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1. In this section we look first at the history of health promotion and women's health. There is ample evidence that the Canadian women's health movement has a long history of using a social determinants, population health model to understand women's health. The principles of health promotion have historically been applied in developing programs around women's health. We then provide a conceptualization of health, health promotion and prevention. This model is based on the premise that prevention (primary, secondary, and tertiary) remains an important part of our work to promote women's health, but that it must be informed by the principles of health promotion.
2. Over the years, a community-based women's health infrastructure has developed in Canada. Historically, this was partially supported through initiatives of the federal government, particularly Health Canada and the Secretary of State Women's Program, and partially through provincial and municipal government funding. In large part, the movement is driven by the energy and commitment of women across the country who often work for little or no pay in communities from coast to coast. In 1981, for instance, prior to the Ottawa Charter (1986) or the Framework for Health Promotion (Epp, 1986), the St. John's Status of Women's Council and the Newfoundland and Labrador Women's Institutes joined together and obtained funding from the Health Promotion Contribution Program of Health and Welfare Canada to carry out a women's health project. To quote from the final report:
3. The women's health movement exists in harmony with and is often indistinguishable from other parts of the women's movement. Given the social determinants model, this is to be expected. In many communities, the organizations that generated women's health projects, centres or coalitions were also involved in advocating for or establishing shelters for battered women, sexual assault services, birth control services, and so on. The network is extensive: in 1993, for instance, 371 Canadian shelters for battered women were identified (MacDonald, 1993). Even in larger urban centres where numbers and distances are greater than in small towns or communities, the staff involved in these different women's health services have networked in various ways. In Calgary, for instance, there is an umbrella organization of women's groups called Women Looking Forward. On a national level, the National Action Committee on the Status of Women (NAC) serves this function. At its annual meeting, women from all over the country can meet and exchange information as well as set policy and direction for NAC's lobbying and educational functions. For many years, NAC has had a policy committee on women's health that followed a social determinants model of health.
4. Recent examples of community-based action in women's health include the initiatives of breast cancer survivors and advocates. Breast cancer survivors, seeing what AIDS activists had achieved, began to come together and to form education, support and advocacy groups (Batt, 1994). While the influence of AIDS activism on breast cancer survivors is more recent and apparent, the influence of feminist theory and the women's health infrastructure is also present. Many survivors draw on their feminist analysis in how they respond to their experiences around breast cancer (S. Batt, personal communication, Dec. 14, 1995). As a result of the advocacy of breast cancer survivors and the philosophical support of public servants in Health Canada, the National Forum on Breast Cancer became the first opportunity for researchers, clinicians and breast cancer survivors to interact face to face and to share perspectives. Since that time, more breast cancer action groups have formed across the country in small towns, as well as large centres. These groups provide support to individuals and education and advocacy to the community at large.
5. Health, viewed from a social determinants perspective, is multidimensional and can be viewed as a dynamic system with two components: Health Balance and Health Potential. In Health Balance the physical, psychological, social, and spiritual aspects of our health interact to create a state of well-being or "health status" (Noack, 1987). When asked, "Compared to other people your age, how is your health?", it is our health balance that we evaluate in response. At any given time, we may be at a high or a low level of Health Balance. An equally important part of our health is our Health Potential or the resources we have to maintain or restore our Health Balance. These resources can include such things as genetic predispositions to wellness or illness (e.g., fitness or whether we experience menstrual pain), money to purchase food or services, or skills that are acquired (e.g., coping skills or assertiveness). This conceptualization of health takes us away from an individualistic orientation since many determinants of health are beyond the control of individuals. Health potential must also be assessed at the level of community (e.g., access to health care, and employment opportunities ). The social determinants model of health, as we have pointed out in the background, is nothing new to feminists and is consistent with feminist theory. The women's health movement in Canada has emphasized the role of self-help groups in collective analysis of social, economic and historical factors associated with health problems (McDonnell, 1985, cited in Horne, 1995).
6. The World Health Organization (1986, p. 246) and the Federal Government of Canada (Epp, 1986, p.6) define health promotion as "the process of enabling people to increase control over and to improve their health". Health promotion is not synonymous with prevention, which is primarily focused on problems, dysfunctions, or diseases, but no consensus has developed about the relationship between the fields. There are three levels of prevention. Primary prevention focuses on the prevention of the occurrence of problems; secondary prevention is directed at early detection of problems in order to stop their progression; and tertiary prevention is aimed at stopping the development of complications, usually described as treatment (Last, 1987). We believe that health promotion, as defined above, can be distinguished from prevention by its focus on Health Potential, or increasing people's health resources. The three levels of prevention are primarily directed at restoring Health Balance. Health promotion, therefore, must also play a coordinating role with the three levels of prevention (Thurston & McGrath, 1995; Thurston & Bowhay, 1991). The degree of linkage between health promotion and prevention depends, by definition, on the actual program objectives, activities, and projected outcomes; however, the implication is that people involved in health promotion or prevention must take a more global perspective and look at broader implications of their program activities. Prevention efforts which successfully eradicate disease by diminishing Health Potential must be suspect for long-term negative consequences on health.
7. Population health promotion is based on a number of principles:
-Health promotion is directed towards action on the determinants or causes of health.
-Health promotion combines diverse, but complementary, methods and approaches.
-Health promotion aims particularly at effective and concrete public participation.
-While health promotion is basically an activity in the health and social fields, and not a medical service, health professionals- particularly in primary health care-have an important role in nurturing and enabling health promotion.(WHO, 1986, p. 246-247)
8. The Ottawa Charter (1986) further states: "Caring, holism and ecology are essential issues in developing strategies for health promotion. Therefore, those involved should take as a guiding principle that, in each phase of planning, implementation and evaluation of health promotion activities, women and men should become equal partners". Health promotion theory and practice is concerned with justice and equity, therefore, feminists health proponents and health promotion activists could be natural allies.
9. While Canada has been seen as a world leader in the field of health promotion (Kickbush, 1986), critics have pointed out inherent dangers in some of the health promotion policies. Seen from a certain point of view these policies fit too well into costcutting initiatives and attempts to privatize health. Canada's public health agenda, as it appeared in Achieving Health for All (Epp, 1986), broadened the field of health promotion from one that focused on lifestyle changes and individual prevention to one that promised to redress inequities within the health and social system. In theory, it moved toward social reform and action, addressing the issue of healthy environments and questions of power and control (Ottawa Charter 1986; Vertinsky, 1992). Yet women's concerns do not always reach the level of policy development and implementation. We have had some important contributions in Canada in the form of centres funded for research on violence against women and the promise now of research centres on women's health. The economic policies of our governments, however, are preventing a truly radical change in the perception of women's work and health.
10. If public policy explicitly asks for community developmentthe form of selfcare, mutual aid, fostering public participation, or strengthening community services (to use the language of Epp's health promotion framework)we must be aware of its possible implications for women's lives and health. When community development entails the empowerment of community members and their real participation in the identfication of issues, and of setting agendas, then we will have a truly collectivist and negotiated process. Healthy public policy must entail a broad contextual understanding of women's lives and women's health. This implies a comprehension of violence against women, racism, the structures of poverty, and the ideologies of caring.
11. In this section we will describe some recent Canadian health projects or initiatives which exemplify the principles of health promotion for women described above. The first, Nobody's Perfect, is a support program for young, single, low income parents. It is an example of a program that addresses justice and equity, is multisectoral and multidisciplinary, and has benefits beyond the goal of enhancing parenting skills. It allows participants to look at parenting and associated problems in the broader context of their everyday lives. The other examples are discussed in less detail. The Breast Cancer Information Exchange Pilot Projects are intended to widely disseminate breast cancer information in a way that is empowering to recipients. Four of the pilot projects are described very briefly and more information is provided on the fifth. These projects show, among other things, how participation can be encouraged to overcome barriers between health care providers and consumers, how organizations and sectors can collaborate to reach a common goal, and how national programs can facilitate communication and efficient use of resources while following principles of health promotion. The Pap Awareness Project is an example of using the principles of health promotion to improve secondary prevention of cervical cancer. It is an example of health providers and women working together. The Women and Tobacco initiative is described briefly to illustrate how feminist analysis brings a fresh perspective to a social determinants model. Finally, we describe the McMaster Research Centre for the Promotion of Women's Health, a multidisciplinary centre with a focus on the promotion of women's health in the workplace.
12. Nobody's Perfect (NP) is a parenting support program supported by the former Family and Child Health program in the Health Promotion Directorate of Health Canada. It was developed in the Atlantic Region and implemented nationally in partnership with a variety of provincial governmental and nongovernmental organizations, including First Nations, and continues to be used across the country. NP was based on a number of assumptions and operating principles consistent with health promotion. It was designed to enable parents to increase control over and to improve their child's health by addressing issues of justice and equity, building upon participant's strengths, enhancing mutual support as well as self-help, and using a multidisciplinary, multifactorial analysis of the issues. These programs see child and parent health as interconnected and mutually reinforcing.
13. The first principle of NP is that health is holistic and must be viewed in terms of both individual and social factors. NP recognizes that poverty is associated with ill health in all aspects of our lives and that income, cultural and social milieu of the community largely determine the extent to which resources are developed for and devoted to child health. In many communities, support systems and are not readily accessible to parents. NP, therefore, addresses issues of justice and equity. NP was developed for those parents with the least access to services and parenting Health Potential; that is, NP "targets parents who possess one or more of the following characteristics: young; single; low-income; low-education; and those who experience social, cultural or geographic isolation" (VanderPlaat, 1989, p. 1).
