bluuebunny/crossref_metadata_2025 huggingface dataset:
Method and Design Issues in Evaluation of Community Health Education Programs: A Case Study in Breast and Cervical Cancer
Authors: Windsor Richard A. , Kronenfeld Jennie J. , Ory Marcia G. , Kilgo Julia Snow
Published: February 2007

Systematic evaluation efforts are often neglected in com munity health education programs due to lack of financial or technical resources. The utility of including program evaluation at an early state in program development and implementation is demonstrated in this case study of a community-wide breast and cervical cancer education program. A number of methodological issues that the health education practitioner should consider in evaluations of community health programs are identified and discussed including: 1) selection of design; 2) establishing controls; 3) determination of sample size; 4) standardization of instruments; 5)selection bias; and 6) participant attrition. Implications for program development are examined.
Secondary Preventive Health Behavior
Authors: Wheeler John R.C. , Rundall Thomas G.
Published: February 2007

A comprehensive model of secondary preventive health behavior, defined as the use of physician services for preventive care, is constructed which specifies the interrelationships among people's health beliefs, their health status, their accessibility to care, their sociodemo graphic characteristics, and their use of services. The model is tested by applying path analysis to a household survey of adult residents of Washtenaw County, Michigan. The results support the contention that many factors influence secondary preventive utilization, some principally directly and some largely indirectly through their effects on other vari ables. Accessibility to care, health status, health beliefs, and sex all direct ly influence use, while education and age have indirect effects. Income has indirect effects on use which, because they are in opposing directions, cancel each other out.
Developing Education for Children with Asthma Through Study of Self-Management Behavior
Authors: Clark Noreen M. , Feldman Charles H. , Freudenberg Nicholas , Millman E. Joel , Wasilewski Yvonne , Valle Iraida
Published: February 2007

Bronchial asthma is the major cause of disability in child hood. Among its effects are impaired levels of physical activity and self- esteem, reduced school attendance and performance, and increased utili zation of emergency health services. This paper describes the develop ment of a health education program designed to test the hypothesis that better family self-management of asthma can reduce the negative impact of the disease. Three hundred low income Black and Hispanic families were enrolled in the study. Children and primary caretakers were inter viewed separately to obtain baseline data on current levels of self-manage ment and to assess needs for educational intervention. Data have been accumulated on a variety of topics concerning asthma self-management, including health practices and beliefs, coping skills, asthma knowledge, and locus of control. An Asthma Self-Management Index was developed to measure positive management behaviors by the family. The needs assessment indicated that six core themes were priorities for these families in terms of relevant skills and behaviors. These topics were incorporated as lesson plans in the intervention.
The State of School Heart Health Education: A Review of the Literature
Authors: Iammarino Nicholas K. , Weinberg Armin D. , Holcomb J. David
Published: February 2007

The evidence and presence of modifiable risk factors asso ciated with heart disease has heightened interest among health educators in developing prevention oriented programs. In an attempt to assist in planning future curriculum efforts and research in this area a literature re view was conducted. It is presented and organized within the following three major categories: 1. incidence of cardiovascular risk factors (in the school age population); 2. need for health education (the status of adoles cent health and problems of motivation); and 3. evaluations of current heart projects (knowledge, attitudes and behavioral outcomes). A few clas sic articles were included: the primary literature reviewed was that of the past 10 years. The following conclusions were drawn: 1. there is a need to be concerned about the cardiovascular health of young people; 2. the need for educational programs about proven methods of prevention is well documented; 3. studies have found that adolescents do not have suf ficient knowledge upon which to make healthful decisions related to pre venting cardiovascular disease; 4. research has demonstrated that well de signed programs can be effective in increasing health knowledge and pro moting positive attitudes; 5. some programs have encouraged behavioral change; 6. most programs ha ve proven too expensive to become integral components of the curricula; and 7. further educational research must be conducted so that health education might by the end of this decade play a significant role in the reduction of the morbidity and mortality inflicted by cardiovascular disease.
Applications of Social Support Theory to Health Education: Implications for Work with the Elderly
Authors: Minkler Meredith
Published: February 2007

