Search

Chronic conditions are common, costly, and major causes of death and disability.* Addressing chronic conditions and their determinants in young adulthood can help slow disease progression and improve well-being across the life course (1); however, recent prevalence estimates examining chronic conditions in young adults overall and by subgroup have not been reported. CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) to measure prevalence of 11 chronic conditions among adults aged 18-34 years overall and by selected characteristics, and to measure prevalence of health-related risk behaviors by chronic condition status. In 2019, more than one half (53.8%) of adults aged 18-34 years reported having at least one chronic condition, and nearly one quarter (22.3%) reported having more than one chronic condition. The most prevalent conditions were obesity (25.5%), depression (21.3%), and high blood pressure (10.7%). Differences in the prevalence of having a chronic condition were most noticeable between young adults with a disability (75.8%) and without a disability (48.3%) and those who were unemployed (62.3%) and students (45.8%). Adults aged 18-34 years with a chronic condition were more likely than those without one to report binge drinking, smoking, or physical inactivity. Coordinated efforts by public and private sectors might help raise awareness of chronic conditions among young adults and help improve the availability of evidence-based interventions, policies, and programs that are effective in preventing, treating, and managing chronic conditions among young adults (1).

Objectives To examine the association between chronic obstructive pulmonary disease status and indicators of economic instability and stress to better understand the magnitude of these issues in persons with chronic obstructive pulmonary disease. Methods Analyzed 2017 Behavioral Risk Factor Surveillance System data from 16 states that administered the ‘Social Determinants of Health’ module, which included economic instability and stress measures ( N = 101,461). Associations between self-reported doctor-diagnosed chronic obstructive pulmonary disease status and each measure were examined using multinomial logistic models. Results Adults with chronic obstructive pulmonary disease were more likely ( p Discussion Financial, housing, and food insecurity and frequent stress were more prevalent in adults with chronic obstructive pulmonary disease than without. Findings highlight the importance of including strategies to address challenges related to economic instability and stress in chronic obstructive pulmonary disease management programs.

Pandemics are stressful times, full of uncertainty and fear. During the COVID-19 pandemic, many Americans have experienced feelings of stress, grief, and loss. How Right Now ( HRN )–and its Spanish-language counterpart, Que Hacer Ahora ( QHA )–is an evidence-based, culturally-relevant communication campaign designed to promote and strengthen the emotional well-being and resiliency of populations adversely affected by the COVID-19 pandemic and beyond. Developed by the Centers for Disease Control and Prevention (CDC) with support from the CDC Foundation, the campaign aims to help all Americans but has a specific focus on some of the disproportionately affected groups, including adults over 65 and their caregivers, individuals with pre-existing physical and mental health conditions, people experiencing violence, and those experiencing economic distress. Based on rapid, but robust, formative research, HRN offers audience-centric messages representing the real, everyday experiences and emotions that these audiences are having and addresses them in actionable ways. These include messages that address the social and structural barriers that disproportionately-affected groups have been facing long before the pandemic—and which are felt more acutely now. This paper provides an overview of the rapid, mixed-method, culturally-responsive formative research process undertaken to inform the development of HRN . Specifically, it describes how HRN ’s disproportionately-affected audiences describe and discuss their emotional well-being during COVID-19 through the lens of Social Determinants of Health (SDOH). We introduce a secondary theory, Vital Conditions for Health and Well-Being (VCHW), which conceptualizes holistic well-being and the conditions that give rise to it and identifies levers for community change and improvement. Data collection methods included an environmental scan (n ≥ 700 publications); social listening (n ≥ 1 million social media posts); partner needs-assessment calls (n = 16); partner-convened listening sessions with community members (n = 29), online focus groups (n = 10), and a national probability survey (n = 731), all in English and Spanish. Findings suggest that HRN ’s priority audiences’ emotional well-being and SDOH are interconnected. Disruptions in SDOH due to the COVID-19 pandemic can lead to emotional well-being challenges, eg, anxiety, for HRN ’s priority audiences. While some disruptions may lead some people to adapt, connect with others, and be more resilient, there is a disparate impact of emotional well-being amid COVID-19 for those already experiencing disparities linked to SDOH. Understanding the perspectives and experiences of disproportionately affected populations through the lens of SDOH is vital to identifying the kinds of supports and services–like How Right Now/Que Hacer Ahora –required for these populations.

