OBJECTIVES: Alzheimers disease (AD), the most common form of dementia, the group of brain disorders that cause memory loss and decline in mental function over time is the third most expensive disease in the nation, after heart disease and cancer. Average lifetime costs per patient are $174,000 with annual estimates of $80 to $100 billion dollars in health care expenses and lost wages for the AD patient or their family caregivers. The research study was designed to describe social policy and its affects on the eligibility and determination of benefits for two community-dwelling patients with AD and their caregivers in Southwestern Pennsylvania. METHODS: Secondary data analysis was conducted from data drawn from a previous study, The Process of Medication Taking. Data for this study included participant observations, interactive unstructured informal interviews, open-ended formal interviews and case description. Constant comparative analysis is used to determine similarities and differences between cases. RESULTS: Family caregivers aim to achieve quality care and services for the AD patient. To achieve this objective, the family and patients traverse a pathway of social care needs. Along the way, the family and caregivers approach milestones. These landmarks include accessing social services, cultivating a social support network, maintaining continuity of care, and managing the health care needs beyond the diagnosis of AD. Along the pathway to achieving the objective of quality care and services, there appear barriers and setbacks such as social service eligibility, location to eligible services and lack of support by family and friends. PUBLIC HEALTH SIGNIFICANCE: The amount of AD patients has doubled since 1980 and is expected to continue to expand to 11.3 to 16 million people by the year 2050. Furthermore, much of the long-term care is being provided by the family caregivers. Programs such as Medicare, Medicaid and Social Security Disability Insurance do not cover all of the needs and financial obligations for patients and their families. Even after these public programs, families continue to remain financially responsible for the care of their family member. Therefore, policy focused on evaluating AD on the basis of diagnosis rather than social policy eligibility criteria, such as age, may be warranted to provide optimal benefits for patients and family caregivers.

Refugees resettled in the U. S. have received little attention from the academic community. This research study seeks to address this gap by looking at an especially vulnerable refugee group, the Somali Bantus, recently resettled in Pittsburgh, Pennsylvania, and the public health significance of their long-term integration in the wider American culture. Oppressed for centuries, treated as third-class citizens, forced to flee their homes and condemned to live in refugee camps for ten to twelve years because of international events, Somali Bantus qualify as a uniquely disadvantaged refugee population. For this study, interviews were conducted with Somali Bantus and service providers in Pittsburgh to assess their experiences of resettlement. Somali Bantus have a history of being oppressed and discriminated against. Using the qualitative grounded theory approach the exploratory research here shows, the history of discrimination the Somali Bantus have experienced has long-term impacts on individual Somali Bantu's sense of personal agency. Additionally, the enormous need of the Somali Bantu community created conditions in which service providers competed with one another, rather than collaborating. This lack of cooperation among providers and the system of resettlement in the U. S. that encourages refugees to work as soon as possible, regardless of language ability, further hindered the ability of the Somali Bantus to exercise personal agency after arriving in the U. S.

Objectives: This study, utilizing the socio-ecological perspective, assesses the number of hospital discharges to shelters, their perceived appropriateness, and possible solutions to problems of inappropriate discharges. The socio-ecological perspective is employed to explore individual, community, and political factors involved in inappropriate discharging. Methods: Twenty-two staff and administrators from 12 of the 16 emergency homeless shelters in Allegheny County, PA were recruited by mailings (response rate=75%). A face-to-face, semi-structured interview was conducted with each of the 22 participants. Participants were asked to report on the number of discharges they received from hospitals in the past 12 months, whether or not these discharges were appropriate, and on possible solutions to the problem of inappropriate discharges. Results: Participants reported a total of 415 discharges from hospitals to shelters; 91 (22%) of the discharges were considered to be inappropriate. The two solutions most often reported by participants to the problem of inappropriate discharge were to cultivate bidirectional communication between hospitals and shelters, and to develop medical/psychiatric respite for the homeless population (50%, and 32% the respectively). Participants believed that the responsibility for the problem of inappropriate discharges rested at multiple levels of the ecological system including the individual, organizational, and political levels. Participants proposed solutions that targeted homeless individuals, shelters, hospitals, and policy makers. Conclusions: Inappropriate discharges are a problem in Allegheny County, PA and better communication amongst providers and the development of respite services are possible solutions. The etiological nature of this problem rests at multiple levels of the ecological system including the individual, organizational, and political levels, and thus interventions ought to be targeting these levels. Public Health Significance: Ensuring that homeless persons receive appropriate follow-up care may eventually reduce the number of re-hospitalizations, improve the overall health of the homeless population, and aid in the fight to eliminate homelessness.

