Community Based Participatory Research (CBPR) is becoming popular in the field of public health. While many studies focus on including adults in the CBPR process, far fewer have utilized the input and expertise of children and adolescents. Successful CBPR projects are important to the field of public health due to their ability to open the doorway to the health needs and experiences of youth. This review paper first provides relevant background information regarding the health of youth living in the United States, the importance of adopting a life course approach to public health interventions, and the field of Community Based Participatory Research. It then explains the review methodology utilized and presents the results of the literature review. Specific attention is paid to summarizing CBPR work conducted with youth and the key issues related to such work. This review concludes by providing suggestions for future successful applications of CBPR with youth populations, and discusses the benefits and challenges of conducting this type of research. Results from this review contribute to a better understanding of the importance of utilizing ideas and insights of young people in order to create programming and policy changes that effectively address their needs.

Substance abuse is related to many other health problems, thus making the topic of great public health significance. The scope of this study is the results of focus groups conducted with physicians across the state of Pennsylvania; specifically Harrisburg, Pittsburgh, and Philadelphia. The purpose was to ascertain the barriers to identifying problem alcohol and drug use in patients by practicing physicians. Physicians statewide acknowledged key barriers to screening; time, access to treatment and financial reasons, both patient financial issues or problems and reimbursement from insurers or commercial payers. Additional barriers that were identified as a result of the focus groups included stigmatizing attitude toward substance use, physicians lack of self-efficacy in managing substance use disorders, and lack of knowledge in this area, among others. The study discusses the results of the focus groups and explores the education that could be offered to physicians in order to increase their knowledge in the area of screening and the identification of problem drug or alcohol use.

BACKGROUND: The Latino population of greater Pittsburgh is considered invisible because it is not concentrated within one geographic area. This is of great public health significance, because such dispersion is a major barrier for Latinos seeking quality health care and social services. In the last ten years, this population has grown over 44%, and many of the estimated 20,000 Latinos in the Pittsburgh area do not have medical insurance. Across the nation, research has shown that Latinos often suffer from higher incidence of diseases and accidental deaths. Latinos also frequently experience limited access to health care and social services, and the level of social integration experienced by population members is directly related to this diverse communitys quality of life. METHODS: This study is based on qualitative interviews with a small, purposive sample of young adult Hispanic immigrants, a group likely to experience barriers to accessing services. A free clinic, staffed by bilingual volunteers, was the initial access point to reach uninsured population members. Interviews with participants were recorded, transcribed, and studied to discover which health care and social service needs the community feels they lack, and how their level of social integration was related to their access to services. RESULTS: The most frequently mentioned service needs were dental services, health insurance, bilingual health service providers and/or translation services, and English language classes. Social isolation, lack of legal documentation, fear, racial discrimination, and lack of cultural competence on behalf of institutional employees were frequently cited as major barriers to accessing services. The length of respondents stay in Pittsburgh did not appear to have a significant effect on improving respondents access to needed services. Access to services was related more to the size and extent of ones social network, which usually consisted of family members who had lived in Pittsburgh before the respondent arrived, or which grew slowly over the time the respondent lived in Pittsburgh. CONCLUSIONS: Pittsburghs Latino population would benefit from increased outreach efforts and increased community mobilization strategies. As a new growth community, Pittsburgh service providers are not fully prepared to reach the needs of the population. Additional research, qualitative in nature, will help to increase awareness and understanding of the challenges faced by this community as it seeks to access much needed services and health care.

Minorities suffer disproportionately from tobacco smoke-related morbidity and mortality nationwide. Tobacco-related illnesses are responsible for approximately 47,000 deaths of African Americans annually. Furthermore, greater tobacco- related health disparities exist among African American women in the state of Pennsylvania and the city of Pittsburgh; as the local and state maternal smoke rates exceed the national average. Additionally, low birth weight and infant mortality rates linked to maternal smoking has been disproportionately elevated among African American women in this geographical area. African American mothers who quit smoking generally have higher relapse rates than their Caucasian counterparts. Research limitations in understanding the smoking cessation, self- quitting and relapse prevention among African American women particularly in Pittsburgh, PA; serves as a foundation for this study. Thus, two focus groups were conducted with a sample of 13 African American maternal smokers in the Pittsburgh area to assess their smoking and quitting experiences as well as their unmet needs for cessation treatment. A brief survey was administered to ascertain the participants socio demographic characteristics. The data collected mirror previous research as nicotine addiction, stress and poor social surroundings act as barriers to successful quitting. The women identified willpower as the key to permanent smoking cessation but lack the self-efficacy to quit. Recommendations for advanced investigations and cessation programs for this population are provided. The findings from this exploratory study are significant to public health research as they provide a guide for future research and offer valuable insight for modifying and creating effective smoking cessation interventions for African American women; which can produce long term effects by decreasing the maternal smoking rate disparity in Pittsburgh, Pennsylvania.

