Ten awards totalling $45,830 were made by the Center for the 2002-2003 funding cycle. Please contact the individual researchers for more information.
One of the key issues in substance abuse service delivery to ethnic minority consumers and their families is the provision of culturally competent care that incorporates into treatment the unique cultural context of the individual. Such culturally competent services are more likely to engage individuals and their families and to foster retention in treatment, thus producing better outcomes of care and reducing the use of costly acute and inpatient services, as well as preventing the shifting of the costs of addiction onto social service, primary health care, and criminal justice systems. Joan Bloom (Public Health; jbloom@uclink4.berkeley.edu) and her colleague Anne Morris will seek to define the practice of culturally competent services from the perspective of multiple stake-holders providing or receiving services through the Asian American Recovery Services, Inc. (AARS), a non-profit substance abuse treatment organization serving diverse Asian American communities in three Bay Area counties. Through key informant interviews with program administrators, clinicians, and other direct care staff-as well as with consumers of services and their families-they will develop, pilot, and validate a qualitative survey instrument that will then be used in an assessment of program practices.
Implied by the intersection of biological, social, and environmental research, communal bereavement posits that populations subjected to ambient threats to physical and emotional security will exhibit a higher than otherwise expected proportion of individuals, including pregnant women, in whom the corticosteroid response has been triggered. Among the suspected sequelae of the response in pregnant women is increased risk of spontaneous abortion among male fetuses in the first trimester of gestation and of premature delivery among fetuses in the third trimester. These two effects supposedly result in increased incidence of very low weight infants within two months of the ambient threat and in decreased sex ratios (i.e., males live births/female live births) eight and nine months later. Ray Catalano (Public Health; rayc@berkeley.edu) and his colleague Brenda Eskenazi (Public Health; eskenazi@berkeley.edu) will test the hypothesis that cohorts in gestation in New York State at the time of the events of September 11 will exhibit lower than expected sex ratios and higher than expected odds of very low birthweight. It is hypothesized that the differences between expected and observed outcomes will decrease with distance of county of residence from New York City.
Strenuous working conditions and occupational fatigue in pregnancy have been associated with pre-term delivery (PTD) and low birthweight (LBW) among working women. Associations have also been reported between objective or perceived stressful life events, anxiety, depression, low levels of social support, and adverse pregnancy outcomes. Some studies have suggested that daily hassles and other chronic stressors-such as those involved in poverty, racial discrimination, or poor working conditions-might be better predictors of health problems than more infrequent, severe life events. The inconclusive findings from these studies point to the challenge of designing better studies that more precisely examine the effect of multiple stressors and consider host reactivity, moderating resources, and the mediating role of biological factors on preterm deliveries. While recent studies suggest that the effects of stress on PTD may be mediated by increases in placental secretion of corticotropin-releasing hormone (CRH), no studies have looked at this relationship among working women specifically. Sylvia Guendelman (Public Health; sylviag@berkeley.edu), together with colleagues Tom Boyce (Public Health; boyce@socrates.berkeley.edu), Martin Kharrazi, and Michelle Pearl, will examine race/ethnicity, socioeconomic status (SES), and CRH levels and their relationship to stress and PTD/LBW in working women and will investigate whether antenatal leave may be a beneficial intervention for reducing adverse pregnancy outcomes, particularly in higher-risk subgroups in the U.S.
In much of the developing world daughters receive lower education and other investments than do their brothers and may even be so devalued as to suffer differential mortality. Daughter disadvantage may be due in part to social norms that prescribe that daughters move away from their natal family upon marriage, a practice known as virilocality. Past research suggests that the health of daughters is lower in regions where daughters move away. If families in virilocal regions emphasize the importance of having sons, they will typically have children more often and more quickly after the birth of a daughter. David Levine (Business; levine@haas.berkeley.edu) and Michael Kevane will evaluate the effects of virilocality on female disadvantage using data from the Indonesia Family Life Survey. Based on an analysis of a number of health-related measures of son preference-including disadvantages in height-for-age for girls and women-they will test whether virilocal groups have "missing daughters."
The consequences for health care of the 35 percent drop in Cuban GDP between 1989 and 1994 are not fully understood. Despite data suggesting that the Cuban primary care and health-promotion systems have continued to function rather well in the 1990s, it is possible that the quantity and quality of care in the secondary and tertiary care sectors serving Cubans (rather than foreigners) have suffered during this period. If this is true, an underground health care market might have developed for Cubans with hard currency. Additionally, as market-based economics reforms of the 1990s have resulted in self-interested behavior, there is concern that a two-tier system of health care based on ability to pay is developing in Cuba. Jane Mauldon (Public Policy; jmauldon@socrates.berkeley.edu) and Kamran Nayeri (UC DATA; knayeri@berkeley.edu) will explore the changes within and interactions between the tertiary, secondary, and primary care systems in Cuba, as well as the extent of health care rationing and its consequences and implications for health care services.
