MARCH/APRIL 1996
State Minority Health Agencies
A newsletter of the Office of Minority HealthOffice of Minority Health
Public Health Service
U.S. Department of Health and Human Services
MARCH/APRIL 1996
The State of Minority
Health Minority Health
Perspective OMH Convenes Third State
Meeting North Carolina Launches
Diversity
Initiatives OMH Honors State
Representatives Increasing I'mmunization
Rates in
Iowa I'mmunization Resources
California Coalition
I'mpacts Health
Policy Making Strides in South
Carolina Town Meetings Examine
Health Care in
Virginia Taking the Neighborhood
Back Florida Commission Submits
Health
Recommendations Oklahoma OMH Responds to
Minority Health
Needs The Resource Persons
Network Pennsylvania Program
Educates
Community Publications Available
from OMH Resource
Center Resources: State
Health Funding Alert
Managed care is basically characterized as the integration of financing, management, and the delivery of health services, with providers taking on financial risk. Its a combination that some have railed against, citing times when one of the most popular forms of managed care, health maintenance organizations (HMOs), have let financial considerations interfere with consumer access to services.
Under an HMO plan, patients must choose from a selection of primary care doctors. These doctors are the "gatekeepers"-- the central point for all medical care. They decide on the need for treatment and determine whether referrals to specialists are necessary. They are generally aid one monthly fee for all services as opposed to the traditional fee for service system. Regardless of how many times a patient is seen, the doctors fee doesnt change. Some say going for routine care can be a relatively simple process, but the more serious a patients problems, the trickier the system can be. Since doctors must pay for specialized treatment out of their fees, managed care critics fear patients are denied needed treatment when its expensive.
These factors are critical for minorities, said Dr. Chapman, especially since so many states are making moves to restructure the traditional fee-for-service Medicaid program. Jointly financed at the federal and state level, the program provides 32 million low income people with health coverage. States have been using waivers under sections 1115 and 1915(b) of the Social Security Act in an effort to steer Medicaid recipients and others who are poor into managed care. The number of Medicaid enrollees in managed care arrangements is up to approximately eight million. Both types of waivers, which are controlled by the Health Care Financing Administration, allow for testing new methods of administering Medicaid. Section 1915(b) waivers permit local demonstration projects and 1115 waivers allow for research and demonstrations on a statewide basis. The 1115 waivers are very desirable from a states perspective because "even at the cost of narrowing services, they allow states more freedom to expand eligibility definitions," said Elizabeth Wehr, J.D., senior research associate at George Washington Universitys Center for Health Policy Research. By obtaining the waivers, states can carry out demonstration programs that mandate managed care enrollment, thereby ensuring that Medicaid recipients have access to a primary care physician.
The need to give Medicaid recipients regular care through a primary care doctor is evidenced by the costly misuse of emergency rooms, said Dr. Chapman. He described a study that examined 17,000 patient charts at Greater Southeast Community Hospital in Washington, D.C.
The study showed that patients were flooding the emergency room (ER) with minor problems, and in essence, using the ER as a primary care facility. At least half of these patients received Medicaid.
Backers of managed care point out that being able to access primary care increases the odds of preventing diseases or detecting them in the earliest stages. But theres still concern that managed care limits choice of both doctor and hospital.
It has been traditionally difficult for minority providers to gain inclusion into managed care organizations. Upon enrollment, some patients are forced to give up relationships with doctors they have relied on for years. This can complicate health care for anyone, especially minorities, who have a hard enough time finding culturally appropriate health care, said Dr. Chapman.
"Because of the need to decrease cultural barriers to care such as provider insensitivities, the managed care system has to move itself into a learning mode," he said. "The way to do this is to open the lines of communication and collaborate with state agencies and community organizations."
When the state of Missouri put in its application to CMMS for a 1115 waiver, the states Office of Minority Health raised several questions. According to Jacqueline Horton, chief of the office, this included: "Will minority patients be allowed to choose minority providers? Will HMOs be required to form relationships with community health organizations?"
Discrimination can rear its head in managed care settings in many ways. "There may be enrollment practices that discourage minority participation," said Ms. Wehr. For example, a certain plan may have no sickle cell anemia specialists on board, and consequently is not equipped to serve populations known to have a high incidence of the disease such as African Americans.
