni, Robert Watkins, Laurene Tumiel-Berhalter

Faculty Publications

Community-based participatory research (CBPR) is a mechanism to improve environmental quality in communities primarily inhabited by minorities or low income families. A collaborative partnership between the University at Buffalo and the Toxic Waste Lupus Coalition was formed to investigate the high prevalence of lupus in the area and whether cases of disease were linked to chemicals found at a nearby New York State Superfund site in East Buffalo. The purpose of the study was to use CBPR practices to educate impacted residents and enable their participation in efforts to get a nearby contaminated waste site remediated. Community members were active …

A 53-Year-Old Male Iron Foreman Dies After Fall From Steel Decking, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Falls

During the fall of 2007, a 53-year-old male iron foreman died when he fell approximately 18 feet from roofing being installed on a retail building under new construction. Two work crews were installing metal decking for a roof by laying corrugated metal sheets to the joists of a retail building being constructed. All workers wore personal fall arrest systems complete with lanyards on the roof; none of the workers were tied off to the building. The foreman had accessed the work site via a 32-foot extension ladder to check on the progress of the work. After speaking to the first …

Designation Of Medically Underserved And Health Professional Shortage Areas: Analysis Of The Public Comments On The Withdrawn Proposed Regulation, Emily Jones, Leighton C. Ku, Joseph Lippi, Ramona Whittington, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In February 2008, the Health Resources and Services Administration (HRSA) proposed new regulations that would have modified and combined the Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) designation processes. The comment period was extended twice in response to the large volume of comments, through June 30th. On July 23rd, HRSA effectively withdrew the proposed rule, announcing that in light of its preliminary review of comments, the agency had elected to develop a new proposal. This Research Brief highlights some of the salient issues surrounding the proposed rule, based on an analysis of the public comments by researchers …

Coffee Intake And Risk Of Incident Diabetes In Puerto Rican Men: Results From The Puerto Rico Heart Health Program, Barbara J. Fuhrman, Ellen Smit, Carlos J. Crespo, Mario R. Garcia-Palmieri

Community Health Faculty Publications and Presentations

Objective: To study prospectively the association of coffee intake with incident diabetes in the Puerto Rico Heart Health Program cohort, comprising 9824 middle-aged men (aged 35-79 years). Methods: Of 9824 men, 3869 did not provide a fasting blood sample at baseline, 1095 had prevalent diabetes and 131 were not given fasting glucose tests at any subsequent study visit. Thus, the present analysis includes 4685 participants. Diabetes was ascertained at baseline and at two study visits between 1968 and 1975 using fasting glucose tests and self-reports of physician-diagnosed diabetes or use of insulin or hypoglycaemic medication. Logistic regression analysis was used …

The Big Sky Model: A Regional Collaboration For Participatory Research On Environmental Health In The Rural West, Tony J. Ward, Diana Vanek, Nancy Marra, Andrij Holian, Earle Adams, David Jones, Randy Knuth

Public and Community Health Sciences Faculty Publications

As an innovative community-based framework for science learning, the Big Sky Model is guiding high school and tribal college students from rural areas of Montana and Idaho in their understanding of chemical, physical, and environmental health concepts in the context of their own homes, schools, and communities. Students participate in classroom lessons and continue with systematic inquiry through actual field research to investigate a pressing, real-world issue: understanding the complex links between poor air quality and respiratory health outcomes. This article provides background information, outlines the procedure for implementing the model, and discusses its effectiveness as demonstrated through various evaluation …

"Sitting In Different Chairs:" Roles Of The Community Health Workers In The Poder Es Salud/Power For Health Project, Stephanie Farquhar, Noelle Wiggins, Yvonne L. Michael, G. Luhr, Jennifer Jordon, A. Lopez

Community Health Faculty Publications and Presentations

Evaluations of Community Health Worker programs consistently document improvements in health, yet few articles clearly describe the roles of Community Health Workers (CHWs) from the CHWs' perspective. This article presents the CHWs' points of view regarding the various roles they played in a community-based participatory research (CBPR) project, Poder es Salud/Power for Health in Portland, Oregon, including their roles as community organizers and co-researchers. Methods: Authors draw from an analysis of transcript data from in-depth interviews conducted with CHWs to present a description of the strategies employed by the CHWs to build leadership skills and knowledge among community members. CHWs …

