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This study assessed perspectives of NCAA D-II and D-III Athletics Directors (ADs) regarding the possible implementation of competitive e-Sports on college campuses. It examines if ADs view e-Sports as a legitimate sport in parallel with others that are traditionally offered by athletic departments, and their perspective regarding where on college campuses e-Sports should be housed. Results demonstrated that ADs view e-Sports differently than other sport programs (F = 13.439; p = .001), and this was key in determining where they thought e-Sports programs should be administered (F = 6.696; p = .013). However, some expressed a willingness to consider implementing e-Sports due to the opportunity it could present (F = 2.209; p = .021). These results suggest that an apparent conflict exists between ADs’ perceptions of e-Sports and of its potential as a growth opportunity. However, if colleges decide to implement e-Sports as an athletic program, consideration should be given to governance concerns, budgetary concerns, and the health and wellness of participants.

As the population of Aotearoa/New Zealand heads towards one-in-four being aged over 65-years-and-over by 2040, it is anticipated that family members will play an increasingly important role in caring for older relatives with chronic and age-related health issues. Multi-generational, and in particular three-generational living arrangements, combined with family care of older relatives are a growing trend; a trend already even evident among Māori communities. This paper reports on a study that explored the care experiences and expectations of 14 past and current Māori carers (aged 23 to 72-years) of older relatives. Interviews were audio-recorded, transcribed verbatim, and coded independently. The initial thematic analysis revealed nine themes and participants were invited to feedback on the summary in person or in writing. The feedback resulted in the original themes being collapsed into four (with subthemes): “Care is Normal”; “Collective Coordination of Care”; “Insider-Carer—Outsider Perspectives on Caring”; and “Societal Influences on Family Care/Carers”. Firstly, these themes highlight how Māori cultural norms infuse direct care, support, and coordination roles within family care of the older family member. Secondly, they reveal the challenges for family carers in talking about their work with others, especially (thirdly) in the face of negative attitudes towards care and carers of an older family member within wider society. These findings have implications for cultural and wider socio-political influences in socialising different groups to carer role expectations. If society is to better prepare future caregivers for their role, ongoing research is needed with the various cultural groups in Aotearoa/New Zealand.

1 2 1 1 2 1/15 Purpose: Inclusive recreation practices are one of the most recognized means of providing recreational sport opportunities for youth with disabilities. Municipal recreation departments are responsible for ensuring opportunities to partake in youth sport programs. This study evaluates the extent to which recreation departments are providing inclusive recreational sport opportunities to individuals with disabilities. Methods: This study employed a cross-sectional design mail survey to gather data from recreation directors across New England. The two dependent variables for this study are provision of inclusive services and perceived challenges to providing those services. The independent variables include director recreation/sport education, years as a director, and community size. Analysis included univariate, bivariate, and ANOVA for the quantitative data. Qualitative data were reviewed for commonalities. Results: There were 136 respondents for a response rate of 34.8%. Most (85%) directors noted their agency provided some inclusive recreation. Areas of success included accessible facilities and accommodations/modifications. Areas of needed improvement included staff training and providing transportation for individuals with disabilities. The only significant factor was years as a Director (F=4.315; p=0.016). The multiple comparison test found statistical significance between those with the fewest years of experience (x=22.14) and highest experience (x=19.57). The top challenges in providing inclusive recreational sport was additional expense, and the lack of training for the provision of these services. Conclusions: Without director support, inclusive recreation can be difficult to achieve. Director support, including making inclusion an agency priority, reflecting inclusion in the agency's mission, and hiring practices was imperative to facilitating an inclusive recreation environment and program. Financial concerns and need for staff training are the biggest obstacles to providing inclusive recreational sport programming. Applications in Sport: Training of recreation and youth sport staff members, including those that aspire to be directors, can have a great impact on opening opportunities for inclusive recreational sports. University academic recreation and sport management programs need to embed the principles and practices of inclusion into their curriculum. In-service training can be an important tool to increase inclusion offerings to the community, increasing the amount of staff members who can facilitate increased opportunities for inclusive recreational sport.

