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In this article, the authors examine communication between women living with human immunodeficiency virus (WLH) and health care providers (HCPs) regarding abnormal Pap tests. During the period of March 2011 through April 2012, 145 WLH were recruited from Ryan White funded clinics and community-based AIDS service organizations located in the southeastern United States. WLH who had an abnormal Pap test (69%,n = 100/145) were asked if their HCP shared and explained information about abnormal Pap tests. The authors performed chi-square tests and multivariable logistic regression analyses using Stata I/C 13. HCPs shared information about abnormal Pap tests with 60% of participants, and explained the information they shared to 78% of those. Health literate participants were more than three times as likely to have read the information received about abnormal Pap tests (adjusted odds ratio [aOR] = 3.49, 95% confidence interval [CI] 1.19–10.23), and almost five times as likely to have understood the cancer information they read (aOR = 4.70, 95% CI 1.55–14.24). Knowing other women who had had an abnormal Pap test was not significantly associated with cancer information seeking or processing after controlling for confounding factors. The present findings underscore the need to increase WLH’s health literacy as an intermediate step to improving patient–provider communication among WLH. Lay sources of cancer information for WLH warrant further study. [ABSTRACT FROM PUBLISHER]

Cigarettes are responsible for nearly 443,000 deaths per year in the United States. Eighty percent of adult smokers began smoking before the age of 18. In 2009, 17.2% of high school and 5.2% of middle school youths reported being a smoker. Research on school perceptions suggests that “engaged” students get more from school on all levels, including reduced health risk behaviors. The purpose of this study was to identify which school perceptions are protective against tobacco use in a sample of middle school youths. Results conclude that high levels of educational attachment are significantly associated with low levels of tobacco use. [ABSTRACT FROM AUTHOR]

This article aimed to examine changes in the HIV prevention capacity of HIV prevention program managers who completed the Institute for HIV Prevention Leadership (“Institute”) between 2002 and 2004, and who worked in community-based organizations that primarily served African Americans. Participants completed a survey at three points in time, in which they rated the frequency with which they conducted activities related to HIV prevention practice. Participants also rated their confidence in performing activities. Repeated measures ANOVA was conducted to detect differences at three time points (baseline, immediate posttest, and 6 months posttest). A significant overall positive trend was found in the frequency and confidence of participants to perform specific HIV prevention practices and an overall positive trend in the frequency of processes that support HIV prevention practice. Investment in long-term, intensive, capacity-building programs like the Institute is critical to address the increasing incidence of HIV in many African American communities. [ABSTRACT FROM PUBLISHER]

Objective and background: Our objective was to examine HIV testing uptake among postmenopausal women. Many women are routinely tested for HIV during pregnancy. Disproportionate numbers of women beyond reproductive age are diagnosed HIV-positive late in the disease course. Some older women and healthcare providers have dismissed early AIDS symptoms as signs of aging. This has resulted in missed opportunities for early initiation of effective antiretroviral therapy. Methods: Behavioral Risk Factor Surveillance System (BRFSS) 2008 data were analyzed for non-Hispanic white and non-Hispanic black women (50-64 years) from six deep south states. Logistic regression models examined associations between uptake of HIV testing and population/behavioral characteristics. Results: More than half of our sample (1091 of 2027) had an HIV test during their postreproductive years (>45 years old). Women 50-54 years old were about 40% as likely to have been tested for HIV during their postreproductive years as those 60-64 years old (adjusted odds ratio [AOR] 0.62, 95% confidence interval [CI] 0.45-0.84). Population characteristics, such as race/ethnicity, family poverty status, and urbanization, as well as HIV exposure risk, were all potential confounders of this relationship. Conclusions: Routine HIV testing is underused among women during their postreproductive years. HIV prevention messages that target midlife women are needed to reduce the prevalence of HIV/AIDS and disproportionate burden of late diagnosed HIV infection in this population. [ABSTRACT FROM AUTHOR]

Most HIV-prevention funding agencies require the use of evidence-based behavioral interventions, tested and proven to be effective through outcome evaluation. Adaptation of programs during implementation is common and may be influenced by many factors, including agency mission, time constraints, and funding streams. There are few theoretical frameworks to understand how these organizational and program-related factors influence the level of adaptation. This study used constructs from both Rogers’s diffusion theory and Rütten’s framework for policy analysis to create a conceptual framework that identifies determinants hypothesized to affect the level of adaptation. Preliminary measures of these constructs were also developed. This framework and its measures assess organizational and program-related factors associated with adaptation and could serve as a model to assess implementation and adaptation in fields outside of HIV prevention. [ABSTRACT FROM PUBLISHER]

This article reports on the curricular innovation and the study of public health. It discusses that the schools of public health are about educating leaders who are expected to take responsible roles in the professional practice of public health and is not just about educating individuals for content alone.

