Traditional Outreach Research Articles

Does Respondent Driven Sampling Alter the Social Network Composition and Health-Seeking Behaviors of Illicit Drug Users Followed Prospectively?

Respondent driven sampling (RDS) was originally developed to sample and provide peer education to injection drug users at risk for HIV. Based on the premise that drug users' social networks were maintained through sharing rituals, this peer-driven approach to disseminate educational information and reduce risk behaviors capitalizes and expands upon the norms that sustain these relationships. Compared with traditional outreach interventions, peer-driven interventions produce greater reductions in HIV risk behaviors and adoption of safer behaviors over time, however, control and intervention groups are not similarly recruited. As peer-recruitment may alter risk networks and individual risk behaviors over time, such comparison studies are unable to isolate the effect of a peer-delivered intervention. This analysis examines whether RDS recruitment (without an intervention) is associated with changes in health-seeking behaviors and network composition over 6 months. New York City drug users (N = 618) were recruited using targeted street outreach (TSO) and RDS (2006–2009). 329 non-injectors (RDS = 237; TSO = 92) completed baseline and 6-month surveys ascertaining demographic, drug use, and network characteristics. Chi-square and t-tests compared RDS- and TSO-recruited participants on changes in HIV testing and drug treatment utilization and in the proportion of drug using, sex, incarcerated and social support networks over the follow-up period. The sample was 66% male, 24% Hispanic, 69% black, 62% homeless, and the median age was 35. At baseline, the median network size was 3, 86% used crack, 70% used cocaine, 40% used heroin, and in the past 6 months 72% were tested for HIV and 46% were enrolled in drug treatment. There were no significant differences by recruitment strategy with respect to changes in health-seeking behaviors or network composition over 6 months. These findings suggest no association between RDS recruitment and changes in network composition or HIV risk, which supports prior findings from prospective HIV behavioral surveillance and intervention studies.

From Subject Selectors to College and Interdisciplinary Teams

In addition to enduring a recent renovation, the staff of the J. Willard Marriott Library underwent reorganization. This was a response to the changing digital landscape, reduction in budget, and student requests for one central space to go to, to obtain technology and reference assistance. In the Public Services Department the subject departments were reorganized into task-oriented departments. The traditional outreach and collection development duties of subject librarians were addressed by the development of a second layer of organization, the college and interdisciplinary teams. This article addresses reorganization of the Public Services Department in general and the response of the science and engineering personnel specifically.

The Cost of Convenience

Lower transaction costs have shifted voter registration activities online and away from traditional modes of outreach. Downloading forms may impose higher transaction costs than traditional outreach for some people and thereby decrease electoral participation. A randomized, controlled experiment tested this hypothesis by encouraging treatment participants via e-mail to use online voter registration tools. The treatment group was 0.3 percentage points less likely to be registered to vote after the election. A follow-up experiment sent reminders via text message to randomly selected people who had downloaded registration forms. The treatment increased rates of registration by 4 percentage points, suggesting that reminders can ameliorate many of the negative effects of directing people to downloadable online registration forms.

The Black Belt Environmental Science and Arts Program

The goal of the Black Belt Environmental Science and Arts Program (BBSEAP) is to enhance classroom instruction in the environmental sciences for students in grades 5-8 of selected counties in Alabama's Black Belt region. BBSEAP differs from traditional outreach activities in that public school students come to off-campus, outdoor sites for instruction. The Auburn University Environmental Institute (AUEI) administers the program with support from local Alabama Cooperative Extension System (ACES) representatives. Since 2005, more than 2,000 students have participated in the program. Funding for BBESAP comes from government and corporate grants.

