Photovoice as Counterspeech.

A notorious hate group purchased anti-Muslim advertisements on buses operated by the San Francisco Municipal Transit Authority. The San Francisco Human Rights Commission engaged members of the Arab, Middle Eastern, Muslim, and South Asian communities in a photovoice project to explore the cultural identities, challenges, and resilience of community members coping with discrimination. The project provided a case example of photovoice as counterspeech and demonstrated the way in which counterspeech empowers affected communities to push back against harmful and threatening expression with resilience, cultural pride, and self-determination. Women and men in the photovoice participant group represented a wide range of backgrounds and ethnicities: Palestinian, Indian, Pakistani, and Lebanese. Religious affiliations included Muslim, Sikh, Christian, nondenominational, and agnostic. The exhibit was presented to the public in three major venues and was made available online.

Creating opportunities for training California's public health workforce.

INTRODUCTION: Today there are significant challenges to public health, and effective responses to them will require complex approaches and strategies implemented by a qualified workforce. An adequately prepared workforce requires long-term development; however, local health departments have limited financial and staff resources. Schools and programs accredited by the Council for Education on Public Health (CEPH) are required to provide continuing education but are constrained by the lack of resources, limited time, and geography. METHOD: To meet these challenges, a statewide university/community collaborative model for delivering continuing education programs was developed. A needs assessment of California's public health workforce was conducted to identify areas of interest, and two continuing education trainings were developed and implemented using innovative distance education technology. RESULTS: Thirty-six percent of the participants completed electronic evaluations of learning outcomes and use of the digital technology platform. Participants indicated a significant increase in knowledge, reported that the trainings were cost effective and convenient, and said that they would participate in future online trainings. Collaborative partners found that this model provides a cost-effective, environmentally sound, and institutionally sustainable method for providing continuing education to public health professionals. DISCUSSION: Offering continuing education via distance technology requires substantial institutional infrastructure and resources that are often beyond what many public institutions can provide alone. This project provides a model for collaborating with community partners to provide trainings, using a digital technology platform that requires minimal training and allows presenters and participants to log on from anywhere there is Internet access.

Assessing the professional development needs of public health educators in light of changing competencies.

INTRODUCTION: Because of the need for a well-trained public health workforce, professional competencies have been recently revised by the Institute of Medicine and the National Health Educator Competencies Update Project. This study compared the self-identified training needs of public health educators with the updated competencies and assessed employer support for continuing education. METHODS: A convenience sample of public health educators was recruited from an e-mail list of San Jose State University master of public health alumni. Respondents completed a Web-based survey that elicited information on emerging trends in public health education, training needs, and employer support for continuing education. RESULTS: Concerns about funding cuts and privatization of resources emerged as a theme. Key trends reported were an increase in information technology, the need for policy advocacy skills, and the importance of a lifespan approach to health issues. Primary areas for training were organization development, evaluation, and management. Although most employers were reported to support continuing education, less than two-thirds of respondents were reimbursed for expenses. CONCLUSION: These findings have implications for both research and practice. Innovative technologies should be developed to address health education professionals' training needs, and emerging themes should be incorporated into curricula for students.

Older African Americans' perceptions of pharmacists.

OBJECTIVE: To describe older African Americans' communication with pharmacists and their opinions, beliefs, perceptions, and attitudes about the role of the community pharmacist. DESIGN: We conducted six sex-specific focus groups for this qualitative study. SETTING: Community-based senior-serving agency located in a predominantly African American neighborhood in San Francisco, California. PARTICIPANTS: Insured, older African Americans (>60 years of age) with chronic disease; 30 women (4 groups) and 12 men (2 groups). RESULTS: A majority of participants took four to six prescription medications and reported an average of two chronic illnesses. While most expressed a desire to have a trusting relationship with a community pharmacist who is respectful, professional, and knowledgeable, none reported such a relationship, stating that the primary function associated with pharmacists is filling prescriptions. Participants reported an interest in engaging in informed decision-making, including discussions regarding medication options, side effects, and concerns about rising medication costs; however, few reported feeling comfortable initiating such discussions. Communication barriers identified by participants included perceived lack of interest or knowledge by the pharmacist, time constraints, and an inability to identify the pharmacist. CONCLUSIONS: It appears that the role of the pharmacist is not being fully realized by this sample of insured, older African Americans with chronic disease. This may be mediated by suboptimal experiences of patient-pharmacist communication and the patient-pharmacist relationship. Future research is needed to examine the patient-pharmacist relationship and its contribution to health disparities to inform pharmacy practice, training, and policy.