The large body of evidence linking social support and health provides an important supplement to earlier theory and research suggesting the more direct role social contacts may play in influencing health behavior. Three major hypotheses have been set forth concerning the precise mechanism of action through which social support may work to maintain health and decrease susceptibility to illness. Each of these theoretical positions is described and its empirical base examined. The particular relevance of social support theory for work with the elderly is discussed. The concept of social marginality, and such network properties as strength of ties, reciprocity and network size are examined in light of their implications for the design of programs aimed in part at fostering social support among the elderly. Several examples of innovative health education programs are used to illustrate the relevance of different theoretical principles in practice settings. Attention finally is focused on the need for looking beyond social networks to the social policy and environmental contexts within which they operate. Facilitating change in those social and institutional policies which mitigate against network development and maintenance among the elderly is suggested as an important task for health education theorists and practitioners.
The Effectiveness of Education for Family Management of Asthma in Children: A Preliminary Report
Authors: Clark Noreen M. , Feldman Charles H. , Evans David , Millman E. Joel , Wailewski Yvonne , Valle Iraida
Published: February 2007

This paper reports preliminary findings in a convenience sample of one half the population enrolled in a study of self-management in low income families where a child has asthma. In initial evaluation data, parents participating in self-management education reported significantly less fear and anxiety associated with their children's wheezing episodes than did control families. They also reported that their children exhibited fewer signs of stress during a wheezing episode. A trend toward reduced school absences and emergency room visits was noted among participating families. The actions taken by a family to manage the illness increased with the number of sessions attended.
Mass Media Campaigns: The Odds Against Finding Behavior Change
Authors: Wallack Lawrence M.
Published: February 2007

The use of mass media has long been an attractive method tor implementing and discharging institutional responsibility for the promotion of good health practices and the prevention of various social and health problems. Although there is a long history of such efforts, relatively little is known about the effects such campaigns might have. The large number of programs currently being conceived and implemented on local, state, and federal levels have not benefited as much as they might have from the experience of past mass media efforts. This paper reviews the history, commonalities, assumptions, and effects of planned large- scale campaigns to communicate information to the general population to encourage moderation or abstinence in the use of alcohol, drugs, or tobacco. The concept of experimental design is critiqued regarding the appropriateness of such a model for evaluation of mass media campaigns. Suggestions are offered for making evaluations of such campaigns more able to generate useful information for program and planning purposes. This includes expanding evaluation questions through additional forms of inquiry rather than constricting the information obtained through methods based on assumptions of experimental design.
Overview: The HMO Environment in the Eighties and Related Issues in Health Education
Authors: Deeds Sigrid G.
Published: February 2007

Solid, though unspectacular, growth of the HMO concept and its concomitant health education components is noted in the 1970s. This trend is expected to continue through the 80s. The overarching priority concern in this decade is cost containment. Two strategies for containment, competition and regulation, are examined for their health education implications. The growth of IPA's brings forth problems in the delivery of health education services within that type of HMO. Other implications and issues within health education practice are identified. These include multiple definitions of health education, the interactive behavioral model, incongruent values among professionals, the relationship of patient education to the quality of care, the marginality of health education, financing, and consumer rights. Realistic, immediate expectations coupled with strong vision of the future potential for health education is urged.
Developmental Stages of Health Education in HMOs
Authors: Vosen Barbara , Deeds Sigrid G.
Published: February 2007

With no standards for comparison, expectations for health education programs and judgments of their success are subjective. Regardless of initial differences in variables such as starting point of the program, resource allotment, and organizational characteristics and structures, all health education programs have some similar goals and development processes. The goals are: the need to establish long-term relationships, gain visibility, and appeal to the dominant domains within the organization in order to survive. An empirical three-stage model is proposed as a generic development process. The stages, formation, action, and stabilization, propose more sophisticated and complex programmatic content evolving as the initial strategic organizational issues are resolved.
Promoting Employee Acceptance of a Consumer Bill of Rights in a Complex Medical Care Organization: A Case Study
Authors: Mullen Patricia D. , Leifer Benjamin H.
Published: February 2007

To develop strong health education programs, health educators working in complex medical care organizations must often secure professional cooperation across disciplines, coordination of services, and orientation of policies, procedures, and personnel toward patient preferences and needs. Frequently, they undertake these tasks against the tide, within a problematic organizational structure. The present case study illustrates the difficulties posed by introducing change in medical care organizations in the context of an education program to aquaint employees of a large HMO with a consumer bill of rights mandated by the consumer Board of Trustees. The underlying assumption was that in a bureaucratic institution, an employee-centered and modest system reform strategy would be effective in bringing about client- centered outcomes—in this case, increased recognition of client rights. The case analysis and results of a post-intervention, cross-sectional survey suggest that in units where a threshold level of participation was reached, there were improvements in knowledge about the Bill and employee attitudes. The program was less successful with hospital nurses whose feelings about physicians were not taken into account fully, and with physicians whose relative lack of integration into the policy and managerial domains made them harder to reach.
The Role of Patient Interventions in Ambulatory Quality Assurance Programs
Authors: Wilner Susan , Winickoff Richard N. , Schoenbaum Stephen C. , Coltin Kathy L.
Published: February 2007

