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In July 2015, the Journal of the American Geriatrics Society published a manuscript titled, "Failing to Focus on Healthy Aging: A Frailty of Our Discipline?" In response, the American Geriatrics Society (AGS) Clinical Practice and Models of Care Committee and Public Education Committee developed a white paper calling on the AGS and its members to play a more active role in promoting healthy aging. The executive summary presented here summarizes the recommendations from that white paper. The full version is published online at GeriatricsCareOnline.org. Life expectancy has increased dramatically over the last century. Longer life provides opportunity for personal fulfillment and contributions to community but is often associated with illness, discomfort, disability, and dependency at the end of life. Geriatrics has focused on optimizing function and quality of life as we age and reducing morbidity and frailty, but there is evidence of earlier onset of chronic disease that is likely to affect the health of future generations of older adults. The AGS is committed to promoting the health, independence, and engagement of all older adults as they age. Geriatrics as an interprofessional specialty is well positioned to promote healthy aging. We draw from decades of accumulated knowledge, skills, and experience in areas that are central to geriatric medicine, including expertise in complexity and the biopsychosocial model; attention to function and quality of life; the ability to provide culturally competent, person‐centered care; the ability to assess people's preferences and values; and understanding the importance of systems in optimizing outcomes. J Am Geriatr Soc 67:17–20, 2019. [ABSTRACT FROM AUTHOR]

School communities face challenges in responding effectively to the rising incidence of student self-harm. Evidence-informed guidelines may provide a platform for schools to provide better responses and improve the outcomes of students who engage in self-harm. This paper critically reviews policies published in English targeted for schools or education settings on effective early identification and intervention for children and adolescent self-harm. A grey literature search was conducted using "Start Page" web search engine with a documentary analysis approach applied to review polices that met criteria. The review identified 16 policies that aim to help school and education staff to identify and respond to student self-harm. The key themes include identification and risk assessment, intervention, roles and responsibilities, as well as addressing issues surrounding evidence-based psychological education and intervention. An evidence-informed policy that addresses multiple aspects of responding to and reducing student self-harm may be a vital foundation of a school's response to this growing public health issue. This paper outlines key points that will help inform the development of evidence-informed guidelines for schools to respond to student self-harm and presents an exemplar policy framework for use by schools.

In response to the diverse number of child sexual abuse (CSA) prevention programs currently implemented in school contexts, this paper examines key considerations for selecting such initiatives and the multiplicity of understandings required to inform facilitation of contextually relevant prevention curriculum. First, the paper examines concerns about the lack of explicit professional development for educators concerning child protection, and the need to develop understandings about prevention program best practices within pre-service and in-service training. Second, drawing on a systematic review of literature, the paper identifies five key considerations to inform teachers' selection and facilitation of CSA prevention curriculum in school contexts. Third, the paper advances calls by Wurtele (2009) and presents CSA prevention "best practices" overview and "model programs" list for professionals such as teachers. (Contains 1 table.)

Objectives This study examines the influence that smokefree workplaces, restaurants and bars have on the adoption of smokefree rules in homes and cars, and whether there is an association with adopting smokefree rules in homes and cars. Methods Bivariate probit models were used to jointly estimate the likelihood of living in a smokefree home and having a smokefree car as a function of law coverage and other variables. Household data were obtained from the nationally representative Social Climate Survey of Tobacco Control 2001, 2002 and 2004-2009; clean indoor air law data were from the American Nonsmokers' Rights Foundation Tobacco Control Laws Database. Results ‘Full coverage’ and ‘partial coverage’ smokefree legislation is associated with an increased likelihood of having voluntary home and car smokefree rules compared with ‘no coverage’. The association between ‘full coverage’ and smokefree rule in homes and cars is 5% and 4%, respectively, and the association between ‘partial coverage’ and smokefree rules in homes and cars is 3% and 4%, respectively. There is a positive association between the adoption of smokefree rules in homes and cars. Conclusions Clean indoor air laws provide the additional benefit of encouraging voluntary adoption of smokefree rules in homes and cars. [ABSTRACT FROM AUTHOR]

The authors discuss the disparity in African American infant mortality and suggest ways to surmount the problem. They believe the causes of the disparity are historical and biopsychosocial; racial and ethnic disparities are found in health outcomes. Eliminating factors that cause high rates of pre-term births (PTB) and low birth weight (LBW) is important as. The authors opine that a multidisciplinary approach would address the various causal factors.

