While tobacco use remains a leading preventable risk factor for mortality and morbidity in Canada (Patra, Rehm, Baliunas & Popova, 2007), the overall smoking prevalence rate of Canadians has decreased substantially from close to 50% of the population in 1965 to 16.1% of the population in 2012 (Canadian Tobacco Use Monitoring Survey (CTUMS) 2012; Reid, Hammond, Rynard & Burkhalter, 2014). However, up to 85% of individuals with a mental illness continue to use tobacco products (Harris, Parle & Gagne, 2007), contributing to an inequitable distribution of negative health outcomes for this population. Individuals with severe mental illness die an estimated twenty-five years earlier than the general population, with sixty per cent of these deaths due to cardiovascular, pulmonary and infectious disease (Parks, Svendsen, Singer, & Foti, 2006). A recent study that examined specific tobacco-attributable deaths in these populations found that tobacco accounted for 53% of deaths in individuals with schizophrenia, 50% of all deaths for those diagnosed with a depressive disorder, and 48% of all deaths for those with a diagnosis of bipolar disorder (Callaghan et al., 2014). This research project is intended to increase our understanding of what constitutes an effective intervention for smoking cessation and smoking reduction in a population of individuals with severe mental illness who are homeless or vulnerably housed, living in a large urban setting. Two areas of inquiry were proposed. The first inquiry examined data collected as part of a needs assessment to determine the overall prevalence rate of smoking and related behaviours for a population of individuals with severe mental illness receiving services from a community mental health agency. We found that the tobacco use prevalence was 72%, and 62% of smokers had high or very high levels of nicotine dependence; however almost half of respondents (47%) were interested in quitting or reducing tobacco within the next 6 months. Smokers were found to be over 9 times more likely to have a co-occurring substance use disorder (OR=9.44, 95%CI[6.33,14.08]). The second inquiry was a pilot study conducting a randomized controlled trial design to evaluate smoking cessation and smoking reduction outcomes for two groups of individuals (n=61) with severe mental illness receiving different smoking cessation interventions. Clients randomly assigned to the routine Smoking Cessation group (SC-R) received up to 24 weeks of no-cost Nicotine Replacement Therapy (NRT) and clients assigned to the Smoking Cessation Plus group (SC+) received up to 24 weeks of no-cost Nicotine Replacement Therapy (NRT) plus two initial individual sessions of motivational interviewing followed by weekly psychosocial group interventions for up to 24 weeks. Primary outcomes were levels of tobacco use at the 3-month and 6-month follow-up. The 7-day point prevalence abstinence rate measured at 3 months was 21.9% (n=7) for the SC+ group and 13.8% (n=4) for the SC-R group (OR=1.75,95%CI[.46,6.74]). At 6 months, the 7-day point prevalence abstinence rate was 12.5% (n=4) for the SC+ group and 6.9% (n=2) for the SC-R group (OR=1.93, 95%CI[.33,11.41]). Secondary outcomes included change in reported quality of life, physical health and mental health status functioning over the course of the study. We found that there were no statistically significant differences in the smoking quit or smoking reduction rates between the two treatment groups. At the 3-month time point the overall quit rate for both groups combined was 18% (n=11) and at the 6-month time point the quit rate was 10% (n=6). Reduction in the number of daily cigarettes smoked was statistically significant over time (F [1.68, 98.90] = 55.13, p < .001, η p 2 = 0.48) for both groups, as was the overall reduction of the FTND score (F [2, 94] = 17.98, p < .001, η p 2 = 0.28). This research demonstrates that collecting vital tobacco prevalence and dependency information is a straightforward and important task for community mental health agencies. Individuals with mental illness have both the interest and ability to quit or reduce their use of tobacco. Practitioners need to be aware of alternative smoking practices that may contribute to understanding tobacco use patterns and dependence in this population. Other factors such as co-morbid substance use disorder and level of community functioning may influence smoking status and, consequently, how treatment is provided. The findings of the pilot trial demonstrate the feasibility of conducting smoking cessation research with the population. Findings also suggest that a larger definitive trial is warranted to examine the effectiveness of the SC+ intervention. This research adds to the limited but growing knowledge base of how to address tobacco use and provide treatment to this vulnerable group, and will contribute to advances in population health by informing effective interventions with the attendant implications for program and policy development.