Wehr recommended the collection of data to monitor utilization patterns by race, national origin, and primary language. Without this documentation, she said, no plans performance can be monitored effectively.
Dr. Chapman acknowledged the power minority health representatives have in influencing their state agencies in the decision-making discussions about managed care. Speakers on the panel agreed that a transition to Medicaid managed care is at its best when careful planning is involved.
Stephanie White-Perry, M.D., director of the Office of Minority Health for the state of Tennessee, said poor planning is what got TennCare off to a shaky start.
TennCare eliminated traditional Medicaid in Tennessee and utilizes managed care with HMOs and preferred provider networks (PPOs). A plus, said Dr. Perry, is that 95 percent of Tennessee residents now have health insurance. The program covers about 700,000 previous Medicaid recipients, plus 400,000 who had been uninsured. The downside is that TennCare was implemented swiftly, causing disruption in coverage to beneficiaries and payments to providers.
In an effort to cut costs, TennCare started on a speedy track. Tennessee put in a request for a 1115 waiver in June, 1993. CMMS approved the request that November, and TennCare was up and running in January of 1994.
The result was inadequate education about the new program and not enough public input. So as not to duplicate mistakes By Clay E. Simpson, PhD from the past, a TennCare Roundtable made up of consumers and Minority Health providers has been established to boost public participation.
A few months ago, employees from CMMS gave a presentation on Medicaid managed care to staffers at the Office of Minority Health in Rockville, Maryland. They covered the factors they consider when reviewing requests for waivers and monitoring state progress.
"Its a thorough process," said Rita Johnson Mills, director of CMMS's Medicaid Managed Care Team. The agency looks at a number of components, she said, such as a states system for external quality review, the grievance and appeals process when service is denied, and whether patients understand that if they don't choose a primary care doctor, one will be chosen for them.
Rachael Block, associate director of CMMS's Medicaid Bureau, said that a definite change in philosophy is occurring."The role of the state Medicaid Director was one of a passive billpayer." But under managed care, she said, these directors are purchasing a defined benefits package.
The success in doing this is based on which states will consciously design programs around the needs of the Medicaid population and form linkages to managed care organizations.
The OMH contact for managed care is Joan Jacobs, 301-443-9923.
See page 6 for article on the Latino Coalition for a Healthy California. The coalition strives to increase cultural competency in managed care settings.
Change is becoming another word for health care. The challenge is making sure the interests of minorities don't fall through the cracks amidst all of the shakeups. Congress and the administration are discussing managed care, reduced federal influence, and the expanded role of the states.
As a result, we are seeing some minority communities become attractive targets for health insurers, while other minority communities continue to beneglected.
For the sake of the people we represent, we need to be on top of the governmental action that stimulates and inhibits changes in the health care system. These changes affect how federal money comes into your state for Medicaid, maternal and child health services, immunizations, substance abuse services, and a host of other public health functions. They affect who in your state controls money and how it is spent.
Several 1115 and 1915b waivers (see lead article) have already been approved for some states, including Hawaii and Oregon--states that have successfully implemented Comprehensive Health Care Reform Demonstration Projects. These projects allow states and the federal government to pursue Medicaid projects that test new ideas for delivering health services to low-income and uninsured people.
The U.S. Department of Health and Human Services is committed to helping states use this waiver authority to test well-designed, creative approaches to health care. And as the office responsible for coordinating minority health policy and programs, OMH vigorously reviews issues of concern in state health reform efforts.
In evaluating proposals, OMH looks for: requirements that services are provided in different languages; adequate coverage for treatment in areas in which minorities bear a disproportionate burden; and the provision of enabling services such as transportation.
At OMH, we remain dedicated to keeping minority health in the forefront. And we need you to do the same. Both of us have an enormous responsibility--to lead the nation in making progress. Minority populations are depending on all of us. Together, we can hold our ground.
Wed like to hear about your progress and achievements in minority health. Send any comments to OMH-RC, PO Box 37337, Washington, DC 20013-7337.
Dr. Lee discussed the changing roles of federal and state agencies during his address at the Office of Minority Healths 3rd State Minority Health Representatives Meeting, held June 26-29, 1995, in Silver Spring, Maryland. "The plan," said Dr. Lee, "is for us to reach an agreement with the states about objectives, and then let the states decide best how to achieve those objectives."
