A perinatal intervention program for urban american indians part 2: the story of a program and its implications for practice

This is the story of how a culturally aware staff successfully intervened with a clientele of another culture. A high infant mortality rate for American Indians in Milwaukee, WI, prompted a community health agency to initiate a program to address the problem. Efforts were made to educate the American Indian community about the importance of both prenatal and postnatal care. Part 1 of this report was published (Davis & Prater, 2001) and presented the design and implementation of the program, as well as program outcomes. Here, Part 2 describes aspects of the same program, including the personal story of a client and the results of an evaluation conducted by a three-person research team. Implications for practice are also presented. Among these are suggestions for hiring and retaining staff, locating and retaining clients, addressing cultural sensitivity, and identifying administrative actions that enhance program operation. The personal stories of two additional clients are included to illustrate the difficult reality of some clients' lives and the resulting necessity for flexibility and resourcefulness on the part of program staff. This program represents the positive impact that program workers had on the problem of American Indian infant mortality.     

DEPRESSION AND RELATIONAL HEALTH IN ASIAN AMERICAN AND EUROPEAN AMERICAN COLLEGE WOMEN

Research consistently demonstrates elevated rates of depression among college‐aged women, yet evidence of racial differences in depression among this population are poorly understood. Moreover, the correlates of depression among Asian American women are also understudied. In this exploratory analysis, we examined mean differences in depression levels in a sample of Asian American (n = 117) and European American (n = 257) students from a women's liberal arts college. We also estimated associations between depression and relational health in three types of relationships (mentor, friend, and college community) using ordinary least squares regression. Relational health was examined as a buffer (i.e., moderator) against depression. Results indicated no differences in depression levels between Asian American and European American women. Relationships with the college community were associated with lower levels of depression in both groups of women. Limited evidence suggested that relational health served as a buffer. Results are discussed in light of interventions for college campuses.     

Child abuse and neglect in American Indian communities

Child abuse and neglect have recently been found to occur among American Indians at rates comparable to other American population groups. Little is known about the clinical spectrum of Indian maltreatment, the psychodynamics and effective treatment modalities. Cultural misunderstanding, modernization, poverty, situational stress, poor parenting skills because of early break-up of Indian families, alcoholism, unusual perceptions of children, handicapped children, and divorce constitute factors associated with maltreatment in cases cited. Old solutions of removing children from families were largely inappropriate and ineffective and are being replaced by local efforts to develop foster homes, supportive family services, and legal procedures to protect children. Communication between agencies involved and mistrust of outsiders plus a lack of trained personnel and available community resources continue to pose major barriers to effective treatment and prevention efforts. Recent federal policies and laws clearly place the responsibility for child welfare in the hands of Indian tribes and tribal courts. The non-Indian health professional has an important but limited role in providing technical expertise and in aiding development of community resources, taking care to support but not usurp the emerging leadership of Indian people.     

Sewing machines and bank loans,farming and family planning

Half of a $10,000 grant was given by the International Planned Parenthood Federation (IPPF) to finance the rural development project activities of Danfa, a village of about 835 people in Ghana. In this community the women are hard working but doubly disadvantaged. Along with a high illiteracy rate, the women are limited by inadequate income due to underemployment, under productivity, unfavorable farming conditions, and a lack of resources. Large families, frequent pregnancies, poor mother and child health, and high infant mortality all make matters worse for both the rural farm wife and her family. The project began with a nucleus of women that soon grew to between 24-30. Members soon formed small groups according to their occupational interests. The women grasped the self-help idea immediately. Once or twice a month there were demonstrations and the group worked together in such activities as making soap and pomade, preparing meals, and sewing. Meetings generally ended with a general group brainstorming and then members gathered in smaller groups to review their activities and plan for the future. During the 1st year of the project the men in the group rarely attended meetings. The group gave priority attention to their community's urgent need for working capital. 15 women farmers who met the criteria determined by the group received loans in the 1st round; only 8 satisfied the criteria in the 2nd round. At the beginning of the small loans scheme, the group decided to seek bigger loans from the bank if members proved credit worthy. This requirement was satisfied, and the group began negotiations for a loan with the Agricultural Development Bank. The group received the total group loan. The Ghana Home Science Association considers the project to be successful in several respects. Team spirit has developed the group, and the women play important and respected roles. Family planning problems are regularly presented for discussion, but it is difficult to correlate these ideas with practice. The ability of members to discuss these problems comfortably is an indication of their acceptance of family planning as an important topic in their lives.     

