Recruitment incentives to reduce disparities among medically underserved men.Abstract: This study examined two techniques for recruitment by mailed invitation of underserved, low-income men to an educational program about prostate cancer screening Prostate cancer screening is an attempt to identify individuals with prostate cancer in a broad segment of the population—those for whom there is no reason to suspect prostate cancer. . The Ethnic Sensitive technique used special envelopes and letterhead; the $2 Incentive technique used cash to say "thanks" for reading the cover letter. Low-income households were randomized ran·dom·ize
tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es
To make random in arrangement, especially in order to control the variables in an experiment. to one of four groups: Controls, Ethnic Sensitive Only, $2 Incentive Only, or the Combination of both approaches. The $2 Incentive technique increased rates of making appointments to attend the educational program (p=0.01), yet many of these men did not keep their appointments. However, the Ethnic Sensitive method doubled actual attendance rates (p = O. 04) and was the most cost-effective method studied.
Historically, African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race. and low-in come men have not participated in research studies. Medically underserved men and African American men are less likely to participate in education and screening for prostate cancer prostate cancer, cancer originating in the prostate gland. Prostate cancer is the leading malignancy in men in the United States and is second only to lung cancer as a cause of cancer death in men. (Smedley, Stith, and Nelson, 2003). National legislation to reduce health disparities
Health disparities (also called health inequalities in some countries) refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups. support research efforts is aimed at improving participation (Haynes & Smedley, 1999; Committee on CA Research Among Minorities, 1999). Still, better recruitment strategies for medically underserved men are needed (Guralnik & Leveille, 1997; Weinrich, Weinrich, Ellison, et al, 2000; Weinrich, Boyd, Greene, et al, 1998).
African-American men have the highest prostate cancer incidence and mortality rates of any ethnic group. Their incidence rate is 206.7 per 100,000, versus 132.7 in Caucasians (Reis, Eisner, Kosary, et al, 2000; Greenlee, Hill-Harmon, Murray, & Thun, 2001). Recent improvements in prostate cancer detection at earlier stages and improved survival rates have not occurred to the same extent in African American as in Caucasian men (Hankey, Feuer, Clegg, et al., 1999).
Poverty is associated with poorer prostate cancer outcomes, and lower-income men are more likely to be diagnosed at an advanced stage (Haynes & Smedley, 1999; Klausner, 1999; Guralnik & Leveille, 1997; Kington & Smith, 1997; Shingawa, 2000; Greenwald, Borgatta, McCorkel, et al, 1996; Roetzheim, Pal, Tennant, et al, 1999; Hebert, Hurley Hurley has become the English version of at least three distinct original Irish names: the Ó hUirthile, part of the Dál gCais tribal group, based in Clare and North Tipperary; the Ó Muirthile, based around Kilbritain in west Cork; and the OhIarlatha, from the district of , Olendzki, et al, 1998; Freeman, 1989; Link, Northridge, Phelan, et al, 1998; Hoffman-Goetz, Breen, & Meissner, 1998; Polednak, 1997, Committee on CA Research Among Minorities, 1999; Bennett, Fereira, Davis, et al, 1998, ACS (Asynchronous Communications Server) See network access server. , 1990; Robinson, Ashley, & Haynes, 1996). Although national data bases do not currently gather or report income (P. Wingo, personal correspondence, February 22, 2000), two published studies document the association between prostate cancer and income. Stage at diagnosis of prostate cancer was inversely in·verse
1. Reversed in order, nature, or effect.
2. Mathematics Of or relating to an inverse or an inverse function.
3. Archaic Turned upside down; inverted.
1. correlated cor·re·late
v. cor·re·lat·ed, cor·re·lat·ing, cor·re·lates
1. To put or bring into causal, complementary, parallel, or reciprocal relation.
2. with income among 117 blacks in North Carolina North Carolina, state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N). Facts and Figures
Area, 52,586 sq mi (136,198 sq km). Pop. (Conlisk, Lengerich, Denmark-Wahnfried, et al, 1999). In the South Carolina South Carolina, state of the SE United States. It is bordered by North Carolina (N), the Atlantic Ocean (SE), and Georgia (SW). Facts and Figures
Area, 31,055 sq mi (80,432 sq km). Pop. (2000) 4,012,012, a 15. Prostate Cancer Project (Weinrich, Weinrich, Ellison, et al, 2000), the detection rate for prostate cancer was significantly greater in the lowest income group of men (p < 0.01).
