bluuebunny/crossref_metadata_2025 huggingface dataset:
Specific Psychosocial and Behavioral Outcomes from the Systemic Lupus Erythematosus Self-Help Course
Authors: Braden Carrie Jo , McGlone Katalina , Pennington Floyd
Published: February 2007

This study tested hypotheses about the consistency of specified outcomes with strength of program treatment indexed by time spent in a given activity in the Systemic Lupus Erythematosus Self-Help (SLESH) course. Participants had significant increases in enabling skills and in use of relaxation and exercise activities. Participants also had significantly less depression. Consistency between amount of time spent in class and significant changes over time was demonstrated by analysis of treatment strength-response for perception of limitations, depression, enabling skill and for use of rest, relaxation, heat, and exercise activities.
Teaching and Social Support: Effects on Knowledge, Attitudes, and Behaviors to Prevent Low Back Injuries in Industry
Authors: Daltroy Lawren H. , Iversen Maura D. , Larson Martin G. , Ryan James , Zwerling Craig , Fossel Anne H. , Liang Matthew H.
Published: February 2007

This study was funded in part by NIH grant AR36308 The authors thank the employees of the United States Postal Service and the American Postal Workers Union (APWU), Boston Metro Area Local, and Maithandlers Local 301 for their help and cooperation; therapists from the Department of Rehabilitation Services, Bngham and Women's Hospital for help in training workers; and Ms Nancy Tanner for typing
Social Support Interventions for Rheumatoid Arthritis Patients: The Cart before the Horse?
Authors: Lanza Ana F. , Revenson Tracey A.
Published: February 2007

Enthusiasm about the potential of social support to promote successful adaptation to chronic illness has already led to support interventions for arthritis patients designed to increase coping ability, reduce the need for professional mental health services, and limit periods of disability. But have we put the cart before the horse? Do these interventions achieve these goals? Existing interventions are reviewed, and a number of research issues are addressed from within an ecological framework, including the content of support interventions, the source of support, the type of support provided, support as an intervention variable versus outcome, and the need to target interventions not only to patients but to their family members and health professionals. It is suggested that future interventions be more theoretically grounded.
Development of Level of Institutionalization Scales for Health Promotion Programs
Authors: Goodman Robert M. , McLeroy Kenneth R. , Steckler Allan B. , Hoyle Rick H.
Published: February 2007

This study was conducted to test an instrument for measuring the level of institutionalization (LoIn) of health promotion programs. Institutionalization occurs when a program becomes an integral part of an organization, and the LoIn instrument is a beginning effort to measure the extent of program integration into organizations. The instrument is based on theory that holds that organizations are composed of production, maintenance, supportive, and managerial subsystems. Institutionalization occurs when a program becomes imbedded into these subsystems. A questionnaire designed to test this construct was mailed to 453 administrators in 141 organizations that operate health promotion programs. Based on 322 usable responses (71%), a confirmatory factor analysis was conducted. The results support the hypothesis of an eight-factor model: four factors concern how routinized the program was in each subsystem and four factors concern the degree of program saturation within each subsystem. Correlations of the eight factors with the number of years the programs had been in operation, and managers' perceptions of program permanency, indicated that the four routinization factors were more highly correlated with program longevity than the four niche saturation factors, and the niche saturation factors were more highly correlated with managers' perceptions of program permanence than the routinization factors. The instrument, which is available from the authors, may be used as both a research instrument and a diagnostic tool in assessing the institutionalization of health promotion programs.
Health Insurance Coverage for Smoking Cessation Services
Authors: Schauffler Helen Halpin , Parkinson Michael D.
Published: February 2007

The health benefits from quitting smoking have been well documented; however, most health insurance plans in the United States, both public and private, have excluded coverage of smoking cessation services. Since 1988, numerous public health policy documents have called for health insurance coverage of smoking cessation services, although there is little agreement over what kinds of services or interventions are most appropriate for health insurance coverage. The purposes of this paper are to (1) describe current public policy for health insurance coverage of smoking cessation services; (2) review the current status of policy adoption by private health insurance carriers, health maintenance organizations, self-funded employers, as well as public insurance programs including Medicare and Medicaid; (3) analyze the major barriers faced by health insurers, health care providers and policy makers in offering coverage for smoking cessation services; and (4) outline the specific policy options that the federal government, state governments, employers and anti-smoking coalitions can take to increase insurance coverage for smoking cessation services. The paper concludes with recommendations for actitioners, researchers and policy makers.
Development and Validation of the Parent Health Locus of Control Scales
Authors: DeVellis Robert F. , McEvoy DeVellis Brenda , Blanchard Lynn White , Klotz Mary Lou , Luchok Kathryn , Voyce Charlene
Published: February 2007

