Public Health Social Work
Public Health Social Work
Public health research incorporates a broad array of studies that address systems, policies, and personnel that work to prevent disease, prolong life, and promote better health care. Within the broad array of public health research are studies specific to public health social work practice, an area of practice that has strong historical roots in the social work profession. Public health social work practice uses a research-based epidemiologic approach to identify and address social problems that affect the health status and social functioning of population groups. Public health social work emphasizes interventions that address primary prevention and includes practice at multiple levels including individuals, groups, communities, and populations.
Key foci of public health social work include HIV/AIDS disease and transmission prevention, child and elder maltreatment prevention and intervention, acute and chronic health care services, services to persons with disabilities, mental health and substance abuse prevention and interventions, services to older persons, disaster preparedness and response, and maternal and child health. The U.S. Department of Health and Human Services (HHS) Health Services Resources Administration’s Bureau of Maternal and Child Health (MCH) oversees several programs that support public health social work leadership, training, and research. More than 20 social work programs offer joint MSW and Masters of Public Health (MPH) degrees including several with specialties in maternal and child health (www.naddssw.org). These programs include the current MCH social work grantees: University of North Carolina, University of Maryland, and University of Pittsburgh.
Sources of federal funding for public health social work research include the National Institutes of Health (www.nih.gov), the Centers for Disease Control and Prevention (www.cdc.gov), the Agency for Healthcare Research and Quality (www.ahrq.gov), the Health Services Resources Administration (www.hrsa.gov), the Department of Veteran’s Affairs (www.va.gov), and the Centers for Medicare and Medicaid Services (www.cms.gov). State and local governments and foundations such as the Robert Wood Johnson Foundation (www.rwjf.org), the John A. Hartford Foundation (www.jahf.org), the W.K. Kellogg Foundation (www.wkkf.org), the Lance Armstrong Foundation (www.laf.org), and the American Cancer Society also support public health social work research.
Social workers engaged in public health research may affiliate with the American Public Health Association’s Social Work Section (http://hshp.syr.edu/aphasw/index.htm), the Association of State and Territorial Public Health Social Workers, or the Group for Public Health Social Work Initiatives (GPHSWI) (http://www.bu.edu/ssw/mswmph/about/gpsi.html). On May 19, 2005 in celebration of the 25th anniversary of the Boston University School of Social Work’s joint MSW/MPH program, the GPHSWI hosted a national conference highlighting public health research and practice (http://www.bu.edu/dev/ssw/mswmph/) including rehabilitation and spinal cord injury, HIV prevention, health care of immigrants, social work in primary care practice, integration of physical health and mental health, childhood obesity, treatment adherence, responses to Hurricane Katrina, and workforce issues.
On Dec. 1, 2005, the National Institutes of Health (NIH) issued three program announcements entitled Social Work Practice and Concepts in Health to encourage researcher-initiated social work research at three levels:
These landmark research grant opportunities highlight social work’s current and potential contributions to our nation’s public health and well-being. The NIH Social Work Workgroup that was initially convened under the leadership of the Office of Behavioral and Social Science Research (OBSSR) to develop the Congressionally requested NIH Plan for Social Work Research (http://obssr.od.nih.gov/Publications/SWR_Report.pdf) in 2003, has been a major force in promoting social work research applications at NIH. All of the recommendations of the NIH Plan are in keeping with the NIH goals which are to:
- Foster fundamental creative discoveries, innovative research strategies, and their applications as a basis to advance significantly the Nation’s capacity to protect and improve health;
- Develop, maintain, and renew scientific human and physical resources that will assure the Nation’s capability to prevent disease;
- Expand the knowledge base in medical and associated sciences in order to enhance the Nation’s economic well-being and ensure a continued high return on the public investment in research; and
- Exemplify and promote the highest level of scientific integrity, public accountability, and social responsibility in the conduct of science (http://www.nih.gov/about/).
The recent tenth anniversary celebration of the NIH OBSSR highlighted recent behavioral and social science contributions including social work research on health promotion and disease prevention (Social Information-Processing Skills Training to Promote Social Competence and Prevent Aggressive Behavior in the Third Grade by M. Fraser, et al. at University of North Carolina – Grant # 5R21DA013874-03) as well as a poster session on the center funded at University of Chicago, led by Sarah Gehlert to study Breast Cancer and Social Interactions: Identifying Multiple Environments that Regulate Gene Expression – Grant # 5P50ES012382-02. Penelope Trickett of University of Southern California School of Social Work also presented on the Impact of Sexual Abuse on Female Development – Grant # 5R01HD039129-05.