14. The interconnection of parental and child health is also recognized in NP. One assumption states that parents tend to place their children's needs above their own and to look for resources designed to restore the imbalance in their children's health; however, because parental and child health are intertwined, resources to maintain the balance of health for both are necessary. Another assumption is that parenting involves a set of skills or resources that are not genetic, or obtained at birth and can, therefore, be supported by a community.
15. The priorities for program development incorporate the holistic nature of health and include both self-help and mutual support, relying on group activities where mutual support, peer criticism, self-help and education can occur. Mutual support and self-help are two of the three mechanisms considered intrinsic to health promotion in Achieving Health for All (Epp, 1986). The assumption that solutions to parenting resource problems should be practical, inexpensive, and positive is in keeping with the focus on justice, as well as with popular opinion within the field of health promotion program planning. Finally, the philosophy of NP, as described in the BC Experience, "that each parent brings rich experiences and feelings to the group" and that facilitators are trained in the participant-focused approach (Rechler & Rogers, 1993, p.11), reflect an orientation to critical education or conscientization as described by Friere which can lead to social change as well as individual change, a goal of health promotion. This orientation helps avoid victim blaming where the individual is seen, or comes to be seen, as personally responsible for her inadequacies or lack of resources and for the solutions. Avoidance of victim blaming is critical to health promotion.
16. The core of the NP Program is five books providing information that will help parents cope with body, safety, mind, behaviour, and parenting. "Body explains normal growth, maintaining health and recognizing illness. Safety provides information on accident prevention and first aid. Mind describes the social, emotional and intellectual development of children. Behaviour offers a problem-solving method for handling common behaviour problems. Parents addresses a variety of ways in which parents can meet their own needs as well as those of their children" (NP Brochure). The content of the five NP books is multidisciplinary, drawing on knowledge from psychology, sociology, nursing, medicine, etc. Each subject is looked at from a multifactorial perspective; for example, the Mind includes developmental factors, emotional, and social factors that affect children's mental health. Multidisciplinarity and multifactorial programs are central to the practice of health promotion.
17. In each book the material is aimed at the three levels of prevention: Primary, avoiding accidents, behaviour problems, and associated parental stress or grief; Secondary, recognizing the warning signs of problems both in the child and oneself and having regular check-ups; and tertiary, treating problems or getting help through activities such as first aid, or behaviour modification. All of the information and skills are presented with the intention of increasing self-help, coping skills, social support, self-confidence, and self-image. Thus prevention is being accomplished within a health promotion framework.
18. Parent support programs that are designed from a health promotion perspective have a number of secondary benefits such as the prevention of family violence. Parent support programs that support consciousness raising, mutual support, enhanced personal well-being, and skill development address the barriers to problem solving that abused women face, thus encouraging them to take rapid action to either avoid a relationship where abuse happens or to take action to leave such a relationship. In addition, parents can come to understand the consequences of their own childhood experiences of abuse which indirectly benefits their children. The content of parent support programs in a health promotion framework clearly is directed to the prevention of child abuse or neglect and to the enhancement of child well-being.
19. Health Canada announced a major breast cancer initiative in 1992 which included the National Forum on Breast Cancer, enhanced research support, and activities to coordinate screening, to set guidelines for care, to enhance continuing education for health professionals, and aid to the Canadian Breast Cancer Network, a national coalition of breast cancer survivors and survivor groups. Another component of the initiative was the funding of five breast cancer information exchange projects which are intended to assist persons living with breast cancer and their families, care givers, and those at risk of contracting breast cancer in making informed decisions about a variety of concerns related to breast cancer. A call for proposals was made and the selected projects were based on collaboration between treatment, research and consumer groups, and were funded in December 1992 for a five year period.
20. We will provide a brief description of four of the projects and more detail on the fifth to illustrate the adoption of a health promotion framework. All of the projects routinely network through the project coordinators and collaborate in exchange of resources. Occasionally, materials are developed for a national audience and are reviewed by all of the projects.
21. The Atlantic Breast Cancer Information Project (ABCIP) is led by a Steering Committee comprised of the presidents of the four Atlantic divisions of the Canadian Cancer Society. A 20 member advisory committee has overseen projects such as development of a resource manual for regional information; regional information on unconventional therapies; information menu cards and corresponding packages; and an internet cancer discussion and support group. The Quebec Breast Cancer Information Exchange Network is led by an Executive Committee composed of the project director, the Director of finances for Hôpital Hôtel-Dieu de Montréal and a representative from the Quebec Ministry of Health. An advisory committee representing many stakeholders was formed and a provincial survey of knowledge conducted. Network "substations" are being created around the province. In the Ontario project, an Advisory Panel provides the strategic direction for the project and a Project Team oversees day to day operations. Five breast cancer survivors from the Panel and the team form an Executive Committee. Examples of project activities include: production of a newsletter; a database of services; the book, A Guide to Unconventional Therapies; development of a Multicultural Communities Initiatives Work group; and funding of two consortiums which will undertake projects in the north of the province. The British Columbia (B.C.)/Yukon Breast Cancer Information Project is sponsored by the B.C. Cancer Agency and the regional division of the Canadian Cancer Society (CCS). Of 15 Advisory Panel members, 8 are breast cancer survivors. Among other things, the project has expanded and marketed the CCS cancer information telephone line; produced a newsletter; surveyed women living with breast cancer; and promoted the book "Breast Cancer: All You Need to Know to Take an Active Part in Your Treatment".
22. Breast Cancer InfoLink, Prairies/NWT (BCIL) is the fifth project serving Manitoba, Saskatchewan, Alberta and the North West Territories. Established by a consortium of the Alberta Cancer Board, the Canadian Cancer Society, and The University of Calgary, Department of Community Health Sciences, the project has an Advisory Panel with representatives from the consortium as well as from the groups that the project intends to serve: family physicians and oncology nurses (health professionals; the Alberta Farm Women's Network (rural women); the Breast Cancer Program of Manitoba; the Department of Health and Human Services of NWT; 8 breast cancer survivors (some of whom also represent groups such as Reach for Recovery and the Canadian Breast Cancer Network); and one woman who is in the category of high risk.
23. The project coordinator of BCIL has met with 11 groups of women throughout Alberta to discuss their information needs, their preferred sources and format and timing of information. The women were involved in discussing the best services for rural settings; medical as well as non-medical dimensions of their experiences with breast cancer; and their ideas for collaborating and coordinating breast cancer information tailored to the needs of different audiences. The coordinator also brought together the various support groups and programs for women with breast cancer in the two major urban areas, Calgary and Edmonton. This was the first time that many of these groups had exchanged information. All of the consultations have fed into design of a needs assessment process and questionnaires to reach 7 groups: women living in the NWT; aboriginal women; women living in remote communities; survivors who do not belong to a breast cancer support group; women at risk because of history in a first degree family member; rural physicians and primary health care providers; and women at the pre-diagnosis stage (i.e., women who have a breast lump or an abnormal mammogram).
24. A Community Contact (CC) model has been developed to enable women to share information. It will be piloted in 2 rural Alberta and a northern Manitoba site in 1996. A CC is someone who will act as a local resource person for women in the community who want breast cancer information. BCIL will provide training (a resource manual has been developed), basic expenses and will link the community contacts in a network. A resource for others as well as the CCs is a Breast Cancer Reference Manual, a comprehensive information guide. The manual is being developed by a committee of breast cancer survivors and health professionals from the region and will be reviewed by a group of health professionals. A video highlighting the range of support possible for breast cancer patients will target newly diagnosed women and is being produced for BCIL by Take Charge Athletics (a breast cancer support group) and The University of Calgary.
25. The Pap Awareness Project (PAP) is a two year project implemented under the Awareness and Education Program, an intervention study designed to reduce morbidity and mortality from cervical cancer. The four year intervention study is intended to determine effective ways to increase compliance with cervical cancer screening recommendations. The study collected baseline data on the frequency, knowledge and attitudes about Pap smear screening in women and physicians in two cities. A random digit dial telephone survey of women aged 20 to 69 years and a mailed survey of all physicians providing cytology screening were two of the methods used to collect baseline data.
26. The PAP is being developed using a community mobilization approach to involve direction, input and decision making at the community level. A Community Advisory Committee (CAC) oversees the development and implementation of education projects. A key objective of the PAP is the involvement of women from under-screened groups in the planning, implementation, and delivery of education projects to inform women about the importance of regular Pap smear screening. The second component of the Awareness and Education Program is the Physician Working Group. This volunteer group of eight physicians will develop educational materials to increase physician compliance with recommendations for Pap smear screening. A Community Coordinator has been hired to support the implementation of both the PAP and Physician Working Group and to liaise between the two projects. The PAP is housed at the Red Deer Regional Health Unit which provides operational support (e.g., mail services, local telephones).
27. The goal of the PAP is to reduce the incidence of, and mortality from, cervical cancer in Red Deer, Alberta by increasing the number of women who are screened regularly with cervical cytology. An emphasis will be placed on targeting women 18 to 69 years of age who have not had a Pap smear within the past three years (under-screened women). The first objective of the program is to develop and implement a community based awareness and education program using a collaborative team approach to:
-determine barriers, needs and potential solutions to regular Pap smear screening for each group;
-identify ways to reach women in the under-screened groups; and
-develop appropriate methods to educate and inform under-screened women about the importance of regular Pap smear screening.
28. The second objective is to involve all key stakeholders, and specifically women from the under-screened groups, in the planning, development and implementation of the PAP by seeking their participation as members of the Community Advisory Committee and working groups to carry out specific projects of the PAP.
