Community Health Equity Research & Policy

The purpose of this exploratory study is to provide a deep understanding of young women's personal accounts of violence to inform prevention programs and policies. Individual and focus group interviews about everyday experiences with violence were conducted with 67 young women, ages 15–19, at a high school in San Francisco, California. Qualitative methods were used to assess the range of young women's experiences with community and interpersonal violence. Three themes emerged from the data: 1) witnessing dating violence; 2) emotions and the language of the body; and 3) the paradox of love and violence. Violence in the lives of young women challenges assumptions about what “youth violence” means, how it happens, and who it happens to.

Among the strategies being tested to improve prompt and appropriate treatment of febrile illness, especially malaria, in young children is the prepackaging of antimalarial drugs in easy to use daily dosages. A TDR-sponsored study in three rural communities in southern Nigeria tested a delivery system for prepackaged chloroquine and cotrimoxazole for children aged 6 months to 6 years. A variety of distributors were trained including village health workers (VHWs), patent medicine vendors (PMVs), and health clinic staff. These distributors also performed community health education. During a 12-month study period, 3954 units of project medicines were sold. While VHWs accounted for the majority of distributors and as a group sold the largest proportion of drugs overall, health staff sold the highest number on average. A follow-up survey found a 25 percent increase in the use of antimalarials over baseline, almost all of which could be attributed to sales of the project chloroquine. While there was also an increased use of cotrimoxazole over baseline, the contribution of project drugs was less. PMVs remained the most common source of treatment both before and after intervention, and there was a small but significant rise in the proportion who sought care from VHWs. While 93 percent of respondents sought care for their sick child within 24 hours, there was significantly more delay among those whose first choice was a government or private clinic. Factors that were positively associated with use of project drugs included reports that the child had a high temperature and seeking care from a VHW or PMV. The results indicate that it is possible to gain a significant market share for prepackaged drugs using locally available distribution channels. The value lies in using a variety of channels, both ones that are centrally located and others that are accessible to scattered, outlying communities that are poorly served by orthodox medicine.

Cancer is the leading cause of death among Asian-American women in the United States and breast cancer is the most commonly diagnosed cancer among Asian-American women. Early detection through breast cancer screening has been found to improve the rate of survival for breast cancer. This study examined factors associated with breast cancer screening among 345 Vietnamese women ≥40 years old residing in a low-income Houston area. Data were collected through a self-administered questionnaire assessing socio-demographic characteristics, access to care factors, acculturation, and perceived susceptibility and severity of risks. Results showed 38 percent, 49 percent, and 33 percent of the respondents reporting having had a breast self-exam, a clinical breast exam, and a mammogram, respectively. Predictors of breast cancer screening include education, employment, ability to speak English, having lived in the United States for more than five years, and having a regular place of care. Implications of this study include the need for a culturally-relevant educational program for this understudied population.

To address the need for innovative approaches to diarrhea prevention in developing countries, we conducted two studies in Zambia to compare the effect of social marketing alone (SM) with social marketing plus motivational interviewing (SM+MI) on the adoption and continued use of a household-based water chlorination and storage intervention called the safe water system (SWS). In Study 1, we conducted a baseline survey, implemented SM+MI in intervention households, SM in comparison households, implemented the SWS, then compared chlorine residuals in stored water in SM and SM+MI households. In Study 2, we compared chlorine residuals in SM and SM+MI households 16 months after a similar implementation project in a different population. The proportion of SM+MI households with adequate chlorine residuals was 16-fold higher in Study 1 and 2-fold higher in Study 2 than SM households. MI is a promising method for motivating the adoption and sustained use of safe water behaviors.

This historical cohort study investigated whether dimensions of the expanded Health Belief Model (HBM), the theoretical framework most applicable to the Women's Center Jamaica Foundation (WCJF) Program for Adolescent Mothers, can be applied to predict the occurrence of repeat pregnancies among teen mothers. A random sample (n = 260) of primiparous Jamaican adolescent mothers 16 years and under who gave birth in 1994 in the parishes of Kingston & St. Andrew, St. Catherine, and Manchester was selected from vital records and interviewed in 1998 for this study. Multivariate analyses indicated that in addition to WCJF program participation, perceived severity, perceived susceptibility, and perceived benefits were significant (p < .05) independent predictors of repeat pregnancy. We recommend the HBM as a useful tool to identify participants who are more likely to experience one or more repeat pregnancies.

In health education and promotion, “risk factors” for disease gathered from epidemiological research form the basis from which the majority of recommendations to individuals for lifestyle change are made. Unfortunately, many health practitioners are unaware that this type of research was never intended to be applied to individuals. The result is ongoing public confusion and anxiety concerning health recommendations and a loss of credibility for health professionals. This article: 1) briefly reviews the most commonly encountered limitations inherent in epidemiological research; 2) explores the problems and potential negative consequences of incorrectly applying epidemiological research in health education and promotion; and 3) makes recommendations to help health practitioners more skillfully interpret and incorporate into their work findings from epidemiological research.