We describe the development and validation of the Parent Health Locus of Control (PHLOC) scales. Using factor analytic and item analytic methods, 30 items comprising six scales were extracted from a pool of 84 items. The individual scales correspond to beliefs in Child, Divine, Fate, Media, Parental, and Professional Influence over child health. Results were compared for six samples totalling 822 parents. Internal consistency reliabilities were above .70 for all scales with all samples. Test-retest correlations based on a separate sample were all above .60. Validity was assessed by means of a known groups strategy that made use of presumed differences among the six samples studied. The results generally agreed with predicted differences, offering good initial evidence of the validity for the PHLOC scales.
Barriers to Human Immunodeficiency Virus Related Risk Reduction among Male Street Prostitutes
Authors: Simon Patricia M. , Morse Edward V. , Balson Paul M. , Osofsky Howard J. , Gaumer H. Richard
Published: February 2007

Two hundred eleven male street prostitutes between the ages of 18 and 51 years were interviewed and tested for antibodies to the human immunodeficiency virus (HIV). Economic, social, and emotional barriers to the reduction of HIV-related risk behavior were examined within the context of several concepts present in the Health Belief Model (HBM). Three lifestyle factors were found to function as barriers to engaging in risk reduction behavior. Subjects who were more economically dependent on prostitution, perceived less control over the hustling encounter, and reported increased pleasure from sexual activity with their customers were more likely to engage in risk-taking behavior. Prostitutes' perception of the severity of HIV infection was not significantly associated with their risk behavior. Unexpected findings indicated that increases in perceived susceptibility to HIV and perceived benefit of condom use for HIV prevention were significantly related to increased risk-taking behavior. Practical applications of findings in the design and implementation of future HIV-related preventive health education programs are discussed.
Evaluation of Interventions to Improve Solar Protection in Primary Schools
Authors: Girgis Afaf , Sanson-Fisher Rob W. , Tripodi D. Anthony , Golding Tim
Published: February 2007

Childhood and adolescence are critical periods in the etiology of subsequent melanoma and nonmelanocytic skin cancers. The aims of the study were (a) to develop a valid measure of solar protection in 9 to 11-year-old school students, (b) to evaluate the differential effectiveness of two interventions aimed at changing solar protection in this age group, and (c) to identify the predictors of use of a high level of solar protection. A Solar Protection Behavior Diary was developed and validated during a pilot, after which 11 schools were randomly allocated to one of three groups: intensive intervention (247 students), standard intervention (180 students), or control (185 students), with students in years 5 and 6 participating in the study. Students completed the validated diary (for 5 days) and a knowledge and attitudes questionnaire at pretest and at two posttest periods (4 weeks and 8 months after pretest). Results indicated that students in the intensive intervention group were significantly more likely to have used a high level of protection at both posttest periods compared to the control and standard intervention groups. There was no difference in the protection level of the control and standard intervention groups at either posttest, indicating that this minimal intervention was not effective in changing the solar protection behavior of the students. Students with a high level of solar protection at pretest were also significantly more likely to have a high level of protection at both posttest periods, and those with a greater number of opportunities to protect were less likely to protect at the second posttest.
AIDS and the African American Woman: The Triple Burden of Race, Class, and Gender
Authors: Quinn Sandra Crouse
Published: February 2007

The disproportionate impact of human immunodeficiency syndrome (HIV) disease on African American women is devastating to their lives, their families, their communities, and our society. Among AIDS cases in women, 52.5% are black. African American women with HIV disease constitute one of the least powerful and most burdened segments of society. The African American woman whose behavior places her at risk for HIV infection must be the focus of increased prevention and treatment efforts. This article will describe risk factors for HIV infection and AIDS educational needs of women at risk. The interaction of race, gender, and social class will be explored. The controversy over medical manifestations of HIV will be addressed within the context of the social reality of African American women at risk. Reproductive rights and public policy issues will be discussed. Health educators must overcome their fear, class prejudice, and racial bias in order to form the interracial coalition necessary to lead our nation in the struggle to stop the devastation of AIDS among African American women and children.
Persuasive Conversations between Friends about Health and Safety Precautions
Authors: Weinstein Neil D.
Published: February 2007

One hundred eighty-five conversations in which a college student attempted to convince a friend to adopt a health or safety precaution were examined. A detailed category coding system was developed to describe the content of such conversations and to answer nine specific questions about these interactions. Among other results, the data showed that subjects spend very little time describing the nature of the harm that might occur and usually speak of protection in dichotomous, all-or-none terms rather than acknowledging degrees of risk. Much time is spent discussing the correct actions to take and the problems faced in carrying out these actions. Initial and 2-month assessments of persuasiveness found no significant relationships between the presence of specific themes and changes in intentions or behavior. The observed content of these conversations is discussed in relation to current theories of self-protective behavior and likely mechanisms of social influence.
Population Prevalence and Correlates of Stages of Change in Physical Activity
Authors: Booth Michael L. , Macaskill Petra , Owen Neville , Oldenburg Brian , Marcus Bess H. , Bauman Adrian
Published: February 2007