Using Motivational Interviewing in HIV Field Outreach With Young African American Men Who Have Sex With Men: A Randomized Clinical Trial

We sought to determine whether field outreach with motivational interviewing, as compared with traditional field outreach, leads to increases in HIV counseling and testing and rates of return for test results among young African American men who have sex with men (MSM). In a randomized, 2-group, repeated-measures design, 96 young African American MSM completed a motivational interviewing-based field outreach session and 92 young African American MSM completed a traditional field outreach session. The percentages of participants agreeing to traditional HIV counseling and testing (an oral swab of the cheek) and returning for test results were the primary outcome measures. More of the participants in the motivational interviewing condition than the control condition received HIV counseling and testing (49% versus 20%; chi(2)(1) = 17.94; P = .000) and returned for test results (98% versus 72%; chi(2)(1) = 10.22; P = .001). The addition of motivational interviewing to field outreach is effective in encouraging high-risk young African American MSM to learn their HIV status. Also, peer outreach workers can be effectively trained to reduce health disparities by providing evidence-based brief counseling approaches targeting high-risk minority populations.

Engaged outreach: using community engagement to facilitate access to higher education for people from low socio‐economic backgrounds

Despite ongoing equity initiatives, there is still a clear discrepancy in regards to access to higher education for potential students from socially disadvantaged backgrounds. This paper reports on an action research initiative that has developed a model of engaged outreach as an alternative approach to traditional university outreach. Engaged outreach uses the principles of higher education community engagement to develop stronger relationships between universities and their local communities for the purposes of increasing aspiration and access to higher education. The project was designed using a reflective, collaborative process with local Pacific Island immigrant communities living in an area of high social deprivation in southeast Queensland, Australia. Research progressed in three key stages, which together form the basis of the proposed model of engaged outreach. While it is acknowledged that the success of engaged outreach will depend on its implementation as a long‐term strategy, preliminary results from this pilot project suggest that it demonstrates real potential to address this important but seemingly entrenched issue in Australian higher education.

Students’ clinical experience on outreach placements

Primary care outreach placements increasingly feature in UK undergraduate dental curricula. The profile of clinical work undertaken on placement may differ from traditional hospital-based programmes and between outreach settings. An appreciation of any differences could inform curriculum development. To compare the profiles of clinical work experienced on a traditional hospital-based programme and outreach placements in different settings. One dental hospital and eight existing primary care block placements in England. Subjects were four cohorts of senior dental students in one UK dental school. Departmental records provided data on students' clinical experience in different settings and their achievement of placement learning objectives. Descriptive statistics for groups were compared. (1) Counts of patients encountered and of clinical procedures completed in the following categories: simple plastic restorations, endodontics, cast restorations, dentures, extractions and children's dentistry. (2) Student perceptions of placement learning reported via Likert scales. Outreach students encountered twice as many patients and typically completed about three times as much clinical work as students in the hospital, e.g. 44 cf 16 simple plastic restorations, seven cf two endodontic procedures. There were variations in profiles by setting. For example, amalgam being more likely to be used on outreach especially in the General Dental Service; more children's dentistry in community services and more extractions in Dental Access Centres. Students reported learning outcomes generally being achieved (average 94%) although with some variation by setting. Dental outreach training greatly increases the quantity of students' clinical experience in everyday dentistry compared to a hospital-based programme. Placements also increase awareness of service delivery and develop clinical skills. There are appreciable variations between outreach settings possibly reflecting their purposes. Multiple contrasting outreach placements for each student might increase the uniformity of learning experiences.

Serving members and reaching others: The performance and social networks of a landowner cooperative

Local forest landowner associations and broader peer-to-peer learning efforts have received attention–particularly in the United States of America–as ways to increase landowner engagement in forest planning and management. Unlike traditional technical assistance and outreach, knowledge is primarily shared among landowners as opposed to being derived from natural resource professionals. While potentially promising, few studies have investigated these approaches. Through a study of a landowner cooperative in Wisconsin, I report on a finding that considers both the effectiveness of a landowner cooperative in the Upper Midwest (USA) and the social network members rely on in decision-making. The former relies on an importance–performance analysis (IPA) of the services provided by the cooperative and the latter on an egocentric network analysis of members with an emphasis on strong and weak ties. Data were collected via a mail survey to which 146 members (81%) responded. The IPA indicates that the cooperative is providing services with which members are largely satisfied. The network analysis suggests that members, through strong ties, discuss their land with on average three others—primarily natural resource professionals (including cooperative staff), as opposed to other members, neighbors, and kin. However, by virtue of membership, they share weak ties with other members whom they see as trustworthy. The extent to which a network perspective might be applied to similar situations is discussed, as are conceptual implications and future directions. The main conclusion is that the emergence of local landowner associations and peer-to-peer learning requires research methods that better capture the social nature of these new directions.

