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Background: The experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents of children with developmental disabilities (DDs) in health and early learning systems are largely understudied. Inclusive, affirming services are critical to timely identification and intervention for DDs. This literature review aimed to establish whether LGBTQ parents experience structural bias and discrimination when accessing care for their children in health and early learning systems. Methods: PubMed, ERIC, and Scopus were searched for empirical research from 1990 to 2020 on: LGBTQ; parents, children, families; bias, disparities, discrimination; and health and early learning services. Themes were analyzed by conceptual model bias levels, participant type, and setting. Results: The search yielded 1,872 unduplicated records (three through hand search). Twenty-nine articles representing 26 studies in health and early learning in eight countries met the inclusion criteria. Biases common across sectors included challenges surrounding LGBTQ status disclosures; lack of acknowledgment of non-biological parents; and heterosexist forms. Knowledge gaps and negative attitudes about LGBTQ families were found among some professionals and students. Conclusion: Some LGBTQ parents experienced bias and discrimination while accessing care for their children in health and early learning systems. Policies and programs to implement and monitor LGBTQ-inclusive health education and evaluate practice changes are recommended to improve professionals' knowledge, attitudes, and behavior. Multilevel workforce development (e.g., accreditation standards, organizational audits, and training) is needed to create and sustain LGBTQ-affirming health and education environments. Honoring LGBTQ family diversity and reducing health and early learning inequities are critical for improving children's health and education outcomes.

The hookah pipe is an ancient tool for smoking tobacco and is a growing public health concern at the global level. YouTube is a website that allows its members to post videos for people to watch and to share comments about the videos in an online forum. The purpose of the study was to investigate the types of videos about hookah on YouTube, their popularity, and the demographics of those who post and view the videos. YouTube was searched using the terms "hookah" and "shisha." Two independent reviewers watched each video and created categories based upon content, being Instructional, Review, Trick, Comedy, Commercial, or Health. Popularity was measured by viewer ratings and by the number of times each video was viewed in a 30-day period. Demographic information was obtained from YouTube. Findings suggested that hookah videos are viewed frequently, rated positively, most often feature and are viewed by young males in nearly every nation in the world, meaning, these videos are an international phenomenon and provides evidence of hookah's growing popularity across the globe. Health professionals should consider creating and posting videos that provide the YouTube audience with evidence-based information about the harmfulness of smoking hookah. (Contains 2 tables and 1 figure.)

Background: Interest in and use of complementary and alternative medicine (CAM) in the United States is increasing. However, CAM remains an area of nascency for researchers and western practitioners. Purpose: The purpose of this study was to examine U.S. health educators' attitudes toward CAM and their use of common CAM therapies. Methods: A cross-sectional online survey was conducted among members of a professional health educator listserv. Results: Health educators generally have positive attitudes toward CAM and about 90% have used at least one CAM therapy in the last 12 months. Differences in CAM attitudes and use were significant, with females reporting more positive attitudes toward and use of CAM. Discussion: Health educators' overall positive attitudes toward CAM are consistent with the limited extant literature. However, important differences were found by various demographic characteristics, not previously identified. Translation to Health Education Practice: The results of this study support the small, but growing, body of literature regarding the need for CAM education for future health education professionals. A discussion of various approaches to the integration of CAM education into professional preparation programs is included. (Contains 6 tables.)

The education and training of students to become culturally competent and globally aware is a priority in higher education. Faculty hold the keys to international experience for students by offering an international curricular focus, coursework, and enrichment projects. Utilization of the Internet as a portal for international collaboration holds promise to broaden the ability of faculty to facilitate global education and research. This pilot study assesses the current participation in, support of, and barriers to Internet-based international collaborations of 34 faculty from 13 different countries. A high level of personal experience with Internet collaborations utilizing primarily e-mail and online chat was reported by 82% of the faculty. Common barriers cited to Internet-based collaboration were the lack of administrative and financial support to begin or maintain the activity. An overwhelming majority (90%) of the respondents indicated the need for an Internet-based portal for the purpose of international collaboration and education. (Contains 4 tables.)

