Elaine M. Walker

Gender-based health interventions in the United States: An overview of the coalition for healthier community initiative

Health disparities by gender constitute an important yet often overlooked aspect of health around the globe. Within the United States, there is both a paucity of research as well as planned programs that take into account how socio-cultural roles and expectations for men and women may differentially affect symptoms, access to care, and treatment. Viewing womens health exclusively as a function of sex (i.e., biological) differences represents a narrow understanding that does not fully explain gaps in health disparities between men and women. In September 2010, the U.S. Department of Health and Human Services (DHHS) launched a national initiative entitled the Coalition for a Healthier Community (CHC) to employ a gender-based framework in several urban, suburban and rural communities across the nation. The Office on Womens Health (OWH) within the DHHS funded 10 coalitions to ultimately improve the health of women and girls utilizing a gender-based approach. This article provides an overview of the initiative and the focus of the special issue.

The Impact of State Policies and Actions on Local Implementation Efforts: A Study of Whole School Reform in New Jersey:

This article integrates the technical model of policy implementation with a coconstructed perspective of implementation to understand the impact of the New Jersey Department of Education’s (NJDOE) actions and policies on implementation of a set of court-ordered mandates in 30 of the state’s poorest school districts (referred to as the Abbott or special needs districts). The analysis reveals that the organizational responses of the NJDOE subverted the goals of the reforms. At the same time, local districts have interpreted and responded to the reforms in ways that are consonant with their own experiences and understandings. The article concludes with the observation that the ambient political environment in which the NJDOE operates places it in a conflictual relationship with not only the local districts but with the state’s Supreme Court, which is the progenitor of the reforms.

Whole school reform and preschool education: The role of preschool education in policy decisions regarding the improvement of disadvantaged school systems

In 1998, the New Jersey Supreme Court ordered the state to implement an ambitious agenda for reforming preschool education in the states 30 poorest school districts. This reform formed part of a larger attempt to overhaul educational programming in these school districts. The preschool reform attempted to meld, both programmatically and fiscally, community and public school preschool programs. According to the Courts ruling, all 3- and 4-year-olds residing in these school districts must be provided with high-quality preschool educational experiences. This paper offers insights into the challenges that the State of New Jersey is experiencing as it seeks to comply with the Courts mandate. The paper highlights issues related to determining program content, establishing teacher certification requirements, securing adequate funding and ensuring adequate enrollment. These issues are implicated within the larger discourse of what constitutes effective and high-quality preschool programs.

Evaluation considerations for community-based gender-informed health interventions

Evaluations of gender-based interventions have been consistently criticized for their lack of methodological rigor. This is largely due to the complex design of many of the interventions, coupled with difficulties in measuring the outcome and impact of these interventions. This article proposes a number of ways to improve these evaluations both at the community and individual level. We recommend use of organizational theory and narrative inquiry methods, such as the appreciative inquiry technique, to examine how communities design gender-based interventions. In addition, we suggest a variety of methods to measure the effects of these interventions on gender norms in the community for example, policy analysis, multilevel modeling, and social conversations. With respect to measuring outcomes at the individual level, we argue for more rigorous evaluation designs in order to improve internal and external validity claims. Additionally, we suggest that evaluations should incorporate different methodologies, for example autobiographical narratives, which allows one to give saliency to the subjective voices of participants. Finally, we emphasize that evaluation designs need to document the long term effects of intervention programs and define the expected outcomes with greater specificity.

Guest editor's introduction to special issue

To the extent that the United States continues to lead Western developed countries in births to teenage mothers, teenage pregnancy prevention remains a major public health issue. It has assumed even greater urgency because of its intersection with race and class. Research has shown that risk factors increase, while protective factors decrease, for African-American youth, Hispanic youth, and adolescents living in poverty. These youths are at greater risk of engaging in sexual behavior at a younger age; having multiple sexual partners before marriage; and contracting a sexually transmitted infection. In addition, the research has shown that teens that become pregnant are more likely to have depressed human capital, since in many instances they are unable to complete their schooling, and as a consequence are more apt to be trapped in poverty. Indeed, teen mothers are less likely to complete high school. Only one-third receive a high school diploma, and only 1.5% earn a college degree. While there is agreement on the need for the creation of sound public health policy approaches to teen pregnancy, there is considerable debate on how to do so most effectively. In the vast field of public health and, in particular, adolescent health and behavior, discernible differences can be found among policy-makers, practitioners, researchers and non-governmental organizations regarding the most effective strategies to reverse the current upward spiral in births to teen parents, after years of declining birth rates among young mothers. A number of questions have emerged: (1) What theoretical foundations ought to undergird such interventions? (2) Are there innovative preventive approaches and techniques that are widely replicable? (3) What are the key indicators of effectiveness? and (4) How important is it that curricula be designed to be culturally appropriate? To date, these questions remain open; and the question remains of how best to respond to them remains unresolved. In this special issue, authors representing various disciplinary backgrounds seek to provide partial answers to some of questions raised. The research findings presented in this volume are based on studies from seven programs that received funding through the Adolescent Family Life Program (AFL) administered by the Office of Population Affairs in the U.S. Department of Health and Human Services. The AFL program was enacted to develop, implement, and test innovative programmatic (and potentially replicable) approaches to prevent teenage pregnancy, and to provide services to pregnant and parenting adolescents. Over the past 29 years, the AFL program has funded a multitude of research and demonstration projects. Prevention demonstration projects serve youth between the ages of 9 and 19. However, these programs have tended to focus primarily on younger children between the ages of 9 and 14. While the design and implementation of each prevention project is unique; more than 80% of all prevention projects funded by the AFL program are community-based, and the majority of these community-based efforts occur in schools. Journal of Children and Poverty Vol. 17, No. 1, March 2011, 3 5