Biological control with specialist, nonindigenous, herbivorous insects is an important option for controlling invasive exotic plants in wildlands and nature reserves. It is assumed that biological control agents will reduce the dominance of the target weed, thereby increasing the native diversity of the associated plant community. However, this hypothesis has rarely been tested. We introduced Aphthona nigriscutis into grassland sites infested with the invasive exotic species Euphorbia esula L. on a nature reserve in Montana (U.S.A.). Two sites with better soil had been treated previously with herbicide, whereas two other sites had not. We measured the density and biomass of Euphorbia vegetative and flowering stems and number of native and exotic shrubs, grass-like plants, and forbs in 48 microplots in Aphthona release and control macroplots at each site. After 5 years, Aphthona release was associated with a 33–39% decline in Euphorbia aboveground biomass compared with controls at all sites. Other effects of the biocontrol depended on the site. Biocontrol slowed the recovery of species diversity at the sites previously treated with herbicide but slowed the loss of diversity at sites without a history of herbicide. Biocontrol introduction was not associated with a disproportionate increase in nontarget exotic species. Release of Aphthona caused a decline in the biomass of flowering stems relative to controls at good-soil, previous-herbicide sites but was associated with a relative increase in flower stem mass at poor-soil, no-herbicide sites. Our results suggest that biocontrol reductions in weed dominance will not always be associated with increased species diversity. More emphasis should be placed on conserving desirable communities and less on simple weed control. Monitoring of community-level effects should accompany biocontrol introductions on nature reserves. [ABSTRACT FROM AUTHOR]

The main threats to world order are terrorist and extremist activities. On the world stage, countries unite into a coalition with the aim to increase the efficiency of the fight against terrorism. At the local level, the terrorist threat is fought by the security services. In order to prevent global human victims, which may arise as a result of terrorist attacks, the government is taking a number of normative legal acts, which prevent the activities of militants. The main problem that arises in the preparation of the law is the lack of a clear understanding of what the "terrorism" and "extremism" are. Therefore, in this paper, a complete analysis of these terms will be made on the basis of normative legal acts of some countries such as the USA, Russia, Kazakhstan, and scientists specialized in the subject. Research of the terms "extremism" and "terrorism" has shown that these concepts are different, but at the same time interconnected. This relationship is expressed in the fact that terrorism is a continuation of extremism, its next step. The disengagement of these concepts will allow the legislator to create more specific laws, that will cover the entire field of criminal activities.

This article focuses on such a highly relevant subject as the prevention and correction of deviant behavior in the adolescent environment. The study revealed the main vectors for the development of the modern science of deviant behavior, identified the main causes of deviations and carried out a comparative analysis of the work on the prevention of deviant behavior in the CIS countries and abroad. This paper proved that the key factor in the prevention and correction of deviant behavior should be, firstly, the family as the primary and the most important institution of identity formation, and secondly, the pedagogically controlled environment of educational institutions serving as a condition for socialization and personal development for children and adolescents.

Grade inflation is a global phenomenon that has garnered widespread condemnation among educators, researchers, and the public. Yet, few have deliberated over the ethics of grading, let alone the ethics of grade inflation. The purpose of this paper is to map out and examine the ethics of grade inflation. By way of beginning, we clarify why grade inflation is a problem of practical ethics embedded in contemporary social practice. Then, we illuminate three different aspects of grade inflation--longitudinal, compressed, and comparative--and explore the ethical dilemmas that each one raises. We demonstrate how these three aspects may be seen as corresponding to three different victims of grade inflation--individuals, institutions, and society--and hence also to three potential agents of harm--teachers, schools, and educational systems. Next, we reflect upon various compelling reasons that these agents inflate grades, whether from an ethic of care, fiduciary responsibility, or simple self-preservation. Subsequently, we consider a variety of means of combatting grade inflation, and invite more educators and philosophers to delve into the complex practical ethics of grade inflation.