Impact Of Haemophilus Influenzae Type B Conjugate Vaccine On Bacterial Meningitis In The Dominican Republic, Ellen H. Lee, Miriam Corcino, Arelis Moore De Peralta, Zacarias Garib, Chabela Peña, Jacquelin Sánchez, Josefina Fernández, Jesús M. Feris-Iglesias, Brendan Flannery

Publications

OBJECTIVES:

Widespread use of Haemophilus influenzae type b (Hib) vaccines has dramatically reduced the burden of Hib disease throughout the Americas. Few studies have evaluated the impact of Hib vaccination on non-culture-confirmed disease. This study analyzed trends in probable bacterial meningitis before and after the introduction of Hib vaccine in the Dominican Republic and estimated vaccine effectiveness against Hib meningitis.

METHODS:

Meningitis cases among children < 5 years of age were identified from admission records of the main pediatric hospital in Santo Domingo during 1998-2004. Laboratory criteria were used to classify meningitis cases with probable bacterial etiology; confirmed cases had positive bacterial culture or antigen detection in cerebrospinal fluid. Cumulative incidence rates of confirmed and probable bacterial meningitis were calculated for children living in the National District. Confirmed cases of Hib meningitis were enrolled in a case-control study with age- and neighborhood-matched control children to calculate vaccine effectiveness.

RESULTS:

Before vaccine introduction, annual rates of meningitis with probable bacterial etiology were 49 cases per 100 000 children < 5 years old; Hib accounted for 60% of confirmed bacterial cases. During 2002-2004, after vaccine introduction, annual rates of probable bacterial meningitis were 65% lower at 16 cases per 100 000, and Hib accounted for 26% of confirmed cases. Rates of Hib meningitis and probable bacterial meningitis with no determined etiology declined by 13 and 17 cases per 100 000, respectively.

CONCLUSIONS:

Introduction of Hib vaccine substantially reduced the incidence of confirmed and probable bacterial meningitis in …

Incidence Of Cancers Of The Oral Cavity And Pharynx Among American Indians And Alaska Natives, 1999–2004, Marsha E. Reichman, Janet J. Kelly, Carol L. Kosary, Steven S. Coughlin, Melissa Jim, Anne P. Lanier

United States Public Health Resources

BACKGROUND. Previous studies identified disparities in incidence rates of cancers of the oral cavity and pharynx between American Indians/Alaska Natives (AI/AN) and non-Hispanic whites (NHW) and differences between various AI/AN populations. Reporting among AI/AN has been hampered by: 1) heterogeneity among various anatomic sites of oral cavity and pharyngeal cancers obscuring unique patterns of individual anatomic sites; 2) race misclassification and under-reporting of AI/AN; and 3) sparseness of data needed to identify regional variations.

METHODS. To improve race classification of AI/AN, data from US central cancer registries were linked with Indian Health Service (IHS) records. AI/AN incidence data …

Cancer In American Indian And Alaska Native Young Adults (Ages 20–44 Years): Us, 1999–2004, Hannah K. Weir, Melissa Jim, Loraine D. Marrett, Temeika L. Fairley

United States Public Health Resources

BACKGROUND. An examination of cancer incidence patterns in American Indians and Alaska Native (AI/AN) young adults may provide insight into their present and future cancer burden.

METHODS. To reduce racial misclassification, incidence data were linked with the Indian Health Service (IHS) patient services database. Age-adjusted cancer incidence rates per 100,000 (AAR) and corresponding rate ratios (RR) for young adults (ages 20-44 years) were compared across IHS regions and for selected cancers within Contract Health Service Delivery Area counties by race (AI/AN vs non-Hispanic whites [NHW]) and sex.

RESULTS. The all-sites cancer incidence rate was lower for AI/ANs …

Gastric Cancer Among American Indians And Alaska Natives In The United States, 1999–2004, Charles Wiggins, David G. Perdue, Jeffrey A. Henderson, Michael G. Bruce, Anne P. Lanier, Janet J. Kelly, Brenda F. Seals, David K. Espey

United States Public Health Resources

BACKGROUND. Gastric cancer incidence rates for American Indians and Alaska Natives (AI/ANs) historically have exceeded those for non-Hispanic whites (NHWs). Previous reports may have underestimated the true burden of gastric cancer in AI/AN populations because of misclassification of AI/AN race in cancer registries.

