Even for employed problem drinkers who are not abusing drugs and who have no serious medical problems, an initial referral to AA alone or a choice of programs, although less costly than inpatient care, involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse.

The "second public health revolution" targets factors in the environment, together with lifestyle, to prevent illness and untimely death. Yet the growth of the "wellness movement" has driven a wedge between public health advocates who argue for environmental solutions and those whose major focus is individual behavior. This tension is nowhere more evident than in the workplace, where the new wellness professionals are at odds with specialists in occupational health and industrial hygiene. This paper reports findings from a cross-sectional survey of a sizeable sample of workers at six New England facilities of a very large American manufacturing firm, assessing their perceptions of risk in the two domains: environmental exposures and lifestyle risks. Multiple regression analyses reveal that both job risks and life risks are associated with a variety of potentially costly and disruptive health problems, even after controlling for demographic and occupational factors. This analysis suggests that wellness programs in the workplace will be more effective if they integrate environmental protection with efforts to reduce lifestyle risk.

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Demonstrating Excellence in Practice-based Teaching for Public Health is a report intended to provide a resource for practice-based teaching of public health and includes a brief explanation of terms and practices, as well as suggestions on methodologies for implementation. No comparable resource currently exists that assists faculty and practice partners to recognize, implement, and promote practice-based teaching. This article summarizes findings from the report, including an explanation of practice-based teaching, its guiding principles, practical approaches, and recommendations on sustaining and advancing partnerships for professional public health education and training.

A B S T R A C TJuvenile justice systems in the United States do not always respond effectively to substance abuse problems among young offenders. In 2002, the Robert Wood Johnson Foundation launched a 10-community demonstration project to address this problem. Reclaiming Futures (RF) relies on community partnerships to improve treatment quality, strengthen local leadership, expand inter-organizational collaboration, and create systems of shared performance management. The initial findings of a cross-site evaluation suggest that Reclaiming Futures is yielding important and positive change. Bi-annual surveys of key informants measure the quality and integration of juvenile justice and substance abuse treatment systems in each community. Of 13 indices measured by the surveys, 11 showed significant improvements between 2003 and 2005. Laura Burney Nissen, Ph.D., M.S.W., National Program Director of Reclaiming Futures in Portland, Oregon, has spent the last 16 years as an advocate, researcher, and developer of strength-based service delivery systems for youths in a wide variety of treatment and juvenile justice settings. A founder of the Center for High

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Objective This study examined use of the Americans With Disabilities Act (ADA) among persons with rheumatic diseases and assessed which factors were associated with use. Methods A mail survey was conducted among adult patients recruited from 21 rheumatology practices. Subjects answered questions about their inclination to use the ADA in the community or at work and about factors thought to be associated with use. The outcome was stage of behavior change, the behavior being use of the ADA. Ordinal logistic regression identified independent correlates of the outcome. Results Of 631 subjects, 47% experienced an ADA‐resolvable barrier to community activity, and 63% of 183 employed subjects needed a job accommodation or experienced health discrimination. However, only 7% of the full sample and 10% of the employed subgroup had used the ADA. Factors associated with use were detailed knowledge, perception of being disabled, skill in requesting use, and health professional use suggestion. Conclusions Although many persons with rheumatic diseases experience community barriers or need workplace accommodations, they currently underutilize the ADA. Use could be enhanced by health professional suggestion and referral or by community programs designed to address the factors identified.

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