New immigrants to Canada are identified as a vulnerable population in mental health and, as a result, organizations are signaling the need to enhance their mental health supports. The research uses focus groups and questions based on the messaging of a Canadian school mental health program to understand how new immigrant mothers interpret and develop key aspects of their mental health literacy and how they attain parent empowerment. A thematic assessment of the knowledge, interpretation, action and decision-making of the study participants (n=7), all recent immigrants to Canada and mothers of high school students, shows that new immigrant mothers are prepared to follow a path towards mental health literacy. At the same time, however, there are barriers that can block progression towards mental health literacy for this audience. These findings are supported by three umbrella themes: the first main theme “home as haven” espouses maternal roles in mental health maintenance such as protector and communicator, the second main theme “knowledge versus suspicions of mental health and mental illness” represents informed views and support of mental illness and myths and illusions of mental illness, and the third main theme, “additional barriers to mental health literacy” includes the hardships of immigration and fear of knowledge. The study concludes that new immigrant mothers appreciate the importance of fostering mental health understanding and discussion with their children at the same time that they encounter obstacles to the advancement of their mental health literacy. This study is relevant to the field of communication in that it demonstrates the experience of new immigrant mothers as a secondary audience in mental health programming. As the caregivers of their children, they are in position to enforce the messages and health maintenance behaviours of a school-based mental health program aimed at adolescents.

Diante da realidade de segregação residencial existente no Brasil, determinada pela heterogeneidade de renda, de condições sociais entre bairros e distritos, evidencia-se uma sociedade cada vez mais penneada por iniquidades sociais e ambientais. Somado a isto, há o fato do crescimento da concentração populacional em áreas urbanas. Este e outros fatores geram transformações nas estruturas das cidades acentuando conflitos referentes ao uso e ocupação do solo. Tais conflitos requerem agilidade de suprir demandas de fornecimento de serviços essenciais, tais como de abastecimento de água e esgotamento sanitário, especialmente quando se trata destes serviços às populações vulneráveis. Para apoio a medição e visualização desse cenário, de forma a elaborar políticas públicas e empresarias, é fundamental a utilização de indicadores, os quais, no entanto, não estão prontamente disponíveis. Emerge assim a necessidade de proposição de indicadores que mensurem o fornecimento dos serviços às populações vulneráveis em áreas urbanas. Neste contexto, com estudo de caso para o Estado de São Paulo, Brasil, a pesquisa teve como enfoque atuar na interface teórica e prática para proposição de indicadores. Foram realizadas, então, revisão bibliográfica, análise documental e discussão crítica com base no aprendizado do estudo de caso. Doze indicadores foram propostos e um sistema de indicadores de benchmarking dos serviços de abastecimento e esgotamento sanitário voltados às populações vulneráveis foi estruturado. O sistema e os indicadores foram identificados por meio do alinhamento de diferentes visões dos atores, o que permitiu que fossem condizentes com a realidade dos serviços, e posteriormente, mais facilmente implementados. / The income heterogeneity and social conditions between neighborhoods and districts show a society increasingly permeated by social and environmental inequities by means the reality of residential segregation that exists in Brazil. In addition, there is population growth occurred concentrated in urban areas, this and other factors that generate transformations in the structures of cities accentuating conflicts regarding the use and occupation. Such conflicts require flexibility to supply demands for essential services such as to provi de water and sanitation services, especially aimed to vulnerable populations. For the measurement and visualization ofthis scenario, in order to produce the policies and business, it is essential to use of indicators, which, however, are not readily available. Thus emerges the need to propose indicators that measure the provision of services to vulnerable populations in urban areas. In this context, with case study in Sao Paulo State, Brazil, the research was focused on theoretical and practical interface to proposed indicators. Were performed also, literature review, document analysis and critical discussion based on the learning case study. Twelve indicators were proposed and a system of benchmarking indicators for the water supply and sanitation services to targeted vulnerable populations was structured. The framework and indicators were proposed by aligning different views of the actors, in a way to be consistent with the reality of services and more easily implemented.

