A Note from the Editor

The themes of preventive care and diagnosis, especially in pediatric and Latino populations, run through nearly all the papers in this issue, reminding us of the vital roles played by clinics, community programs, and providers in maintaining optimal health among people whose chances for it are severely weakened by a lack of socioeconomic resources, by environmental and sociocultural stressors, and by the absence of a standardized health care system.

A supplement from the Centers for Disease Control and Prevention's (CDC's) Racial and Ethnic Approaches to Community Health (REACH) 2010 accompanies this issue. The REACH 2010 program sponsors interventions in 42 cities in the U.S., a number of which are covered here, ranging from Fort and McLellan's account of the Meharry Medical College post-baccalaureate program introducing future health care providers to the world of community health, to Koch-Wesser et al.'s report on the health of Cambodians living in Lowell, Massachusetts, to two faith-based initiatives (one in the Bronx and the other in Chicago) among African Americans, to an investigation of the relationship between health and discrimination. Each of the supplement's eleven papers succeeds balancing local and national concerns.

Kaplan et al.'s paper in the CDC REACH 2010 supplement stands out for how the REACH team in the Bronx implemented community-based participatory research. Pastors and other church leaders in the Bronx, rather than the research team, ultimately decided how the intervention was conducted, making it take on a highly context-specific character. Community members taught, led, and assisted one another while the research team provided information, assistance, and programming only as needed. This is different from much of what goes by the name of community-based participatory research in that the community had much of the power implicit in decision-making and budgeting. It also illustrates robustly what cultural competence can look like in public health interventions.

This quarter's regular issue leads off with an important paper by Leslie et al. comparing pediatric populations treated at community clinics with others treated at private offices in San Diego County in order to assess American Academy of Pediatric guidelines for the diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD). The authors find no significant differences between sites in the rates of ADHD or the treatment children received by 12 months after the evaluation. What they did find, however, was a significantly greater occurrence of Oppositional Defiant Disorder/Conduct Disorder (ODD/CD) among the children seen in clinics. Those children were also more likely, based on their socioeconomic profiles, to have experienced socio-environmental stressors (foster care, homelessness, parental drug use, domestic violence) that are independently linked to ODD/CD. The authors emphasize the importance of providers being on the lookout for ODD/CD, perhaps in conjunction with ADHD but perhaps not, and possible socio-environmental stressors when working with children from low-income backgrounds.

A team of researchers from Stanford and a clinic serving a primarily Latino population in Palo Alto compared providers' recognition of psychosocial problems in low-income Latino children with those of the children's parents. Despite strong skills in Spanish and long experience working in Latino communities, providers recognized none of the children with significant symptoms of anxiety and/or depression identified by parents, only 20% of those with parent-identified clinically significant symptoms of aggression, and 18% of children with parent-identified clinically significant attention/hyperactivity symptoms. The paper dovetails nicely with Leslie, emphasizing again the importance of providers being vigilant about the diagnosis of mental health problems in pediatric populations, especially minority populations, where there is a long history of under-diagnosis.

In contrast, Asanbe and Lockert find somewhat fewer cognitive problems among school-aged children with prenatal cocaine/polydrug exposure than had been found in prior studies. While the children studied had significantly lower scores on global intelligence and verbal comprehension tests than a matched cohort without prenatal drug exposure, they scored equally well as those children on 8 of 11 cognitive tasks. The authors argue that the emphasis of policy for such children should shift from coping with so-called crack-baby damage (which...