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Ockene JK, Edgerton EA, Teutsch SM, Marion LN, Miller T, Genevro JL, Loveland-Cherry CJ, Fielding JE, Briss PA. Integrating evidence-based clinical and community strategies to improve health. Am J Prev Med 2007; 32:244-52. [PMID: 17296474 DOI: 10.1016/j.amepre.2006.11.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 10/30/2006] [Accepted: 11/10/2006] [Indexed: 10/23/2022]
Abstract
Multiple and diverse preventive strategies in clinical and community settings are necessary to improve health. This paper (1) introduces evidence-based recommendations from the U.S. Preventive Services Task Force sponsored by the Agency for Healthcare Research and Quality and the Community Task Force sponsored by the Centers for Disease Control and Prevention, (2) examines, using a social-ecologic model, the evidence-based strategies for use in clinical and community settings to address preventable health-related problems such as tobacco use and obesity, and (3) advocates for prioritization and integration of clinical and community preventive strategies in the planning of programs and policy development, calling for additional research to develop the strategies and systems needed to integrate them.
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Affiliation(s)
- Judith K Ockene
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
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102
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Fogelholm M, Valve R, Absetz P, Heinonen H, Uutela A, Patja K, Karisto A, Konttinen R, Mäkelä T, Nissinen A, Jallinoja P, Nummela O, Talja M. Rural-urban differences in health and health behaviour: a baseline description of a community health-promotion programme for the elderly. Scand J Public Health 2007; 34:632-40. [PMID: 17132597 DOI: 10.1080/14034940600616039] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To (1) describe the setting and design of the Good Ageing in Lahti Region (GOAL) programme; (2) by using the baseline results of the GOAL cohort study, to examine whether living in urban, semi-urban, or rural communities is related to risk factors for chronic diseases and functional disability in ageing individuals. DESIGN The baseline data of a cohort study of ageing individuals living in three community types (urban, semi-urban, rural). Data were collected by two questionnaires and laboratory assessments. SETTING Fourteen municipalities in the Lahti region (Päijät-Häme County) in Finland. PARTICIPANTS A regionally and locally stratified random sample of men and women born in 1946-50, 1936-40, and 1926-30. A total of 4,272 were invited and 2,815 (66%) participated. MAIN RESULTS Elevated serum cholesterol, obesity, disability, sedentary lifestyle (<2 times/week walking), and high fat intake were more prevalent in rural vs. urban and semi-urban communities. After adjustment for sex, age, education, obesity, diet, physical activity, smoking, and alcohol use, rural communities remained the only community type with increased (p<0.05) probability for high BMI (OR 1.33) and high waist circumference (OR 1.43). CONCLUSIONS The unfavourable health and lifestyle profile, together with an old population, makes health promotion for elderly citizens a special challenge for rural communities such as those in Päijät-Häme County, Finland. Most, if not all, of the differences in health between the three community types were explained by educational background, physical activity, and smoking.
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Affiliation(s)
- Mikael Fogelholm
- The UKK Institute for Health Promotion Research, Tampere, Finland.
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103
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Yancey AK, Fielding JE, Flores GR, Sallis JF, McCarthy WJ, Breslow L. Creating a robust public health infrastructure for physical activity promotion. Am J Prev Med 2007; 32:68-78. [PMID: 17218192 DOI: 10.1016/j.amepre.2006.08.029] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 06/30/2006] [Accepted: 08/30/2006] [Indexed: 11/20/2022]
Abstract
The essential role of physical activity both as an independent protective factor against numerous common chronic diseases and as a means to maintain a healthy weight is gaining increasing scientific recognition. Although the science of physical activity promotion is advancing rapidly, the practice of promoting physical activity at a population level is in its infancy. The virtual absence of a public health practice infrastructure for the promotion of physical activity at the local level presents a critical challenge to control policy for chronic disease, and particularly obesity. To translate the increasing evidence of the value of physical activity into practice will require systemic, multilevel, and multisectoral intervention approaches that build individual capability and organizational capacity for behavior change, create new social norms, and promote policy and environmental changes that support higher levels of energy expenditure across the population. This paper highlights societal changes contributing to inactivity; describes the evolution and current status of population-based public health physical activity promotion efforts in research and practice settings; suggests strategies for engaging decision makers, stakeholders, and the general public in building the necessary infrastructure to effectively promote physical activity; and identifies specific recommendations to spur the creation of a robust public health infrastructure for physical activity.