METHODS. Population-based cancer registry data from 1999 through 2004 were used to describe gastric cancer incidence in AI/ANs and NHWs in the US. To address misclassification of race, registry data were linked with Indian Health Service administrative records, and analyses were restricted to residents of Contract Health Service Delivery Areas (CHSDA). Disease patterns were assessed …

Shea/Apic Guideline: Infection Prevention And Control In The Long-Term Care Facility, Philip W. Smith, Gail Bennett, Suzanne Bradley, Paul Drinka, Ebbing Lautenbach, James Marx, Lona Mody, Lindsay Nicolle, Kurt Stevenson

United States Department of Veterans Affairs: Publications

Long-term care facilities (LTCFs) may be defined as institutions that provide health care to people who are unable to manage independently in the community.¹ This care may be chronic care management or short-term rehabilitative services. The term nursing home is defined as a facility licensed with an organized professional staff and inpatient beds that provides continuous nursing and other services to patients who are not in the acute phase of an illness. There is considerable overlap between the 2 terms.

More than 1.5 million residents reside in United States (US) nursing homes. In recent years, the acuity of illness …

An Integrated Intervention In Pregnant African Americans Reduces Postpartum Risk: A Randomized Trial, Ayman El-Mohandes, Michele Kiely, Jill G. Joseph, Siva Subramanian, Allan A. Johnson, Susn M. Blake, Marie G. Gantz, M. Nabil El-Khorazaty

Publications and Research

Objective—To evaluate the efficacy of an integrated multiple risk intervention delivered mainly during pregnancy, in reducing such risks (smoking, environmental tobacco smoke exposure, depression and intimate partner violence) postpartum.

Design—Data from this randomized controlled trial were collected prenatally and on average 10 weeks postpartum in six prenatal care sites in the District of Columbia. African Americans were screened, recruited and randomly assigned to the behavioral intervention or usual care. Clinic-based, individually tailored counseling was delivered to intervention women. The outcome measures were number of reisks reported postpartum and reduction of these risks between baseline and postpartum.

Results—The …

The Effectiveness Of Treatment In An Inpatient And Outpatient Psychiatric Facility, Timothy Quan Tran

Loma Linda University Electronic Theses, Dissertations & Projects

The present study is aimed at examining treatment outcome in a large psychiatric facility that provides both inpatient and outpatient services to a broad range of patients. Not only will patient outcomes be assessed at a facility-wide level, but patient outcomes on the various units/programs in the facility will also be assessed and compared. It is expected that, facility wide, patients will show significant improvement on the outcome measure from admission to discharge, but that patient outcomes will differ across the various units/programs in the facility. In sum, the results of the paired-sample t-test and effect size obtained in this …

Breast Cancer Screening Disparities In Japanese-American Women, Theodora Stratis

Loma Linda University Electronic Theses, Dissertations & Projects

Cancer screening disparities in ethnic minority women have received much research attention in the last several years due to a marked increase in ethnic minority cancer incidence and poor survival rates (Miller, Kollnel, Bernstein, Young Swanson, West et ah, 1996). Breast cancer is the leading cause of death for Asian American women (Asian American Network for Cancer Awareness, Research & Training, 2002) and, although their incidence and mortality rates are lower than Caucasian women, these rates continue to increase every year. This increasing mortality rate is likely due to the underutilization of breast cancer screening by Asian American women. Asian …

Is American Health Care Uniquely Inefficient?, Alan M. Garber, Jonathan Skinner

Dartmouth Scholarship

No abstract provided.

Gender Differences In The Risk Of Hiv Infection Among Persons Reporting Abstinence, Monogamy, And Multiple Sexual Partners In Northern Tanzania, Keren Z. Landman, Jan Ostermann, John A. Crump, Anna Mgonja, Meghan K. Mayhood, Dafrosa K. Itemba, Alison C. Tribble, Evaline M. Ndosi, Helen Y. Chu, John F. Shao, John A. Bartlett, Nathan M. Thielman

Faculty Publications

Background: Monogamy, together with abstinence, partner reduction, and condom use, is widely advocated as a key behavioral strategy to prevent HIV infection in sub-Saharan Africa. We examined the association between the number of sexual partners and the risk of HIV seropositivity among men and women presenting for HIV voluntary counseling and testing (VCT) in northern Tanzania.

