Asian American Health Initiative

(Drs. C. Ed Hsu, Robert Gold and Nancy Atkinson - September 2004 - June 2005) Developing a community Health Surveillance Database for Asian Americans of Montgomery County, Maryland (Montgomery County Health and Human Services)

The purpose of this project is to assist Montgomery County, Maryland to establish an Asian American Health Initiative to help reduce health disparities between racial/ethnic minorities and the general population. The project involves the development of an initial health needs assessment and database to assess the health related needs of Asian American residents, particularly those who are low income and uninsured. This health needs assessment data will help the County to formulate and further refine a plan of action for the Asian American Initiative so that it is responsive to meeting those needs.

The Maryland “Checkpoints” Program

(Dr. Kenneth Beck - October 2002) The purpose of this investigation is to evaluate the efficacy of a parent-based intervention designed to increase the level of parental supervision and regulation of their teen’s driving experience during the first 12 months of licensure.

The intervention consists of educational and motivational materials that are delivered to parents at Maryland’s Motor Vehicle Administration. These include a video (which explains the program, presents information on teen driving risks and explains the advantages of a special parent-teen driving agreement), and a parent-teen driving agreement. This project is a collaborative investigation between the National Institute of Child Health and Human Development, the Maryland Department of Transportation, and the University of Maryland.

Maryland Sobriety “Checkpoint Strikeforce” Evaluation

(Dr. Kenneth Beck - October 2002) The purpose of this project is to collaborate with the National Highway Traffic Safety Administration (NHTSA) in evaluating the impact of their “Checkpoint Strikeforce” initiative. In an effort to detect and deter drunk drivers, the Maryland State Police will be conducting a series of roadside sobriety checkpoints, supplemented by a media campaign to promote public awareness of this effort. Evaluating the impact of this initiative will include monitoring arrests for alcohol-impaired driving, alcohol-related admissions to Maryland’s Shock-Trauma Center and exit interviews at the Motor Vehicle Administration. The University of Maryland will conduct a telephone survey to measure public awareness and attitudes about drinking and driving. The data from this survey will be compiled with other data collected by other federal and state agencies to determine the impact of the “Checkpoint Strikeforce” initiative.

Body Fun: Health Education Enhancements and Online Community

(Cancer Research Foundation of America - Drs. Nancy Atkinson and Robert Gold - October 2002) The overall goal of this technology development project is to redesign and update an interactive game, Dr. Health’nstein’s Body Fun™, for children that teaches healthy lifestyle habits, translate it for application to the web, and use it as a centerpiece for building an online health community for children.

MCPS Middle School Tobacco Education Evaluation

(Montgomery County Public Schools - Drs. Nancy Atkinson and Robert Gold - October 2002) Design and development of two online surveys to be used to evaluate the fidelity of implementation of two different middle school tobacco education curriculums.

Development of a Community-Campus Partnership (The Seat Pleasant-University of Maryland Health Partnership)

(Dr. Jerrold Greenberg) Various projects underway and being planned involving students, faculty, and others in the community and community health agencies.

Examining sexual violence among intercollegiate athletes – predictors of rape myth acceptance

(Dr. Robin Sawyer) Assisting NCAA with risk reduction programming.

Researching knowledge, attitudes and usage of Emergency Contraceptive Pills among university students

(Dr. Robin Sawyer)

Comparison of Self-Report vs. Global Position System Methods of Assessing Teen Driving

(Dr. Kenneth Beck) Are teen reports of overall driving for a 7-day period an accurate reflection of their actual driving in that time? The purpose of this study is to determine the accuracy and validity of self-reports of the amounts (e.g., frequency, time, and distance) of driving by teens. The amount of driving that teenagers do is important to both their experience and exposure. The only way to get proficient at driving is to drive; therefore, the more teens drive, the more valuable experience they gain. However, the amount they drive is also related to their risk of crash or injury. Especially if their driving is done in higher-risk driving conditions such as at night or with teen passengers. The trend in policy has been to limit exposure by delaying licensure and restricting early driving. So, determining how much teens drive is important. Teen self-reports of driving will be compared to data obtained through an automated global positioning system (GPS) of tracking motor vehicle use. This project is a collaborative investigation between the National Institute of Child Health and Human Development, and the University of Maryland.