Between science and common science. Nonformal education for village health workers in Kenya

To help the 50,000 people living in Saradidi improve their community, the Anglican Church of the Province of Kenya of originally organized a health project in 1979 as the cornerstone of an extensive rural development effort to reach people through parish and congregational committees. The Saradidi Health Program intended to reduce the high rates of infant and child mortality and morbidity by directly involving the community in the provision of its own health care and the improvement of its quality of life. Each village elected its own health and development commitee and later selected volunteers to work in the community. Training was given to those selected to organize teir communities for the health program--the Nyamrerwa or Village Health Helpers (VHHS). Their task was not simply to provide information about appropriate health practices, but the much more difficult 1 of spanning the 2 worlds of medical science and traditional beliefs and practices. Over the course of several years, the experience at Saradidi proved that these 2 worlds need not be in competition. They could be complementary provided that the VHHS were capable of integrating their newly-acquired knowledge with the common sense of centuries-old practice. An evaluation of the program has shown that the VHHS have now begun to accoomplish their task of influencing the practices and changing the attitudes of the people in Saradidi. The nonformal approach is effective because it involves the whole community in the process of promoting good health. The VHHS act as a catalyst, bringing together useful information and practices from the outside and making them part of the community's own information and practices.     

American Indian Imagery and the Miseducation of America

During the past three years, a vast array of institutions charged with protecting the educational welfare of children, including school districts, state education departents, and even the United States Department of Justice, have faced the task of determining the appropriateness of American Indian imagery as the cornerstone of personal, school, and community identity. In this paper, an argument is introduced that the continued use of American Indian sport imagery is symptomatic of a form of cultural illiteracy. A case is further made that these images contribute not only to a hostile culture and classroom climate for American Indians but also serve to miseducate Americans in general about our shared history.     

Indigenous cultural contexts for STEM experiences: snow snakes’ impact on students and the community

Opportunities for American Indian youth to meaningfully engage in school-based science, technology, engineering, and mathematics (STEM) experiences have historically been inadequate. As a consequence, American Indian students perform lower on standardized assessments of science education than their peers. In this article we describe the emergence of meaning for students—as well as their community—resulting from Indigenous culturally-based STEM curriculum that used an American Indian tradition as a focal context. Specifically, the game of snow snakes (Gooneginebig in Ojibwe) afforded an opportunity for STEM and culturally-based resources to work in unison. A case study research design was used with the bounded case represented by the community associated with the snow snake project. The research question guiding this study was: What forms of culturally relevant meaning do students and the community form as a result of the snow snake game? Results indicate evidence of increased student and community engagement through culturally-based STEM experiences in the form of active participation and the rejuvenation of a traditional game. Implications are discussed for using culturally-based contexts for STEM learning.     

Ethnic and Racial Identity in Adolescence: Implications for Psychosocial,Academic, and Health Outcomes

The construction of an ethnic or racial identity is considered an important developmental milestone for youth of color. This review summarizes research on links between ethnic and racial identity (ERI) with psychosocial, academic, and health risk outcomes among ethnic minority adolescents. With notable exceptions, aspects of ERI are generally associated with adaptive outcomes. ERI are generally beneficial for African American adolescents' adjustment across all three domains, whereas the evidence is somewhat mixed for Latino and American Indian youth. There is a dearth of research for academic and health risk outcomes among Asian American and Pacific Islander adolescents. The review concludes with suggestions for future research on ERI among minority youth.     

