Analysis approaches to community evaluation

Analysis approaches to the evaluation of community interventions must be sensitive to a wide variety of analytic contaminants that may bias the statistical assessment of changes in outcome measures. These contaminants include model misspecifications related to failures to control for community-specific time trends, temporal autocorrelated errors in equations, spatial autocorrelated errors among geographic units, and other failures of unit independence otherwise indexed by estimated intraclass correlations. Although an enormous amount of progress has been made toward the solution of many of these analytic problems over the past years, the contemporary evaluator of community interventions is left with a number of unenviable design and analysis choices; choices that inevitably force an assessment of the relative threats of different sources of error to the internal and external validity of the evaluation. This article describes the choices made for the evaluation of the Community Trial Project outcome data.     

Validating quality indicators. Quality as relationship between structure, process, and outcome

Theory and research have not kept pace with the growing interest in evaluating quality of mental health care, resulting in the use of unvalidated quality indicators. A framework for validating quality indicators is offered by which quality is viewed as the relationship between service structures, processes, and outcomes. Adoption of this framework will facilitate the measurement of quality using valid indicators and should be useful to agencies in their continuous quality improvement efforts. Valid information about the quality of mental health care services will help purchasers and consumers make more informed health care decisions.     

Implementation and process evaluation of a student "school-as-community" group. A component of a school-based drug abuse prevention program

Little documentation exists regarding the functioning of formalized adolescent groups as drug abuse prevention agents. Two studies are described that were conducted at high schools whose students are at high risk for drug abuse. Twenty-one schools were randomly assigned to one of three conditions: (a) standard care, (b) classroom drug abuse education only, or (c) classroom plus school-as-community. Results of the first study indicated that the school-as-community component--which involved weekly meetings and periodic events at seven schools--was implemented as planned, drug abused focused, and perceived as productive in discouraging drug abuse. In the second study, staff in the classroom plus school-as-community condition self-reported involvement in the greatest number of community activities across the school year, compared with staff from the other two conditions. These two studies support the feasibility of formalized groups of high-risk youth to promote drug-free events.     

People behaving badly

With every cigarette we smoke, every fat-filled snack we consume, and every lap we don't take around the track, we risk our health. This state-by-state look at what we do and don't do reveals poor health practices wherever you look.     

Partner patterns in the sexual behavior of unmarried,rural Thai men

"After a brief discussion of related studies of Thai youths' attitudes toward sexual activity, data from a 1988 national survey of young males (ages 15-24) about their family planning knowledge, attitudes, and practices are used to document the age pattern of sexual initiation, the prevalence of youths' encounters with commercial sex workers, the prevalence of their experience with non-commercial partners...and the degree to which the two patterns--commercial and noncommercial--are 'networked' because young men engage in both types of sexual activity. Finally, background characteristics of male youths that are associated with these patterns of sexual activity are examined."     

Excessively pronated feet: a health hazard to developing children

There is a serious misconception on the part of the public as well as amongst a great number of professionals to equate the problem of flatfoot with excessively pronated feet in growing children. This is a matter of grave concern since flatness of the arch of the foot can be a normal or abnormal finding in foot posture, whereas the excessively pronated foot is flattened as part of a pathological structural malposition. This inherent biomechanical defect is commonly present in the great majority of human children and is the basic reason for most postural pathology of the lower extremity.Excessive pronation of the feet in children should in no way be interpreted as a normal condition to be automatically outgrown. As a matter of fact, Whitman, the famous Orthopaedic Surgeon, noted in 1917 in his text Orthopaedic Surgery that pronation of the feet commonly seen in children is more likely to worsen than improve over the years. This paper presents the probable cause of the condition, treatment and prevention of the problem and recommendations for the future.The deforming foot posture known as excessive pronation is familiar to Podiatric Medicine and to Medicine generally. Yet, in spite of this familiarity, only an insignificant number of the millions of children in our country receive the simple available help required to minimize the problem.The Podiatric profession has within its grasp the wherewithal to correct this situation, through education and counseling of parents, through cooperation with pediatricians and other professionals and by utilizing technological advances in children's footgear and orthotics. It is the intention of this paper to provide an overview of the literature and history associated with the problem of excessive pronation in children, as well as to suggest some simple techniques for improving this situation.Dr. Tax is an international renowned consultant to many Podiatric Hospital amon which is the Veterans Administration in New Jersey, New York College of Podiatric Medicine, Ohio College of Podiatric Medicine. He has written and lectured extensively on the subject of children and problems with their feet.     

Rethinking assimilation and ethnicity: the Chinese in Thailand

US theoretical models of assimilation of ethnic groups within a larger culture usually assume a unilinear, unidimensional process, which is simplistic, does not account for the persistence of ethnicity, and oversimplifies the process of social change. The argument is advanced that ethnic identity is both primordial and situational (a private sense that is self-maintaining, cumulative, deepening, and self-affirming). Typically, a person has one primary ethnic identity, but where ethnic boundaries overlap, there is instrumental identity. Chinese in Thailand mostly adopt Thai values, speak the Thai language, go to Thai schools, join Thai associations, and celebrate Thai religious festivals. Their secondary identity as Chinese is integrated into their associations with other Chinese and in the home through the use of the Chinese language. Their Chinese identity appears also in ancestor worship. There are symbiotic relationships between native Thais and Chinese Thais along class lines. The Chinese are known to have great financial and economic resources, while the Thais have political and administrative control. These differences with the power elites separate the Chinese from the Thais and interfere with assimilation. The power is balanced. If the Chinese gained in political and administrative power, the balance would be upset, and the interests of both groups would be threatened. The view of Whitten and Whitten acknowledges that individuals and groups act to make the best of the situation and are not merely victims of social forces. Actions are maintained and resisted. The important consideration in theory-building is not the terms of assimilation but the terms specifying the conduct of the group as a whole and as individuals in daily social interactions. The theoretical discussion focuses on border crossings, the Skinner view of the Chinese, bilingualism and cultural education, socioeconomic organizations, occupational differences, and religion, tradition, and ethnic identification.     

Social determinants of life expectancy]

"Life expectancy and mortality increasingly are analyzed in the context of social factors. This study analyzes the impact of social position, marital status, and religious confession on cohort life expectancy. The analysis is based on [German data from the] Socio-Economic Panel Survey, wherein proxy-interviewee's parents have been used to estimate cohort mortality. Results confirm a lower mortality risk of the upper classes and of married persons. However, as opposed to other studies, Catholics do not have a lower, but even a higher mortality risk." (SUMMARY IN ENG)