In order to track the contributions of social work research to our nation’s public health, the Institute for the Advancement of Social Work Research (IASWR) has developed the Directory of Social Work Research Grants Awarded by the National Institutes of Health 1993-2005 (visit www.iaswresearch.org and click on NIH Social Work Directory in the right sidebar). The directory identifies more than 500 grants awarded to social work researchers from at least 47 different social work education programs and 15 different NIH and HHS institutes and centers. A review of the research studies highlight the extent to which social workers address health disparities, health care access, co-occurring disorders, cultural and environmental contexts of health care and social development, sexual health, family dynamics, spirituality, and hard to reach and at-risk populations.
A search in Social Work Abstracts between 2000 and the present provides an overview of research topics that address a broad array of public health issues.
PROMOTING HEALTH AND WELLNESS
Motivational enhancement counseling strategies in delivering a telephone-based brief HIV prevention intervention.
Rutledge-S-E; Roffman-R-A; Mahoney-C; Picciano-J-F; Berghuis-J-P; Kalichman-S-C. Clinical Social Work Journal. 29(3): 291-306, Fall 2001.
Motivational enhancement therapy (MET) interventions are being increasingly added to the menu of behavioral interventions for HIV prevention. They present few logistical and psychological barriers for at-risk persons who are ambivalent about transmission risk reduction and appear to offer promise of being transferable to community-based organizations and public health programs. The authors describe the principles of motivational interviewing, a counseling style often used in conjunction with MET, and demonstrate and discuss its application with case examples drawn from a recent pilot trial of a telephone-delivered brief motivational enhancement for HIV risk reduction with men who have sex with men (MSM). (Journal abstract.)
Comparing lesbians’ and heterosexual women’s mental health: A multi-site survey.
Hughes-T-L; Haas-A-P; Razzano-L; Cassidy-R; Matthews-A. Journal-of-Gay-and-Lesbian-Social-Services. 11(1): 57-76, 2000.
Despite increased awareness of, and interest in, the health status of lesbians over the past decades, many gaps remain in our knowledge of lesbians’ mental health. Much of the existing research on lesbian health has been conducted with small, homogenous samples and few studies have included comparison groups of heterosexual women. This paper presents descriptive data from a study of lesbian health conducted in Chicago, Minneapolis/St. Paul, and New York City between 1994-1996. The data presented here focus on several important indicators of mental health from 550 lesbians and a demographically matched comparison group of 279 heterosexual women. Similarities and differences based on sexual orientation are described and findings are discussed in relation to other relevant studies. (Journal abstract.)
Post-traumatic stress disorder (PTSD) in victims of domestic violence: A review of the research.
Jones-L; Hughes-M; Unterstaller-U. Trauma, Violence, & Abuse. 2(2): 99-119, April 2001.
The objectives of this research were to analyze data from literature based on studies of battered women to determine (a) the correlation of domestic violence and post-traumatic stress disorder (PTSD), (b) the best treatment strategies for PTSD, and (c) the evidence of PTSD treatment effectiveness with battered women. Findings were (1) symptoms of battered women are consistent with PTSD symptoms; (2) certain populations are at higher risk of developing PTSD symptoms; (3) intensity, duration, and perception of the battering experience is a significant factor in the severity of the PTSD symptoms; (4) demographic variables influence PTSD severity; (5) standardized PTSD assessment is needed by professionals working with women experiencing domestic violence; (6) there is a need for greater public health involvement for prevention, identification, and medical treatment of domestic violence and PTSD; and (7) certain treatment strategies are recommended for PTSD but lack rigorous testing of their efficacy. (Journal abstract.)
INTERNATIONAL HEALTH ISSUES
Community reactions to the SARS crisis in Hong Kong: Analysis of a time-limited counseling hotline.
Leung-T-T-F; Wong-H. Journal-of-Human-Behavior-in-the-Social-Environment. 12(1): 1-22, 2005.
This paper is based on an analysis of the calls to a time-limited hotline specifically set up in response to the SARS (Severe Acute Respiratory Syndrome) crisis in Hong Kong in 2003. The findings indicated that the arena and level of concern raised by the hotline callers are associated with the situation of the callers and the developmental phase of the disaster. The authors call for welfare service organizations to adopt a differential service focus for different phases of disaster development, when they are confronted with similar public health hazards in the future. The study also identifies the special role played by women in containing the epidemic, and suggests more gender sensitive intervention planning in addressing the needs of women in their gatekeeping and caregiving roles during an epidemic. (Journal abstract.)