Our lives: an examination of sexual health issues using photovoice by non-gay identified African American men who have sex with men.

African American men who have sex with men and who do not identify as gay are at high risk for HIV infection. This paper presents the results of the photovoice component, a participatory action research method, of a two-tiered qualitative study design that explored the perceptions of non-gay identified African American men who have sex with men living or working in the San Francisco Bay Area regarding the social, cultural, community, and family influences associated with their HIV risk and their general sexual health. Major themes that emerged from the photographs and discussions fell into three main categories: (1) The importance of a black identity, (2) factors inhibiting HIV prevention, and (3) factors that maintain health or promote health. Through their photographs, the men in this study explored the challenges and difficulties associated with maintaining their sexual health, in addition to describing the health promoting factors that reinforce wise choices in their everyday lives.

Patient-led partner notification for syphilis: Strategies used by women accessing antenatal care in urban Bolivia.

Maternal syphilis adversely affects close to one million pregnancies worldwide every year with consequences that may include spontaneous abortion, stillbirth, neonatal death, premature birth, neurological impairment and bone deformities of the neonate. In Bolivia, the maternal syphilis rate has been estimated at 4.3% among women with live births and 26% among women with stillbirths. Partner notification is critical to the prevention of maternal re-infection and vertical transmission of syphilis. Patient-led partner notification, also known as patient referral, is the recommended starting point for partner notification programs in resource poor settings because it requires less infrastructure and provider involvement. Though patient referral requires a higher level of engagement on the part of individuals, few studies have examined, in depth, the process of patient-led notification. Further, we found no studies of this type conducted in Bolivia, a country where culturally acceptable and appropriate interventions are needed to control maternal syphilis. This study examined partner notification, for the first time, from the perspective of women accessing treatment for maternal syphilis in Bolivia. Semi-structured interviews were conducted with 18 women who had attempted or planned to attempt notifying their partner. The interview guide was designed to investigate the experience of patient-led partner notification for syphilis with particular emphasis on the strengths and capacities of the participants. Accordingly, we applied an existing theoretical model for individual empowerment in the analysis of the interviews with the participants. This emphasis on the positive, solution-finding capacities of the participants allowed us to investigate the ways in which participants took control over an aspect of concern to their health. More studies are needed which examine successful patient-led strategies for partner notification and their connections with long-term health outcomes.

Responsibility for HIV prevention: patterns of attribution among HIV-seropositive gay and bisexual men.

The Seroconversion Narratives for AIDS Prevention (SNAP) study elicited narratives from recently infected seropositive gay and bisexual men that described the circumstances of their own seroconversion. This analysis of the narratives explored participants' attributions of responsibility for HIV prevention before and after they became infected. Before becoming infected with HIV, responsibility for prevention was often attributed to HIV-negative individuals themselves. These retrospective attributions revealed themes that included feelings of negligence, a sense of consequences, followed by regret. After seroconversion, responsibility for HIV prevention was primarily attributed to HIV-positive individuals themselves. Themes within these attributions included pledges to avoid HIV transmission, a strong sense of burden related to the possibility of infecting someone, and risk reduction strategies that they implemented in an attempt to avoid HIV transmission. Greater understanding of ideas related to responsibility has the potential to increase the effectiveness of HIV prevention interventions.

Upper extremity pain and computer use among engineering graduate students.

BACKGROUND: The objective of this study was to investigate risk factors associated with persistent or recurrent upper extremity and neck pain among engineering graduate students. METHODS: A random sample of 206 Electrical Engineering and Computer Science (EECS) graduate students at a large public university completed an online questionnaire. RESULTS: Approximately 60% of respondents reported upper extremity or neck pain attributed to computer use and reported a mean pain severity score of 4.5 (+/-2.2; scale 0-10). In a final logistic regression model, female gender, years of computer use, and hours of computer use per week were significantly associated with pain. CONCLUSIONS: The high prevalence of upper extremity pain reported by graduate students suggests a public health need to identify interventions that will reduce symptom severity and prevent impairment.