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Affiliation(s)
- Antronette K Yancey
- Department of Health Services and Center to Eliminate Health Disparities, UCLA School of Public Health, Los Angeles, California 90095, USA.
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104
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Toledo ME, Vanlerberghe V, Baly A, Ceballos E, Valdes L, Searret M, Boelaert M, van der Stuyft P. Towards active community participation in dengue vector control: results from action research in Santiago de Cuba, Cuba. Trans R Soc Trop Med Hyg 2007; 101:56-63. [PMID: 16824565 DOI: 10.1016/j.trstmh.2006.03.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2005] [Revised: 03/21/2006] [Accepted: 03/31/2006] [Indexed: 10/24/2022] Open
Abstract
Community participation is advocated as essential for attaining effective dengue prevention, but knowledge of how to foster this is limited. In Santiago de Cuba, multiple small task forces were created at the neighbourhood level that included all stakeholders in the control of Aedes aegypti. The task forces assessed the perceived needs and elaborated action plans to promote specific behavioural change and to reduce environmental risks through social communication strategies and intersectoral local government activities. We monitored five dimensions of the participation process and assessed behavioural and environmental results and entomological outcomes. Participation was weak to good. At the household level, uncovered water storage containers decreased from 49.3% to 2.6% between 2000 and 2002, and removing larvicide from them dropped from 45.5% to 1%. There was a reduction of 75% in the absolute number of positive containers and a significant decrease from 1.23% to 0.35% in the house index. Local task forces, in which the interests of householders as well as vector control workers are directly represented, can lead to effective government-community partnerships that resolve problems of mutual concern.
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Affiliation(s)
- M E Toledo
- Department of Epidemiology, Instituto de Medicina Tropical Pedro Kouri, Autopista Novia del Mediodia Km 6 1/2 La Lisa, Ciudad de La Habana, Cuba.
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105
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Pronyk PM, Hargreaves JR, Kim JC, Morison LA, Phetla G, Watts C, Busza J, Porter JDH. Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet 2006; 368:1973-83. [PMID: 17141704 DOI: 10.1016/s0140-6736(06)69744-4] [Citation(s) in RCA: 555] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND HIV infection and intimate-partner violence share a common risk environment in much of southern Africa. The aim of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) study was to assess a structural intervention that combined a microfinance programme with a gender and HIV training curriculum. METHODS Villages in the rural Limpopo province of South Africa were pair-matched and randomly allocated to receive the intervention at study onset (intervention group, n=4) or 3 years later (comparison group, n=4). Loans were provided to poor women who enrolled in the intervention group. A participatory learning and action curriculum was integrated into loan meetings, which took place every 2 weeks. Both arms of the trial were divided into three groups: direct programme participants or matched controls (cohort one), randomly selected 14-35-year-old household co-residents (cohort two), and randomly selected community members (cohort three). Primary outcomes were experience of intimate-partner violence--either physical or sexual--in the past 12 months by a spouse or other sexual intimate (cohort one), unprotected sexual intercourse at last occurrence with a non-spousal partner in the past 12 months (cohorts two and three), and HIV incidence (cohort three). Analyses were done on a per-protocol basis. This trial is registered with ClinicalTrials.gov, number NCT00242957. FINDINGS In cohort one, experience of intimate-partner violence was reduced by 55% (adjusted risk ratio [aRR] 0.45, 95% CI 0.23-0.91; adjusted risk difference -7.3%, -16.2 to 1.5). The intervention did not affect the rate of unprotected sexual intercourse with a non-spousal partner in cohort two (aRR 1.02, 0.85-1.23), and there was no effect on the rate of unprotected sexual intercourse at last occurrence with a non-spousal partner (0.89, 0.66-1.19) or HIV incidence (1.06, 0.66-1.69) in cohort three. INTERPRETATION A combined microfinance and training intervention can lead to reductions in levels of intimate-partner violence in programme participants. Social and economic development interventions have the potential to alter risk environments for HIV and intimate-partner violence in southern Africa.
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Affiliation(s)
- Paul M Pronyk
- Rural AIDS and Development Action Research Programme, School of Public Health, University of the Witwatersrand, Acornhoek, South Africa.