It is not yet known whether the potential benefits of prostate cancer screening outweigh out·weigh
tr.v. out·weighed, out·weigh·ing, out·weighs
1. To weigh more than.
2. To be more significant than; exceed in value or importance: The benefits outweigh the risks. the associated risks. But most experts agree that all men, including the medically underserved, should be involved in prostate cancer screening educational programs, so that they can make an informed decision whether to undergo screening (Brawley, 2001; Weinrich, 2001; Magee & Thompson, 2001).
Recruitment of African American and low income men to educational programs can be difficult, time consuming, and costly. Recruitment strategies reported in the literature include testimonies from sports figures, key community leaders, and political leaders (Paskett, Tatum, D'Agostino, et al, 1999); use of peers (Weinrich, Weinrich, Stromborg, et al, 1993; Weinrich, Boyd, Greene, et al, 1998); health printed materials with reduced literacy levels (Weinrich, 1999, Reflections); and incentives such as a tee-shirts or coupons (Heberlein & Baumgarten 1978).
Weinrich demonstrated that her educational interventions (Client Navigator See Netscape Navigator, Netscape and Norton Navigator.
Navigator - Netscape Navigator and Peer Educator), as well as local presentations in medically underserved neighborhoods were useful tools to increase participation in free prostate cancer screening programs (Weinrich, Weinrich, Boyd, et al 1998; Weinrich, 1999, Reflections). In a group of men recruited at their place of work, the cost per man screened varied widely, depending upon the intervention A procedure used in a lawsuit by which the court allows a third person who was not originally a party to the suit to become a party, by joining with either the plaintiff or the defendant. used (Weinrich, Weinrich, Ellison, et al, 1999). Finding simple cost-effective recruitment strategies for low-income and African American men in the general population remains a critical priority. Cost continues to be a major barrier to sharing in the benefits of today's cost-conscious health care system.
The present study tested two intervention techniques using mailed invitations to target low-income and African American men. The goal was to encourage recipients to make an appointment to attend an educational program for prostate cancer screening. The design of the study was inspired by Dillman's total design method (Dillman, 2000). Dillman's book contains suggestions regarding both the type of paper to use for a mail survey and how to include financial incentives for participation.
The two intervention techniques studied here were mailing "ethnic sensitive" letterhead and envelopes (instead of standard University of Louisville See also
1. ^ 
2. ^  URL accessed on June 8 2006
3. stationery The term for boilerplate in the Eudora mail client, starting with Version 3.0. Stationery files are stored on disk and brought into new messages or added to replies. See boilerplate. ) and including $2 to say "thank you" for reading the mailing.
Survey Sampling Inc. provided a roster of 770 household names History
Household Names have been together since 1998, with various members rotating throughout the line-up with singer, Jason Garcia, until it was solidified in the summer of 2000 with bassist/keyboardist, Chris Peters, and drummer, C. J. and addresses constructed by combining US Census and marketing data. Households were chosen for their low median annual household incomes (below $30,000), as well as their proximity to the screening site, their high prostate cancer mortality rates (33.1 to 38.4 per 100,000, versus 24.9 for Kentucky as a whole), and their high likelihood of containing at least one eligible man aged 40 years or greater. About 30% of the households in the target ZIP code zip code
System of postal-zone codes (zip stands for “zone improvement plan”) introduced in the U.S. in 1963 to improve mail delivery and exploit electronic reading and sorting capabilities. areas were African American (Jefferson County Jefferson County is the name of 25 counties and one parish in the United States. The following are named for Thomas Jefferson, third President of the United States:
Before letters were mailed, listed households were randomized to one of the interventions or one of the two control groups. One hundred seventy-one letters were mailed to each group, except for Control Group II (pure controls), which contained 86 addresses. Control Group II received no mailing.
Two mailed intervention techniques were tested, both singly and jointly, for recruitment of low-income men: Ethnic Sensitive Only, $2 Incentive Mailing Only, and Combination (using both the Ethnic Sensitive and the $2 Incentive techniques).
This study served only as a pilot study for a larger, subsequent study; no formal field testing was performed. There were two control groups: Control group I, which received a plain letter announcing the free Prostate cancer educational program and the opportunity to obtain free screening, and Control group II (pure community controls) did not receive a letter at all. The two outcomes of interest were responding to the mailed letter by making an appointment to attend, and actually attending the educational program. There was no attempt to follow up non-responding households, by mail or by telephone.