During the last two decades, obesity rates in the United States have escalated dramatically, and intense media coverage of obesity issues has fueled consumer interest in low-carbohydrate diets designed to promote rapid weight loss. The food industry has fostered the assumption that a drop in carbohydrate consumption will translate into a drop in weight. Studies of low-carbohydrate dieters, however, have indicated that weight loss is due primarily to calorie reduction rather than carbohydrate restriction. When lowfat foods were heavily promoted, dieters assumed consumption of reduced-fat or fat-free foods would result in weight loss, unaware that calorie consumption could increase even if fat intake was reduced. This pattern is likely to be repeated if escalating consumption of low-carbohydrate foods translates into increased calorie intake. Once polarized, low-fat and low-carbohydrate advocates, as well as health professionals, have moved toward agreement on a number of critical points designed to promote weight loss as well as to prevent chronic disease. These groups recommend a diet rich in fruits, vegetables, whole grains, low-fat dary products, lean meats, poultry, and fish. Despite this congruence, the weight loss industry aggressively continues to market new diets, products, and services. Ironically, as the diet business becomes more profitable, obesity rates continue to climb in the United States.

One of every 10 adolescents in the United States has asthma. Adolescents who lack asthma control are at increased risk for severe asthma episodes and death. The National Heart, Lung, and Blood Institute 2007 asthma guidelines and research studies indicated that school nurses are instrumental in assisting adolescents to monitor their asthma, learn asthma self-management skills, and improve health outcomes. This integrative review examines the research from 2005 to 2011 to identify strategies for school nurses to employ with adolescents to foster self-management skills. The research reviewed here supports the need for school nurses to engage adolescents with asthma to practice self-management behaviors. They should educate the adolescent for asthma, monitor how well the adolescent controls asthma, manage acute asthma episodes by using an asthma action plan, and coordinate care by obtaining written consent from parents to share health information with health care providers. (Contains 7 tables.)

Introduction: Due to the increasing number of clinical trials conducted globally, there is a need for quality continuing education for health professionals in clinical research manager (CRM) roles. This article describes the development, implementation, and evaluation of a distance-based continuing education program for CRMs working outside the United States. Methods: A total of 692 applications were received from CRMs in 50 countries. Of these, 166 were admitted to the program in two cohorts. The program, taught online and in English, included 4 required and 1 optional course. Course materials were also provided as hard copies and on CDs. A pretest/posttest design was used to evaluate the outcome of the program in terms of changes in knowledge, participants' capacity-building activities at their research sites; and participant and supervisor perceptions of program impact. Results: Participants demonstrated significant improvements in knowledge about clinical research, rated course content and teaching strategies positively, and identified the opportunity for interactions with international peers as a major program strength. Challenges for participants were limited time to complete assignments and erratic Internet access. Participants offered capacity-building programs to 5061 individuals at their research sites. Supervisors indicated that they would recommend the program and perceived the program improved CRM effectiveness and site research capacity. Discussion: Results suggest that this type of continuing education program addresses a growing need for education of CRMs working in countries that have previously had limited involvement with global clinical trials. (Contains 6 tables and 1 exhibit.)

Purpose: Little is known about health-related advertising on university environments. Given the power of advertising and its potential effect on health behaviors, the purpose of this paper is to assess the health-related advertisement environment and policies on university campuses. Design/methodology/approach: In total, ten geographically and ethnically diverse US university campuses that were trained in using the health-related advertisement survey tool participated in the study. Inter-rater reliability with data collectors at each university was established before data commencement began in Spring 2011. The survey tool assessed the types, locations, and prevalence of health-related advertisements and messages (e.g. nutrition, alcohol, tobacco) on campus, and included both advertisements and messages related to any aspect of health by any sponsor. Current campus health-related policies from each institution were collected as well. Findings: The largest proportion of advertisements on all campuses were for diet/nutrition, exercise/fitness, and alcohol. The majority of advertisements promoted positive health behaviors recommended by health professionals. Unbranded advertisements were more likely to promote positive health behaviors than branded advertisements. Diet/nutrition, tobacco, and drug advertisements were more likely to be positive, whereas alcohol-related advertisements tended to be negative. Originality/value: The paper's findings indicate significant gaps in campus health-related policies with regard to healthy eating and physical activity and lack of policies covering health-related advertisement content. Benchmark data like those reported here can help campus stakeholders set priorities and work with campus decision makers to advocate for the development and implementation of healthy campus policies that support healthy environments. (Contains 4 tables.)