Monitoring the Future of Maryland’s Traffic Safety Programs

(Dr. Kenneth Beck) The purpose of this project will be to assist safety program coordinators in evaluating their programs. A comprehensive, statewide monitoring system will be developed that will allow a regular surveillance of Maryland’s population concerning the scope of highway safety issues that are being addressed by the State Highway Safety Office. This system, like other national monitoring systems employed by CDC and NIH, will focus on a variety of cross-cutting and topical areas and will employ telephone surveys of a representative sampling of households (800-1,000) throughout the State of Maryland to determine the extent and significance of behavioral and attitudinal risk factors concerning the various focus areas of the Highway Safety Office. This information is vital in developing countermeasures and in targeting them appropriately. Reliance upon vital statistics alone (i.e., crash reports, fatalities) cannot identify the predisposing, reinforcing or enabling factors that underlie the population’s willingness to accept and support traffic safety initiatives. This project is funded by the Maryland Highway Safety Office of Department of Transportation.

Adolescent Alcohol/HIV Prevention Interventions

(Dr. Bradley Boekeloo) Funding Agency: National Institute on Alcohol Abuse and Alcoholism (NIAAA) Collaborators: The George Washington University Medical Center , Kaiser Permanente Mid-Atlantic Region. Summary: The purpose of this four year study is to assess the effectiveness of a brief office-based intervention to prevent or delay alcohol use in adolescents ages 12-17.

College Student Sexual Risk Taking

(Dr. Bradley Boekeloo) Summary: Using survey data from 246 college students enrolled in undergraduate personal health classes, researchers are investigating the relationships between several aspects of sexual risk taking relative to the college environment. By better understanding the relationships between alcohol use, casual sex, and discussion with a sexual partner researchers hope to reveal a new model that is predictive of condom use for college students.

National Minority AIDS Education Training Centers (NMAETC)

(Dr. Bradley Boekeloo) Funding Agency: Health Resources Services Agency (HRSA) Collaborators: Howard University, Charles R. Drew University, Meharry Medical College, Morehouse School of Medicine, IMANI
Summary: The NMAETC provides training to minority health care providers in the treatment and management of HIV/AIDS. The mission of the NMAETC is to increase the knowledge of minority providers and ultimately to increase their capacity to treat. The NMAETC sites are located at historically Black institutions in order increase the number of minority providers who are educated.

Delta AIDS Education Training Centers (DAETC)

(Dr. Bradley Boekeloo) Funding Agency: HRSA. Collaborators: Louisiana State University (LSU). Summary: The DAETC provides training to health care providers in the treatment and management of HIV/AIDS.

National Peer Treatment Education Program (NPTEP)

(Dr. Bradley Boekeloo) Funding Agency: HRSA. Collaborators: Howard University. Summary: The NPTEP provides HIV/AIDS training and treatment education to minority peer educators. The goal of the program is to increase the number and quality of well-trained minority peer treatment educators who work in highly impacted or emerging HIV/AIDS communities.

Targeted Provider Education Demonstration Project (TPED)

Funding Agency: HRSA. Collaborators: Howard University. Summary: The TPED provides HIV/AIDS training for allied health and support service providers.

Prevention Science Decision Support System

(Dr. Nancy Atkinson - Sub-contractor to Macro International Inc., submitted to The Center for Substance Abuse Prevention, Substance Abuse and Mental Health Administration, U. S. Department of Health and Human Services). The purpose of this project is to design and develop an online decision support system to assist state and community prevention specialists in substance abuse prevention programming. (1/99 - 6/03)

Food Stamp Nutrition Education Program, Nutrition Education and Digital Inclusion to Promote Healthful Diets and Physical Activity Among Maryland Food Stamp Recipients

(Dr. Nancy Atkinson - USDA, 2002-2005) The long-term aim of the Maryland Food Stamp Nutrition Education Program is to improve the overall health of limited resource populations in Maryland by reducing diet-and physical activity-related risks of chronic disease and by increasing available resources. The current proposal addresses nutrition, weight control, and physical activity patterns and needs of those food stamp eligible participants in five counties in the State of Maryland. This is the beginning of a four-year effort to assess needs and assets among those eligible individuals and households in these counties, to design and implement programs appropriate to those needs and assets, and to evaluate those programs for their effectiveness, sustainability, and prospects for effective dissemination of those programs to other counties in the State. The first year of this effort will be a state-wide needs assessment among the population of interest.