NIEHS Supports Partnerships in Environmental Public Health

NIEHS Supports Partnerships in Environmental Public Health Linda S. Birnbaum, PhD I would like to start by thanking the journal for inviting me to write an editorial to accompany Dr. Juliana van Olphen and her colleagues’ thoughtful evaluation that focuses on the important topic of community health partnerships.1 As the new director of the National Institute of Environmental Health Sciences (NIEHS) and the National Toxicology Program, I am pleased to take on this role during a time when both the environment and health are top priorities for our country. I am a big supporter of community-based participatory research (CBPR) that ensures community members have an active role in planning, implementing, translating and disseminating research that addresses local environmental health concerns. NIEHS has been a long-standing leader in fostering partnerships between community groups and researchers to better understand environmental causes of disease. Our commitment is demonstrated in a number of ways. For example, NIEHS, in cooperation with the National Cancer Institute, requires that a Community Outreach and Translation Core (COTC) is established in each of our four Breast Cancer and the Environment Research Centers—one of which was the subject of Dr. van Olphen’s independent analysis published in this issue. COTCs conduct essential work to ensure that the views and concerns of the breast cancer advocacy community are heard and that the research findings are disseminated to the public. Developing educational materials for children and adults about breast cancer and the environment, holding public awareness forums and town meetings, and exploring areas of concern or interest to the community are all essential activities led by the COTC to create community participation in environmental health issues such as breast cancer. What van Olphen’s article demonstrates is that COTCs can further advance and promote CBPR principles within research-intensive Centers. NIEHS grantees employing CBPR approaches are contributing to our understanding about breast cancer and the environment. There is a growing body of literature showing that early-life exposures to endocrine disruptors—particularly during gestation and childhood, but also continuing through puberty, first childbirth, and breastfeeding—are critical to later-life breast cancer risk. As researchers learn more about what causes and how to prevent breast cancer, grantees such as those we support through our environmental justice program are spreading the word and empowering communities to take action. Breast cancer advocates in two communities that differ in racial/ethnic and economic character are working in partnership with researchers to assess household exposures to endocrine disrupting compounds, and to develop communication tools for reporting results to affected individuals and communities.2 These research findings are being used by community groups and advocates to affect public health and lead to policy changes. Congress recently recognized the contributions of NIEHS and the National Institutes of Health as a whole for their outstanding work in the breast cancer and environment area, when it passed the “Breast Cancer and Environment Research Act of 2008.”3 The Act looks to NIH to take a lead role in defining the future research agenda for collaborative research efforts related to breast cancer and the environment. NIEHS’ leadership role in translating research on breast cancer and the environment is the outgrowth of the Institute’s commitment to CBPR approaches that promote having the community actively involved in shaping and conducting research and intervention strategies. Since 1995, through its CBPR activities, the Institute has supported principles that have been developed and shared by leaders in the field such as those developed by Barbara Israel et al. 4 and Lawrence Green et al.5 Principles that call for building on the strengths and resources within the community; focusing on the local relevance of public health problems; and disseminating results to all partners are endorsed by NIEHS and are evident in work supported by NIEHS. Recognizing the [End Page 195] continuum of CBPR, the Institute promotes these principles throughout a variety of programs from traditional outreach and education efforts to more complex biomedical, hypothesis-driven research questions that address environmental justice and health disparities issues. To build upon our past accomplishments and to progress our research agenda in this area, we recently sought input from research grantees and members of advocacy...