29. A third objective is to collaborate with the Physician Working Group so that women are given a consistent message about Pap smear screening and to facilitate communication of issues between the PAP and Physician Working Group.
30. The intervention study was initially perceived by some members of the medical community as an attempt to "take over" Pap smear screening for the women of Red Deer. This issue was addressed by individual contact with a number of physicians in the community and by a presentation at rounds at the Red Deer Regional Hospital by the principal investigator. The relationship of the PAP with community physicians is a critical one since physicians are the main providers of Pap smear screening. It should be noted that many positive responses have been received from Red Deer physicians about the project and that eight physicians have agreed to serve on the Physician Working Group. Project staff and the CAC of the PAP (which will include a physician) will need to consider this past history, in addition to the stresses resulting from the restructuring of the health care system, as the education and awareness programs are developed and introduced into the community.
31. The first Canadian workshop on Women and Tobacco in 1988 was attended by representatives from about 60 women's groups. Through workshops, the participants, most of whom were women, came up with six major recommendations:
-Develop special programs for young girls and women in schools;
-Develop programs focusing on specific groups;
-Promote legislation to reduce tobacco consumption;
-Develop educational messages that are usable, relevant, accessible, available and subject to evaluation; and
-Develop and promote realistic female images. (Horne, 1995, p. 7).
33. In 1994, Canada introduced the Tobacco Demand Reduction Strategy (TDRS) with three key elements: legislation, public education and research. The Tobacco Sales to Young Persons Act set a national age limit at 18 for sales of tobacco and increased fines for illegal sales. Development of several gender specific programs has been another key focus. The manual "Evening the Odds" was developed in partnership with the Canadian Association for Advancement of Women and Sport for use by community leaders to identify ways for educators and the sport community to prevent smoking and increase fitness in young women. The "Child-to-Child Program" encourages aboriginal children aged 9 to 12 to research health issues in their communities and to set goals for change. "Quit 4 Life" includes a self-help kit for teens and a toll-free line for information. Over half of the callers have been girls. A program tailored to low-income women deals with the stressors connected to living on a low income or social assistance and provides child care and transportation. It is being piloted across Canada. Gender sensitive research has found that adolescent girls have concerns related to self-image and body weight which are linked to smoking rates. Other research has shown that women continue to be represented as smokers (Health Canada, 1995b). One of the most valuable contributions of TDRS has been research which has confirmed the associations between inequity and lack of power and smoking among women.
34. Successful strategies in dealing with the issues of smoking and tobacco use require participation, cooperation and collaboration between various sectors. When dealing with women, girls and tobacco, significant partnerships have been forged with the women's health movement, women's groups, anti-poverty groups, Aboriginal communities, and women's health and fitness providers. (Health Canada, 1995b, p. 8).
35. The McMaster Research Centre for the Promotion of Women's Health (MRCPOWH) has been funded by Health Canada and the Social Sciences and Humanities Research Council of Canada for five years, from 1993Its mandate is to establish a basis for new, communitygenerated approaches to the promotion of women's health. For the first five years the Centre is focusing its research primarily on women and work: paid and unpaid, in the home and outside the home. Conducting participatory action research, the Centre will investigate a diversity of occupations, a diversity of health issues, and a diversity of population groups. The research is designed to include actions for social change.
36. Although the Centre acknowledges that there are many ways to conduct research on women's health, it emphasizes the following principles: women's knowledge of their own health needs is essential to the design of any health promotion intervention; social investigation and action should be part of the same process; research should give immediate benefits to the community; and research should offer longresults by aiming to eliminate the structural sources of the identified problem (Denton, et al., 1994).
37. Instead of studying women as mothers, wives or reproductive agents, the Centre focuses on women and work, believing that women's labour, having been invisible, underpaid or unpaid, is crucial to the quality of life and health in women's lives. Research includes: specific workplace conditions (either in the home or outside); the effects of working conditions on women with specific health problems (e.g., disabilities, chronic diseases); and work as it affects women with diverse backgrounds.
38. Major research projects in the Centre can be classifed in four groups: 1. the health of women working in community based health and social service agencies; 2. the health of immigrant, refugee and visible minority women; 3. women with disabilities; and 4. young women and mothers. Included within these categories are for instance a project documenting a lesbian support group for a woman diagnosed with breast cancer: "weaving care outside 'family'"; or the health experiences and indicators among black female sole parents; or a study of support needs for women with multiple sclerosis.
39. Most notable about these projects is the degree to which community is involved in the research process from the needs assessment stage to the implemention of action for change. The research is informed by feminist pinciples, avoiding the treatment of women as objects, promoting women's voices in program and policy planning, and empowering women to take control of their lives. The kind of research and documentation in process ranges from survey and focus group data collection to popular theatre and collections of women's narratives. The sites of research include among others a nonfood processing factory, Children's Aid Societies, HomePrograms, various grasswomen's groups including many immigrant and refugee groups.
40. In selecting the six major challenges for health promotion and women's health, we allowed those that were most salient to us at the time to take priority. In keeping with our approach to health promotion, the challenges cannot be seen as separate with easily definable boundaries. The lack of gender sensitive research, for instance, is linked to the relative absence of women in policy making positions and to a failure to integrate feminist understanding and critique into the relevant disciplines. Single issue intervention models allow many people to ignore the issue of violence against women, and so on. While our list of challenges is not exhaustive, we believe the reader will find ample food for thought.
41. The lack of sensitivity to gender issues in research continues to be a major challenge. Just as epidemiological and biomedical researchers have generalized their findings to women when their studies included only males (Phillips, 1995), public health and health promotion researchers have treated gender as a secondary variable. While the justice and equity principles of health promotion (WHO, 1986) should make health promotion proponents and feminists natural allies, in fact, the field of health promotion is no more likely to take gender seriously than other fields (Thurston, 1994) and the literature on health determinants has not consistently treated gender as an important variable (Health Canada, 1995).
42. Eichler (1991) has identified seven types of sexist research, four primary and three derived from the primary, but so common that separate notice is warranted. While these are applied to research, they have major implications for practice and program development. The first, Androcentricity, involves viewing the world from a male perspective. Overgeneralization occurs when studies extrapolate from a gender biased sample to the whole population. Ignoring sex as an important variable is called Gender Insensitivity and the Double Standard, as the name implies, involves evaluating, treating, or measuring identical factors in men and women by different means. The first derived type of sexist research is Sex Appropriateness where human traits are assigned to or considered more important for one gender. Familism occurs when the unit of attention or analysis is the family, whereas individuals within the family are actually affected differently. Finally, Sexual Dichotomism occurs when the sexes are treated as unique social and biological groups. Each of these types of sexist research is described in detail with examples in Eichler's (1988) book which is highly recommended.
43. One area in which sexist and gender insensitive research and practice has weakened program effectiveness is prevention of wife battering. If we examine the challenges (reducing inequities; increasing prevention; enhancing coping), mechanisms (self-care; mutual aid; healthy environments), and strategies (fostering public participation; strengthening community health services; coordinating healthy public policy) of the Canadian health promotion framework (Epp, 1986), we can easily see how a women's health issue such as wife abuse can be addressed: economic inequities; self-help books; support groups; strengthening community shelter services. The fact remains that the tertiary health care system has not addressed wife abuse in any meaningful way after more than 15 years of research and education (Abbott, Johnson, Koziol-McLain, Lowenstein, 1995), nor have the public health system (Sorenson & Saftlas, 1994) or health promotion advocates. In 1985, Nuttal, Greaves and Lent identified wife battering as "an emerging problem in public health" (p. 297); ten years later, this problem has barely broken the surface and the silence continues (Thurston, 1995a).
44. Confusion surrounds the terms used to describe participation by members of the public in health care decision-making. Windle and Cibulka (1991) state that there is disagreement over such basic terms as "citizen", "consumer" and "participation", and the term "public" can be added to this list. In fact, these terms are used interchangeably in the literature on public/citizen/consumer participation in health care. Public is a more general term and it is argued that hospital boards, for instance, have always included representatives of the public. Consumers are those members of the public who have had direct experience as users of a health care service; and may include those members of the public in a particular catchment area who could potentially be users of the service(s) (Bellin, 1991; Feingold, 1977; Hochbaum, 1977). The latter is applicable to primary care and/or health promotion programs. Consumers are all members of the public, but not all members of the public can be considered consumers. The distinction between public and consumer is that consumers are participating primarily because of the perspective and expertise they bring as users of a service.
45. Participation has meant either sharing of power or complete citizen control in the decision-making process, or no redistribution of power in the decision-making process and the public being "educated" and/or "consulted with" (Hochbaum, 1977; Checkoway, 1982). The demand for public participation in health care, both at an individual and collective level, has roots in the women's movement (Siler-Wells,1988).
46. In the political arena, numerous provincial and federal government reports, and the World Health Organization, have advocated for increased public participation in health care at both the individual and collective level (Siler-Wells, 1988; Crichton, Hsu & Tsang, 1990; Mhatre & Deber, 1992; Premier's Commission, 1989; Premier's Council, 1991). In 1965, the Report of the Royal Commission on Health Services commented that: "the achievement of the highest possible health standards for all our people must become a primary objective of national policy and a cohesive factor contributing to national unity, involving individual and community responsibilities and actions" (Siler-Wells, 1988). A recent review of Canadian provincial health commissions and reports (Alberta, Saskatchewan, Ontario, Quebec, New Brunswick, and Nova Scotia) revealed that increased public participation was one of the major principles advocated by all the provinces (Mhatre & Deber, 1992).