Context: The Cuban medical education and health care systems provide powerful lessons to athletic training educators, clinicians, and researchers to guide educational reform initiatives and professional growth. Objective: The purpose of this paper is to provide a brief overview of the Cuban medical education system to create parallels for comparison and growth strategies to implement within athletic training in the United States. Background: Cubans have experienced tremendous limitations in resources for decades yet have substantive success in medical education and health care programs. As a guiding practice, Cubans focus on whole-patient care and have established far-reaching research networks to help substantiate their work. Synthesis: Cuban medical education programs emphasize prevention, whole-patient care, and public health in a unique approach that reflects disablement models recently promoted in athletic training in the United States. Comprehensive access and data collection provide meaningful information for quality improvement of education and health care processes. Active community engagement, education, and interventions are tailored to meet the biopsychosocial needs of individuals and communities. Results: Cuban medical education and health care systems provide valuable lessons for athletic training programs to consider in light of current educational reform initiatives. Strong collaborations and rich integration of disablement models in educational programs and clinical practice may provide meaningful outcomes for athletic training programs. Educational reform should be considered an opportunity to expand the athletic training profession by embracing the evolving role of the athletic trainer in the competitive health care arena. Recommendation(s): Through careful consideration of Cuban medical education and health care initiatives, athletic training programs can better meet the contract with society as health care professionals by integrating the Accreditation Council for Graduate Medical Education's core competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice now promoted in the Commission on Accreditation of Athletic Training Education's "2020 Standards for Accreditation of Professional Athletic Training Programs." Conclusion(s): Educational and health care outcomes drive change. Quality improvement efforts transcend both education and health care. Athletic training can learn valuable lessons from the Cubans about innovation, preventative medicine, patient-centered community outreach, underserved populations, research initiatives, and globalization. Not unlike Cuba, athletic training has a unique opportunity to embrace the challenges associated with change to create a better future for athletic training students and professionals.

This paper examines the working philosophy of a university-community collaborative program--the Robinson Community Learning Center (RCLC), a multifaceted community service center located in the Northeast Neighborhood of South Bend, Indiana, in the United States. This program's multitude of educational and social services includes individualized academic tutoring programs, violence prevention programs, computer classes, exercise classes, health services, and entrepreneurship classes. The invigoration of the Northeast Neighborhood that has occurred consequent to the RCLC's opening appears to be related to not only the significant financial and human resources garnered by its sponsoring higher education and community partners, but also by the shared philosophy of action that guides its everyday work. This philosophy, which is informed by Catholic social teaching, the African American Prophetic Christian tradition, and critical perspectives on social change, is especially evident in the leadership of the RCLC. This paper, then, describes the RCLC's philosophy of action and situates this philosophy in the broader discussion of higher education-community collaboration and critically prophetic action. The paper has implications for institutions of higher education that are seeking effective ways to engage their surrounding communities.

In the last 30 years, the application of the Delphi technique has been increasing. With the recent availability and established popularity of Internet-based research tools, the Internet has been identified as a means for mitigating Delphi limitations, maximizing its advantages, and expanding the breadth of its application. The discourse on the application of "e-Delphi" has been speculative in nature, however, with pragmatic analysis of Internet-based Delphi administration being limited in scope. Concomitantly, methodological guidance for conducting the e-Delphi in health education is limited, with best-practice implementation strategies yet to emerge. This paper advances the understanding of the e-Delphi technique, contributes to the evolution of this Internet-based research methodology, and provides guidance for the e-Delphi researcher in health education. Further, it offers a contribution to the discourse about Internet-based inquiry generally, and on using the e-Delphi technique in health education specifically. The authors illustrate that e-Delphi has a range of benefits that are effective and efficient in assuaging traditional Delphi limitations; nevertheless, a set of methodological issues remain unaddressed and make apparent the need for future research investments to better understand and alleviate challenges presented for e-Delphi research in health education. (Contains 1 figure and 2 tables.)

Although youth in the United States remain substantially more violent than adolescents and young adults in most industrial countries, the National Institutes of Health's (NIH) State-of-the-Science Conference on Preventing Violence and Related Health-Risking Social Behaviors in Adolescents identified many reasons for optimism about our capacity to develop effective prevention and intervention responses. The research is getting better and contrary to popular opinion we do know a lot about what does work. Future advances will depend upon our insistence on the use of effectiveness evidence and the development of a taxonomy which will facilitate cross disciplinary communication.

An expert on the sociology of video games highlights the power of this medium to popularize violence among children. But few are aware that some of the most technologically potent products are violent war games now being produced at taxpayer expense. These are provided free as a recruiting tool by the United States military. The author contends that government production and circulation of highly sophisticated violent video games is unethical and contradicts violence prevention efforts among children and youth.

Childhood and youth violence in the schools is a major concern in the United States. School-associated violent deaths between 1194 and 1999 have increased, and significantly more students report taking a weapon to school. This paper discusses the causes and correlates of school violence, including the accumulation of social and psychological risk factors related to violence and the effect of the interaction between the child's biological predispositions and home and school experiences on the child's ability to develop positive values, form positive relationships and attach to the school. The paper further describes violence prevention strategies and programs in the schools that emphasize the importance of a connection between the family and the schools which are both embedded within the broader community. These strategies and programs include families and schools collaborating to teach, model and reinforce prosocial behavior and anger management, communicating successes and problems, facilitating student involvement, and building parent/school/community partnerships that support school-based peacekeeping projects. Additional suggestions that increase active parental involvement in the school, positive parent/school communication, and school support through parent/school/community partnerships are provided.