The development of a risk assessment instrument for the prevention of Vesico vaginal fistula in Nigeria.
Onolemhemhen-D; Pugh-K. Journal-of-Social-Work-Research-and-Evaluation. 4(2): 189-198, Fall/Winter 2003.
The objective of this study was to validate a screening instrument for the detection of women at risk of vesico vaginal fistula (VVF), a debilitating birth injury commonly found in northern Nigeria. The risk assessment instrument was administered to a total of 197 fistula patients receiving treatment at health care facilities in Kaduna State, Nigeria. A group of 203 women in three villages in Kaduna State, Nigeria who reported delivering without complications served as the control group. Group scores on the instrument were compared. Statistical testing found a correlation between the VVF screening scores and the predicted probability of having VVF. Women with higher scores on the screening instruments were more likely to have a fistula than women with lower scores. A logistic regression model using VVF and non-VVF as the dependent variable found that women with higher screening scores were 1.393 times more likely to be diagnosed with VVF than women with lower scores. A ROC curve established the accuracy of the screening tool at 88.6% using a cutoff point of 16. The Onolemhemhen VVF Risk Assessment Instrument is a simple, inexpensive, and accurate method of screening Nigerian women for VVF. (Journal abstract.)
Promoting methodological pluralism, theoretical diversity and interdisciplinarity through a multi-leveled violence prevention initiative in South Africa.
Stevens-G; Seedat-M; Swart-T-M; van der Walt-C. Journal-of-Prevention-and-Intervention-in-the-Community. 25(1): 11-29, 2003.
Violence prevention within low-income, under-resourced communities presents significant challenges to community development researcher-practitioners seeking to maximize partnerships, resource utilization, and overall program effectiveness. This article highlights a South African research and service delivery organization’s efforts to develop a violence prevention matrix, premised upon an adaptation of the public health approach and the infusion of a critical, community development praxis. It presents preliminary outcomes of a multi-level pilot application of this matrix in a low-income neighborhood in South Africa, specifically focusing on evaluating its capacity to foster methodological pluralism, theoretical diversity, and interdisciplinarity, together with promoting community empowerment and coalition-building strategies. (This is one of six articles in this special issue on prevention and intervention in post-Apartheid South Africa.) (Journal abstract.)
Driving and dementia of the Alzheimer type: Beliefs and cessation strategies among stakeholders.
Perkinson-M-A; Berg-Weger-M-L; Carr-D-B; Meuser-T-M; Palmer-J-L; Buckles-V-D; Powlishta-K-K; Foley-D-J; Morris-J-C. The-Gerontologist. 45(5): 676-685, October 2005.
Although driving by persons with Alzheimer’s disease (AD) is an important public health concern, we know little about the attitudes and perceptions of key stakeholders regarding driving safety in these individuals or the factors that precipitate and influence driving assessment and cessation decisions. We convened 10 focus groups composed of persons intimately involved in driving decisions for older adults to identify and compare beliefs and perceptions concerning AD and driving and to identify effective strategies to limit or cease unsafe driving. The 68 focus-group participants included health professionals, transportation and law-enforcement professionals, current and former drivers with AD, and family caregivers of current and former drivers with the disease. With few exceptions, participants said that a diagnosis of very mild AD alone did not preclude driving. Most regarded family members as pivotal in monitoring and managing unsafe driving and recognized their need for institutional and medical support, especially support from physicians in counseling and evaluation of health-related fitness of older drivers. Members of each group acknowledged their own roles and responsibilities in driving decisions and described difficulties they experienced in making assessments and implementing decisions to limit or stop the driving of given individuals with AD. Education of families, professionals, and transportation specialists is needed to understand the influence of AD severity on driving abilities, identify problem driving behaviors, make appropriate referrals of unsafe drivers, and access available resources for drivers with AD and those most responsible for their safety. (Journal abstract.)
To die destitute today: What are the implications for social work?
Fox-M. Australian-Social-Work. 58(2): 188-198, June 2005.