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106
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Mummery WK, Schofield G, Hinchliffe A, Joyner K, Brown W. Dissemination of a community-based physical activity project: The case of 10,000 steps. J Sci Med Sport 2006; 9:424-30. [PMID: 16890489 DOI: 10.1016/j.jsams.2006.06.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 06/23/2006] [Accepted: 06/24/2006] [Indexed: 11/23/2022]
Abstract
This paper describes the use of a web-site for the dissemination of the community-based '10,000 steps' program which was originally developed and evaluated in Rockhampton, Queensland in 2001-2003. The website provides information and interactive activities for individuals, and promotes resources and programs for health promotion professionals. The dissemination activity was assessed in terms of program adoption and implementation. In a 2-year period (May 2004-March 2006) more than 18,000 people registered as users of the web-site (logging more than 8.5 billion steps) and almost 100 workplaces and 13 communities implemented aspects of the 10,000 steps program. These data support the use of the internet as an effective means of disseminating ideas and resources beyond the geographical borders of the original project. Following this preliminary dissemination, there remains a need for the systematic study of different dissemination strategies, so that evidence-based physical activity programs can be translated into more widespread public health practice.
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Affiliation(s)
- W Kerry Mummery
- School of Health and Human Performance, Central Queensland University, Rockhampton, Qld 4702, Australia.
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107
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Merlo J, Chaix B. Neighbourhood effects and the real world beyond randomized community trials: a reply to Michael J Oakes. Int J Epidemiol 2006; 35:1361-3. [PMID: 17008359 DOI: 10.1093/ije/dyl211] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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109
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Bonell C, Hargreaves J, Strange V, Pronyk P, Porter J. Should structural interventions be evaluated using RCTs? The case of HIV prevention. Soc Sci Med 2006; 63:1135-42. [PMID: 16697512 DOI: 10.1016/j.socscimed.2006.03.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Indexed: 10/24/2022]
Abstract
Structural interventions addressing macro-social determinants of risk have been suggested as potentially important adjuncts to biomedical and behavioural interventions for the prevention of HIV and other diseases. A few interventions of this type have been evaluated using randomised controlled trials (RCTs), the most rigorous design to evaluate the effects of biomedical and behavioural interventions. The appropriateness of applying RCTs to structural interventions is however debated. This paper considers whether issues of ethics, feasibility and utility preclude the use of RCTs in evaluations of structural interventions for HIV prevention. We conclude there is nothing particular to this category of interventions prohibiting use of RCTs. However, we suggest that RCTs may prove unacceptable, unfeasible or not useful in certain circumstances, such as where an intervention brings important benefits other than HIV prevention (such as increased income); where leaders of clusters do not allow decisions about macro-social policies to be determined randomly; where the unit of social organization addressed by an intervention is so large that recruitment of adequate numbers of clusters is impossible; and where the period required to trial interventions extends beyond practical decision-making time-scales. In such cases, alternative evaluative designs must be assessed for their ability to provide evidence of intervention effectiveness.
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Affiliation(s)
- Christopher Bonell
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK.
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110
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Oakes JM. Commentary: advancing neighbourhood-effects research--selection, inferential support, and structural confounding. Int J Epidemiol 2006; 35:643-7. [PMID: 16556642 DOI: 10.1093/ije/dyl054] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Michael Oakes
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
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111
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Abstract
Prevention of disease is the only method to substantially reduce morbidity and mortality in a population. The two key determinants of disease are the levels of risk factors/determinants and the adherence to efficacious therapies, and there are two approaches to these: public health and preventive medicine. Clinical trials remain the cornerstone for evaluating new approaches. Effectiveness studies are required to evaluate the best approaches to deliver efficacious therapies; public health and preventive medicine programs must include the entire population, and can be costly. Environmental changes have greater benefits and a greater likelihood of reaching large segments of the population, but the preventive medicine approach is better for high-risk diseases. New risk factors and diseases evolve from the upper to lower social classes, while preventive therapies evolve from the upper to lower education groups.
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Affiliation(s)
- Lewis H Kuller
- Graduate School of Public Health, University of Pittsburgh, GSPH, 130 North Bellefield Ave., Room 550, Pittsburgh, PA 15213, USA.