To help college health services in all parts of the country improve their approach to latent tuberculosis, two Listservs were provided for them to post their questions on dealing with TB infection. In this article, the authors present some of the questions posted in the Listservs and their corresponding answers. In their answers, the authors have tried to highlight areas of agreement, continuing controversy, and discrepancies between the Massachusetts recommendations and those of the Centers for Disease Control and Prevention and the American College Health Association. The authors conclude that a successful program of risk assessment, targeted tuberculin skin testing, and treatment of latent TB infection benefits both the individual student and the college community. Such an approach prevents cases of active TB and also uses college health service financial resources and personnel time efficiently.

This essay explores the intersection of US Empire on HIV/AIDS policies and the politics of "gifting." It does so from an analysis of several key US initiatives: the Project for a New American Century, the US National Security Strategy, and the President's Emergency Plan for AIDS Relief. History provides numerous examples where US international aid places expectations on the recipient with enormous consequences accrued to the giver--the contemporary time is no exception. Gifting, an especially powerful tool of US hegemony, is a means of social control, reflects power relations, and socialises the receiver by transmitting a set of expectations and values which bolster US ideology. US foreign policies, including those related to HIV/AIDS and HIV/AIDS education, are directly influenced by these three initiatives which are woven together to construct a new "American internationalism." (Contains 2 notes.)

An increase in interest in crimes against people with developmental disabilities (PWDD) has been observed in the past decade. However, little attention has been given to intrafamilial homicides of PWDD. This paper provides a preliminary description of these types of homicides as they affect PWDD. Content analysis of media accounts of intrafamilial homicides of PWDD describes the characteristics of those involved and the circumstances of the homicides. This study examined a subset of data of 1967 homicides of PWDD and found 308 cases of intrafamilial homicide representing the deaths of 314 PWDD. These homicides represented 15.96% of overall homicides of PWDD obtained in the original study. A similar number of homicides of male and female victims were reported. Compared to other family members, biological parents were most frequently implicated in the deaths of PWDD, with biological mothers, acting alone, implicated most often. Biological mothers were most frequently implicated in the deaths of daughters, while biological fathers were most frequently implicated in the deaths of sons. The majority of PWDD who were killed were four years of age or younger. Beating, shooting, neglect, asphyxia, burns, and poisoning were the most common causes of death. Discussion focuses on media representation of homicides, intrafamilial homicide, and prevention. (Contains 4 tables.)

The aim of this paper was to gain an understanding of the views of a group of physical education teacher educators on the purpose(s) of school physical education and whether, how and why these views have changed over time. Semi-structured individual interviews were carried out with thirteen physical education teacher educators; a fourteenth participant responded to interview questions in writing. Participants were based in seven countries: Belgium, Finland, Germany, Ireland, New Zealand, Switzerland and the USA. A relative consensus on the overarching purpose of physical education was evident, centred on physical education preparing young people for a lifetime of physical activity. The framing of this shared purpose differed somewhat between participants, reflecting a range of perspectives on the value of physical activity. Delineating the boundaries of their subject, participants characterised obesity prevention and maximising in-class physical activity as potential by-products rather than as goals of the subject. The views of many had changed over time, influenced by such factors as findings from research, societal expectations and a perceived need to legitimise physical education within school and university contexts. We note that many of the influences acting on the views of the physical education teacher educators are also known to affect practicing teachers. This suggests a possibility, in the open reflection of physical education teacher educators on the interaction between their views and the institutional and societal contexts within which they work, to provide future teachers with alternative value pathways paved with relatable explanations and shared experiences.