The link between the public hospital and the destitute funeral has a long historical background with hospitals today continuing to retain their delegation over the fates of those who die destitute within them. This qualitative study evaluates the roles and skills of social workers when assessing the need for a destitute funeral in the public hospital system. Social workers located in two public hospitals within the same Area Health Service participated in interviews to evaluate the roles and responsibilities of social workers when working with destitute funeral recipients and their significant others. Emergent from these interviews are the social workers’ candid perception of the importance of the destitute death. The analysis is structured according to the priority that the social workers themselves accorded: the importance of the destitute death to the organization, the family and friends of the destitute person, the social workers themselves, and to society as a whole. The implication for social work practice is that this study informs policy locally within the hospital social work department, and public health policy within the hospital system. In addition, it is a springboard for practice reflection and advanced clinical practice by social workers in the field of destitute funerals. (Journal abstract.)
Nursing home residents with emphysema/COPD compared to other residents.
Buchanan-R-J; Chakravorty-B; Wang-S; Ju-H; Hackethorn-D. Journal-of-Social-Work-in-Disability-and-Rehabilitation. 3(1): 53-78, 2004.
Over the past 20 years, the prevalence and age-adjusted death rate for chronic obstructive pulmonary disease (COPD) has increased by 30%, with most of this increase in persons over 65. Over 444,000 Minimum Data Set (MDS) admission assessments recorded in the MDS during 2000 were analyzed, including 68,439 assessments for residents with emphysema/COPD (15.4%). Profiles of nursing home residents with emphysema/COPD were created and compared to other residents. These profiles describe demographic characteristics, health status, and treatments received. Residents with emphysema/COPD were less physically and cognitively disabled than other residents, but more likely than other residents to have cardiovascular diseases, pneumonia, and respiratory infections. Residents with emphysema/COPD were more likely to receive oxygen therapy, IV medications, and monitoring for acute medical conditions than other residents. Almost 30% of residents with emphysema/COPD experienced daily pain, with two-thirds rating their pain as moderate to severe. More than 50% of residents with emphysema/COPD had no advanced directives, only 39% had a Do Not Resuscitate order, and only 16% executed a living will. Hopefully, with continued efforts by palliative care advocates, better pain management and advanced care planning will take place in nursing facilities. (Journal abstract.)
Alcohol consumption by elderly Americans.
Breslow-R-A; Faden-V-B; Smothers-B. Journal-of-Studies-on-Alcohol. 64(6): 884-892, November 2003.
The purpose of this study was to estimate the prevalence of alcohol consumption in Americans age 65 years and older using data from three nationally representative cross-sectional surveys: the National Health Interview Survey (NHIS-2000), the Behavioral Risk Factor Surveillance System (BRFSS-2001), and the National Household Survey on Drug Abuse (NHSDA-2000). Alcohol consumption levels were defined as none, moderate (<1 drink a day) and heavier (>1 drink a day). The NHIS assessed alcohol consumption in the past year, and the BRFSS and NHSDA assessed alcohol consumption in the past 30 days. Differences between the BRFSS and NHSDA were tested using multinomial logistic regression. Age trends in alcohol consumption (between age 65 and 84 years) were tested using logistic regression. All analyses were weighted to produce national estimates. In men, the prevalence of moderate drinking was 37.6% in the NHIS, 38.7% in the BRFSS and 27.2% in the NHSDA. The prevalence of heavier drinking among men was 10.1%, 10.1%, and 9.2%, respectively. In women, the prevalence of moderate drinking was 32.3% in the NHIS, 27.7% in the BRFSS, and 21.5% in the NHSDA. The prevalence of heavier drinking among women was 2.2%, 2.6%, and 2.4, respectively. In increasingly older groups of men, moderate drinking remained stable, while heavier drinking significantly decreased in two of three surveys. Conversely, in increasingly older groups of women, moderate drinking remained stable. In the years 2000 to 2001, approximately one third of the U.S. elderly population, about 11 million persons, consumed alcohol. The risks and benefits of drinking by elderly Americans will become an increasingly important public health issue as this segment of the population expands over the coming decades. (Journal abstract, edited.)
Addressing the social lives of older Americans: A new challenge for public health.
Palombo-R-D, Dissertation, Brandeis Univ., PhD, May 2003.