This article discusses the competition in the funding for the prevention of HIV in the United States. The article discusses the cost of HIV medical care and the costs of medical research and the development of research centers. Community-based organizations have been at the forefront of providing prevention programs for both HIV and AIDS. An economic analysis of the effectiveness of public health interventions is presented. It is evaluated just how many HIV patients would need to be averted in order to declare cost saving efforts.

The purpose of this study was to gain an understanding of the challenges African-American women in abusive relationships face when they consider seeking-help from their informal networks. Data are reported from interviews with 15 African-American women who were self-identified as having survived physical intimate partner violence. A 13-item, semi-structured interview guide was developed in order to elicit information from participants. All of the interviews were audio-recorded, transcribed, and coded for analysis. This analysis revealed emergent themes from these interviews concerning the social factors and perceptions that influence help-seeking behavior. Participants perceived their informal networks as willing to offer instrumental support. However, informal networks were not emotionally supportive. Participants also noted that the African-American community at-large believes victims of violence to be ‘stupid’ for remaining in violent relationships. Additional results are also discussed. Results may be used to help enhance efforts to reduce the rates of intimate partner violence among African-Americans. [ABSTRACT FROM AUTHOR]

The article looks at the role of community-based organizations (CBOs) in HIV/AIDS prevention programs and presents a curriculum to enhance the prevention program capacity of CBOs. According to the article, many CBOs are not able to plan and carry out prevention intervention programs for culturally diverse populations. The article discusses the development of HIV Prevention Leadership from the U.S. Centers for Disease Control and Prevention and the Association of Schools of Public Health Institute.

Rates of HIV/AIDS are rising on the campuses of Historically Black Colleges and Universities (HBCUs). This paper examines the extent of these students' knowledge of their sexual partners' HIV risk behaviors and how their decision-making regarding sexual activity is shaped by this knowledge or lack of knowledge. Six focus groups were conducted with African American men and women attending HBCUs in the southeastern US. Commonality and divergence exist on the influences on African American male and female students' HIV risk taking behaviors, including media, community, family, and religion. Participants in these focus groups indicated that engaging in discussions about HIV/AIDS could be detrimental to their relationships. The reluctance to engage in discussions about HIV/AIDS offers compelling evidence of the need to enhance the communication and negotiation skills of these students in order to reduce barriers to safer sex. [ABSTRACT FROM AUTHOR]

Ilustrates how the Arnold School of Public Health in South Carolina is responding to the challenges faced by the U.S. public health system through its teaching, research and service/outreach functions. Investigation of the capability of schools of public health to address several areas of action and change included in the report "The Future of the Public's Health in the 21st Century"of the U.S. Institute of Medicine (IOM); Evaluation of curriculum and courses for public health action; Applicability of the call of the IOM report for adopting a population approach that considers determinants of health and the facilitation of communication in the health system; Assessment of the public health initiatives of the Arnold School.

Objective: To investigate physician-patient communication in the context of hysterectomy decision making. Methods: A series of 17 focus groups with African American and white women (n=82) between the ages of 30 and 65 were run. Personal interviews with physicians (n=7) also were conducted. Transcripts were analyzed using NUD*IST software and note-based techniques. Results: For both patients and physicians, the optimal physician-patient interaction would be for the physician to provide plain, usable information to the patient allowing the patient to make the hysterectomy decision. Conclusions: The current state of physician-patient interaction represents collaboration but not a shared approach approximating the deliberative model. [ABSTRACT FROM AUTHOR]

Six focus groups were conducted in South Carolina with African American women (n = 42) aged 19-51 years to identify factors that influence physical activity. Transcripts were analyzed using NUD*IST. Cultural influences were seen as more important in determining the type of physical activity than its level. Barriers to and enablers of physical activity were identified in the social and physical environments, as were policy issues affecting physical activity in the community and at the work site. Potential community and work site interventions were suggested. Child care and monetary costs were frequently cited as barriers to physical activity. [ABSTRACT FROM AUTHOR]

Purpose: This exploratory study used focus groups to examine attitudes and beliefs of HIV-infected African American women of child-bearing age about pregnancy and antiretroviral therapy. Methods: A convenience sample of thirty-three African American women of child-bearing age participated in five focus groups. Attitudes and beliefs about pregnancy decisions and the use of antiretroviral therapy during pregnancy were examined. Results: Many of the women in this study living with HIV remained committed to having children and expressed confusion about their chances of transmitting the virus to their children. Conclusions: Health care providers must be aware of these concerns and convey clear and accurate information through the most readily accepted channels. Participants suggested that messages about these issues be conveyed by other women living with HIV who have faced these same decisions. [ABSTRACT FROM AUTHOR]

Examines the attitude of African-American women toward antiretroviral therapy for HIV in the U.S. Annual incidence rate of AIDS; Assessment on the number of children with perinatally acquired AIDS; Increase in the number of HIV-infected mothers prescribed prenatal AZT.