TRAINING IN SUPPORT OF THE AMERICAN INDIAN ELDERCARE CAMPAIGN: REPLICATION OF AN AMERICAN INDIAN HOME‐CARE TRAINING PROGRAM

In 1991, the federal Administration on Aging initiated the National Eldercare Campaign to broaden the base of commitment and societal involvement to assist today's vulnerable elderly. With Administration on Aging funding, the project described in this study sought to enhance services to American Indian elders by training individuals as home‐care workers. The project replicated a previously developed American Indian paraprofessional home‐care worker curriculum at Fond du Lac Tribal and Community College in Cloquet, Minnesota. This program, which is transferable to Indian and non‐Indian communities, addressed three contemporary aging issues. First, it addressed the need to incorporate diversity and minority aging knowledge into the curriculum of postsecondary education. Second, it provided more accessible and better quality community‐based in‐home care to meet the needs of frail elderly. Third, this training program confronted the pervasive lack of employment opportunities in many American Indian and other minority communities.     

What about African American older women and depressive symptoms?

ABSTRACT

Depression is a major problem among African American older women; however, they also tend to be understudied as members of a multiple minority and oppressed group. As matriarchs and grandmothers in their families and communities, depression often emerges and becomes a detrimental problem for these older African American women. This study, a secondary data analysis, utilized the Health and Retirement Study (HRS) 2010 database to examine depression among older African American women. This article discusses the joint impact of age, social support, religion, caregiving, and physical health on depression among older community dwelling African American women. Findings indicate that age, physical health, and marital status as an aspect of social support were significant predictors of whether or not an older African American woman had ever had depression and whether or not she felt depressed in the past year. Receiving help from relatives as an aspect of social support also remained significant for participants who were feeling depressed in the past year. Implications for research, theory, and policy are offered.     

Child maltreatment prevalence and mental disorders outcomes among American Indian women in primary care

OBJECTIVE: To examine (1) the prevalence, types, and severity of child abuse and neglect (CAN) and (2) the relationship between CAN and lifetime psychiatric disorders among American Indian women using primary care services. METHODS: A cross-sectional study was conducted among 234 American Indian women, age 18-45 who presented for outpatient ambulatory services at a community-based Indian Health Service Hospital in Albuquerque, New Mexico. Dependent measures included mood, substance abuse, and anxiety disorders as well as posttraumatic stress disorder (PTSD) as measured by the Composite International Diagnostic Interview. CAN was assessed using the Childhood Trauma Questionnaire. RESULTS: Approximately three-quarters of respondents (76.5%; 95% CI = 70.4, 81.7) reported some type of childhood abuse or neglect; over 40% reported exposure to severe maltreatment. Severity of child maltreatment was associated in a dose response manner with lifetime diagnosis of mental disorders. After adjusting for social and demographic correlates, severe child maltreatment was strongly associated with lifetime PTSD (prevalence ratio [PR] 3.9; 95% CI = 1.9, 8.0); and was moderately associated with lifetime substance use disorders (PR = 2.3; 95% CI = 1.6, 3.3); mood disorders (PR = 2.1; 95% CI 1.4, 3.2); and with two or more disorders (PR = 2.3; 95% CI = 1.6, 3.4). CONCLUSION: CAN was common in our sample of American Indian women in primary care and was positively associated with lifetime psychiatric disorders outcomes. Screening for CAN and psychiatric disorders would enhance the treatment of patients seeking primary care services. Primary prevention of child maltreatment might reduce the high prevalence of mental disorders among American Indian women.     

Pregnancy and delivery for women with a history of child sexual abuse

OBJECTIVE: To study whether women with a history of child sexual abuse are at increased risk of delivering low birth weight infants. Secondary aims were to study smoking habits, obstetric complications, health care use, and health complaints during pregnancy among women with a history of child sexual abuse. METHOD: In a case control study, 82 women with birth of a low birth weight infant (< 2500 g) (cases) and 91 women with birth of a normal birth weight infant (controls) were interviewed about experiences of child sexual abuse. RESULTS: Fourteen percent of the women disclosed a history of child sexual abuse involving at least genital touch. Birth of a low birth weight infant was not associated with a history of child sexual abuse (OR 1.03, 95% CI .44-2.40). More women with a history of child sexual abuse were smokers during pregnancy (56% vs. 31%) compared with nonabused women. Abused women reported lower age at menarche and sexual debut. Nonscheduled contacts with the antenatal care clinic and discomfort during pregnancy were more frequent among abused women when controlled for low birth weight. CONCLUSIONS: Women who delivered low birth weight infants were not more likely to have experienced child sexual abuse than women who delivered nonlow birth weight infants. Abused women were unemployed and daily smokers more often than nonabused women. Some of the abused women reported more health complaints, and more use of health care services during pregnancy, but did not have more obstetric complications during pregnancy and delivery.     

