Public Health Commons^™

Health Systems And Maternal Mortality, Neonatal Mortality And Child Health: Review Of Selected Service Delivery Models, Md. Noorunnabi Talukder, Ubaidur Rob

Reproductive Health

Effective maternal and child health services at the community level in developing countries are rarely available. In many developing countries the health systems cannot provide quality maternal and child health care services due to lack of adequate human resources; shortages of equipment, drugs, and supplies; and absence of proper referral mechanisms. Strengthening health systems is central to improving maternal and child health. A variety of targeted interventions have been implemented in the health systems of developing countries. This study was conducted to identify the health service delivery models that have contributed to the reduction of maternal, infant, and child mortality …

Kenya: Begin Community Dialogue On Fgm/C By Discussing Cultural Justification, Frontiers In Reproductive Health

Reproductive Health

Female genital cutting is strongly supported among the Somali ethnic community in Kenya, and the severest form (infibulation) is primarily practiced. This type of cut is associated with increased incidence and seriousness of obstetric and gynecological problems relative to uncut women and those with less severe forms of FGM/C. As stated in this brief, efforts to encourage abandonment should begin with community discussion about the socio-cultural reasons for cutting. Simultaneously, health-care providers need training in how to manage complications of FGM/C. In 2004, FRONTIERS collaborated with UNICEF on a four-month diagnostic study on FGM/C practices among the Somali community in …

Senegal: Mainstreaming Adolescent Health: Building On Local Support Systems, Frontiers In Reproductive Health

Reproductive Health

In 1999, FRONTIERS began a three-year collaboration with the World Health Organization, the Center for Research and Training, the Population Training Group, and the Ministries of Health, Education, and Youth to test the feasibility, effectiveness, and cost of school-, clinic-, and community-based interventions to improve the reproductive health of youth aged 10–19. This adolescent reproductive health (ARH) study showed that the multisectoral, multidisciplinary approach increased knowledge about youth reproductive health among young people, the community, schools, and health-care providers. As noted in this brief, one of the guiding principles of the ARH study was to build sustainability through existing institutions, …

Episiotomy And Obstetric Trauma In Nevada: Evidence From Linked Hospital Discharge And Birth Data, Gulzar H. Shah, Joseph A. Greenway, Wei Yang

Nevada Journal of Public Health

Based on the perception that episiotomy prevents obstetric trauma, the procedure is liberally performed in U.S. Hospitals. Using linked Nevada Birth Registry and Nevada Impatient Hospital Discharges (2000 to 2005), we applied descriptive analyses and logistic regression to examine the status of Nevada episiotomy practice and its impact on birth trauma for mothers. Of 106,461 vaginal live births, 26,383 (24.8%) episiotomies were conducted. Obstetric trauma rate declined from 5.2% of vaginal deliveries in 2000 to 4.4% in 2005. After statistically controlling for the effect of other risk factors, zero parity, episiotomy, other instrument assisted deliveries, non-MDs as birth attendants, rural …

Las Vegas: A Sustainable Urban Environment For Health?, Nancy Menzel

Nevada Journal of Public Health

The rapid growth of Las Vegas has resulted in negative consequences for the health of its residents to a level that threatens the area’s sustainability. This article reviews key indicators of population health in Las Vegas through the framework of the US Centers for Disease Control and Prevention’s Healthy People in Healthy Places and concludes that public health professionals, citizens, businesses, and political leaders must act now to protect and improve population health.

Book Review: Social Justice: The Moral Foundations Of Public Health And Health Policy, Robin West

Georgetown Law Faculty Publications and Other Works

This essay is a review of Social Justice: The Moral Foundations of Public Health and Health Policy by Madison Powers & Ruth Faden (2006).

In this pathbreaking book, senior bioethicists Powers and Faden confront foundational issues about health and justice. How much inequality in health can a just society tolerate? In a world filled with inequalities in health and well-being, which inequalities matter most and are the most morally urgent to address? In order to answer these questions, Powers and Faden develop a unique theory of social justice that, while developed for the specific contexts of public health and health …

The Latino Caregiver Experience Among Dementia And Non-Dementia Caregivers : Can Community Based Care Management Improve Caregiver Health?, Catherine Oliveros