The federal government would be a partner with the states, providing overall monitoring to keep Congress and the public informed. Putting decision-making at the state level allows for more flexibility in targeting resources and identifying problems, he said. While certain national goals to improve minority health will stay in place, performance partnerships will address the variation between states in terms of priority areas.
This idea of shifting away from federal control has its advantages, but some state representatives raised concern about how state performance and accountability will be measured. It will be important, responded Dr. Lee, to develop data systems that help states not only identify core objectives, but also monitor progress.
Dr. Lee noted that he envisions stronger relationships between states and the Centers for Medicare and Medicaid Services, as well as the Office of Minority Health. De to recent reorganization, OMH will no longer serve only the Public Health Service, but the entire Department of Health and Human Services.
The overall goal of this third state meeting was to empower minority representatives "with useful information and guidance on ways to capitalize on emerging issues such as managed care, performance partnerships, and electronic communications," according to Clay E. Simpson, Jr, PhD, deputy assistant secretary for minority health.
The session on performance partnerships covered strategies that can help minority communities benefit from partnerships. In the telecommunications session, meeting partcipants learned how to access information and data sources through the Internet.
"It is imperative that those of us responsible for minority health are able to quickly exchange information, expertise, and assistance," said Dr. Simpson.
The North Carolina Office of Minority Health (NC-OMH) evaluated access to care for African Americans, Hispanics/Latinos, and Native Americans, and found that there was an insufficient number of services or programs geared to these groups.
Few states have greater population proportions of racial and ethnic minorities than North Carolina does. African Americans make up 22 percent of the states population, twice the national figure. The Hispanic population there, estimated at 100,000, is growing at three times the rate of other groups. In the 1990 census, 80,000 North Carolinians reported their race as Native American.
Its these statistics that led NC-OMH to set a cultural diversity initiative into motion. Last February, NC-OMH and Training Research Development (TRD), a private North Carolina group, conducted the Organizational Climate Assessment on diversity in public health. Preliminary results indicate that most respondents were not exposed to different cultures growing up and feel theyve had little training on cultural values and styles of different groups.
With a TRD consultant, NC-OMH developed a guide for cultural diversity training that is specific to public health. It covers cultural self-awareness, ethnic socialization patterns, and a framework for developing cultural competence.
This guide was used for a pilot training with 25 participants from five local health departments in North Carolina. Regional trainings also took place in December 1995 and January 1996.
The ultimate goal is that those trained at regional sessions will train others at local health departments. These Train the Trainer sessions began in February.
As part of the cultural diversity initiative, NC-OMH held a statewide conference last June. It was designed to provide an overview of cultural diversity issues in North Carolina and identify components of a culturally competent public health agency.
A survey of 35 counties in North Carolina with high Hispanic populations revealed that only four counties had interpreter services available "almost always" at the local health department.
With a committee of health and human services professionals, NC-OMH began to address the needs identified in the survey by developing recommendations for interpreter services.
NC-OMH also provided the first state training for interpreters in health care settings. This training is for people fluent in Spanish and English. Participants received several materials including a document called Guidelines for Interpreter Services in Public Health Agencies.
Participant objectives included understanding the importance of confidential interpreter services, defining the role of an interpreter in a health care setting, and improving the use of interpreter techniques and resources. The second level of interpreter training is slated for the Spring of 1996 and will depend on funding.
Both the cultural diversity and interpreter initiatives are critical to North Carolinas public health system, according to Barbara Pullen-Smith, executive director of the NC-OMH.
"This isnt a quick fix," she said, "but rather a long-term process that local agencies will be involved with. Our assessments have shown the problems, and the support for making improvements is there. The question at this point is not whether the initiatives will work, but whether well be able to implement them uniformly across the state."
For more information, call the Office of Minority Health in North Carolina at 919-715-0992.
Ms. Taylor was recognized for her work as director of Oregons Office of Multicul- tural Health. Mr. Wallace is the former director of the Office of Minority Health at the Texas State Department of Health. And Ms. Mitchell was acknowledged for her efforts as executive director of the Florida Commission on Minority Health.
Each award recipient has made valuable contributions to improving the quality of life for minorities. OMH wishes them continued success.
Early is really the key word since every year, millions of children die from vaccine-preventable diseases. Many parents think that immunization can wait until their children go to school, but public health officials in Iowa recommend that children receive the basic series of shots by age two. The schedule is broken down so that a child is immunized at two months, four months, six months, and 12-15 months of age.
