Community Action Program Research Articles

Critical Literacy among the Working Poor: Individualism and Pseudostructural Interpretive Narratives of Health Inequalities

Critical literacy is akin to a sociological imagination as it involves the ability to distinguish between private troubles and public issues and the competency to use such distinctions to facilitate and engage in social change. This article is a case study of low-income rural Whites' personal interpretations of health and income inequalities with a concern for understanding the potential effectiveness of a community action program (CAP) designed to enhance their critical literacy. Findings reveal that low-income rural Whites predominantly use ideologies of individualism to interpret the inequalities experienced by others, they employ a pseudostructural level analysis tempered by individualism to interpret their experience of health and income inequalities, and they respond collectively along racial and national lines when considering overall inequalities. Based on these findings, I provide suggestions on how CAPs can more effectively elevate the critical literacy of low-income rural Whites.

Dissemination of Prevention: Community Action Targeting Alcohol Use-Related Problems at Licensed Premises

In 2003, a community action program targeting alcohol use–related problems at licensed premises was disseminated to municipalities in Stockholm County. The intervention program includes local mobilization, training in responsible beverage service, and stricter enforcement of extant alcohol laws. This research studies the dissemination process, which was based on Diffusion of Innovations Theory. The communities followed a systematic model for dissemination: engaging a local coordinator, conducting interviews with owners of licensed premises, creating an action group, presenting results from studies to the local media, and initiating training in responsible beverage service. Evaluation of uptake is based on meeting minutes from local action groups and activity reports. Preliminary results indicate that the dissemination strategy has been fairly successful. Half of the communities (7 of 14) contacted are implementing the model program. Further research is needed to more fully explore the potential of the use of the Diffusion of Innovations Theory, taking into consideration different stages of community readiness.

Health Impact Assessment on the Benefits of Reducing PM2.5 Using Mortality Data From 28 European Cities

P-003 Introduction: The proposed new European Directive on ambient air quality has generated debate regarding the establishment of appropriate PM2.5 values. An annual average of PM2.5 concentration of 25 μg/m3 by 2015 has been proposed. This study estimates the potential benefits in deaths that could be prevented, by reducing PM2.5 annual levels to 25, 20, 15 and 12 μg/m3 respectively. Methods: Population data, total deaths and annual mean concentrations of PM10 from 28 cities of the APHEIS network for 2001 or 2002 were used. The Health Impact Assessment (HIA) exposure-response functions (ERF) for total mortality were derived from Pope et al 2002. PM10 measurements were corrected in order to compensate losses of volatile particulate, and converted to PM2.5 using a local conversion factor; if not available, the default European factor of 0.7 was used. Attributable cases were estimated using a software created by the French Air Pollution and Health Surveillance Programme (PSAS-9). Results: The total study population is 44 million inhabitants. Mean annual levels of corrected PM10 ranged from 17.0 to 67.8 μg/m3. Conversion factors from PM10 to PM2.5 were quite heterogeneous ranging 0.3 to 0.8. The derived PM2.5 values ranged from 7.2 to 43.4 μg/m3. Three cities had PM2.5 annual levels below 12 μg/m3 with eight above the 25 μg/m3 level. The HIA indicates that reducing the PM2.5 levels to 12 μg/m3 could prevent 21391 premature deaths per year across the 28 cities studied (95% confidence Interval 5848–35732). HIAs for reductions in PM2.5 annual mean concentrations to 15, 20, and 25 μg/m3 estimated potential gains of 16143 (4407–27001), 9857 (2686–16510) and 6359 (1777–11077) less premature deaths respectively. Discussion and Conclusions: Direct PM2.5 measurements were not used in this HIA, but a previous study showed that converted PM2.5 from PM10 levels were quite similar to measured levels in 12 cities where both measures were available (Apheis 2005). Although several limitations have been described related to HIA methodology, this approach is useful to estimate health impacts and to help in developing a new environmental policy. Important benefits in delaying premature deaths could be achieved by reducing PM2.5 annual levels through European cities. Reducing annual mean levels of PM2.5 to 20 μg/m3 could prevent 55% more premature deaths than a reduction to 25 μg/m3. This reduction in deaths would reach 154% and 236% if levels were reduced to 15 or 12 μg/m3, respectively. More recent cohort studies have suggested even greater risk reductions from lowering PM2.5. The Apheis programme was supported by the European Commission DG SANCO programme of Community action on pollution-related diseases.

