Social work interest in prevention: a content analysis of the professional literature.
Abstract: Every day in the United States, over half a million social workers provide services to people with health, mental health, and substance abuse problems in a fragmented system that emphasizes disease treatment over prevention. Powerful issues--including health inequities, population aging, globalization, natural disaster, war, and economic downturn--make the need for preventive approaches more critical than ever. Despite social work's historic commitment to enhancing human well-being and public health involvement, little is known about how social work currently views prevention or whether it is being addressed in the social work professional literature. To determine whether, and to what extent, prevention is addressed, discussed, and published in social work journals, the authors--all public health social work researchers--undertook a content analysis of nine peer-reviewed journals, analyzing all articles published from 2000 to 2005. A total of 1,951 articles were reviewed and coded for prevention according to specified criteria. A relatively small number--109 (5.6 percent)--were found to meet the criteria for being a prevention article, suggesting that prevention is still a minority interest area within social work. A renewed conversation about prevention in social work can enhance opportunities for strong social work participation in the transdisciplinary collaboration needed in this new era of health reform.

KEY WORDS: health education; health promotion; prevention; public health; social work
Article Type: Report
Subject: Social case work (Health aspects)
Medicine, Preventive (Management)
Preventive health services (Management)
Authors: Marshall, Jamie Wyatt
Ruth, Betty J.
Sisco, Sarah
Bethke, Christina
Piper, Tinka Markham
Cohen, Micaela
Bachman, Sarah
Pub Date: 07/01/2011
Publication: Name: Social Work Publisher: National Association of Social Workers Audience: Academic Format: Magazine/Journal Subject: Sociology and social work Copyright: COPYRIGHT 2011 National Association of Social Workers ISSN: 0037-8046
Issue: Date: July, 2011 Source Volume: 56 Source Issue: 3
Topic: Event Code: 200 Management dynamics Computer Subject: Company business management
Product: Product Code: 8000140 Health Problems Prevention; 9105230 Health Problems Prevention Programs NAICS Code: 621999 All Other Miscellaneous Ambulatory Health Care Services; 92312 Administration of Public Health Programs
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 262582571
Full Text: Every day in the United States, over half a million social workers provide services to people suffering from health, mental health, and substance abuse disorders and problems (Bureau of Labor Statistics, 2007).The delivery of this care occurs in a fragmented system that emphasizes disease treatment over prevention, uses a maze of bureaucratic structures to contain spiraling costs, and fails to meet a significant portion of the population's needs (Schroeder, 2007).Although advances in public health, medicine, technology, and social sciences have unquestionably fueled overall health improvements in the United States during the last century, multiple indicators suggest that health progress has stalled and that the current system is in crisis (Turnock, 2007). Americans now spend more than citizens of any other country on health care; by 2015, it is estimated that a full 20 percent of the U.S. gross domestic product will be spent on health care (Borger et al., 2006).Yet the results of this investment are unclear, as disparities are rampant, and the United States ranks poorly in comparison with other nations on nearly every measure of health status (Relman, 2007; Schroeder, 2007). For example, the United States ranks 46th in life expectancy and 42nd in infant mortality among 192 nations (Borger et al., 2006). One recent study found higher rates of chronic disease prevalence and medication usage in the United States than in 10 European countries that spend considerably less on health (Thorpe, Howard, & Galactionova, 2007).

Deeply embedded ethnic, racial, gender, income, and geographic inequities are pervasive in health outcome measures, reflecting the broad and persistent unequal conditions that shape population health and well-being (Satcher & Higginbotham, 2008; Warnecke et al., 2008).These disparities--the result of multifaceted socioeconomic, systems, and policy issues--have proven intractable within the current health care context despite substantive efforts to address them (Voelker, 2008). One of the systemic factors involved in producing disparities, lack of insurance and underinsurance, continues to dramatically increase in the United States. Some 47 million Americans, almost 18 percent of the U.S. population, lack health insurance of any kind, and many millions more are underinsured (Johnson, 2007).The health consequences are well known to social workers and make our work more complex. Uninsured individuals disproportionately hail from socially disadvantaged and stigmatized groups; they receive fewer preventive and health-related services, which leads to increased need for interventions when care is finally accessed and to generally worse health outcomes (Hadley, 2006).