Each mailing included a flyer informing men about the free prostate cancer educational program, which was held at a local hospital. An acceptance form and a stamped return envelope were also included. The cover letter gave eligibility criteria, brief information about prostate cancer screening, and the time, date and location of the program. The letter also emphasized that the prostate cancer screening would be free if they did participate.
The stationery used for the Ethnic Sensitive Intervention technique was an attractive off-the-shelf line of stationery from a local copy center with a design similar to Kente ken·te
1. A brightly patterned, handwoven ceremonial cloth of the Ashanti.
2. A durable machine-woven fabric similar to this fabric, prominently featured in Afrocentric fashion. cloth.
The idea of using special paper was taken from Dillman's book (Dillman, 2000); the specific design chosen was based on informal consultation with local African American men. The US Postal Service postal service, arrangements made by a government for the transmission of letters, packages, and periodicals, and for related services. Early courier systems for government use were organized in the Persian Empire under Cyrus, in the Roman Empire, and in medieval prostate cancer stamp was also used, and the message "This could save your life" was printed on the front of the envelope. The $2 Incentive Intervention technique added the closing statement, "Thanks for reading this letter" along with two new one-dollar bills. The Combination Intervention combined both approaches. There were two control groups: Control Group 1 received a standard letter asking men to participate in the free prostate cancer educational program; Control Group 2, which was used to detect awareness of the screening program arising by word-of-mouth and local advertisement, received no letter.
Men were mailed letters based on their randomization randomization (ranˈ·d·m group. All men who kept the appointment signed an informed consent form and completed a questionnaire on site, which obtained basic demographic information and questions measuring knowledge and attitudes towards prostate cancer screening. Attendees then participated in an educational program that focused on the benefits and limitations of prostate cancer screening, and decided whether or not to undergo CaP screening.
Six hundred eighty-four letters were mailed (Figure 1). Twenty-two were undeliverable un·de·liv·er·a·ble
Difficult or impossible to deliver: undeliverable mail.
un due to incorrect addresses (3.2%), We therefore estimate that no more than 96.8% (662/684) of the original listings were valid. This estimate was used as part of the procedure to adjust crude response rates.
[FIGURE 1 OMITTED]
Data were entered using Microsoft Access A database program for Windows, available separately or included in the Microsoft Office suite. Access is programmable using Visual Basic for Applications (VBA). Access can read Paradox, dBASE and Btrieve files, and using ODBC, Microsoft SQL Server, SYBASE SQL Server and Oracle data. and SAS (1) (SAS Institute Inc., Cary, NC, www.sas.com) A software company that specializes in data warehousing and decision support software based on the SAS System. Founded in 1976, SAS is one of the world's largest privately held software companies. See SAS System. (SAS, 2002). Analyses to compare the relative effectiveness of the interventions were carried out using LogXact (Cytel Software, Cambridge MA) for exact (nonparametric) logistic regression In statistics, logistic regression is a regression model for binomially distributed response/dependent variables. It is useful for modeling the probability of an event occurring as a function of other factors. . Analyses were based on die number of men who made appointments (or who attended the program), using the number of letters mailed as the denominator denominator
the bottom line of a fraction; the base population on which population rates such as birth and death rates are calculated.
denominator for all response rates.
Many households on the original address list did not contain an eligible respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests. . Yet to estimate the true proportion of eligible subjects who made an appointment when they received our letter, it was necessary to estimate the fraction of listed households that contained one. The crude response rates ("responses per address") were therefore divided by the estimated fraction of listed households that contained an eligible respondent ("eligible subjects per address"). This procedure gave adjusted rates (responses per eligible subject). The adjustment occurred only after statistical analyses had been carried out on the original data and had no impact on the statistical significance of the results.
The fraction of households that contained an eligible man was estimated by multiplying mul·ti·ply 1
v. mul·ti·plied, mul·ti·ply·ing, mul·ti·plies
1. To increase the amount, number, or degree of.
2. Mathematics To perform multiplication on. the fraction of the 684 letters originally mailed that were not returned due to an invalid Null; void; without force or effect; lacking in authority.
For example, a will that has not been properly witnessed is invalid and unenforceable.
INVALID. In a physical sense, it is that which is wanting force; in a figurative sense, it signifies that which has no effect. address (which we used as a conservative estimate of the proportion of valid addresses) times the proportion of households contacted that contained an eligible subject when we called a random sample of 178 households that had not answered our initial letter. Each of these 178 households was called up to three times, at different times of the day and on different days of the week.
