Mindy Thompson Fullilove

Culturally competent healthcare systems: A systematic review☆

Culturally competent healthcare systems-those that provide culturally and linguistically appropriate services-have the potential to reduce racial and ethnic health disparities. When clients do not understand what their healthcare providers are telling them, and providers either do not speak the clients language or are insensitive to cultural differences, the quality of health care can be compromised. We reviewed five interventions to improve cultural competence in healthcare systems-programs to recruit and retain staff members who reflect the cultural diversity of the community served, use of interpreter services or bilingual providers for clients with limited English proficiency, cultural competency training for healthcare providers, use of linguistically and culturally appropriate health education materials, and culturally specific healthcare settings. We could not determine the effectiveness of any of these interventions, because there were either too few comparative studies, or studies did not examine the outcome measures evaluated in this review: client satisfaction with care, improvements in health status, and inappropriate racial or ethnic differences in use of health services or in received and recommended treatment.

The effectiveness of early childhood development programs: A systematic review

Early childhood development is influenced by characteristics of the child, the family, and the broader social environment. Physical health, cognition, language, and social and emotional development underpin school readiness. Publicly funded, center-based, comprehensive early childhood development programs are a community resource that promotes the well-being of young children. Programs such as Head Start are designed to close the gap in readiness to learn between poor children and their more economically advantaged peers. Systematic reviews of the scientific literature demonstrate effectiveness of these programs in preventing developmental delay, as assessed by reductions in retention in grade and placement in special education.

Memories of Childhood Sexual Abuse: Remembering and Repressing

Women involved in out-patient treatment for substance abuse were interviewed to examine their recollections of childhood sexual abuse. Overall, 54% of the 105 women reported a history of childhood sexual abuse. Of these, the majority (81%) remembered all or part of the abuse their whole lives; 19% reported they forgot the abuse for a period of time, and later the memory returned. Women who remembered the abuse their whole lives reported a clearer memory, with a more detailed picture. They also reported greater intensity of feelings at the time the abuse happened. Women who remembered the abuse their whole lives did not differ from others in terms of the violence of the abuse or whether the violence was incestuous. These data bear on current discussions concerning the extent to which repression is a common way of coping with childhood sexual abuse trauma, and also bear on some widely held beliefs about the correlates of repression.

Black-White Inequalities in Mortality and Life Expectancy, 1933–1999: Implications for Healthy People 2010

Objectives. Optimistic predictions for the Healthy People 2010 goals of eliminating racial/ethnic disparities in health have been made based on absolute improvements in life expectancy and mortality. This study sought to determine whether there is evidence of relative improvement (a more valid measure of inequality) in life expectancy and mortality, and whether such improvement, if demonstrated, predicts future success in eliminating disparities. Methods. Historical data from the National Center for Health Statistics and the Census Bureau were used to predict future trends in relative mortality and life expectancy, employing an Autoregressive Integrated Moving Average (ARIMA) model. Excess mortality and time lags in mortality and life expectancy for blacks relative to whites were also estimated. Results. Based on data for 1945 to 1999, forecasts for relative black:white age-adjusted, all-cause mortality and white:black life expectancy at birth showed trends toward increasing disparities. From 1979, when the Healthy People initiative began, to 1998, the black:white ratio of age-adjusted, gender-specific mortality increased for all but one of nine causes of death that accounted for 83.4% of all US mortality in 1998. From 1980 to 1998, average numbers of excess deaths per day among American blacks relative to whites increased by 20%. American blacks experienced 4.3 to 4.5 million premature deaths relative to whites in 1940–1999. Conclusions. The rationale that underlies the optimistic Healthy People 2010 forecasts, that future success can be built on a foundation of past success, is not supported when relative measures of inequality are used. There has been no sustained decrease in black-white inequalities in age-adjusted mortality or life expectancy at birth at the national level since 1945. Without fundamental changes, most probably related to the ways medical and public health practitioners are trained, evaluated, and compensated for prevention-related activities, as well as further research on translating the findings of prevention studies into clinical practice, it is likely that simply reducing disparities in access to care and/or medical treatment will be insufficient. Millions of premature deaths will continue to occur among African Americans.

Stigma as an Obstacle to AIDS Action: The Case of the African American Community

The control of the spread of AIDS depends on the willingness of the U.S. society to undertake a series of prevention actions. A corollary of this is that the prevention action must be managed in a manner that is sympathetic to affected populations. The presence of homophobia is widely recognized in African American churches, and has hampered their ability to engage in AIDS prevention. This article explores the problem of homophobia in the African American community. A secondary analysis of focus group transcripts was undertaken. The data indicate that homophobia is common in various segments of the community. Stigma creates a heavy burden for gay men and impedes their ability to fight AIDS. The data suggest that more effective AIDS prevention will require eradicating stigmatizing attitudes toward gay men.