Powerful demographic changes are also affecting current practice. The health needs of the over-65 age group, expected to grow to more than 20 percent of the population in 20 years, will significantly affect the health care system and the field of social work (Oliver & DeCostero, 2006; Rosen & Zlotnik, 2001; Sisco, Volland, & Gorin, 2005). Population aging is associated with increasing chronic disease rates: cardiovascular disease, diabetes, stroke, and cancer now afflict more than 90 million Americans and are responsible for 70 percent of all deaths in the United States (Centers for Disease Control and Prevention, 2008). Some 80 percent of U.S. older adults live with one chronic disease, and some 43 percent of those adults over age 65 have three or more chronic diseases (Oliver & DeCostero, 2006). Growing chronic disease comorbidity threatens to overwhelm the current system, presenting challenges for all health professionals, including social workers (Wieland, 2005).

Population shifts are not limited to demographic pressures. Globalization, population movement, and climate change have provided opportunities for disease and infection to emerge on a larger scale (Galambos, 2005; Yu, 2008). SARS (severe acute respiratory syndrome), drug-resistant tuberculosis, and aviary influenza are examples of emerging global infections present in settings where social workers labor, including prisons, hospitals, and schools (Gearing, Saini, & McNeill, 2007; Rowland, 2007; Tiong, 2006). Immigration, war, displacement, and disaster are also increasing in amount and impact. Research on disasters, fueled by 9/11 and Hurricane Katrina, suggests that the health effects of human-made and natural disasters have been widely underestimated; as displacement, climate change, and civil unrest worsen, the amount of related mental illness and behavioral disorders measurably increases (Harding, 2007; Satcher, Friel, & Bell, 2007). War, if survived, predictably damages human health; its public health consequences have been well established (Levy & Sidel, 2009). It is estimated that 25 percent to 30 percent of the veterans of the wars in Iraq and Afghanistan report psychological symptoms of posttraumatic stress disorder and other mental disorders; their family members--particularly children--experience mental stressors that are relatively unstudied (Seal, Bertenthal, Miner, Sen, & Marmar, 2007; Wheeler & Bragin, 2007).

Even a short review of health issues in the United States suggests that significant social, environmental, and economic factors--the social determinants of health--powerfully affect health outcomes across populations (Baker, Metzler & Galea, 2005; Drexler, 2008). Social workers encounter these social determinants daily as they struggle to provide remediation, treatment, problem-solving, and intervention services to the most vulnerable populations in society (Alpeter, Mitchell, & Pennell, 2005; Gehlert, Mininger, Sohmer, & Berg, 2008).Providing limited, remedial health and psychosocial care in a rapidly changing system that emphasizes intervention long after problems and diseases have advanced is frustratingly familiar to social workers. For many social work clients, there are insufficient or inadequate services; those in need often cannot pay for them; and many conditions do not respond well, fully, or at all to current interventions (Albee, 2000).With the recent economic downturn, there is growing ethical, financial, and practical urgency associated with the current health care arrangement and increased recognition that broad commitment to prevention must accompany efforts at reform (Halfon, 2008; Woolf, 2007).