Dr. Nayeri and Professor Cándido López Pardo (of the University of Havana) have recently had their paper, Economic Crisis and Access to Care: The Cuban Health Care System Since the Collapse of the Soviet Union, accepted for publication in the International Journal of Health Services. (Abstract)
Anemia and intestinal helminth (worm) infections are major public health problems among pre-school aged children in slum areas of Delhi; it has been hypothesized that these health problems may contribute to low pre-school attendance and enrollment. The Indian non-governmental organization PRATHAM has undertaken a project that provides a health and nutritional package-consisting of Vitamin A and iron supplementation and deworming with albendazole-to children in 268 urban Indian pre-schools in an ongoing health and nutrition program. Working with PRATHAM, Edward Miguel (Economics; emiguel@econ.berkeley.edu) will study how improvements in child health and nutritional status affect current pre-school attendance and enrollment among 3- to 5-year-old children and how program treatment effects differ by the gender, initial health and nutritional deficiency, and socioeconomic status of the recipients. This project is closely related to Miguel's ongoing work on child health and education in rural Kenya-the focus of a 2001-2002 CHR Small Grant Award, which found that deworming has a major impact in boosting school attendance among primary school children-especially among the youngest primary school children.
Medical sociologists have written widely about the relative decline in the power and dominance of physicians in recent decades. Part of this decline is attributed to increased health-care consumerism, as increased medical knowledge on the part of health care consumers (or patients) has led them to question medical decisions and challenge physician authority. The phenomenon of consumerism and the role of patients' medical knowledge in the purchase of health care services have largely been ignored by economists, despite the fact that prominent economists have characterized the consumption of health-care services as essentially the purchase of medical knowledge by patients from physicians. Richard M. Scheffler (Public Health; rscheff@berkeley.edu) and his colleague Richard Smith will examine one possible mechanism by which consumer knowledge is increasing to determine how this may be affecting demand in the physician-services market. They hope to provide a better understanding of patient preferences in this era of chronic diseases, which in turn could provide guidance for a redesign of reimbursement policies that would provide greater incentives to physicians to deliver care that is both of high quality and low in cost.
Standard measures of evidenced-based mental health interventions may be too long, complex, or confusing for use in routine practice settings and may not measure outcomes equivalently in all patient subgroups. In particular, inter-ethnic and inter-cultural differences in language use, communication styles, beliefs, and social desirability concerns may affect responses to outcome measures. If measures do not have the same meaning to all cultural, racial and ethnic subgroups, differential measurement of outcomes may lead to inappropriate conclusions about the effectiveness of mental health interventions in minority populations and contribute to documented disparities in service access and utilization. Lonnie Snowden (Social Welfare; snowden@berkeley.edu) and Martha Shumway will extend their ongoing work on cognitive approaches to mental health measurement by specifically examining cross-cultural variation in responses to standard outcome measures by testing cognitive models of question answering using outcomes data from two diverse community mental health settings. They will also develop and test an objective checklist for evaluating "culture-related" problems with standardized questions.
Political and social infrastructure is critical for confronting HIV/AIDS. Ann Swidler (Sociology; swidler@berkeley.edu) seeks to understand why some African states and localities have mobilized to fight AIDS, why some have been more effective than others, and why NGOs have been able to work more effectively in some places than in others. Political capacity and political will at the national level as well as such local infrastructure as health clinics, schools, and basic civic order are crucial for combating AIDS in Africa. International NGOs and public health organizations such as the World Health Organization work with and through local and national institutions, so they too depend on national political cooperation and local "social capital" to implement their public health projects. Her research has both theoretical and practical importance. Theoretically it will improve our understanding of how major institutions deal with health crises, and practically it analyzes how international Non-Governmental Organizations (NGOs) and African governing authorities respond to HIV/AIDS.
Due to a variety of economic, social, and geographic barriers, the delivery of basic primary health care-immunizations, prenatal and delivery care, family planning, and treatment of the common illnesses of childhood-is practically impossible in the rural areas of many low-income countries. Several countries have developed focused programs in which minimally trained community health workers have provided a variety of services such as health education, family planning, oral rehydration therapy education, and directly observed tuberculosis treatment. Julia Walsh (Public Health; jwalsh@socrates.berkeley.edu), in collaboration with a not-for-profit health service provider in India and the BayArea International Group, plans to study the cost-effectiveness of providing basic health services by non-physicians in a variety of situations. Her report on this research will then be sent to health services donors such as the World Bank and USAID and will be used in the design of a pilot implementation plan in rural northern India.
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