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This paper considers the changes in education and capacity building that are needed in response to environmental and social challenges of the 21 st Century. We argue that such changes will require more than adjustments in current educational systems, research funding strategies, and interdisciplinary collaborations. Instead, it calls for a deeper questioning of the assumptions and beliefs that frame both problems and solutions. We first discuss the challenges of transforming education and capacity building within five key arenas such as interdisciplinary research, the primary, secondary and tertiary education systems, researchers from the developing world, and the public at large and politicians. Our starting point is that any type of revolution that is proposed in response to global change is likely to reflect the educational perspectives and paradigms of those calling for the revolution. We differentiate between a circular revolution (as in the "plan-do-check-act cycle" often used in change management) versus an axial revolution (moving to a different way of thinking about the issues), arguing that the latter is a more appropriate response to the complex transdisciplinary challenges posed by global environmental change. We present some potential tools to promote an axial revolution, and consider the limits to this approach. We conclude that rather than promoting one large and ideologically homogenous revolution in education and capacity building, there is a need for a revolution in the way that leaders working with education and capacity building look at systems and processes of change. From this perspective, transformative learning may not only be desirable, but critical in responding to the challenges posed by global environmental change.

Poorer survival from oral and pharyngeal cancer (OPC) has been reported for populations of lower socioeconomic status (SES), adjusting for risk factors such as patient and clinical characteristics. Beyond these risk factors, higher rates of tobacco use may be a mediator for the observed poorer OPC survival for low SES populations. In this study, we aimed to examine the impact of the relationships among SES, individual smoking status, and living in a region with a higher smoking rate on OPC survival. We obtained Florida Cancer Data System data from 1996 to 2010 and merged the data with US Census data and Behavioral Risk Factor Surveillance System data from 1996 to 2010. We built multivariable survival models to quantify the mediational effect of individual smoking on overall and OPC-specific survival, adjusting for regional smoking, demographics, and clinical characteristics. We found that lower SES, individual smoking, and living in a region with a higher smoking rate were all strongly associated with poorer survival. We estimated that the indirect effect of individual smoking accounted for a large part (ranged from 13.3% to 30.2%) of the total effect of SES on overall and OPC-specific survival. In conclusion, individual and regional smoking are both significant and independent predictors of poor cancer survival. Higher rate of individual smoking is partially responsible for poorer cancer survival in low SES populations. Results of this study provide rationale for considering a multi-level approach that simultaneously targets both individual and contextual factors for future smoking cessation interventions.

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Background Finding dentists who treat Medicaid-enrolled children is a struggle for many parents. The purpose of this study was to identify non-reimbursement factors that influence the decision by dentists about whether or not to participate in the Medicaid program in Florida. Methods Data from a mailed survey was analyzed using a logistic regression model to test the association of Medicaid participation with the Perceived Barriers and Social Responsibility variables. Results General and pediatric dentists (n=882) who identified themselves as either Medicaid (14%) or Non-Medicaid (86%) participants responded. Five items emerged as significant predictors of Medicaid participation, with a final concordance index of 0.905. Two previously unreported barriers to participation in Medicaid emerged: 1) dentists’ perception of social stigma from other dentists for participating in Medicaid, and 2) the lack of specialists to whom Medicaid patients can be referred. Conclusions This study provides new information about non-reimbursement barriers to Medicaid participation.