Objectives: How Right Now (HRN) is an evidence-based, culturally responsive communication campaign developed to facilitate coping and resilience among US groups disproportionately affected by the COVID-19 pandemic. To inform the development of this campaign, we examined patterns in emotional health, stress, and coping strategies among HRN’s audiences, focusing on differences among racial and ethnic groups. Methods: We used a national probability panel, AmeriSpeak, to collect survey data from HRN’s priority audience members in English and Spanish at 2 time points (May 2020 and May 2021). We conducted statistical testing to examine differences between time points for each subgroup (Hispanic, non-Hispanic Black, and non-Hispanic White) and differences among subgroups at each time point. Results: We found disparities in COVID-19–related mental health challenges and differences in coping strategies. Non-Hispanic Black respondents were more likely than non-Hispanic White respondents to report challenges related to the social determinants of health, such as affording food and housing (26.4% vs 9.4% in May 2020) and experiencing personal financial loss (46.6% vs 29.2% in May 2020). In May 2021, 30.6% of Hispanic respondents reported being unable to meet basic food or housing needs versus 8.2% of non-Hispanic White respondents, and 51.6% reported personal financial loss versus 26.5% of non-Hispanic White respondents. Conclusions: Our study further illuminates what is needed to build emotional well-being pathways for people who historically have been economically and socially marginalized. Our findings underscore the need for public health interventions to provide culturally responsive mental health support to populations disproportionately affected by COVID-19 during the pandemic and into the future, with a focus on racial and ethnic disparities.

OBJECTIVE: To assess the prevalence of migraine or severe headache among US adults by inflammatory bowel disease (IBD) status. BACKGROUND: Emerging evidence in clinical settings suggests a higher prevalence of migraine among patients with IBD than those without IBD. METHODS: Data from 60,436 US adults aged ≥18 years participating in the 2015 and 2016 National Health Interview Survey (NHIS) were analyzed. The relationship between IBD status and migraine or severe headache was assessed overall and stratified by levels of selected characteristics including sex, age, race/ethnicity, education, poverty status, marital status, smoking status, obesity status, serious psychological distress, and major chronic condition status. RESULTS: Overall, the age-adjusted prevalence of migraine or severe headache was 15.4% (n = 9062) and of IBD was 1.2% (n = 862). A higher age-adjusted migraine or severe headache prevalence was reported among participants with IBD than those without IBD (28.1% vs. 15.2%, p

An increasing volume of literature has sought to identify factors that motivate cities to pursue sustainability and adopt climate policies. However, most empirical studies were done in Western countries, where relatively high local autonomy and low pressure on industrial growth create conditions for spontaneous policy innovations in sustainability. This paper uses China’s Low-Carbon City Pilot Program as a case to investigate motivations for local sustainability actions in an authoritarian context. Our event history analyses confirm the effects of multi-level governance on local sustainability initiatives in China, particularly horizontal competition across jurisdictions, priorities and preferences of upper-level authorities, as well as local determinants including leadership, capacity, politics, and environmental stress. The findings contribute to the comparative urban governance scholarship by highlighting the unique feature of “experimentation under hierarchy” in shaping urban sustainability policymaking in China.

Cigarette smoking remains the leading cause of preventable disease and death in the United States (1). Although the percentage of all U.S. adults who smoke cigarettes has declined substantially since the mid-1960s (1,2), marked disparities persist, and declines have not been consistent across population groups (1,2). Studies have shown that cigarette smoking is as common, and sometimes more so, among adults with a history of epilepsy compared with those without a history of epilepsy, but reasons for this are unclear (3-6). Compared with adults without epilepsy, adults with epilepsy report lower household income, more unemployment and disability, worse psychological health, and reduced health-related quality of life (3,4,6,7). Trends in cigarette smoking among U.S. adults with epilepsy have not been previously assessed. CDC analyzed National Health Interview Survey (NHIS) data among 121,497 U.S. adults from 2010, 2013, 2015, and 2017 to assess current cigarette smoking by epilepsy status. From 2010 through 2017, the age-standardized percentages of current smoking were 24.9% among adults with active epilepsy, 25.9% among adults with inactive epilepsy, and 16.6% among adults with no history of epilepsy. After accounting for differences in data collection intervals and patterns in smoking status among subgroups, CDC found that current cigarette smoking declined significantly from 2010 to 2017 among adults with no history of epilepsy (19.3% to 14.0% [p