Community Consultation and Intervention: Supporting Students Who Do Not Access Counseling Services

Although the severity of psychological problems among college students and the demand for campus counseling services has increased, many students who could benefit from mental health services still do not access them. This article describes Community Consultation and Intervention, a program designed to support students who are unlikely to access professional help despite the best efforts of traditional counseling center outreach. Community Consultation and Intervention reaches into the campus community to intervene by advising faculty and staff who may be the only contact for a distressed student, taking on a nontraditional “student support” role in direct interactions with students, offering advocacy when university systems or other environmental stressors precipitate psychological problems, and providing case management and crisis intervention services on behalf of the university when troubled students are especially concerning and disruptive to their communities. The most novel element of the program—the student support role—is distinct from conventional counseling in that it privileges problem solving, support, advice, and advocacy over focusing on emotions and other traditional mental health interventions. Case studies and programmatic challenges are described.

P.O.W. (Protect Our Women): Results of a Breast Cancer Prevention Project Targeted to Older African-American Women

ABSTRACT Objective: Encourage older African-American women to participate in breast cancer detection. Breast cancer deaths for older African-American women are higher than for Caucasian counterparts. Effective outreach education about mammography and breast exam is one method to reduce the disparity by encouraging women to enter treatment earlier through earlier diagnosis. Traditional outreach strategies have proven ineffective with this cohort. Method: In this study we utilized the trust placed in known community leaders to recruit older African-American women to participate in breast health education leading to completion of a mammogram. One hundred sixty-two women were identified as participants. Results: Seventy-nine percent of the women who completed the project obtained mammograms and 9% had mammograms scheduled at 1-month follow-up, whereas 22% of the individuals who received only mailed educational materials completed mammograms and none had scheduled mammograms pending. Discussion: Health education for difficult-to-reach populations can be effective but requires greater inclusion of community partners to offset issues related to trust, health beliefs, and access.

Notes on a cautionary (tall) tale about respondent-driven sampling: A critique of Scott's ethnography

Serious methodological and ethical flaws are detailed in an ethnographic study of a respondent-driven sampling (RDS) project for drug users in Chicago. The study is also disconnected from the larger social context within which the project operated, and from the existing literature on human-subject problems the author claims he “discovered” about RDS – problems common to traditional outreach projects that researchers have known about and managed successfully for years. Due to an admitted bias in the author's sampling, and an eagerness to accept respondents’ claims uncritically, the author's results are not generalizeable to RDS projects operating in other cities, in Chicago itself, or even to the specific project studied.

Sharing Anatomy With Elementary Students Via Two‐way Videoconferencing

Sharing human anatomy with elementary age children is often a difficult task to undertake. Logistics of bringing students to your campus, and then the ethics of bringing young students into human anatomy facilities often prohibit this age group from inclusion in outreach programs. This study shows how using live, two‐way videoconferencing technology is an effective solution to this problem, and it can reach much larger audiences of children than traditional anatomy outreach programs. A Tandberg II Intern module was used to transmit video images from the human gross anatomy laboratory at the University of North Texas Health Science Center, Department of Cell Biology and Genetics, to 54 elementary schools across the state of Texas. Approximately 3000 students watched the program on the cardiopulmonary system, and saw demonstrations on healthy and diseased human heart and lung tissue. Four schools were interactive and students could ask questions directly to the moderator. Models and skeletons were used to show relationships of the heart and lung in the human body, and these were related to state of Texas’ science standards on how systems work together. Teacher feedback was very positive and plans are already being made for future presentations. In conclusion, use of live, two‐way videoconferencing is a very efficient method of sharing human anatomy to elementary students for science outreach programs.

Diminishing Disparities: Starting in Our Own Backyards

Diminishing Disparities: Starting in Our Own Backyards

Implementing a Social Enterprise Intervention with Homeless, Street-Living Youths in Los Angeles

Homeless, street-dwelling youths are an at-risk population who often use survival behaviors to meet their basic needs. The traditional outreach approach brings services into the streets, yet does not adequately replace the youths' high-risk behaviors. Similarly, job training programs often fail to address the mental health issues that constitute barriers to their productive employment. Drawing on social development principles, the Social Enterprise Intervention (SEI) model is proposed as an alternative approach. The SEI seeks the tripartite effect of employment, service-related, and mental health outcomes for street youths. This article compares existing intervention models and suggests that through the SEI, homeless youths can acquire vocational and business skills, clinical mentorship, and linkages to services that otherwise would not be available to them, given their street-dwelling status.

