Clarence Spigner

Explanations of ethnic and gender differences in youth smoking: A multi-site, qualitative investigation

Two of the most powerful predictors of adolescent smoking are ethnicity and gender, but little research has focused on understanding how these factors play a role in adolescent smoking. This paper reports results from a qualitative, multi-site investigation of explanations for ethnic and gender differences in cigarette smoking with five ethnic groups: whites, African-Americans, Hispanics, Native Americans, and Asian-American/Pacific Islanders. Across 11 states, we conducted 178 focus groups with a total of 1175 adolescents. The groups explored such major research themes as reasons for smoking and not smoking; images of smoking and smokers; messages youth receive about smoking and not smoking; and the social context of smoking. We synthesized data from the focus groups through multiple cross-site collaborations and discussions, with an emphasis on identifying consistent themes across a majority of groups and sites. Striking differences emerged across ethnic and gender sub-groups in reasons for not smoking. African-American females in particular viewed not smoking as a positive identity marker. Asian-American/Pacific Islander females similarly reported strong mandates not to smoke. Youths perceptions of family messages about smoking also varied by ethnicity and gender, with African-American, Hispanic, and Asian-American/Pacific Islander youth consistently reporting strong, clear anti-smoking messages from family. These findings, notable in their consistency across geographic regions, may shed light on the discrepant prevalence of smoking across ethnic and gender groups.

Does Tobacco Industry Marketing Excessively Impact Lesbian, Gay and Bisexual Communities?

Background: Tobacco industry documents have revealed marketing plans specifically to reach lesbian, gay and bisexual (LGB) populations. Research supports a causal linkage between receptivity and exposure to tobacco industry marketing and tobacco use uptake among adolescents. Pro-tobacco messages may diminish the effectiveness of tobacco control activities and contribute to the high smoking prevalence among LGB populations. Objective: To compare receptivity and exposure to tobacco industry marketing between LGB and heterosexual populations. Methods: Nearly 400 gay or bisexual men and more than 600 lesbian or bisexual women were identified in the 2003–2006 Washington State Behavioral Risk Factor Surveillance System (BRFSS), a state-wide, population-based telephone survey of adults. The BRFSS included questions measuring receptivity and exposure to tobacco industry marketing. Multiple logistic regression models stratified by gender were used to assess differences for lesbians, gays and bisexuals separately, in comparison to their heterosexual counterparts. Results: As expected, smoking prevalence was higher among LGB populations than among heterosexuals. After adjustment for demographic differences and smoking status, gay and bisexual men reported more exposure to tobacco industry marketing (free sample distribution) than straight men, but were equally receptive to it. Lesbian and bisexual women were more receptive to and reported more exposure to tobacco industry marketing than straight women. Conclusion: LGB communities, especially lesbian and bisexual women, appear to be effectively targeted by tobacco industry marketing activities. Strategies to limit tobacco industry marketing, and increase individuals’ resistance to marketing, may be critical to reducing smoking among LGB populations.

Knowledge and opinions about organ donation among urban high school students: pilot test of a health education program

Background: Increasing the diversity of the organ donor pool might improve the opportunities for people of color on organ transplant waiting lists to receive donated organs. We report on the results of a pilot classroom health education program to improve knowledge about organ donation and transplantation among a diverse student body at an urban high school. 
Methods: The effectiveness of the educational program was evaluated with baseline and follow‐up questionnaires which examined: 1) whether the program increased knowledge about organ donation; 2) whether the students’ opinions about organ donation changed; and 3) whether the program was related to any changes in opinion. 
Results: On the follow‐up questionnaire, correct answers on 15 factual questions increased by 18% for the treatment group, compared to 5% for the control group (p=0.00). Regarding opinions, at baseline 92% of white students had positive opinions about donation, compared to 48% of the students of color (p=0.00). In the follow‐up survey, the increase in positive opinions among the students of color was significantly greater than among white students (p=0.04). In this pilot study, however, changes in opinions occurred with equal frequency among students in the treatment and control groups. 
In regression analysis, both knowledge of the subject and discussing donation with ones family were significantly associated with positive opinions about donation. 
Conclusions: Overall, this pilot study provided encouraging evidence that the classroom health education program affected knowledge about organ donation, and that opinions about organ donation are responsive to increases in knowledge.

Developing competencies for a graduate school curriculum in international health.

which does not have a school of public health (SPH) The University of Washington School of Public Health (UW SPH) in Seattle, Washington, has met this chal-lenge by expanding and reorganizing its international public health teaching. We have established competen -cies for our global health MPH scholars, with a focus on addressing large public health problems with a social justice perspective.The emergence of the global health concept over the last decade reflects heightened awareness of accelerating globalization processes that challenge the traditionally drawn boundaries between the interna-tional and domestic health professional worlds. While the precise definition of global health continues to be contested, it is widely agreed that increased global flows of resources, information, people, and infectious diseases, together with growing global inequality, have created new public health problems that require fresh and innovative approaches. With this recognition has come a spate of new global health centers, departments, institutes, and programs in American and European universities that seek to redefine approaches to public health and recalibrate training to new global health realities for the next generation of health researchers and practitioners. While the urgency for such redefined training is apparent, there is little in the current public health literature that attempts to identify just what this training should include. In spite of new global health program proliferation, core professional global health competencies have yet to be defined, and no consensus for development of appropriate curricula has emerged in the public health field. The recent creation of a new Department of Global Health (DGH) at UW has presented cur-riculum planners, charged with developing new MPH, doctor of philosophy (PhD), and doctor of medicine programs, with these immediate challenges. This article describes the consensus-building process conducted by the DGH curriculum committee over a one-year period in which global health competencies were identified and curriculum needs redefined. While debates about the meaning and scope of global health will continue, basic guidelines for new kinds of training are urgently needed to prepare health workers for the rapidly chang-ing environment they will soon confront.Through this recently established DGH (which has received much of its new funding through an endowed grant from the Bill and Melinda Gates Foundation), UW is poised to rapidly expand its international health student enrollment, course offerings, and degree programs. Other prominent universities have launched similar efforts in just the last two years. In 2006, Duke University in Durham, North Carolina, to date, launched a new Global Health Institute, which started its education program with an undergraduate certificate. The Johns Hopkins University in Baltimore, Maryland, launched a Center for Global Health, bringing together its SPHs, medicine, and nursing schools in a collaborative effort. In addition, other schools such as The George Washington University in Washington, DC, have recently started offering MPH degrees in global health.As UW prepared to launch its DGH—a collaboration between the SPH and the school of medicine—the curriculum committee of the existing international health program embarked on a complete review of UW’s current course offerings in anticipation of growth and expansion. We found very little guidance for this effort in the public health literature. Patrick reported major gaps in public health training, along with the implication of inadequate coursework in SPHs and in medical schools.