There is an increased need for educational programs about health careers as evidence shows the number of American students pursing advanced degrees in science and healthcare continues to decrease. The Pennsylvania Governors School for Healthcare, a summer residential program for high school students, is designed to introduce participants to various health careers, teach students about the research process and the nature of scientific inquiry, facilitate project-based learning, refine critical thinking skills, and foster positive interactions with practicing physicians and other health professionals. Assessment instruments such as exit surveys and focus groups were developed and used to capture data on student satisfaction with the program, the influence of its curriculum on student knowledge, attitudes and awareness of various health careers and to what degree the program affected or changed student career interest. Results indicated that the majority of students felt the program increased their knowledge and awareness of heath careers and influenced their future career choice in a health profession. Student participation in healthcare curriculum, activities and interactions with health professionals provided them with a positive hands-on experience. Overall, students were highly satisfied with the program. The Pennsylvania Governors School for Healthcare significantly influenced the interest and future goals of its participants in their desire to pursue a career in healthcare. Research outcomes will be given to the Pennsylvania Governor's School for Healthcare as a program improvement tool for future programs. The relevance of public health in this thesis is to promote educational programs about health related careers as a viable method of successfully initiating and/or maintaining a students interest in the health professions.

The demographics of the United States are changing daily and the foreign population has increased with numerous languages currently spoken in the country. African refugees are one of the fastest growing populations of the U.S. many of whom have been displaced from their country due to civil unrest. An example of an immigrant population that is growing rapidly in the U.S. is the Somali Bantu whom like other immigrant ethnic populations do not have adequate access to health care because of their economic status, lack of health insurance, and cultural and language barriers. Due to these circumstances and lack of knowledge on health related issues, Somali immigrant women will choose to neglect their health over their children and spouses ignoring the importance of preventive, maternal, or reproductive health. The Institute of Medicine (IOM) and many health care providers have observed that the root causes for disparities in ethnic groups are multifactorial and complex and exist due to a range of barriers such as language, education levels, geography, and cultural familiarity. Healthy People 2010 address the health concerns of the future of the nation and in order to meet the goals and eliminate health disparities, public health practitioners must reach out to immigrant populations. This research paper presents an analysis of findings from a community-based assessment regarding the resettlement challenges and health care needs of the Somali Bantu immigrant population in Pittsburgh, Pennsylvania which is a public health issue that needs to be addressed. This research paper will also propose steps to help improve the knowledge and quality of health care for the immigrant Somali Bantu in Pittsburgh through an intervention program with the focus on women and maternal health.

Based on a social-ecological model of health, this thesis discusses the results of an exploratory, qualitative study, Photovoice Families that employed Photovoice and photo-elicitation methodology to examine how 12 lesbian women in the Pittsburgh, Pennsylvania area defined and configured their families. Participants were given disposable cameras and asked to photograph the people that they considered to be a part of their family. This study explores the structure of family within the lesbian community and the meaning attached to the roles of individuals in lesbian womens lives. Previous research suggests that many lesbian and gay people create families of choice out of a network of friends, co-workers and others because of a lack of acceptance or understanding from their families of origin. Other studies contradict these findings and reveal that lesbian women do remain connected with families of origin and that these people have important roles in their lives. Participants in this study chose parents, siblings, nieces, nephews, surrogate families, friends, their community and many other people to photograph and to call family. More important than the concepts of families of origin or families of choice was the idea that families take care of and protect each other, regardless of whether they are related by biology or friendship. This study suggests that the creation of family is an active process in which women designate people whose relationships support and affirm them. A social-ecological model of health views all aspects of a persons environment including social, cultural and family backgrounds as important factors that impact health. Support and influence from others, particularly close friends and family members, can have an impact on both a persons physical health as well as their sense of emotional well-being. By illuminating sources of social support in a population that is frequently marginalized and ignored, this study can make an important contribution to the design of public health programs and policies.

Adolescent health is a growing concern among professionals since it has been shown that the majority of deaths and disabilities that occur in this age group are largely determined by behaviors. Many adolescents engage in risky behaviors such as early sexual promiscuity, substance abuse and violence, which can have long lasting or permanent consequences. In order to significantly reduce the incidence of health disparities in these areas, public health interventions must be innovative, specific and comprehensive in addressing the behaviors that lead to such issues. It is also imperative that existing interventions address barriers many youth face including lack of knowledge and empowerment about the negative effects of risky behavior. Although challenges remain in educating and promoting health services to an ever-changing adolescent population, interventionists should focus on identifying the causes of early initiation of risky behaviors and the rationale behind why they continue. This is of public health significance because there are a number of health issues facing at-risk youth in underserved populations such as early sexual behavior, violence and substance abuse. Interventions will be identified utilizing music as a mechanism to inform youth about healthy behaviors. Adolescents are influenced by music and other forms of media which has a direct effect on their behavior. The influences of hip-hop music and its effects among adolescent behavior will be discussed. A qualitative evaluation strategy is proposed for the KRUNK Movement health initiative for youth located in the greater Pittsburgh area.