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112
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Veazie MA, Galloway JM, Matson-Koffman D, LaBarthe DR, Brownstein JN, Emr M, Bolton E, Freund E, Fulwood R, Guyton-Krishnan J, Hong Y, Lebowitz M, Ochiai E, Schoeberl M, Robertson RM. Taking the Initiative. Circulation 2005; 112:2538-54. [PMID: 16230505 DOI: 10.1161/circulationaha.105.169179] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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113
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Kegler MC, Williams CW, Cassell CM, Santelli J, Kegler SR, Montgomery SB, Bell ML, Martinez YG, Klein JD, Mulhall P, Will JA, Wyatt VH, Felice TL, Hunt SC. Mobilizing communities for teen pregnancy prevention: associations between coalition characteristics and perceived accomplishments. J Adolesc Health 2005; 37:S31-41. [PMID: 16115569 DOI: 10.1016/j.jadohealth.2005.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe coalition membership, examine associations between coalition processes and short-term coalition outcomes, and assess the relative contribution of key coalition processes to perceived accomplishments in teen pregnancy prevention coalitions. METHODS A self-administered survey was distributed to active members of 21 teen pregnancy prevention coalitions in 13 communities. The overall response rate was 67%, with 471 surveys returned. Process measures included staff competence, member influence in decision making, and coalition functioning. Short-term outcome measures included perceived accomplishments, member satisfaction, member participation, and coalition viability. RESULTS About 50% of coalition members represented health or teen pregnancy prevention or youth development service organizations, with 13% participating primarily as residents or youth. None of the process measures were associated with coalition viability (defined as active 2 years post-survey). Many bivariate associations between coalition processes and other short-term outcomes were significant at the individual and coalition levels of analysis. In a multivariate random coefficients model, coalition functioning (p <.001) and member influence in decision making (p = .019) were significantly associated with perceived coalition accomplishments. CONCLUSION Consistent with research on coalitions that have addressed other health issues, good coalition processes were associated with short-term indicators of effectiveness in these teen pregnancy prevention coalitions. Coalition processes were not associated with coalition viability 2 years post-survey, however, suggesting that other factors influence coalition survival.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Kerner J, Rimer B, Emmons K. Introduction to the Special Section on Dissemination: Dissemination Research and Research Dissemination: How Can We Close the Gap? Health Psychol 2005; 24:443-6. [PMID: 16162037 DOI: 10.1037/0278-6133.24.5.443] [Citation(s) in RCA: 176] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One of the greatest challenges facing health promotion and disease prevention is translating research findings into evidence-based public health and clinical practices that are actively disseminated and widely adopted. Despite the tremendous strides made in developing effective disease prevention and control programs, there has been little study of effective dissemination of evidence-based programs to and adoption by community, public health, and clinical practice settings. This special section provides a venue in which to highlight exemplary dissemination research efforts while also identifying limitations in research to date and framing important future research questions. This issue establishes a resource for investigators interested in dissemination research, with relevance to health psychology. In this sense, it can serve as a benchmark by which to examine subsequent progress. The 6 articles reflect the state of the science in dissemination research for the promotion and adoption of health behavior change interventions.
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Affiliation(s)
- Jon Kerner
- Division of Cancer Control and Population SciencesNational Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Washington, DC, USA.
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115
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Veazie MA, Galloway JM, Matson-Koffman D, Labarthe DR, Brownstein JN, Emr M, Bolton E, Freund E, Fulwood R, Guyton-Krishnan J, Hong Y, Lebowitz M, Ochiai E, Schoeberl M, Robertson RM. Taking the initiative Implementing the American Heart Association Guide
for improving cardiovascular health at the community level. Glob Heart 2005. [DOI: 10.1016/j.precon.2005.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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116
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Small R, Brown S, Dawson W, Watson L, Lumley J. PRISM: mounting a community-randomised trial. Establishing partnerships with local government. Aust N Z J Public Health 2005; 28:471-5. [PMID: 15707190 DOI: 10.1111/j.1467-842x.2004.tb00030.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This paper describes initial partnership development in PRISM (Program of Resources, Information and Support for Mothers), a community-randomised trial to improve maternal health in the first year after birth conducted in Victoria in the period 1998--2003. First, we discuss the principles underpinning community recruitment methods in PRISM that guided both our initial approaches to, and our continuing relationships with, communities. Second, we outline the strategies used to recruit communities and to establish the groundwork for ongoing partnerships over the projected six years of the study.
