James Teufel

Rural Medical-Legal Partnership and Advocacy: A Three-Year Follow-up Study

Introduction. Medical-legal partnerships perform advocacy services for vulnerable and underserved populations, who are burdened disproportionately by legal and medical problems. This study aimed to examine the effectiveness and projected sustainability of a rural medical-legal partnership (MLP). Methods. Five years of baseline data and three years of follow-up data were analyzed using descriptive and inferential statistics as well as logic modeling. Results. The benefit relative to cost of the MLP increased between the years of 2002-2006 and 2007-2009. The number of people served increased across the two time periods, and the proportion of cases won remained the same. Overall, the population served remained similar across time. The MLP continued to show social and financial impacts, such as health care recovery dollars (319% return on investment between 2007 and 2009), Social Security benefits, family law services, and end-of-life guidance. Conclusion. A rural MLP can maintain its impact and efficiency across time and have opportunities for expansion.

Process and Impact Evaluation of a Legal Assistance and Health Care Community Partnership

Community health partnerships have increased in popularity, but their effectiveness is often not evaluated. Through secondary data analysis, this study evaluates a program that offered access to legal services to address health-related issues, such as Medicaid reimbursement, Social Security benefits, medication coverage, and divorce. Based on the analysis reimbursements to expenditures, the health and law program appears to be cost-effective and thereby economically sustainable. The cost-effectiveness of this program increases the likelihood that it will be institutionalized and/or expanded. This program evaluation is used to exemplify how community stakeholders could partner to leverage resources to establish a sustainable community health and law program to address the needs of people living in medically underserved areas.

Active Generations: An Intergenerational Approach to Preventing Childhood Obesity.

BACKGROUND Over the last 3 decades, US obesity rates have increased dramatically as more children and more adults become obese. This study explores an innovative program, Active Generations, an intergenerational nutrition education and activity program implemented in out-of-school environments (after school and summer camps). It utilizes older adult volunteers to implement a version of the evidence-based childhood obesity prevention program, Coordinated Approach to Child Health, in 8 US cities. METHODS Approximately 760 children in third- to fifth-grade participated in Active Generations, a 10-lesson, intergenerational, childhood obesity prevention program. Children completed an age-appropriate survey instrument, the Active Generations survey (AGS). The AGS is a valid and reliable, self-administered, self-report, paper-and-pencil survey designed to assess knowledge, attitudes, and behaviors. It was administered by trained volunteers on the first day and last day of the program. Constructs assessed included physical activity, nutrition, and media use. RESULTS Students significantly increased their reported fruit and vegetable consumption post-program. For example, the percentage of students reporting eating 3 or more servings of vegetables per day was 16% greater post-program. Students were more likely to report reading food labels and greater confidence that they could participate in physical activity. They also significantly decreased their daily screen time. CONCLUSIONS Active Generations is a promising childhood obesity prevention program.

Effects of a Single-Lesson Tobacco Prevention Curriculum on Knowledge, Skill Identification and Smoking Intention.

One in five students report experimenting with tobacco before the age of 13 and most prevention efforts take place in the school setting. This study measures the effect of a single-lesson tobacco prevention curriculum, conducted by a health education center, focusing on knowledge of tobacco, ability to identify refusal techniques, and intent not to smoke. Data were collected, via electronic keypads, from students visiting a non-school, health education center in Michigan (n = 704 intervention and 85 comparison). Contingency table Chi-squared tests and t-tests demonstrated that a single lesson can improve general knowledge and ability to identify appropriate refusal techniques. Improvement in intent not to smoke was not significant because both groups had very high intent prior to implementation. Similar to results from other programs, multivariate logistic regression of gender, general knowledge, and skill identification revealed that only the skill variable was associated with intent not to smoke at pretest. Recommendations are given for further research and for designing more effective curricula or programs.

Persistence of racial disparities in prescription of first-generation antipsychotics in the USA

The aim of this study was to estimate the prevalence of first‐generation antipsychotics (FGA) prescribed for treatment of psychiatric and neurological conditions and use of benztropine to reduce extrapyramidal side effects (EPS) by patient race/ethnicity in a nationally representative sample of adult outpatient visits.

Building Community and Social Capital by Engaging Capacity-building Volunteers in Intergenerational Programs

As the number of older adults in the United States rises, it becomes increasingly necessary to view aging differently. According to the United States Census Bureau (2012), 13% of the population was...

Evaluation of a Peer-Led, Low-Intensity Physical Activity Program for Older Adults.