Book Reviews 125 All of the above and more are detailed by Claerbaut. He also covers Michigan State’s program as it went into decline in the late 1960s. Daugherty began to miss on the recruiting trail. At the same time, African American students and athletes on campuses across the nation more vocally joined the civil rights protest movement. It was a difficult period for Daugherty, who never sought credit for his progressive attitudes of providing black athletes equal opportunities. One of his responses was to break more barriers with black assistant coaches. Sherman Lewis, Daugherty’s first Underground Railroad All-American as a halfback from Louisville, Kentucky, joined the MSU staff in 1969. Raye was hired part time in 1971 and full time in 1972. Raye and Lewis went on to the National Football League as assistant coaches and offensive coordinators. A consequence of Daugherty doing what was right without seeking credit allowed myths surrounding a 1970 game matching USC and the University of Alabama to usurp his far more significant role. That is reason to link Daugherty with the words of David Maraniss, the Pulitzer Prizewinning biographer, who wrote, “History writes people out of the story. It’s our job to write them back in.” Thus, until that national trip-wire is no longer stepped over and subsequently triggered, the more the merrier to rightly place Daugherty’s story back into history. Tom Shanahan Author, Raye of Light Anna Clark. The Poisoned City: Flint's Water and the American Urban Tragedy. New York: Metropolitan Books, 2018. Pp. 305. Index. Notes. Cloth: $30.00. Journalist Anna Clark provides a gripping, thought-provoking, and comprehensive account of the people who caused, suffered from, and exposed the Flint water crisis. Clark’s brilliant story reminds us of the farreaching , devastating effects of lead exposure and that safe, high-quality drinking water is essential to good health. Clark meticulously details how corruption, recklessness, and arrogance of public officials, prejudice, and greed characterized the crisis in Flint. The Poisoned City is divided into three parts, each subdivided into several chapters. Part one reviews how water that blessed the indigenous Ojibwa people would eventually curse Flint residents. We learn how industrialization coincided with mistreatment and development of waterways. Vast, ferocious Lake Huron served as Flint’s freshwater 126 The Michigan Historical Review source for nearly 50 years. Amid financial distress, Flint switched to the Flint River water system in April 2014. The new water treatment program lacked corrosion control, breaking federal law. Adding to Flint’s woes were exorbitant water and sewer bills, an aging water infrastructure, and decreased federal funding. Clark also describes the federal government’s alarming apartheid approach to city building. Vicious, systematic tactics prolonged residential segregation and created multigenerational housing inequalities. Desegregation triggered a large-scale departure of whites. In 2014, General Motors (GM) workers noticed water-corroded engine parts. People wondered what it did to the inside of humans. Part two discusses the damaging health effects of and countless sources of exposure to lead. We meet longtime GM research director and leaded gasoline creator Charles Kettering. We gain insight into leaded gasoline’s profitability, Flint’s re-engineering to favor automobiles, fierce rebuttals to decries of lead hazards, ethical burdens of proving lead toxicity, the lead industry’s massive lobbying, and victim-blaming in response to residents’ concerns. Clark discusses loopholes in lead restriction policies, manipulation of lead testing, and a trend of childhood lead poisoning in shrinking cities. We learn how biochemist Marc Edwards, veteran journalist Curt Guyette, regulations manager Miguel Del Toral, pediatrician Mona Hanna-Attisha, and local residents rallied to spur a movement to urge governmental action. We also see effects of a very expansive law signed in 2011 that gave emergency managers unyielding power. Part three details the switch back to Detroit water in October 2015 and the flawed, hasty decision-making of untrustworthy leaders. Governor Rick Snyder declares a state of emergency in January 2016 and announces a two-year Legionnaire’s disease outbreak. Declaration of a federal emergency in Flint follows. A myriad of lawsuits, rebuttals, indictments, and pushbacks ensues. Apologies are offered, promises are made, and secrecy and injustices proliferate. Sadly, accountability...

Objective: To describe faculty efforts to deliver and evaluate health disparities–related education in US online undergraduate and graduate public health courses. Design: A pre- and post-survey was given to a cohort of 46 US college students in three public health courses taught asynchronously online over an 8-week period in 2017. This study took place at a mid-sized, public, rural, midwestern US university. Method: Faculty received professional development and online training and were assigned to develop courses for a new public health programme. Following the receipt of ethical approval, students completed anonymous, online pre- and post-surveys to assess effect of intentional instructional approaches on their knowledge and attitudes about health disparities. Curricula incorporated various assessment methods and teaching strategies. Descriptive statistics were used to compare pre- and post-survey scores and analyse demographic data. Paired t-tests and one-way analysis of variance were used to analyse pre- and post-survey test scores. Results: At post-survey, students demonstrated a positive change in mean scores for several items, including for ability to discuss the role of theory in understanding health behaviour and disparities in health status (3.20 vs 4.06; p < .001) and ability to discuss strategies health promotion programmes can use to reduce health disparities (3.47 vs 4.40; p < .001). Post-survey response rate was 87%. Conclusion: Results suggest an effective way to increase health disparities knowledge among online college students. Additional research is encouraged to expand upon these findings.