CRACK 'HOS AND SKEEZERS: TRAUMATIC EXPERIENCES OF WOMEN CRACK USERS

The involvement of women in crack cocaine abuse has had a severe impact on their health, the health of their children and the stability of their communities. Of particular concern has been the development of a system of barter in which crack‐for‐sex exchanges are the means through which women obtain the drug. Earlier studies have suggested that drug abuse may be related to and exacerbated by trauma. In the project described herein, we interviewed women crack users in Harlem to study the relationship between trauma, crack use, and crack‐related sexual behavior. Results suggested the existence of three types of trauma: (1) traumas that predate the respondents onset of crack use; (2) traumas that were the direct sequelae of crack use; and (3) stigma trauma, that is, trauma that results from membership in a despised or oppressed group. We observed a complex inter‐relationship involving crack use, crack‐for‐sex transactions, and these three types of trauma. Treatment of the eventual co‐morbidity of trauma and...

Developing the guide to community preventive services—overview and rationale

When the GUIDE TO COMMUNITY PREVENTIVE SERVICES: Systematic Reviews and Evidence-Based Recommendations (the Guide) is published in 2001, it will represent a significant national effort in encouraging evidence-based public health practice in defined populations (e.g., communities or members of specific managed care plans). The Guide will make recommendations regarding public health interventions to reduce illness, disability, premature death, and environmental hazards that impair community health and quality of life. The Guide is being developed under the guidance of the Task Force on Community Preventive Services (the Task Force)-a 15-member, nonfederal, independent panel of experts. Subject matter experts, methodologists, and scientific staff are supporting the Task Force in using explicit rules to conduct systematic literature reviews of evidence of effectiveness, economic efficiency, and feasibility on which to base recommendations for community action. Contributors to the Guide are building on the experience of others to confront methodologic challenges unique to the assessment of complex multicomponent intervention studies with nonexperimental or nonrandomized designs and diverse measures of outcome and effectiveness. Persons who plan, fund, and implement population-based services and policies to improve health at the state and local levels are invited to scrutinize the work in progress and to communicate with contributors. When the Guide is complete, readers are encouraged to consider critically the value and relevance of its contents, the implementation of interventions the Task Force recommends, the abandonment of interventions the Task Force does not recommend, and the need for rigorous evaluation of the benefits and harms of promising interventions of unknown effectiveness.

Providing affordable family housing and reducing residential segregation by income

The inadequate supply of affordable housing for low-income families and the increasing spatial segregation of some households by income, race, ethnicity, or social class into unsafe neighborhoods are among the most prevalent community health concerns related to family housing. When affordable housing is not available to low-income households, family resources needed for food, medical or dental care, and other necessities are diverted to housing costs. Two housing programs intended to provide affordable housing and, concurrently, reduce the residential segregation of low-income families into unsafe neighborhoods of concentrated poverty, are reviewed: the creation of mixed-income housing developments and the Department of Housing and Urban Development (HUD) Section 8 Rental Voucher Program. The effectiveness of mixed-income housing developments could not be ascertained by this systematic review because of a lack of comparative research. Scientific evidence was sufficient to conclude that rental voucher programs improve household safety as measured by reduced exposure to crimes against person and property and decreased neighborhood social disorder. Effectiveness of rental voucher programs on youth health risk behaviors, mental health status, and physical health status could not be determined because too few studies of adequate design and execution reported these outcomes.

The Community Guide’s model for linking the social environment to health ☆ ☆☆

In the mid-1990s, the independent national Task Force on Community Preventive Services (the Task Force) was created under the auspices of the Department of Health and Human Services to summarize what is known about the effectiveness of community-based interventions to improve population health outcomes. The Task Force wanted to examine broad social determinants of health from an ecologic perspective—one that recognized the connection between health and sustainable human, cultural, economic, and social activities. Communities interact with resources in the social and physical environments over broad periods of time. Understanding patterns of health or disease requires a focus not only on personal behaviors and biologic traits but also on characteristics of the social and physical environments that shape human experience and offer or limit opportunities for health. Social Determinants of Health

Stories of spiritual awakening : The nature of spirituality in recovery

Substance abuse has had a devastating impact on the lives of millions. As substance use and abuse continues to ravage communities, researchers remain in the dark about what works to ensure successful recovery from addiction. In searching for the answers, researchers have often overlooked the role of religious and spiritual practices and beliefs in preventing use and relapse. The study reported here describes the process of spiritual awakenings experienced by some persons in recovery during their quest for sobriety. The data suggests that persons in recovery often undergo life altering transformations as a result of embracing a power higher than ones self, that is, a Higher Power. The result is often an intense spiritual journey that leads to sustained abstinence. Given how widespread substance abuse is, research on the nature, implications, and limitations of a spiritual approach to addiction might offer new options for treatment.