Health Impact Assessment of PM10 on Mortality and Morbidity in Children in Central-Eastern European Cities

SAA5-O-07 Background and Objective: The 4th Ministerial Conference on Environment and Health adopted the Children's Environment Health Action Plan in 2004. The aim of regional priority goal III is to prevent and reduce respiratory diseases due to outdoor air pollution, and the frequency of asthmatic attacks. The objective of this study was to estimate the potential benefits in terms of childhood deaths and morbidity that could be prevented by improving ambient air quality in Central-Eastern European cities of the Apheis network participating in the ENHIS programme. Methods: Exposure-Response Functions for HIA in children were selected for long-term effects of PM10: total and respiratory postneonatal mortality (Lacasaña et al, 2005), postneonatal Sudden Infant Death Syndrome (SIDS) (Woodruff et al, 1997), and for short-term effects we looked at hospital respiratory admissions in birth to 14-yr-old children (Anderson et al, 2004). Six Central-Eastern European cities summing 8 millions inhabitants provided data on PM10, mortality and morbidity of children for the year 2001. Attributable cases were estimated using software created by the French Air Pollution and Health Surveillance Programme (PSAS-9). Two scenarios were used for long-term effects of PM10 and postneonatal mortality (total, respiratory, and SID syndrome): reduction of the annual mean value of PM10 to a level of 40 μg/m3, to 20 μg/m3 (Limit of 1999/30/CE Directive for 2010), and by 5 μg/m3. For HIA on short-term effects of PM10 and hospital respiratory admissions in children under 15 year: reduction of PM10 levels to a 24-hour value of 50 μg/m3 in all days exceeding this value (Limit of 1999/30/CE Directive), to 20 μg/m3 and reducing by 5 μg/m3 of all the 24-hour values. Results: The yearly mean values of PM10 ranged from 22.0 to 62.0 μg/m3. All other things being equal in the participating cities, reduction of the annual mean value of PM10 to a level of 40 μg/m3 would prevent yearly around 7 cases of total postneonatal mortality in Cracow and Bucharest. A reduction to a level of 20 μg/m3 would prevent 21 total postneonatal deaths in the 6 cities, one respiratory and 2 SID cases in 3 cities with available data. A short-term reduction of PM10 concentration to a 24-hour value of 20 μg/m3 would prevent 186 hospital admissions for respiratory diseases in 3 cities. Discussion: The results indicate that reductions in PM10 concentrations can beneficially protect children's health in Central-Eastern European cities. Acknowledgements: The ENHIS programme is supported by the European Commission DG SANCO (Grant No. SPC 2003112). The Apheis programme was supported by the European Commission DG SANCO programme of Community action on pollution-related diseases (Contract Nos. SI2.131174 [99CVF2-604]; SI2.297300 [2000CVG2-607]; SI2.326507 [2001CVG2-602]) and the participating institutions in 12 European countries.

A community action programme for reducing harmful drinking behaviour among adolescents: the Trelleborg Project

To evaluate a 3-year community intervention programme by measuring changes in drinking patterns in a 15-16-year-old population. The action programme included five demand-reducing and one supply-reducing interventions. Cross-sectional, non-repeated data were collected from a questionnaire distributed in classrooms from 1999 to 2001 and 2003 (n = 1376, 724 boys and 652 girls; response rate = 92.3%). Stepwise logistic regression analyses were used to determine the relationship between different risk factors and excessive drinking, heavy episodic drinking, purchaser of alcohol and alcohol provided by parents. The results from the intervention community were also compared with similar Swedish cross-sectional data sets. The results of our analyses indicated a decrease in harmful drinking behaviour in Trelleborg when comparing baseline with postintervention measurements. The comparison with other studies showed that the changes in these indicators were more rapid and consistent in Trelleborg. Finally, the multivariable logistic regression analyses showed that the outcomes were not likely to be attributed to changes in environmental factors. We concluded that a community action programme based on the systems approach reduced hazardous alcohol consumption effectively among adolescents in Trelleborg.

Intergenerational Community Action and Youth Empowerment

Empowerment theory can provide a useful framework for the design and evaluation of intergenerational community-building programs. Using an intervention research approach that draws heavily on empowerment theory, the author designed, facilitated, and evaluated an innovative model for intergenerational community engagement involving undergraduate students and older adult residents of an assisted living facility. This “Intergenerational Community Action Group” met at the assisted living facility throughout a school year to engage in group-building activities, to discuss and choose an issue of concern to them in the community, and to plan and implement an action project to address the issue. This article discusses the use of empowerment theory in intergenerational community action and similar programs, and reviews the empowerment outcomes for youth participants in the Intergenerational Community Action Group.