Preventable differences in health outcomes between U.S. population subgroups, related to factors such as race or ethnicity, income, and geographic location, are troubling. Geographically, rural American communities experience higher rates of adverse health conditions when compared with urban areas, further widening disparities in health outcomes. Such disparities necessitate the creation of effective curricula to enable students to address the health needs of underserved populations. By intentionally incorporating health disparities awareness content into the curricula, undergraduate and graduate public health programs can play an integral role in developing conscious health practitioners to help close gaps in health outcomes. Moreover, rural health courses may increase students’ interest in rural health careers. This article presents the process and results of faculty efforts to design and deliver health disparities–related education in undergraduate and graduate public health courses at a rural Midwestern U.S. university. Various teaching development programs inspired faculty to use intentional instructional approaches to teach students about health disparities. Consequently, faculty incorporated a variety of assessment methods and teaching styles to infuse health disparities awareness content into public health courses. Results from students’ course evaluations and reflections are discussed along with lessons learned and implications for future pedagogical directions.

There are emerging concerns about the preparedness of rural communities in the United States in the face of the 2019 novel coronavirus (called SARS-CoV-2, causing the disease COVID-19) considering the existing disparities across the social determinants of health between rural and urban Americans. Taking into account the current exponential rate of spread of the coronavirus, this article critically examines the risk facing the 60 million Americans living in rural areas, discusses possible solutions pertaining to rural COVID-19 prevention, and examines measures to consider to prepare for this epidemic before it reaches rural areas.

Breast cancer patients undergoing radiotherapy often experience severe levels of anxiety and depression within the African context. There is a gap in the research literature from Africa, particularly Ghana, with few studies focusing on depression among patients undergoing radiation treatment. The purpose of the study was to find various interventions for depression and anxiety among breast cancer patients in Ghana. A mixed method study examined breast cancer patients undergoing radiotherapy and their responses through a concurrent triangulation involving an interview with selected professional and a detailed patient survey. In all, 100 patients between the ages of 20-89 completed a questionnaire and individual interviews were held with 6 professionals with a minimum of 5 years of work experience. Themes were generated through open coding of the interview data, while multiple regression was performed to determine the relationship between depression and anxiety with the independent variables. In all, 89% had no family history of breast cancer, and the majority (55%) had the disease duration of one to three years. Almost 95% of patients with breast cancer had anxiety and depression in different categories. This included hair loss, discolored finger nails, cost of treatment, and fear of the unknown. Age and monthly income of patients were statistically significant in predicting the anxiety and depression among the patients. Coping mechanisms are essential for all patients undergoing treatment. This study’s implications will lead to positive change when all stakeholders assist in implementing measures to promote coping strategies for breast cancer patients in Ghana.

The commentary elucidates the importance of Protection Motivation Theory (PMT) as a theoretical framework to encourage the practice of social distancing in rural areas as the world grappled with the pandemic of COVID-19 outbreak.

Foundations of Rural Public Health in America spans a wide variety of important issues affecting rural public health, including consumer and family health, environmental and occupational health, mental health, substance abuse, disease prevention and control, rural health care delivery systems, and health disparities. Divided into five sections, the book covers understanding rural communities, public health systems and policies for rural communities, health disparities in rural communities and among special populations, and advancing rural health including assessment, planning and intervention. Written by a multidisciplinary team of experienced scholars and practitioners, this authoritative text comprehensively covers rural health issues today.

Mounting evidence suggests that differential environmental exposures significantly contribute to a wide range of population health disparities. Adopting a life course approach to maternal and child health enables readers to uncover the mechanisms by which prenatal and early life environmental exposures potentially shape both short- and long-term physical and mental health outcomes. This chapter applies the life course approach to explore the adverse influences of environmental risk factors on maternal and child health. The following four case studies will be discussed: (1) the pervasive impacts of secondhand smoke; (2) the deleterious effects of lead exposure; (3) the development of asthma; and (4) the potential origins of autism spectrum disorder. The chapter also provides recommendations for programmatic and policy interventions to reduce the prevalence of four salient environmental hazards, including secondhand smoke, lead, air pollution, and pesticides, as well as proposed future directions in research regarding these exposures.