More than 90 percent of the national health budget is spent on treating diseases and complications, yet half of all annual deaths are associated with preventable conditions (Mokdad, Marks, Stroup, & Gerberding, 2004; O'Byrne, Brammer, Davidson, & Poston, 2002; Satcher, 2006). Despite this, only approximately 2 percent of the national health budget is spent on population-based prevention (Satcher, 2006). Strengthening prevention, while logically and morally compelling, will require a significant shift in health priorities and a commitment to some type of universal coverage on the part of elected officials, health care leaders, and the public (Woolf, 2007). Professions have a role to play in facilitating this shift; vocal support and leadership on issues of prevention, public health, and health care reform are vital to building national momentum (Flint & Gorin, 2008; Schroeder, 2007). Many health professions--including psychiatry, nursing, and counseling psychology--are currently engaged in professional discussion of their role in prevention and public health, as reflected in journal content, conference themes, and research (Conye, 2000; Hage et al., 2007; Koplan et al., 2007; Mrazek & Ritchie, 2007).The social work profession, with its historic commitment to social justice and service to vulnerable populations, has a convincing reason to reconsider its role in prevention as well.

A HISTORY OF PREVENTION IN SOCIAL WORK

The social work profession's involvement in prevention dates back to the early 20th century, when social workers first worked in settlement houses and labored in the fields of infectious disease control and maternal and child health (Bloom 1995; Carlton, 1988; Dhooper, 1997; Popple & Leighninger, 2002). These early public health social workers applied a preventive focus to casework and used informal risk analysis to promote early intervention. Focused mostly on individuals, they incorporated an initial understanding of social determinants of health and viewed communities as target populations (Ruth & Sisco, 2008). To maximize impact, they partnered across disciplines in what were considered nontraditional services at the time (Bracht, 1978; Cowin, Rice, & Schmidt, 1965). Still, the majority of social work practice was concentrated in secondary and tertiary interventions, designed to mitigate the impact of health problems after they had already arisen (Roskin, 1980). Social work interest in primary prevention--the prevention of illness and dysfunction before they develop--was spurred by Rapoport's seminal 1961 attempt to conceptualize it for the profession (Gilbert, 1982; Rapoport, 1961; Roskin, 1980). In the decade that followed, primary prevention was the focus of a federal call to action and embraced as a timely concept across all health and human services, including social work (Klein & Goldston, 1977). Growing awareness of the role of social environment in chronic disease processes and mental illness reflected social work's own emphasis on person-in-environment and fueled social work interest in prevention. In 1982, Nance observed that social work tradition and ideology seemed to support involvement in primary prevention and hypothesized that this would be reflected in the professional literature; her content analysis of social work journals from 1977 to 1980 found that just 2.4 percent of articles focused on prevention. She concluded there were substantive obstacles to interest in prevention in social work, notably a need for knowledge development and research (Nance, 1982).

In the ensuing two decades, the social work literature began to highlight the power of the public health model and to emphasize prevention (Bracht, 1978; Coulter & Hancock, 1989; Gilbert, 1982; Hooyman, Schwanke, & Yesner, 1980; Roskin, 1980). Diligent efforts to introduce epidemiology to social workers and to promote prevention throughout social work education and the workplace were made (Siefert, Jayaratne, & Martin, 1992; Tendler & Metzger, 1978; Whitman & Hennelly, 1982). By the 1980s, "new" prevention issues such as HIV/ AIDS, substance abuse, violence, and aging emerged (Coulter & Hancock, 1989; Moroney, 1995). Social work involvement in community prevention partnerships spotlighted the value of time-tested social work methods such as community organizing and stakeholder-driven research (Bracht, 1999) By the millennium, the skills of prevention, health promotion, and social epidemiology were increasingly viewed by the profession's leaders as critical to social work's survival as a core health profession in health care's "brave new world" (Vourlekis, Ell, & Padgett, 2001; see also Berkman, 1996; Black, 1984; Volland, Berkman, Stein, & Vaughn, 1999). A small but substantive body of research contributed to a social work perspective on risk, protection, resilience, and prevention and has continued to grow (Bloom, 1996; Fraser & Richman, 1999; Hawkins, 2006). A degree of professional support for prevention was integrated into the most recent practice standards for social workers in health care settings, identifying prevention, health promotion, and health education as core practice competencies (NASW, 2005). To some social work scholars, it even seemed that prevention articles were appearing more frequently in social work journals, signaling an opportunity for a renewed discussion of prevention (Rosenberg & Holden, 1999).