47. In an effort to better understand what public participation means in the context of health care, and how it can be more productively fostered, MacKean and Thurston (1995) developed a conceptual model with two major components: 1) Arnstein's (1969) "ladder of citizen participation", which is commonly cited in the public participation literature; and 2) factors that influence how far up the participation ladder the public gets in health care decision-making. These factors include characteristics of: the context or setting; public participants and the support offered them; the change that is occurring; the participatory techniques used; and finally, the goals and objectives of public participation. For instance, societal expectations of the role that is to be played by patients and the role that is to be played by health care professionals has had a huge impact on public participation at both levels. The concept of the willing, passive and compliant patient (Parson's sick role) is integrated in health care. Also, there is a mystique around medicine and a general public perception that it is far too complex a field for the average person to understand (Checkoway, 1982; Havinghurst, 1986). The beliefs of professionals working in an organization with respect to whether public participants will be supportive allies may affect their support of public participation in the organization. For example, if health care professionals view the interests of the public as being more aligned with their own than the administration, they may be interested in forming an alliance with the public. Conversely, the administration may be very pro public participation if they feel the public's interests are more compatible with their own than the physicians (e.g., changing the emphasis of primary care from treating illness to prevention). Historically, people with power do not willingly give it up (Arnstein, 1969); so the authority of citizen or public groups needs to be clearly defined (Bracht, 1991), ideally with legal, formal authority (O'Neill, 1992). Public participants need a mandate from the users or the community that they are drawn from. If a public participant has no constituency to draw upon for ideas and support, the probability of being effective is generally reduced. Godbout (1981) and O'Neill (1992) discuss the importance of ensuring that there are mechanisms in place for public representatives to access their constituents. Furthermore, while health professional representatives generally have fellow committee members from whom they can seek validation of ideas if needed, the token public representative is doomed to isolation.
48. Batt (1994) identified the problem of access in her book: One question, though, is how we will form our committee, let alone find our 150 delegates. The other committees have the university and cancer infrastructure from which to draw representatives. We have a constituency that is largely invisible and silent" (p. 341-2). Women are characteristically the gatekeepers of the family's health and put the health of others before their own. A question that must be addressed is: How to involve women without increasing their burden?
49. A further interpretation of the term 'participation' might be the work that the community can do to promote health. Whereas this notion is consistent with an empowering and enabling health promotion context, as envisioned in the Ottawa Charter, it can also be manipulated for economic, costgoals on the part of governments at a time of fiscal restraint. Often added responsibilities are given to the "community" without necessary enabling resources. When the work of caretaking is moved from the hospitals and the state to the community, it inevitably impacts on women's lives more significantly than on men's.
50. Home care and homemaker services are the primary vehicles throughout Canada by which services are provided to clients. Volunteers also provide a significant and valuable service to clients through friendly visiting, delivery of mealswheels and other important services. Prior to 1960, only 27 homemaker services existed in Canada, and by 1982 approximately 540 agencies were in operation. Home Support Canada estimated that in 1992, fortyeight to fifty thousand people were involved in homemaking across Canada with an estimated 14,000 homemakers working in Ontario (Martin Matthews, 1992). The employment of registered nurses in Ontario's home care programs nearly doubled during the period between 1984 and 1989 going from 2337 in 1984 to 3944 (Hiscott, 1993). The demand for therapists and case managers has also increased accordingly. The volunteer labour force is indispensable to the human service system. In Ontario alone there are just under 2 million volunteers who provide approximately four and a half billion dollars worth of work every year and contribute 352,990,000 hours of volunteer labour each year (graff, 1987). Investigations have begun into women's work of "caring" both within families and outside the home, in paid or unpaid work (Anderson & Elfert, 1989; Armstrong, et al. 1994; Aronson, 1990, 1991, 1992; Baines, Evans & Neysmith, 1991; Croft, 1986; Dalley, 1990; Evans, 1991; Ferguson, 1991; Finch ,1984; Finch & Groves, 1983; Graham, 1983, 1985; Guberman, 1990; Heller, 1986; Hooyman, 1987; James, 1989; Laurence, 1992; Medjuck, O'Brien & Tozer 1992; Wuest, 1993). Wuest (1993) points out that current Canadian "Health care professionals are complicit in sustaining women's oppression by reinforcing . . . institutions" that use women's unpaid caring labour (p. 407).
51. The theoretical framework for analyzing this under or unpaid women's work must be based on a recognition of institutional and ideological structures that inform women's lives. What remains in the private realm is traditionally held to be invisible to the public. What is accepted to be "natural", unskilled and "feminine" (i.e., women's caring and emotional labour) must be shown to have a fundamental place in society's system of production and reproduction (James, 1989). The basic division and opposition between public and private care must be examined (Aronson,1991). The ideology and practices that maintain a system of informal care must be acknowledged both in setting up alternatives to informal care and in finding sufficient support systems for those doing informal care (Aronson, 1991). The basic ideology of "familism" (Dalley, 1990; Wuest, 1993) which "fosters relationships of domination and subordination , patterns of domestic labor, altruistic care giving of children and the elderly, and patterns of dependency, all of which serve women poorly" (Wuest 1993, p. 408) must be exposed. The actual skills, demands, conditions and effects of the job of care giving must be examined and accounted for. Each of these fields would need detailed investigation. In 1983, Rimmer outlined the "true [economic] costs of community care" paying particular attention to the sacrifices women must make in order to care for their relativesresulting in longpoverty, dependence and ill health. Yet, public policy has not changed in the interval.
52. Related to the issue of sexist research is the issue of models of knowing, ethical analysis, communication, and program planning which may be biased and not gender neutral as assumed. Belenky, Clinchy, Goldberger and Tarule (1986) talk about gender differences in understanding the world with implications for pedagogy. Larrabee (1993) has brought together a collection of writings continuing on the theme of gendered moral development and the implications for ethical analysis. Harding (1986) has identified some of the sexism in the philosophy of science. A critical area women's health issue which has not been informed by gendered and feminist analysis is the prevention of child sexual abuse. One of the defining characteristics of theories is whether they are informed by feminist criticism (Yll, 1993). Feminist theorists view abuse within a broad social context within which gender and power are key elements. Linkages between various forms of violence are made through these elements and social institutions (e.g., the family) are understood, in part, by examining these elements. Feminist theorists have made less of a contribution to understanding child abuse than other forms of violence against women (e.g., wife abuse); however, it has been argued convincingly that psychological and sociological theories which ignore gender and power issues are unlikely to advance our understanding (Yll, 1993).
53. One of the reasons that people avoid discussions of theory is that they hope to avoid the ideological battles identified by Edwards and Lohman (1994). In discussing the backlash directed at professionals in situations where a large number of cases of CSA have been identified, Edwards and Lohman (1994) observed that the different meanings that people place on events can become part of an ideological battle. Certain perspectives challenge the status quo in power relations in society, notably the feminist theories, and see child sexual abuse as a means of oppression and maintenance of power; however, in opposition to this, others (e.g., Krivacska, 1992) maintain that CSA is an act of sexual expression where power is used as a tool. Failure to declare our beliefs or theories allows us to sidestep potential ideological conflicts and to operate as though agreement on assumptions was implicit.
54. The major professionals involved in CSA prevention (e.g., teachers, physicians, nurses, social workers, psychologists, lawyers, police) are not generally seen as social change agents. Therefore, CSA has become a field where professional careers can be made without challenging social structures; Edwards and Lohman (1994) refer to some "expert" spokespersons as "moral entrepreneurs". It is therefore neither necessary nor desirable to initiate debates over theoretical frameworks. The field of CSA has never had a grassroots movement similar to the battered women's movement or rape crisis movement (even though CSA prevention has been modelled on sexual assault prevention (Yll, 1993)). The relative absence of activists in CSA prevention may explain why feminist theory has had less impact on CSA prevention: they simply were not present to initiate theoretical debates.
55. Another reason for ignoring theory and, feminist theory in particular, is that the changes required appear smaller and more manageable. For instance, Radomsky (1995) indicated that only major changes in models of training and practice will enable physicians to address CSA in adults, and by implication, in children. But changing the biomedical model would bring wider changes to the profession and subsequently to the health care system. As Sherwin (1992) sees it: physicians' "view of reality is seldom challenged, even when the subject matter on which they speak extends beyond scientific evidence" (p. 5). Thus, although physical examination is currently irrelevant in 50% of cases (Heiman, 1992; Johnson, 1991) and, if secondary prevention or early identification is successful, it should be irrelevant in a higher proportion of cases, it is still recommended that physicians be trained to physically exam children to diagnose CSA. Part of the reason for placing credence on "medical evidence" is the ideological position that it is more objective and more credible than a child's statement and that position is also difficult to change. In fact, physicians should be looking for signs other than physical evidence and must rely on communication from the child, a practice approach more in keeping with Radomsky's (1995) view.