As populações remanescentes de quilombos tiveram seu direito à propriedade das terras que ocupam garantido pelo Art. 68 dos Atos das Disposições Transitórias da Constituição Federal de 1988. Entretanto, essas populações ainda enfrentam dificuldades de acesso a serviços essenciais como os de saúde. A proposta deste trabalho é apresentar dados referentes ao acesso a serviços odontológicos e estimar a necessidade de prótese da população quilombola de Santo Antônio do Guaporé, Rondônia, Brasil. Para isso, foi realizado um estudo transversal seguindo a metodologia proposta pelo Projeto SB Brasil 2003 para identificar as condições de acesso e a necessidade de prótese dessa população. Foram examinadas 29 pessoas acima de 12 anos de idade. Das 62,1% dessas pessoas que consultaram o dentista pelo menos uma vez; 37,9% consultaram havia mais de três anos; 41,4% foram atendidos no serviço público; para 58,6% dos examinados, o motivo da consulta foi a dor e 44,8% avaliaram o atendimento como bom. Em relação à necessidade de prótese, 48,3% necessitam de prótese superior e 72,4% inferior; 17,2% necessitam de combinação de próteses superior, e 13,8% inferior. Os dados apontam a dificuldade das condições de acesso ao serviço odontológico, e a precariedade das condições bucais, marcadas pela necessidade de tratamento reabilitador. / The leftover populations of hiding-places had a right to the property of the lands that they occupy guaranteed by Art. 68 of the Acts of the Transitory Arrangements of the Federal Constitution of 1988. Meantime, these populations still face difficulties of access to essential services like those of health. The proposal of this work is to present data referring to the access to odontologic services and appreciates the necessity of prosthesis of the population fugitive Negro slave of Saint Antônio of the Guaporé, Rondônia, Brazil. For that, a cross study was carried out when Brazil 2003 is following the methodology proposed by the Project SB to identify the conditions of access and the necessity of prosthesis of this population. 29 persons were examined above 12 years of age. Of 62,1 % of these persons who consulted the dentist at least once; 37,9 % consulted that there were more than three years; 41,4 % was attended in the Civil Service; for 58,6 % of the examined ones, the cause of the consultation went to pain and 44,8 % they valued the service like good. And relation to the necessity of prosthesis, 48,3 % needs superior prosthesis inferior and 72,4 %; 17,2 % needs combination of próteses inferior superior, and 13,8 %. The data point to the difficulty of the conditions of access to the odontologic service, and the precariedade of the buccal conditions, marked by the necessity of treatment reabilitador.