Objectives. To demonstrate a flexible and practical method to obtain near real-time estimates of the number of at-risk community-dwelling adults with a chronic condition in a defined area potentially affected by a public health emergency. Methods. We used small area estimation with survey responses from the 2016 Behavioral Risk Factor Surveillance System together with a geographic information system to predict the number of adults with chronic obstructive pulmonary disease who lived in the forecasted path of Hurricane Florence in North and South Carolina in 2018. Results. We estimated that a range of 32 002 to 676 536 adults with chronic obstructive pulmonary disease resided between 50 and 200 miles of 3 consecutive daily forecasted landfalls. The number of affected counties ranged from 8 to 10 (at 50 miles) to as many as 119 to 127 (at 200 miles). Conclusions. Community preparedness is critical to anticipating, responding to, and ameliorating these health threats. We demonstrated the feasibility of quickly producing detailed estimates of the number of residents with chronic conditions who may face life-threatening situations because of a natural disaster. These methods are applicable to a range of planning and response scenarios.

Health plans and risk-bearing provider organizations seek information sources to inform proactive interventions for patients at risk of adverse health events. Interventions should take into account the strong relationship between social context and health. This retrospective cohort study of a Medicare Advantage population examined whether a change in self-reported health-related quality of life (HRQOL) signals a subsequent change in healthcare needs.A retrospective longitudinal analysis of administrative claims data was conducted for participants in a Medicare Advantage plan with prescription drug coverage (MAPD) who responded to 2 administrations of the Centers for Disease Control and Prevention 4-item Healthy Days survey within 6-18 months during 2015-2018. Changes in HRQOL, as measured by the Healthy Days instrument, were compared with changes in utilization and costs, which were considered to be a reflection of change in healthcare needs.A total of 48,841 individuals met inclusion criteria. Declining HRQOL was followed by increases in utilization and costs. An adjusted analysis showed that every additional unhealthy day reported one year after baseline was accompanied by an $8 increase in monthly healthcare costs in the subsequent six months for the average patient.Declining HRQOL signaled subsequent increases in healthcare needs and utilization.Findings suggest that HRQOL assessments in general, and the Healthy Days instrument in particular, could serve as a leading indicator of the need for interventions designed to mitigate poor health outcomes and rising healthcare costs.III.

IMPORTANCE: The coronavirus disease 2019 (COVID-19) pandemic, associated mitigation measures, and social and economic impacts may affect mental health, suicidal behavior, substance use, and violence. OBJECTIVE: To examine changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdose (OD), and violence outcomes during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Centers for Disease Control and Prevention’s National Syndromic Surveillance Program to examine national changes in ED visits for MHCs, SAs, ODs, and violence from December 30, 2018, to October 10, 2020 (before and during the COVID-19 pandemic). The National Syndromic Surveillance Program captures approximately 70% of US ED visits from more than 3500 EDs that cover 48 states and Washington, DC. MAIN OUTCOMES AND MEASURES: Outcome measures were MHCs, SAs, all drug ODs, opioid ODs, intimate partner violence (IPV), and suspected child abuse and neglect (SCAN) ED visit counts and rates. Weekly ED visit counts and rates were computed overall and stratified by sex. RESULTS: From December 30, 2018, to October 10, 2020, a total of 187 508 065 total ED visits (53.6% female and 46.1% male) were captured; 6 018 318 included at least 1 study outcome (visits not mutually exclusive). Total ED visit volume decreased after COVID-19 mitigation measures were implemented in the US beginning on March 16, 2020. Weekly ED visit counts for all 6 outcomes decreased between March 8 and 28, 2020 (March 8: MHCs = 42 903, SAs = 5212, all ODs = 14 543, opioid ODs = 4752, IPV = 444, and SCAN = 1090; March 28: MHCs = 17 574, SAs = 4241, all ODs = 12 399, opioid ODs = 4306, IPV = 347, and SCAN = 487). Conversely, ED visit rates increased beginning the week of March 22 to 28, 2020. When the median ED visit counts between March 15 and October 10, 2020, were compared with the same period in 2019, the 2020 counts were significantly higher for SAs (n = 4940 vs 4656, P = .02), all ODs (n = 15 604 vs 13 371, P