Background Physical inactivity is a primary contributor to decreasing functional physical fitness and increasing chronic disease in older adults. Purpose This study assessed the health-related benefits of ExerStart for Lay Leaders, a 20-week, community based, peer-led, low-impact exercise program for older adults. ExerStart focuses on aerobic endurance, muscular strength, flexibility, and balance. Methods Using a pre/posttest evaluation design, researchers examined the effects of the program on 432 older adults in St. Louis, Missouri, and Houston, Texas. Participants completed self-report surveys as well as observed functional physical fitness assessments. Results Participants in ExerStart for Lay Leaders significantly improved their perceived satisfaction with body function, functional physical fitness, perceived overall health, and body mass index. Discussion This study adds to the evidence that older adults benefit from structured, peer-led exercise programs. The increased physical fitness, if maintained, may lead to a decrease in falls, adult obesity, and nursing home placements. Translation to Health Education Practice The current research has important implications for implementing outcome-based and cost-effective health education programs for older adults, including using peer leaders as a cost reduction technique to implement and disseminate research informed programs into community settings.

An Intergenerational Volunteer-Led Approach to Tutoring Elementary School Students in the United States

In the United States, educational attainment and literacy strongly influence employment, income, health, and wealth within and across generations (Braveman, Egerter, & Barclay, 2011; Egerter Braveman, Sadegh-Nobari, Grossman-Kahn, & Dekker, 2011; Sum, Kirsch, & Yamamoto, 2004). Reading achievement impacts level of educational attainment, and research supports that volunteer-led, intergenerational tutoring programs can improve the reading achievement of school-age children (Gattis et al., 2010). Since 1989, OASIS has recruited and united volunteer tutors ages 50 and older with students in kindergarten through fourth grades (ages 6 to 10). To date, over 100,000 volunteers have tutored nearly 350,000 children across the United States with the aim of improving reading skills, academic performance, and attitudes about learning. OASIS currently implements its intergenerational tutoring program in close to 900 public and parochial elementary schools that are spread across more than 100 school districts in 25 U.S. cities. On an annual basis, nearly 6,000 volunteer older adults tutor over 10,000 children.

Sex Differences in Risk Factors and Conditions of Incarcerated Violent Offenders

Background: Violence is widely recognized as a major public health problem requiring public policy intervention. Previous studies have not adequately addressed possible sex differences in risk factors and risk conditions of incarcerated violent offenders. Using a large, nationally representative sample of state and federal prisoners, this study tested if sex moderated the association between risk (factors and conditions) and type of adult crime conviction (violent versus nonviolent crime). Methods: Using the 2004 Survey of Inmates in State and Federal Correctional Facilities, self-reported socioeconomic and mental health-related risk factors and background factors were obtained for a cross-section of N=16,152 incarcerated adults in stratified sample state and federal prisons located in the United States. The sample was weighted to reflect the population of prisoners. Results: Parental substance abuse, a history of physical abuse or sexual abuse, depression symptoms, and psychosis symptoms all distinguished incarcerated violent offenders from incarcerated non-violent offenders regardless of sex. A history of sexual abuse was particularly high in men compared to women among incarcerated violent offenders but not among non-violent offenders. Conclusion: This study highlights the fact that regardless of sex, childhood background, reports of abuse, and select mental health disorders predicted the type of crime that resulted in incarceration as an adult. Findings support path dependence of type of criminal incarceration of adults. The predictors distinguishing violent and non-violent crime incarceration are almost identical for males and females. The risk factor distinguishing non-violent crime incarceration is adult drug use. The risk factors distinguishing adults incarcerated for violent crime indicate more social and environmental vulnerability as children, increased likelihood of abuse, and greater burden of psychosis and depression. This study supports that the treatment foci for violent and nonviolent prisoners should differ by type of crime but not by sex given type of crime.

Planning and Response to Communicable Disease on US Domestic Air Flights

Globalization along with the ongoing spread of novel infectious diseases including influenza, coronavirus, and Ebola has spurred growing interest and significant research on the impact of commercial air travel as a factor contributing to the spread of disease from one geographic location to another. Despite this, there has been little to no research on the appropriate response to this public health challenge and the coordination of response capabilities across key responders. We conducted a tabletop exercise to explore a scenario that simulated a U.S. domestic commercial flight transporting a passenger infected with probable MERS-CoV. Participants included a broad range of stakeholders in a medium-sized Mid-western U.S. city. The tabletop exercise revealed gaps in public health preparedness among response partners that require improved collaboration among public health, airport operations and airline personnel, and fire and emergency management services.