Evaluating Maternal and Child Health and Leadership Competencies of Emerging MCH Leaders: The MCHC/RISE-UP Experience.

PURPOSE: This study examines maternal and child health core competencies and leadership characteristics of undergraduate students following participation in the Maternal and Child Health Careers/Research Initiatives for Student Enhancement-Undergraduate Program (MCHC/RISE-UP). MCHC/RISE-UP is a 10-week public health leadership program designed to promote diversity in public health workforce through mentored research, community engagement and advocacy, and clinical experiences for undergraduate students. DESCRIPTION: The MCHC/RISE-UP is a national consortium of University Centers for Excellence in Developmental Disabilities including, (1) Kennedy Krieger Institute (Kennedy Krieger, lead institution) partnering with Morgan State University, a Historically Black University, (2) the University of South Dakota partnering with Tribal Serving Institutions; and (3) the University of Southern California Children's Hospital-Los Angeles and their partner institution, California State University Los Angeles, a Hispanic Serving Institution. ASSESSMENT: Eighty-four junior and senior undergraduates and recent baccalaureate degree students who participated in the MCHC/RISE-UP worked on 48 maternal and child health projects. Following the MCHC/RISE-UP, students demonstrated statistically significant improvements in all maternal and child health core competencies. Transformational leadership characteristics also increased (mean increase 9.4, 95% CI 7.2-11.8; p < 0.001). At closing interview, over twice as many students endorsed a public health career goal compared to program admission (17.9 vs. 57.7%; p = 0.022). CONCLUSION: Multi-institutional collaborative public health leadership programs may extend the reach and recruitment of diverse students into the maternal and child health field. Experiential, didactic, and mentored learning opportunities may enhance student integration of maternal and child health competencies and transformational leadership characteristics.

The interaction of drug use, sex work, and HIV among transgender women.

Transgender women have a higher prevalence of drug use, HIV, drug use, and sex work than the general population. This article explores the interaction of these variables and discusses how sex work and drug use behaviors contribute to the high rates of HIV. A model predicting HIV rates with sex work and drug use as well as these behaviors in the transgender woman's social network is presented. Challenges to intervening with transgender women, as well as suggestions and criteria for successful interventions, are discussed.

Substance Use Among Gang Member Adolescents and Young Adults and Associations With Friends and Family Substance Use.

PROBLEM: Gang membership is an indicator of chronic substance use. Social network studies indicate that substance use in youth is related to substance use in friends and family; however, no such analyses among gang youth have been conducted. METHODS: Interviews were conducted with a sample of young gang members (n = 60) in Los Angeles. Univariate analyses were conducted. FINDINGS: Cigarette use in gang members was strongly associated with cigarette use in friendship networks. There were no associations for use of alcohol and marijuana. CONCLUSIONS: Few associations emerged between substance use in participants and their friends/family. Possible explanations for these findings are presented.

Perceived peer influence and peer selection on adolescent smoking.

Despite advances in tobacco control, adolescent smoking remains a problem. The smoking status of friends is one of the highest correlates with adolescent smoking. This homophily (commonality of friends based on a given attribute) may be due to either peer pressure, where adolescents adopt the smoking behaviors of their friends, or peer selection, where adolescents choose friends based on their smoking status. This study used structural equation modeling to test a model of peer influence and peer selection on ever smoking by adolescents. The primary analysis of the model did not reach significance, but post hoc analyses did result in a model with good fit. Results indicated that both peer influence and peer selection were occurring, and that peer influence was more salient in the population than was peer selection. Implications of these results for tobacco prevention programs are discussed.

Peer influences on adolescent cigarette smoking: a theoretical review of the literature.

This article reviews several classes of theories to elucidate the relationship between adolescent cigarette smoking and friends' cigarette smoking. Perceived influence theories hinge upon an adolescent's perception of friends' smoking behavior. External influence theories are those in which friends' smoking behavior overtly influences adolescent smoking. Group level theories examine how differences at the level of subculture, gender, and race/ethnicity influence the relationship under study. Network theories are also discussed. A model integrating relevant theories into a longitudinal model representing friend influences on adolescent smoking is presented, along with implications of the results presented for adolescent tobacco prevention programs.

Effects of a social-network method for group assignment strategies on peer-led tobacco prevention programs in schools.

OBJECTIVES: Our study tested the effectiveness of network methods for identifying opinion leaders and for constructing groups. METHODS: Three conditions-random, teacher, and network--ere randomly assigned to 84 6th-grade classrooms within 16 schools. Pre- and postcurriculum data on mediators of tobacco use were collected from 1961 students. Peer leaders in the network condition were identified by student nominations, and those leaders were matched with the students who nominated them. RESULTS: Students in the network condition relative to the random condition liked the prevention program more and had improved attitudes (beta = -0.06; P <.01), improved self-efficacy (beta = -0.10; P <.001), and decreased intention to smoke (adjusted odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.38, 0.55). CONCLUSIONS: The network method was the most effective way to structure the program. Future programs may refine this technique and use it in other settings.

Smoking behavior among urban and rural Native American adolescents in California.

BACKGROUND: Previous studies have documented a high prevalence of tobacco use among Native American adolescents. However, little is known about the smoking behavior of Native American adolescents who live in urban areas. This study used statewide data from California to examine the smoking behavior and related psychosocial risk factors among Native American adolescents living in urban and rural counties. METHODS: The Independent Evaluation of the California Tobacco Control Program conducted three population-based statewide surveys of 10th-grade California public school students in 1996, 1998, and 2000. Past-month smoking and psychosocial correlates were examined among 22,440 respondents, including 1060 Native Americans. RESULTS: Native Americans had a 32% excess risk of past-month smoking compared with other ethnic groups. Smoking prevalence did not differ between urban (27.7%) and rural (29.3%) Native Americans. Native Americans reported higher access to cigarettes and exposure to smoking peers than other groups. Those psychosocial variables explained some, but not all, of the excess risk of smoking among Native Americans. CONCLUSIONS: Effective smoking prevention and cessation interventions are needed for Native American adolescents in urban and rural areas of California.