The science-policy nexus has long puzzled scholars and managers working across diverse public policy areas, including environment. The rise of science-based management, especially in an era of big data, assumes science can improve environmental policy. At the same time, increasing attention to stakeholder engagement provides avenues for non-scientists to participate in collaborative environmental management, which might displace science in decision-making processes. Prior research points to a variety of factors thought to affect the degree to which science is used in collaborative partnerships. Drawing on such research, we examine the use of science across 9 collaborative partnerships structured and resourced from the top-down by a state government agency. All of these partnerships are working in the U.S.’s second largest estuary, the Puget Sound in Washington State. Data from partnership meeting minutes indicates that science is scarcely discussed in executive committee meetings, but is more commonly discussed in technical committee meetings. We thus might expect that the ecosystem management plans produced by these technical committees would be closely informed by science. Results indicate these plans include few citations to peer-reviewed scientific studies, but they do draw consistently on scientific information from grey literature including scientific and technical reports from federal and state agencies. These results raise important questions about government efforts to foster the use of science in collaborative partnerships, including the benefits and drawbacks of using grey literature rather than scientific articles directly, the interaction of science with other forms of knowledge, and local actors’ capacity to understand and access science.

Chapter 1 provides an introduction to the history and background to a general desire to try to find ways to improve population health through primary care and public health. The first Practical Playbook derived from an internet-based initiative that sought to find, assemble, assess, and share stories of how communities and agencies across the United States were working together to improve health. This text is the second development from that, after the realization that a completely new text was needed that would build on the experiences of the broadening array of sites and sectors and provide a concise set of tools, methods, and examples that support multi-sector partnerships to improve population health. The chapter then outlines the coverage of the rest of the chapters.

Over the last few years, this chapter explains, the role of training and the workforce has moved from the position of not a primary concern to an important factor in public health issues. Part of the shift was the result of the rapid growth of community partnerships, making the opportunity to include learners more than an isolated possibility. Another was the infrequent presence of learners, training programs, or professional schools in the partnerships, even though many were occurring in the neighborhoods around the professional schools and programs. And a large part was the eagerness of the learners themselves. However, as this next section of chapters will explain, the voice of students and residents in the health improvement process has not yet reached full force.

This chapter introduces the next section of the book which is about sustainability and finance when it comes to cross-sector collaboratives for population health improvements. It states that the focus should be on closing the gap when it comes to health disparities and a goal needs to be reducing the need for health care services. Effectively acquiring, managing, and sustaining financial investments in health is fundamental to the success of multi-sector and community-led health improvement initiatives. The chapter outlines the topics covered by the individual chapters in this section.

This chapter concludes the book and looks to the future. The teams and partnerships for health are clearly underway across the United States. From this point on, health care professionals and other agencies will all need to incorporate lessons learned and practices adopted into training programs, for all the health and related disciplines. Rather than learn what makes a difference in health, the aim should be to discover and then teach what makes a difference for some, and what works better for others. Training would be best carried out in teams, so the skills of teamwork and partnership are not just ideas, but practiced skills. The chapter concludes with this thought: health is something we can achieve together, but that no person or group can achieve alone.

Collaborative governance applied to environmental issues is becoming more common, and evaluation of such efforts can provide useful information for multiple audiences. However, due to a variety of challenges, collaborative governance practitioners rarely evaluate the outcomes of collaboration and their contributions to these efforts. With these challenges in mind, the William D. Ruckelshaus Center designed an evaluation framework that can meet multiple parties’ objectives, be integrated into practitioners’ existing services, and balance flexibility and practicality with rigor and replicability. The Center conducted a pilot of this framework on a collaborative watershed management effort in southeastern Washington State, where the Center had previously assisted with organizational development. The resulting evaluation highlights a variety of social, knowledge-based, and economic outcomes for the collaborative, as well as lessons for practitioners and evaluators of collaborative governance. We suggest that this methodology can be useful for practitioners interested in evaluating similar collaborative efforts.

Collaboration has become a common alternative to traditional top-down approaches to environmental management and conservation. One critique of collaborative processes is that science is not sufficiently linked to conservation actions. To better understand how science is used in collaborative decisions, we asked how the use of science is affected by the structure of collaborative processes, paying specific attention to the role of explanatory variables such as stakeholder engagement, how information is gathered, and how decisions are made. Case survey methods (a form of systematic review) were used to analyze 30 case studies of collaborative management of marine, estuarine, and coastal systems across the United States. We found that increased stakeholder participation (i.e., two-way flow of information between parties), face-to-face communication among stakeholders, increased contribution of information from academic stakeholders, careful consideration and selection of participants (e.g., stakehold...