56. As identified in a review of the prevention literature (Bagley, Thurston & Tutti, 1996; Bagley & Thurston, 1986), the consequences of ignoring theory go beyond failure to identify the significant points for intervention and models for programs, although this consequence is serious enough. Blaming the victim can result from a failure to analyze sociocultural forces that create victims. A "blame the victim" response can result in iatrogenic treatment. When the victim is a very young child, some people need another "victim" or scapegoat and the professional may become a target (Edwards and Lohman (1994) and may become hesitant to identify CSA (Elias, 1994). Ignoring theory and feminist critique allows us to tinker with existing programs or services rather than to question the premises upon which they are based. It also allows us to place equal weight on issues that may have very different roles in etiology of abuse or outcome of prevention (e.g., "serious consequences" for the family of false positive suspicions). Without attention to theory, the writing about CSA continues to obscure important variables; for instance, it is usually disproportionately mothers who attend prevention programs, not fathers, so the use of a generic term such as parent in reports misleads the reader. Finally, it has been argued that expert models (where the professional diagnoses the problem and recommends an intervention) tend to disempower those who are the targets for help, to make systemic change unlikely, and to perpetuate victimhood and the "need" for experts (Kretzmann & McKnight, 1993).
57. Despite successes attributable to the women's movement, studies continue to show that men are over-represented in positions of leadership in universities, the health care sector and other professions. This is such common knowledge that we will spend no time discussing the facts. The result is that the power for setting the research and practice agendas; reviewing grant and program applications; and deciding which networks are supported and who gets information, among other things, is biased against women and visible minorities.
58. Current social policy is out of step with social reality. Current policies focused on privatization and devolution of health and social services to the "community" have disproportionately discriminated against women. The framework and principles of health promotion include justice and equity and should ensure that healthy public policy is developed by including the voices of the most marginalized in society and ensuring that their needs are addressed. However, the theoretical underpinnings of social policy have been patriarchal and the welfare state, past and present, has done little to empower women (McCormack, 1991). In order to create healthy public policy that is equitable, feminist theoretical analysis is critical (Green, 1994). Points of conflict for women with public policy occur around many issues (e.g., child care, midwifery, cancer treatment) and efforts to resolve conflict can result in social change. Collaboration between groups involved with different points of conflict but with similar ideologies can enhance the change process and, perhaps more importantly, can prevent burnout among change agents.
59. The climate of rapid social change provides an opportunity to realign policy with the lived realities of all people. Women's groups must obviously be engaged in the process; however, these are typically non-profit with a small resource base outside of the members. Development of effective strategies to meaningfully involve marginalized groups in partnerships, public participation and policy development is necessary to advance authentic healthy public policy.
60. Preventing intimate violence is a major challenge for the health system but also for how we work in health promotion. The statistics on violence against women are staggering and it impacts on the physical, social, emotional , psychological and spiritual health of every victim. The consequences for the health of women in general have received little attention outside of feminist writing (Thurston, 1995b). As identified earlier, despite the congruence between the new view of health and the issue of violence against women, community health and tertiary care professionals have played a limited role in preventing this violence. Few programs address the fact that as many as two out of ten female participants may be experiencing ongoing physical abuse. Although as many as 25% of pregnant women may be battered, for instance, how many prenatal programs take this into consideration? North and Rothenberg (1993) recognized that violence could be an outcome of partner notification of HIV status, but this connection is rarely made in the literature. One reason for this is the single issue intervention approach.
61. While there are many challenges to be faced in making health promotion more relevant for women, we would like to conclude on a positive note. Certainly, much progress has been made in improving the status of women in society and there is reason to be optimistic that this will continue. Furthermore, because of the principles of health promotion, there is goodwill towards women and visible minorities within the field. The congruence between feminist theory, the policies of the women's health movement and the principles of health promotion should make progress easier than has often been the case. The establishment of three to five centres of excellence in women's health based on a social determinants model will also serve to advance the field.
1. Abbott, J., Johnson, R., Koziol-McLain, J., Lowenstein, S.R. (1995). Domestic violence against women: Incidence and prevalence in an emergency department population. Journal of the American Medical Association, 273(22), 1763-1767.
2. Anderson, J., & Elfert, H. (1989). Managing chronic illness in the family: Women as caregivers. Journal of Advanced Nursing, 14, 735
3. Armstrong, H., Armstrong, P., Choiniere, J., Feldberg, G., & White, J. (1994). Take care: Warning signals for Canada's health system. Toronto: Garamond Press.
4. Arnstein, S.R. (1969). A ladder of citizen participation. American Institute of Planners Journal, 35(4), 216-224.
5. Aronson, J. (1990). Women's perspectives on informal care of the elderly: Public ideology and personal experience of giving and receiving care. Ageing and Society 10, 651
6. Aronson, J. (1991). Dutiful daughters and undemanding mothers: Constraining images of giving and receiving care in middle and later life. In C. Baines, P. Evans, & S. Neysmith, (Eds.), Women's caring: Feminist perspectives on social welfare, (p. 138. Toronto: McClelland & Stewart.
7. Aronson, J. (1992). Women's sense of responsibility for the care of told people: "But who else is going to do it?" Gender and Society, 6, 8
8. Bagley, C., Thurston, W. E. & Tutti, L. (1996). The understanding and prevention of child sexual abuse. Volume I: Children, assessment, social work and clinical issues, and prevention education. Hampshire, England: Ashgate Publishing Ltd.
9. Bagley, C., Thurston, W. E. (1996). The understanding and prevention of child sexual abuse. Volume II: Male victims, adolescents, adult outcomes, and offender treatment. Hampshire, England: Ashgate Publishing Ltd.
10. Baines, C., Evans, P., & Neysmith, S. (Eds.). (1991). Women's caring: Feminist perspectives on social welfare. Toronto: McClelland & Stewart.
11. Batt, S. (1994). The politics of breast cancer. Charlottetown. PEI: Gynergy Books.
12. Belenky, M.F., Clinchy, B.M. Goldberger, N.R., & Tarule, J.M. (1986). Women's ways of knowing: The developemnt of self, voice, and mind. New York: Basic Books Inc.
13. Bellin, A. (1981). Reaction of a frustrated citizen. Community Mental Health Journal, 17(1), 83-91.
14. Canadian Public Health Association (1990). Women and AIDS. The New Facts of Life, 4(3), 1.
15. Checkoway, B. (1982). Public participation in health planning agencies: promise and practice. Journal of Health Politics, Policy and Law, 7(3), 723-733.
16. Croft, S. (1986). Women, caring and the recasting of need: A feminist reappraisal. Critical Social Policy, 6, 23
17. Dale, L. (1984). Final report: Women's Health Education Project of Newfoundland and Labrador, Jan. 1981 - Aug. 1984. (Available from: Health Promotion Directorate, Health and Welfare Canada, Halifax Regional Office).
18. Dalley, G. (1990). Ideologies of caring: Rethinking community and collectivism. New York: Macmillan.
19. Denton, M., Hajdukowski-Ahmed, M., O'Connor, M., Williams, K., Zeytinoglu, I.U. (1994). A theoretical and methodological framework for research on women work and health. Hamilton, Ont.: MRCPOWH Working Paper Series #1, McMaster University.
20. Edwards, S.S.M., & Lohman, J.S-de S. (1994). The impact of "moral panic" on professional behaviour in cases of child sexual abuse: An international perspective. Journal of Child Sexual Abuse, 3(1), 103-126.
21. Eichler, M. (1991). Nonsexist research methods: A practical guide. New York: Routledge, Chapman and Hall, Inc.
22. Elias, H. M. (1994). The impact of "moral panic" on professional behaviour in cases of child sexual abuse: Review, commentary and legal perspective. Journal of Child Sexual Abuse, 3(1), 137-139.
23. Epp, J. (1986). Achieving health for all: A framework for health promotion. Ottawa: Minister of Supply and Services.
24. Evans, P. (1991). The sexual division of poverty: The consequences of gendered caring. In C. Baines, P. Evans, & S. Neysmith (Eds.). Women's caring: Feminist perspectives on social welfare. Toronto: McClelland & Stewart.
25. Feingold, E. (1977). Citizen participation: a review of the issues. In H. Rosen, J. Metsch, & J. Levy (Eds.),
The Consumer and the Health Care System (p. 153-160). New York: Spectrum Publication Inc.
26. Ferguson, E. (1991). The childcare crisis: Realities of women's caring. In C. Bains, P.Evans, & S. Neysmith (Eds.). Women's caring: Feminist perspectives on social welfare. Toronto: McClelland & Stewart.
27. Finch, J. (1984). Community Care: Developing nonalternatives. Critical Social Policy. 9, 6
28. Finch, J. and Groves, D. (Eds.). (1983). A labour of love: Women, work and caring, (p.13. London: Routledge & Kegan Paul.
29. Friere, P. (1970). Cultural action for freedom. Cambridge, Mass: Harvard Educational Review.
30. Godbout, J. (1981). Is Consumer Control Possible in Health Care Services? The Quebec Case. International Journal of Health Services, 11(1), 151-167 .
31. Graff, L. (1987). Voluntary activity in Ontario: How much is 4.5 billion dollars worth? Profile #25, (pp. 1-11). Ottawa: Social trends Analysis Directorate, Department of the Secretary of State, Multiculturalism and Citizenship Canada.
32. Graham, H. (1983). Caring: A labour of love. In J. Finch & D. Groves (Eds.). A labour of love: Women, work and caring, (p. 13. London: Routledge & Kegan Paul.
33. Graham, H. (1985). Providers, negotiators and mediators: Women as the hidden carers. In E. Lewin & V. Olesen (Eds.). Women, health and healing. New York: Tavistock.
34. Green, K.L. (1994). Promoting women's health: Insights from recent research. In B.S. Bolaria & R. Bolaria (Eds.). Women, medicine and health, (pp.375-387). Halifax,NS: Fernwood Publishing.
35. Guberman, N. (1990). The family, women, and caregiving: Who cares for the caregivers. In V. Dhruvarajan (Ed.). Women and well(p. 67. Montreal: McGill University Press.