Explores the perceptions of women on alternative therapies available for managing symptoms related to menopause and to the need for hysterectomy. Discussion of the Ethnicity, Needs and Decisions of Women project; Analysis of the emergent themes by race or surgery experience; List of possible alternatives for managing symptoms.

This study surveyed face-to-face 111 African American newly diagnosed and living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) from the Washington D.C. area, to ascertain the use of, and need for, early intervention services. The survey instrument included sections on demographics, level of health functioning and health indicators, social and financial support, and needed services. This article constructs a health status proxy variable from survey items and examines its relationship to biological and social variables. Variables found to have a significant relationship with health status are gender, type of health insurance, employment, receiving Social Security Disability Income, and level of education. A log-linear model for selection of parsimony found that the type of health insurance was most highly predictive of health status, when controlling for other variables. Persons who receive Medicaid report no better levels of health status than those without health insurance. Having private health insurance is associated with a 5.3-fold greater chance of having good or excellent health status. [ABSTRACT FROM AUTHOR]

As part of the Ethnicity, Needs, and Decisions of Women (ENDOW) project, in-depth qualitative interviews and focus groups were conducted at four sites, Alabama, New Mexico, South Carolina, and Texas. In South Carolina and Alabama, African American and white women were interviewed. In Texas, African American, Caucasian, and Hispanic women were interviewed, and in New Mexico, focus groups with Caucasian, Hispanic, and Navajo women were conducted. The Texas site also conducted focus groups with lesbian women. Data were collected on women's experiences with and attitude toward menopause, hysterectomy, and hormone replacement therapy (HRT). Information also was gathered on women's concerns and what experiences they have had or expect to have with healthcare providers and what they perceive their friends', families', and sexual partners' attitudes are toward hysterectomy. Numerous commonalties of experience existed across racial and ethnic groups. Overall, the women who participated believed that doctors do not take the time to explain issues related to menopause, hysterectomy, and HRT. Most of the women who have had a hysterectomy were satisfied with the outcome of surgery, as painful symptoms were relieved. There are also several interesting differences among the groups. Decision-making patterns differed among the ethnic groups, as did experience with healthcare providers. Many women in the focus groups expressed mistrust of or negative opinions of healthcare providers. African Americans expressed mistrust of their motives for recommending surgery, as did several of the Caucasian, non-Hispanic women. Most of the Hispanic participants respected and trusted their providers. All groups said they would seek additional medical opinions if they could afford to do so. [ABSTRACT FROM AUTHOR]

Although hysterectomy is a frequently performed surgical procedure, little is known about how women make decisions regarding hysterectomy. This report details the women's perceptions of male partners' knowledge and attitudes about hysterectomy and the role women expect or allow men to play in their decision-making process. Seventeen focus groups were conducted with a total of 82 African American and Caucasian women aged 30-65 years in two coastal counties of South Carolina. Transcripts were coded and analyzed using the nonnumerical unstructured data indexing searching and theory building (QSR NUD*IST®) software program. Results indicate that women perceive men to be not well informed or knowledgeable about hysterectomy, to be concerned about the quality of sexual relations after hysterectomy, and, in some cases, to be neutral about hysterectomy. African American women reported that men hold more negative perceptions about hysterectomized women. Caucasian women stressed men's inability to understand what a woman is going through and men's concern with the hysterectomy's effect on their own egos. Nonhysterectomized women felt that men would be more bothered by a surgical procedure that left more visible effects (such as mastectomy). These women defined a limited role for men in their decision making regarding hysterectomy, consisting of discussion and offering of support/sympathy, but they reserved the actual decision for themselves. In a few instances, women accorded men a role in the hysterectomy decision based on a religious interpretation of marriage. Intervention programs are recommended that target women and their partners together, using hysterectomized women and their partners as peer educators. [ABSTRACT FROM AUTHOR]

The article presents aspects of motivation of a volunteer AIDS care team program. Currently, two patterns have emerged as a religious response to AIDS. The first is the recognition that people living with ADS need help and the church will provide it, although some religious beliefs concerning sexuality do inhibit various forms of prevention and education. The second pattern is one of condemnation concerning the behaviors surrounding HIV transmission. Churches in the latter category respond by promoting prevention of transmission through sexual abstinence and refraining from illegal use of injection drugs. Volunteers are an essential part of many health, education, and community organizations. Working with people living with HIV/AIDS is especially demanding work. Individuals with AIDS are a diverse group of people. This diversity requires volunteers to be able to handle unexpected cultural, religious, and lifestyle differences. This article presents the results on the psychosocial aspects of why the volunteers were motivated to join in the effort and what motivates them to remain committed to the program. The use of focus groups in this study was appropriate and beneficial.