This paper highlights several studies conducted by a quality assurance research program in a health maintenance organization which provide tangible support for the need to integrate patient interventions with quality assurance activities. A model for quality assurance is described which proposes to include identification of the role of patient behavior in affecting health outcomes, and to develop intervention mechanisms directed towards patients. The experiences from this investigation suggest the need to add patient interventions to the traditional quality assurance efforts of affecting system and provider behaviors. Four of the ten projects conducted are described to illustrate these issues. Topics reviewed are maternity care, hypertension, management of breast disease, and pap smears for high-risk women. These recommendations are particularly appropriate for health maintenance organizations since both quality assurance and health education programs are mandated in the 1973 HMO Act. However, these findings are of relevance to other ambulatory care settings as well.
The Professional Health Educator in HMOs: Implications for Training and Our Future in Medical Care
Authors: Squyres Wendy
Published: February 2007

Health Educators who work in HMOs face most of the problems and predicaments of their colleagues in medical care as well as some additional challenges. In keeping with the national interest in role definitions for health educators in various settings, this paper examines the role, functions, and skills of health educators in medical care, with special attention and case examples in HMOs. Several key issues, in role definition, are identified: 1) the lack of standards for training health educators in medical care; 2) the lack of agreement on health education roles and functions; and 3) the lack of reality-based training for health educators in medical care settings. The one hopeful note for the future is that current efforts at role definition are by and large efforts of the health education profession to set its own standards. Countering that note are directions that the profession is moving that jeopadize its effectiveness and future in medical care. This paper recommends that health educators from academia and practice work collaboratively on role definition, as well as standards for training.
Promoting Health and Preventing Disease— Some Thoughts for HMOs
Authors: Carlaw Raymond W. , DiAngelis Nina M.
Published: February 2007

Many of the predisposing factors to current morbidity and mortality relate to societally approved behaviors. Attempts to intervene or change behavioral patterns after a chronic condition is clinically established are limited in effectiveness. Because health maintenance as a conceptual activity occurs outside the medical care delivery system, organizations committed to health maintenance must be active in the school, workplace, and the community if they are to be effective. The concept of prepaid health insurance has been extended in the HMO Act to include responsibility for the maintenance of health and the prevention of disease. This paper provides a three stage model for preventive and promotive activities in HMOs. The case is made that HMOs have a responsibility to provide health promotion and disease prevention services beyond the clinical setting.
Children's Concepts of Health and Illness— and Implications for Health Education: An Overview
Authors: Kalnins Ilze , Love Rhonda
Published: February 2007

Research on children's concepts of health and illness has been dominated by two theoretical approaches. The first has been concerned with the delineation of age-related qualitative changes in children's concepts of health and illness and the interpretation of these changes within a Piagetian framework. The second approach, based on expectancy theory from social psychology, has focused on children's perceptions of vulnerability to health problems and the relationship of these to potential health behavior. Both approaches have emphasized children's concepts of illness or of health problems. Thus, there is a dearth of literature on concepts of health per se.
A Developmental Analysis of Children's Ideas of Health
Authors: Natapoff Janet Nielson
Published: February 2007

This article analyzes children's ideas of health using a Piagetian developmental framework and draws implications for health education. Young children see health as a positive, enabling concept unas- sociated with illness. Older children associate health and illness but see health as long term and sickness as short term. The development of a concept of health follows a progression similar to that outlined by Piaget and verified by researchers looking at related concepts. An understanding of cause and effect, the ability to conserve ideas and reverse thinking, consider the future and formulate at least tentative hypotheses are processes which mature with age and experience. The concept of health expands and changes as these processes mature. This analysis suggests that health oriented educational programs which are consistent with the child's ability to process information might be more effective than traditional disease-oriented programs. It also raises several questions for future research.
The Development of Children's Eating Habits: The Role of Television Commercials
Authors: Balfour Jeffrey D. , McLellarn Robert W. , Fox Daniel T.
Published: February 2007