Background: Over the past two decades, obesity among women has significantly increased, with women having the highest prevalence in the United States. Obesity prevention programs and interventions focusing on women have traditionally included individual-level approaches although obesity is a multi-level problem. The research literature has cited numerous factors that contribute to obesitybehavioral, personal, psychological, sociodemographic, environmental, biological, and childbearing. As a result, recent public health efforts have shifted away from individual approaches to those that handle multiple factors. Methods: While multiple factors have been associated with obesity among women, the degree and variability of the factors have not been determined in the literature. These three studies seek to explore the effects of the multiple factors on BMI in U.S. women using the International Classification of Functioning, Disability and Health (ICF) Core Sets for Obesity, developed by the World Health Organization and data from the National Health and Nutrition Examination Survey (NHANES). Linear regression was used in the analyses. Results: Significant factors of obesity were sociodemographic information (age, income, and race), body weight perceptions, coexisting health conditions, physical functioning, and engaging in physical activity and proper nutritional practices. Conclusions: Obesity prevention and treatment programs for U.S. women should focus on the most significant factors identified in these studies to decrease obesity incidence and prevalence. Public Health Relevance: The information garnered from this study can be used to further identify the most important characteristics needed for future obesity prevention programs for women.

This thesis describes and assesses existing services for homeless persons with mental illness and suggests improvements. The topic of services for homeless persons with mental illness is of public health significance since the problem has been getting worse in the past few years, with people unable or unwilling to access appropriate services Mental illness in the homeless population is looked at from a social-ecological perspective, including individual, community and policy levels. Current national programs are discussed including Medicaid, SSI, HUD, SAMHSA and ACT. The McKinney Act is discussed as one of the most important pieces of homeless policy. A more in-depth discussion of Allegheny County community capacity and services for homeless persons with mental illness is included. Housing First/Harm reduction, Operation Safety Net, Community Human Services Corporation, Health Care for the Homeless, Mental Health Courts and Police Training are discussed. Key informant interviews reveal frustrations with funding streams, lack of affordable housing and lack of appropriate job opportunities, specific to Allegheny County. An extension of this thesis to include focus groups and interviews with homeless individuals and shelter staff would reveal a more comprehensive view of homeless persons with mental illness. Suggestions for improvements in providing mental health services include, following the housing first/harm reduction model, improving quality of life through increased social supports of this population, advocacy of homeless persons with mental illness, an increase of funding streams that promote collaboration among community agencies, more street outreach for the chronic homeless population and overall more collaboration among different agencies in Allegheny County including, government, social services, education, police and emergency services.

Amyotrophic lateral sclerosis (ALS), an incurable neuromuscular disease, causes progressive paralysis resulting in respiratory failure and ultimately death. Although there are only 30,000 people nationwide living with ALS, this population is of significant public health concern as those afflicted with ALS suffer from progressive symptoms of disability, making them a particularly vulnerable population in need of public health advocacy for improved access to medications and care. As the symptoms of disability become increasing acute in the final months of life, achieving the best quality of life possible is of paramount importance. To achieve this, a number of medications exist to both treat the direct and indirect symptoms of ALS. The purpose of this thesis is to examine barriers terminal ALS patients experience in accessing medications, medication trends as ALS patients near death, and the effect of medications on quality of life for ALS patients in the terminal phase of the disease. Literature pertaining to the terminal phase of ALS was reviewed and an analysis of secondary data was performed. The data analyzed for this thesis was from the National Institute of Mental Health grant funded Living with ALS study, which collected medication data in the preceding months before death from terminal ALS patients. For the purposes of this analysis, patient medications were categorized into four domains: ALS treatment medications, palliative medications, mood medications, and other medications. The correlation between the medication domains and sociodemographic and quality of life indicators were investigated. Changes in medications over time were also investigated. Results of the analysis revealed that those with higher incomes and educational attainment were taking significantly fewer palliative medications. Additionally, those on Medicaid were on significantly fewer other medications. Finally, across all medication domains, medication use declined significantly as patients approached imminent death. These findings suggest that the medications used to treat the symptoms of ALS do little to improve symptoms and even less to improve quality of life. Future research recommendations include exploring patients motivations for discontinuing medications, improving symptom management medications, and improving ALS patients access to both pharmacological and non-pharmacological interventions to improve overall quality of life.