This cross sectional study uses data from the 1999 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS), an annual statewide telephone survey of Massachusetts adults. The sample included 333 adults age 65 and older: 117 with functional limitations and 216 with no functional limitations. The following research question was posed: What are the health and social factors that influence psychological well being for adults age 65 and older with and without functional limitations and how do these factors differ by gender and age? Findings indicate that having a functional limitation or chronic disease does not in and of itself predict poorer psychological well being and that social support resources play a stronger role in predicting psychological well being for elders with functional limitations compared with elders with no functional limitations, and particularly among women compared with men. Age differences in the use of social resources were also found.
CHILDREN AND YOUTH
A meta-analysis of the relationship of child sexual abuse to HIV risk behavior among women.
Arriola-K-R-J; Louden-T; Doldren-M-A; Fortenberry-R-M. Child-Abuse-and-Neglect. 29(6): 725-746, June 2005.
This study is a meta-analysis of the literature exploring the relationship between child sexual abuse (CSA) and HIV risk behavior among women. Four outcome variables were tested: unprotected sex; sex with multiple partners; sex trading; and adult sexual revictimization. Forty-six studies met the inclusion criteria and were included in the analysis, and separate meta-analyses were performed for each of the four dependent variables described above. Using the correlation coefficient r as an effect size estimate, results indicated an average effect size of .05 for the unprotected sex meta-analysis (N = 16 studies), .13 for the sex with multiple partners meta-analysis (N = 23 studies), .12 for the sex trading meta-analysis (N = .23 studies), and .17 for the adult sexual revictimization meta-analysis (N = 21 studies). The authors conducted a test of three potential moderator variables (sources of sample, definition of CSA based on type of contact, and definition of CSA based on maximum age of victim). Results did not support the hypothesis that these three variables explain a significant amount of variability in effect sizes with one exception: Studies that define CSA more broadly to include adolescent victims (e.g., victims up to 17 years of age) had larger and more homogenous effect sizes for the sex trading meta-analysis than those that defined CSA as having occurred at younger ages. These findings suggest a small positive relationship between CSA and subsequent HIV risk behavior among women that varies as a function of how CSA and HIV risk behavior are operationalized. (Journal abstract.)
Youth engaging in online harassment: Associations with caregiver-child relationships, Internet use, and personal characteristics.
Ybarra-M-L; Mitchell-K-J. Journal-of-Adolescence. 27(3): 319-336, June 2004.
To date, research focused on “traditional” (i.e. in-person) youth bullying behavior has documented serious psychosocial challenges for those involved. How this literature translates to youth engaging in aggressive behaviors online has yet to be examined. Using the largest US sample of youth Internet users to date, psychosocial characteristics of youth engaging in internet harassment were examined. Results from the nationally representative survey suggested that Internet harassment is a significant public health issue, with aggressors facing multiple psychosocial challenges including poor parent-child relationships, substance use, and delinquency. Comparisons to traditional bullies were made, with similarities and differences noted. (Journal abstract.)
Adolescent preventive health and teams-games-tournaments: A research and development paradigm entering its fourth decade of research.
Wodarski-J-S; Wodarski-L-A; Parris-H-N. Journal-of-Evidence-Based-Social-Work. 1(1): 99-123, 2004.
The problematic behaviors of teenagers and the subsequent negative consequences are extensive and well documented: unwanted pregnancy, substance abuse, violent behavior, depression, and social and psychological consequences of unemployment. In this article the authors review an approach that uses a cooperative learning, empirically based intervention that employs peers as teachers. This intervention of choice is Team-Games-Tournaments (TGT), a paradigm backed by four decades of empirical support. The application of TGT in preventive health programs incorporates elements in common with other prevention programs that are based on a public health orientation and comprise the essential components of health education, that is skills training and practice in applying skills. The Teams-Games-Tournaments intervention supports the idea that children and adolescents from various socioeconomic classes, between the ages of 8 to 18, in classrooms or groups ranging in size from 4 to 17 members, can work together effectively in cooperative instructional situations where group members serve as teachers for one another. Teams-Games-Tournaments has been applied successfully in such diverse areas as adolescent development, sexuality education, psychoactive substance use, anger control, coping with depression and suicide, nutrition, comprehensive employment preparation, and family intervention. This article reviews the extensive research on TGT using examples of successful projects in substance abuse and nutrition. Issues are raised that relate to the implementation of preventive health strategies for adolescents, including cognitive aspects, social and family networks, and intervention components. (Journal abstract.)
Prevention of STDs and HIV at Ecole de la rue: The case of Quebec City’s Maison Dauphine.
Binet-L; Noel-L; Trottier-G. Canadian-Social-Work-Journal. 4(1): 94-102, Autumn 2002.