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Affiliation(s)
- Rhonda Small
- Mother and Child Health Research, School of Public Health, La Trobe University, Victoria.
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117
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Matson-Koffman DM, Brownstein JN, Neiner JA, Greaney ML. A site-specific literature review of policy and environmental interventions that promote physical activity and nutrition for cardiovascular health: what works? Am J Health Promot 2005; 19:167-93. [PMID: 15693346 DOI: 10.4278/0890-1171-19.3.167] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To review the literature to determine whether policy and environmental interventions can increase people's physical activity or improve their nutrition. DATA SOURCES The following databases were searched for relevant intervention studies: Medline, Chronic Disease Prevention File, PsychInfo, Health Star, Web of Science, ERIC, the U.S. Department of Transportation, and the U.S. Department of Agriculture. STUDY SELECTION To be included in the review, studies must have (1) addressed policy or environmental interventions to promote physical activity and/or good nutrition; (2) been published from 1970 to October 2003; (3) provided a description of the intervention; and (4) reported behavioral, physiological, or organizational change outcomes. Studies that had inadequate intervention descriptions or that focused on determinants research, individual-level interventions only, the built environment, or media-only campaigns were excluded. DATA EXTRACTION We extracted and summarized studies conducted before 1990 (n = 65) and during 1990-2003 (n = 64). DATA SYNTHESIS Data were synthesized by topic (i.e., physical activity or nutrition), by type of intervention (i.e., point-of-purchase), and by setting (i.e., community, health care facility, school, worksite). Current studies published during 1990-2003 are described in more detail, including setting and location, sample size and characteristics, intervention, evaluation period, findings, and research design. Findings are also categorized by type of intervention to show the strength of the study designs and the associations of policy and environmental interventions with physical activity and nutrition. CONCLUSIONS The results of our review suggest that policy and environmental strategies may promote physical activity and good nutrition. Based on the experimental and quasi-experimental studies in this review, the following interventions provide the strongest evidence for influencing these behaviors: prompts to increase stair use (N = 5); access to places and opportunities for physical activity (N = 6); school-based physical education (PE) with better-trained PE teachers, and increased length of time students are physically active (N = 7); comprehensive work-site approaches, including education, employee and peer support for physical activity, incentives, and access to exercise facilities (N = 5); the availability of nutritious foods (N = 33), point-of-purchase strategies (N = 29); and systematic officer reminders and training of health care providers to provide nutritional counseling (N = 4). Further research is needed to determine the long-term effectiveness of different policy and environmental interventions with various populations and to identify the steps necessary to successfully implement these types of interventions.
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Affiliation(s)
- Dyann M Matson-Koffman
- National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA 30341-3717, USA
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118
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Galea S, Sisco S, Vlahov D. Reducing Disparities in Vaccination Rates Between Different Racial/Ethnic and Socioeconomic Groups. J Ambul Care Manage 2005; 28:49-59. [PMID: 15682961 DOI: 10.1097/00004479-200501000-00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are well-documented disparities in vaccination rates between different socioeconomic and racial/ethnic groups in the United States. These disparities persist in spite of an overall increase in vaccination rates during the last decade and the implementation of several interventions that have aimed to increase vaccination rates in disadvantaged groups. Although many interventions are efficacious at improving vaccination rates under trial conditions, these interventions when extended to the general population frequently do not appreciably improve its health. Explanations for this limited intervention efficiency include poor adherence to protocols in real life versus idealized trial situations, changes in baseline so that the trial conditions are no longer replicable, and the contribution of other community-level factors that make it difficult to extend the trial methods to other communities. Multilevel community intervention trials recognize and address the multiple competing forces that shape the health of the population in cities and have the potential to increase vaccination rates among minorities and marginalized groups.
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Affiliation(s)
- Sandro Galea
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Ave, New York, NY 10029, USA.