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: This study provides an analysis of the Latino caregiving community in Southeast Texas and the role community based care management plays in influencing caregiver physical and emotional well-being. Design and Methods: A non-random sample of 63 Latino caregivers was interviewed by phone. Caregiver physical and emotional well-being was studied through burden, depression, perceived health status, and resourcefulness. Regression, correlation, and comparison analysis was performed with key variables. Results: Acculturation was positively correlated with care management use. In comparing dementia and non-dementia caregivers both groups had similar levels of depression and burden, however, the dementia group had significantly lower levels …

The Qingdao Twin Registry: A Focus On Chronic Disease Research, C. Anderson Johnson, Zengchang Pang, Feng Ning, Jennifer B. Unger, Shaojie Wang, Qian Guo, Weihua Cao, Liming Lee

CGU Faculty Publications and Research

With the changing patterns of morbidity and mortality in China, noncommunicable chronic diseases have become the major threats to the health of the Chinese population. The causes of chronic diseases include genetic factors and behavioral risk factors such as the use of tobacco, alcohol, and other drugs, unhealthy dietary behaviors, and lack of physical activity. Twin studies offer a unique opportunity to disentangle the genetic and environmental risk and protective factors for chronic disease. The Qingdao Twin Registry (QTR) was initiated in 1998 as part of the National Chinese Twin Registry. Over 11,000 pairs of twins and multiples of all …

Community Mobility And Dementia: A Review Of The Literature, Nina M. Silverstein, Megan Vanderbur

Gerontology Institute Publications

By the year 2030, 70 million Americans will be 65 or older. Approximately 80 percent of this population will likely be driving themselves. And without appropriate and timely interventions, many are likely to be driving with Alzheimer’s disease (AD). Current estimates suggest that 2 percent of the population 65 to 74, 19 percent of the population 75 to 84, and 47 percent of the population 85 and older are likely to suffer from Alzheimer’s disease or a related disorder. By the year 2050, the number of Americans with Alzheimer’s disease could range from 11.3 million to 16 million. This significant …

Stress, Coping, Social Support, And Prostate Cancer Risk Among Older African American And Caucasian Men, Ann L. Coker, Maureen Sanderson, Gary L. Ellison, Mary Kay Fadden

CRVAW Faculty Journal Articles

Objectives: While psychosocial stress and high effort coping have been associated with reduced immune function, no epidemiologic study has addressed psychological stress and risk of prostate cancer. The purpose of this analysis was to investigate the association between stress, coping, social support, and risk of prostate cancer among older men (age 65–79 years). Design: Population-based case-control study in South Carolina.

Participants: Cases were 400 incident, histologically confirmed prostate cancer cases identified through the South Carolina Central Cancer Registry between 1999 and 2001 (70.6% response rate). Controls were 385 men identified through the 1999 Health Care Financing Administration Medicare beneficiary file …

The Complex Realities Of Indigenous Health Care Delivery, Megan Waterman

Independent Study Project (ISP) Collection

The indigenous population of Australia faces a life expectancy that is eighteen years lower than the general population. This study addresses this incredible disparity by exploring the historical, cultural and social forces that impact on health status, focussing especially on health care service utilisation. Qualitative methods of interviewing and participant observation have been used to examine the two sectors of Aboriginal health service delivery in urban Victoria: Aboriginal community controlled health organisations (ACCHOs) and mainstream organisations. Accounting for the complex forces and realities in health service delivery, this is a discussion of the important components of the current realities for …

Examining The Structural Covariates Of Methamphetamine Use: A Social Disorganization Perspective, Justin Smith

Masters Theses

There have been many anecdotal accounts describing the characteristics of individuals involved in methamphetamine use, trafficking and production. However, prior to the current study there was yet to be a macro-level analysis of methamphetamine use. The extant macro-level literature on drug use has suggested that areas with high levels of social disorganization experience high rates of drug use. It was expected that school-districts with low SES and high rates of ethnic heterogeneity, residential instability and family disruption will experience high rates of methamphetamine use. In addition, it was expected that rural school districts would show higher rates than urban and …

Measuring The Influence Of Built Neighborhood Environments On Walking In Older Adults, Yvonne L. Michael, Tracey Beard, Dongseok Choi, Stephanie Farquhar, Nichole Carlson

Community Health Faculty Publications and Presentations

Examined the degree of association between perceived and objective characteristics of the neighborhood environment and the relation of each type of measurement to neighborhood walking in older adults. Participants included 105 adults aged 65-92 (mean age 75.1) from 10 neighborhoods in Portland, Oregon, participating in Senior Health and Physical Exercise (SHAPE), a randomized walking intervention. Neighborhoods were stratified by a "walking friendliness" ranking variable. This variable was derived for each neighborhood based on available social and environmental data that were hypothesized to correlate with walking and physical activity: high income, high older adult population density, high proportion of white residents, …

