to view the program - Society for Public Health Education

in their home areas; and reach parts of communities that, while vital
in the fight against HIV transmission, would have traditionally been
inaccessible. Conclusion: Through Freirian theory, this pilot program
shows potential for increasing the impact of community engagement
and cultural competency. More research is needed to better understand
to full potential of this program.
28. *A social ecological perspective on barriers to practicing secondary
abstinence among young African-American women at
risk for HIV/STIs
Erin Bradley, MPH, Emory University; Kirk Elifson, PhD,
Emory University; Jessica Sales, PhD Emory University, ; Ralph
DiClemente, PhD, Emory University
Background: HIV/STIs rates among sexually experienced African-
American females are striking. Although some young women reduce
their risk by choosing to abstain from sex for various periods of times
following sexual debut, a practice known as secondary abstinence,
others who desire to abstain find it difficult to do so and remain at
risk. Theoretical Framework: A social ecological approach was used to
explore personal and contextual barriers that hinder interested young
women from becoming or remaining abstinent. Methods: Grounded
theory, an inductive approach consisting of systematic data collection
and analysis techniques, was employed. In-depth interviews were conducted
with 20 sexually-experienced African-American young women,
ages 18-23, who had completed an HIV-risk reduction program and
expressed interest in secondary abstinence. Results: Respondents
identified individual-level barriers, such as thinking about sex and
substance use, as challenges to becoming or remaining abstinent.
However, partner-related barriers such as imbalances in sexual
decision-making power, and situational barriers, such as being alone
with a partner presented the greatest challenges for young women.
Conclusions: Contextual factors play a vital role in understanding
young women’s sexual behavior. Researchers and health professionals
should help equip young women to identify and overcome both
personal and environmental challenges to practicing secondary abstinence.
Implications: Insight can be used to strengthen the abstinence
component of HIV prevention programs designed to reduce HIV/STI
rates among young African-American females.
29. Patient-Centered Medical Homes: Healthcare System
Integration that Increases Access and Enhances Chronic Care
Management
Alicia Chung, BA, MPH, Teachers College, Columbia University
Background: Nearly 46 million Americans are without health
insurance (CDC, 2010). Of those who are insured, adequate chronic
care management, including asthma and diabetes, remains sparse.
Patient-centered medical homes are a burgeoning solution as a
healthcare delivery model that applies comprehensive team-based
care coordination that aligns physician reimbursement structure with
quality patient care. Objective: This study aimed to evaluate the level
of private insurer, state and hospital system participation related to
patient-centered medical home adoption and impact. Methods: A
literature review of national patient-centered medical home projects
was conducted to determine participation rates, physician reimbursement
structures, changes in patient utilization rates and improvements
in health outcomes. Qualitative telephone interviews were conducted
with senior executives from 31 national health insurance companies,
state health departments and hospital systems. Results: Private insurers
are involved with 20 patient-centered medical homes involving
20,000 physicians and 4.4 million members (Patient Centered Primary
Care Collaborative). Case study pilot demonstration projects reported
health outcome and cost saving improvements where evaluated.
Conclusion: Patient-centered medical homes offer a potentially viable
healthcare delivery model to increase access and quality at an affordable
cost. Additional research is needed to determine cost savings
across various demographics. Implications: The medical home model
could drive behavior economics towards healthy outcomes through
payment alignment and care coordination.
30. *Agenda-Setting for Expanded Policy-Driven Change:
Research Directions and Implications for Leadership and
Practice Development
Charles Kozel, PhD, MPH, CHES, College of Health and Social
Services, Department of Health Science, New Mexico State University,
Anne Hubbell, PhD, Department of Communication, New Mexico
State University ; Michael Hatcher, DrPhD, Div of Toxicology and
Environ Medicine, Agency for Toxic Substances and Disease Registry;
Frank G. Perez, PhD, Department of Communication, U. Of Texas
at El Paso; Sharon Thompson, PhD, MPH, CHES, Department of
Health Promotion, U. Of Texas at El Paso
This research provides novel directions for methods and practices for
addressing health disparities through expanding the diffusion of policy-driven
health promotion and disease prevention innovations. The
interplay of how the media, public, and policy makers influence each
other is termed agenda-setting. This perspective suggests that direct
attitudinal effects of what to think are less empirically established
than are indirect cognitive effects of what to think about (Cohen, 1963;
McCombs & Shaw, 1972). Agenda-setting conceptualizes the process
of how issues move from relative unimportance to the forefront
of media professionals’, members of the public, and policy makers’
thoughts (Dearing & Rogers, 1996). An area within agenda-setting
research, Health Promotion Agenda-Setting (HPA-S), provides practitioners
with a framework, and strategies to set agendas for sustained
*Denotes Poster Promenade
SOPHE-NACDD 2011 Joint Academy and Midyear Scientific Meeting 53