Kathleen M. Roe

Grandmothers as caregivers : raising children of the crack cocaine epidemic

Foreword - Troy Duster Introduction Social and Cultural Contexts of Caregiving Hearing the Voices, Telling the Stories The Grandparent Caregiver Study Assuming the Caregiver Role The Health Status of Grandmother Caregivers The High Costs of Caring Economic Considerations Social Networks and Social Support Coping with the New Caregiving Combining Work and Childcare The Continuity of Caregiving Raising the Children of the Crack Cocaine Epidemic Special Considerations Community Interventions to Support Grandparent Caregivers Implications for Policy

Substance use prevention for adolescents: the Icelandic Model

Data from the European School Survey Project on Alcohol and other Drugs have shown that adolescent substance use is a growing problem in western and particularly Eastern European countries. This paper describes the development, implementation and results of the Icelandic Model of Adolescent Substance Use Prevention. The Icelandic Model is a theoretically grounded, evidence-based approach to community adolescent substance use prevention that has grown out of collaboration between policy makers, behavioural scientists, field-based practitioners and community residents in Iceland. The intervention focuses on reducing known risk factors for substance use, while strengthening a broad range of parental, school and community protective factors. Annual cross-sectional surveys demonstrate the impact of the intervention on substance use among the population of 14- to 16-year-old Icelandic adolescents. The annual data from two cohorts of over 7000 adolescents (>81% response rate) show that the proportions of those who reported being drunk during the last 30 days, smoking one cigarette or more per day and having tried hashish once all declined steadily from 1997 to 2007. The proportions of adolescents who reported spending time with their parents and that their parents knew with whom they were spending their time increased substantially. Other community protective factors also showed positive changes. Although these data suggest that this adolescent substance use prevention approach successfully strengthened a broad range of parental, school and community protective factors, the evidence of its impact on reducing substance use needs to be considered in light of the correlational data on which these observations are based.

Toward a Unified System of Accreditation for Professional Preparation in Health Education: Final Report of the National Task Force on Accreditation in Health Education

During the past 40 years, health education has taken significant steps toward improving quality assurance in professional preparation through individual certification and program approval and accreditation. Although the profession has begun to embrace individual certification, program accreditation in health education has been neither uniformly available nor universally accepted by institutions of higher education. To further strengthen professional preparation in health education, the Society for Public Health Education (SOPHE) and the American Association for Health Education (AAHE) established the National Task Force on Accreditation in Health Education in 2001. The 3-year Task Force was charged with developing a detailed plan for a coordinated accreditation system for undergraduate and graduate programs in health education. This article summarizes the Task Force’s findings and recommendations, which have been approved by the SOPHE and AAHE boards, and, if implemented, promise to lay the foundation for the highest quality professional preparation and practice in health education.

The Assumption of Caregiving: Grandmothers Raising the Children of the Crack Cocaine Epidemic

In this article, selected findings are presented from a study of the experiences of 71 African American women who have become the sole caregivers for at least one grandchild or great-grandchild as a result of the involvement of the parent in use of crack cocaine. Despite the unique circumstances of each situation, three patterns of the assumption of caregiving emerged from analysis of the intensive interviews and participant observation: sudden assumption, negotiated assumption, and inevitable assumption of the permanent caregiver role. Each pattern is described along six dimensions: forewarning, initiation, the trigger event, the caregivers goal, her assumed trajectory of the caregiving period, and her perceived influence on her own destiny. These accounts provide important information for those who work with women, children, and families, as well as unique insight into the consequences of the crack cocaine epidemic.

Current Developments in Accreditation and Certification for Health Promotion and Health Education: A Perspective on Systems of Quality Assurance in the United States

The health education profession in the United States employs parallel, and overlapping, systems of voluntary credentialing to ensure quality in professional preparation. The U.S. approach to quality assurance comprises credentialing at the individual level, including certification, and at the institutional level, including regional and program-specific accreditation or approval of professional preparation degree programs. These multiple systems and levels of quality assurance have evolved during a half century but have not been uniformly available or universally embraced by the field, employers, or those in the institutional settings in which health educators now receive their professional preparation. This article reviews the current scope of credentialing systems in the United States and explains whom they serve and how they function. Recent developments that are now reshaping the landscape of quality assurance in health education and health promotion are also discussed.

Progress in the Pipeline: Replication of the Minority Training Program in Cancer Control Research

BACKGROUND This paper evaluates the replicability of an NCI-funded didactic/experiential program to increase the diversity of doctorally-prepared cancer disparities investigators. METHODS The program was developed and operated successfully for three years in Northern California when a replication was established at UCLA. Feasibility, process, impact, and outcome measures on UCSF and UCLA summer-institute participants were compared. RESULTS Average participant rankings of the influence of the program on intention to apply for a doctorate were 9.1/10 (UCSF) and 8.6/10 (UCLA). A total of 22.5% of UCSF and 10% of UCLA participants have enrolled in, been accepted by, or completed doctoral programs. Among these alumni, 68% (21/31) of UCSF and 60% (3/5) of UCLA participants plan to conduct their doctoral research in cancer control. CONCLUSIONS This program has been successfully replicated and has met its objective to increase the pipeline of ethnically diverse doctoral-level public health researchers. Expansion of the program to other regions of the US is feasible and indicated.