There is growing evidence that the long-term consumption of the typical high-sugar, high-calorie American diet may lead to a variety of health problems. Since the majority of food ads on television are for high-sugar, high-calorie types of foods, researchers have begun investigating the effects of these commercials. A number of self-report, survey, and correlational studies have found that children watch on the average 28 hours of TV a week, see over 11,000 low-nutrition "junk" food ads a year on TV, believe (at the younger ages) that commercials tell the truth, recall the ads, and often request in stores foods that are highly advertised. A series of behaviorallexperimental studies conducted at the University of Montana are reported in some detail. The initial stage of the research focused upon the development of a methodology for assessing the impact of commercials upon the actual amounts of foods consumed. Next, a series of studies investigating the effects of low-nutrition, pro- nutrition, and nonfood commercials upon the eating behaviors of children was begun. The results, to date, suggest low-nutrition ads are most effec tive in increasing total caloric consumption. Additionally, low-nutrition ads seem to affect boys more than girls and are not mediated by cognitive development. Finally, pro-nutrition ads have so far proven ineffective in increasing consumption of pro-nutrition foods. Some of the implications of applying the growing body of empirical literature on children's television to social policy issues are also discussed.
Medicines and "Drugs": What Do Children Think?
Authors: Bush Patricia J. , Davidson Frances R.
Published: February 2007

Sixty-four urban children grades K-6 were interviewed in an exploratory study in 1980 to provide information about children's knowledge and orientations toward medicines and abusable substances. Responses indicated children believe themselves to have considerable autonomy in medicine use — 72% said they ask for medicines, 67% get medicines for themselves and others, and 19% (more often older and less economically advantaged) buy medicines by themselves. For six of eight common health problems, e.g. colds, headaches, children said they were more likely than their mothers to take something special; for nervousness and trouble sleeping, mothers were perceived as more likely. Most children distinguished among health problems when indicating probabilities, and many distinguished between themselves and their mothers when naming specific medicines. Children exhibited considerable misinformation and confusion about medicines and "drugs," e.g. one-third of the children said medicines and drugs were the same thing, while nearly one-fifth said they were not. Sixteen percent of the children said "bad drugs" come from commercial establishments such as drug stores. Children might benefit from efforts to provide them integrated information about medicines and abusable substances, and to deal with questions and anxieties provoked by the mixed messages they receive from adults and society. In view of the amount of autonomy indicated, physicians might increase children's compliance with medicine use by addressing the child as well as the parent. A larger study of 420 children is underway.
Current Knowledge about the Health Behavior of Young Children: A Conference Summary
Authors: Bruhn John G. , Parcel Guy S.
Published: February 2007

Twenty-five researchers involved in work related to the health behavior of young children attended an invitational conference to achieve consensus regarding: (a) the definitions, research methods, instru ments, and variables that should guide future research into the health behavior of young children, and (b) the nature of the knowledge deficits that should be addressed by future research. The researchers examined the predisposing, enabling, and reinforcing factors related to health behavior, the important types of health behavior of children, the valid indicators of health behavior, and the conceptual framework within which these things can be viewed effectively. Although the stated goal of the conference was not achieved (i.e., to gain consensus about a set of guidelines in order to focus directions in data collection and thereby to facilitate comparability of results), the conference did obtain interdisciplinary perspectives on the state of the theory, research instruments, and knowledge gaps in the health behavior of children. Innovative research designs, and more rigorous research methods need to be applied to the entire area of health behavior before guidelines can be proposed.
Labels, Systems and Motives: Some Perspectives For Future Research and Programs
Authors: Gochman David S.
Published: February 2007

Future research in children's health behavior, and its potential implications for health education programs, are discussed in terms of (1) the effects of labels and definitions, (2) the relevance of systemic approaches, and (3) the need for determining health-relevant motives. A working definition of "health behvior" as an area of basic, interdisciplinary research is established, in contrast to the definition of behavioral medicine.
The Role of Health Education in Public Policy Development
Authors: Steckler Allan , Dawson Leonard
Published: February 2007

Health educators should view policy development as a unit of professional practice analogous to the individual, the small group, the community, and the organization. The impact of policy on other units of practice and on people served by health educators is too great and the competition for scarce resources for health and human services is too keen to be disregarded. An increasingly active role in the policy process is, therefore, vital to the profession. Unfortunately, many health educators find an active role strange and lack guidelines for effective policy intervention. This paper attempts to mediate that situation.