How does women’s education influence infant survival? A structural equation model using aggregate data from 95 low- and middle-income countries

Previous studies have shown that women’s education increases infant survival with a magnitude that varies along methodological designs. Besides, the causal chain from women’s education to infant survival has so far remained largely unknown. This cross-country study investigates the relationship between women’s education and infant survival in 95 low- and middle-income countries using a comprehensive set of mediating and control variables. The article applies structural equation modelling on aggregate data, which were produced by the UN, UNESCO, UNICEF and the World Bank. The independent variables are from 2000 to 2009, and the dependent variable, infant mortality, is from 2018. The models are adjusted for income level, population size and extreme epidemic or political instabilities. Structural equation modelling is an advantageous method to specify how women’s education affects infant survival explicitly through the indirect influences of an enhanced child health provision and through an increased reproductive autonomy for women. Overall, women’s education is an equally important variable with poverty alleviation and women’s reproductive autonomy in explaining the cross-country variation in infant survival. The models, taking into account key child health policies, provide new evidence on how women’s education is mediated to better infant survival in low- and middle-income countries.     

The role of acculturation in explaining ethnic differences in the prenatal health-risk behaviors, mental health, and parenting beliefs of Mexican American and European American at-risk women

OBJECTIVE: To assess: (1) ethnic differences in the health-risk behaviors, mental health problems, and adverse parenting beliefs during pregnancy of low-income Mexican American and European American women; and, (2) the extent to which these risks varied with levels of acculturation among low-income Mexican American women. METHOD: Participants were 594 primiparous, low-income, urban women. A cross-sectional design was used to compare the 331 Mexican American women to the 263 European American. Language was used to assess the level of acculturation of the Mexican American women. Interviews were used to evaluate health-risk behaviors, mental health problems, and adverse parenting beliefs. RESULTS: In comparison to European American women, Mexican American women were at lower risk for cigarette smoking during pregnancy and higher risk for adverse parenting beliefs. Among Mexican American women, Spanish speakers were at lower risk for cigarette smoking and mental health problems during pregnancy, and higher risk for adverse parenting beliefs than bilingual and English speakers. CONCLUSIONS: The findings indicate that ethnic differences in cigarette smoking and parenting beliefs during pregnancy were concentrated on the less acculturated, low-income, and primarily unmarried Spanish speaking Mexican American women. Moreover, acculturation is differentially related to cigarette smoking and parenting beliefs. Therefore, acculturation needs to be considered in the development of preventive interventions in order to appropriately target the specific needs of different sub-populations of Mexican Americans.     

An Investigation of How Culture Shapes Curriculum in Early Care and Education Programs on a Native American Indian Reservation

This article investigates how culture shapes instruction in three early care and education programs on the Flathead Indian Reservation. Interviews with eight early childhood teachers as well as classroom observations were conducted. The investigation is framed by the following research question: How does the culture of the family and community shape curriculum? Data analysis suggested that ongoing communication with parents and community about teaching within a culturally relevant context, building a sense of belongingness and community through ritual, and respecting children, families, and community were essential to defining the Native American Indian culture within these early learning programs.     

Nurses' attitudes and knowledge of their roles in newborn abandonment

The practice of abandoning newborns shortly after birth has always existed. Occurring in primitive and contemporary societies, the motivations for newborn abandonment are varied and dependent upon the social norms of a specific geographic region at a given point in time. Because the desire to abandon an infant has had no support system in American society, such unwanted infants have been abandoned in a manner leading to their deaths. In response, many states have passed safe-haven legislation to save the lives of unwanted newborns. The laws typically specify a mother's ability to "abandon" her child to a medical service provider. However, judgmental attitudes and a lack of accurate information may impede a health care provider's ability to carry out a safe-haven law. The study described here examines a sample of nurses in a state with a safe-haven law. The study revealed no significant correlation between a nurse's knowledge, attitude, and self-perception of preparedness to manage a newborn abandonment event. owever, the outcomes highlight the negative attitudes and lack of knowledge many nurses possess regarding newborn abandonment and the women who commit this act. Educational programs for all health care providers and the community are essential to the efficacy of the legislation that currently exists. Continued multidisciplinary strategizing and general awareness are needed to serve as catalysts to build supports for unwanted newborns and their safe assimilation into the community.     

