Change IS Possible: Reducing High-Risk Drinking Using a Collaborative Improvement Model

Abstract

Objective: To describe the adoption of public health and improvement methodologies to address college students’ high-risk drinking behaviors and to aid in prevention efforts. Participants: Members of 32 colleges and universities, content experts, and staff members of the National College Health Improvement Program (NCHIP). Methods: A 2-year learning collaborative developed by NCHIP trained individuals from 32 different college and universities in using the Plan–Do–Study–Act cycle as a method to create and implement initiatives aimed at reducing students’ high-risk drinking behaviors and related harms. Results: Participants experienced success ranging from noteworthy increases in type and amount of interventions directed at reducing high-risk drinking, to creating collaboratives across campus, the local community, and stakeholders. Challenges related to data collection and creating lasting cultural change remain. Conclusions: The use of quality improvement methodologies and creation of a national collaborative successfully effected meaningful change in high-risk drinking behaviors on college campuses.     

Partner‐specific relationship characteristics and condom use among young people with sexually transmitted diseases

This study describes associations of partner‐specific relationship characteristics with consistent condom use among 297 young people (ages 13–24) with sexually transmitted diseases (STD). Relationship‐specific variables were relationship quality, reasons for sex, relationship duration, duration of sexual relationship, coital frequency, “established” versus “new” sexual partner, cohabitation, children, sexual coercion, and drug or alcohol use associated with coitus. Relationship characteristics associated with consistent condom use included lower relationship quality, lower emotional reasons for sex, lower coital frequency, sex with a new partner, noncohabitation, and not having a child with the partner. Controlling for sociodemographic variables, factors exhibiting independent associations with consistent condom use were lower relationship quality, lower coital frequency, and not having a child with the partner. While condom use with potentially high risk new partners is important, other types of relationships are also risky but associated with lower likelihood of consistent condom use. Better understanding of complex relationship characteristics is necessary to improve STD intervention programs.     

Risk,interest groups and the definition of crisis: the case of volcanic ash

This paper considers a key aspect of the ‘risk society’ thesis: the belief that we should be able to manage risks and control the world around us. In particular it focuses on the interface between risk and risk events as socially constructed and the insights that ‘critical situations’ give us into ‘the routine and mundane’, the otherwise taken for granted assumptions underlying risk regulation. It does this with reference to the events precipitated by the April 2010 volcanic eruption in the Eyjafjallajökull area of Iceland. The resulting cloud of volcanic ash spread across Europe and much of Europe's airspace was closed to civil aviation for six days, with far reaching consequences including huge financial losses for airlines. The social processes of defining and reacting to risk and crisis both reveal and generate dilemmas and challenges in regulation. This paper examines the role of different interest groups in defining risk expectations and thereby redefining the ash crisis as a regulatory crisis.     

Dimensions of power: older women's experiences with electroconvulsive therapy (ECT)

Older women are particularly prone to being treated for depression, and, despite the controversy surrounding it, electroconvulsive therapy (ECT) has gained popularity as a treatment with this population. Research has examined the physical and cognitive changes associated with ECT but there is little understanding regarding how older women themselves experience this treatment. In order to gain better understanding into the subjective experience of receiving ECT, this qualitative study explored the experiences of six older women who were treated with ECT for a diagnosis of depression, using in-depth personal interviews. Analysis suggests that this experience for these older women could not be understood in isolation. Rather, their stories highlighted the importance of interpreting the ECT experience within a broader context that included the larger depression experience, the dynamics of helping relationships, and the discourse available to them for sense-making. Specifically, the central theme underpinning all of these women's stories was the shifting of power from themselves to others. This paper examines how this occurred and discusses implications for practice.     

Socioeconomic Determinants of White and Black Males’ Life Expectancy Differentials, 1980

Epidemiological transition theory suggests that two population existing under disparate socioeconomic conditions would have different life expectancies as the result of cause-of-death differences. The effect of racial socioeconomic differentials on the total racial life expectancy differential are examined as they act through specific cause-of-death differentials. Results suggest that residential isolation of blacks has a strong effect on the total life expectancy differential as it acts through the racial homicide differential. The racial unemployment difference also has a strong effect on the total differential as it acts through the racial heart disease differential. Implications of the findings for reducing life expectancy differentials are discussed.     

Developmental outcomes after five years for foster children returned home, remaining in care, or adopted

A substantial proportion of children who enter foster care in the US are infants or toddlers and will exit from foster care before they have been in care for long, either returning home or to adoption. These first years of involvement may predict a significant amount about children's longer term development so understanding developmental outcomes after five years is valuable to understanding if child welfare services (CWS) are serving the intention of promoting the well-being of children. A subsample of 353 infants (less than 13 months of age when investigated by CWS) and subsequently placed into foster care were selected from the National Survey of Child and Adolescent Well-Being. After 66 months, these infants had been reunified, adopted, or were still in foster care. Bivariate comparisons were completed. Statistical controls for maltreatment type and severity, demographic traits, and current caregiver education were implemented to help clarify the role of terminal child welfare placement, current caregiver behaviors, and household income, on eight linear regression models of developmental outcomes. Results support the longstanding tenet of child welfare services policy that remaining in foster care is less developmentally advantageous than having a more permanent arrangement of return home or adoption.     

Affective and Cognitive Correlates of Gambling Behavior in University Students

The purpose of the following study was to explore certain affective and cognitive components and their relationships to gambling behavior in an undergraduate population. Specifically, the aim was to predict gambling severity using depression scores on the BDI-II, the dependency and self-criticism subscales on the DEQ, emotional awareness scores on the LEAS, cognitive flexibility scores from the STROOP, and a creativity subtests from the TTCT. Participants were 200 undergraduate students and 3.5–7.5% of individuals reported some level of problematic gambling behavior. Multiple regression analysis indicated that self-criticism and creative originality were significant predictors of gambling behavior, explaining 7.6% of the variance. Further analyses reveal a non-linear trend in the creative originality of those who gamble; only the at-risk gamblers were high in creativity whereas abstainers and problematic gamblers display similarly lower levels of creativity. Results are discussed in regards to Blaszczynski and Nower’s Addiction 97:487–499 (2002) subtypes of gambling vulnerability.     

Growth in medical director numbers continues.

A recent survey shows that nearly two-thirds of all hospitals have or are considering a medical director position. Comparative data show that the average bed size of hospitals with a medical director continues to decline as more and more institutions add the position. The reasons for the growth, according to the survey, are the increasing demands of administering a medical staff and responding to regulatory agencies.     

Whose Project is it Anyway? Sharing and shaping the research and development agenda

The NHS and Community Care Act 1990 (NHSCCA) requires that local authorities should consult with service users in their review and planning of services. This requirement is open to various levels of interpretation. The exercise becomes more complex when planning and review are based on a funded research project, in which the voice of users can easily be lost or their participation only nominal. This article examines some of the key issues and dilemmas in partnership research, through critical evaluation of a research project in which the authors were involved. Paradoxically, it is issues of power, control, expertise, authority and accountability which emerge as recurrent themes in examination of the practice of partnership.