Over the last two years, Iowa has seen a 27 percent increase in the number of two-year-olds there who are fully vaccinated. This is due mainly to the work of an immunization project sponsored by the Iowa Department of Public Health, Division of Family and Community Health.
The project is administered by AmeriCorps Volunteers in Service to America (VISTA), a national service program that provides volunteers with money for education in exchange for service to the community.
Volunteers in Iowa target families of all races, with emphasis on the fastest-growing populations, according to Colleen Lemkuil, project supervisor. To reach the increasing number of Asians in Sioux City, for example, a 62-year-old Vietnamese man is spearheading outreach efforts.
"Hes older, and that's important in the Asian community because people really look up to him," said Lemkuil. "Hes also in a good position to decide on the most effective techniques," she added, such as which Asian celebrations are appropriate for conducting immunization education.
During training, all VISTAs learn about the technical aspects of immunization and community planning. A VISTA in Dubuque said she makes trips to the courthouse to review birth certificates. Then she formulates her list of infants, sends letters to the families, and makes home visits, encouraging parents to stick to the recommended immunization schedule.
As far as Lemkuil can see, the biggest barriers to immunization in Iowa are language and transportation. She recalls the time one volunteer made about 20 calls, searching for printed flu information in Spanish. Another volunteer spent 160 hours in three months driving families to doctors appointments.
The VISTA program is built around facing such challenges and bringing people together to solve problems at the local level. Iowas success with increasing immunization rates has hinged on its ability to carry out statewide tracking and reach many populations.
Janice Herndon, minority health liaison in the states department of health, summed up the programs effectiveness: "I know that several thousand children would be without immunization services if it were not for Americorps VISTA."
For more information about the immunization program, call Colleen Lemkuil at 515-281-8517.
Medicaid and Childhood I'mmunizations: A National Study; and Building a National I'mmunization System: A Guide to I'mmunization Services and Resources. Contact: The Childrens Defense Fund, 25 E St., NW, Washington, DC 20001, 202-662-3652.
"Governed by a policy committee of clinic directors, physicians, and public health officials, the coalition is dedicated to improving access to health services for Latino populations," said Ms. Castellano.
LCHC is supported by Public Advocates, Inc., a nonprofit law firm with a 23-year history of advocating for minorities. The coalition has also received funds from the San Francisco Foundation, the W.K. Kellogg Foundation, and the federal Office of Minority Health.
These funds have enabled the coalition to hold policy events in San Francisco, Fresno, and Los Angeles, said Ms. Castellano. "Weve been able to increase the number of people who can join us in meeting with policymakers, submitting testimony at hearings, and distributing policy reports."
One of the coalitions most significant accomplishments is the development of the Cultural Index of Accessibility to Care for managed care organizations. The standards, which call for better interpreter services and provider training in multiculturalism, have been adopted by Californias Department of Health Services.
The coalition also brought in a statewide group to broaden the cultural index and make it relevant to other minority populations.
The LCHC and the University of San Francisco won a grant from the State Health Services Tobacco Control Section to coordinate the network on Hispanic/Latino Tobacco Control. LCHC will include tobacco issues in its advocacy agenda and educate Californias legislators on the dangers of tobacco use.
Other objectives for the future include expanding the Rapid Response Network, a statewide network of individuals who want to become involved with legislation affecting Latinos. LCHC created a policy paper on block grants and Medicaid cuts, and mailed it to members of the network. "Were asking that people take action," said Castellano. "Its not enough that people get the information. We need network members to use the information to implement policy changes."
For more information about the Latino Coalition for a Healthy California, call 415-431-7430.
"These collaborative efforts have allowed for directing and maximizing resources," according to Gardenia Ruff, director of the office. "And this has enhanced the ability of various organizations and groups to promote and implement their respective initiatives."
Raw sewage from outhouses spilled onto childrens play areas. Ditches overflowed with contaminated water. It was a first-hand look at a community forced to live in sub-standard housing, without indoor plumbing or sewage systems.
The visit was part of the committees endeavor to hear about Virginias health problems from the people most affected by them. Over an 18-month period in 1992 and 1993, Virginias Minority Health Advisory Committee (MHAC) held town meetings in eight parts of Virginia: Lawrenceville, Alexandria, Norfolk, Richmond, Roanoke, Onley, Bristol, and Arlington.