In Quebec, the plight of street youth is a concern in many respects (Roy, et al., 2001). In addition to high mortality rates caused by overdose and suicide (Roy, et al., 1998a; Roy, et al., 1998b), there are the risks of infection by HIV and the hepatitis viruses, not to mention the high transmission rate of STDs (Poulin, et al., 1997). Prevention initiatives are in general favorably received in the context of young people with special needs, but they are a formidable challenge when these youths are part of a dynamic of exclusion. In Quebec City, the agency known as Les (Euvres de la Maison Dauphine, situated in the heart of the old city, has opened its doors since 1992 to a clientele of young people with adjustment difficulties. Here, street youth find refuge and support in their efforts toward social reintegration after an imposed, or more or less chosen interval on the street. In 1998, with support from the Ministere de l’Education, Sister Cecile took up the challenge of offering street youth a place to complete their primary and secondary school studies (Greffard, 2001). In the fall of 1999, a training program on sexuality and the prevention of blood-borne and sexually transmitted infections were offered to students enrolled in the school program of Ecole de la rue. An evaluation of this program’s implementation was made as the program was being carried out. The results of this evaluation are the basis of this article. (Journal abstract.)
Negative caregiver strategies and psychopathology in urban, African-American young adults.
Koenig-A-L; Lalongo-N; Wagner-B-M; Poduska-J; Kellam-S. Child-Abuse-and-Neglect. 26(12): 1211-1233, December 2002.
There were three aims: (1) assess the prevalence of reported exposure to negative caregiver strategies in a community-based African-American population, (2) examine the sources of variation in caregiver parenting strategies, including demographic variables and child characteristics, (3) investigate whether mental disorders in young adulthood may differ based on reported degree of exposure to negative strategies. The participants were 1197 African-Americans involved in a 1999-2001 young adult follow-up (age M = 19.6, SD = .6) of an evaluation of school-based interventions in the Baltimore, MD metropolitan area. Measures included teacher-report of child aggression in first grade, parent-report of demographic variables in first and sixth grade, and young adult self-report of symptomatology, suicidal behaviors, and childhood caregiver discipline strategies. Fifty-four percent of the sample reported some use of physical discipline by caregivers. Lower family income and younger caregiver age, as well as teacher reports of child aggression, were related to reports of caregiver’s high use of negative strategies. In addition, young adults who reported a high rate of negative caregiver strategies had a significantly increased risk for psychopathology and were over twice as likely to have experienced a history of suicidal ideation than those reporting low exposure. The results demonstrate the importance of examining variation in this population, with the poorest and the youngest using negative parenting strategies more frequently. In addition, the present study replicated previous findings of the link between negative caregiver discipline strategies and psychopathology. This association appears robust across diverse populations. The implications for preventive interventions are discussed. (Journal abstract.)
Youths’ access to mental health services: The role of providers’ training, resource connectivity, and assessment of need.
Stiffman-A-R; Hadley-Ives-E; Dore-P; Polgar-M; Horvath-V-E; Striley-C; Elze-D. Mental-Health-Services-Research. 2(3): 141-154, September 2000.
This paper posits that providers with training in and knowledge of mental health resources are more likely to recognize youth’s mental health problems, and provide youth with services. In 1994 and 1996, the authors interviewed 792 adolescents who were involved with St. Louis public health, juvenile justice, child welfare, or education service sectors. A total of 282 youth had received some services, listing 533 providers. The authors identified 364 of those providers, and 61% (222) responded concerning service need, service use, and provider knowledge and behavior. Structural equation models demonstrated that provider assessment of youth’s mental health problems is the largest and provider knowledge of service resources the second largest determinant of service provision. Youth’s self-reported mental health is not positively associated with increased services and is only minimally associated with provider assessment of their problems. Training (both professional and inservice) contributes to higher assessments of youth’s problems and greater resource knowledge, which is associated with increased service provision. Providers from the mental health and child welfare sectors have more professional training in mental health and are more likely to receive inservice training. Inservice training should be offered to all who work with youth. (Journal abstract, edited.)
Intensity of case management services: Does more equal better for drug-dependent women and their children?
Jansson-L-M; Svikis-D-S; Breon-D; Cieslak-R. Social-Work-in-Mental-Health. 3(4): 63-78, 2005.