HIV/AIDS Outreach in Southern New Mexico

This paper describes the outreach component of the New Mexico Border Health Initiative (NMBHI), one of five Special Projects of National Significance funded in 2000 along the United States/Mexico border by the Health Resources and Services Administration. The initial intent of the NMBHI was to utilize the traditional promotormodel of natural helpers within the informal support systems in the communities in which they physically live for the purpose of increasing utilization of HIV/AIDS prevention services. What evolved instead was more closely aligned with traditional street outreach, whereby peers were utilized to engage and inform potential clients about HIV prevention, provide HIV testing and link HIV-affected persons to medical services. Programmatic elements, implications for practice, and recommendations for program coordinators are presented in the paper.

Learning preferences, job satisfaction, community interactions, and urban forestry practices of New England (USA) tree wardens

The first state-legislated and mandated municipal urban forestry officials in the United States were tree wardens. Massachusetts state law enabled municipalities to appoint tree wardens first in 1896 and mandated their appointment beginning in 1899; five other states passed similar legislation shortly thereafter. These municipal officials have jurisdiction over most, and sometimes all, public trees in the municipality they serve. This study used a structured mail survey to explore ways tree wardens acquire professional information, what modes of learning they prefer, how they interact with their communities, and what urban forestry tasks they do. Results suggest that New England tree wardens acquire information in several ways, including the Internet, yet prefer traditional outreach education tools such as workshops and conferences, especially those that involve more than one speaker, informational handouts, and both indoor and outdoor lectures and exercises. Tree wardens value highly interacting with other tree wardens and depend on peers and colleagues for information and assistance in decision making. They also value other organizations, such as the Cooperative Extension System, state forestry agencies, and state tree warden associations, for information. Results further suggest that public safety is their primary motivation and that they spend most of their time on associated tasks such as risk tree assessment and removal. They recognize the value of tree replacement and certain urban forestry planning practices such as tree risk assessment and inventories. Tree wardens place less importance on municipal shade tree ordinances and shade tree or urban forest committees or commissions. It is recommended that people and organizations responsible for tree warden education conduct activities that bring tree wardens together frequently and combine social and educational activities and emphasize traditional outreach education delivery systems.

The role of contact efficacy in evaluating sexual health promotion—evidence-based outreach work within a public sex environment

This paper explores the role of contact efficacy in evidence-based health promotion by evaluating a public sex environment (PSE) based sexual health outreach program. The service operated in situ from a dedicated mobile unit to promote sexual health among PSE users. A cross-sectional survey (response rate 56%) measured socio-demographics, sexual health behaviours and outreach-service use among men sampled within the PSE (n = 216). Most participants were aware of the service and two-thirds had contacted them. Men who had not completed hepatitis A vaccination (odds ratio (OR) = 2.02), who had ever received money for sex (OR = 2.07) or who reported a diagnosed mental health disorder(s) (OR = 2.38) were significantly more likely to have contacted the service. Although 89% of service users perceived the intervention positively, only 26% felt it had contributed to sexual behaviour changes. The 'mobile-unit' outreach model contacted a large proportion of PSE users, specifically men who had greater health needs. We advocate the adoption of this outreach model over traditional PSE-based outreach approaches. Contact efficacy evaluation is useful to assess ongoing health interventions. However, caution must be exerted when interpreting certain contact efficacy results. Since causality may not always be inferred, triangulation with other evaluative methodologies is recommended.