First a conceptual framework is offered. Operational definitions of important terms are given, including policy, public policy, social policy, health policy, and health education policy. A model of the policy development process is presented, detailing the purpose and dynamics of several steps: establishing problem awareness, setting goals and objectives, selecting a course of action, designing alternative courses of action, analyzing policy, assigning implementation responsibility, implementing, and evaluating.

Then five categories of intervention strategies encompassing 16 individual suggested roles ranging from indirect influence to direct political involvement are presented. The categories are: acting as a source of policy information, providing technical assistance, organizing, influencing policymakers, and taking direct political action.
Communicating Health Information to Urban Mexican Americans: Sources of Health Information
Authors: Gombeski William R. , Ramirez Amelie G. , Kautz Judith A. , Farge E.J. , Moore Thomas J. , Weaver Frank J.
Published: February 2007

Data from a six-week hypertension campaign aimed at urban Mexican Americans were analyzed to document how they receive their health information and to identify the communication channels most likely to reach different segments of the Mexican-American community. The nine sources of information examined were doctor, nurse, pharmacist, family, friends, radio, newspaper, television, and magazine. The most common source of health information reported was doctor, followed by television, newspapers, magazines, family, and radio. Interview language (Spanish or English) was a significant predictor of the amount of health information received from all nine sources. Sex, family income, education, and age also were shown to affect the amount of health information received from various sources. Profiles of respondents most likely to use each source of health information are presented and implications for health educators are discussed.
The Impact of Communications on the Self-Regulation of Health Beliefs, Decisions, and Behavior
Authors: Leventhal Howard , Safer Martin A. , Panagis Daphne M.
Published: February 2007

The models used in the study of communication and health behavior have changed from those describing how to impose health actions on relatively passive respondents to models describing how respondents regulate their own health practices. We have traced the change from the fear-drive model, which described how fear induced change, to the parallel response model, which described how subjects processed information and generated coping responses to solve the problem posed by both the objective health threat and by their subjective fear. The data supporting this change showed that increasing fear led to more favorable attitudes but that fear alone was insufficient to create action: Specific action instructions had to be added to both high and low fear and both combinations produced the same level of health action. Neither the data nor the parallel model specified what subjects learned about the threat that made exposure to a high or low fear message necessary for behavior change. The parallel response model has been elaborated into a more complete systems model and new studies show how health threats are represented. They have found attributes such as IDENTITY (label and symptoms), CAUSES, TIME LINES or duration, and CONSEQUENCES, that set goals and criteria to generate and evaluate problem solving (coping) behavior. Suggestions are made for applying this more complete model to public health practice.
The Application of Health Education Principles to Automobile Child Restraint Programs
Authors: Eriksen Michael P. , Gielen Andrea C.
Published: February 2007

Motor vehicle accidents are the leading cause of death in the United States for children over the age of one, killing 1,500 children under 5 years of age and injuring approximately 70,000 in 1980. The most effective preventive strategy for this problem is the proper and consistent use of child auto restraints. However, this behavior is practiced by less than 10% of parents. Even with educational efforts, loaner programs, and legislated mandates, the majority of children ride unprotected. The purpose of this paper is to describe the application of health education principles to the problem of childhood motor vehicle-related morbidity and mortality.

This paper illustrates the use of the PRECEDE model for planning, implementing, and evaluating a comprehensive child restraint education and loaner program in Maryland. The educational diagnosis was based on a review of the child restraint-related literature as well as on an analysis of Maryland accident and safety data. The design and development of educational programs and materials to increase the proper and consistent use of car safety seats is described. In addition, program evaluation activities are outlined which will provide documentation of changes in car seat usage rates and trends in childhood morbidity and mortality from motor vehicle accidents in Maryland.
A Small Group Strategy for Improving Compliance Behavior and Blood Pressure Control
Authors: Bowler Michael H. , Morisky Donald E.
Published: February 2007

A brief small group structured approach to improving compliance behavior and blood pressure control is described. The group intervention is based on the results of a diagnostic baseline survey of ambulatory hypertensive patients receiving care in an inner-city hospital. It was tailored to meet the expressed needs of that population group. Three main steps characterize the intervention: examining health behaviors and compliance issues with the patients using rehearsal of specific coping skills in problem solving activity; using Locus of Control concepts to facilitate process; and encouraging the patient to practice and apply the coping skills in stressful situations. Major themes within the group sessions and general outcomes are examined.
The Impact of Technology on the Future of Health/Illness Education
Authors: Watson Joan E.
Published: February 2007