Stages of change for exercise, sociodemographic variables, and beliefs about the health benefits of exercise were obtained for a representative sample of Australian adults (N = 4404). Logistic regression analysis was used to examine the relationship between exercise stage of change and sociodemographic variables and beliefs about the benefits of exercise. Thirteen percent of respondents stated that they did not exercise and did not intend to start; 10% stated that they did not exercise but were thinking of starting; 16% stated that they exercise occasionally and were not thinking of doing more; 23% stated that they exercised occasionally and were thinking of doing more; and 38% stated that they exercised regularly and intended to continue. Intention to do more exercise generally decreased with increasing age, but increased with level of education. An increased frequency of exercise and an intention to do more exercise was associated with the belief that exercise would help to prevent heart disease and with a higher level of education. The results provide a useful profile of the exercise habits (and intention to change those habits) of population subgroups. Public communication campaigns on the benefits of physical activity should focus particularly on those who do not intend to exercise, older adults, and the less well educated.
Lay Evaluation of Symptoms by Older People: An Assessment of Potential Risk
Authors: Stoller Eleanor Palo , Forster Lorna Earl , Pollow Rachel , Tisdale William A.
Published: February 2007

This paper examines the appropriateness of lay evaluations of potential risk of symptoms among a sample of 667 elderly people living in community settings. Data were gathered through personal interviews and 3 weeks of structured health diaries in which older respondents recorded the symptoms they experienced. Potential medical risk was determined on a symptom by symptom basis based on clinical information gathered during the interviews. Almost three fourths of the respondents exhibited potential clinical risk for at least one symptom they experienced during the 3-week diary period. One in eight respondents was judged at risk yet gave no evidence of physician consultation, either during or prior to the diary period. Implications of these results for health education designed to improve consultation decisions among elderly people are discussed.
Efficacy of a Home-Based Human Immunodeficiency Virus Prevention Video Program for Teens and Parents
Authors: Winett Richard A. , Anderson Eileen S. , Moore John F. , Taylor C. David , Hook Richard J. , Webster Deborah A. , Neubauer Tamara E. , Harden Mark C. , Mundy Laurie L.
Published: February 2007

Family-based communication about sexual behavior and sexuality is a predominate theme in the key risk reduction and service objectives for human immunodeficiency virus (HIV) prevention and related issues in Healthy People 2000. These recommendations are particularly poignant for younger adolescents who are not yet sexually active and whose social orientation is primarily to family and parents. A family-centered, home-based, video program to foster parent and teen knowledge and communication regarding issues related to HIV prevention and to increase family and teen communication skills was used in an intensive field test of program efficacy. Sixty-nine families with at least one adolescent age 12 to 14 years were recruited through their primary-care physicians and were randomly assigned to either experimental (video with information and skills training) or control (video with information only) conditions in a pre-posttest with a 4-month follow-up design. Both versions of the video program resulted in substantial increases in HIV-related knowledge for parents and teens, but only the skill-training (experimental) version produced increases in knowledge of communication skills and behavioral demonstrations of family problem solving. Approaches for a broader and more effective parent-training video program and for dissemination through primary-care physicians are discussed.
Validity of Physician Self-Report in Tracking Patient Education Objectives
Authors: Roter Debra L. , Russell Nancy K.
Published: February 2007

Patient education objectives are included as a strategy in every health promotion area addressed in Healthy People 2000. The likelihood of accomplishing these objectives is linked to the accuracy of the baseline estimates of practice. These estimates have most usually relied upon patient and physician reports. However, the accuracy of these reports has been infrequently studied. We analyzed audiotapes of interactions among 377 adult chronic disease patients and 38 physicians in a variety of practice settings to estimate the accuracy of their reports. Our findings indicate that neither doctors nor patients provide a consistently accurate reflection of health promotion discussions, nor do they appear to agree with one another very much as to what was discussed. Smoking and diet were reported quite accurately by both doctors and patients, whereas discussions regarding physical activity, alcohol, and stress were less so. Further, our findings suggest that underreport may pose an even greater threat to accurate estimates of physician practice than overreports.
Implementation and Acceptance of Outreach Telephone Counseling for Smoking Cessation with Nonvolunteer Smokers
Authors: Britt John , Curry Susan J. , McBride Colleen , Grothaus Louis , Louie Douglas
Published: February 2007