The public policy and public management literatures together support a vibrant discussion of collaborative governance. Much of this scholarship takes a broad perspective focusing on questions such as what collaborative governance is; why collaborative governance emerges; or why individuals and organizations choose to participate in voluntary, nonbinding collaborative efforts. This paper focuses specifically on the role of public managers as leaders, encouragers, and followers of collaborative governance. We examine the decision calculus factoring into the choice of collaborative governance as a toolbox for achieving desired policy goals. That is, we ask why public managers choose to devote public resources to collaborative governance. What motivates public managers to pick up the phone, write a check, or otherwise change their current behavior? We develop 20 propositions that contextualize this choice in terms of two overarching questions: (i) How do institutional structure and organizational strategy intersect to influence the ways in which public managers design and implement collaborative governance?; and (ii) Why do public managers choose particular roles within collaborative institutions? In doing so, we demonstrate how the public policy and public management literatures can be coupled to better understand a theoretical issue that each research body struggles to encapsulate in isolation.

We describe an evidence-based framework to define and assess the impact of quality improvement (QI) in public health. Developed to address programmatic and research-identified needs for articulating the value of public health QI in aggregate, this framework proposes a standardized set of measures to monitor and improve the efficiency and effectiveness of public health programs and operations. We reviewed the scientific literature and analyzed QI initiatives implemented through the Centers for Disease Control and Prevention’s National Public Health Improvement Initiative to inform the selection of 5 efficiency and 8 effectiveness measures. This framework provides a model for identifying the types of improvement outcomes targeted by public health QI efforts and a means to understand QI’s impact on the practice of public health.

The shift from government to governance and the increasing reliance on public-private partnerships are well documented, but there is less clarity regarding how to measure the performance of these new arrangements. Performance measures based on traditional governmental forms, such as centralized planning and regulation, are relatively straightforward. In collaborative governance, however, the wide range of policy tools for enabling and encouraging public-private partnerships—such as grants, contracts, and technical assistance—requires more nuance in distinguishing outputs from outcomes. Choosing appropriate output and outcome measures is necessary if public-private partnerships are to be held accountable for performance. Drawing on evidence regarding inconsistent use of performance measures from the Performance Assessment Rating Tool (PART), a classification system is presented for defining outputs and outcomes for different types of programs. PART data are used to demonstrate the need for a consistent cla...

SUMMARYOver the last decade, hundreds of payments for ecosystem services (PES) programmes have been initiated around the world, but evidence of their environmental benefits remains limited. In this study, two PES programmes operating in the municipality of Coatepec (Mexico) were evaluated to assess their effectiveness in protecting the region's endangered upland forests. Landsat satellite data were analysed to assess changes in forest cover before and after programme implementation using a difference-in-differences estimator. Additionally, surveys and interviews were conducted with local residents and a subset of PES programme participants to evaluate the programmes’ social and environmental impacts, particularly the effect of the programmes on landowner behaviour. The remote-sensing data show that deforestation was substantially lower on properties receiving PES payments compared to properties not enrolled in the programmes, but the programmes did not prevent the net loss of forests within Coatepec. Moreover, the on-site interviews suggest that the payments may have had little impact on deforestation rates, and that other factors contributed to the conservation of forests in PES properties. These findings suggest that risk-targeted payments, robust monitoring and enforcement programmes, and additional conservation initiatives should be included in all PES schemes to ensure environmental effectiveness.

Community-based management has increasingly replaced centralized planning and regulation as an alternative means for conserving natural resources. But there is little empirical evidence to suggest whether community-based management has a positive or negative impact on the actual condition of natural resources. If, as is commonly argued, conservation success depends largely on local context, then we must think carefully about the entire causal chain of community-based management activities, from the inputs supporting decision-making processes to management outputs and environmental outcomes. We accordingly discuss appropriate methodologies for demonstrating the causal impacts of community-based management on natural resource conservation.