Low Birth Weight, Very Low Birth Weight And Infant Mortality In San Bernardino County : A Secondary Analysis Of Maternal Factors, Rebecca D. Nanyonjo

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: National and state infant mortality rates have slowly declined over the last several years. Despite this reduction, San Bernardino County still has one of the highest infant mortality rates in California and racial disparities between Black and White infants not only persist but continue to widen. These disparities remain at the forefront of concern. Healthy People 2010 target objectives have yet to be reached, while national and state proposed plans have supported the statement that a community's largest health problem is initiated by its infant mortality. The purpose of this study was to investigate maternal factors through use of …

Cultural/Interpersonal Values And Smoking In An Ethnically Diverse Sample Of Southern California Adolescents, C. Anderson Johnson, Paula Palmer, Jennifer B. Unger, Sohaila Shakib, Peggy Gallaher, Anamara Ritt-Olson, Michele Mouttapa

CGU Faculty Publications and Research

In ethnically diverse school contexts, values from multiple cultures might influence adolescents' attitudes and behaviors. This study developed scales to assess cultural values among Southern California 6- grade adolescents (N=2281) and evaluated the associations between values and smoking. The scales assessed values salient in many Hispanic and Asian cultures: Respect for Adults (e.g., filial piety, respeto). Interpersonal Harmony (e.g., saving face, simpatia), and Differentiated Gender Roles (e.g., machismo). In cross-sectional and one-year longitudinal models. Respect for Adults and Interpersonal Harmony were associated with a lower risk of lifetime smoking. The associations were significant even after controlling for demographic characteristics, friends' …

Sex-Education And Preventative And Contraceptive Services: Educação-Sexual E Serviços Contraceptivos E Preventativos, Elizabeth M. Ortiz

Independent Study Project (ISP) Collection

Maternal morbidity is one of the leading causes of death amongst women in Latina America. Lack of access to Reproductive Health services has incited a continental epidemic amongst adolescent women - and should be considered a public health crisis. Yet, there is little being done by the governing male bodies to secure access and the Right to Reproductive Health services. This is not only a means of re-enforcing gendered inequalities- but also class, and racial disparities. Reproductive Health in Brazil and Northeastern Brazil in particular, serves as an allegory for socio-economic, gender, ethnic, and racial inequality in the region. The …

Racial Disparity And Socioeconomic Status In Association With Survival In Older Men With Local/Regional Stage Prostate Cancer: Findings From A Large Community-Based Cohort, Xianglin L. Du, Shenying Fang, Ann L. Coker, Corinne Aragaki, Janice N. Cormier, Yan Xing, Beverly J. Gor, Wenyaw Chan

CRVAW Faculty Journal Articles

BACKGROUND

Few studies have examined the outcomes for Hispanic men with prostate carcinoma and incorporated socioeconomic factors in association with race/ethnicity in affecting survival, adjusting for factors on cancer stage, grade, comorbidity, and treatment.

METHODS

We studied a population-based cohort of 61,228 men diagnosed with local or regional stage prostate carcinoma at age 65 years or older between 1992 and 1999 in the 11 SEER (Surveillance, Epidemiology, and End Results) areas, identified from the SEER-Medicare linked data with up to 11 years of followup.

RESULTS

Low socioeconomic status was significantly associated with decreasing survival in all men with prostate carcinoma. …

Strengthening Care And Support Services In The Era Of Treatment: Symposium Report, Horizons Program

HIV and AIDS

Sub-Saharan Africa has been devastated by the AIDS epidemic, with almost 26 million people infected in the region. As international attention continues to focus on sub-Saharan Africa as the region most affected by AIDS, hopeful signs have emerged, such as increased access to antiretroviral therapy (ART). Although the availability of ART has greatly increased in South Africa, care and support services continue to play a critical role in the lives of people infected and affected by HIV. In response to a growing call from program managers and researchers in South Africa to engage in a dialogue with policymakers and donors …

Preparedness For Hiv/Aids Service Delivery: The 2005 Kenya Health Workers Survey, National Aids And Std Control Programme, Ministry Of Health Kenya