36. Harding, S. (1986). The science question in feminism. New York: Cornell University Press.
37. Havighurst, C.G. (1986). The changing locus of decision-making in the health care sector. Journal of Health Politics, Policy and Law, 11(4), 697-735.
38. Hiscott, R. (1993). Registered nurse employment in Ontario home care programs. Home Health Care Services Quarterly, 14(2/3), 73-83.
39. Hooyman, N. (1990). Women as caregivers of the elderly: Implications for social welfare policy and practice. In D.E. Biegel & A. Blum, (eds). Aging and caregiving: Theory, research and policy. Newbury Park. Newbury Park, CA: Sage Publications.
40. Hochbaum, G.M. (1977). Consumer participation in health care planning: toward conceptaul clarification. In H. Rosen, J. Metsch, & J. Levy (Eds.), The Consumer and the Health Care System (p. 267-277). New York: Spectrum Publication Inc.
41. Health Canada (1995a). Centres of excellence for women's health: Women's health framework. (Available from Women's Health Bureau, 0911A Brooke Claxton Bldg., Tunney's Pasture, Ottawa, K1A 0K9).
42. Health Canada (1995b). A Canadian Approach to women and smoking. Prepared for Health Canada for the Eleventh Commonwealth Health Ministers Conference, December, Cape Town, South Africa.
43. Heiman, M.L. (1992). Annotation: Putting the puzzle together: Validating allegations of child sexual abuse. Journal of Child Psychology and Psychiatry, 33(2), 311-329.
44. Heller, A. (1986). Health and home: Women as health guardians. Ottawa: Candian Advisory Committee on the Status of Women.
45. Hooyman, N. ( ) Women as Caregivers of the Elderly: Implications for social welfare policy and practice. In D. E. Biegel & A. Blum, (Eds.). Aging and caregiving: Theory, research and policy. Newbury Park, (p. ). ___, CA: Sage Publications.
46. Horne, T. (1995). Women and tobacco: A framework for action. (Available from Women and Tobacco Reduction Programs,
47. James, N. (1989). Emotional labour: Skill and work in the social regulation of feelings. Sociological Review, 1, 15
48. Johnson, C. F. (1991). Prolapse of the urethra: Confusion of clinical and anatomic characteristics with sexual abuse. Pediatrics, 87(5), 722-725.
49. Kickbusch, I. (1986). Health promotion: A global perspective. Canadian Journal of Public Health, 77, 321
50. Kretzmann, J.P., & McKnight, J.L. (1993). Building communities from the inside out: A path toward finding and mobilizing a community's assets. Chicago, IL: ACTA Publications.
51. Krivacska, J.J. (1992). Child sexual abuse prevention programs: The Prevention of childhood sexuality? Journal of Child Sexual Abuse, 1(4), 83-112.
52. Labonte, R. (1989). Community empowerment: The need for political analysis. Canadian Journal of Public Health, 80, 87
53. Labonte, R. & Penfold, S. (1981). Canadian perspectives in health promotion: A critique. Health Promotion, 20 (2): 4
54. Larrabee, M.J. (Ed.) (1993). An ethic of care: Feminist and interdisciplinary perspectives. New York: Routledge, Chapman, and Hall.
55. Last, J. (1987). Public health and human ecology. East Norfolk, CT: Appleton and Lange.
56. Laurence, M. (1992). Womancarecare: power and policy. Canadian Woman Studies, 12, 31
57. MacDonald, G. (1993). Transition home survey, 1992-93. Health Reports, 5(4), 377-379.
58. MacLeod, L. (1995). Desperately seeking certainity: Assessing and reducing the risk of harm for women who are abused. Edmonton, AB: Alberta Advisory Council on Women's Issues.
59. Martin Matthews, A. (1992). Homemaker services to the elderly: Provider characteristics and client benefit, 1989-92. Guelf, Ont.: The Gerontology Research Centre, University of Guelph.
60. McCormack, T. (1991). Politics and the hidden injuries of gender: Feminism and the making of the welfare state. Ottawa: Canadian Research Institute for the Advancement of Women.
61. Medjuck, S., O'Brien, M., & Tozer, C. (1992). From private responsibility to public policy: Women and the cost of caregiving to elderly kin. Atlantis: A Women's Studies Journal, 17 (2), 44
62. Mhatre S.L. & Deber, R.B. (1992). From equal access to health care to equitable access to health: a review of Canadian provincial health care commissions and reports. International Journal of Health Services, 22, 645-669.
63. Noack, H. (1987). Concepts of health and health promotion. In T. Ablin, Z.J. Brzezinski, and V.D.L. Carstairs (Eds.). Measurement in health promotion and protection, (pp. 5-28). Copenhagen: World health Organization.
64. Nobody's Perfect (Undated). Brochure. (Available from Family and Child Health, Health Promotion Directorate, Health Canada, Ottawa).
65. Nobody's Perfect (Undated). Program Books: Mind, Safety, Body, Behaviour, Parents. (Available from Family and Child Health, Health Promotion Directorate, Health Canada, Ottawa).
66. North, R.L., Rothenberg, K.H. (1993). Partner notification and the threat of domestic violence against women with HIV infection. The New England Journal of Medicine, 329(16), 1194-1196.
67. Nuttal, S. E., Greaves, L.J., & Lent, B. (1985). Wife battering: An emerging problem in public health. Canadian Journal of Public Health, 76, 297-299.
68. O'Neill, M. (1992). Community participation in Quebec's health system: a strategy to cutail community empowerment? International Journal of Health Services, 22(2), 287-301.
69. Ottawa Charter for Health Promotion. (1986). An International Conference on Health Promotion: The move towards a new public health. World Health Organization, Health and Welfare Canada, Canadian Public Health Association. Canadian Journal of Public Health, 77, 426
70. Phillips, S. (1995). The social context of women's health: Goals and objectives for medical education. Canadian Medical Association Journal, 152(4), 507-511.
71. Premier's Commission on Future Health Care for Albertans (1989). The Rainbow Report: Our Vision for Health. Edmonton: Alberta Legislative Assembly.
72. Radomsky, N.A. (1995). Lost voices: Women, chronic pain, and abuse. New York: Harrington Park Press.
73. Rechler, Z. & Rogers, M. (1993). Nobodys Perfect: The British Columbia Experience. British Columbia Council for the Family.
74. Rimmer, L. (1983). The economics of work and caring. In J. Finch & D. Groves (Eds.). A labour of love: Women, work and caring, (p. 131. London: Routledge & Kegan Paul.
75. Sherwin, S. (1992). No longer patient: Feminist ethics and health care. Philadelphia, PA: Temple University Press.
76. Siler-Wells, G.L. (1988). Directing Change and Changing Direction: A New Health Policy Agenda for Canada. Ottawa: Canadian Public Health Association.
77. Sorenson, S.B., Saftlas, A.F. (1994). Violence and women's health: The role of epidemiology. Annals of Epidemiology, 4(2), 140-145.
78. Sourdif, I. (1993). Femmes, sida et MTS: Stratégies d'action en matière de prévention et d'education. Canadian Journal of Public Health,84(S1), S28-S30.
79. Thurston, W. E. (1995a). Women's health: Has the silence deafened us? Submitted.
80. Thurston, W. E. (1995b). Violence against women: A major health issue. Submitted.
81. Thurston, W. E. (1994). Health promotion research in the 90's and beyond. Panel presentation, Health Promotion Division, Canadian Public Health Association Annual General Meeting, June, Edmonton, Alberta.
82. Thurston, W.E. & Bowhay, C.L. (1991). Healthy public policy on women and substance use: A discussion paper. (National Alcohol and drug Study,
Women's Project, Health Promotion Directorate, Health and Welfare Canada).
83. Thurston, W. E. & McGrath, A. (1995). Health promotion for women: The need for a global analysis in local programs. In C. Pizanias & J.S. Frideres (Eds.). Freedom within the margins: The politics of exclusion, (pp. 199-127). Calgary, AB: Detselig Enterprises Ltd.
84. Windle, C. & Cibulka, J.G. (1981). A framework for understanding participation in community mental health services. Community Mental Health Journal, 17(1), 4-18.
85. VanderPlaat, M. (1989). Nobody's Perfect: Process and Impact Evaluation Report. The Atlantic Regional Health Promotion Committee.
86. Wardrop, K. (1993). A framework for health promotion...A framework for AIDS. Canadian Journal of Public Health,84(S1), S9-S13.
87. Wuest, J. (1993). Institutionalizing women's oppression: The inherent risk in health policy that fosters community participation. Health Care for Women International, 14(5): 407
88. World Health Organization (1986). Health promotion: A discussion document on the concept and principles. Public Health Reviews, 14, 245-253.
89. Yll, K. A. (1993). Through a feminits lens: Gender, power, and violence. In R.J. Gelles and D.R. Loseke (Eds.). Current controversies on family violence, (pp. 47-62). Newbury Park, CA: Sage.


text:
James Gray insists St Albans City's successive away wins proves they can handle life in the Conference South.
The Saints responded to their opening defeat by winning 3-2 at Staines Town, having been 2-0 down, before following this up with a 1-0 victory at Farnborough on Saturday.
City have now won five consecutive away matches which is their best run for 12 years and the joint manager believes his side are starting to settle in the new division.
Gray said: "We needed to up our game so to get two away victories is very welcome. It's been a good week for us.
"We have done well to win at a couple of the league's established clubs and it gives us confidence that we've managed to do this already.
"It's been a long pre-season and the fruits of this have been shown by these two away wins."