Despite this progress, social work's relationship to prevention remains uncertain. Beyond the linkage afforded through dual-degree training programs in social work and public health, graduate schools of social work do not generally appear to teach prevention, health promotion, or social epidemiology (Copeland, Jackson, Jarman-Rhode, Rosen, & Stone, 1999; Kadushin & Egan, 1997; Ruth, Wyatt, Chiasson, Geron, & Bachman, 2006). Workforce studies indicate that a small minority of current social workers describe themselves as "public health social workers," a group most likely to be engaged in prevention (Clark, 2006). And descriptive studies of MSW/MPH graduates suggest that these practitioners encounter workplace obstacles such as a lack of familiarity and consensus regarding the definition, content, capacities, and roles for public health social workers with a prevention orientation (Ruth et al., 2006).

Yet many issues that concern social workers--from mental and substance abuse disorders to violence and HIV/AIDS--are preventable; a growing transdisciplinary movement recognizes that these complex health care challenges can only be addressed through collaborative, prevention-oriented research, training, and practice (Syme, 2008; Walker, 2008). Such collaborations offer social work wide-ranging opportunities for social workers to share best practices, to partner for greater effect, and to increase visibility as members of the public health workforce (Gebbie & Turnock, 2006; Ruth et al., 2006).

EXAMINING SOCIAL WORK PROFESSIONAL JOURNALS: PURPOSE OF THE STUDY

A content analysis of the social work journal literature was undertaken to determine whether and to what extent prevention was being written about, researched, and addressed in the major journals of the social work profession. A secondary goal of the study was to assess whether the amount of prevention content had increased or decreased since the similar study by Nance (1982) nearly 30 years ago.

Content analysis is an established, versatile method for rigorous examination of information, content, and themes in written or symbolic materials, such as texts or journals (Neuendorf, 2002).Content analysis has been used in social work research to examine topics such as end-of-life and aging content in textbooks, LGBT and racism content in social work journals, and social science source content in social work practice journals (Bush, Epstein, & Sainz, 1997; Grise-Owens, 2002; Kramer, Pacourek, & Hovland-Scafe, 2003; McMahon &Allen-Meares, 1992; Tompkins, Rosen, & Larkin, 2006).

Content analysis is a particularly useful method for examining how professional journals shape the dialogue, content, theories, methods, and intentions of professional intervention (Kreuger & Neuman, 2006). Professional journals have a powerful effect on professions; they have been described as "footprints" by which the development of knowledge in a profession can be traced (Bush et al., 1997). Journals help to establish the issues that are addressed by professions, and they provide current information on research, theory, and practice (McMahon & Allen-Meares, 1992; Voorhis & Wagner, 2001). Systematic content analysis of a profession's major journals can help to explain the place of prevention in social work today. Inclusion or exclusion of prevention content in the social work literature sends an important message about the place of prevention in social work (Grise-Owens, 2002).

METHOD

Selected Journals

Nine social work journals were selected for review in this content analysis: Child Welfare, Families in Society, Health & Social Work, Journal of Gerontological Social Work, Journal of Social Work Education, Social Service Review, Social Work, Social Work Research, and International Social Work. Journals selection was based on two criteria: (1) ranking in studies of perceived journal quality, familiarity, and citation frequency (Sellers, Mathiesen, Perry, & Smith, 2004; Sellers, Smith, Mathiesen, & Perry, 2006) and (2) representation of a broad array of subject areas in social work practice. The content analysis was conducted during 2006 and 2007. Years of analysis were 2000 through 2005 inclusive. Of particular interest were themes and trends associated with entry into the new millennium. All scholarly articles were reviewed; letters, introductions, book reviews, and editorials were excluded.