HIV and AIDS

Kenya is one of the few countries that has succeeded in changing the course of the HIV/AIDS epidemic, and there is strong evidence of a decline in incidence. However, AIDS-related deaths now exceed new infections, and almost nine out of ten Kenyan adults do not know their HIV status. The expansion of HIV services in Kenya, including voluntary counseling and training and prevention of mother-to-child transmission programs, has enabled more Kenyans to learn their status. However, this leaves out many individuals who could benefit from HIV testing and counseling, such as hospital patients. Patients who present to a health-care facility …

Yaari Dosti: Young Men Redefine Masculinity, A Training Manual, Horizons Program, Coro For Literacy, Mamta, Instituto Promundo

HIV and AIDS

This training manual, developed by the Population Council in collaboration with Instituto PROMUNDO, CORO for Literacy, MAMTA, and DAUD promotes gender equity and addresses masculinity as a strategy for the prevention of HIV. Adapted from the “Program H: Working with Young Men Series” developed in Brazil by Instituto PROMUNDO, it promotes the positive aspects of masculinity, encourages men’s participation in sexual and reproductive health, promotes respect for sexual diversity, and improves understanding of the body and sexuality. In this manual, HIV prevention is addressed within the larger framework of gender roles and relationships. Gender disparity, widely prevalent in Indian society …

Shifting Support For Inequitable Gender Norms Among Young Indian Men To Reduce Hiv Risk And Partner Violence, Ravi K. Verma, Vaishali Sharma Mahendra, Julie Pulerwitz, Sujata Khandekar, Gary Barker, P. Fulpagare, S.K. Singh

HIV and AIDS

India accounts for the second largest population of people living with HIV/AIDS (5.1 million), and almost half of new infections occur in young men below age 30. While there are multiple factors influencing young men’s HIV risk in India, one that is receiving increasing attention is early socialization about masculinity. Young men in India mature and develop in a male-dominated context, having little contact with female peers and virtually no sex education. In this context, most boys develop a sense of masculinity characterized by male dominance in the sexual arena and other areas. Although there is increasing awareness of the …

Day Of Dialogue On Public Sector Pricing Of Pharmaceutical Products, Population Council

Formulation/Product Development

For decades, patients, doctors, ethicists, and other interested parties have debated the economics of the pharmaceutical industry. What is the best way to get medications and related products to the people who need them, regardless of their ability to pay? Can prices be lowered without jeopardizing basic research for new drugs? Are pharmaceutical company pricing practices monopolistic? What are the legal and ethical obligations related to drugs developed—partially or fully—with public funds? The Population Council convened a daylong meeting of academics, scientists, representatives from the nonprofit sector, the pharmaceutical industry, foundations, and government donor agencies, and practicing lawyers and doctors. …

Science-Based Organic Farming 2006: Toward Local And Secure Food Systems, Charles A. Francis, Katja Koehler-Cole, Twyla Hansen, Peter Skelton

Publications from the Center for Applied Rural Innovation (CARI)

Organic farming includes growing food and fiber—animals, agronomic crops, horticultural fruits and vegetables, related products—as one dynamic and rapidly evolving component of our complex U.S. food system. Even as more farmers are moving toward organic certification and participation in an environmentally sound and economically lucrative market, questions arise about the long-term social impacts and sustainability of a set of practices that has gone from a movement to an industry. Consolidations in the organic trade have brought multinational corporations to the table, as they have observed a grassroots activity that has grown by 20% per year for the past two decades, …

Reducing Aids-Related Stigma And Discrimination In Indian Hospitals, Vaishali Sharma Mahendra, Laelia Gilborn, Bitra George, Luke Samson, Rupa Mudoi, Sarita Jadav, Indrani Gupta, Shalini Bharat, Celine Daly

HIV and AIDS

People living with HIV/AIDS in India, as elsewhere, face stigma and discrimination in a variety of contexts. Research in India has shown that stigma and discrimination against HIV-positive people and those perceived to be infected are common in hospitals and act as barriers to seeking and receiving critical treatment and care services. Recognizing the need to move beyond documentation of the problem, three New Delhi hospitals; SHARAN, an Indian NGO; and the Horizons program, with support from the National AIDS Control Organisation (NACO), carried out an operations research project to develop and test responses to hospital-based stigma and discrimination against …

Promoting More Gender-Equitable Norms And Behaviors Among Young Men As An Hiv/Aids Prevention Strategy, Julie Pulerwitz, Gary Barker, Marcio Segundo, Marcos Nascimento