Background: Many economic evaluations of human papillomavirus vaccination should ideally consider multiple disease outcomes, including anogenital warts, respiratory papillomatosis and non-cervical cancers (eg, anal, oropharyngeal, penile, vulvar and vaginal cancers). However, published economic evaluations largely relied on estimates from single studies or informal rapid literature reviews.Methods: We conducted a systematic review of articles up to June 2016 to identify costs and utility estimates admissible for an economic evaluation from a single-payer healthcare provider's perspective. Meta-analyses were performed for studies that used same utility elicitation tools for similar diseases. Costs were adjusted to 2016/2017 US$.Results: Sixty-one papers (35 costs; 24 utilities; 2 costs and utilities) were selected from 10 742 initial records. Cost per case ranges were US$124-US$883 (anogenital warts), US$6912-US$52 579 (head and neck cancers), US$12 936-US$51 571 (anal cancer), US$17 524-34 258 (vaginal cancer), US$14 686-US$28 502 (vulvar cancer) and US$9975-US$27 629 (penile cancer). The total cost for 14 adult patients with recurrent respiratory papillomatosis was US$137 601 (one paper).Utility per warts episode ranged from 0.651 to 1 (12 papers, various utility elicitation methods), with pooled mean EQ-5D and EQ-VAS of 0.86 (95% CI 0.85 to 0.87) and 0.74 (95% CI 0.74 to 0.75), respectively. Fifteen papers reported utilities in head and neck cancers with range 0.29 (95% CI 0.0 to 0.76) to 0.94 (95% CI 0.3 to 1.0). Mean utility reported ranged from 0.5 (95% CI 0.4 to 0.61) to 0.65 (95% CI 0.45 to 0.75) (anal cancer), 0.59 (95% CI 0.54 to 0.64) (vaginal cancer), 0.65 (95% CI 0.60 to 0.70) (vulvar cancer) and 0.79 (95% CI 0.74 to 0.84) (penile cancer).Conclusions: Differences in values reported from each paper reflect variations in cancer site, disease stages, study population, treatment modality/setting and utility elicitation methods used. As patient management changes over time, corresponding effects on both costs and utility need to be considered to ensure health economic assumptions are up-to-date and closely reflect the case mix of patients. [ABSTRACT FROM AUTHOR]

Corruption and malpractices in higher education are today a major concern in nearly all higher education systems worldwide. It is a multifaceted phenomenon and has become particularly visible in the academic domain. This paper represents an exploration of the possible role that quality assurance can play in addressing corruption and malpractices. First, it briefly studies the factors that enhance the risk of corruption and malpractice in higher education. Second, it examines how quality assurance systems can potentially identify and prevent corruption in higher education. Third, it discusses organisational options that prevent corruption in the quality assurance procedure itself. In other words, how the quality assurance procedure should be built in order to lower the risk of becoming itself the object of unethical behaviour and corruption.

The Advisory Committee on Immunization Practices (ACIP) at the Center for Disease Control and Prevention (CDC) will be considering a new vaccination recommendation for the prevention of invasive "N. meningitidis" infection when meningococcal conjugate vaccines are licensed in the United States. The CDC has also updated the Working Group in the epidemiology of meningococcal disease. Although the rates of disease are highest among infants, the rates among adolescents and young adults are double those of the general population, and case fatality rates are 3- to 4-fold higher among teens. The risk among college freshmen living in dormitories is higher than that among dormitory residents, freshmen in general, college students in general, and the general population of persons aged 18 to 23 years. The Working Group and the ACIP also reviewed cost-effective studies. The CDC has conducted an extensive cost-effectiveness analysis, and the bottom line is that there are no cost savings to society for vaccinating adolescents against meningococcal disease. In this article, the author offers his views concerning ACIP's and CDC's stance on the cost-effectiveness of vaccinating adolescents against this disease.

Background: Type 1 diabetes (T1D) is a devastating autoimmune disease, and its rising prevalence in the United States and around the world presents a critical problem in public health. While some treatment options exist for patients already diagnosed, individuals considered at risk for developing T1D and who are still in the early stages of their disease pathogenesis without symptoms have no options for any preventive intervention. This is because of the uncertainty in determining their risk level and in predicting with high confidence who will progress, or not, to clinical diagnosis. Biomarkers that assess one's risk with high certainty could address this problem and will inform decisions on early intervention, especially in children where the burden of justifying treatment is high. Single omics approaches (e.g., genomics, proteomics, metabolomics, etc.) have been applied to identify T1D biomarkers based on specific disturbances in association with the disease. However, reliable early biomarkers of T1D have remained elusive to date. To overcome this, we previously showed that parallel multi-omics provides a more comprehensive picture of the disease-associated disturbances and facilitates the identification of candidate T1D biomarkers. Methods: This paper evaluated the use of machine learning (ML) using data augmentation and supervised ML methods for the purpose of improving the identification of salient patterns in the data and the ultimate extraction of novel biomarker candidates in integrated parallel multi-omics datasets from a limited number of samples. We also examined different stages of data integration (early, intermediate, and late) to assess at which stage supervised parametric models can learn under conditions of high dimensionality and variation in feature counts across different omics. In the late integration scheme, we employed a multi-view ensemble comprising individual parametric models trained over single omics to address the computational challenges posed by the high dimensionality and variation in feature counts across the different yet integrated multi-omics datasets. Results: the multi-view ensemble improves the prediction of case vs. control and finds the most success in flagging a larger consistent set of associated features when compared with chance models, which may eventually be used downstream in identifying a novel composite biomarker signature of T1D risk. Conclusions: the current work demonstrates the utility of supervised ML in exploring integrated parallel multi-omics data in the ongoing quest for early T1D biomarkers, reinforcing the hope for identifying novel composite biomarker signatures of T1D risk via ML and ultimately informing early treatment decisions in the face of the escalating global incidence of this debilitating disease. [ABSTRACT FROM AUTHOR]