The impact of technological advancement and societal pressure for comprehensive, cost effective health care are two current trends which will determine the future of health/illness education. This article predicts a future of health/illness education based on these trends. The issues of depersonalization, cost, privacy, and control involved in the use of computers in health care are identified and discussed
Adolescents' Communication Styles for Learning About Birth Control from Mass Media
Authors: De Pietro Rocco , Clark Noreen
Published: February 2007

This article is an exploratory study to identify discrete factors which predict the way in which adolescents are likely to communicate about birth control after receiving information from a mass medium is described. First, we discuss styles of interacting with others regarding information from mass media which have been described in previous research. Five styles are identified: media-oriented, peer-oriented, home-oriented, professionally-oriented, and multi-source oriented. Next, we discuss categories of factors which theoretically should distinguish among the five communication styles. These factors are drawn from theories and previous research in communication and social learning. Using data collected from a random sample of 100 adolescents, we then test the predictive ability of categories of factors. Discriminant analysis is used to determine which factors within categories are most predictive of style and which best discriminate between styles. Eight factors are identified which predict 75% of all communication styles. The factors are sex, race, giving advice about sex, seeking information about birth control, dating rules regarding where one can go, dating rules regarding behavior on dates, feelings of pride, and feelings of popularity. Finally, we discuss the significance for practitioners of study findings and of predicting adolescents' communication styles.
Social Networks among Elderly Women: Implications for Health Education Practice
Authors: Israel Barbara A. , Hogue Carol C. , Gorton Ann
Published: February 2007

The general aim of the present study was to examine and help clarify the properties of the distinctions between social networks and social support, their relationship to health status, and their impli cations for health education practice. More specifically, a secondary data analysis was conducted with 130 white women, community resi dents, between the ages of 60 and 68, which examined the relationship between psychological well-being and social network characteristics. These characteristics are categorized along three broad dimensions: structure—links in the overall network (size and density); interaction— nature of the linkages themselves (frequency, homogeneity, content, reciprocity, intensity, and dispersion); and functions which networks provide (affective support and instrumental support). A combination was made and relative strength investigated of several network char acteristics representative of the quality of interactions (i. e., reciprocal affective support, intensity, and affective support) and those repre senting the quantity of interactions (i.e., size, density, and frequency).
Community Organization Influence on Local Public Health Care Policy: A General Research Model and Comparative Case Study
Authors: Brown E. Richard
Published: February 2007

The community organization literature consists mainly of case descriptions and analyses, on the one hand, and integrative works that prescribe or classify community organization methods or attempt to develop more theoretical models. There is a need for an intermediate level of empirical research that will generate comparable data on several cases, analyze factors that influence community organization, test hy potheses, and help develop an empirically grounded and more rigorous community organization theory.

This article presents a research model developed to study community organization influence on local public health care policy. The model is applied in a comparative case study of such community organization experiences in seven California counties. Findings from the study are prsented and analyzed, and several factors are identified that were important in the success or failure of these community organization efforts.
Communicating Health Information to the Public: Effectiveness of a Newsletter
Authors: Seibold David R. , Meyers Renée A. , Willihnganz Shirley C.
Published: February 2007

Following a review of health information campaign is sues and research on the efficacy of selected communication channels, this paper reports an investigation of a specific medium—a health in formation newsletter—including whether and how much of it recipients read, its perceived information value, its impact on self-reported ac tions, its comparative role as a source of health information, and the extent to which results vary with selected characteristics of recipients who responded to a mail survey (n = 887). Results indicate that the newsletter is read and utilized by most recipients and serves for many as a major source of health information. Moreover, there is evidence of direct and indirect newsletter effects on respondents' self-reported health practices. Findings varied significantly with the sex and health professional status of recipients.
Illness Attributions and The Health Belief Model
Authors: King Jennifer B.
Published: February 2007

This paper proposes an attributional approach to the traditional Health Belief Model (HBM). It is argued that this approach has two purposes: (1) health beliefs might themselves be determined by attribution and (2) the prediction of health behavior might be sig nificantly improved by combining health beliefs with illness attribu tions. The theoretical framework for this approach is adapted from models of causal attribution and relevant literature on illness attribu tions is reviewed.

Two empirical studies are described testing the plausibility of an attributional approach to health behavior. A preliminary study investi gates the relationship between health beliefs and illness attributions of heart patients. Health beliefs were found to be significantly related to causal explanations of heart disease. The main study is a prospective investigation of the impact of attributions and health beliefs on health behavior—in this case attendance at screening for high blood pressure. Discriminant analysis revealed a combination of health beliefs and at tributions of high blood pressure that produced a highly significant prediction of the decision to participate in the screening.

