Community Coalitions' Gender-Aware Policy and Systems Changes to Improve the Health of Women and Girls.

BACKGROUND: Addressing environmental barriers and community conditions through policy and systems change provides the foundation for creating sustainable public health change at the population level. In an effort to influence population-level change that is gender aware, the United States Department of Health and Human Services Office on Women's Health funded the Coalition for a Healthier Community initiative supporting 10 grantees in the implementation of gender-based, public health systems approaches to improve women and girls' health. METHODS: A national evaluation assessed the extent to which these gender-aware public health systems approaches result in programs and policies that are sustainable and cost effective in addressing health disparities in women and girls. For this paper, a review of policies reported on in grantees' quarterly progress reports was conducted, and policies were categorized based on each policy's status, level, sector affected, and whether it was gender aware. RESULTS: The review revealed 77 policies at varying stages of development or implementation intended to facilitate systems-level change at the coalition, school, organizational, local, or state level. Fifty-one percent of these policies were identified as being gender aware, because they were intended to reduce barriers to or increase facilitators of gender equity. CONCLUSIONS: Community coalitions, like the Coalition for a Healthier Community coalitions, can be valuable channels for promoting policy change, as demonstrated by the many policies developed and/or supported by the Coalition for a Healthier Community grantees in their attempt to meet the needs of women and girls.

Investigating Community Concerns Regarding HIV Prevention Organizations' Expertise in Serving HIV-Vulnerable Populations.

BACKGROUND: People living with human immunodeficiency virus (HIV)/AIDS (PLWH/A) and others affected have expressed that cultural differences between patients and providers can create barriers to care and prevention. These barriers are exacerbated in the case of vulnerable populations who are often marginalized by society. During the formative phase of a community-based participatory research (CBPR) process, the researchers' community advisory committee (CAC) and HIV stakeholders shared anecdotes of incongruencies between needs of HIV-vulnerable populations and expertise of local providers. In response, researchers worked with the CAC to develop survey questions intended for providers of HIV prevention services in a region afflicted with some of the highest HIV prevalence rates in the country. OBJECTIVE: The objective of this study was to identify and validate HIV stakeholders' perceptions about challenges to provision of HIV services through a sequential mixed methods study design. METHODS: Thirty HIV prevention organizations (HPOs) were identified as local leaders in HIV prevention by community stakeholders and through community event attendance. Each HPO was invited to participate in an interviewer-assisted survey examining population-specific expertise and service for 15 HIV-vulnerable populations. Frequency analysis was used to compare HPOs' expertise relative to who they serve (n = 26). RESULTS: Although 13 of the HIV-vulnerable populations were served by more than 50% of the HPOs, only 2 of these 13 populations were served with high expertise by more than one half of the HPOs in the sample. CONCLUSION: These data give credence to the CAC's concern regarding misalliance between whom HPOs serve and with whom they have high expertise, a factor potentially influencing HIV outcomes among HIV-vulnerable populations.

Evidence from the field: Findings on issues related to planning, implementing and evaluating gender-based programs.

An Initiative of the United States Department of Health and Human Services' Office on Women's Health (OWH), Coalition for a Healthier Community (CHC), supports ten grantees across the U.S. in the implementation of gender-based health interventions targeting women and girls. A national evaluation is assessing whether gender-focused public health systems approaches are sustainable and cost effective in addressing health disparities in women and girls. To inform the evaluation, a systematic examination was conducted of literature in both the public and private sector designed to track, assess, understand, and improve women's health, public health systems approaches, and the cost-effectiveness and sustainability of gender-based programs. A two-person team assured the quality of the results following the review of abstracts and full-text articles. Of 123 articles meeting eligibility criteria (See inclusion criteria described in Section 2.2 below), only 18 met inclusion criteria specific to a focus on a systems approach, cost-effectiveness and/or sustainability. Studies assessing systems approaches suggested their effectiveness in changing perceptions and increasing knowledge within a community; increasing involvement of local decision-makers and other community leaders in women's health issues; and increasing community capacity to address women and girls' health. Further evaluation of the cost-effectiveness and sustainability of gender-based approaches is needed.

Perceptions of high-achieving African American/Black tenth graders from a low socioeconomic community regarding health scientists and desired careers.

Measures are needed to assess youth perceptions about health science careers to facilitate research aimed at increasing youth pursuit of health science. Although the Indiana Instrument provides an established measure of perceptions regarding nursing and ideal careers, we were interested in learning how high-achieving 10th graders from relatively low socioeconomic areas who identify as black/African American (black) perceive health science and ideal careers. The Indiana Instrument was modified, administered to 90 youth of interest, and psychometrically analyzed. Reliable subscales were identified that may facilitate parsimonious, theoretical, and reliable study of youth decision-making regarding health science careers. Such research may help to develop and evaluate strategies for increasing the number of minority health scientists.