Coding Terms

The definition of coding terms is an essential step in the content analysis process (Neuendorf, 2002). A team of six researchers with a minimum of master's-level training in social work and public health consulted the social work literature and held a series of iterative discussions to identify the terms for coding prevention and prevention activities in social work. The umbrella code terms of "prevention," "health promotion," and "health education" (P/HP/HE), as articulated in the NASW Standards for Social Work Practice in Health Care Settings (NASW, 2005), were chosen for this analysis. These standards provide specific guidelines for social work practice in health settings and articulate prevention, health promotion, and health education as essential skills for competent social work practice. Widely disseminated, these standards help to guide practice, promote accountability, and inform social work licensure nationwide and are broadly available to social workers and the public (see http://www.socialworkers.org). For the purposes of this study, prevention was defined as actions taken to prevent the occurrences of adverse social health effects or to minimize their impacts once they have occurred, health promotion was defined as any combination of interventions designed to facilitate behavioral and environmental adaptations that improve or protect health, and health education was defined as learning opportunities designed to facilitate voluntary behavior change conductive to good health (Turnock, 2007).

Article Review Process

All articles from 2000 to 2005 in the selected journals were reviewed by teams of three researchers. Teams were randomly formed among the six researchers described earlier; teams were changed periodically to enhance interrater reliability. In the first phase of analysis, individual team members reviewed articles independently and coded them. First, article titles, key words, and abstracts were analyzed for the code terms (P/HP/HE). If the code terms were not present in the title, key words, or abstract, reviewers analyzed the full text. Articles could be descriptive, empirical, or conceptual, but at least one of the code words had to be printed somewhere in the body of the article, and overall content had to reflect the defined code terms (P/HP/HE). Individual reviewers coded each article "Yes P/HP/HE" or "No P/ HP/HE." The teams then came together for final coding; each article was reviewed, and a final code determination was made. In situations in which there was disagreement, a two-thirds majority determined the final code following discussion. For purposes of the study, articles coded as "Yes P/HP/HE" were then referred to as prevention articles.

Secondary Analysis

The reviewers conducted a secondary analysis of prevention articles to identify content themes. A team of three reviewers first individually reviewed the title, abstract, and key word content of all prevention articles, compiling a list of the most frequently occurring topics or themes. Once the list was compiled, the team reviewed and categorized each prevention article into one or two theme areas. All articles were categorized into at least one content theme; those with two or more focuses were coded into a maximum of two theme areas.

FINDINGS

Out of 1,951 articles reviewed, a total of 109 articles (5.6 percent) were coded as prevention articles. Health & Social Work contained the largest percentage of prevention articles. Social Service Review contained the least, followed by the Journal on Social Work Education (see Table 1). The year 2001 contained the highest number of prevention articles overall (6.94 percent), followed closely by 2005 (6.90 percent) (see Table 2). Reviewers achieved initial agreement on 88.88 percent of the articles. Of the 217 articles in which there was disagreement in the initial review, 73 were coded and included after discussion using a simple majority rule, while 144 were not coded and included. The average interrater agreement was .963, with a composite reliability of 98.6 percent (1, 878 agreements).

The secondary review of the 109 prevention articles for content themes (see Table 3) found the highest number of prevention articles related to violence and trauma, followed by articles containing prevention as it related to some aspect of culture/ race/ethnicity. The fewest number of prevention articles were focused on suicide, environment, and spirituality/faith-based programs and practices. A total of 12 articles (11 percent) were coded as other; these focused on individual topics related to prevention. Percentages reported are based on 109 prevention articles, although some articles were coded into two content areas to account for dual focuses (for example, substance abuse and HIV/AIDS).

DISCUSSION

Prevention articles accounted for 5.6 percent of total articles reviewed, a relatively small percentage of the total.