Private troubles and public issues: providing abortion amid competing definitions.

Sixteen years after the Supreme Court liberalized abortion policy, the United States continues to debate two competing and seemingly irreconcileable definitions of abortion. The experience of those who provide abortion has received relatively little research attention despite this unique set of historical circumstances. This paper presents findings from an exploratory study of 130 abortion workers (physicians, nurses and counselors). The data suggest that, despite formal beliefs about abortion rights, the situated experience of providing legal abortion evokes a range of abortion definitions. Seven central definition themes were cited repeatedly by the respondents: abortion as a womans right, a destructive act, part of the practitioners work, a technical procedure, a positive act, murder and an irresponsible act. Respondents perceived each definition to fit within one of three fixed and familiar perspectives: medical, pro-choice or pro-life. Each perspective was understood to have its own exclusive meanings, vocabulary and imagery which automatically remanded the situated definitions to a broader social context. Each definition of abortion was seen to define the event itself as well as to input specific meaning and differential value to what is aborted, the woman terminating her pregnancy, the nature of abortion work and the role of the practitioner. These definition components were perceived to be specific, codified and mutually exclusive within the different definition themes. They also were found to be linked to expected and specified feelings. The co-existence of feelings or definitions that were perceived as consistent was hardly noted by respondents.(ABSTRACT TRUNCATED AT 250 WORDS)

Observations of the Past Decade™s Efforts to Bridge the Gaps between Health Education and Health Promotion Practice and Research:

What have we done to enhance our image as profes sionals? There have been few contributions made to the body of written knowledge by practitioners. There is little solid evidence from health educators that health education works. There is scant display of scientific rigor in what we do in the practice of health education. There are few who consider involvement with and con tribution toward the growth and development of the profession as important to their own personal profes sional development. There are so few who consider professional preparation as only the first step in profes sional development. —Ware (1976)

In the Shadow of the Rainbow: Identifying and Addressing Health Disparities in the Lesbian, Gay, Bisexual, and Transgender Population— a Research and Practice Challenge:

T he image of the rainbow often evokes peace, calm, and possibility. It is connected to luck and the promise of treasure on the other side. The rainbow has also been a symbol of pride and freedom for many in the lesbian, gay, bisexual, and transgender (LGBT) community. In this context, the rainbow suggests unity, integrity of difference, and belief in a place where “the clouds are far behind us.” Yet, too many LGBT people live too much of their lives in the shadow of the rainbow, forced to hide or deny their identity and sexual orientation. The individual consequences of living as an openly gay person can be profound—rejection by family and friends, physical violence and verbal abuse, insensitive health and social services, loss of jobs or housing, and lack of protection under the law. On a broader scale, the rainbow’s shadow hides physical, mental, and social health disparities, often undocumented in research and discounted in interventions but nonetheless real. Like the rainbow, the image of a vibrant circle of research and practice also evokes a sense of possibility and discovery. This circle, so crucial to the practice of health promotion, can perpetuate disparities by ignoring, misunderstanding, or misrepresenting the health and experiences of LGBT people. Or, the circle can illuminate, linking lived experience and insight from practice to the questions and analysis of our research. As a group of public health education practitioners and researchers, we offer this commentary to raise the issues, spark discussion, and engage the circle.

The Use of International Service Learning Initiatives for Global Health Education Case Studies From Rwanda and Mexico

Global health education and health promotion have the potential to engage students, scholars, and practitioners in ways that go beyond the classroom teaching routine. This engagement in global communities, can range from reflection on continuing deep-seated questions about human rights and civic responsibility to the use of health education and promotion–related theoretical, intellectual, and practical skills. In the arena of global health education and promotion, these skills also range from leadership and advocacy to decision making, critical and creative thinking, teamwork, and problem solving. In recent times, there has been a growing interest in cross-cultural collaborations and educational initiatives to improve stakeholder’s understanding of global health principles and practices, to enrich the experiences of health professionals, and to improve the lives of those who are disenfranchised and live across borders. In this article of Health Promotion Practice, we highlight two unique cases of cross-national collaborations and provide a glimpse of the various shapes and forms taken by cross-cultural educational initiatives for global health education and promotion. We summarize the history, philosophy, and current working practices relevant to these collaborations, keeping in view the global health domains, competencies, and activities. In addition, we also compare the key components and activities of these two case studies from Rwanda and Mexico, wherein communities in these two countries collaborated with academic institutions and health professionals in the United States.