EFFICIENT INTERACTIVE TOOLS FOR CONTINUOUS EDUCATION INFORMATION EXTENSION

This paper is part of the dissemination activities of the project “Quality Management Network for CEECs (Central And East European Countries)” in the frame of Leonardo da Vinci Programme, Community action programme on vocational training, Procedure B, Second phase: 2000–2006, agreement no. RO/03/B/F/NT 175064.

Overserving at licensed premises in Stockholm: effects of a community action program.

The aim of this research was to study the sustainable effects of a community action program on alcohol service to intoxicated patrons at licensed premises. Since 1996, the hospitality industry and authorities in Stockholm, Sweden, have been cooperating to reduce problems related to alcohol consumption at licensed premises. The intervention has included community mobilization, training in responsible beverage service (RBS) and enforcement. A pretest in 1996 and follow-ups in the 1999 and 2001 designs were used to study licensed premises in Stockholm. Male actors portraying intoxicated patrons visited the licensed premises and attempted to order beer. Observers were present at each visit. At the pretest, 92 licensed premises were visited, 47 in north central Stockholm and 45 in south central Stockholm. In 1999, 103 establishments were visited, 61 in north central Stockholm and 42 in south central Stockholm. At the latest follow-up in 2001, 100 licensed premises were visited, 56 in north central Stockholm and 44 in south central Stockholm. The results from the latest follow-up in 2001 showed a statistically significant improvement over those of earlier measures, with a refusal rate of 70% compared with 47% in 1999 and 5% in 1996. There were improvements in both study areas (i.e., north and south central Stockholm). There has been a significant improvement in the rate of refusal of alcohol service at licensed premises in Stockholm during the project period. The reason for this is probably a combination of the intervention efforts: community mobilization, RBS training and a more efficient monitoring of alcohol service by authorities.

Sarge: The Life and Times of Sargent Shriver

In Seinfeld, a popular sitcom of the 1990s, the character Elaine asks, “Whatever happened to Sargent Shriver? Is he still with the Kennedys? … Is he out of the loop?” Indeed, by then Sargent Shriver seemed to have fallen off the political landscape, and remembrances of him too often conveyed a slightly negative tone. In Sarge, Scott Stossel, senior editor of the Atlantic Monthly, resurrects the career of one of the most important public figures of the 1960s. Shriver not only played an important role in John F. Kennedy's 1960 presidential campaign and interregnum, he was also the founding father of the Peace Corps, perhaps the most unique and successful federal initiative of the 1960s, and from 1964 to 1966 he concurrently served as the director of President Lyndon B. Johnson's War on Poverty. While the Job Corps and community action programs proved disappointing, other Shriver-created initiatives such as Head Start, Neighborhood Health Services, and Legal Services for the Poor have had enduring successes. In the 1960s and 1970s, Shriver also had strong party support for various national offices, eventually becoming George McGovern's running mate in 1972 after Thomas Eagleton's forced departure. Stossel depicts Shriver as a creative leader, an intellectual, someone who connected easily with people. In many ways, according to Stossel, Shriver's abilities more than matched those of the Kennedy brothers with whom he was closely linked.

Discourses in the European Commission's 1996-2000 Health Promotion Programme.

This article is a discourse analysis of 'The Community Action Programme on Health Promotion, Information, Education and Training 1996-2000'. The analysis uses six stages to discourse analysis. A religious discourse is used to construct the Programme and a military discourse is used to construct its implementation. These discourses are embedded in a scientific discourse. This analysis reveals that despite rhetorical endorsement of the concept of empowerment in health promotion, this Programme disempowers through vagueness, clear hierarchies of power and an emphasis on scientific methods of evaluation. The analysis also reveals that there has been a shift in blame in recent health promotion policy, the reflection is now on the collective as opposed to individual behaviour.