Brief supportive telephone counseling is a promising adjunct to self-help smoking cessation programs. This article reports rates of participation, predictors of participation, and content of telephone counseling calls with nonvolunteer smokers who were identified through health surveys administered to a random sample of enrollees in a health maintenance organization. Eighty-six percent of smokers accepted at least one of three counselor calls; 66% accepted all three calls. Baseline characteristics associated with acceptance of calls included being female and greater average length of time to the first cigarette of the day. Acceptance did not differ significantly by stage of cessation. First calls with smokers who accepted all three calls were longer and were more likely to be with smokers who were willing to take a specific next action step. Overall, 12% of the sample reported having quit smoking by the third counseling call, with the highest quit rate (23%) among smokers who, at baseline, were planning to quit in the next month. Implications for large-scale interventions with smokers in health care and other organizations are discussed.
Research in Dental Health Education and Health Promotion: A Review of the Literature
Authors: Brown Louise F.
Published: February 2007

This article presents a review of research in dental health education and health promotion. In the period 1982 to 1992, a total of 57 studies evaluating the effectiveness of interventions to alter individuals' behavior related to dental health were identified. Combining the results of these 57 studies with descriptive articles published over the same period, it appears that dental health education can result in improvements in objective measures of dental health behaviors and actual oral health measures, but has only limited success in changing attitudes towards dental issues and achieves only short-term gains in knowledge. The limited use of theoretical frameworks, poor statistical analyses, the use of convenient samples and the short postintervention follow-up periods diminish the contribution of this research to the development of dental health policy and the formation of strategies to improve the health of communities.
Empowerment through Photo Novella: Portraits of Participation
Authors: Wang Caroline , Burris Mary Ann
Published: February 2007

Photo novella does not entrust cameras to health specialists, policymakers, or profes sional photographers, but puts them in the hands of children, rural women, grassroots workers, and other constituents with little access to those who make decisions over their lives. Promoting what Brazilian educator Paulo Freire has termed "education for critical consciousness," photo novella allows people to document and discuss their life conditions as they see them. This process of empowerment education also enables community members with little money, power, or status to communicate to policymakers where change must occur. This paper describes photo novella's underpinnings: empowerment education, feminist theory, and documentary photography. It draws on our experience implementing the process among 62 rural Chinese women, and shows that two major implications of photo novella are its contributions to changes in consciousness and in forming policy. The camera is my tool. Through it I give a reason to everything around me. Andre Kersetz
Implementing the Boston Healthy Start Initiative: A Case Study of Community Empowerment and Public Health
Authors: Plough Alonzo , Olafson Freya
Published: February 2007

This article examines the efforts on the part of a city health department, in partnership with a broad-based coalition of community-based, government, and social service agen cies, to plan and implement, using principles of empowerment and community partici pation, a federally funded infant mortality reduction program. It examines the social and institutional dynamics of sharing power in an environment highly charged politically. Infant mortality in Boston is much more than a public health problem. It is the focal point of complex racial, political, and institutional factors. This case study illustrates how empowerment moves from rhetoric to reality and the challenge to both traditional public health practice and traditional community mobilization. The article describes the federal Healthy Start Initiative and its community participation mandate, the background on infant mortality in Boston, a case study of the development of the Healthy Start program from the perspective of community empowerment, and finally, the lessons learned in the first 2 years of the program. It describes the controversies encountered, some of the mistakes made, and the ways found that government must be reinvented if empowerment is to be a real public health tool.
Survey of Neighborhood-Based, Comprehensive Community Empowerment Initiatives
Authors: Eisen Arlene
Published: February 2007

There is a developing consensus among health educators and other public health specialists that successful programs—especially among low-income people—emerge from empowered communities that participate proactively in all phases of program planning, implementation, and evaluation. Yet, there is no consensus on the definition of empow erment or on the guidelines that successful community empowerment initiatives have followed. The author surveys 17 community empowerment initiatives based in neigh borhoods representing the diversity of low-income communities—both rural and urban— throughout the country. The objective of the paper is to explore the ways different initiatives have defined and operationalized their commitment to community empow erment and to examine the implications of these data for health educators. In order to understand the varying effectiveness of the initiatives surveyed, the author compares them considering several variables: their history and neighborhood context, their planning process and structure, their goals and objectives, their strategies, their relationships to their funders, and their accomplishments.
Health Promotion and Empowerment: Reflections on Professional Practice
Authors: Labonte Ronald
Published: February 2007