Knowledge and opinions about organ donation and transplantation among Vietnamese Americans in Seattle, Washington: a pilot study

Abstract:  Background:  Racial/ethnic minorities comprise almost 50% of registrants on national waiting lists for organ transplantation in the USA. As the list continues to expand, organ shortage becomes a bigger problem. Increasing donation rates especially among racial minority groups would lower the waiting times for these groups.

An Exploration of Family Influences on Smoking among Ethnically Diverse Adolescents

In an attempt to better understand mechanisms throughwhich families might influence adolescent smoking, focus group data collected as part of a larger study of ethnic and gender differences in teen smoking were analyzed for family-related themes. Across six sites, 132 focus groups were conducted with African American, American Indian, Hispanic, Asian/Pacific Islander, and White youth. Similarities across race/ethnicity were evident in the content of antismoking messages and the feeling among youth that theywould get in trouble with their parents if caught smoking. African American and Asian/Pacific Islander youth appeared more concerned about their parents thinking less of them if they smoked than were youth from other racial/ethnic groups. White and American Indian youth were more likely to discuss that their parents felt it was their own decision as to whether or not to smoke than were the other groups.

Organ Donation and Transplantation: Ethnic differences in knowledge and opinions among urban high school students

Purpose : To assess knowledge and opinions about the process of human organ donation and transplantation among American teenagers. Methods : A culturally sensitive 35-item self-administered survey assessing knowledge, opinions, and family discussion about organ donation and transplantation was conducted with 247 students in 13 separate classrooms encompassing three urban high schools in the same city. Results : More than 50% of the students did not know the correct answers to 13 of the 16 questions on factual knowledge. The sources of information about organ donation and transplantation among students were primarily television and school. African-Americans and Asian-Americans were significantly less likely to want to become organ donors when compared to non-African-Americans and non-Asian-Americans, respectively. Asian-Americans were significantly less likely to have discussed the matter with family members. Conclusions : Accurate, up-to-date, culturally sensitive youth-oriented health education that emphasizes family discussions about organ donation and transplantation is needed.

Correlates of Patient-Reported Racial/Ethnic Health Care Discrimination in the Diabetes Study of Northern California (DISTANCE)

Objectives. We examined possible determinants of self-reported health care discrimination.Methods. We examined survey data from the Diabetes Study of Northern California (DISTANCE), a race-stratified sample of Kaiser diabetes patients. Respondents reported perceived discrimination, and regression models examined socioeconomic, acculturative, and psychosocial correlates.Results. Subjects (n = 17,795) included 20% Blacks, 23% Latinos, 13% East Asians, 11% Filipinos, and 27% Whites. Three percent and 20% reported health care and general discrimination. Health care discrimination was more frequently reported by minorities (ORs ranging from 2.0 to 2.9 compared with Whites) and those with poorer health literacy (OR51.10, 95% CI: 1.04–1.16), limited English proficiency (OR = 1.91, 95% CI: 1.32–2.78), and depression (OR = 1.53, 95% CI: 1.10–2.13). Conclusions. In addition to race/ethnicity, health literacy and English proficiency may be bases of discrimination. Evaluation is needed to determine whether patients are treated differently or more apt to perceive discrimination, and whether depression fosters and/or follows perceived discrimination.

Our Community in Focus The Use of Photovoice for Youth-Driven Substance Abuse Assessment and Health Promotion

The successful development and implementation of prevention curricula requires seeking strategies that combine the strengths of researchers and community members. Because young people are considered to be the experts in their own lives, it is important to determine effective ways to engage them in substance abuse assessment and prevention initiatives. The community-based participatory action research methodology of photovoice is one way to engage youth in assessment of this public health issue. “Our Community in Focus” was a project that used the photovoice methodology to engage high school youth in a community-based assessment of adolescent substance use and abuse. Through the photovoice method, youth were able to reflect their community’s strengths and concerns with regards to adolescent substance abuse, as they took photographs to answer the question “What contributes to adolescents’ decisions to use or not to use alcohol and other drugs?” The youth and the community were highly receptive to the project and its methodology, and photographs taken by photovoice participants presented a compelling argument for action.

Effects of classroom education on knowledge and attitudes regarding organ donation in ethnically diverse urban high schools

Cárdenas V, Thornton JD, Wong KA, Spigner C, Allen MD. Effects of classroom education on knowledge and attitudes regarding organ donation in ethnically diverse urban high schools. 
Clin Transplant 2010: 24: 784–793.