Background: In Canada, failure to disclose HIV+ status before sex can result in incarceration and status as a registered sex offender for life. In 2012, the Supreme Court of Canada ruled that there is no legal mandate for HIV disclosure before sex if (i) a condom is used and (ii) HIV viral loads are extremely low. There is very little known about how the legal mandate for HIV disclosure might inequitably affect the health and safety of sex workers. Purpose: This study critically interrogates the interplay between the legal mandate for HIV disclosure and the routine health-conscious practices (e.g., HIV testing, condom use) of HIV-negative survival sex workers, with particular attention to inequitable health and safety outcomes. This study also qualitatively investigates the structural and social forces that mediate vulnerability to HIV infection and transmission among sex workers, their clients, and their non-commercial, intimate partners. Method: This study employed an adapted grounded theory approach to conducting and analyzing (n=9) open-ended, in-depth interviews with a convenience sample of currently working and recently exited sex workers who were clients at PEERS, an NGO offering services and support to sex workers in Victoria, Canada. Findings: The criminalization of HIV nondisclosure had no discernable influence on behavioural HIV risk factors or HIV testing. Participants lacked accurate knowledge of the legal mandate for HIV disclosure. HIV-related health literacy was low. Participants strongly supported HIV disclosure as a legal obligation – but only for exacting justice, and not for reliably offering protective health benefits. The uptake of high-risk sexual practices was driven almost exclusively by (i) extreme needs when servicing clients (e.g., drugs, childcare, money) and (ii) the rich symbolism of condomless sex in non-commercial, intimate partnerships. Participants reported differential degrees of entrenchment in the sex trade at various times in their working lives due to extreme needs. Participants emphasized the importance of ongoing HIV testing as a personal responsibility in order to monitor and maintain their sexual health. Participants identified increased uptake of HIV-related knowledge as affording the most significant protective health benefits against HIV infection. Implications: Lower levels of HIV-related health and legal literacies in the sample call for greater scrutiny of the impacts of initiatives such as ‘Seek and Treat for Optimal Prevention of HIV/AIDS’ (or STOP HIV/AIDS®) which target vulnerable populations across British Columba [BC]. Deeply entrenched sex workers have little recourse to exit the sex trade immediately upon receiving an HIV+ test result, especially in under-resourced social assistance milieux. Targeting this population for HIV testing facilitates the creation of a new caste of HIV+ potential criminals, despite the well-established, beneficial health outcomes at the individual and population levels from early commencement of antiretroviral treatment. Conclusion: Survival sex workers require special considerations in HIV pre-test counselling. The empowerment of sex workers can come firstly through the enhancement of HIV-related health – and legal – literacies. Full knowledge of the advantages and disadvantages of HIV testing will allow the consent for HIV testing to be truly informed. New HIV testing guidelines make BC the first province to recommend regular HIV screening for all adults. These guidelines also recommend exclusion of discussions of the criminalization of HIV nondisclosure in pre-test counselling for all patients. Re-thinking the consent for HIV testing among sex workers is crucially important for their immediate health and safety. / Graduate

No description available.

El cambio climático es atribuido directa o indirectamente a la actividad humana y se considera como la mayor amenaza a la salud pública del siglo XXI. Tiene impactos sobre el acceso al agua, la alimentación, en la agricultura y medios de vida, y en la salud de las personas. El objetivo de este texto es evaluar las percepciones del cambio climático en niños, niñas, adolescentes, autoridades y representantes de organizaciones juveniles, de mujeres y que trabajan con la niñez en las regiones de Cusco, Loreto y Piura, en Perú. Para ello se realizó un estudio cualitativo que utilizó la técnica de Fotovoz con doce adolescentes y entrevistas a profundidad con veintidós actores clave. Para el análisis se utilizaron las narrativas en las fotos y el análisis temático de las entrevistas. En las tres regiones se identificaron cambios extremos en el clima. En la región de Cusco reconocieron el cambio de temperatura con sequías y heladas, mientras que en Loreto y Piura manifestaron aumento en la intensidad de lluvias. En general, estos cambios afectaron la agricultura. El cuidado del agua como recurso, tanto en su acceso y calidad, fue una gran preocupación para todos los participantes. El estudio concluye que no se identifica el concepto de cambio climático como tal, sin embargo, describen cambios y variaciones en el clima que afectan sus actividades diarias, en particular la agricultura. Un tema transversal a todas las regiones fue el cuidado y uso del recurso del agua. Además, los jóvenes se mostraron particularmente entusiasmados en colaborar en iniciativas futuras contra el cambio climático.