Objectives: To present new estimates of the average lifetime costs per child maltreatment victim and aggregate lifetime costs for all new child maltreatment cases incurred in 2008 using an incidence-based approach. Methods: This study used the best available secondary data to develop cost per case estimates. For each cost category, the paper used attributable costs whenever possible. For those categories that attributable cost data were not available, costs were estimated as the product of incremental effect of child maltreatment on a specific outcome multiplied by the estimated cost associated with that outcome. The estimate of the aggregate lifetime cost of child maltreatment in 2008 was obtained by multiplying per-victim lifetime cost estimates by the estimated cases of new child maltreatment in 2008. Results: The estimated average lifetime cost per victim of nonfatal child maltreatment is $210,012 in 2010 dollars, including $32,648 in childhood health care costs; $10,530 in adult medical costs; $144,360 in productivity losses; $7,728 in child welfare costs; $6,747 in criminal justice costs; and $7,999 in special education costs. The estimated average lifetime cost per death is $1,272,900, including $14,100 in medical costs and $1,258,800 in productivity losses. The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion. In sensitivity analysis, the total burden is estimated to be as large as $585 billion. Conclusions: Compared with other health problems, the burden of child maltreatment is substantial, indicating the importance of prevention efforts to address the high prevalence of child maltreatment. (Contains 4 tables.)

Skin cancer is an increasing problem in Europe, America and Australasia, although largely preventable by avoiding excessive ultraviolet (UV) exposure. This paper presents the findings of a systematic review of qualitative research about the prevention of skin cancer attributable to UV exposure. The aim is to understand elements that may contribute to the successful or unsuccessful conveyance of skin cancer prevention messages and their uptake by the public. A systematic review was undertaken using evidence identified through searching electronic bibliographic databases and Web sites and reference list checks. Predefined inclusion and exclusion criteria were used. Sixteen study reports (relating to 15 separate studies) were included from the United Kingdom, United States, Australia, Canada and New Zealand. Each included study was quality appraised, and the findings were extracted into an evidence table. A coding scheme, framed by the Health Belief Model, was developed by the reviewers and informed analysis and synthesis. This showed that most people perceived their susceptibility to skin cancer, and its severity, as low. While benefits of adopting changed behaviour were acknowledged, there were substantial barriers to this, including positive perceptions of a tan as healthy and attractive and the hassle of covering up or using sunscreen. Peers, parents and media may offer "cues to action" that encourage adoption of preventative behaviour and finally self-efficacy or the perceived ability to make such changes. Effective health education messages will need to address the barriers to adopting protective behaviours identified through this review.

Sexuality education for school-aged young people is a crucial component of all quality education systems. It prepares young people for participation in society as responsible, mature and community-minded citizens. Most contemporary school education curricula generally aim to enhance young people's knowledge, skills and understandings of the world, and of their rights as human beings and citizens of nations. The current sexuality problems of many young people are the opposite of these; namely, ignorance, lack of skills, misunderstandings, and loss of rights, as well as unnecessary fear and shame about themselves and others. Many young people do not receive any sexuality education at all, and frequently parents have been found to be unsatisfactory providers of sexuality education for their offspring. Schools, then, become the logical place to provide this. Nowadays, the earlier maturing of girls and boys provides a further persuasive argument for quality sexuality education in all schools. The absence or erosion of school-based sexuality education through ignorance, fear or unreasoned response helps support ignorance about sexual behaviours, increased rates of unwanted pregnancy, sexually transmitted infections, and the cruel loss of life opportunities for young people. The present paper responds to 12 parental objections to school sexuality education, by providing research facts and evidence-based reasoned arguments to them.

In relation to treatment-related research in the United States, there is relatively little systematic effort focused on the combination of risk and prevention for anxiety pathology. This article broadly discusses risk factor research and prevention program development for anxiety psychopathology. The authors also specifically discuss papers in this special issue that are focused on these topics. Risk factor research should be used by clinical researchers to inform prevention programs, and reciprocally, prevention knowledge should be effectively utilized to drive new, clinically focused risk factor research.