Recent reformulations of health promotion focus on empowerment as both a means and an end in health promotion practice. Both concepts, however, are rarely examined for their assumptions about social change processes or the potential of community groups, professionals, and institutions to create healthier living situations. This article attends to some of these assumptions, expressing ideas generated during 6 years of professional training workshops with over 2,500 community health practitioners in Canada, New Zealand, and Australia. The article first argues that health promotion is not a social movement but a professional and bureaucratic response to the new knowledge challenges of social movements. As such, it has both empowering and disempowering aspects. The article analyzes empowerment as a dialectical relation in which power is simultaneously given and taken, and illustrates this in the context of health promotion programs. A model of an empowering professional (institutional) health promotion practice is pre sented, in which linkages among personal services, small group supports, community organizing, coalition advocacy, and political action are made explicit. Practice examples are provided to illustrate each level of the empowering relation, and the article concludes with a brief discussion of the model's educational and organizational utility.
New Health Promotion Movement: A Critical Examination
Authors: Robertson Ann , Minkler Meredith
Published: February 2007

In the last decade, a revolution has been occurring in the field of health promotion. Guided to a large extent by position papers disseminated by the World Health Organization (WHO) Europe Health Promotion Office, and furthered by the Ottawa Charter, the Epp Report in Canada, the Healthy Cities project, as well as by other efforts, this new health promotion movement has introduced new ideas, new language, and new concepts about what constitutes health and how health promotion efforts should be configured to achieve health.
Participatory Health Development in Rural Nepal: Clarifying the Process of Community Empowerment
Authors: Purdey Alice F. , Bahadur Adhikari Gyan , Robinson Sheila A. , Cox Philip W.
Published: February 2007

Community-based participatory development empowers villagers to develop community cohesion and confidence, increase their ability to identify, analyze, and priorize their own needs, and organize the resources to meet these needs. An important first step in the process involves establishing a cohesive and functional community group. The authors believe that this is best accomplished through villagers' critical examination of their experiences with development including their understanding of reasons for success or failure, and the gradual emergence of a model of working together that acknowledges and builds on participation and collective expertise. This approach to development is demonstrating encouraging results in a rural area of western Nepal in a university affiliated Canadian/Nepali Health Development Project. This paper describes two mini-projects to illustrate the evolution of group formation through reflection, analysis, and action, and identifies outcomes that could serve as indicators of community empowerment. The paper also presents a generic model of empowerment, and offers lessons learned by the project through the application of the empowerment process to sustainable health development.
Empowering Communities: Action Research through Healthy Cities
Authors: Flynn Beverly Collora , Ray Dixie Wiles , Rider Melinda S.
Published: February 2007

The Healthy Cities process uses action research to empower communities to take action for health. Five concepts that link community empowerment and action research are: focus on community, citizen participation, information and problem solving, sharing of power, and quality of life. Two city examples from Healthy Cities Indiana, a pilot program of CITYNET Healthy Cities, provide illustrations of these concepts. The dynamics of community participation in action research and the successes and barriers to community participation are presented. Outcomes that empowered the community are suggested: the extent to which Healthy City projects are initiated, their progress monitored, continued action in health supported, resources obtained, and policies promoted that contribute equity in health.
Ethnographic Approach to Community Organization and Health Empowerment
Authors: Braithwaite Ronald L. , Bianchi Cynthia , Taylor Sandra E.
Published: February 2007

The purpose of this article is to address pertinent issues relative to the association between community organization and health empowerment methods in ethnic communities of colour. It seeks to address these issues by utilizing ethnographic procedures for documenting community health concerns and by advocating for empowerment for people of colour and their participation in coalition partnerships. Increasingly the importance of citizen participation in the planning, assessment, and implementation of community-based health initiatives has been identified as essential for effective health promotion and disease prevention programs. This article argues for the utility of a community organization approach for achieving health empowerment, and subsequently decreasing the excess deaths in communities of colour. The interface of ethnographic procedures, community organization, and development of community-owned action plans for programming health interventions is discussed.
Using the Health Belief Model to Predict Safer Sex Intentions of Incarcerated Youth
Authors: Lux Kathleen M. , Petosa Rick
Published: February 2007

The purpose of this study was to test constructs of an enhanced version of the health belief model (HBM) in predicting juvenile delinquents' safer sex intentions. An accessible sample (n = 452) of incarcerated youth between the ages of 13-18 years from a midwest-em state were subjects. HBM constructs were measured with an instrument tested for face, content, and construct validity as well as internal reliability. HBM constructs accounted for 28% of the variance in safer sex intentions. The results of this study support the use of the HBM in understanding human immunodeficiency virus (HIV) risk behavior in this population. The implications of these results for theory-based HIV prevention among incarcerated youth are presented.
Health Education Interventions among Native Americans: A Review and Analysis
Authors: LeMaster Pamela L. , Connell Cathleen M.
Published: February 2007