The purpose of this descriptive phenomenological study was to give voice to an underserved and vulnerable population in Uganda, Africa to advocate for health priorities. Nineteen members of the village of Namagera, identified as a leper colony, were selected by community members and volunteered to participate in every element of this study. Descriptive phenomenology was the guiding philosophy and community-based participatory research methods and photovoice provided the lens for social action. Leininger’s theory of culture care diversity and universality (Leininger & McFarland, 2006) anchored the study in cultural caring and the community nursing practice model (Parker et al., 2020) kept the researcher grounded in the purpose of advancing the science of caring in community nursing. The research team included the researcher, the 19 participants, and six research assistants, who also served as language facilitators. Using photovoice methods, participants identified strengths and needs and used digital cameras to capture health concerns in the community. Eighty photos were analyzed by the participants and priorities were determined. The selected photos were placed on a photo board and shared with the whole community for input. Community members selected the health priorities and ranked them in importance: access to clean water, sanitation, disease, challenges for the elderly and disabled, lack of medical treatment, transportation, unemployment, and protection of the environment. The participants categorized the health priorities into three clusters of themes: basic needs, safety, and social/environmental. The themes were further incorporated into action plans identifying impeding factors for which the community would require outside assistance and promoting factors for which the community could solve themselves. Findings of this study illuminate the emergence of community empowerment: Community members found their voices, identified health priorities, and advocated for solutions. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2020. / FAU Electronic Theses and Dissertations Collection

The lifetime prevalence of posttraumatic stress disorder (PTSD) ranges from 1 to 14 percent in the general population. Diagnosis is based on criteria that address hallmark symptoms of the disorder from re-experiencing the trauma to hyperarousal, emotional numbing, and avoidance of memories, thoughts, or feelings associated with the event. PTSD is particularly prevalent in vulnerable populations and comorbid with substance use disorders, serious mental illness, or both. Psychological treatment options are more strongly recommended than pharmacological treatment by the American Psychological Association (APA); however, the efficacy of psychotherapy is less studied in vulnerable populations for fear that substance use or mental health outcomes will worsen. Prolonged exposure (PE) therapy and cognitive processing therapy (CPT) are the most investigated forms of cognitive behavioral therapy (CBT) in vulnerable populations and involve overcoming the trauma through repeated exposure for PE or processing with a clinician for CPT. A review of all randomized controlled trials (RCTs) that have evaluated the effect of either form of CBT on non-combat PTSD, substance use disorder (SUD), and mental health outcomes found that PE administered alongside SUD treatment had the greatest positive impact on PTSD and SUD outcomes. PE also had a better impact than CPT on PTSD outcomes in individuals with PTSD and serious mental illness (SMI); however, neither form of CBT performed substantially better than the other with respect to mental health outcomes. In future studies, the impact of psychological treatments on PTSD and other health outcomes needs to be assessed on the same variables in larger populations of vulnerable individuals that are inclusive and representative of those receiving care for SUD and SMI in community health care settings.

The homeless population in Anchorage, Alaska faces many unique challenges. Over the past several winters, a number of homeless individuals have succumbed to the effects of exposure despite available cold weather services. This study investigated individual experiences within the homeless population of Anchorage, Alaska during times of inclement winter weather. Self-determination theory was used to explore motivations of behaviors of the population and to uncover the reasons why this population does not use cold weather services offered by the Municipality of Anchorage. The research questions addressed participant awareness of available cold weather services, survival strategies during inclement winter weather, and barriers to cold weather service use. This phenomenological study examined those lived experiences. Purposeful sampling was used to recruit eligible individuals (n = 14) at a local soup kitchen, and participants engaged in semistructured interviews. Data analysis procedures used McCormack's lenses and horizontalization to reveal emerging themes. Key findings included a lack of knowledge of emergency services, various survival strategies, and self-imposed barriers to services. The implications of these emerging revelations may positively influence public health providers to modify education delivery methods and interventions used to reach the homeless population in Anchorage, Alaska, with the ultimate goal of preventing wintertime mortalities.