James Comley's goal was enough to fire the Saints to the points at Farnborough and the manager was impressed with their defensive solidity.
Gray said: "We were very good in the first half but they came back into it in the second half.
"Farnborough put us under pressure but defensively we were strong and Joe Welch made a couple of good saves."
The Saints will attempt to get off the mark at Clarence Park this weekend when they entertain Bishop's Stortford before travelling to early leaders Eastbourne Borough on Monday.
Gray said: "We need to put on a performance at home on Saturday because we didn't really show up in our first match.
"But perhaps that was down to nerves and we've since picked up a few wins.
"We just hope that we can express ourselves and show our expansive game to the fans."
There is a team and supporters' coach going to Eastbourne for the Vanarama Conference South game on Bank Holiday Monday.
The coach will depart at 9.15am from the Clarence Park entrance to the ground.
To reserve £15 seats, call Ian Rogers on 07714 145862 or alternatively, you can book them at this week's game against Bishop's Stortford.

subset: commoncrawl


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Product Information
Protect your dog during the blustery winter with a warm coat tough enough to take on the elements.
Why We Love It:
We love the durability and warmth of this verstile dog jacket. The Muttluks Belted Dog Coat in Black features three layers of warmth and versatile fit. The nylon exterior with lofty inner core and faux sherpa interior will protect your dog's tender skin from bitter cold. With fourteen sizes, this coat for dogs is versatile enough for most breeds. Button closure at neck, and belted with adjustable strap and durable plastic buckle on the belly. Chest piece keeps it all together and adds extra warmth and coverage. Elastic back leg straps. Machine washable.
Important Sizing Note: The following measurements are the dimensions of the actual product, not of the pet they fit. After measuring your pet, make sure all measurements fit within the following dimensions (with a little room to spare in the chest and neck).Size 8
Really love this coat. It took me a long time to find just the right coat for my baby and this one really works great.
This coat is warm, provides chest protection, and is very easy to put on and take off. I bought 4 of them and they fit beautifully.
I did have one problem. I found it impossible to button the one button which has to be fastened for the coat to stay on. I solved that problem by getting ponytail holders with a decorative button attached to them, and now that button is easily fastened. The ponytail holders are made by gymboree, discontinued, but available on ebay. I hope this info helps anyone else who is finding that button a big problem.
Great coat-- I recommend it!


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Wait + IPL Q&A
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How Long Until Hair Grows Back After IPL?
Dear Doctors, Thanks for your answers about the lasting of IPL hair removal. About how long is the mentioned "period of time"? READ MORE
When is It Safe to Get IPL After Inflamed Acne Goes Away?
Is there a certain amount of time I should wait to get an IPL if I just had a few inflamed acne that went away but left a red mark (no indentations)? READ MORE
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In a relationship, I'm looking for an enjoyable person whom I share a mutual attraction too. An independent woman with empathy for differences of opinions. I'd prefer someone whose active and enjoys trying new things, especially beer/food. As for this site, I'd like make a connection with people on a meaningful level, and potentially develop that further more if mutual interest persists.
Cooking. Over the past year I taught myself to cook and routinely make fairly high quality dishes; recent meals include catfish and shrimp gumbo with a dill cous cous pilaf, savory garlic 'smoked' ribs with greens, Sonoran vegetarian BBQ pizza, vegetarian chili, buffalo chicken tacos, rotini with fennel vegetable marinara.
Archer, the daily show and some sports are all I have time to watch at this point.
As for food, I love all types of food. Some recent favorites were mentioned above, you can ask about all time favorites.
You get hazed (via exams, qualifying exams, preliminary exams etc.) until you feel stupid by people who may have got picked on when they were kids (professors) for 4-6 years. Expecting to work 60 hours is standard regardless of pay. If you tolerate their hazing and eventually figure out what it is they want you to do, then they'll let you join their special Ph.D. club.
(For the record this is meant in jest rather than bitterness. I do enjoy the work I do).
if you enjoy sports and/or thinking. No I don't personally find that pair ironic.
Think we have something in common.


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|You are in: Health
Wednesday, 23 January, 2002, 19:00 GMT
Organ transplant breakthrough
Scientists have successfully frozen whole organs without destroying their function.
The breakthrough raises the possibility that doctors will eventually be able to keep donor organs in deep freeze until they are needed for transplant operations.
It might also allow women who have to undergo cancer treatment to store healthy organs, and have children when they would otherwise have been infertile.
But until now it has not proved possible to freeze and store whole organs because the freezing and thawing process does too much damage.
The researchers carried out their research on rats.
Pregnant rodent
They removed and stored the creatures' ovaries in liquid nitrogen, then successfully transplanted them into rats that were genetically identical.
Although the transplanted ovaries were less efficient after freezing, more than half ovulated normally and one recipient became pregnant.
Lead researcher Professor Roger Gosden, of the Eastern Virginia Medical School, US, said that if the technique could one day be applied to humans, it would offer an option to women and children who would otherwise be sterilized by chemotherapy.
It might also be used to reduce the risk of premature sterility in women with other medical conditions.
Advances in freezing techniques could also make it possible to store and successfully transplant other organs. At present, freezing tends to cause irreparable damage to the blood vessels.
Professor Gosden told BBC News Online: "The take-home message is that we have demonstrated that whole organ transplantation is feasible.
"The frozen ones were not all successful, but that is not surprising because 50 years after the first successful sperm freezing results are still not perfect."
Professor Gosden said it would be more difficult to freeze human organs successfully because they were larger.
However, the blood vessels, being larger, would potentially present less problems during surgery.
The research is published in the magazine Nature.
See also:
27 Feb 01 | Health
Human ovaries 'grown in mice'
24 Feb 99 | Health
Ovary tissue breakthrough
25 Oct 00 | Health
Ovary transplant IVF 'within a year'
Internet links:
The BBC is not responsible for the content of external internet sites
Top Health stories now:
Links to more Health stories are at the foot of the page.
Links to more Health stories
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To BBC Sport>> | To BBC Weather>>
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Chocolate Covered Doughnut Oil Painting Kitchen Art Still Life Donut
painting by artist Debra Sisson
7 in X 5 in (17.8 cm X 12.7 cm)
This painting is already sold. However, I may have other paintings available.
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I found mostly love when I researched em. Mine has the m22v and m22sd. Someone compared the 22sd to the seymour duncan JB. I'm willing to agree. Anyways.. great low end and lots of body so to speak. And as I said.. the coilsplit is awesome.
Either way.. happy camper
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Instead of writing a summary this week about the swimmers of the meet, I thought I'd let them introduce themselves to you. Rachel Leeds and Teddy Hutchinson had a great weekend at DePauw. Here are their stories!
What initially attracted you to Wittenberg?
When beginning my college search I knew I wanted to go to a small school that had a prestigious name and well-known education program. I looked at other schools similar in size including Ohio Wesleyan and Butler University but in the end after I visited campus I got the feeling that Wittenberg was the place for me and I could see myself being a student and student athlete on this campus.
What is you favorite and least favorite stroke?
I swim IM so I kind of forced to have to like all of them but if I had to choose I guess my favorite would be fly, least favorite probably breaststroke.
Do you have any hobbies?
I love arts and crafts, especially coloring.
What are you majoring in?
I am an early childhood education and intervention specialist double major and a minor in sociology
What is your favorite thing about Wittenberg?
All of the traditions, the beautiful campus and the amazing people!
Any stories you would like to share about the team?
Sitting every bus ride next to Jenna blasting her 90s ipod music, watching movies such as The Princess Bride and 30 Days of Night. Hearing all of the boys in the back of the bus screaming about how they are the best movies ever!
What initially attracted you to Wittenberg?
I had not heard of Wittenberg until I got a letter from Coach Koukis. She called me a couple of times and I decided to come here after my recruiting trip. I loved the people here and had a great time.
What is you favorite and least favorite stroke?
My favorite stroke is backstroke and my least favorite stroke is breaststroke.
Do you have any hobbies?
Hobbies in college? My hobbies include hanging out with my friends among other things.
What are you majoring in?
What is you favorite thing about Wittenberg?
My favorite thing about Wittenberg is that everyone is very friendly and very sociable.


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May Contain Spoilers
After reading Vision in Silver, I wanted to read another book with wolves. While Patricia Briggs' werewolves have little in common with Anne Bishop's Wolves, Cry Wolf was a great choice. I was a little confused at first, but I really enjoyed this story and the characters, and I'm am looking forward to reading the other Alpha and Omega books.Read more


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Ingenue Headwrap by Adrienne Krey
Welcome! You are browsing as a guestWould you like to see 14 projects made from this pattern and much more? create a free account What am I missing?
© Adrienne Krey
© Adrienne Krey
© Adrienne Krey
Ingenue Headwrap
This pattern is available for $3.50 USD buy it now
This chunky knit headband is a cinch to knit and wear! Simple, subtle bow detail can be worn in front, to the side or in the back. A great, fashionable hat substitute for chilly ears.
Quick to knit with less than one skein of bulky or aran weight yarn, this headband makes for an easy wardrobe essential.
In this pattern, you just need to know how to knit, purl and pick up stitches. Perfect for beginning knitters!