MHAC found that some common themes thread through every meeting. The list includes HIV/AIDS, the lack of funding for community based organizations; problems with health care access; chronic and disabling health conditions; and intentional injuries.
"Virginias minority health initiative has focused on documenting the health status of minorities through publishing documents and enhancing data collection and reporting systems," said L. Robert Bolling, director of Virginias Office of Minority Health.
A report published by Mr. Bollings office summarizes the town meetings and provides data on the most prevalent health problems by race. For example, a study conducted by Virginia Commonwealth University shows that African Americans, more than any other group in Virginia, lack health insurance.
Other access issues frequently mentioned were lack of affordable transportation, lack of health education, and lack of universal health care services.
One meeting participant called for the use of "unconventional methods such as alternative service hours, immunization services taken to housing communities, health fairs, servicing people who fall through the cracks--not poor enough to receive health care from the health department but unable to pay for health care..."
Several recommendations emerged from the town meetings, according to the report. Committee members suggested that primary care services be coordinated with local public and private human service agencies to supply transportation and child care services to indigent patients.
There was also a recommendation that Virginia supplement the federally funded Community Health Center Program by providing loans and grants to create primary health clinics in all medically underserved areas in the state.
Authors of the report say that based on the public testimony, its obvious that adequate solutions are not being implemented in the states current health delivery system, and that effective solutions will only come from change.
"Change may not be cheap or easy," they say, "and will only happen through commitment and collaboration between policy-makers, providers, and the community." For more information, contact Virginias Office of Minority Health at 804-786-4892.
Of those 1500, 20 percent had a cholesterol level above 200. Twenty-five percent had a curvature of the spine but were never told by the school nurse. At least two tested positive for the human immunodeficiency virus. And a whopping 1,444 had dental problems.
Of the nearly 200 females who were examined, 25 turned out to be pregnant but were unaware of it. The 25 young ladies later discovered that prenatal care was slowed by Medicaid limitations.
Tampa was just one of the cities in which the Florida Commission on Minority Health held a community forum in order to identify health problems among minorities.
The Florida Legislature created the commission in 1993. In accordance with the Minority Health I'mprovement Act, commission members were appointed by Governor Chiles, the house speaker, and the President of the Senate. The charge of this two-year commission was to address health issues of African Americans, Hispanic Americans, Native Americans, Asian Americans, and other minorities, and to advocate for the state creation of an Office of Minority Health. During the 1995 Florida Legislative Session, consensus was not reached to establish such an office and the official sunset date for the Florida Commission on Minority Health was in July of 1995. A report of recommendations has been submitted to the governor and state legislature.
After examining the poor minority health status, barriers to health care access, and the low numbers of minority health professionals in the state, the commission proposed the following:
Health Resources: The commission introduced a plan for the establishment of an Office of Minority Health at the state level. Proposed goals of the office would include monitoring and reporting on minority health data, services and programs; building coalitions with local health departments and community-based organizations; serving as a liaison to other states, the federal government, and national organizations; and working to improve minority health in urban and rural areas.
Health Care Status: The commission recommended increased coalition building, especially among minority physicians, to offer medical exams for minorities who are poor or in prison. There is also a need to empower parents to apply for family mental health services. Presentations and programs were proposed as ways to boost awareness and utilization of state services.
Health Care Access: Health care financing was cited as one of the biggest obstacles. Florida has 2.7 million uninsured residents, and ranks fourth in the nation of uninsured residents under the age of 65. The commission recommended the establishment of a minority health data network so that patterns of access could be monitored. A main data collection center would serve as a clearinghouse for use by government agencies, universities, and others. Such a center would work closely with the State Center for Health Statistics and there would be cultural competency training for personnel involved in data collection and assessment.
Health Professions: In order to increase the number of minority health professionals in Florida, the commission proposed that a survey be administered to medical and health care training schools in order to determine the levels of minority recruitment, training, and graduation. There should also be funding and programmatic support coming from the states department of education to promote the training of minority health professionals, the report suggests.
For more information on minority wellness issues, call Elizabeth Michael, State Health Office, Minority Wellness Program Coordinator, 904-487-3220.