ABSTRACT: This study examines the effect of financial characteristics of rural primary care programs on the probability of their continuing as federally funded entities. A randomly selected national cohort of rural primary care programs (n=162) was used to compare financial measures of programs that were continuing and those that were noncontinuing. Financial data were obtained from 1978-1987 Bureau Common Reporting Requirements (BCRR) forms submitted to the Bureau of Health Care Delivery and Assistance of the Department of Health and Human Services as part of the requirement to receive federal grant support for the programs. The results emphasize the importance of both outside funding and increased level of self-sufficiency in the continuation of rural primary care programs. Noncontinuing programs often suffer from both a lack of self-sufficiency and a lack of outside funding, mostly from federal sources. To a lesser extent, the number of patients also affects the program's chance of continuation. From a policy perspective, government intervention is both necessary and likely if rural primary care programs are to succeed and fulfill their mission of providing primary care for the medically underserved who are primarily poor, uninsured, and unable to pay. [ABSTRACT FROM AUTHOR]

The use of nonphysician providers, such as nurse practitioners, physician assistants, and certified nurse midwives, in rural areas is critically important due to the continued primary care access problems. This study examines the major factors influencing the use of nonphysician providers in rural community and migrant health centers based on a 1991 national survey of the centers. This study demonstrates that the employment of nonphysician providers in rural community and migrant health centers is significantly influenced by both supply and demand factors. Among supply factors, there is a significant and positive relationship between the number of total staff and the number of nonphysician providers employed. There is a significant but inverse relationship between the number of physicians and the number of nonphysician providers employed, indicating nonphysician providers primarily serve as substitutes for physicians in rural community and migrant health centers. The supply of nonphysician providers, as measured by the number of affiliated training programs, is significantly related to the employment of nonphysician providers. The demand variable, geographic location, and the centers' staffing policies are also significant determinants of the use of nonphysician providers. [ABSTRACT FROM AUTHOR]

This article examines the association between knowledge of AIDS and skill among social workers in South Carolina. Compassionate care for AIDS patients is critical. Anything less than sincere concern, whether because of prejudices or fears about AIDS among social workers, can interfere with the care provided to AIDS patients. Social worker have taken a major role in providing social, mental health, counseling, and other services to those clients and their families as part of their professional tradition of providing services to underprivileged and socially stigmatized populations However, few studies have looked at the impact of social workers' knowledge and competence on attitudes toward people with HIV AIDS. If an enhancement of knowledge and skill can result in a better understanding of patients' predicament and a more caring attitude, social agencies should therefore direct their efforts toward providing such training to their staff. The current study examines AIDS- related knowledge and skill among social workers in South Carolina and their attitudes toward people with HIV/AIDS to test the hypothesis that knowledge and skill are significantly associated with improving attitudes.

Medicaid waivers play an important role in the health policy process. Various health care policy initiatives have encouraged states to experiment with their Medicaid programs by expanding coverage to populations not traditionally covered by Medicaid, or by delivering Medicaid services in non traditional ways. Lessons learned by individual states' Medicaid waivers could be an important part of the health care reform debate. This paper presents an evaluation of a Medicaid waiver operating in South Carolina. The South Carolina Community Long-term Care Waiver for the Elderly and Disabled is evaluated for cost effectiveness, quality of care, and client satisfaction. This evaluation shows that the waiver is highly effective in offering individuals who are medically and financially eligible for Medicaid supported nursing home care a viable, cost effective, high quality alternate to institutionalization. [ABSTRACT FROM AUTHOR]

The article highlights the First International Conference on AIDS Education in Columbia, South Carolina from July 31 to August 1, 1987. It includes information on the topics discussed, attendees of the event and recommendations from each workshop.

The article discusses various reports published within the issue, including one by Griffith and colleagues on the role of faith communication in preventing HIV, one by Rhodes and colleagues on the results of the implementation of the intervention of a chat room through research partnership based in a community, and one by Sowell and Phillips regarding the contribution of sex-seeking through the Internet on risky sexual behavior.

This article presents information on a research study in a national project on decision making about hysterectomy and the use of hormone replacement therapy (HRT). ENDOW is a collaborative project funded by Centers for Disease Control and Prevention. The initial phase of ENDOW used focus group discussions to gain an understanding of women's experiences with and attitudes toward menopause, hysterectomy and HRT. This information was used to develop surveys for all four sites as well as a core questionnaire to which each site added questions that addressed the primary interests and concerns of that site. Focus group research has roots in two distinct disciplines, marketing, in which focus groups were used after World War II by researchers investigating motivation and psychology, in which focus groups stemmed from group therapy. Articles in this issue demonstrate the richness of the data obtained from focus groups and focused individual interviews. In the first article, an overview of issues related to hysterectomy decisions and the use of HRT is presented along with an introduction to the ENDOW project.