In the last 10 years, the problem of school exclusion in England has reached a crisis point. Figures on permanent exclusions from primary, secondary and special schools in England show that for 1996/97, 12 700 children were excluded. Among these, 12% were pupils permanently excluded from primary schools. When the present Labour Government came to office, it made tackling these interlinked problems, i.e. poverty, poor skills and high crime, a priority because of the great human costs to individuals and society, and because of the impact on public finances and the health of the economy. Therefore, the government launched in 1997 the Social Exclusion Unit as one the first governmental actions targeting the phenomenon of school and social exclusion. As part of these initiatives, this paper focuses on the prevention of exclusion from primary school and the first year of secondary school at Key Stages 1 and 2 (4-11 years old) due to emotional and behavioural problems either at home or at school. The study aims to establish whether a new intensive, multidisciplinary intervention for pupils excluded from primary school because of disruptive/antisocial behaviour helps reduce the number of excluded days and the reoccurrence of emotional and behavioural difficulties when compared with routine care. (Contains 5 tables and 2 figures.)

This paper evaluates a recent innovation in regulating risk called management-based regulation. Traditionally, risk regulation has either specified a particular means of achieving a risk-reduction goal or specified the goal and left the means of achieving that goal up to the regulated entity. In contrast, management-based regulation neither explicitly imposes the means, nor the ends. Rather, what is required is that each regulated entity review its production processes and develop a set of goals and procedures that will reduce risk. I evaluate the effectiveness of management-based regulation by taking advantage of policy variation that occurred when 14 states adopted such regulations for toxic chemical control in the 1990s. Using panel data for just over 31,000 manufacturing plants in the United States, I investigate whether facilities subject to management-based regulations had larger changes in total quantities of toxic chemical releases, engaged in more pollution prevention activities, or reported fewer toxic chemicals to the Toxics Release Inventory (TRI). The results indicate that management-based regulation has had a measurable positive effect on the environmental performance of manufacturing plants. In particular, plants subject to management-based regulation experienced larger decreases in total pounds of toxic chemicals released and were more likely to engage in source reduction activities.

Youth violence is widely recognized as a critical social issue in the United States, and many approaches to prevention have been developed in recent years. Emerging research suggests that only approaches that are deeply embedded in cultural, community, and organizational contexts are likely to be powerful enough to have a meaningful collective impact. No programs of this kind is truly practical and socially valid have yet reached a level where they can be regarded as well established, but data is beginning to appear that can guide community efforts. In this review, two classes of behavioral programming that appear promising as partial solutions to this need are identified: universal skills training and ecological strategies that focus on interlocking cultural practices. Progressive refinements in both are appearing through programs of developmental research. This paper reviews the state of the science in these efforts.

Adolescent pregnancy and parenting remains a pressing social and public health concern because the United States continues to have the highest teen pregnancy rate among Western developed nations and because of the attendant social, psychological, and physical problems for young parents and their children. Prevention efforts to reduce the incidence of pregnancy and parenting among all teens continue to be critical. Even though funding constraints may limit the number of programs, it is possible to maximize the effectiveness of those that do exist or are developed. The most effective prevention programs are those based on theoretical models. This paper focuses on common theoretical models in four areas (developmental, perceived control, attitudes/ intentions, and social learning) that can be easily applied to pregnancy prevention program development. After a short description of the theory and a discussion of its use in the literature, the theory's relevance to pregnancy/parenting prevention program development is discussed. (Contains 1 note.)

This paper examined the attitudes and perceptions of urban college students regarding Acquired Immune Deficiency Syndrome (AIDS) awareness and prevention. AIDS has devastated the lives of citizens in the United States. The Centers for Disease Control and Prevention indicate that the AIDS incidence rate for young Americans between the ages of 13 to 25 years rose nearly 20 percent, and approximately 50 percent of new infections are among individuals who are younger than 25 years old. Therefore, finding better methods to communicate AIDS risk knowledge to those Americans who are at greater risk of infection is paramount in the fight against this deadly scourge. We measured AIDS risk knowledge, self efficacy, and condom perception using three scales. Regression and analysis of variance techniques were employed to evaluate the hypotheses. Findings indicate significant age, gender and class rank effects for self-efficacy and condom perception among participants. Condom perception significantly predicted AIDS risk knowledge. Males reported higher self-efficacy and condom perception scores than females, and younger participants reported higher self-efficacy scores than older participants.