COST AND COST-EFFECTIVENESS ESTIMATES
The cost of preparing each mailed invitation was computed by adding together the cost of each component: stationery, envelope and stamp, reply form for making an appointment, stamped reply envelope, two $1 bills (where applicable), and staff time to prepare each invitation. Costs were compared--per letter mailed, per appointment made, and per actual attendee--for each of the four groups (Controls, Ethnic Sensitive only, $2 Incentive only, and Combination). Fixed costs fixed costs,
n.pl the costs that do not change to meet fluctuations in enrollment or in use of services (e.g., salaries, rent, business license fees, and depreciation). to present the program were not included in the comparisons.
RESULTS DEMOGRAPHICS OF PARTICIPANTS
Forty-six men made appointments to attend; twenty-seven men actually attended the educational program. One attendee at·tend·ee
One who is present at or attends a function. See Usage Note at -ee1.
a person who is present at a specified event
Noun 1. was ineligible in·el·i·gi·ble
1. Disqualified by law, rule, or provision: ineligible to run for office; ineligible for health benefits.
2. for the study (over 70 years old). The mean age of the remaining 26 men was 53 years (SD = 7.9 years). Most of the men were married (69.2%). Twenty percent of the men had an income of less than $833 per month. Detailed demographic data on program attendees is shown in Table 1. No individual demographic data was available for households and men that did not respond. One of the 26 program attendees brought along a friend who had not received a letter, leaving 25 men for the statistical analyses.
The 46 appointments made represent about 7% of the letters mailed (return rate per letter mailed). As explained below in the section on adjusted response rates, the actual response rate among eligible men who received the letters was much higher--over 14% (response rate per eligible household). Similarly, the 26 men who attended represented almost 4% of letters mailed, but over 8% of the eligible men who received letters. These differences reflect the high proportion of invalid addresses on the original list, rather than reluctance by the men to respond to the offer. The effectiveness of the methods studied may be assessed by examining the response rates (per eligible man).
RESULTS FOR EACH INTERVENTION
Control group I, which received only a plain letter, yielded six replies (3.5% of 171) requesting an appointment for screening (note that this is the crude, or unadjusted, rate of responses per household on the mailing list An automated e-mail system on the Internet, which is maintained by subject matter. There are thousands of such lists that reach millions of individuals and businesses. New users generally subscribe by sending an e-mail with the word "subscribe" in it and subsequently receive all new ). Four of these six men kept their appointment. The Ethnic Sensitive Only Intervention yielded nine replies (5.3% of 171), eight of whom kept their screening appointment. The Incentive Only Intervention yielded thirteen replies (7.6% of 171), four of whom kept their appointment. Finally, the Combination Intervention yielded eighteen replies (10.5% of 171), nine of whom nine kept their appointment (Table 2). No men from Control Group II (pure controls, who received no letter at all) attended the prostate cancer educational program. Adjusted response rates--described in detail below--were over twice as high as these crude return rates.
In the exact logistic regression models, the interaction between the Ethnic Sensitive and the Incentive Intervention techniques was not statistically significant. Hence, the final models were main-effects models (both for predicting making an appointment and predicting program attendance), under which the effect of each mailing technique did not depend upon whether or not the other technique was used alongside of it.
Although the data in Table 2 suggest that each intervention technique increased the rate of making appointments, only the $2 Incentive mailing technique achieved statistical significance (odds ratio estimate = 2.17, one-sided p=0.01). For the Ethnic Sensitive mailing method, the odds ratio was 1.46 (p=0.14).
For actual attendance at the CaP screening educational program, the logistic regression model showed no evidence whatsoever that the $2 Incentive technique increased participation. But the Ethnic Sensitive technique led to substantial increases in attendance. The odds ratios associated with program attendance for the Ethnic Sensitive and $2 Incentive mailing techniques were equal to 2.18 (one-sided p<0.04) and 1.09 (p=0.50), respectively.
ADJUSTED RESPONSE RATES
As explained in the Methods section, response rates were adjusted by dividing each by the estimated fraction of households on the original list that contained an eligible male subject. Of the 684 letters mailed, 22 were returned by the Postal Service "due to invalid address." Assuming that the remaining 662 addresses were all valid, the proportion of addresses that represented valid households was 662/684, or 96.78%. Of the 178 nonresponding households mentioned earlier that were selected at random for telephone calls to ascertain eligibility, 48.5% of the ones that were reached contained a man who met the study inclusion criteria
Inclusion criteria are a set of conditions that must be met in order to participate in a clinical trial. (see Figure 1 for details). The product of these two ratios is 96.78% x 48.39% = 46.83%. Each crude response rate (per household listed) was divided by 0.4683 to obtain the estimated true response rate per eligible man. This correction for ineligible addresses on the original list more than doubled the estimated response rates. Results are graphed below in Figure 2.
