A general causal model to guide alcohol, tobacco, and illicit drug prevention: assessing the research evidence

The problems associated with the use of alcohol, tobacco, and other drugs (ATOD) extract a significant health, social, and economic toll on American society. While the field of substance abuse prevention has made great strides during the past decade, two major challenges remain. First, the field has been disorganized and fragmented with respect to its research and prevention practices; that is, there are often separate ATOD prevention "specialists." Second, both the prevention researchers who test the efficacy of specific prevention strategies and the practitioners who implement prevention efforts often lack an overall perspective to guide strategy selection. To address these limitations, we present an ATOD causal model that seeks to identify those variables (Domains) that are theoretically salient and empirically connected across alcohol, tobacco, and illicit drugs. For the researcher, the model demonstrates important commonalities, as well as gaps, in the literature. For the practitioner, the model is a means to recognize both the complexity of the community system that produces ATOD problems and the multiple intervention points that are possible within this system. Researchers and practitioners are thus challenged to work synergistically to find effective and cost-effective approaches to change or reduce ATOD use and associated problems.     

"Our babies shall not die": a community's response to medical neglect

The free neighborhood health center in a Midwest U.S. town was developed in response to a report that indicated that infant mortality rates were higher for the Black community than for the community-at-large. The health center soon took on the full range of health problems brought by clients regardless of client's race, ethnicity, or income. The processes for managing health care problems in an environment where racism was the rule rather than the exception are considered in this study.     

Children''s Exposure to Arsenic from CCA-Treated Wooden Decks and Playground Structures

CCA-treated wood is widely used in the fabrication of outdoor decks and playground equipment. Because arsenic can be removed from the surface of CCA-treated wood both by physical contact and by leaching, it is important to determine whether children who play on such structures may ingest arsenic in quantities sufficient to be of public health concern. Based on a review of existing studies, it is estimated that arsenic doses in amounts of tens of micrograms per day may be incurred by children having realistic levels of exposure to CCA-treated decks and playground structures. The most important exposure pathway appears to be oral ingestion of arsenic that is first dislodged from the wood by direct hand contact, then transferred to the mouth by children's hand-to-mouth activity. The next most important pathway appears to be dermal absorption of arsenic, while ingestion of soil that has become contaminated by leaching from CCA-treated structures appears to be of lesser importance, except possibly in the case of children with pica. Considerable uncertainty, however, is associated with quantitative estimates of children's arsenic exposure from CCA-treated wood. Priorities for refining estimates of arsenic dose include detailed studies of the hand-to-mouth transfer of arsenic, studies of the dermal and gastrointestinal absorption of dislodgeable arsenic, and studies in which doses of arsenic to children playing in contact with CCA-treated wood are directly determined by measurement of arsenic in their urine, hair, and nails.     

Mnemonic Institutions and Residential Clustering: Jewish Residential Patterns in Toronto

In this paper, we envisage how the sociohistorical experiences of groups are related to their residential patterns. We posit that the residential clustering of a group can be strongly related to the group's mnemonic institutions, which are organizational symbols of collective identity that link the present to the past. We present the case of Jewish residential clustering patterns in Toronto to demonstrate our arguments. We employ 2001 Canadian Census tract‐level data to show Jewish residential clustering patterns in relation to the presence of a synagogue or Jewish community center, the mnemonic institutions of Jews.     

Expanding social health protection in Cambodia: An assessment of the current coverage potential and gaps,and social equity considerations

The Royal Government of Cambodia recently launched its National Social Protection Policy framework to strengthen and expand social security and assistance. To inform social health protection policy, we examine socio-economic survey data and administrative coverage data to assess the coverage potential of existing coverage mechanisms and current gaps; and compare equitable contribution rates. Over 53 per cent of the population currently has no social health protection coverage mechanism, and about 16 per cent of the population who do have access to a mechanism are not yet enrolled. Current expansion efforts focus on the formal employee scheme, primarily benefiting individuals from higher income households. In addition, recent coverage expansion to some informal workers leaves significant gaps, particularly among the informal sector. We find out-of-pocket health care expenditure to be an excessive share of income among lower wealth quintile individuals and conclude they are financially vulnerable. Finally, we illustrate that an equitable approach to individual, monthly health care contributions among the lower three quintiles has a severely limited potential for revenue generation, and collection costs could exceed the amount collected. Therefore, we recommend that vulnerable groups should be exempted from contribution payments as social health protection is expanded.