Investigating Managed Care Enrollment: Last year, Floridas Sun-Sentinel newspaper published results of an investigation into the states Medicaid HMOs. What reporters found were shady enrollment practices and widespread dissatisfaction among patients. The quick rise in the number of managed care enrollees in Florida is partly due to state regulations that allow HMO sales agents to set up booths at food stamp offices. They give poor people free items such as diapers in exchange for signing up with a plan. According to the report, the give-aways sometimes attract immigrants and others with limited English skills--people who end up signing enrollment forms without fully understanding what managed care really means.
Over the last few years, representatives from the office and members of a minority health advisory group have held a series of meetings in order to pinpoint minority health needs. They discovered that Hispanics wanted more information circulating on how to access Spanish language services. As a result, two advertisements listing and promoting Hispanic health clinics in the state, are now listed in the Hispanic Yellow Pages.
The Asian population requested assistance with putting together a health fair for refugee families. The Oklahoma City University Nursing Department undertook the primary responsibility of organizing the event, and the Oklahoma City Health Department supplied professionals who could conduct screenings.
Services offered to the approximately 150 participants included pneumonia and flu vaccinations, cholesterol testing, instructional breast and testicular examinations, blood pressure and blood sugar screening, and nutrition education.
African Americans also requested health fair assistance. At one fair, conducted in support of a baptist church coalition, staff members from county and state health departments participated on educational panels.
Oklahomas Office of Mnority Health covers many cities with its outreach activities. The office has helped the Greenwood Cultural Center in Tulsa, Oklahoma create violence prevention programs. For Ardmore, Oklahomas Martin Luther King Jr., Birthday Celebration, O-OMH convened African American health providers to discuss concerns about minority provider inclusion under the states managed care system.
American Indians in Oklahoma expressed interest in having the Oklahoma State Department of Health create a directory of health services and resources. A brochure containing this information is almost completed. There was also a call for more intense recruiting of American Indians into the health professions. O-OMH is working toward this end through a partnership with the American Indian Research and Development Agency in Norman, Oklahoma, and the Native American Center of Excellence Consortium.
At one minority health meeting, Clark Hamilton, M.D., medical consultant to O-OMH, gave a presentation on environmental health. He discussed the Federal Agency for Toxic Substances and Disease Registrys efforts related to testing for food poisoning. Other topics were funding, grant proposals, and technical assistance.
Both meetings "offered a unique opportunity for community networking and capacity builiding," according to Clyde Benn, director of Oklahomas Office of Minority Health. The atmosphere of openness paved the way for effective communication, he added.
"For instance, when a participant shared information surrounding a need, in almost every instance, someone responded with an offer to help. The scenario can best be described as people helping people."
"On the horizon at O-OMH is more linkages with Oklahomas institutions of higher learning," said Mr. Benn. "We would like to design practicum programs for minority students pursuing health careers, as well as establish collaborative activities that improve delivery of health care to ethnic and minority communities."
For more information about Oklahomas Office of Minority Health, call 405-271-4200.
Twenty-nine new members have joined since October. Their areas of expertise include alternative medicine, grant writing and development, conference planning, substance abuse counseling, and ethnocultural issues in social work. If you would like to request an application to join the network, or more information on how the network can help your organization, call 1-800-444-6472 and ask to speak with an information specialist.
Results of the testing, which took place during National Radon Awareness Week last October, were recently released. PRC teamed up with the local utility to have meter readers, each accompanied by a bilingual community radon tester, go door to door to place detectors in 270 homes.
They returned to neighborhoods a few days later and retrieved 91 percent of the detectors. This personal approach to detector retrieval was a great improvement over previous distribution efforts that relied on the homeowner to retur test kits.
Results revealed that the homes tested did not appear to have a serious radon problem overall. However, seven homes did equal or exceed the Environmental Protection Agencys action limit of 4.0 picocuries of radon/liter of air. (A picocurie is a unit of measurement for radiation.)
If 1,000 non-smokers were exposed to 4.0 picocuries over a lifetime, about two people could get lung cancer. Because radon decay products cling to smoke particles, about 29 of 1,000 smokers could get lung cancer if exposed to the same 4.0 radon level over a lifetime.