[FIGURE 2 OMITTED]
Response to the program was quite favorable fa·vor·a·ble
1. Advantageous; helpful: favorable winds.
2. Encouraging; propitious: a favorable diagnosis.
3. . Every man who attended the educational program chose to have the prostate cancer screening.
COST OF THE MAILING
The Control Mailing letters each cost $1.43--twenty-five cents for letterhead and envelope, $0.17 for reply form and envelope, $0.68 for two postage stamps This is a list of postage stamps that are especially notable in some way.
The best-known stamps:
Costs per appointment made ranged from $13.61 (Ethnic Sensitive only) to $21.13 ($2 Incentive only). Costs per program attendee ranged from $15.32 (Ethnic Sensitive only) to $68.67 ($2 Incentive only). The cost per appointment made and the cost per program attendee were each lowest by far for the Ethnic Sensitive only method. This resulted from the modest additional cost of the Ethnic Sensitive stationery and from the substantial increase in response rates.
The results can also be shown in terms of the expected number of men who will make an appointment or who will attend the educational program for each $100 in recruitment cost. Each estimate is just $100 divided by the cost per appointment or attendee. Results derived from the adjusted response rates are shown in Figure 3. The superiority of the Ethnic Sensitive Only method is clearly apparent; for program attendance, it is almost twice as effective as the next best choice.
[FIGURE 3 OMITTED]
Compared to the recruitment techniques described in the Introduction, neither technique was expensive. This approach worked at least as well as the strategies discussed earlier, which used Peer Educators or Client Navigators for subjects recruited from their work sites.
The large discrepancy DISCREPANCY. A difference between one thing and another, between one writing and another; a variance. (q.v.)
2. Discrepancies are material and immaterial. in the rate at which men kept their appointments was of particular interest. Did men who received the $2 Incentive feel under an obligation to make an appointment? If so, why did they so often fail to attend the educational program? Why was the Ethnic Sensitive/mailing so successful? Did it have particular appeal to African American men? Or was it simply that, as more than one respondent remarked, "I knew it wasn't a bill as soon as I saw it?" These questions need to he addressed in subsequent studies, to help refine future recruitment methods for this group of subjects.
LIMITATIONS OF THIS STUDY
Several considerations should be taken into account before attempting to generalize generalize /gen·er·al·ize/ (-iz)
1. to spread throughout the body, as when local disease becomes systemic.
2. to form a general principle; to reason inductively. our results:
* The response rates are low, even after adjusting for ineligible household addresses, making it difficult to generalize the findings. This population is difficult to study; few if any studies achieve high response rates without large investment of time and money.
* No attempt was made to follow up non-responding households. More thorough follow-up, either by mail or by telephone, could have increased response rates substantially.
* A more accurate listing of eligible households would have saved substantial effort and expense. But our subjects move frequently, which makes it extremely difficult to obtain and maintain accurate address lists.
* The low rate at which men who received the $2 Incentive kept their appointments deserves study, particularly to ascertain whether more intensive follow-up, perhaps including a telephone reminder, might increase their rate of participation.
Regardless of the recruitment method used, health care providers must recognize that recruiting low-income men is requires a large commitment of time and resources. Even with the best recruitment methods, the response rate for medically underserved men will remain significantly lower than for men who have more experience in accessing the health care system, and greater personal resources to cover the cost of care.
The adjusted response rates, which reflect the true probability that an eligible recipient responds to the mailing, were at the lower end of the response rates--20% to 80%--that are commonly reported in the mail survey literature (Dillman, 2000). The authors emphasize that this is a credible response rate for the medically underserved men from low-income households studied here. Most mail surveys target the general population or even middle or upper-income households (for marketing purposes).
These results could be useful in any urban setting where recruitment using mailed letters is desired. Generalizing the specific results obtained in this study uncritically to other settings is not advisable ad·vis·a·ble
Worthy of being recommended or suggested; prudent.
ad·visa·bil , since the specific demographic characteristics of each study population will influence overall participation. Yet the Ethnic Sensitive technique may well prove useful in other contexts. Future research could test the intervention in other ethnic groups as well as measure the impact of the Ethnic Sensitive stationery on men from Caucasian, Latino, and other ethnic groups. Health care providers desiring to recruit medically underserved men for health programs or health research may also find our results useful for their work.
