Long-term impact of Drug Abuse Resistance Education (D.A.R.E.). Results of a 6-year follow-up

The long-term effectiveness of Drug Abuse Resistance Education (D.A.R.E.) was assessed by contrasting drug use and other D.A.R.E.-related attitudinal latent variables among 356 twelfth-grade students who had received the program in the 6th grade with 264 others who did not receive it. A prior study of these subjects when they were in 9th grade had shown no significant differences. A follow-up survey in 12th grade assessed central D.A.R.E. concepts such as self-esteem, police bonds, delay of experimentation with drugs, and various forms of drug use. Although the authors found no relationship between prior D.A.R.E. participation and later alcohol use, cigarette smoking, or marijuana use in 12th grade, there was a significant relationship between earlier D.A.R.E. participation and less use of illegal, more deviant drugs (e.g., inhalants, cocaine, LSD) in a development sample but not in a validation sample. Findings from the two studies suggest a possible sleeper effect for D.A.R.E. in reference to the use of harder drugs, especially among teenage males.     

Campaigning against female genital mutilation in Ethiopia using popular education

In Ethiopia, the Italian Association for Women in Development (AIDOS) has been working with Ethiopia's National Committee on Traditional Practices Affecting the Health of Women and Children for 5 years. AIDOS began working on female genital mutilation in the early 1980s and rejects charges of cultural imperialism that are applied to Northern organizations attempting to help African organizations address this violation of universal human rights. In Ethiopia, 85% of women are mutilated, with most undergoing Sunna, or removal of the prepuce of the clitoris. The joint project seeks to increase awareness about the health consequences of female genital mutilation in the target group. The primary technique used is provision of training of trainers courses and presentation of four modular units and audiovisual materials specifically designed for use with socially influential women, male and female secondary school students, community leaders, and health workers. In addition, an information/education campaign uses videos and sound and slide shows with accompanying story books. A second category of communication tools was developed for a mass information campaign, including radio spots, posters, information leaflets, and a newsletter. When the project was ready for expansion into the southern region of the country, it became clear that a new participatory communication strategy was required to stimulate discussion, such as the use of role playing and theater. Working together, the two organizations have successfully confronted project constraints such as the difficulty in assessing project impact, scheduling problems, and gender-biased assess to information.     

Bruises on the soul: older women,domestic violence and elder abuse

This article presents an overview on the status of current knowledge concerning elder abuse and neglect, and to move to a consideration of factors from the field of domestic violence. For many years, attempts to understand the phenomenon of elder abuse remained a problem because of its complexity. This paper, however, discusses abuse and neglect at three levels--macro, mezzo, and micro: macro abuse refers to issues at a societal level; mezzo abuse refers to behaviors, attitudes, and policies inflicted on older people at the community level; micro abuse refers to issues in the domestic setting. All definitions of elderly abuse generally include physical, psychological and financial abuses and neglect. Added to these categories of abuse are sexual and social abuses. Attempts were also made to understand the dynamics of elderly abuse. Majority of the cases of abuse among elderly people happens among the females and is mostly inflicted by their spouses. Deteriorating health, thwarted hopes, expectations and plans; a diminution in capacities to function and manage; an increase in vulnerability and dependence all contribute to the development or continuation of abusive situations within intimate relationships in old age. Although gender played a major role in elderly abuse, attempts to consider it in relation to this issue remained limited. Based on the discussions presented, it was made clear that elderly abuse is comparable to domestic violence, although it is different from other forms of family violence.     

Talking of racism: The project of a society of diversity

‘We have a choice, and we can decide to make a society in which diversity is accepted, encouraged and made central to human practice’ (Essed, 1996, viii)     

Personal Network Correlates and Predictors of Homelessness for Injection Drug Users in Baltimore, Maryland

Injection drug users are at high risk for homelessness and human immunodeficiency virus (HIV) infection. This study sought to examine incidence rates and the social and economic antecedents of homelessness of impoverished inner-city injection drug users. Of the 569 participants, from a nontreatment sample who participated HIV prevention study, interviewed at baseline, 324 (57%) were reinterviewed 5.2 months later. At baseline 48% of the participants reported that they had been homeless in the past 10 years. Of the 324, 18% reported that at both interviews they had been homeless within the prior 6 months, 12% reported homelessness at baseline but not at follow-up, and 8% reported homelessness at follow-up but not at baseline. At baseline personal social support network characteristic of size of material aid and size of sex network was found to be associated with self-reports of homelessness. Baseline reports of presence of mother in personal network, size of material aid network, and network density were found to be associated with reports of homelessness at follow-up. These result suggest the need for alternative approaches to addressing issues of homelessness injection drug users.     