Specialized programs for pregnant, drug dependent women have assisted many in achieving abstinence during pregnancy. Following delivery, however, such women often resume drug use and drop out of treatment, placing their children at even greater risk for subsequent medical and developmental problems. Standard outreach services, while generally effective as a public health measure for high-risk populations of women and children, are often insufficient for chronic and severely drug dependent women. This study was a randomized clinical trial comparing maternal and infant outcomes for drug dependent women assigned to either routine or intensified case management services for the first 4 months following delivery. Women randomly assigned to intensified case management showed better treatment retention, accessed a greater variety of services, were more likely to be abstinent from cocaine at 4-month follow-up and felt their children received greater benefit from the services than women assigned to routine case management. The number of case management visits was positively correlated with total time in treatment across both intervention groups. Study findings support the efficacy of intensified case management service for drug dependent women and their children. (Journal abstract.)
Correlates of safe syringe acquisition and disposal practices among young IDUs: Broadening our notion of risk.
Sherman-S-G; Rusch-M; Golub-E-T. Journal-of-Drug-Issues. 34(4): 895-912, Fall 2004.
This study examines the relationship of syringe use patterns with acquisition and disposal practices among injection drug users (IDUs). Study participants (N = 294) were IDUs between 15 and 30 years old in Baltimore, Maryland, who had initiated drug injection within the past five years. Safe acquisition was defined as obtaining syringes from the Baltimore syringe exchange program and pharmacies. Safe disposal was defined as depositing syringes at the syringe exchange program or in a closed container. Participants were primarily male, white, and had low levels of education. In the six months prior to being interviewed, 25% reported safe syringe acquisition and 47% reported safe disposal. In a multivariate model controlling for demographic variables, factors that were significantly associated with safe acquisition were injecting for more than two years, obtaining two or more syringes per pickup, using a syringe for five or more injections, and safe disposal of syringes. In a multivariate model controlling for demographic variables, factors that were significantly associated with safe disposal were injecting daily and safe syringe acquisition. Infectious disease prevention efforts need to specifically target young and newly initiated IDUs in promoting safe syringe acquisition and disposal practices. (Journal abstract.)
Ethnic variation in the prevalence of substance use disorders in youth sectors of care.
Aarons-G-A; McCabe-K; Gearity-J; Hough-R-L. Journal-of-Ethnicity-in-Substance-Abuse. 2(3): 59-81, 2003.
This study examines ethnic variation in the prevalence of substance use disorders (SUDs) among adolescents who received services in one or more public sectors of care including: Alcohol and Drug, Juvenile Justice, Mental Health, Public School-based services for youths with serious emotional disturbance, and Child Welfare, in relation to age, gender, and service sector affiliation. Participants included 936 adolescents 13-18 years of age randomly sampled from all youths who were active in at least one of the above five sectors of care (N = 12,662) in San Diego County, California. SUDs were assessed through structured diagnostic interviews conducted from October 1997 through February 1999. Significant ethnic differences in prevalence rates were found in all sectors except child welfare. African-American youths were significantly less likely than Caucasian youths to meet criteria for lifetime and past-year SUDs. Differential patterns of SUDs were found for ethnic groups relative to Caucasian youths. Substance use disorders are prevalent among youths in all service sectors and there are significant ethnic differences that may represent differential substance use patterns as well as disparities in opportunities for treatment versus more restrictive services. Standardized evidence-based assessment and triage protocols may help in identifying and helping youths with substance use disorders in public service systems. (Journal abstract.)
Alcohol use in pregnant low-income women.
O’Connor-M-J; Whaley-S-E. Journal-of-Studies-on-Alcohol. 64(6): 773-783, November 2003.
This study had two aims: (1) to examine the prevalence rates of prenatal alcohol consumption in a group of women participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Southern California, with special emphasis on Hispanic women, and (2) to identify variables associated with postconception drinking in low-income minority women. The study employed a cross-sectional survey that assessed alcohol use rates, demographic variables, and alcohol risk status. Participants were 826 pregnant women enrolled in the Public Health Foundation enterprises (PHFE) WIC Program in Los Angeles and Orange Counties, CA. Pregnant women who enrolled self-administered a specially designed alcohol screener. Findings were that 24% of sample women were consuming alcohol post conception. Of that percentage, approximately two thirds drank prior to pregnancy recognition, and one third continued to drink after pregnancy was confirmed. Approximately 30% of white non-Hispanic, black non-Hispanic, and English-speaking Hispanic women were found to drink post conception compared with 15.8% of Spanish-speaking Hispanic women. This finding supported recent research that suggests more acculturated Hispanic women tend to incorporate the drinking patterns of the larger U.S. population to a greater extent than less acculturated Hispanic women. Although a number of demographic variables differentiated women who were abstinent from those who were postconception drinkers, the best predictor of postconception alcohol consumption was the women’s high-risk drinking score as measured by the TWEAK (sensitivity = 70.1%, specificity = 88.5%). Results suggest the importance of screening low-income minority pregnant women in a community setting so that interventions can be initiated to prevent fetal alcohol syndrome and related conditions. (Journal abstract.)