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This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
Silver-particle-incorporated polyurethane films were evaluated for antimicrobial activity towards two different bacteria:
Partially implanted medical devices become increasingly vulnerable with time to microbial colonization. A particularly common example of this is the intravascular infusion line, used for both acute and chronically ill patients. Maintained sterility here is vital for avoiding frequent line changes and for the safe administration of hydration fluids, electrolytes, drugs, nutrients and blood components. Regardless of the therapeutic benefits of intravascular devices, the escalating incidence of colonization and infection imposes a further, major therapeutic challenge [
Polymer-silver combinations have been reported for a range of non-medical applications, where their electrical conductivity, light scattering and catalytic activity have proven to be valuable [
Resistance to the antimicrobial activity of Ag has been reported for some microorganisms [
Polyurethanes (PUs) comprise an important polymer group, used in industry as coatings, adhesives, foams, rubbers and composites. More recently, shape memory materials based on PU have been investigated and detailed structure and property correlations derived [
Here, we report on the structural, mechanical and thermal properties of PU, loaded with Ag salt and Ag nanoparticles, along with resultant antimicrobial activity.
Silver is less prone to microbial resistance than antibiotics, especially if rapid bactericidal action is achieved [
Fourier Transform Infra-red (FTIR) spectra of polyurethane (
The field emission scanning electron microscopy (FESEM) micrographs of PU and PU-Ag films are shown in
Field emission scanning electron microscopy (FESEM) images of polyurethane (
Except for Ag-lactate, the contact angle for PU decreased from 89.8° to 75.9° after Ag loading, indicating a more hydrophilic surface (
The X-ray Diffraction (XRD) patterns of pure PU, PU-10% (w/w) AgNO3, PU-1% (w/w) Ag lactate, PU-10% (w/w) Ag lactate and PU-Ag nanoparticles are shown in
Contact angle measurements for polyurethane (
X-ray Diffraction curves for polyurethane (
A different distribution of silver in the polyurethane-silver composites may account for slight differences in the observed peaks for each formulation, but the presence of hard segments appears unaffected. A decrease in the number of hydrogen bonds between the soft and hard segments of polyurethane might be expected, decreasing crystallinity, consistent with such an observation on polypropylene containing micro- and nano-scale silver powders [
The UV-Vis spectra of pure PU, PU-AgNP film along with preformed AgNP solution are shown in
UV-Vis absorption spectra of PU-AgNP film (▽) along with PU film (Δ) and 12.46μg/ml AgNP solution (□).
To assess the effect of silver on the PU mechanical properties, tensile testing was undertaken (
The stress-strain curves recorded for polyurethane (
Hardness measurements of polyurethane (
Tear resistance measurements of polyurethane (
The storage modulus E' (energy stored during deformation due to stress) and damping factor tanδ (the ratio of energy dissipated and energy stored during deformation) of PU and PU-silver composites as a function of temperature are shown in
Temperature dependence of the storage modulus of polyurethane (
Temperature dependence of the tanδ of polyurethane (
When antibacterial activity was assessed for
Film activity was also seen against
Zone of inhibition (ZOI) for different PU-Ag composite films for
|Film type
|Average ZOI (mm)
|Haemolysis effect
|1% AgNO3
|10% AgNO3
|wide effect
|10% Aglactate
|Ag nanoparticles
Zone of inhibition (ZOI) for different PU-Ag composite films for
|Film type
|Average ZOI (mm)
|Haemolysis effect
|1% AgNO3
|10% AgNO3
|wide effect
|1% Aglactate
|10% Aglactate
|Ag nanoparticles
Two bacterial strains, namely
Polyurethane was synthesized from its monomer, MDI and PTMO by a two-step process, using BD as a chain extender. First, the pre-polymer was prepared from a reaction of 5.005 g of MDI in 40 mL of DMF and 10 g of PTMO in 20 mL of DMF in a 500-mL four-neck cylindrical vessel heated to 60 °C for 90 min with mechanical stirring under a nitrogen atmosphere. Subsequently, 0.92 g of BD in 10 mL DMF was added slowly to the prepolymer at 110 °C over 240 min and the mixture allowed to react fully. The molar ratio used was 1:2:1 for MDI:PTMO:BD, which was consistent with providing a 67% soft segment polymer. The polyurethane product was finally washed with Milli-Q water (18 MΩ∙cm) then methanol and in an oven at 80 °C [
Five-hundred millilitres of 1 mM silver nitrate solution in distilled water was heated to boiling. Then, 20 mL of 1% (w/v) sodium citrate solution was added, and boiling continued until a pale yellow solution was obtained [
One gram of PU was dissolved in 25 mL THF, and after stirring until homogeneous, 25 mL of the polymer solution was cast in a glass Petri dish of a 96-mm diameter. The polyurethane-only films were allowed to dry at room temperature for two days; then, they were removed for further characterization.
Composite films of different silver content were readily obtained using a solvent casting method [
A polyurethane film of a 96-mm diameter was soaked in 520 mL of an aqueous suspension of silver nanoparticles (100 μg/mL). One millilitre of THF was added, and the mixture was kept in closed glass vials overnight to promote the coverage of the surface. THF served as a stabilizer and prevented the formation of larger nanoparticles [
For the zone inhibition study, 25 mL of sterile iso-sensitest agar, according to the manufacturer's instructions, was poured into 90-mm disposable, sterilized Petri dishes supplemented with 5% (v/v) defibrinated horse blood and allowed to solidify. The plates were stored at 4–8 °C in sealed plastic bags. Ten microlitres of bacterial water were streaked over a plate and spread uniformly using a 6-cm sterile needle. PU pieces were then gently placed over the solidified agar in different Petri dishes. Incubation times were 24 h at 37 °C.
For structure analysis, the FTIR spectra of samples were recorded on an FTIR spectrometer (Nicolet 8700 FTIR, Thermo Electron Corporation, Hertfortshire, UK) and spectra collected from 400 to 4000 cm−1, with 4 cm−1 resolution over 128 scans. For the FESEM study, a Jeol JSM 6300F instrument (Tokyo, Japan) recorded gray scale images with 8-bit resolution at different magnifications at a primary electron beam energy of 10 kV operated at a working distance of 15 mm. Ultrasonically-cleaned unmodified and modified PU with different Ag loadings were made conductive with an ultrathin layer of gold deposited by sputtering before the FESEM measurements.
Contact angle measurement was undertaken using a CAM 200 model, KSV instrument using droplets of 2 μL of double distilled water dispensed on film on a glass substrate. Five sets of measurements were made to derive the mean and standard deviation. The X-ray Diffraction patterns of samples were recorded with an Xpert-Pro X-ray diffractometer (PANalytical, Almelo, the Netherlands) employing a scanning rate of 0.03° /min from 5° to 120° with Cu Kα irradiation (45KV, 30 mA; the wavelengths of Cu Kα1 and Cu Kα2 are 1.540598Å and 1.54442Å, ratio 2:1).
For mechanical testing, tensile strength was determined using an Instron Universal Testing machine (model No 5584, Instron Co., Macclesfield, UK) at room temperature. Rectangular specimens (60 mm × 6 mm) were stretched until breaking at a crosshead rate of 20 mm∙min−1; stress-strain curves were recorded. Hardness and tear resistance were respectively determined according to ASTM D2240-05 [
To test thermal properties, Dynamic Mechanical Analysis (DMA) was performed on a Dynamic Mechanical Thermal Analyser DMA Q 800 at a frequency of 1 Hz, an amplitude of 15 μm and a static force of 0.01 Newtons. Samples were kept under isothermal conditions at −100 °C for 2 min and heated from −100 to 0 °C at a heating rate of 5 °C∙min−1. The sample used had a dimension of 20 mm in length, 5.3 mm in width and 0.14 mm in thickness. The data presented represent the mean of three independent measurements.
Polyurethane, despite its hydrophobic nature, is hygroscopic and so can take up silver salt solution for composite formation. The later interaction with an external solution can then release bactericidal concentrations of silver ion with an evident effect on
We acknowledge generous support from the European Commission (Grant No. IST-2002-1-001837). We sincerely thank R.M. Wilson, Queen Mary, University of London, for carrying out X-ray Diffraction of polyurethane-silver composites
The authors declare no conflict of interest.


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ROOTS-L ArchivesArchiver > ROOTS > 2008-06 > 1214865697
Subject: Re: [ROOTS-L] ROOTS Digest, Vol 3, Issue 385 /boltz
Date: Mon, 30 Jun 2008 18:41:37 EDT
My GR. GRandmother was CHARLOTTE CATHERINE TIMMONS YOUNY BOLTZ.
She was 2nd wife to ABRAHAM BOLTZ in GREENE CO. IN. BLOOMFIELD. He died in
1908 and she in 1911. Her first husband was SOLOMON YOUNG who died 1861 at
age 22 . She had 10 children by ABRAHAM BOLTZ. Maybe JACOB was his father.
PENN. was where BOLTZ was born. MILDRED
**************Gas prices getting you down? Search AOL Autos for
fuel-efficient used cars. (http://autos.aol.com/used?ncid=aolaut00050000000007)
This thread:


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Wood Nymph Model
SSPictographyPhotographer Female Columbia, Missouri, US
My Website: S.S Pictography on FacebookMy MM URL: http://www.modelmayhem.com/SSPictography
Mayhem # 2396688
About MeS.S Pictography is about "Alternative art". I enjoy taking pictures of People, Events, and Things that are considered Different, Exotic, Alternative and Fun! I love Models who are Tattooed, Pierced, Or who aren't the kind of gal who could appear in Vogue or mainstream media.Ive Done Bands, Burlesque, Fire-spinning, Freak Shows, Ghost hunting and Tons of model shoots for Women and Men.The best way to contact me is through Email or Facebook at this time. Id love to Gain some new models and maybe some Interesting People to do collaborations with!
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