Methodology/ Principal Findings: Clients presenting for HIV VCT at a community-based AIDS service organization in Moshi, Tanzania were surveyed between November 2003 and December 2007. Data on sociodemographic characteristics, reasons for testing, sexual behaviors, and symptoms were collected. Men and women were categorized by …

Pengelolaan Sampah Berbasis Masyarakat Di Kampung Rawajati Jakarta Selatan, Catur Puspawati, Besral Besral

Kesmas

Kampung Rawajati di Jakarta yang menerapkan sistem pengelolaan sampah berbasis masyarakat merupakan alternatif upaya mengatasi sampah rumah tangga. Penelitian ini bertujuan mengetahui pengaruh sistem tersebut terhadap penurunan berat sampah rumah tangga. Dengan desain studi potong lintang, penelitian ini dilakukan pada sampel 175 ibu rumah tangga yang dipilih secara acak. Hasil penelitian ini menunjukan bahwa pengelolaan sampah berbasis masyarakat dapat menurunkan berat sampah sebesar 28,3%. Analisis regresi linier ganda memperlihatkan bahwa kegiatan pengelolaan yang berpengaruh terhadap penurunan berat sampah adalah kegiatan reuse, daur ulang, dan pembuatan kompos (nilai-p < 0,05). Pembuatan kompos merupakan variabel yang berkontribusi terhadap penurunan berat sampah 657,3 gram setelah dikontrol variabel perancu. Penurunan berat sampah ditemukan lebih besar pada rumah tangga yang mendapat pelatihan. Tidak ada perbedaan penurunan berat sampah menurut jumlah anggota keluarga, penghasilan rumah tangga, dan pengetahuan ibu. Disarankan agar Pemerintah DKI Jakarta dapat melakukan replikasi model pengelolaan sampah berbasis masyarakat kepada wilayah lainnya, dengan memberikan pelatihan pengelolaan sampah kepada masyarakat. Kampung Rawajati in Jakarta applies community-based solid waste management system as an alternative way to overcome household waste problem. The objective of the research is to assess the effect of community-based solid waste management on reduction of household waste weight. This study has crosssectional study design and was conducted on 175 housewife as respondent who were selected randomly. The data was collected by interview using structured questionnaire and weighing of household waste. The result shows that the community-based solid waste management can reduce 28.3% of household waste weight (weight before: 1.845 gram/house/day and after: 1.324 gram/house/day). Multiple linear regression analysis shows that variables affecting the reduction of solid waste including re-using activity, recycling, and composting (p-value <0.05). Composting represents the biggest effect to reduction (657.26 gram) after controlled by potential confounders. The reduction was higher among household with waste training and number of trained household member. It was found that number of family member, family income, and mother knowledge are not significant. It was recommended to the Government of DKI Jakarta to replicate this community-based waste management system to other regions by providing training facilities on solid waste management.

Faktor Penentu Kontaminasi Bakteriologik Pada Makanan Jajanan Di Sekolah Dasar, Anton Wibawa

Kesmas

Makanan jajanan merupakan produk pengolahan makanan yang banyak dijumpai di sekitar sekolah dan dikonsumsi secara rutin oleh banyak anak usia sekolah. Selain bermanfaat makanan jajanan juga berisiko menimbulkan masalah kesehatan. Tujuan penelitian ini adalah mengetahui kontaminasi bakteriologi pada makanan jajanan serta faktor yang mempengaruhinya. Penelitian ini menggunakan disain potong lintang (Cross Sectional), dengan sumber data sekunder kegiatan pengawasan makanan dan minuman oleh Dinas Kesehatan Kabupaten Tangerang tahun 2006. Sampel diambil dari 159 Sekolah Dasar di kabupaten Tangerang. Variabel yang diamati adalah : pengetahuan, perilaku, peralatan sarana air bersih, sarana pembuangan limbah, tempat pembuangan sampah dan lokasi usaha, sedangkan variabel terikat …

Analisis Praktek Bidan Pada Pelayanan Ibu Bersalin Dan Bayi Baru Lahir, Alhafiza Putra

Kesmas

Sekitar tigapuluh persen kematian bayi terjadi pada periode neonatal yang 80 % di antaranya terjadi pada minggu pertama. Hal tersebut mengindikasikan status kesehatan ibu dan bayi baru lahir yang rendah serta akses dan kualitas pelayanan persalinan masih rendah. Tahun 2006, kematian neonatal di Kabupaten Solo adalah 47 dari 8.250 kelahiran hidup dan di Kecamatan Lembah Gumanti adalah 23 kematian neonatal dari 1,091 kelahiran hidup. Tujuan penelitian ini untuk mengetahui pengaruh praktek bidan di wilayah kerja Puskesmas Alahan Panjang terhadap pelayanan ibu bersalin dan bayi baru lahir pasca persalinan. Penelitian dilakukan dengan metode kualitatif diskusi kelompok terarah, wawancara mendalam dan observasi. …