The consumer health information (CHI) movement is the result of various twentieth-century ideologies and is an outgrowth of the broader consumer movement. From a sociocultural and political perspective, the consumer, civil rights, and women's movements and related societal shifts helped pave the way for the consumer health movement, which laid the foundation for the CHI movement. All are examples of freedom of choice expressed through action and mirror a growing societal determination to exert control over important areas of one's life. The provision of consumer health information is a necessary support mechanism for that portion of health care focused on investing in risk reduction and shared decision making. As changes in the U.S. health-care system occur over time, access to CHI is likely to remain prominent and increasingly important to the ordinary person. Examining key components of the movement's origins helps elucidate both present and future trends. (Contains 5 tables and 5 footnotes.)

Aim: Evidence-based recommendations regarding which exercise tests to use in children and adolescents with cerebral palsy (CP) are lacking. This makes it very difficult for therapists and researchers to choose the appropriate exercise-related outcome measures for this group. This study aimed to identify a core set of exercise tests for children and adolescents with CP. Method: Fifteen experts (10 physical therapists/researchers and five exercise physiologists; three from the Netherlands, two from the USA, one from the UK, five from Canada, and four from Australia) participated in a Delphi survey which took four stages to achieve a consensus. Based on the information that was collected during the survey, a core set of measures was identified for levels I to IV of the Gross Motor Function Classification System (GMFCS). Results: For children with CP classified at GMFCS levels I and II, tests were identified for two motor skills (walking and cycling). For the subgroup of children with CP classified at GMFCS level III, the tests that were identified related to walking, cycling, and arm cranking. For children with CP classified at GMFCS level IV, the tests included in the core set were related to cycling and arm cranking. Interpretation: The core set will help physical therapists, exercise physiologists, and other health professionals who work with children and adolescents with CP to decide which test(s) to use in clinical practice or research. This will facilitate comparability of results across studies and clinical programmes.

This article describes how the CS2day (Cease Smoking Today) initiative positioned continuing education (CE) in the intersection between medicine and public health. The authors suggest that most CE activities address the medical challenges that clinicians confront, often to the neglect of the public health issues that are key risk factors for the onset and exacerbation of diseases. The authors further suggest that the educational activities of the CS2day initiative functioned as Type III translational science in that it facilitated the use of research-derived practice guidelines in clinical practice and in the community. The article concludes by stating that the successful results of the CS2day initiative illustrate what can happen when continuing education efforts develop from a public health problem rather than just a practice gap identified in a clinical practice setting. (Contains 2 figures.)

Community health education does more than educate communities about health. In the most basic form, community health education seeks to enable citizens to assume responsibility for their own and their community's health through an understanding of their community's health problems and the societal influences that act upon them. Many community health education programs focus on populations described as minority, at-risk, low-income, and medically underserved. Over 43 million people in the United States are classified as medically underserved, with racial and ethnic minority populations making up a disproportionate percentage of this population. Many community health education programs address these issues through community health workers (CHWs) who lead efforts to increase access to health service delivery and reduce communities' diseases. Known by myriad titles, CHWs are individuals indigenous to their communities who culturally link community members with health service delivery systems through outreach. This chapter provides an overview of community health education; describes efforts occurring within the Mississippi Delta and Alabama to develop individuals as community health advisors for their local areas; and describes the process of their learning to become agents of change in their own lives and in the lives of their community members.

A significant proportion of the US young people are currently involved in the juvenile justice system. Of all youth in the United States, approximately 21% suffer from a diagnosable mental or substance use disorder that causes at least minimal impairment. This estimate is likely 2-3 times higher for youth who enter the juvenile justice system. A continuum of services for mentally ill juvenile offenders is critical to assisting youth to reintegrate into their schools and communities. This article provides recommendations to school health professionals to assist with the reentry of mentally ill, post-incarcerated youth.