Latino Genetics Community Consultation Network, Baylor College of Medicine

(Dr. Nancy Atkinson, 2002-2003) The goal of this project is to pilot test a participatory model of community consultation among a sample of representatives of US Latinos to identify, prioritize, and disseminate information on genetics issues. Following the development of background papers, we will use a Delphi process to ask Latino stakeholders, government representatives, and researchers to develop a consensus of what the key issues are. These will be further defined and actions plans developed at an in person meeting.

Chronic and Episodic Eating Disorder Behavior Among Military Personnel

(Dr. Nancy Atkinson - collaboration with Uniformed Services University of the Health Sciences, 2001-2003) In collaboration with researchers at USUHS, we are conducting secondary analyses on a survey data gathered from over 3,000 people in the armed forces. One purpose of the analyses is to compare the rates of chronic eating disorders to that of the general population. We are also using the data to describe episodic eating behavior related to the demands of military service. These data will be used to guide health education and weight control program planning.

Worker Education and Training Response to Bio-terrorism

(Dr. Robert Feldman) The aim of the present study is to evaluate worker education and training response activities that address health concerns in the wake of the September 11th terrorist attacks on the World Trade Center (WTC). Both workers conducting emergency response to bio-terror incidents and conducting post-emergency remedial clean up work are the focus of the training. The training will address emergency response awareness and hazardous waste worker training. The trainers have previously conducted training for workers involved in the clean up of the WTC site and the anthrax contaminated facilities in New York, New Jersey and Washington, D.C. The evaluation of the training at the University of Maryland College Park will seek to determine whether the training program is effective and successful.

Smoking Cessation for Latino Immigrant Workers: Integrating Smoking Cessation into Worker Training

(Dr. Robert Feldman) The aim of the research is to reduce smoking among Latino immigrant workers. The researcher will develop, implement and evaluate a culturally and linguistically appropriate program. This program will be integrated with an occupational cancer prevention program for Spanish-speaking residents of Montgomery County using the training and assistance programs that the Alice Hamilton Occupational Health Center currently provides. Based upon CDC’s Best Practices (1999), we plan to offer a multi-component smoking cessation program, in Spanish, that will include written materials, posters, verbal messages, testimonials from Latino immigrant workers who are ex-smokers, and a telephone cessation help and support line staffed by a promotora. The messages and themes of the program will be based upon Latino cultural values (Marin, 2001), such as, familialism (family influence), personalismo (personal relationships), and simpatia (smooth interpersonal relationships). The scarcity of programs for Latinos and especially for workers highlights the need for such a program. A strong evaluation of the goals of the program will determine not only the impact of the program on the psychosocial and behavioral factors (i.e., smoking rates) of the participants, but also the community impact by examining the program’s influence on cultural norms about smoking. Therefore, this program aims to reduce health disparities caused by tobacco use, enhance the quality of life of this underserved population, and serve as a model for the development of culturally appropriate programs in Montgomery county.

State Prevention System – Management Information System (SPS/MIS)

(Dr. Robert Gold) Subcontract from Macro International Inc. (Funds originating at Center for Substance Abuse Prevention (CSAP/SAMSHA/DHHS.)

Prevention Decision Support System (DSS)

(Dr. Robert Gold) Supplemental funds subcontract from Macro International Inc. (Funds originating at Center for Substance Abuse Prevention (CSAP/SAMSHA/DHHS.)

Centers for Advanced Prevention Technologies (CAPT) Evaluation

(Dr. Robert Gold) Supplemental funds subcontract from Macro International Inc. (Funds originating at Center for Substance Abuse Prevention (CSAP/SAMSHA/DHHS.)

Prevention Science Decision Support System

(Sr. Robert Gold) Sub-contractor to Macro International Inc., submitted to The Center for Substance Abuse Prevention, Substance Abuse and Mental Health Administration, U. S. Department of Health and Human Services. Project Director.