Differences among Journals

The data reflect notable differences among journals included in the sample in the amount of content on prevention. Health & Social Work and Social Work, both journals published by NASW Press, contained the largest percentages of prevention articles (23.85 percent and 19.27 percent, respectively). It is not surprising that Health & Social Work, given its health-related mission and readership, had the highest percentage of prevention-related articles. In addition, Social Work, the profession's flagship journal, widely read by practitioners, dedicated almost 20 percent of its articles to prevention. In contrast, Social Service Review, widely considered the most prestigious social work journal (Sellers et al., 2004), contained the lowest percentage of prevention-related articles, despite its macro-level focus on social welfare policy, organization, and practice. The Journal of Social Work Education, read broadly by social work educators, contained relatively few articles on prevention, raising questions about the presence of prevention in social work education. Finally, population-focused journals, such as Child Welfare and the Journal of Gerontological Social Work, showed modest amounts of prevention scholarship. This is noteworthy given the mounting perception that issues such as aging and child abuse urgently require population-focused public health approaches (Gebbie, Rosenstock, & Hernandez, 2002). Additional study of the findings across the time period reviewed yielded no observable trends or changes in frequency of prevention articles over the six-year period.

Content Themes

There was a wide range of content themes in the 109 prevention articles. Some thematic areas, such as pregnancy and sexually transmitted disease prevention, have been associated with social work since the profession's inception, whereas others, such as HIV/AIDS and the environment, have emerged only in recent decades. Topics related to mental health services--such as violence, trauma, suicide, substance abuse, and mental health treatment--were frequent and unsurprising given the steady increase in social workers providing direct services, counseling, and therapy (Whitaker & Arrington, 2008). Prevention articles related to aging and culture/race/ethnicity, which included articles focused on immigration and acculturation, were also relatively frequent. With current immigration trends projected to continue (U.S. Census Bureau, 2008), recognition of the value of a public health approach to these issues is vital. Social determinants issues such as homelessness, environment, global health, and chronic disease were not widely represented, despite ongoing national and international emphasis on the need to address social determinants to improve health outcomes (Krisberg, 2008/2009).

Language and Terminology

Inconsistencies in language and terminology were noted throughout the review. Various descriptive terms were used to identify activities that could have been characterized as prevention, health promotion, or health education, such as "interrupting problem cycles," "strengthening well-being," "creating upstream interventions," and "stress buffering. "Many of the articles did not explicitly name prevention, health promotion, or health education efforts or goals although their language suggested them. Further, some articles used public health terminology such as "mediating factors," "risk factors," and "populations at risk" outside of the public health approach context. For example, some articles discussed improving outcomes in an at-risk population but did not link the interventions to benchmark indicators that might have helped measure whether outcomes had been achieved.

Limitations

A key limitation of this study is that the content analysis was based on a limited sample of nine journals. Although the journals were selected according to well-defined criteria, the sample does not represent an exhaustive review of all literature related to public health social work. Social work is actively involved in prevention activities in a number of arenas that may or may not have been represented by the journals selected, such as domestic violence, foster care, and school health. Future research efforts would benefit from casting a broader net to include more targeted journals that focus on specific social welfare problems. A broader scan of the literature could yield different results.

Despite the best attempts to carefully sample a cross-section of journals, the journals and years analyzed were not comprehensive, raising generalizability concerns. Nine out of more than 40 professional social work journals were analyzed, and the analysis was limited to six years of data. The focus on social work journals excluded other forms of social work professional communications and text as well as the work of social work scholars publishing in other fields.

In addition, as with all content analyses, this study was not exempt from inherent coding bias due to the complex definition of prevention terms. Although interrater reliability was high, there is always a risk that discussion among coders may have led to a dependent outlook regarding what constituted P/ HP/HE. Finally, it is possible that the years analyzed may have been unusual; the culmination of the millennium, and significant national events such as 9/11 and Hurricane Katrina, may have positively influenced the frequency of prevention-related articles.

IMPLICATIONS

If professional journals are indeed the "footprints" of a profession, tracing the thinking and knowledge development in a field (Bush et al., 1997), the findings of this study suggest that prevention is still a minority interest area within social work. At best, there has been a doubling of the number of articles on prevention in the last 25 years, from Nance's (1982) finding of 2.4 percent in 1982 to 5.6 percent in the years 2000 to 2005. However, Nance focused her research specifically on primary prevention, whereas this study applied a broader definition for prevention, including all social work writing on secondary and tertiary prevention activities in a sample of journals. Thus, although there appears to have been a gradual increase in prevention content in the journals sampled, it is difficult to ascertain whether this represents a true increase or merely an expansion of the meaning of prevention. In either case, it appears that the number of articles on prevention remains quite low.