The final discussion is devoted to the theoretical and practical im plications of an attributional approach for health and medical educa tion, particularly within the medical consultation.
Spontaneous Classification of Foods by Elementary School-Aged Children
Authors: Michela John L. , Contento Isobel R.
Published: February 2007

This study examined children's conceptions about nutrients and the dimensions underlying their classifications of foods into groups. Children aged 5 to 11 (59 girls and 56 boys) placed 71 foods into groups by whatever criteria they wished. The bases of these clasifications were recorded, as were the children's answers to questions about nutrients and their responses in tasks assessing cognitive developmental level. A cluster analysis of the classification data yielded four major groups. However, these groups differed in several respects from the Basic Four food groups generally taught in nutrition education, in ways including the presence of a sweets group. Multidimensional scaling analysis revealed common underlying dimensions of sweet versus nonsweet foods and meal entrees versus drinks and breakfast foods, suggesting that perceptual, functional, and physical properties of foods influenced food classifications by children regardless of cognitive developmental level. However, only "concrete operational" children were sub stantially influenced by dimensions involving degree of processing of foods and origin of foods in plants or animals. Understanding of nutrients improved with cognitive developmental level, but generally poor understanding was evident. The results highlight the need to design health education curricula that are appropriate to students' cognitive developmental levels and to their naturally occurring conceptualizations.
Health Promotion Approaches to Occupant Protection: An Epidemiologic Framework
Authors: Tolsma Dennis D.
Published: February 2007

The size of the problem, the potential for prevention, and the Nation's prevention priorities all support public health action to prevent injuries. A balanced approach to this problem should include both environmental and health promotion strategies. Centers for Disease Control (CDC) is encouraging development of health promotion capability at the community level; the approach bases planning and implementation of programs on epidemiologic analysis to define the problem. Behavioral risk factor surveillance data will help states and communities establish baselines and determine priorities. Baseline data from the state-based surveillance system illustrate risk levels of motor vehicle occupants, e.g., 58% of adults report "seldom" or "never" using seat belts, and one of every seven males ages 18-34 report driving after having too much to drink. A health promotion plan developed by the Oakland County, Michigan, Health Department illus trates the use of these kinds of data as an epidemiologic framework; this plan identifies child passenger safety as a priority for action and establishes measurable objectives to reduce risk through health promotion programs. Health promotion includes not only interventions that support individual behavior change but also community change. By acquiring epidemiologic data and conveying it both to individuals and community decision makers, the public health community supports increased community efforts to protect occupants of motor vehicles.
Safety Belt Use, Ejection and Entrapment
Authors: O'Day James , Scott Robert E.
Published: February 2007

One in every five occupants thrown from a car receives fatal injuries. A motorist who uses a safety belt, in all probability, will not be thrown from the car during a crash. The rate of fatal injury for ejected occupants was found to be 40 times the rate for occupants not thrown from their cars, as determined from national accident sampling data. These data refute the popular notion that "being thrown clear" has survival benefit. In addition, there was no evidence that wearing a safety belt increased fatality risk from vehicle fire or submersion.
A Community Health Education Approach to Occupant Protection
Authors: Gemming Marianne G. , Runyan Carol W. , Hunter William W. , Campbell B.J.
Published: February 2007

The goal of enhancing motor vehicle occupant protection is vital to the public's health. Controversies about passive versus active protection and voluntary versus mandatory measures continue. A program which employed a combination of positive reinforcements (incentives) and wide-scale community education succeeded in raising the community seat belt usage rate from 24 to 41% in 6 months. This rate was sustained at 36% at six-month follow-up. This article reviews the major features of the "Seat Belts Pay Off' campaign and its evaluation and considers both theoretical and pragmatic issues pertinent to replicating the program in other community settings.
Preventing Death and Injury in Childhood: A Synthesis of Child Safety Seat Efforts
Authors: Roberts Michael C. , Turner Daniel S.
Published: February 2007