Estimating the benefits and costs of a universal substance abuse screening and treatment referral policy for pregnant women.
Berger, L. M. Journal-of-Social-Service-Research. 29(1): 57-84, 2002.
Prenatal substance exposure poses a significant public health problem in terms of both its economic costs to society and the health and development of those children affected. While substance abusing pregnant women and their children could benefit from early identification and appropriate interventions, drug testing of infants is controversial, and there is currently no national policy regarding the drug testing of infants, nor substance abuse screening for pregnant women. This paper provides a cost-benefit analysis of a universal substance abuse screening and treatment referral policy for pregnant women. Results suggest that the monetary benefits of such a policy will only out-weigh its costs if it does little to increase post-birth child protective services reporting and/or foster care placement rates. Thus, additional policies regarding the ways in which screening results are used may be important factors in determining the effects of a universal substance abuse screening policy for pregnant women. (Journal abstract.)
TRAUMA AND DISASTER
Community and university participation in disaster-relief recovery: An example from eastern North Carolina.
Farquhar-S; Dobson-N. Journal-of-Community-Practice. 12(3/4): 203-217, 2004.
Marginalized groups that are traditionally excluded from policy and decision making are often also disproportionately affected by the hardships of natural disasters. By including community residents in research and planning, public health practitioners and researchers can create programs that have immediate relevance and policy implications. This article describes a case study of the formation of a community-university partnership and a community-based participatory research project conducted in the aftermath of Hurricane Floyd. The description of methods used and the implications for practice highlight the importance of including those most affected by a natural disaster. Members of several groups worked collaboratively to define the social and public health concerns of a rural North Carolina community and to create changes in disaster-recovery policy and practice. (This is one of 12 articles in this special issue on university-community partnerships.) (Journal abstract.)
Posttraumatic stress disorder symptoms in Hispanic immigrants after the September 11th attacks: Severity and relationship to previous traumatic exposure.
Pantin-H-M; Schwartz-S-J; Prado-G; Feaster-D-J; Szapocznik-J. Hispanic-Journal-of-Behavioral-Sciences. 25(1): 56-72, February 2003.
This study examined posttraumatic stress disorder (PTSD) symptoms severity in Hispanic immigrants exposed to September 11th attacks through television, ascertained the relationship between previous traumatic exposure and September 11th-related symptoms, and investigated the effect of television exposure of the attacks on symptoms. A total of 110 Hispanic immigrant adults (22 males, 88 females) living more than 1,000 miles from the attacks completed measures of natural disaster exposure, war violence exposure, and September 11th-related PTSD symptoms. Of the sample, 14% self-reported September 11th-related PTSD symptoms were consistent with a * Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnosis. Previous exposure to natural disasters and war violence was significantly related to September 11th-related PTSD symptomatology. Individuals with symptoms consistent with a DSM-IV PTSD diagnosis reported twice as much war violence exposure and one-and-a-half times as much natural disaster exposure as those not meeting criteria. Results are discussed regarding potential public health implications. (Journal abstract.)
The challenge of interdisciplinary collaboration in addressing the social determinants.
Whiteside-M. Australian-Social-Work. 57(4): 381-393, December 2004.
The importance of professional disciplines working together to address the critical social and health issues facing society today cannot be overstated. Policy makers, service providers and researchers have long been calling for greater interdisciplinary collaboration. Despite this, there has been little systemic analysis of the constraints involved in such collaboration. Far too often disciplines continue to work in solo. This paper aims to analyze the barriers to interdisciplinary collaboration through a case study of the relationship between social work and public health to work together and enhance each other’s efforts to address their common goal of greater social equality. However, this will require a genuine commitment from both disciplines to develop a shared political analysis, common language, and a framework for action, which uses their respective strengths. (Journal abstract.)