Relatively few health education interventions directed at preventive health behaviors and management of chronic illness among Native Americans have been reported in the literature. This article provides a selective review of health education interventions among Native Americans that address the prevention and management of chronic illnesses/conditions as well as preventive health behaviors. For each intervention included in the review, a description of its cultural relevance, sample, design, and evaluation is provided. Limitations are noted, as well as implications for research and practice.
Health Education Intervention Strategies: Recommendations for Future Research
Authors: Steckler Allan , Allegrante John P. , Altman David , Brown Richard , Burdine James N. , Goodman Robert M. , Jorgensen Cynthia
Published: February 2007

While the ultimate goal of health education interventions is to positively influence health status, more proximal indicators of success are changes in intermediate outcomes, or impact. Because health education interventions work through intermediate outcomes, the linkage to health status is often assumed to be at a conceptual or theoretical level. The term health education intervention strategy is a heuristic device used to conceptualize and organize a large variety of activities. There is a wide range of studies and reports in the literature that either test specific intervention strategies or report on larger health education efforts combining several strategies. This article organizes the discussion to focus on individual-, community-, and policy-level interventions. Mass communications are also considered, and the authors comment on program planning issues that cut across specific interventions at the individual, community, and policy levels. Eleven recommendations are offered for future health education intervention research.
Settings as an Important Dimension in Health Education/Promotion Policy, Programs, and Research
Authors: Mullen Patricia Dolan , Evans David , Forster Jean , Gottlieb Nell H. , Kreuter Matt , Moon Robert , O'Rourke Thomas , Strecher Victor J.
Published: February 2007

Settings—community, worksite, schools, and healthcare sites—constitute an important dimension of health education/health promotion policy and programs and for research about program needs, feasibility, efficacy, and effectiveness. These settings vary in the extent of coverage of and relationships with their respective constituencies, valued outcomes, and quantity and quality of evidence about the effectiveness of setting-specific and cross-setting programs. Main sources of evidence for program efficacy and effectiveness are summarized, leading to the conclusion that strides have been made toward building a strong evidentiary base for health education/health promotion in these settings. Gaps in research exist, especially for diffusion of effective programs, new technologies, the influence of policy, relations between settings, and approaches to marginal and special subgroups. Recommendations are offered for cross-setting and within-setting research related to intervention.
A Research Agenda for Health Education Among Underserved Populations
Authors: Marín Gerardo , Burhansstipanov Linda , Connell Cathleen M , Gielen Andrea C. , Helitzer-Allen Deborah , Lorig Kate , Morisky Donald E. , Tenney Martha , Thomas Stephen
Published: February 2007

This article summarizes the outcome of health education efforts among populations that, due to their cultural heritage, have received limited services. The literature reviewed shows that programs found to be effective in one population cannot be assumed to be equally effective with a different population. An argument is made for the design of culturally appropriate and group-specific interventions which would properly serve the various underserved populations. Research needs to be conducted to identify appropriate approaches and intervention strategies, as well as the group-specific sociopsychological characteristics (attitudes, norms, values, expectan cies) that are related to health-damaging and protective behaviors.
Evaluation of Health Education Programs: Current Assessment and Future Directions
Authors: Israel Barbara A. , Cummings K. Michael , Dignan Mark B. , Heaney Catherine A. , Perales Daniel P. , Simons-Morton Bruce G. , Zimmerman Marc A.
Published: February 2007

Recently there has been an increase in the different types of strategies used in health education interventions, including an emphasis on broadening programs focused on individual behavior change to include larger units of practice. There has also been an increasing critique of the traditional physical science paradigm for evaluating the multiple dimensions inherent in many interventions. Additionally, there is a growing recognition of the importance of involving multiple stakeholders in designing, implementing, and evaluating interventions. Each of these factors carries specific evaluation challenges. With the overall aim of strengthening the evaluation of health education programs, this article aims to (a) present conceptual and technical design issues and options, (b) describe different approaches to evaluation, (c) highlight evaluation approaches that have been effective, (d) critique the limitations of traditional evaluation approaches, (e) examine promising approaches and implications for future evaluations, and (f) provide recommendations for evaluation designs, data collection methods, roles, responsibilities, and principles for evaluating interventions.
An Economic Evaluation of Four Work Site Based Cardiovascular Risk Factor Interventions
Authors: Oldenburg Brian , Owen Neville , Parle Michael , Gomel Michelle
Published: February 2007