There is a substantial body of evidence that demonstrates an association between religiosity and health outcomes in adults of all ages. Many studies have demonstrated that factors such as religious importance and service attendance may provide social vehicles for factors such as increased access to health care, better management of chronic diseases, and increased availability to preventive health services and education. These religious factors may also influence the way in which a person perceives and copes with his or her health issues. Successful aging theory is a combination of three factors or characteristics: low risk of disease and disease-related disability, high mental and physical function, and active engagement with life. This theory allows for a more holistic approach to aging and health. The overall goal of this observational study using quantitative data from the 1994/95 National Survey of Midlife Development in the United States (MIDUS) was to analyze whether any statistically significant relationships exist between religiosity defined as religious devotion, importance, influence, and service attendance and the three factors of successful aging. The results demonstrated significant relationships between all religiosity variables and active engagement in life. Other statistically significant findings were discovered with the factors: self physical and mental health rating, times in the hospital, routine visits to the doctor, and certain religiosity variables. Many of the findings still existed when analyzed across demographic co-variants. Finally, the use of a theoretical model and logistic regression demonstrated that active engagement in life may be a bridge variable between successful aging health outcomes and service attendance. The results dont show more religion means healthier, but that religion can play an intricate role in an individuals own health. The public health relevance of the study is to make public health professionals aware of the relationships that exist between religiosity and successful aging health outcomes. Religious venues may provide a good resource for preventive health services and education. Most importantly, a persons religious beliefs may affect the way a person deals with physical or mental illness. Public health professionals should embrace the religious beliefs of patients regardless of their own beliefs.

This study looks at the vulnerable population of refugees, specifically refugee youth. Specific attention is paid to mental health issues, notions of belonging, adapting, and acculturation, and the potential role that career guidance education can play in positively impacting the mental health and long-term resettlement success of refugee youth. Results from a search of published literature and interviews with local resettlement organizations in Pittsburgh, PA are summarized. The findings show that the experiences of traumatic events in their country of origin and that life conditions in countries of resettlement, significantly impact the mental health and development of refugee health. Mental health conditions noted in refugee populations include post-traumatic stress disorder, anxiety and depression. Evident in the literature is the hope that the role of education holds for refugee youth and the positive gains that a sense of school belonging has on their depression levels. Career guidance education curricula for general student populations in the United States, has multiple social, educational, and economic benefits. This study suggests that career guidance education curricula targeted to resettled refugee youth, could increase their sense of self-agency, self-efficacy, and empowerment thereby increasing feelings of overall well being and leading to long-term resettlement success. The issue of the status of refugee youths mental health and the potential role that career guidance education can have in helping them understand, think about, and plan for their future is extremely salient to the field of public health. However, it is unknown whether or not career guidance education curricula would be relevant to refugee youth due to differing cultural models dictating career choice and expectations. Recommendations for future research and program development addressing the health and well-being of refugee youth in the Pittsburgh area are provided.

The death of a close family member is a profound insult to a childs developmental course. Though early research assumed that childhood bereavement was a risk factor for mental and behavioral disorders in childhood and adult life, recent research has taken an ecological view of childhood development and considers a childs exposures to risk and protective factors. Yet, it remains unclear as to how many children are affected by the death of a close family member each year and how peer support groups can help children to adapt to such an adverse event. This dissertation represents three distinct stages in the development of a comprehensive evaluation for an agency that provides a peer support service for bereaved children and their families. First, a primary question that arose during initial consultations with the agency was to determine how many children are affected annually within Pennsylvania. This led to an exploration of the epidemiology of childhood bereavement. The methods and data sources used to produce these estimates were critically evaluated and modified to offer a new interpretation of available data. Second, it was important to identify constructs that could be used in an outcomes evaluation of the peer support program. Focus groups were used to explore the perceived benefits of attending peer support groups among caregivers and teens who had attended a spring session at the center. The intention to use focus groups was to increase the validity of constructs and, ultimately, the results of an outcomes evaluation. Third, after identifying evaluation constructs a feasibility study was conducted to pilot an outcomes evaluation instrument. The study involved 30 families who attended the spring 2007 sessions at the center. Results suggested that peer support programs can improve childrens coping efficacy while helping to improve their caregivers perception of social support. The program also improved both children and caregivers sense that they are not alone in their grief. As demonstrated in this dissertation, including the loss of siblings and primary caregiving grandparents in prevalence estimates of childhood bereavement and applying resilience theory to peer support research is of public health relevance.