Continued education of professionals is a major factor for service improvement and evidence-based good practice. This project explores the strategies used for this purpose across countries (CET = continued education and training in the substance abuse field). A structured questionnaire was circulated internationally by an expert committee of the Swiss Federal Office of Public Health. Reports from 11 countries were collected in 2005. The following review is based on these reports and structured according to the questionnaire (questions in italics). The authors of the reports are listed in the acknowledgements. The countries are Australia, Austria, Finland, France, Germany, Greece, Italy, The Netherlands, Scotland, Switzerland, and the United States. As a result of this project, an international think tank on continued education and training was established and is briefly described. (Contains 1 table.)

From the 1920s through the early 1940s, school-based programs in both health and physical education--mandated by government legislation and hailed by the public--increased in scope and complexity. By 1937, the assumption of the interconnectedness of the two fields was institutionalized in the merger of the American Physical Education Association with the Department of School Health and Physical Education of the National Education Association to form the American Association for Health and Physical Education. This paper focuses on the role of health education, physical education, and public health professionals in the emergence and critique of scholastic health and physical education programs in the first half of the 20th century. (Contains 4 notes.)

Globalization, coupled with increased attention to issues surrounding death, highlights the need to explore cultural influences on the social, personal, and psychological consequences of death. This study compared the responses of 82 American and 119 Lithuanian health and social service personnel on seven subscales of the Multidimensional Fear of Death Scale. Lithuanian participants were more likely to express fear of the dying process and fear of the unknown and were less likely to fear the dead than were Americans. The findings suggest that different historical and environmental experiences with death may influence anxiety about various dimensions of death. Cultural differences in the dimensions of death anxiety among health and social service providers in the two nations suggest the importance of differential training based on specific cultural knowledge to improve the quality of care. (Contains 1 table.)

Injury represents the leading cause of death and disability for US children and adolescents. Almost 16 million children are evaluated for injury each year in the United States. Although childhood injury rates are decreasing, 70% of all deaths among children and adolescents aged 5 to 19 years are injury related. Nonfatal injury is the leading cause of both temporary and permanent disability for children 19 years and younger. One quarter of children receive medical treatment in a hospital emergency room or are treated in private physicians' offices for injury annually. Of those hospitalized for trauma, more than one half experience some form of disability from their injury. Head injury has been the subject of most research on child injury disability, but trauma without head injury also has the potential to produce both short- and long-term disability. This paper highlights the need for increased awareness in schools regarding the vulnerability of injured children and adolescents and the role school health professionals can play as important resources for injured students and their families.

Objective: To determine factors influencing the use of outpatient mental health services provided by mental health professionals (OMHS) for children in foster care using a national probability sample in the United States. Method: As part of the National Survey of Child and Adolescent Well-being, detailed survey data were collected on 462 children, ages 2-15, who had been in out-of-home care for approximately 12 months at the time of sampling. A multivariate logistic regression model was used to determine how clinical need, as measured by a Total Problem, Externalizing, or Internalizing Scale T-score of 64 or greater on the Achenbach Child Behavior Checklist (CBCL), and non-clinical factors affected OSMHS use. Results: Over half of the children in the sample received at least one OMHS. Need, older age, and history of sexual abuse history all positively predicted OMHS. A history of physical neglect negatively predicted OSMHS. African-Americans used fewer services than children of Caucasian ancestry at all values on the CBCL. This finding was particularly salient at lower levels of CBCL scores; at higher levels, the discrepancy in the use of services diminished but the proportion of children receiving services remained lower for African-American children. Conclusions: This national study confirms previous findings regarding the use of mental health services based on regional data. Limitations in the use of services imposed by non-clinical factors, specifically, age, race/ethnicity and type of abuse, need to be examined in order to address implicit and explicit policies and practices that may result in inequitable distribution of services.

This study examined the relationship between age or years of experience and employee burnout by performing a meta-analysis on research studies that present findings on relationships between employee burnout and age or years of experience. The problem has practical significance in that the appropriateness of approaches to addressing employee burnout may depend on whether age or years of experience is a factor related to burnout. Results indicated that there was a small negative correlation between employee age and emotional exhaustion, one of the components of burnout, at least for employees in some fields in the United States, and possibly a small negative correlation between years of experience in a field and emotional exhaustion. (Contains 2 tables.)