Virtually all children are at risk for injury and death as passengers in moving vehicles. Between 70% to 90% of the injury and death could be reduced or prevented if children were restrained in safety seats. However, studies show that only a minority of children are properly protected. Numerous efforts have been made to increase the number of children riding in car safety seats. This article reviews and synthesizes the various attempts to motivate safety seat usage by examining the literature on (1) informational and educational programs; (2) safety seat loaner programs; (3) state laws requiring seat usage; (4) behavioral improvement emphasis programs; (5) reward-based programs; and (6) passive prevention approaches through airbags. No one approach appears to be the solution to the complex problem of motivating the preventive behavior of acquiring and consistently using safety seats. Recommendations are forwarded for: (1) de veloping and determining the best techniques for which settings through comparative research; (2) utilizing a developmental perspective in identifying when and what interventions are needed; and (3) implementing creative and comprehensive programs in communities.
Factors Associated with the Use of Child Restraint Devices
Authors: Gielen Andrea Carlson , Eriksen Michael Paul , Daltroy Lawren H. , Rost Kathryn
Published: February 2007

A thorough behavioral diagnosis of why parents do and do not use car safety seats is important for designing an effective, comprehensive approach to the significant public health problem of childhood motor vehicle occupant deaths and injuries. With a clear understanding of the de mographic, knowledge, attitudinal and social support factors related to car seat use, it will be possible to develop or refine program methods and persuasive communication strategies which will have the greatest potential for effectiveness. Project KISS (Kids in Safety Seats) of the Maryland Department of Health and Mental Hygiene surveyed parents of young children in Maryland to identify factors which differentiate child restraint device users from nonusers. A statewide telephone survey was conducted using random digit dialing, a method of computerizied sampling for telephone interviewing. The survey instrument incorporated demographic variables and used Fishbein and Ajzen's model of behavioral intention to develop an attitude scale and identify social referents important to parental safety seat use. Of the factors associated with reported use of car seats, the attitudinal variables were extremely significant. Using these variables as well as spouse approval, socio-demographic characteristics, and other preventive health behaviors of parents, resulted in the correct classification of 75.5% of cases and 26.7% of the variance in reported car seat use. Practitioners can use this analysis to design and target effective educational efforts to those individuals who are least likely to use car seats properly and consistently.
Resource Guide to Occupant Protection Programs and Materials
Authors: Hollenbach Kathryn , Sleet David A.
Published: February 2007

This article lists public and private sector associations and organizations concerned with occupant protection. Many of these organizations will provide catalogues and other public information materials on occupant protection. Some have operational programs designed to influence their members in the health professions or the general public. All of the organizations have printed material available. Some provide additional resources on occupant protection such as educatonal kits, consumer information pamphlets, posters, written testimony, public service announcements, sample legislation, and audio visual aids useful in conjunction with health promotion program development. For information relative to state occupant protection programs, readers should contact their State Office of Highway (Traffic) Safety, Governor's Office, Re gional Office of the National Highway Safety Administration, Regional Office of the Department of Health and Human Services, State Health Department or Department of Preventive Health Services, and regional or state affiliate chapters of national organizations, such as the Child Passenger Safety Associations and the National Safety Councils.
Organization for a Community Cardiovascular Health Program: Experiences from the Minnesota Heart Health Program
Authors: Carlaw Raymond W. , Mittlemark Maurice B. , Bracht Neil , Luepker Russell
Published: February 2007

The World Health Organization has emphasized the importance of community participation as a keystone of primary health care and in meeting their goal of health for all. This article reports on the first three years of experience in a community-based approach to cardiovascular health. The project involves three communities totaling almost a quarter of a million inhabitants with matched comparison communities. An extensive volunteer structure provides a dynamic partnership wih the education research group in bringing learning opportunities and enabling situations for the practice of heart healthy life styles in the total community. The project goal is to demonstrate reduced mortality and morbidity from educational interventions. The parti cipative intervention model suggests a feasible alternative for future public health practice.
An Overview and Analysis of the Health Style Campaign
Authors: Davis Mary F. , Iverson Donald C.
Published: February 2007

In 1981, the Office of Health Information and Health Promotion of the U.S. Department of Health and Human Services launched a national health promotion media campaign titled Health Style. The purposes of the Health Style campaign were: (1) to increase public awareness of the effects of life-style on health; (2) to enable persons to assess which life-style changes would be most conducive to their health; (3) to stimulate information-seeking behavior and; (4) to foster the development of local health promotion activities and referral networks. The campaign was implemented in nine test communities across the United States. This article: (1) provides an overview of the campaign; (2) examines strategies used to implement the campaign in three local communities and; (3) presents the findings of evaluations conducted at both the national and local levels. A summary of lessons learned from the Health Style campaign experience is included in the article.