This paper explores student teachers' understandings of child sexual abuse and strategies to deal with it that are appropriate for the primary school classroom. Evidence of surface and deep learning were obtained from a content analysis of student teachers' responses to an essay-type exam question, using Bloom's taxonomy of educational objectives. The results show that participants were most likely to be rated as having achieved at intermediate levels, and less likely to be at either the lowest or highest levels. The data suggest that greater provision should be made for addressing child sexual abuse during the training of such professionals to enhance their deeper thinking about child sexual abuse and strategies to deal with it. Since pre-service teacher education plays a significant role in enhancing the quality of future teachers, it is important that they are helped to achieve the highest levels associated with understanding universals, principles, generalizations and abstractions. The implications of these results for teaching in primary schools strongly suggest the importance of comprehensive, enhanced, longer, and on-going programmes on child sexual abuse across pre-service education. (Contains 3 figures.)

This paper reviews the international scientific evidence on the effectiveness of secondary prevention interventions for young drug users. The review provides insight into the effectiveness of interventions that have been evaluated using moderately strong research designs. Most of the studies included are from the United States of America. Some interventions are effective in reducing drug use and associated problems while others have no or mixed effect. Those successful in reducing drug use include behavior therapy, Minnesota 12-step programs, residential care, and general drug treatment. Those with either no effect or mixed effect include schools interventions. Involving parents and other agencies may enhance an intervention's effect. There is a lack of good quality studies outside the USA. Future interventions should focus on either low- or high-risk groups of young drug users. Future research should be conducted on a wider range of services for young people and include nonmedical outcomes such as communication skills, schooling, employment, farofly relations, and economic costs.

The Ohio Substance Abuse Monitoring Network (OSAM) is designed to provide accurate, timely, qualitatively-oriented epidemiologic descriptions of substance abuse trends and emerging problems in the state's major urban and rural areas. Use of qualitative methods in identifying and assessing substance abuse practices in local communities is one of the main assets of OSAM Network. Qualitative methods are sensitive to local contextual variability, flexible enough to capture emergent trends, and can be implemented with limited financial resources. This paper describes how qualitative epidemiologic methods, like those used by the OSAM Network, could be applied to inform substance abuse prevention activities, particularly those directed at adolescents.

Unintentional firearm injury in children is a problem in the United States that warrants attention. Recent research has identified several risk factors for such injuries and has developed prevention strategies for reducing their occurrence. Many of these programs, however, have not been evaluated or have been shown to be ineffective. Research on the prevention of other childhood injuries, on the other hand, has shown behavioral skills training to be successful for teaching protective behaviors to children for a variety of injury threats. This paper examines risk factors for firearm-injury in children, briefly reviews existing protection programs and their limitations, provides a brief overview of research on effective childhood injury prevention, and concludes with a description of the components of an effective injury prevention program and directions for future research.

Sickle cell disease (SCD) is a life-threatening condition. Given the nature of the disease and associated complications with high mortality and morbidity rates, it is imperative that patients are diagnosed in early infancy, are established with specialists and general pediatric care immediately, and receive continuity in care. A percentage of patients diagnosed with SCD fall within a vulnerable, at-risk population. This population may face greater social barriers that lead to missed or late diagnosis and therefore delayed management, significantly increasing the risk of morbidity and mortality. Screening tools such as state newborn screens help to identify the diagnosis early. However, patients in vulnerable, at-risk populations who are not established in the health care system may not receive timely communication about their illness and necessary next steps for care. We present a case of a 12-month-old female who is an example of one of the many patients who despite having undergone newborn screening, fell through the cracks due to social barriers including housing instability, food insecurity, and lack of access to transportation. This paper emphasizes the need for and provides a real example of the benefit of access to longitudinal primary care for vulnerable patients. We also demonstrate the role of primary care in clearing the care gaps and coordinating services quickly to ultimately prevent life-threatening complications specifically for children with previously undiagnosed chronic illnesses. [ABSTRACT FROM AUTHOR]

Provides information on the topics of: (1) physical education and fitness programs in the schools; (2) vital statistics on live births, marriage, divorce, and death rates in the United States; (3) AIDS in children; (4) American family trends; (5) maternal and child health care in Europe and United States; (6) early childhood prevention programs. (BB)

Suicide, and its particularly disturbing rise in the last three decades, is a major public health concern. Prevention efforts must be multifaceted, and include the refinement of epidemiological methods in the study of suicide; development of health education, information, and intervention programs dealing with suicide; and increased community awareness of and participation in all suicide prevention efforts. (Author/KS)