The authors argue for a scientifically rigorous, contextually valid, practically relevant, and stakeholder-inclusive Platinum Standard for evidence-based assessment to improve public administration and third-party governance in the twenty-first century. The Platinum Standard would encompass two contending gold standards. The first gold standard, based on experimental methods, counterfactuals, and average causal effects, is better known and more institutionalized in practice. The second gold standard, based on case studies, comparative methods, triangulation, and causal mechanisms, is less known. The Platinum Standard incorporates both sets of standards and provides a framework for integrating them in practice. It recognizes the wide array of goals and methodologies that are appropriate for assessing the performance of public administration and third-party governance initiatives in a dynamic and globalizing world. The two gold standards currently compete for prominence in the field of evidence-based assessment. By 2020, these gold standards should be part of a more inclusive Platinum Standard.

This article tests capture theory by analyzing voting behavior on U.S. Regional Fishery Management Councils. Some seats on the councils are reserved for state and federal agency representatives; others, for political appointees. The political appointees primarily represent special interests (specifically, commercial and recreational fishing interests); a smaller number of appointees represent public interests. We use logistic regression to model the vote of state and federal agency representatives on the councils as a function of the votes of commercial interests, recreational interests, and public interests. We find evidence that some state agencies are captured by special interests from their states, but not systematic evidence across all states. We find that state agency representatives voted with commercial interests from their own state in five of the sixteen states in our sample; with recreational interests in three states; and with both special interests in two states. These ten states support the capture hypothesis; the other six states do not. We find no evidence that federal agencies were captured on the councils. We conclude that the gubernatorial-driven appointment process leads to capture at the state level by promoting voting blocs among state agency representatives and special interests from those states. Federal agency representatives, by contrast, are better able to maintain their distance from state-level politics on the councils, and thereby enhance their ability to vote independently on fishery management measures.

Understanding about what constitutes development effectiveness requires elaboration in order for evidence to add greater value. Development in the twenty-first century is often complicated, if not complex, and correspondingly is most likely to be achieved through diagnostic, contextual approaches to experimentation and innovation. Impact planning, assessment, reporting, and learning systems (IPARLS) can successfully contribute to development effectiveness because they integrate key lessons learned about both the more successful generation and utilisation of evidence, and are aligned with the nature of twenty-first century development. Impact evaluations should be embedded in IPARLS in order to be more legitimate and better used. The systematic application of comparison and triangulation is the platinum standard of rigour for impact evaluations. Impact evaluations can be further improved if they are theory-based, investigate descriptive and causal inference, analyse casual mechanisms, and focus on contextu...

The authors reflect on public health services and systems research (PHSSR). They suggest that in order to advance the field of public health services and systems research, challenges that are apparent within the research will need to be addressed. They argue that with a collaborative effort new, relevant and translatable PHSSR findings can be found that can be used to understand and address public health problems.

Many tout the benefits of collaborative environmental management as an alternative to centralized planning and command and control regulation, but the excitement over collaborative processes has not been matched by evidence that these processes actually improve the environment. The most crucial question in collaborative environmental management remains unanswered and often unasked: To what extent does collaboration lead to improved environmental outcomes? We know much about why collaboration is occurring and how collaborative processes and outputs vary. The primary goal of future research on collaborative environmental management should be to demonstrate whether collaboration improves environmental conditions more than traditional processes and newer market-based processes. Collaboration is not a panacea; it is a choice that policy makers and public managers should make based on evidence about expected outcomes.

E-government developers need to clearly understand processes they are automating and ensure that automated processes are defect-free. This paper introduces readers to Process Definition Language (PDL) technology that provides rigor and precision over traditional forms of process documentation. We report our experience documenting license renewal processes for application in the Mass.gov portal. The PDL helped analysts identify inconsistencies and errors in natural language-based documents that were guiding system development. This case provides an initial demonstration of the benefits PDLs can bring to e-government application development. We conclude with a discussion of the current limitations of PDLs and a discussion of computer-based analysis approaches that will likely emerge in the future.

An intervention to increase condom use by undermining perceptions of invulnerability to HIV was tested in a sample of 128 college students. Participants were randomly assigned to the invulnerability undermined (IU) condition or a demand characteristic control (DCC) condition. The IU condition used tasks that highlighted past failures to protect oneself and the failure of illusory protection strategies. Participants in the DCC condition watched a video on protecting oneself from HIV. Participants in the IU condition, relative to those in the DCC group, had lower perceptions of invulnerability to HIV and higher intentions to use condoms on the immediate postintervention measures; they reported more condom use at the 3-month follow-up. Contrary to prediction, perceptions of invulnerability did not mediate the effects of the intervention on condom use intentions or condom use. The advantage of indirect methods of reducing denial of vulnerability is discussed.