Table 1. Demographic Description of Men Who Attended the Educational Program. Demographics Number (percent) Age (mean = 53 years; s.d. = 7.9 years) 40-49 years 9 (35%) 50-59 years 13 (50%) 60-74 years 4 (15%) Rain African American 21 (81%) Caucasian 5 (19%) Income * (categories in questionnaire) <=$5,000 per year 2 (8%) 5,001-$9,999 3 (12%) $10,000-$24,999 5 (19%) $25,000-$49,999 11 (42%) $50,000 or more 4 (15%) Missing 1 (4%) Education Less than High School Graduate 4 (15%) High School Graduate 9 (35%) Some College or More 13 (50%) Marital Status Married 18 (69%) Not Married 8 (31%) Ever had Prostate Exam Previous DRE 17 (65%) Previous PSA assay 12 (46%) Table 2. Responses to Invitations to Attend CaP Screening Educational Program Made an appointment Letters to attend Attended mailed program Program Type of Mailing N N Percent N Percent Control Group II (plain letter) 171 6 (3.5%) 4 (2.3%) Ethnic Sensitive technique only 171 9 (5.3%) 8 (4.7%) $2 Incentive technique only 171 13 (7.6%) 4 (2.3%) Combination (both techniques 171 18 (10.5%) 9 (5.3%) jointly) Table 3. Summary of Qualitative Data of Self-Reported Life Changes among College Students since the September 11 Attacks. Life changes experienced Frequency More anxious and emotional 44 Fear of densely populated area, feeling scared and worried Apprehensive about deployment of self or loved ones Being more precautions at school and on job More concerned about safety of loved ones Reluctant to go out, considering moving to another country Emotional trauma due to loss of someone close Antagonistic to Arabs, disappointed with humanity As an Arab, being afraid of Americans More appreciative of life, family, and friends 22 Realizing life is precious, not taking life for granted Not getting angry over little things in life More apt to do everything I want to do Taking care of family members and loved ones more More frequent contacts with family members Changes in means of transportation 20 More reluctant to fly, more worried about plane travel Fewer use of air travel, stop using air travel Not taking train, greater alertness in traveling Increased concern about society and politics 12 Watching news more frequently More concerned about what's going on in the world More aware ofworld peace Financial loss 8 Losing a job, having hard time getting a job, decreased work hours Postponement of wedding More patriotic 7 Plan to join the army or ROTC, feeling more patriotic Being more spiritual 7 Praying more, more trust and faith in God Note. Total respondents who answered to the open-ended question were 120. Some respondents listed multiple life changes.
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Of or involving both social and economic factors.
of or involving economic and social factors
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A security analysis that uses financial information derived from company annual reports and income statements to evaluate an investment decision.
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A subordinate committee composed of members appointed from a main committee.
Noun on Labor, Health and Human Services Noun 1. Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979
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HEALTH EDUCATION RESPONSIBILITY AND COMPETENCY COMPETENCY, evidence. The legal fitness or ability of a witness to be heard on the trial of a cause. This term is also applied to written or other evidence which may be legally given on such trial, as, depositions, letters, account-books, and the like.
Responsibility II--Planning Effective Health Education Programs
Competency A--Recruit community organizations, resource people, and potential participants for support assistance in program planning
Sub-competency 4--Incorporate feasible ideas and recommendations into the planning process
Martin Weinrich, Ph.D. is with the School of Public Health and Health Information Sciences, Sally Weinrich, Ph.D. and Rachelle Seger, B.A. are with the School of Nursing, Inka Weissbecker, M.S. is a Doctoral Student in Clinical Psychology, Department of Psychology and Brain Sciences, and Kathy Mayberry Brent Brent, outer borough (1991 pop. 226,100) of Greater London, SE England. The area is a rail and industrial center. Its manufactures include automobile parts, clocks and watches, and electrical equipment. , B.A. is with the Office of Grants Management at the University of Louisville, Louisville, KY. Address all correspondence to Martin C. Weinrich, Ph.D., School of Public Health and Health Information Sciences, University of Louisville, Louisville, KY 40292; PHONE: 502-852-2038; E-MAIL e-mail: see electronic mail.
in full electronic mail
Messages and other data exchanged between individuals using computers in a network. : firstname.lastname@example.org.