Community Service in the Transition: Shifts and Continuities in Participation from High School to College

Continuing a decade-long trend, findings from recent annual surveys of first-year college students have documented their participation in community service as high-school seniors at record high levels (Higher Education Research Institute, 1999, 2000, 2001). Eighty-one percent of the 2000 respondents reported volunteering during senior year, although only 24% expected to continue their volunteer work in college. Because other recent data indicate that 64% of undergraduates actually do volunteer (Levine & Cureton, 1998), the college experience may involve students in the community in ways they do not anticipate when they enter. For the majority of students, these findings suggest, involvement in community service may be episodic and contextually driven--not so much a deeply motivated value-oriented choice as an occasional activity that personal circumstances may dictate, encourage, support, or deter. The responses of the first-year students to other survey items appear to support this claim. For example, while volunteering in high school is on the rise among the respondents, trends over the past decade indicate a simultaneous decline in both interest and participation in other forms of voluntary activity, including community action programs, social activism, political participation, and general civic engagement and altruism (HERI, 1999). Political engagement, according to the 2000 Freshman Survey, is at an all-time low, while becoming well-off is the most important of the measured goals (HERI, 2001). Most strikingly, just 59% of first year students reported a personal commitment to helping others in difficulty, the lowest response level in over a decade. Paradoxically, while more students are volunteering than ever before, they are not espousing the civic values that community service is intended to encourage. For some students, involvement in community service could be motivated less by caring than by other factors, such as personal interests, group norms, or the social benefits they derive from participation. This study investigates the phenomenon of shifting patterns of community service participation during the transition between high school and college and, in so doing, seeks to arrive at greater understanding of the dynamics of social participation and involvement among young adults. The transition to college typically brings about change in students' lives as they move into new educational and social environments (Chickering, 1969; Chickering & Reisser, 1993; Upcraft & Gardner, 1990). While some research addresses college student motivation for involvement in community service (Fitch, 1987; Serow, 1991; Waterman, 1997; Winniford, Carpenter, & Grider, 1997), and other research suggests that high-school participation predisposes students to volunteer in college (Astin & Sax, 1998; Astin, Sax, & Avalos, 1999; Berger & Milem, 2002), little empirical evidence exists to characterize the relationship between high school and college participation. Moreover, little is known about the factors that lead students either to drop or sustain their community service after high school or to begin to volunteer in college. This investigation builds on an earlier study of community service participation among high-school students (Marks, 2002). That study employed Selznick's (1992) sociological theory of social participation to account for variation in patterns of students' community involvement. According to Selznick, individuals who involve themselves in the community do so on a segmental or core basis. Segmental participants, who volunteer from time to time, tend to be motivated by personal interests or extrinsic factors, including normative environments. Core participants are more likely to be motivated by values or deeply held beliefs. Applying the theory of social participation to students' participation in community service during the transition between high school and college, we expect to find similar patterns, a point we return to in a subsequent section. …

Religious organizations in community services: a social work perspective

This book explores the scope and breadth of religious organizations in social work practice. It begins by tracing the origins of the social work profession back to the earliest civilizations and their religious traditions, establishing the precedent for a fruitful commingling of religion and social welfare. The contributors propose that religious/faith organizations can assume responsibilities for social welfare in the 21st century, using the Korean Church as one example of an effective provider of social services. A 12-step model for religious organizations to use to develop community action programs is also presented.

The Cultural Construction of Moral and Civic Identities

In this article, we explore the intertwining of moral identity and the social and cultural context. First, we review existing research on moral identity that has considered the role of social others and the cultural environment. Then we pose questions to further research in this area and offer a 3-level framework with which to understand how the cultural world influences moral identity development. Central to this framework is an analysis of the cultural practices within which moral identities develop, as well as the institutional contexts that support these practices and the social interactions that comprise them. Finally, we illustrate the components of framework using examples of data from 2 studies-1 focused on how an inner city Muslim school worked to foster the moral identities of students and the other on the development of civic identities among urban teens in a community action program.

Effects of a community action programme on responsible beverage service (RBS)

Effects of a community action programme on responsible beverage service (RBS)

STEPS ‐ Structures Towards Emancipation, Participation and Solidarity: A European Project to Combat Discrimination against People with Learning Disabilities

People with learning disabilities are one of the most marginalised groups in European society, rarely recognised as full citizens with equal rights. The European action research programme STEPS focuses on structures, instruments and methods to combat discrimination against people with learning disabilities and aims at full participation and free access to material, cultural and social resources. Partnerships between providers, social welfare administrations, universities and groups of people with learning disabilities in five European countries are defining the project. From England, the Tizard Centre, Parkside NHS Trust, and Kensington and Chelsea Social Services are partner members in the network, and the overall project is financed by the EU community action programme to combat discrimination.