Patient assertiveness in ethnically diverse older women with breast cancer: Challenging stereotypes of the elderly

Patients' views of patient-physician interactions—particularly the perspectives of older, ethnically diverse women—are poorly understood. The older patient's attitude toward and understanding of the medical encounter, however, are essential to the design of strategies to improve patient-physician communication. To date, investigations have primarily emphasised the ways in which the therapeutic relationship is influenced by immutable patient characteristics. This qualitative study extends previous research findings by looking beyond the effect of ascribed categories (such as age, race, and gender) and focusing on aspects of patient behavior, specifically assertiveness. Focus groups were conducted with older African-, Chinese-, European-, and Hispanic American breast cancer patients from sites in the eastern and western United States. The study explores the potential of a form of patient activation for challenging stereotypes of the elderly and changing health care practitioners' behavior.     

Implications of ERISA for health benefits and the number of self-funded ERISA plans

This Issue Brief provides an overview of the issues relating to the Employee Retirement Income Security Act of 1974 (ERISA) and health benefit plans, the major case law relating to ERISA and health plans, and the implications of the preemption of state regulations for health plan sponsors and participants. It also presents the latest data on the number of health plan participants in self-funded ERISA plans. Finally, it presents a summary of current legislative proposals that would attempt to amend ERISA. Under the framework ERISA established for employee benefit plans, the regulation of employment-based health benefit plans has evolved into a two-tiered system in which both federal and state laws play important roles. The Supreme Court has interpreted ERISA's "savings" and "deemer" clauses to mean that insured plans are subject to regulations directly at the federal level and indirectly at the state level, while self-funded plans are regulated exclusively at the federal level. The ERISA statute and the courts' interpretations of the Act have created a sharp controversy over how employee health benefit plans are provided and administered, with state regulators and consumer advocates on one side of the debate and plan sponsors (e.g., employers and unions) on the other. State regulators and consumer advocates tend to favor more regulation, and in many instances greater regulation at the state level, which they argue would provide more protections for consumers. However, employers and unions (or any plan sponsors) think ERISA preemption is very important to their ability to provide innovative and cost-effective health benefits for their employees, and assert that ERISA's present structure should be preserved. The U.S. General Accounting Office (GAO) found that 44 million individuals (39 percent of those in ERISA plans) were enrolled in self-funded ERISA plans in 1993, up from 39 million (33 percent of those in ERISA plans) in 1989. The Employee Benefit Research Institute (EBRI), using the same methodology as GAO with 1995 data, estimated that 48 million individuals (39 percent of those in ERISA plans) were enrolled in self-funded ERISA plans in 1995. When policymakers look to amend ERISA, they should consider whether the change to ERISA will produce a higher level of quality for consumers than is being provided under the present system and will continue to do so in the future. Policymakers must also decide whether quality of care is better enhanced by health plans' greater exposure to liability or by market forces. If policymakers decide that increased exposure to liability is the route to go, will consumers be able to enjoy any potential improvement in quality or will more individuals end up uninsured because of increased costs and not be able to get any care regardless of the quality?     

The majority legal status of women in southern Africa: implications for women and families

Women in many countries of southern Africa do not have majority status or have only recently gained this right. Majority status grants individuals adult legal status and the right to bring matters to court, own and administer property, have legal custody of children, and contract for marriage. This article summarizes the legal status of women in Botswana, Lesotho, South Africa, Swaziland, Zambia, and Zimbabwe. Lack of majority status contributes to the ongoing risk of poverty for women and makes them overly dependent on men. Compounding the situation in these countries is the presence of a dual legal system. Improving the situation of women and their families involves targeting changes in the legal system, influencing implementation of laws, educating women about their rights, and giving women needed support to seek their legal rights. The legal status of women must be viewed in the context of historical changes in the economic, educational, political, and cultural developments of society.The research for this paper was conducted during her previous faculty affiliation with the University of Michigan, School of Social Work. Her research interests include the impact of social change on women and families, rural mental health services, and health and mental health linkages. She received her Ph.D. from Rutgers University and her M.S.W. from the Columbia University School of Social Work.Her research interests are gender, work and family, culture and power, social transformations in rural and peri-urban communities, critical education, women and community politics, history of women, family and kinship issues, and community-based program development and evaluation. She received her M.S.W. from Dalhousie University, Halifax.