The Role of Student Health Services in University-Community Collaborations

(Donna E. Howard, DrPH, Jerrold S. Greenberg, EdD, Carrie Murray MS, Robin Sawyer, PhD ) Conceptual paper, based on the ongoing Seat Pleasant/University of Maryland, Department of Public and Community Health Partnership, exploring the integration of a university’s student health center into such collaborative efforts.

Community-University Health Partnerships: Strategic Issues

(Donna E. Howard, Dr.P.H, Estina Thompson Ph.D, Sharon Desmond, Ph.D, Jerrold S. Greenberg Ed.D) Conceptual paper, based on the ongoing Seat Pleasant/University of Maryland, Department of Public and Community Health Partnership, examining the opportunities and constraint that influence the likelihood that academic faculty will engage in such collaborative efforts.

The Relationship Between Substance Use and Engagement in Risk Behavior for Sexually Transmitted Diseases/Human Immunodeficiency Virus (STD?HIV) among US Adolescents

(Donna E. Howard, DrPH, Min Qi Wang PhD) The study aims to examine the relationship between substance use and STD/HIV-related sexual risk behaviors among sexually active adolescents who participated in the 1999 Youth Risk Behavior Survey (YRBS). The study is a secondary data analysis of the national 1999 wave of the of the ongoing YRBS.

Multiple Sexual Partner Behavior Among Sexually Active U.S. Adolescent Girls

(Donna E. Howard, DrPH, Min Qi Wang PhD) This study examines the relationship of multiple sexual partners to other risk behaviors among a representative sample of ninth through twelfth grade sexually active U.S. girls who completed the 1999 national Youth Risk Behavior Survey. The study is a secondary data analysis of the national 1999 wave of the of the ongoing YRBS.

Psychosocial Correlates Associated with Reports of Dating Violence Among U.S. Adolescent Boys

(Donna E. Howard, DrPH, Min Qi Wang PhD) This study examines the prevalence of physical dating violence and its relationship to risk behavior among a representative sample of ninth through twelfth grade adolescent boys who completed the 1999 national Youth Risk Behavior Survey. The study is a secondary data analysis of the national 1999 wave of the of the ongoing YRBS.

Personal and Social Contextual Correlates of Adolescent Dating Violence

(Donna Howard, DrPH, Yue Qiu, BS, Bradley Boekeloo, PhD, MS) This study examines the association of dating violence with personal and social contextual factors among a sample of 12 to 17 year olds enrolled in managed care health plans in the greater Washington, D.C. metropolitan area. Funding for the research was provided by the National Institute on Alcohol Abuse and Alcoholism to Bradley Boekeloo, Principal Investigator.

The Use of The Case Study Methodology to Teach Ethics to Public Health Students

(Donna Howard, DrPH, Bradley Boekeloo, PhD, MS, Christine Lothen-Kline, MS) This study makes use of the case study methodology for ethics instruction to public health students by applying it to an area of public health interest, that is the identification of suicide ideation among adolescents. Funding for the research was provided by the National Institute on Alcohol Abuse and Alcoholism to Bradley Boekeloo, Principal Investigator.

Adolescent preventive health research at a crossroad: Issues of study integrity, ethics, and imminent harm in the context of adolescent self disclosure of risky behaviors and affective states

(C Lothen-Kline, D Howard, B Boekeloo) This study makes use of a natural experiment to examine the effects of a change in confidentiality agreements on adolescent’s disclosure of suicidal ideation.
Funding for the research was provided by the National Institute on Alcohol Abuse and Alcoholism (Grant#: 1R01AA12257) to Bradley Boekeloo, Principal Investigator.

How alienation and declines in social capital are affecting adolescent well-being

(Donna Howard, DrPH, Bradley Boekeloo, PhD) This study is a theoretical paper which examines the relationship between youth alienation and low neighborhood social capital on the prevalence of adolescent violence, suicide and engagement in other risky behavior.