Recent reports indicate that Latinos, the largest racial/ethnic minority group in the United States, are disproportionately affected by HIV and AIDS. College health professionals, therefore, should understand current sexual behaviors and risk factors among Latino youth. The authors assessed students' condom use at their most recent sexual encounter by using data from those students who reported oral, vaginal, or anal sex during the last 30 days. Fewer than half of recently sexually active Latino students had used condoms during their last oral (4.9%), vaginal (41.3%), or anal (27.8%) sexual encounter. Predictors of condom use varied according to the type of sexual activity. Findings from this exploratory study offer current information about condom use and sexual behaviors among Latino college students and suggest that prevention interventions and messages should be tailored to students' gender and types of sexual activity.Key Words: condom use, Latino/Hispanic students, sexual behavior, sexually transmitted infections

Introduction: Continuing medical education (CME) for physicians and other health personnel is becoming increasingly important in light of recertification requirements. Interactive learning is more effective and may be useful in a continuing education setting. This study examines the use of an audience response system (ARS) as an interactive learning tool for health care providers. Method: We conducted a national randomized controlled trial to evaluate the utility of an ARS to enhance attention and learning. Speakers at 42 clinical round table (CRT) programs in five regions across the United States were randomized to "use" or "no use" of an ARS during their lectures. We surveyed participants to collect data regarding presentation and speaker quality, impressions of the ARS, and knowledge of the material presented. We collected information from speakers regarding ease of use and overall opinions of the ARS. Results: A total of 283 surveys were completed (164 from participants using the ARS and 119 from participants not using the ARS). ARS participants rated the quality of the presentation, the quality of the speaker, and their level of attention more highly than non-ARS participants (p less than 0.05). Knowledge scores (of material presented) were not significantly different between the two groups. Both participants and speakers felt that the ARS was easy to use and preferred to use the system in future CRTs. Discussion: Participants in CRTs with the ARS rated presentation and speaker quality more favorably than those participants in CRTs without the tool. Participant knowledge scores, however, were not significantly different. ARSs may provide easy-to-use tools to enhance attention and enthusiasm in CME learners. (Contains 3 tables.)

This publication presents abstracts, statistics, and references drawn from health manpower literature. It is divided into seven sections; the first section provides statistics on (1) estimated employment in selected health occupations that are potentially entry-level, (2) hospital indicators, and (3) percent distribution of personal health care expenditure by type of care and payment source. Section 2 lists sources for health manpower statistics. The third section contains a staff article on regional variations of health care delivery and utilization in the United States. In section 4, five books are abstracted; for example, the first two are "The Hidden Malpractice--How American Medicine Treats Women as Patients and Professionals," by Gena Corea and "Doing Better and Feeling Worse, Health in the United States," edited by John H. Knowles. In the next section seventeen journal articles are abstracted. For example, the first two are "Hospital Unionism and Employment Stability," by Brian Becker and "A Controlled Trial of the Impact of the Family Practice Nurse on Volume, Quality and Cost of Rural Health Services," by Larry W. Chambers, et al. Section 6 lists recent health articles; the final section lists journals searched for health manpower literature. (Volume 1 of this publication is available as ED 143 825.) (CSS)

Minority students have traditionally been underrepresented in dental schools, which is why enrichment and pipeline programs aimed at helping minority students are necessary. That reality is reflected in their woeful underrepresentation among practicing dentists. Hispanics made up only 5.8 percent of practicing dentists in 2011, according to the Bureau of Labor Statistics, and African-Americans made up only 1 percent--far less than their representation in the general population. This underrepresentation has been blamed in part for the poor dental care that many minorities receive. A 2002 report from the Institute of Medicine notes that "racial and ethnic minority providers are more likely to serve in minority and medically underserved communities" and recommends increasing "the proportions of underrepresented U.S. racial and ethnic minorities among health professionals" to improve access to care. The author reports on pipeline programs that offer minority students a path to dentistry.