HIV and AIDS

The Population Council and the Promundo Institute studied the effectiveness of interventions in Brazil designed to change the attitudes of young men in relation to gender norms and reducing the risk of contracting HIV/STIs. One conclusion of the study was the recognition of the importance of engaging young people (men and women) in the issue of gender relations and the risks of HIV contamination. The results of the study indicate that addressing inequitable gender norms, particularly those that define masculinity, can be an important element of HIV prevention strategies. These findings suggest that group education interventions can successfully influence young …

Abc Messages For Hiv Prevention In Kenya: Clarity And Confusion, Barriers And Facilitators, Julie Pulerwitz, Tiffany Lillie, Louis Apicella, Ann P. Mccauley, Tobey C. Nelson, Simon Ochieng, Peter Mwarogo, Karusa Kiragu, Edward Kunyanga

HIV and AIDS

The Horizons Program and FHI/IMPACT developed a collaborative research study to explore how adults and youth in Kenya define and perceive the ABC (abstinence/being faithful/consistent condom use) terms and behaviors. Additional objectives of the study were to identify attitudes and norms around the ABC behaviors that influence perceptions of them, and the role of important actors in transmitting messages about them. Findings highlight potential challenges in promoting each of the ABC behaviors, as well as some positive elements that can be built upon when developing programs. HIV prevention programs that incorporate ABC messages—both in Kenya and elsewhere—should consider a number …

Examining Adherence And Sexual Behavior Among Patients On Antiretroviral Therapy In India, Avina Sarna, Indrani Gupta, Sanjay Pujari, A.K. Sengar, Rajiv Garg, Ellen Weiss

HIV and AIDS

With increased availability of ART, HIV-positive individuals are living healthier lives and continuing or resuming sexual activity. However, optimism related to ART’s success in slowing disease progression, reducing viral load, and improving health status may lead to more risky sexual practices and a possible increase in transmission of infections. To determining the sexual behavior of HIV-positive persons on ART, the Horizons program, in collaboration with research partners in Delhi and Pune, conducted a study to assess current levels of adherence to ART among a sample of people living with HIV/AIDS, identify the factors that influence their adherence to treatment, and …

Orphans And Vulnerable Youth In Bulawayo, Zimbabwe: An Exploratory Study Of Psychosocial Well-Being And Psychosocial Support, Laelia Gilborn, Louis Apicella, Jonathan Brakarsh, Linda Dube, Kyle Jemison, Mark Kluckow, Tricia Smith, Leslie M. Snider

HIV and AIDS

This Population Council Horizons report presents findings from an exploratory study by the Regional Psychosocial Support Initiative and Catholic Relief Services’ Support to Replicable, Innovative Village/Community-level Efforts Program of vulnerable youth living in and around Bulawayo, Zimbabwe. It describes their demographic characteristics, exposure to stress and trauma, and psychosocial well-being. The report also highlights the relationships between psychosocial well-being outcomes and exposure to stress and trauma, and the differences in psychosocial well-being between males and females, orphaned and nonorphaned youth, and younger and older adolescents. The report concludes with program and research implications.

Understanding Barriers And Challenges To Effective Community Participation In The Rollout Of Hiv/Aids Treatment And Care Services: Report On Research Results Dissemination Meetings, Population Council, Health Systems Trust

HIV and AIDS

The Population Council and Health Systems Trust conducted national, provincial, and community dissemination meetings in 2006 in KwaZulu Natal (KZN), Limpopo, and Gauteng provinces to share results from a 2005 research study: “Understanding barriers and challenges to effective community participation in the rollout of HIV/AIDS treatment and care services.” The objectives were to share the research findings with the communities and organizations that participated in the study; solicit participants’ input in understanding and utilizing the findings; facilitate interaction and exchange between stakeholders including community and facility-based providers involved in ART services; develop key strategies to operationalize findings and for development …

Understanding Barriers To Community Participation In Hiv And Aids Services: Final Report, Ashnie Padarath, Catherine Searle, Eka Esu-Williams

HIV and AIDS

In 2003, South Africa announced its intention to roll out possibly the largest HIV and AIDS treatment program in the world. Much attention is currently focused on supply-side issues, particularly drug procurement and pricing. Far less attention has been paid to demand for and delivery of treatment, care, and support services. Further, although the role of the community and community organizations is articulated in government policy there has been little active engagement with NGOs on the development of these roles or how to encourage community organizations to support and participate in the antiretroviral (ARV) rollout. As noted in this final …