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119
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Kegler MC, Malcoe LH. Results from a lay health advisor intervention to prevent lead poisoning among rural Native American children. Am J Public Health 2004; 94:1730-5. [PMID: 15451742 PMCID: PMC1448526 DOI: 10.2105/ajph.94.10.1730] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested the effectiveness of a community-based lay health advisor intervention for primary prevention of lead poisoning among Native American children who lived in a former mining area. METHODS We conducted cross-sectional population-based blood lead assessments of Native American and White children aged 1 to 6 years and in-person caregiver interviews before (n=331) and after (n=387) a 2-year intervention. RESULTS Mean childhood blood lead levels decreased and selected preventive behaviors improved for both Native American and White (comparison) communities. Several short-term outcomes also improved from pre- to postintervention, but only knowledge and hand-washing self-efficacy increased more among Native Americans than among Whites. CONCLUSIONS Our findings provide limited support for the effectiveness of lay health advisor interventions as a primary lead poisoning prevention strategy for Native American communities.
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Affiliation(s)
- Michelle Crozier Kegler
- Masters in Public Health Program, MSC09 5060, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
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Shi HJ, Nakamura K, Takano T. Health values and health-information-seeking in relation to positive change of health practice among middle-aged urban men. Prev Med 2004; 39:1164-71. [PMID: 15539051 DOI: 10.1016/j.ypmed.2004.04.030] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Preventive health practice is an important component of health promotion strategy. The objectives of this cohort study were to assess changes of health practices over 3 years among middle-aged Japanese men and to examine the factors related to their positive changes in lifestyle. METHODS Three hundred thirty-four randomly selected men in Tokyo completed two face-to-face structured interviews, one in 1998 and the other in 2001. Daily health practices, health values, health-information-seeking, socioeconomic characteristics, and health status were assessed. A Health Practice Index (HPI) was calculated to reflect overall health behavior. According to the change of HPI, the mode of change in general health practice between the first and second interview was classified as positive change, no change, and negative change. RESULTS Percentages of the subjects who engaged in eight identified healthy practices ranged from 31.7% to 54.5% at baseline. The follow-up interval revealed the adoption of each particular healthy or unhealthy practice as 5.7% to 33.6%. A high value placed on health independently associated with positive change of general health practice (OR = 2.95, 95% CI = 1.23 to 7.08), and inversely associated with negative change (OR = 0.45, 95% CI = 0.18 to 1.10); consciously seeking health information associated with positive change (OR = 2.16, 95% CI = 1.07 to 4.36) after controlling for socioeconomic and health status. CONCLUSION Considerable opportunity remains for urban middle-aged men to further improve their health behavior. Health values saliency, sensitively designed health information, and health status perception, as well as socioeconomic status, should be considered for successful promotion of healthy lifestyle among the adult male population.
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Affiliation(s)
- Hui-Jing Shi
- Department of Health Promotion/International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Bunkyo-ku, Tokyo 113-8519, Japan
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Small R, Brown S, Dawson W, Watson L, Lumley J. PRISM: Mounting a community-randomised trial. Establishing partnerships with local government. Aust N Z J Public Health 2004. [DOI: 10.1111/j.1467-842x.2004.tb00947.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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122
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Whittemore R, Melkus GD, Grey M. Applying the social ecological theory to type 2 diabetes prevention and management. J Community Health Nurs 2004; 21:87-99. [PMID: 15123438 DOI: 10.1207/s15327655jchn2102_03] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Obesity and Type 2 diabetes have become major public health problems in the United States. Community health nurses, with expertise in preventive health care, have the potential to play a vital role in addressing these significant health issues. The purposes of this article are to identify current challenges related to obesity and Type 2 diabetes and to present the social ecological theory as a framework for the expansion of the reach of diabetes prevention and management that is relevant to community health nurses.