Objective. Satellite-based remote-sensing analysis is a beneficial, yet underused, tool for environmental policy, planning, and evaluation. We identify its benefits and costs to encourage social scientists to consider the use of remote sensing as a tool for planning and evaluating environmental institutions. Methods. We analyze two multispectral Landsat Thematic Mapper satellite images to evaluate a habitat conservation plan (HCP) implemented pursuant to the Endangered Species Act. Results. Image analysis provides useful broad spatial scale information on HCP performance that is not discernible to the naked eye or through other methodologies. Conclusions. Satellite image analysis should be considered as a tool for planning and evaluating environmental institutional designs—despite the financial costs and requisite technical training. These images provide ecological and land cover change information that may not be available elsewhere. We provide lessons learned to help make analysts cognizant of some important issues surrounding the use of satellite-based imagery for environmental institutional analysis.

Three models of the sources of overprotection in stroke patients were tested in a study of the behavioral and attitudinal concomitants of overprotective caregiving. Stroke patients and their family member caregivers were interviewed to assess feelings of overprotection, physical and mental functioning, and caregiving-related attitudes. The couples were then videotaped as they interacted on four tasks and the tapes were coded for specific behaviors and affect directed toward the patient. Strong support was found for the Resentment model that overprotection will be associated with an overcontrolling caregiving style, negative affect, and resentment toward the stroke patient. No support was found for the model that overprotection is related to overhelping. In addition, feeling overprotected was associated with patient dependency. Two conclusions are discussed: the variety of potential sources of overprotection found in the study and the importance of the emotional tone with which caregivers provide assistance.

Introduction Continuous quality improvement is a central tenet of the Public Health Accreditation Board's (PHAB) national voluntary public health accreditation program. Similarly, the Centers for Disease Control and Prevention launched the National Public Health Improvement Initiative (NPHII) in 2010 with the goal of advancing accreditation readiness, performance management, and quality improvement (QI). Objective Evaluate the extent to which NPHII awardees have achieved program goals. Design NPHII awardees responded to an annual assessment and program monitoring data requests. Analysis included simple descriptive statistics. Setting Seventy-four state, tribal, local, and territorial public health agencies receiving NPHII funds. Participants NPHII performance improvement managers or principal investigators. Main outcome measure(s) Development of accreditation prerequisites, completion of an organizational self-assessment against the PHAB Standards and Measures, Version 1.0, establishment of a performance management system, and implementation of QI initiatives to increase efficiency and effectiveness. Results Of the 73 responding NPHII awardees, 42.5% had a current health assessment, 26% had a current health improvement plan, and 48% had a current strategic plan in place at the end of the second program year. Approximately 26% of awardees had completed an organizational PHAB self-assessment, 72% had established at least 1 of the 4 components of a performance management system, and 90% had conducted QI activities focused on increasing efficiencies and/or effectiveness. Conclusions NPHII appears to be supporting awardees' initial achievement of program outcomes. As NPHII enters its third year, there will be additional opportunities to advance the work of NPHII, compile and disseminate results, and inform a vision of high-quality public health necessary to improve the health of the population.

Two studies evaluated whether there was a subtype of menopausal women and, if so, how it differed from the global gender stereotype. Study 1 had participants generate items associated with women going through menopause, midlife women, and midlife men. Results showed that there is a menopausal women stereotype, and it is mostly negative in content. Moreover, this stereotype differs from the perceptions of women in general. Study 2 examined the effects of the menopausal women stereotype by employing the illusory correlation paradigm (e.g., McConnell, Sherman, & Hamilton, 1994) and found that participants greatly overestimated the number of times that menopausal women and negative moods appeared together. This research highlights the importance of examining stereotype subtypes and subgroups

This study applied social exchange theory as a conceptual framework to examine the effectiveness of various types of mentors and mentor support on proteges' satisfaction with their mentors, jobs, and perceived career success. Participants were 142 ethnically diverse proteges in informal mentoring relationships. It was found that role modeling, reciprocity, and vocational support predicted proteges' satisfaction with their mentors. Vocational support was a significant predictor of proteges' job satisfaction and perceived career success. Proteges were more satisfied with, had higher job satisfaction, and reported that traditional mentors provided significantly more vocational and role modeling support than peer or step-ahead mentors.