At the end of the program, radon testers surveyed 142 residents who had participated in the program to see how much they had learned. Seventy percent were African American, 17 percent were Hispanic, and 13 percent were white. Almost 70 percent of the respondents knew that radon is found in homes, schools, and factories, and almost 60 percent knew that radon is the second major cause of lung cancer. The well-trained youths made sure they told residents the correct answers to the survey questions and informed them about the basic nature of radon and the associated health risks. One young tester, Mario Martinez, 17, said: "This was the best job I ever had because I may have saved my life."
At the heart of the programs success was PRCs commitment to seek mitigation funds for those homes with elevated radon levels.
"Community leaders were initially afraid to heighten awareness and testing of radon in their low-income community without having the means to solve the problem," according to Tom Marshall, radon program coordinator with PRC.
The council was able to secure funding from Delaware County to mitigate the homes with high radon levels.
The Pennsylvania Resources Council is a non-profit citizen action organization located in Newtown Square, Pennsylvania.
For more information, call Tom Marshall at 610-353-1555.
Sources of Health Materials for African Americans, Asian Americans, Hispanics/Latinos, American Indians, and Pacific Islanders. Office of Minority Health Resource Center.
Directory of African American Nutrition Programs. National Council of Negro Women and The Proctor and Gamble Company.
Making Health Communications Programs Work. National Institutes of Health.
National Directory of Hispanic Nurses. National Association of Hispanic Nurses.
Access to Health Care: Key Indicators for Policy. Center for Health Economics Research and the Robert Wood Johnson Foundation.
Guide to Selected HIV Services and Materials for Women. Centers for Disease Control National AIDS Clearinghouse.
Cancer Education Resources for American Indians and Alaska Natives. National Cancer Institute, National Institutes of Health.
Proceedings from the National Conference on Cultural Competence and Womens Health Curricula in Medical Education, Oct. 26-28, 1995, Office of Minority Health and Office on Womens Health.
National Council of State Human Service Administrators. 810 1st St., NE, Suite 500, Washington, DC 20002, 202-682-0100.
Association of State Medicaid Directors. 810 1st St., NE, Suite 500, Washington, DC 20002, 202-682-0100.
National Association of State Mental Health Program Directors. 66 Canal Center Plaza, Suite 302, Alexandria, Virginia 22314.
Association of State and Territorial Health Officials, 415 2nd St., NE, Suite 200, Washington, DC 20002, 202-546-5400.
Association of State and Territorial Directors of Public Health Education. c/o Lydia Pendley, Health Promotion Bureau, New Mexico Department of Health, 1190 St. Francis Drive, PO Box 26110, Santa Fe, New Mexico 87502-6110, 505-827-2380.
National Association of County Health Officials. 444 1st St., NW, Suite 500, Washington, DC 20001, 202-783-5550.
United States Conference of Local Health Officers. 1620 Eye St., NW, Washington, DC 20006, 202-293-7330.
Council of State and Territorial Epidemiologists. 2872 Woodcock Blvd., #303, Atlanta, Georgia 30341-4015, 770-458-3811.
Call us at 1-800-444-6472 to request the name and phone number of the minority health contact person for your state.
The Public Welfare Foundation offers grants that provide temporary funding while organizations search for permanent support. Tax-exempt organizations with programs designed to help the disadvantaged are eligible to apply for this interim funding. Priority areas include programs that affect minority populations, youths, and elderly people. Rolling deadline. Applications may be submitted at any time. Contact: Public Welfare Foundation, Inc., 2600 Virginia Ave., NW, Suite 505, Washington, DC 20037, 202-965-1800.
The Center for Substance Abuse Prevention offers support for planned meetings and conferences on substance abuse prevention. Conferences should focus on one of the following: prevention in relation to violence, HIV/AIDS, high risk youths, cultural diversity, rural areas, persons with disabilities, the workplace, and women. Priority is given to public and private groups, including those representing state and local governments. Deadlines vary. Contact: The National Clearinghouse for Alcohol and Drug Information, 1-800-729-6686.
Closing the Gap is published by the Office of Minority Health Resource Center, a service of OMH. If you have comments please call 1-800-444-6472 with comments, write to OMH-RC, P.O. Box 37337, Washington, DC 20013-7337, or e-mail us at info@omhrc.gov.
Executive Editor Blake Crawford Managing Editor Michelle Meadows Copy Editor Symra Spottswood Production Coordinator Becky Hardaway
Last Modified: July 8, 1996
The Office of Minority Health Resource Center
E-Mail: info@omhrc.gov
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