Knowledge, attitudes, and beliefs about HIV/AIDS among Hindu students from a government women's college of South India

The purpose of the study was to determine the attitudes of Hindu students from a government women's college of South India toward people with AIDS, to assess their beliefs about HIV/AIDS, to determine their knowledge level about HIV/AIDS and to determine how they gain information about HIV/AIDS. The sample consisted of four hundred female students at a government funded Women's University in Southern India who participated in an AIDS survey research project. Participants completed a survey asking about their knowledge, attitudes and beliefs about HIV/AIDS. Results indicated that a majority of the participants learned about HIV/AIDS from reading material while some learned about HIV/AIDS from school classes, and only a few learned from family members. Thirty-nine percent had never communicated to any one about HIV/AIDS. The results indicated that the majority of Indian women in this study did not know about explicit sexual behaviors which transmit the virus. The study also showed that those Indian women university students, by and large, are accepting of people with AIDS but still have fears of getting HIV/AIDS. This data suggest a need to increase educational efforts at the university. It was suggested that counselors take responsibility for helping this population of Indian women become self advocates, particularly in a society which permits men to have multiple sexual relationships. Educators and counselors working with this population must initiate programs that impart accurate and specific knowledge to these female college students and begin to address the multiple psychosocial issues related to HIV/AIDS.     

Public infrastructure,location of private schools and primary school attainment in an emerging economy

The paper argues that access to public infrastructure plays a crucial role on the presence of private schools in a community, as it could not only minimise the cost of production, but also ensure a high return to private investment. Results using community, school and child/household-level PROBE survey data from five north Indian states provide some support to this central hypothesis: even after controlling for all other factors, access to village infrastructural facilities is associated with a higher likelihood of having a private school in the community. This is also corroborated by an analysis of household demand for private schools. The paper concludes by examining the effect of private school presence on year 5 pass rates: while all-school pass rates are significantly higher in villages with a private school, private school presence fails to have significant effect on local state school pass rates.     

Rural underpinnings for resiliency and linkages (rural): A safe schools/healthy students project

Rural Underpinnings for Resiliency and Linkages (RURAL) is an example of a Safe Schools/Healthy Students (SS/HS) project. RURAL provides services to children and families in a rural Kansas county. The county's rates of juvenile alcohol and illicit drug use are higher than state averages. The RURAL project was designed to enhance existing partnerships among three school districts, the local community mental health center, law enforcement, the regional prevention center, and Fort Hays State University. A significant number of evidence‐based strategies were implemented in the schools and community in a short period of time. Using a public health approach to increase school safety and promote healthy behaviors, RURAL introduced strategies designed to provide universal prevention for the school population, early intervention for at‐risk children and families, and intensive services for those with the greatest needs. Services were provided to students (preschool–young adults) and their families. School psychologists held key roles in the development, implementation, and management of the project. Preliminary evaluation findings are presented, and the importance of local process and outcome evaluation is discussed. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 531–547, 2003.     

Nepal: positive trends in ARH

This article records the Nepalese Government's adoption of a strategy, which is consistent with Nepal's second long-term health plan (1997-2017). The primary health care system would deliver an integrated reproductive health package, which gives emphasis on gender perspective, community participation, equitable access and intersectoral collaboration. In addition, some of the appropriate interventions being pursued are the formulation of national policies, provision of counseling and sex education and information, supplying contraceptives, and delivering youth-friendly reproductive health services. However, serious problems hindering efforts to implement effective adolescent reproductive health programs include limited access to food and health care; high infant and maternal mortality rate due to early and frequent pregnancies; low level of contraceptive use and increasing frequency of sexually transmitted diseases cases among adolescents; and low level of literacy, particularly among girls.