We used outcome data from a randomized work site intervention trial to examine the cost-effectiveness of four cardiovascular disease (CVD) risk reduction programs: health risk assessment (HRA), risk factor education (RFE), behavioral counseling (BC), and behavioral counseling plus incentives (BCI). Composite CVD risk scores were derived from measures of serum total cholesterol, blood pressure, number of cigarettes smoked, body mass index, and aerobic capacity. The economic evaluation of the programs focused on the subset of costs most sensitive to the differences between the interventions, and a sensitivity analysis examined some of the relevant cost variations. At the 6-month follow-up (i.e., the "action" or initiation stage of lifestyle change), the RFE, BC, and BCI interventions produced a significant reduction in cardiovascular risk. Incremental analyses demonstrated RFE to be more cost-effective, but not as clinically effective as BC; BC was more cost-effective than RFE when assessment costs were included, and BCI was judged to be the least cost-effective. At the 12-month follow-up (i.e., the "maintenance" stage of lifestyle of change), BC was the only program found to produce a significant reduction in CVD risk. Individualized behavioral counseling was found to be a cost-effective strategy for the initiation and maintenance of CVD risk factor reduction.
Health Behavior Segmentation and Campaign Planning to Reduce Cardiovascular Disease Risk Among Hispanics
Authors: Williams Janice E. , Flora June A.
Published: February 2007

Using the social marketing principle of audience segmentation, a Hispanic audience was disaggregated to examine heterogeneous behaviors and lifestyles that could guide planning for public information campaigns designed to reduce cardiovascular disease (CVD) risk. Signal detection analysis resulted in six mutually exclusive subgroups, based on self-reported behavioral changes to improve health. Subgroups differed significantly in communication, behavioral, psychological, and demographic dimensions, indicating they may require unique campaign planning strategies. To determine whether subgroups were meaningful relative to external health-related criteria, they were compared as to health knowledge and status on cardiovascular disease risk factors. The results showed significant differences among audience subgroups in plasma high-density lipoprotein levels and hypertensive status. Results are discussed in terms of their implications for campaign planning and the need for public health campaigns to diversify strategies when targeting Hispanic audiences.
Examining a Paradox: Does Religiosity Contribute to Positive Birth Outcomes in Mexican American Populations?
Authors: Magaña Aizita , Clark Noreen M.
Published: February 2007

A particularly interesting and consistent finding regarding the health of the Latino population is that Mexican American women, despite their relatively lower socioeconomic status, deliver significantly fewer low birth weight babies and lose fewer babies to all causes during infancy than do women of other ethnic groups. A central thesis of this discussion is that the religiosity and spirituality of many of these Latinas, a key factor in their culture, may protect them and their infants through the pre- and antenatal phases of life. We also suggest that lack of research, related to cultural similarities and differences in Hispanic/Latino subgroups, can lead to faulty or simplistic understanding regarding their health behavior and health status.
Combining Research, Advocacy, and Education: The Methods of the Grandparent Caregiver Study
Authors: Roe Kathleen M. , Minkler Meredith , Fludd Saunders Frances
Published: February 2007

This article presents a case study of the effective synergy of health education inquiry, community collaboration, and policy advocacy. Using the Grandparent Caregiver Study as the example, the authors focus on key methodological decisions that enabled them to incorporate research, education, and advocacy activities into an ever-growing project on a modest budget. The study itself centered on two in-depth interviews with each of 71 African American grandmothers raising young grandchildren due to the crack cocaine epidemic in Oakland, California. The case study demonstrates ways in which health education research can increase the efficacy of individuals and disenfranchised groups to define problems, voice their concerns, and advocate for more just and healthy public policies. Through discussion of the authors' methods and activities, they suggest strategies through which research participants, service providers, and policymakers can work together to bring a new issue to the policy arena through a collaborative and empowering research process.
The Smoke-Free University: Anticipating Health Education Needs of Faculty and Staff
Authors: Robinson Lisa
Published: February 2007

A survey instrument was developed to assess the anticipated impact of smoke-free university policy on faculty and staff and to recommend health education interventions based on stages of change theory and employee interest. Four months before the policy was implemented, the 25-item anonymous questionnaire was sent to a random sample of 1,000 faculty/staff. A majority of university workers (85.5%) are not smokers and approve of the no-smoking policy. Smokers (14.5%) are older than nonsmokers, are more likely to have a high school versus higher education, and are more likely to be maintenance or clerical workers. Most smokers smoke less than one packper day and smoke outdoors during workhours. More smokers were in later stages of change (planning to stop soon) than expected. Interest in availability of smoking cessation activities differed by smoking status and change stage.
The Effect of Sex Education on Adolescents' Use of Condoms: Applying the Solomon Four-Group Design
Authors: Kvalem Ingela Lundin , Sundet Jon Martin , Rivø Kate I. , Eilertsen Dag Erik , Bakketeig Leiv S.
Published: February 2007