Pre-Eklampsia Berat Di Rsud Bayu Asih Purwakarta, Lia Yulianti, Sandra Fikawati

Kesmas

Pada periode 2004 - 2005, kejadian pre-eklampsia berat pada ibu hamil di RSUD Bayu Asih Purwakarta meningkat dari 15,2% menjadi 23,6%. Peningkatan kejadian PEB ini diperkirakan dipengaruhi faktor pendidikan, pekerjaan, umur ibu, paritas, umur kehamilan, riwayat penyakit, dan pemeriksaan antenatal. Penelitian ini bertujuan melakukan analisis berbagai faktor determinan pre-eklampsia berat pada Ibu hamil di RSUD Bayu Asih Purwakarta. Penelitian dengan disain studi case control ini dilakukan pada 133 kasus ibu dengan pre-eklampsia berat dan 133 kontrol ibu dengan non pre-eklampsia berat di RSUD Bayu Asih Purwakarta tahun 2004-2005. Metoda analisis yang digunakan adalah metoda analisis regresi logistik ganda. Penelitian ini …

Malaria Vivax Di Kabupaten Nias Selatan, Lambok Siahaan

Kesmas

Diperkirakan sekitar 2,5 milyar manusia hidup di wilayah endemis malaria dengan ± 300 juta kasus dan ± 1 juta kematian yang sebagian besar adalah anak-anak. Di Indonesia, malaria tak pernah tereradikasi dan mengalami pasang surut dari tahun ke tahun. Di Jawa-Bali, API pada tahun 2001 (0,62%) dan 2004 (0,15‰) dan di luar Jawa-Bali, AMI pada tahun 2001 (26,20‰) dan 2004 (21,20‰) terlihat menurun. Kabupaten Nias Selatan merupakan daerah endemis malaria dengan angka Monthly Malaria Incidence (MoMI) pada 2005 (124,24 ‰). Gempa bumi tektonik dan tsunami dan gempa bumi susulan yang terjadi berpengaruh meningkatkan angka insiden. Lingkungan menjadi lebih kondusif bagi …

Food Group Intake And Risk Of Subtypes Of Esophageal And Gastric Cancer, Stephanie A. Navarro Silvera, Susan T. Mayne, Harvey Risch, Marilee D. Gammon, Thomas L. Vaughan, Wong-Ho Chow, Robert Dubrow, Janet B. Schoenberg, Janet L. Stanford, Brian West, Heidrun Rotterdam, William J. Blot, Joseph F. Fraumeni Jr.

Department of Public Health Scholarship and Creative Works

Incidence rates for adenocarcinomas of the esophagus and gastric cardia have been increasing rapidly, while rates for non‐cardia gastric adenocarcinoma and esophageal squamous cell carcinoma have declined. We examined food group intake as a risk factor for subtypes of esophageal and gastric cancers in a multicenter, population‐based case–control study in Connecticut, New Jersey and western Washington state. Associations between food groups and risk were estimated using adjusted odds ratios (OR), based on increasing intake of one serving per day. Total vegetable intake was associated with decreased risk of esophageal adenocarcinoma (OR = 0.85, 95% CI = 0.75, 0.96). Conversely, total …

Uninsured And Medicaid Patients' Access To Preventive Care: Comparison Of Health Centers And Other Primary Care Providers, Avi Dor, Yuriy Pylypchuck, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This issue of Research Briefs examines health centers' role in reducing disparities in preventive health care access by medically vulnerable and high risk populations. The analysis uses information from several national data sources to examine differences in the provision of preventive health care to Medicaid and uninsured patients between health centers and other primary care providers.