Developing consumer involvement in rural HIV primary care programmes.

OBJECTIVES: As part of a broader medical and psychosocial needs assessment in a rural region of northern California, USA, five focus groups were conducted to explore innovative approaches to creating a system of consumer involvement in the delivery of HIV primary care services in the region. DESIGN: A total of five focus groups (n = 30) were conducted with clients from three of five counties in the region with the highest number of HIV patients receiving primary care. SETTING AND PARTICIPANTS: Participants were recruited by their HIV case managers. They were adults living with HIV, who were receiving health care, and who resided in a rural mountain region of northern California. VARIABLES STUDIED: Group discussions explored ideas for new strategies and examined traditional methods of consumer involvement, considering ways they could be adapted for a rural environment. RESULTS: Recommendations for consumer involvement included a multi-method approach consisting of traditional written surveys, a formal advisory group, and monthly consumer led social support/informal input groups. Specific challenges discussed included winter weather conditions, transportation barriers, physical limitations, confidentiality concerns, and needs for social support and education. CONCLUSIONS: A multiple-method approach would ensure more comprehensive consumer involvement in the programme planning process. It is also evident that methods for incorporating consumer involvement must be adapted to the specific context and circumstances of a given programme.

Promoting self-directed learning for continuing medical education.

Self-directed delivery modes for continuing medical education (CME) are the most effective approaches for improving physician performance. However, instructor-directed programs are still the most popular methods used for CME. The purpose of the study was to assess the utilization, preferences and barriers to use of nine different CME delivery methods by physicians. A self-administered survey of all licensed physicians in Nevada was conducted over a three-month period. Results were analyzed using SPSS for windows (version 10). In-person conferences (92%) and journal review (64%) were the most frequently utilized modes of instruction. Rural physicians were more likely to use interactive video. The top three ranked preferences were in-person conference, print-based self-study and CD-ROM. It is concluded that computer training, dedicated time in the workplace for self-directed methods, and the development of more interactive CD-ROM and Internet programs will encourage the use of self-directed CME.

New choices for continuing education: a statewide survey of the practices and preferences of nurse practitioners.

Technological innovations in the past decade have made possible several promising new modes for delivering continuing education (CE). Offering a wide variety of educational approaches is necessary to satisfy the different learning needs and preferences of program participants. Continuing education planners need to assess the preferences and practices of Advanced Practitioners of Nursing (APNs) when choosing the modes they will offer for delivering CE programs. A survey was conducted with the entire population of licensed APNs in Nevada to assess practices, preferences, and barriers to use of various CE delivery modes. In-person conferences and live satellite conferences were the most frequently used methods. The top three preferences, in rank order, were in-person conference, print-based self-study, and interactive video conference. Live satellite conference was the least preferred method of earning CE credits. Computer-based modes of CE delivery, which include the Internet and CD-ROM, were among the least used. Findings from this study provide useful information for planners of CE programs for APNs. Data acquired in this study also address the dearth of information related to computer use by APNs for obtaining CE.

Cigarette smoking and the desire to quit among individuals living with HIV.

Among individuals living with human immunodeficiency virus (HIV), studies have found that smokers are at greater risk than nonsmokers to develop bacterial pneumonia, oral lesions and acquired immune deficiency syndrome (AIDS) dementia complex. Information is lacking regarding the prevalence of cigarette smoking among people living with HIV or about their intentions to quit smoking. A survey was conducted with a sample of patients attending an HIV outpatient clinic at San Francisco General Hospital to assess the prevalence of cigarette smoking and the level of interest in quitting. In total, 228 assessments were completed. Study results revealed a high percentage of smokers among our sample of individuals living with HIV compared to the percentage of smokers found in the general adult population. A total of 123 individuals (54%) reported that they smoked cigarettes. Men were more than twice as likely to have made previous attempts at smoking cessation than were woman. The majority of cigarette smokers (63%) reported that they were currently thinking about quitting. Respondents' preferences for types of smoking cessation methods are discussed, and recommendations are proposed for identifying and treating tobacco dependence in this population.