A school-based sex education program was developed in order to prevent sexually transmitted diseases and unwanted pregnancies. A Solomon four-group design, with random assignment to the different conditions, was used to evaluate an intervention based on cognitive social learning theory and social influence theory. The main goal of the intervention was to increase use of condoms. A stratified sample of 124 classes (2,411 students) was drawn at random from all the upper secondary schools (high schools/colleges) in one county in Norway. The results indicate a consistent interaction between pretest and intervention, which seems to have an effect on condom use. Pretest or intervention alone did not contribute to this effect. The interaction effect appeared among the students with few sexual partners. Several possible explanations to the observed interaction effect and the implication for future interventions are discussed.
Community Coalitions for Prevention and Health Promotion: Factors Predicting Satisfaction, Participation, and Planning
Authors: Butterfoss Frances Dunn , Goodman Robert M. , Wandersman Abraham
Published: February 2007

Coalitions currently are a popular tool for promoting community-based solutions to health problems, such as alcohol, tobacco, and other drug (ATOD) abuse. Private foundations, granting agencies, and other public health organizations assume that participation of community members in health promotion coalitions will increase the likelihood of program success. This article examines whether key characteristics of coalitions are related to effectiveness as measured by member satisfaction, commitment to the coalition, and the quality of planning efforts. Member survey data from the first year evaluation of an ATOD coalition were analyzed using factor analysis, chi-square, and multiple regression techniques at both the individual and group levels. The results suggest that community leadership, shared decision making, linkages with other organizations, and a positive organizational climate were key determinants of member satisfaction and participation. These same factors were not related to the quality of coalition plans. However, the significance of coalitions for community empowerment and health promotion is discussed.
Evaluation of 37 AIDS Prevention Projects: Successful Approaches and Barriers to Program Effectiveness
Authors: Janz Nancy K. , Zimmerman Marc A. , Wren Patricia A. , Israel Barbara A. , Freudenberg Nicholas , Carter Rosalind J.
Published: February 2007

In 1988, the Robert Wood Johnson Foundation awarded grants to 54 AIDS prevention and service projects. This article presents the results from a survey of the 37 projects that contained a substantial prevention effort and embellishes these findings with qualitative data from in-depth site visits to 12 projects. Survey respondents reported conducting a mean of 19 different intervention activities. Small-group discussion, outreach to populations engaged in high-risk behaviors, and training peers and volunteers were the intervention activities rated most effective by project staff. Qualitative analysis identified eight factors facilitating intervention effectiveness. Three site-visited projects were chosen to exemplify the ways in which these facilitating factors contributed to the perceived effectiveness of small-group discussions, outreach, and the training of peer educators. Recommendations to guide the development and delivery of future community-based AIDS prevention projects are presented.
Linking Stress and Injury in the Farming Environment: A Secondary Analysis of Qualitative Data
Authors: Kidd Pamela , Scharf Ted , Veazie Mark
Published: February 2007

The first step in injury prevention is to understand the injury problem. This includes examining the nature of the problem from the perspective of the target community. This article uses qualitative methods to explain the nature of the injury problem and identifies prevention strategies through a three-step process: identify a causal model, validate the model, and identify strategies using the causal model. A causal model linking safety performance and safety demand, health decision making, and occupational stress was derived by secondary analysis of farm family focus group data (step 1) and validated by other farm family focus groups (step 2). Prevention strategies identified from the causal model (step 3) include decreasing the number of roles performed exclusively by one individual, developing an easy-to-use planning tool that assists farmers in anticipating and reducing future work demands, and developing an education module that incorporates injury costs into safety decision making.
Operationalizing Theoretical Constructs in Bloodborne Pathogens Training Curriculum
Authors: Sinclair Raymond C. , Gershon Robyn R. M. , Murphy Lawrence R. , Goldenhar Linda M.
Published: February 2007

This article describes how the protection motivation theory (PMT) was used to inform the production of video curriculum for a bloodborne pathogens training program for hospital nurses. Although hospital nurses are well acquainted with the work practices designed to prevent bloodborne pathogen exposures (universal precautions), there is evidence that they do not always follow them. First, the onginal PMT is adapted to reflect what is currently known about the role of affect in health behavior prediction. Second, the authors show how the four PMT message constructs—probability of occurrence, magnitude of noxiousness, response efficacy, and self—efficacy—guided the planning, shooting, and editing of the videotapes. Incidental to this process was the operationalization of these message constructs in such a way that affective reactions would result. The results show that this video curriculum successfully aroused negative affect in the target audience. Only by carefully planning and documenting how message constructs are operationalized in health education materials can one be sure of achieving theory-based (and thus the most replicable) message design.