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Stigma reduction has been identified as a key public health strategy to increase enrollment in behavioral health services. As our understanding about stigma reduction has become more sophisticated, there has been an increased recognition that efforts to reduce stigma must engage the complex relationships between stigma, literacy, and contact with others who have a behavioral health condition.The goal of this project was to improve understanding about the relationships between behavioral health literacy, stigma, and contact to inform efforts to increase public behavioral health literacy and decrease stigma. Specifically, this project explored how the structure of these relationships varied for different substance use and mental health conditions.Structural equation modeling was used to depict relationships with data from a nationally-representative survey on behavioral health literacy and stigma.The impact of prior contact and literacy on stigma varied by behavioral health condition.Stigma reduction efforts will be most successful when they match the level of literacy and prior contact with the condition among the target audience for stigma reduction efforts.

Recognizing that community is both a geographic and social space, public health professionals have historically worked to improve health within the community as well as to improve the health of the community. Beginning with the first Healthy People report in 1979, community has been a central theme in public documents which outline the priorities of federal public health agencies. Over the course of four subsequent documents, the meaning of community has been fluid and evolving, and has incorporated the social determinants of health, the ecological model of influence, and broader concepts about the role of place in health outcomes. This chapter identifies the concept of community within each of these documents to provide a critical engagement with the concept of community in American public health over the past forty years. The chapter concludes that the concept of community has shifted from being the geographic location of public health interventions to being the problem for public health interventions, a distinction reflected in the contrast between making a community healthy by improving health within it or making a healthy community by improving the health of the community. Understanding the different possible conceptualizations of community within public health that have existed in the recent past and present in American public health can help practitioners and those working with local organizations to better understand the range of goals and approaches taken by those working on public health issues within communities.

Liver function and histology, together with the haematological changes, were investigated in 12 patients with Felty9s syndrome. Six of them were anaemic. The red cell mass was either normal or increased, and the anaemia was due to a considerable increase in the plasma volume. Two patients had increased haemolysis associated with red cell sequestration by the enlarged spleens. In eight patients liver function tests were abnormal, while in five the liver histology showed lymphocytic infiltration of the sinusoids and portal tracts together with portal tract fibrosis. One of these was later found to have a macronodular cirrhosis. In another there were apparent nodules without a true cirrhosis, and this appearance was also seen in two other patients with Felty9s syndrome in whom histology was available. An increased blood flow through the spleen was found in the two patients examined.