Richard M. Fairbanks School of Public Health
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Item ‘Clustering of exemptions’ as a collective action threat to herd immunity(2003-03) May, Thomas; Silverman, Ross D.In this paper, we examine the phenomenon of ‘clustering of exemptions’ to childhood vaccination, and the dangers this poses both to those exempted as well as the general population. We examine how clusters of exemptions might form through collective action as described by Thomas Schelling, and how religious groups who live in close proximity to one another can “self-select” in a way that exacerbates this phenomenon. Given the growing number of exemptions and the increasing visibility of the anti-vaccine movement, policy makers must be vigilant for dangerous clustering in order to avoid loss of herd immunity.Item Patient Safety and Patients' Rights(2004-06) Silverman, Ross D.Patient safety can be improved through the implementation of a physician reporting system, in which medical errors can be reported confidentially. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.Item Provider Counseling, Health Education, and Community Health Workers: The Arizona WISEWOMAN Project(2004-08) Staten, Lisa K.; Gregory-Mercado, Karen Y.; Ranger-Moore, James; Will, Julie C.; Giulliano, Anna R.; Ford, Earl S.; Marshall, JamesBackground: The Arizona Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project used provider counseling, health education, and community health workers (CHWs) to target chronic disease risk factors in uninsured, primarily Hispanic women over age 50. Methods: Participants were recruited from two Tucson clinics participating in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Women were randomly assigned into one of three intervention groups: (1) provider counseling, (2) provider counseling and health education, or (3) provider counseling, health education, and CHW support. At baseline and 12 months (1998–2000), participants were measured for height, weight, waist and hip circumference, and blood pressure. Blood tests were conducted to check blood glucose, cholesterol, and triglyceride levels. At each time point, participants also completed 24-hour dietary recalls and questionnaires focusing on their physical activity levels. Results: A total of 217 women participated in baseline and 12-month follow-up. Three fourths were Hispanic. All three intervention groups showed an increase in self-reported weekly minutes of moderate-to-vigorous physical activity, with no significant differences between the groups. Significantly more women who received the comprehensive intervention of provider counseling, health education, and CHW support progressed to eating five fruits and vegetables per day, compared with participants who received only provider counseling or provider counseling plus health education. Conclusions: All three interventions increased moderate-to-vigorous physical activity but not fruit and vegetable consumption. The intervention group with provider counseling, health education, and CHW support significantly increased the number of women meeting national recommendations for fruit and vegetable consumption.Item Pasos Adelante: The Effectiveness of a Community-based Chronic Disease Prevention Program(2005-01) Staten, Lisa K.; Scheu, Linda L.; Bronson, Dan; Peña, Veronica; Elenes, JoJeanBackground Implementing programs that target primary prevention of chronic diseases is critical for at-risk populations. Pasos Adelante, or “Steps Forward,” is a curriculum aimed at preventing diabetes, cardiovascular disease, and other chronic diseases in Hispanic populations. Pasos Adelante is adapted from the National Heart, Lung, and Blood Institute’s cardiovascular disease prevention curriculum, Su Corazón, Su Vida, and includes sessions on diabetes and community advocacy and incorporates walking clubs. Context The Pasos Adelante curriculum was implemented in two Arizona, United States-Sonora, Mexico border counties. Key issues in these communities are safety, access to recreational facilities, climate, and cultural beliefs. Methods Pasos Adelante is a 12-week program facilitated by community health workers. The program includes interactive sessions on chronic disease prevention, nutrition, and physical activity. Evaluation of the program included pre-curriculum and postcurriculum questionnaires with self-reported measures of physical activity and dietary patterns. Approximately 250 people participated in the program in Yuma and Santa Cruz counties. Consequences Postprogram evaluation results demonstrate a significant increase in moderate to vigorous walking among participants and shifts in nutritional patterns. Interpretation The Pasos Adelante program demonstrates that an educational curriculum in conjunction with the support of community health workers can motivate people in Arizona/Sonora border communities to adopt healthy lifestyle behaviors.Item The Landscape of the AHRQ Health Information Technology Portfolio(2006) Dixon, Brian E.A major agenda item of the President and Congress is widespread adoption of health information technology (health IT) to improve the quality, safety, and efficiency of health care. This has allowed federal agencies to invest additional money into health IT research. The distribution and potential impact of research dollars spent by one agency supporting this agenda is examined here.Item Bibliography -- Burney’s Burney: Leroy Edgar Burney (1906-1998)(2006-05-18T14:26:45Z) Jay, Stephen J. M.D.Bibliography of Dr. Stephen Jay M.D.'s essay on Leroy Edgar Burney, former U.S. Surgeon General and Commissioner of the Indiana State Board of Health.Item Burney’s Burney: Leroy Edgar Burney (1906-1998)(2006-05-18T14:36:12Z) Jay, Stephen J. M.D.Dr. Stephen Jay M.D. documents the career of public health pioneer Leroy Edgar Burney in a 2002-2003 Indianapolis Literary Club essay. Indiana native Burney launched public health campaigns that educated communities on venereal diseases and smoking cessation. Offices held by Burney include Commissioner of the Indiana State Board of Health and U.S. Surgeon General.Item The influences of course effort and outside activities on grades in a college course(2006-09) Svanum, Soren; Bigatti, Silvia M.The influences of course effort and outside (family, job, social) activities on grades earned in a college course were examined for 230 urban college students. Multiple measurements of hours of work, social and family activities, and course effort were collected over a semester. Path modeling revealed that cumulative GPA and course effort had significant and independent predictive paths with grades. Outside activities did not directly influence course grade. Job activities, however, negatively influenced course grade indirectly through reduced course effort and mediated the influence GPA exerted on course grade. Thus, work demands lessened course effort and lessened GPA-indexed potential for course success. Cumulative GPA positively influenced effort, and effort mediated part of the relation between cumulative GPA and grades.Item From Program to Policy: Expanding the Role of Community Coalitions(Centers for Disease Control and Prevention, 2007) Hill, Anne; De Zapien, Jill Guernsey; Staten, Lisa K.; McClelland, Deborah Jean; Garza, Rebecca; Moore-Monroy, Martha; Elenes, JoJean; Steinfelt, Victoria; Tittelbaugh, Ila; Whitmer, Evelyn; Meister, Joel S.Background Diabetes mortality at the United States–Mexico border is twice the national average. Type 2 diabetes mellitus is increasingly diagnosed among children and adolescents. Fragmented services and scarce resources further restrict access to health care. Increased awareness of the incidence of disease and poor health outcomes became a catalyst for creating community-based coalitions and partnerships with the University of Arizona that focused on diabetes. Context Five partnerships between the communities and the University of Arizona were formed to address these health issues. They began with health promotion as their goal and were challenged to add policy and environmental change to their objectives. Understanding the meaning of policy in the community context is the first step in the transition from program to policy. Policy participation brings different groups together, strengthening ties and building trust among community members and community organizations. Methods Data on progress and outcomes were collected from multiple sources. We used the Centers for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health (REACH) 2010 Community Change Model as the capacity-building and analytic framework for supporting and documenting the transition of coalitions from program to policy. Consequences Over 5 years, the coalitions made the transition, in varying degrees, from a programmatic focus to a policy planning and advocacy focus. The coalitions raised community awareness, built community capacity, encouraged a process of “change in change agents,” and advocated for community environmental and policy shifts to improve health behaviors. Interpretation The five coalitions made environmental and policy impacts by engaging in policy advocacy. These outcomes indicate the successful, if not consistently sustained, transition from program to policy. Whether and how these “changes in change agents” are transferable to the larger community over the long term remains to be seen.