The absence of prevention content in this sample of social work journals may reflect the larger dynamics of U.S. health care since the 1980s. Fiscal accountability, cost containment, and managed care have challenged social work survival in health care settings, limiting innovation and expansion of services. In the market-driven competition of the current health care environment, social workers--like all other health professionals--have little time and few resources to devote to prevention. However, other social service and mental health professions were similarly affected by these dynamics and have begun to engage over the past decade in a renewed conversation about prevention and health promotion in their professional literature. This prompts questions about why this may not be as true for social work.

In addition, whether due to market forces or professional inclination, the overall practice of social work generally remains psychotherapeutically oriented, focused on individuals, and defined through a professional treatment framework (Berkman, Gardner, Zodikoff, & Harootyan, 2005; Jacobson, 2001; Kaplan, Tomaszewski, & Gorin, 2004; Nance, 1982). Linked to this is the overwhelming perception of social work as a problem-solving field in which the work begins after a tragedy, illness, or problem has occurred (Bureau of Labor Statistics, 2007). Both the individual focus and the problem orientation have strengths, including a pragmatic approach to the present well-being of individuals in our society and our role in assisting them. However, overemphasis of these perspectives in our literature may contribute to what appears to be limited interest in larger health promotion and public health trends in which social work could and should be deeply involved.

Our low levels of interest, as reflected in this particular review of social work literature, may come at a cost. Social work professionals are often overlooked as part of the public health workforce; for example, the influential Institute of Medicine report on the crisis in public health infrastructure identified numerous professions likely to partner with public health, but social work was not listed among them (Gebbie et al., 2002; Gebbie & Turnock, 2006; Ruth & Sisco, 2008). This is unfortunate, in light of the growing 21st-century consensus that implementation of a robust, prevention-oriented set of transdisciplinary approaches is imperative to successfully address the challenges of our day--issues ranging from mental health and war to climate change and the built environment (Walker, 2008).

In looking ahead to the next decade, it would seem that many foundational social work ideas, values, and practices are coming of age within public health. Healthy People 2020, the influential U.S. Department of Health and Human Services national strategy for health promotion and disease prevention, will be updated shortly to reflect an even stronger emphasis on the social determinants of health and well-being (Krisberg, 2008/2009). It will use an ecological model to move beyond a narrow health disparities approach to emphasize health equity and establish new benchmarks and goals for national improvement from 2010 to 2020 (Krisberg, 2008/2009; Walker, 2008). Healthy People 2020 explicitly elevates social justice as a goal and will rely on approaches and theories historically central to social work, such as systems, community development, and person-in-environment (Krisberg, 2008/2009).

The social work profession has much to offer the field of public health and the practice of prevention in the next decade and beyond. Social work has been present on the frontlines of health and public health since its inception and carries within it a theoretical and practical set of knowledge and skills that are important to promoting health and well-being. Almost 50 years have passed since Rapoport (1961) initially conceptualized prevention for social work; today, the public health skills of prevention, health promotion, and social epidemiology are increasingly viewed by experts as critical to social work practice and embedded in the profession's standards (NASW, 2005; Rapoport, 1961; Vourlekis et al., 2001).The 2005 National Institutes of Health request for proposals for the Research on Social Work Practice and Concepts in Health R01 grant highlighted social work's potential for improving health outcomes in the United States and explicitly urged the use of a public health framework in proposals (Jenson, 2006). There are undoubtedly many social workers employed in prevention and health promotion activities; in some cases, their work may not be characterized as prevention, and in other cases, they may not call their work "prevention," a reflection of the language confusion noted earlier. A renewed conversation about prevention in the scholarly literature can clarify the work that is already being done in prevention, increase interest in new opportunities, and

pave the way for strong social work participation in the transdisciplinary collaboration that will emerge from this new era of health reform.

