The Multicultural Quality of Life Index: presentation and validation.

RATIONALE AND OBJECTIVES: Quality of life has emerged as a crucial concept for the assessment of health and the planning of health care. Desirable features for the evaluation of quality of life include comprehensiveness, self-ratedness, cultural sensitivity, practicality and psychometric soundness. An attempt to meet these challenges led to the development of a brief multicultural quality of life instrument and to the appraisal of its applicability, reliability and validity. METHODS: The development of the proposed assessment instrument was based on a wide review of the literature and the engagement of a multicultural mental health scholarly team. Its validation was conducted on samples of psychiatric patients (n = 124) and hospital professionals (n = 53) in New York City. RESULTS: A new generic culture-informed and self-rate instrument, the Multicultural Quality of Life Index, has been developed. Its 10 items cover key aspects of the concept, from physical well-being to spiritual fulfilment. Concerning its applicability, mean time for completion was less than 3 minutes and 96% of raters found it easy to use. Test-retest reliability was high (r = 0.87). A Cronbach's α of 0.92 documented its internal consistency and a factor analysis revealed a strong structure. With regard to discriminant validity, a highly significant difference was found between the mean total scores of professionals (x = 8.41) and patients (x = 6.34) presumed to have different levels of quality of life. CONCLUSIONS: The Multicultural Quality of Life Index is a brief and culturally informed instrument that appears to be easy to complete, reliable, internally consistent and valid.

The effect of lead-based paint hazard remediation on blood lead levels of lead poisoned children in New York City.

Despite the widespread use of lead paint hazard control for children with lead poisoning, few controlled studies that estimate the effect of such control on children's blood lead levels have been published. This retrospective follow-up study examined the effects of lead hazard remediation and its timing on the blood lead levels of lead-poisoned children. From the New York City child blood lead registry, 221 children were selected who had an initial blood lead level of 20-44 micro g/dL between 1 July 1994 and 31 December 1996; were 6 months to 6 years of age; had a report of a follow-up blood lead test between 10 and 14 months after the initial test; had a lead-based paint hazard identified in the primary dwelling unit prior to the 10- to 14-month follow-up blood lead test; had resided or spent time at only one address with an identified lead-based paint hazard; and were not chelated. The decline in geometric mean blood lead levels from baseline to 10-14 months later was compared for children whose homes were remediated and whose homes were not remediated during the follow-up period. Regardless of remediation, geometric mean blood lead levels declined significantly from 24.3 micro g/dL at the initial diagnosis to 12.3 micro g/dL at the 10- to 14-month follow-up blood lead test (P<0.01). Among the 146 children whose homes were remediated the geometric mean blood lead levels declined 53% compared to 41% among the 75 children whose homes were not remediated by the follow-up blood lead test, a remediation effect of approximately 20% (P<0.01). After adjusting for potential confounders, the remediation effect was 11%, although it was no longer significant. Race was the only factor that appeared to confound the relationship: Black children had higher follow-up blood lead levels even after controlling for other factors, including the natural logarithm of the initial blood lead level. The effect of remediation appeared to be stronger for younger (10 to <36 months old) than for older (36 to 72 months old) children (P=0.06). While children in homes with earlier remediation (within less than 3 months) appeared to have greater declines in blood lead levels at the follow-up test than children in homes with later remediation (after 3 or more months), this trend was not significant when controlling for confounding factors. The findings of this study suggest that early identification of lead-poisoned children and timely investigation and abatement of hazards contribute to reducing blood lead levels. However, the apparent effect is modest and further research is needed to systematically test and improve the effectiveness of lead hazard controls.

Integrating behavioral and social science into a public health agency: a case study of New York City.

In the last century, both the health and life expectancy of Americans improved dramatically. These gains were primarily the result of advances in public health. But the approaches used may not be adequate to achieve the next level of improvements in health. Because health exists in the context of social, environmental, community, religious, political, and other spheres, ecological approaches that incorporate behavioral and social science theory and methodologies may provide the best avenue for advancing health in the 21st century. In 1999, the New York City Department of Health (NYCDOH) undertook the task of integrating behavioral and social science into its public health practice. The experience serves as a case study on the integration process at a public health agency.

Use of social and behavioral sciences by public health departments in major cities.

Individual behavior and social contexts are critical determinants of health. We surveyed commissioners or their designees in 22 departments of health serving US cities of at least 500,000 people to examine their use of scientific approaches to influence individual behavior and social contexts. Each department used behavioral or social science in its work, but only four departments were judged to have integrated these approaches throughout their operations, using both centralized and decentralized structures. Degree of integration was unrelated to collaboration with universities or communities but was related to use of explicit theories. Behavioral and social sciences were employed most frequently in the areas of HIV/AIDS and maternal and child health and in the service of changing individual behavior rather than larger contexts, although across departments many health problems and approaches were involved. Commissioners generally found the approaches valuable, but articulated barriers to more widespread adoption.

Hearing the voice of the community above the din of the city: New York City Turning Point.

The New York City Public Health Partnership came together to guide the Turning Point Initiative and to involve communities in activities related to improving the health of the city's residents. Early decisions of the Partnership led to the convening of community forums, development of borough planning committees, and creation and implementation of a public health agenda--all of which have fostered community input and participation. Four years later, the Partnership continues to build upon lessons learned and explore ways of ensuring that community voice is incorporated into New York City's public health improvement efforts.