Internet Outreach in Statewide Long-Range Planning: New Jersey Experience

The New Jersey Department of Transportation (NJDOT) recently tested the use of a public involvement website devoted to statewide long-range planning. The website, www.njchoices.com, was launched in April 2000 as a cornerstone of the public involvement program for the current plan update. This initiative allowed NJDOT to explore the use of Internet technology for dialogue concerning long-range investment priorities. In addition, NJDOT gained a better understanding of the technical and administrative requirements of maintaining an interactive site. Along with information on the planning process and statewide transportation issues, the website included mechanisms through which users could voice their concerns. Innovative features included a transportation budget game, an interactive demographic map, and an animated tutorial on the sources of traffic growth. These features received more use than an online survey on transportation priorities or a virtual suggestion box for user comments. Between April 2000 and July 2001, the website recorded 9,209 user sessions, reaching a broader audience than traditional outreach methods for statewide planning. Usage was shown to be strongly associated with publicity for the site. Other findings concern ways to integrate web-based and traditional outreach methods, the importance of user testing of site content, and the need to establish an organizational framework for institutionalization of the website.

ECUMENICAL AFFIRMATION ON MISSION AND EVANGELISM: A REVIEW*

JEAN S. STROMBERG [**] Background The 1970s produced some significant documents on mission and evangelism, such as the Lausanne Covenant (1974) and Evangelii Nuntiandi (1975). [1] The Nairobi assembly (1975) debate on evangelism considerably heightened the need for the World Council of Churches (WCC) to articulate clearly the relationship of the traditional missionary outreach of the churches with involvement in justice issues. [2] What did the various actions for justice in which the churches engaged together through the Council have to do with the proclamation of the kingdom of God, with calling persons to a personal faith in Jesus Christ? The WCC central committee, meeting in 1976 following the Nairobi assembly, requested the Commission on World Mission and Evangelism (CWME) to prepare a paper on the basic convictions and shared affirmations of the churches on the topic of mission and evangelism. My introduction to this discussion coincided with my first CWME commission meeting in Puerto Rico in 1978, as a staff member. At that meeting, commission members refused to respond to such a request. The feeling was strong among the commission members and some staff that no conceptual paper could adequately reflect the churches' experiences in mission and evangelism. Furthermore, one ought not to produce such a document for fear of codifying principles of mission that could serve as a litmus test for orthodoxy, especially in light of the Nairobi assembly discussion. How is it possible, some asked, to put into a document the richness and variety of the experience of God's mission in our world? The only possibility that the commission was willing to consider at that point was to collect and tell stories of the churches' experiences and to leave the interpretation of the richness and meaning of those experiences to others. However, the request of the central committee, the governing body of the WCC between assemblies, could not ultimately be ignored. In and around the preparation for the 1980 World Conference on Mission and Evangelism, to be held in Melbourne, Australia, the idea of the document kept reappearing. At the Melbourne conference itself, a small group of participants worked on a possible draft. That attempt failed. In the middle of a conference that saw itself as responsible for articulating important mission issues of the day, there was considerable misunderstanding about a small group writing a mission statement for approval by another body, the central committee. The suspicion that often accompanies any WCC conference report, that it is written by someone, usually staff, ahead of time, focused on this group. While that attempt was dropped, the Melbourne conference itself, as a worldwide gathering of mission reflection, stories, and experiences, was a significant influence on the document that finally resulted. Following the Melbourne conference, Emilio Castro, then director of CWME, wrote a first draft. After many months of intensive discussions within the staff, with commission members and with wide, inclusive networks of individuals [3] and groups, a document was ready for a first reading by the central committee in July 1981. After further consideration and work the document was approved in July 1982 and sent to the churches for their consideration, inspiration and implementation. [4] Reaction to the Ecumenical Affirmation on Mission and Evangelism The Ecumenical Affirmation (EA) has proved to be .a useful, if imperfect, instrument. The document has been useful in generating discussion and study among a wide spectrum of groups within the Christian family. Those with evangelical perspectives, with very few exceptions, both inside and outside the ecumenical movement, have responded with enthusiasm to the document. This has helped make possible some of the stimulating discussions that have taken place with evangelicals from the Vancouver assembly onwards. …