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Original manuscript received February 17, 2009

Final revision received December 1, 2009

Accepted January 13, 2010

Jamie Wyatt Marshall, MSW,, MPH, is project director, Group for Public Health Social Work Initiatives, and Betty J. Ruth, MSW, MPH, is associate clinical professor, School of Social Work, Boston University. Sarah Sisco, MPH, MSSW, is a consultant, SAE Associates, New York. Christina Bethke, MSW, is project coordinator, Tiyatien Health, Zwedru, Grand Gedeh County, Liberia. Tinka Markham Piper, MSW, MPH, is programs manager, Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada. Micaela Cohen, MSW, MPH, is director of medical services, Pulmonary Hypertension Association, Washington, DC. Sarah Bachman, PhD, is associate professor, School of Social Work, Boston University. Address correspondence to Betty J. Ruth, School of Social Work, Boston University, 264 Bay State Road, Boston, MA 02215; e-mail: bjruth@bu.edu.
Table 1: Summary of Content Analysis Findings

                                         No. of     Percentage
                                        Articles    of P/HP/HE
Journal                                 Reviewed   Articles (n)

Child Welfare                             216       6.94 (15)
Families in Society                       345       3.48 (12)
Health & Social Work                      204      12.75 (26)
International Social Work                 206       5.34 (11)
Journal of Gerontological Social Work     283       3.53 (10)
Journal of Social Work Education          180       2.22 (4)
Social Service Review                     149       1.34 (2)
Social Work                               254       8.27 (21)
Social Work Research                      114       7.02 (8)

                                           Percentage
                                        of Total P/HP/HE    Prestige
Journal                                     Articles       Ranking (a)

Child Welfare                                13.76              8
Families in Society                          11.01              5
Health & Social Work                         23.85              9
International Social Work                    10.10             28
Journal of Gerontological Social Work         9.17             21
Journal of Social Work Education              3.67              4
Social Service Review                         1.84              1
Social Work                                  19.27              2
Social Work Research                          7.34              3

                                           SSCI
                                          Impact
Journal                                 Factor (b)

Child Welfare                               10
Families in Society                         18
Health & Social Work                         8
International Social Work                   26
Journal of Gerontological Social Work
Journal of Social Work Education             5
Social Service Review                       15
Social Work                                  2
Social Work Research                        11

Notes: N = 1,951 articles. P/HP/PE = prevention, health promotion,
or health education; SSCI = Social Sciences Citation Index.

(a) Prestige is the product of the square root of the proportion of
familiarity and the mean score for overall quality (Sellers,
Mathiesen, Perry, & Smith, 2004).

(b) SSCI impact factors measure how often the "typical article" in a
specific journal is cited for a year (Sellers et al., 2004).

Table 2: Summary and Breakdown of P/HP/HE Articles by Year

                                               Year

Variable                  2000   2001   2002   2003   2004   2005

No. of P/HP/HE articles     12     21     14     19     16     27
Percentage of P/HP/HE     4.50   6.94   4.14   5.65   4.46   6.90
  articles

Notes: N = 1,951 articles. P/HP/PE=prevention, health promotion,
or health education.

Table 3: Secondary Review
of Content Themes

Theme                                             n    %

Violence and trauma                               34   31
Culture/race/ethnicity                            20   18
HIV/AIDS                                          14   13
Sexual and reproductive health                    14   13
Aging and older adults                            13   12
Mental health                                     14   13
Global health                                     12   11
Chronic disease                                   10    9
Substance use/addiction                           10    9
Education/training                                 6    6
Prison/incarceration                               5    5
Homelessness                                       3    3
Spirituality/faith-based programs and practices    2    2
Environment                                        2    2
Suicide                                            2    2

Note: N= 1,951 articles.
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