Economics of Aging and Health

Design, implementation, management, and dissemination of research and program development studies on aging, long-term care, and health economics with special emphasis on financing, delivery, and public policy issues. I remain actively involved in research, technical assistance, and program development related to the Robert Wood Johnson Foundation (RWJF) Medicare/Medicaid Integration Program, the RWJF and ASPE Cash and Counseling Demonstration and Evaluation, and the RWJF Partnership for Long-Term Care. These programs focus on strategies for long-term care financing and delivery in the context our overall social and medical systems as outlined elsewhere in this summary of activities.

My work has been structured around the following key questions that highlight several major public policy problems:
• How can we create new ways to pay for long-term care?
• How can we improve the integration of acute and long-term care?
• How can we encourage informal care?
• How can we maximize the independence of disabled persons?

Future Directions:
The four problems outline above and the projects that I have initiated to address them are works in process. I hope to undertake publication opportunities that further disseminate the learning that has been accomplished.

Research and program development that builds on available aging and health related data bases including linked Medicare and Medicaid data is a goal of mine. To accomplish this goal I want to develop a data archive and data analytic capability that will facilitate the receipt and analysis of data. I would like to be able to supplement this effort with primary data when the opportunity and need arises.

Integrated care as we have been pursuing it in the MMIP is a lofty goal with many difficult challenges. I have begun the process of identifying the key building blocks necessary to move toward systems of care that better integrate primary, acute, subacute, long-term care. Care coordination strategies that involve better working relationships between the patient, their family, caregivers, and doctors will be a key subject of my future research.

The role of insurance is implicit in the relationship between MMIP and the Partnership Program. Issues of coverage for dual eligibles as well as the pre-duals need further attention as we continue to pursue Medicare reform. Insurance concepts and benefit package design issues will be of interest to states as well as the Federal government. This is an area that is a potential spin-off activity in which one or both of these levels of government are likely to continue to need help.

State Medicaid programs will increasingly look to home and community based care as an alternative to institutional care. Support for consumer directed care will continue to emerge as this happens. But state will also look to managed care to hold the line on costs. Further exploration and development of how these two concepts can work well together will be needed. I will work with concepts and strategies of health educators and family care specialists to identify, develop, and promulgate the skills necessary to facilitate healthy aging for whomever it is possible and comfortable caring of those at risk for or needing extensive chronic care supports.

Cash and Counseling Demonstration and Evaluation National Program Office

(Dr. Lori Simon-Rusinowitz, Deputy Director/Research Director, October 1995 - present) Conducting policy research on consumer-directed long-term care under the auspices of a three-state demonstration and evaluation funded by the Robert Wood Johnson Foundation and the U.S. Department of Health and Human Services. Entails overseeing a nine-year demonstration and evaluation of state Medicaid programs that provide a cash benefit to long-term care consumers, enabling them to design, purchase, and manage their own personal assistance services. Has entailed overseeing the design and implementation of focus groups and telephone surveys in four states to assess consumers' preferences for a cash option; overseeing the design and implementation of focus groups in two states to enhance consumer enrollment; overseeing the design and implementation of focus groups in two states to study cash option and agency paid workers; managing project contractors for focus groups, telephone surveys, and qualitative interviews; coordinating the production of written reports and journal articles; and monitoring project budgets. Has also involved designing and conducting in-depth interviews with policy experts to assess the status of a "common agenda" between the aging and disability communities, overseeing analysis of the interview data, and producing journal articles reporting interview findings. Also involves leading a team to analyze Demonstration state evaluation data. Will begin conducting policy research to assess policymakers’ opinions regarding payments to family caregivers.

Web-Based Oral Cancer Surveillance System

(Dr. Min Qi Wang) Funded by the New York University Oral Cancer Research, for Adolescent and Adult Health Promotion Center. The system will be pilot tested by the NYU School of Dentistry, with the potential to be adopted by the American Dental Association.

Monitoring the Future of Maryland's Traffic Safety Programs & An Integrated Web-based System

(Dr. Kenneth Beck and Dr. Min Qi Wang)

Substance Abuse Treatment Evaluation

(Dr. Min Qi Wang) Analysis of the 3-year intervention data conducted in Birmingham for the Center for Substance Abuse Treatment.

Youth Risk Behavior

(Dr. Min Qi Wang, with Dr. Howard) Evaluation of the national Youth Risk Behavior Survey data to examine the adolescents’ behaviors associated the HIV risks.