INTRO: In Tobago, HIV rates continue to increase (prevalence rate =5%). Women and youth are increasingly being infected, and heterosexual transmission accounts for most HIV infections. If these trends continue, Tobago's economic and social structure will be in jeopardy. This study has public health significance because it identifies and makes recommendations for incorporating relevant social and cultural factors into HIV prevention programs in Tobago. METHODS: Qualitative methods (participant observations, ethnographic and in-depth interviews) were utilized to unearth (a) pre- and post-HIV infection experiences of People Living With HIV/AIDS (PLWHAs), (b) relevant cultural and social 'influencer' of HIV/AIDS rates, (c) how these factors influence community norms and individual behavior, and (d) appropriate methods/model for incorporating relevant factors into HIV/AIDS prevention programs. PLWHAs, health professionals, community members and leaders were interviewed. RESULTS: 14 PLWHAs, 10 health professionals, 15 community leaders and 25 community members were interviewed. Participant observations occurred in homes, businesses, entertainment events, HIV-related organizations and health facilities. 206 PLWHAs are currently being treated in Tobago (HIV-related medications free to Trinidad and Tobago citizens). Infidelity, sex-in-exchange for resources, abuse and economic need increased PLWHAs' HIV risk. Lack of confidentiality is an issue, and stigma and discrimination are prevalent. There is lack of information about the causes, prevention and treatment of HIV in the general population. Sex is not openly discussed, however youth sexual behavior is common. Serial monogamy coupled with multiple sexual partnering increases general community risk. Consistent and correct condom use is not common, and purchasing or requesting condom use is difficult for women, youth, and married individuals. HIV testing is not common, and pre- and post-test counseling is inadequate. Current HIV prevention programs focus on abstaining, being faithful and using condoms, which do not take into account the complexities surrounding sexual decision making. There is a need for comprehensive HIV prevention programs. RECOMMENDATIONS: A client-centered, risk-reduction model of HIV prevention is recommended. Using the socio-cultural theory of learning, this study highlights the zone of proximal development, the knowledge-in-waiting, knowledge-in-use, agents of change, needed resources, and social environment needed to improve HIV prevention strategies in Tobago.

The United States has an increasing rate of homelessness due to unemployment, an absence or low availability of affordable housing, high rates of mental illness, and physical ailments that prevent productive employment. Due to economics, these homeless tend to only receive medical care through the emergency department (ED). Since the ED is not equipped to handle social issues such as housing, these individuals are often discharged directly onto the street or to shelters. As a result, these inappropriate discharges increase re-hospitalization and poorer health outcomes among this population. The purpose of our study is to explore the issue of hospitals discharging patients to emergency homeless shelters in Allegheny County. Researchers sent mailings to all of the 16 emergency homeless shelters in Allegheny County for recruitment. As a result, 22 shelter administrators and staffs from 12 of the 16 shelters (response rate=75%) participated in a face-to-face, semi-structured interview conducted at their facility. Participants shared the number of discharges they received from hospitals in the past 12 months, the appropriateness of these discharges, and possible solutions to the problem of "inappropriate discharges." Shelter administrators reported receiving 415 discharges from hospitals; they deemed 91 (22%) of the discharges as inappropriate, meaning the patients needs exceeded the resources of the shelter. Even though a majority of participants reported that their shelter was equipped to handle the medical/psychiatric care of their population, their facilities lacked the means to treat those who needed extensive medical and/or psychiatric care. To address this issue of inappropriate discharges, participants suggested that better communication between hospitals and shelters as well as the development of a medical/psychiatric respite for the homeless population (50% of participants stressed the former and 32% the latter) would alleviate this problem. Shelters, aware that this issue is a multi-faceted one, recognize the need for multiple interventions at the individual, community, and government levels to successfully combat this problem. This is a significant public health problem because by addressing the medical and psychiatric needs of the homeless population both prior to and after hospital discharge may eventually reduce re-hospitalizations and improve the health outcomes of this population.

Few studies have been carried out that examine the effects aging has on the health of older LGBT individuals. This is a matter that warrants further research, for approximately half a million gay men and lesbians turn fifty each year. As the number of aging LGBT persons grows, so does the need for competent clinical care that addresses the unique health and psychosocial issues of this population. It has been shown that discrimination against LGBT persons exists in the medical setting. Additionally, the literature suggests that medical students do not receive sufficient training regarding sexual minorities. Educating primary care physicians, medical students and other health professionals on how to communicate more effectively with aging LGBT patients can lead to improved health outcomes. This is a goal of public health. The IRB-approved study described in this thesis aimed to provide the Allegheny County Area Agency on Aging (A.C.A.A.A.) with information about the health and psychosocial issues of older ( ≥ 50) LGBT individuals living in the Pittsburgh area. Over a two-month period in 2006, a comprehensive survey was dissemintated at a variety of locations frequented by LGBT persons. The survey included questions about demographics, quality of received health care, openess about sexual orientation with one’s primary care physician, end-of-life and legal issues, and questions that addressed pertinent LGBT health and psychosocial issues. Results of the survey indicated that the majority of the sample’s respondents (N=79) reported being in good health, receiving competent health care from primary care physicians, being open with their doctors about sexual orientation, and experiencing minimal discrimination from health care providers due to sexual orientation. These positive findings differ from the somewhat discouraging information presented in the literature review. Despite this, the survey results may inspire more rigorous studies to be carried out in the future that address the health and psychosocial issues of older LGBT persons. Further studies may also bring about positive changes in medical schools’ curricula, not to mention changes in public health policies that address the nations aging population as a whole.