Impact Evaluation of a National, Community-Based Program for At-Risk Children in Canada

The Community Action Program for Children (CAPC) is a core component of the Government of Canada's Child Development Initiative announced in 1992. CAPC funds community agencies across Canada to develop early intervention initiatives to promote the health and development of young children at developmental risk. Results from the national evaluation study, presented in this report, suggest that health benefits accruing over a two-year period to family members participating in CAPC were not different from changes observed in control families participating in a national longitudinal study. The findings raise important issues about federal policies and spending priorities for addressing child health needs in the general population.

A community-based prevention program in western Norway: Organisation and progression model

This paper presents the organisation, progression, and main findings from a community-based substance use prevention project in five municipalities in western Norway. At the central level, this project was organised with a steering committee and a principal project leader, who is situated at the Department of Health and Social Welfare at the county level. Locally, the way of organising differed, as one would expect from the community-based model. Top–down/bottom–up strategies can apply both in the way a community organises its efforts, as well as in the relationship between the central project organisation and the participating local communities. It is argued that it can be beneficial for the success of community action programs if one attains a “good mix” between top–down and bottom–up strategies. Factors of importance for such “mix” in the Hordaland project were that the municipalities applied for participation, the availability of economic funding, the venues for meetings between central and local project management, the position of local coordinators, the possibilities for coupling project work to otherwise existing community planning, and the extent of formal bureaucracy.

Evaluation of the European Union Programme of Community Action on Health Promotion, Information, Education and Training 1996-2000.

The Programme of Community Action on Health Promotion, Information, Education and Training 1996-2000 was administered by the European Commission's Services in DGV Luxembourg. The programme was a consequence of a decision of the European Parliament and the Council of the European Union in March 1996. Middlesex University Health Research Centre won the tender to evaluate this programme. In this paper the evaluation team disseminate some of the findings that are pertinent to the international health promotion community. Key findings include significant differences in number of applications and in acceptance rates for different Member States. The expert assessors' opinions of the programme suggest a number of problems with its administration. Some projects were awarded commendably high ratings and others were very weak. The most serious weakness of many of the supported projects is lack of any internal evaluation. In order to broaden the scope of the second phase of the evaluation of this programme, more open communication and dialogue will be needed between all of the stakeholders. This implies a change in the culture of the European Commission's Services which, in the case of the units involved with this evaluation, are lacking in efficiency, openness and transparency.

Rationale and methods of the EFCOSUM project.

To describe the rationale and methods for a European project (EFCOSUM) to develop a method for a European food consumption survey that delivers internationally comparable data on a set of policy-relevant nutritional indicators. Currently Member States are collecting data and information for use at national level. At an international level, such data are often of limited comparability and of varying quality. To promote the development and exchange of adequate, reliable and comparable indicators of public health, and the structures needed to exchange the relevant data, a programme of Community action on health monitoring was set up for the EU. The objective of the action programme is to contribute to the establishment of a Community Health Monitoring System. Data will be made available to all Member States via a telematic network, which is currently being developed for the Health Monitoring Programme. With regard to nutrition, there is a need for a limited set of policy-relevant dietary indicators that are comparable among EU Member States. In the field of nutrition, however, there is a regrettable lack of internationally comparable data. The project 'European Food Consumption Survey Method' (EFCOSUM) therefore aimed to define a (minimum) set of dietary components which are relevant determinants of health and to define a method for the monitoring of food consumption in nationally representative samples of all age-sex categories in Europe in a comparable way. The project was carried out by 14 Member States as well as nine other European countries. Activities of the project included plenary sessions, desk research, and working group activities, building on existing experience from such projects as DAFNE, EPIC, FLAIR Eurofoods-Enfant project, COST Action 99 and others. The proposed method may be used alone, or as a calibration method to accompany existing ongoing studies.

New Jersey Medical School's unique relationship to its community.

The Newark, New Jersey, riot of 1967, sparked in part by tensions created by the conflicting emphasis of President Lyndon Johnson's Model Cities Program, community action programs, and the New Jersey state medical school's move to Newark's Central Ward, has profoundly affected the medical school and its delivery of medical care in Newark. This paper delineates how these Johnson-era programs contributed to the riot and details the continuing legacy of these events on the medical school and the delivery of health care in Newark. The paper concludes that New Jersey Medical School is expected by its community to have a higher standard of local involvement than comparable institutions. Furthermore, it suggests that New Jersey Medical School's relationship and commitment to its community serve as a model for community interactions for medical schools throughout the United States.