Key Findings:

• Compared to those treated by other primary care providers, Medicaid and uninsured patients treated by health centers are significantly poorer, in significantly worse health, and in the case of uninsured patients, more likely to be members of racial and ethnic minority groups. …

Development And Pilot Testing Of A Low Literacy Handout For Hispanic/Latino Caregivers To Promote Breastfeeding And Introduce Age Appropriate Foods For Infants, Judith C. Rodriguez, Nancy Correa-Matos

Florida Public Health Review

Based on input from four focus groups the authors developed a culturally and linguistically appropriate material (CLAM) that used a pictorial format to promote breast feeding and age-appropriate introduction of solids for Hispanics/Latinos that attended a public health clinic in the northeast region of Florida. The handout focused on five key, but simple educational messages. Clients were randomly assigned to receive 1) the physician's usual oral instruction or 2) instruction that incorporated the use, and provision of, the handout. Among the group (n=12) that received the handout the mean month for introduction of solids was 5 months compared to 4.07 …

A Metastasis Or A Second Independent Cancer? Evaluating The Clonal Origin Of Tumors Using Array-Cgh Data, Irina Ostrovnaya, Adam Olshen, Venkatraman E. Seshan, Irene Orlow, D G. Albertson, Colin B. Begg

Memorial Sloan-Kettering Cancer Center, Dept. of Epidemiology & Biostatistics Working Paper Series

When a cancer patient develops a new tumor it is necessary to determine if this is a recurrence (metastasis) of the original cancer, or an entirely new occurrence of the disease. This is accomplished by assessing the histo-pathology of the lesions, and it is frequently relatively straightforward. However, there are many clinical scenarios in which this pathological diagnosis is difficult. Since each tumor is characterized by a genetic fingerprint of somatic mutations, a more definitive diagnosis is possible in principle in these difficult clinical scenarios by comparing the fingerprints. In this article we develop and evaluate a statistical strategy for …

Comorbidities Of Patients With Hypertension Admitted To Emergency Departments In Florida Hospitals

Florida Public Health Review

Although essential hypertension (EHT) tends to coexist with other conditions, few studies have focused on comorbidities and symptoms among patients admitted to emergency departments (ED). The objective was to compare the characteristics, comorbidities and symptoms among patients with three types (unspecified, benign, or malignant) of EHT in Florida. A public use data set of ED patients from the Florida Agency for Health Care Administration (AHCA) from 2005 was used. Records included those with primary diagnosis of three types of EHT based on the International Classification of Diseases, 9th edition (ICD-9) code. Group comparisons were made using Chi square tests and …

Community-Based Long-Term Care In Milwaukee: Wisconsin Still Ahead, Judith D. Moore, Carol O'Shaughnessy, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum has made two site visits to Wisconsin in two years. The first, in August 2007, focused on an overview of Family Care, the state's managed long-term care program, and looking at service delivery in a rural setting. The August 2008 site visit focused on the operations of MCOs and Family Care service providers in the urban environment of Milwaukee. Issues examined included the link between housing and social services, care management, capitation and rate-setting, measuring quality, and integrating people with disabilities into a program that initially targeted the elderly.

Strong As The Weakest Link: Medical Response To A Catastrophic Event, Eileen Salinsky

National Health Policy Forum

Natural disasters and acts of terrorism have placed a spotlight on the ability of health care providers to surge in response to catastrophic conditions. This paper reviews the status of efforts to develop the capacity and capabilities of the health care system to respond to disasters and other mass casualty events. Strategies for adapting routine medical practices and protocols to the demands posed by extraordinary circumstances and scarce resources are summarized. Existing federal roles, responsibilities, and assets relative to the contributions of state and local government and the private sector are described, including specific programmatic activities such as the Strategic …

Tell A Church - Lessons Learned From A Church-Based Tuberculosis Health Education Program

Florida Public Health Review

Historically, the church has been the center of the African American community – contributing to the spiritual and physical well-being of its congregations. Community health education outreach utilizing African American churches could prove effective but is often neutralized by historical feelings of distrust in research and outreach by secular organizations. During the summer of 2007, the “Think TB” project, a tuberculosis education program, attempted to utilize the church as a health education venue and overcome the historical hurdles that usually hamper church- based health education promotion. This paper discusses the “Think TB” program’s challenges and successes.

Properties Of Monotonic Effects On Directed Acyclic Graphs, Tyler J. Vanderweele, James M. Robins

COBRA Preprint Series

Various relationships are shown hold between monotonic effects and weak monotonic effects and the monotonicity of certain conditional expectations. Counterexamples are provided to show that the results do not hold under less restrictive conditions. Monotonic effects are furthermore used to relate signed edges on a causal directed acyclic graph to qualitative effect modification. The theory is applied to an example concerning the direct effect of smoking on cardiovascular disease controlling for hypercholesterolemia. Monotonicity assumptions are used to construct a test for whether there is a variable that confounds the relationship between the mediator, hypercholesterolemia, and the outcome, cardiovascular disease.