Racial/ethnic disparities in patterns and determinants of criminal justice involvement among youth in substance abuse treatment programs.

Adolescent substance abuse is a criminal behavior; however, not all criminal behaviors result in criminal justice involvement. This study examined disparities among adolescents aged 12 to 17 admitted to substance abuse treatment nationwide. Findings indicate significant disparities in patterns and determinants of criminal justice involvement between White and minority adolescents. Minorities were significantly more likely to be involved with the criminal justice system, even after controlling for criminal behaviors, substance abuse, mental health problems, and socioenvironmental risk. Findings reveal that connections to the educational system may be especially important for minority groups. The importance of developing systems of treatment for adolescents in the community and correctional system that are part of the same continuum of care is highlighted.

Pathways to prevention: A training and technical assistance initiative to increase program capacity to address infant mental health issues in Early Head Start.

This article provides an overview of a training and consultation program aimed at enhancing the capacity of Early Head Start (EHS) and Migrant and Seasonal Head Start (MSHS) programs to address infant mental health issues from a promotion, prevention, and treatment perspective. This program was implemented by the Early Head Start National Resource Center (EHS NRC), operated by ZERO TO THREE. The EHS NRC is funded by the Head Start Bureau to provide a diverse array of training and technical assistance support services to Early Head Start programs throughout the country. In the fall of 2001, ZERO TO THREE was funded to design and implement the Pathways Initiative. While ZERO TO THREE was not funded to test the efficacy of the Pathways Initiative as a research intervention similar to other papers described in this special issue, we worked creatively to identify resources that allowed us to engage an external evaluator to look at both process and outcome measures. This paper describes the consultation program, evaluation activities, and key lessons learned.

Social skills and behavior problems of urban, African American preschoolers: role of parenting practices, family conflict, and maternal depression.

This study examined the role of parenting, family routines, family conflict, and maternal depression in predicting the social skills and behavior problems of low-income African American preschoolers. A sample of 184 African American mothers of Head Start children completed participant and child measures in a structured interview. Results of regression analyses revealed that mothers who utilized more positive parenting practices and engaged in more family routines had children who displayed higher levels of total prosocial skills. Positive parenting and lower levels of maternal depressive symptoms were predictive of fewer externalizing and internalizing child behavior problems. Lower family conflict was linked with fewer externalizing problems. Implications of the study for future research and intervention are discussed.

African-American grandmothers as health educators in the family.

More than 18,000 adolescents die each year in the United States from bicycle, motorcycle, car, and truck accidents. This study sought to understand the role of African-American grandmothers as prevention-oriented health educators in the family. Full Model Fitted Regression Analyses were conducted on a sample of African-American grandmothers (N = 105) with 10- to 19-year-old grandchildren. Findings suggest that grandmothers who adopt a proactive, teaching role with their grandchildren are more committed to doing so, confident about doing so, and in a context to do so. In particular, grandmothers who co-reside with their grandchildren are more likely to teach them about how to prevent transportation accidents than those who do not co-reside. These findings could contribute to innovations in existing grandparent education curricula.

Studying the effects of early child care experiences on the development of children of color in the United States: toward a more inclusive research agenda.

Evidence is presented of the different cultural and ecological contexts affecting early child care for families of color. It is argued that improvements on previous research require a fundamental shift in how race, ethnicity, and culture as psychological variables are examined. Furthermore, to avoid the pitfalls and failures of previous research, new research must incorporate expanded models of child care and development in childhood. The integrative model of development for children of color proposed by Garcia Coll et al. (1996) is presented as a basis for developing more specific ecological models relevant to addressing child care issues in ethnic minority families. Finally, priority areas for future research are recommended to stimulate and enable child care researchers to adopt a more inclusive view of child care and its effects.

The influence of racial socialization practices on the cognitive and behavioral competence of African American preschoolers.

The association between parent racial socialization and child competence was examined in a socioeconomically diverse sample of African American preschoolers living in an urban setting. Interviews were conducted in the homes of 200 families. Racial socialization was assessed by parent report as well as by observation of the sociocultural context of the home, and child outcomes were assessed using the Kaufman Assessment Battery for Children and the Child Behavior Checklist. Results indicated that African American parents who provided homes that were rich in African American culture had preschool children who had greater amounts of factual knowledge and better developed problem-solving skills. African American parents who socialized their preschool children to be proud of their heritage reported fewer problem behaviors.