Browsing by Author "Thomas, James C."
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Item Defining and Assessing Organizational Competence in Serving Communities at Risk for Sexually Transmitted Diseases(2002) Thach, Sarah Brill; Eng, Eugenia; Thomas, James C.This study sought to develop an assessment tool to help health agencies enhance their capacity to provide sexually transmitted disease (STD) care to communities at risk and close the gap of racial disparities in health. Specifically, the study sought to (a) define the organizational competence of agencies serving communities at risk for STDs, and (b) develop a method to assess an agency’s organizational competence. In a rural Southern county, qualitative action research methods including key informant interviews, observation, and document review were used to assess four health agencies’ competence in responding to the needs of high STD-risk communities. Nine dimensions of organizational competence were identified: community participation, assessment of community needs, ensured access to services, community outreach, cultural competence, interagency collaboration, policy development, resource acquisition, and organizational commitment to serve. A competent organization was conceived as one that (a) is committed to serve, (b) works with communities at risk, (c) understands and appropriately responds to their needs, and (d) advocates on their behalf.Item Incarceration as Forced Migration: Effects on Selected Community Health Outcomes(2006) Thomas, James C.; Torrone, ElizabethObjectives. We estimated the effects of high incarceration rates on rates of sexually transmitted infections and teenage pregnancies. Methods. We calculated correlations between rates of incarceration in state prisons and county jails and rates of sexually transmitted infections and teenage pregnancies for each of the 100 counties in North Carolina during 1995 to 2002. We also estimated increases in negative health outcomes associated with increases in incarceration rates using negative binomial regression analyses. Results. Rates of sexually transmitted infections and teenage pregnancies, adjusted for age, race, and poverty distributions by county, consistently increased with increasing incarceration rates. In the most extreme case, teenage pregnancies exhibited an increase of 71.61 per 100000 population (95% confidence interval [CI]=41.88, 101.35) in 1996 after an increase in the prison population rate from 223.31 to 468.58 per 100 000 population in 1995. Conclusions. High rates of incarceration can have the unintended consequence of destabilizing communities and contributing to adverse health outcomes.