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123
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Subramanian SV. The relevance of multilevel statistical methods for identifying causal neighborhood effects. Soc Sci Med 2004; 58:1961-7. [PMID: 15020011 DOI: 10.1016/s0277-9536(03)00415-5] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S V Subramanian
- Harvard School of Public Health, Department of Society, Human Development and Health, 677 Huntington Avenue, KRESGE, 7th floor, Boston, MA 02115-6096, USA
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124
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Lobb R, Gonzalez Suarez E, Fay ME, Gutheil CM, Hunt MK, Fletcher RH, Emmons KM. Implementation of a cancer prevention program for working class, multiethnic populations. Prev Med 2004; 38:766-76. [PMID: 15193897 DOI: 10.1016/j.ypmed.2003.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND This paper describes the implementation of the Healthy Directions-Health Centers intervention and examines the characteristics of participants associated with completion of intervention activities. Healthy Directions-Health Centers was designed to address social contextual factors relevant to cancer prevention interventions for working class, multi-ethnic populations. METHODS Ten community health centers were paired and randomly assigned to intervention or control. Patients who resided in low income, multi-ethnic neighborhoods were approached for participation. This study targeted fruit and vegetable consumption, red meat consumption, multi-vitamin intake, and physical activity. The intervention components consisted of: (1) a brief study endorsement from a clinician; (2) an in-person counseling session with a health advisor; (3) four follow-up telephone counseling sessions; and (4) multiple distributions of tailored materials. RESULTS Among the 1,088 intervention group participants, 978 participants (90%) completed at least five out of six intervention activities. Participants who missed clinical appointments were less likely to complete all components of the intervention. Participant characteristics that predicted receipt of clinician endorsement differed from characteristics that predicted completion of health advisor activities. Low acculturation did not present a barrier to delivery of the intervention once the participant was enrolled. CONCLUSIONS Collection and reporting on process evaluation results can help explain variations in program implementation.
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Affiliation(s)
- Rebecca Lobb
- Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care, Boston, MA 02215, USA.
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125
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Oakes JM. The (mis)estimation of neighborhood effects: causal inference for a practicable social epidemiology. Soc Sci Med 2004; 58:1929-52. [PMID: 15020009 DOI: 10.1016/j.socscimed.2003.08.004] [Citation(s) in RCA: 439] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The resurgence of interest in the effect of neighborhood contexts on health outcomes, motivated by advances in social epidemiology, multilevel theories and sophisticated statistical models, too often fails to confront the enormous methodological problems associated with causal inference. This paper employs the counterfactual causal framework to illuminate fundamental obstacles in the identification, explanation, and usefulness of multilevel neighborhood effect studies. We show that identifying useful independent neighborhood effect parameters, as currently conceptualized with observational data, to be impossible. Along with the development of a dependency-based methodology and theories of social interaction, randomized community trials are advocated as a superior research strategy, one that may help social epidemiology answer the causal questions necessary for remediating disparities and otherwise improving the public's health.
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Affiliation(s)
- J Michael Oakes
- Division of Epidemiology and Population Research Center, University of Minnesota, 1300 South 2nd Street, Minneapolis, MN 55454, USA.
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126
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Escoffery C, McCormick L, Bateman K. Development and process evaluation of a web-based smoking cessation program for college smokers: innovative tool for education. PATIENT EDUCATION AND COUNSELING 2004; 53:217-225. [PMID: 15140462 DOI: 10.1016/s0738-3991(03)00163-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2002] [Revised: 04/23/2003] [Accepted: 05/05/2003] [Indexed: 05/24/2023]
Abstract
Smoking cessation interventions are needed for young adults. Innovative approaches to behavior change for this population should be tested. Formative research and process evaluation of those approaches would result in more effective programs. This paper presents the development process and process evaluation of a web-based smoking cessation program. A description of the stages of development is presented with formative research, development of the web-based intervention, formative evaluation, and process evaluation. The smokers reported high usage of the intervention and satisfaction with the intervention in that it helped to raise their consciousness about quitting, encouraged them to set behavioral goals, provided stages of change feedback, and offered interactivity in presenting information and strategies about quitting. The Internet may be a promising tool for patient education according to the process results.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, 1525 Clifton Road, Room 105, Atlanta, GA 30322, USA.
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127
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128
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Abstract
It is now well known that standard statistical procedures become invalidated when applied to cluster randomized trials in which the unit of inference is the individual. A resulting consequence is that researchers conducting such trials are faced with a multitude of design choices, including selection of the primary unit of inference, the degree to which clusters should be matched or stratified by prognostic factors at baseline, and decisions related to cluster subsampling. Moreover, application of ethical principles developed for individually randomized trials may also require modification. We discuss several topics related to these issues, with emphasis on the choices that must be made in the planning stages of a trial and on some potential pitfalls to be avoided.
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Affiliation(s)
- Allan Donner
- Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada.
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129
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Bingenheimer JB, Raudenbush SW. Statistical and Substantive Inferences in Public Health: Issues in the Application of Multilevel Models. Annu Rev Public Health 2004; 25:53-77. [PMID: 15015912 DOI: 10.1146/annurev.publhealth.25.050503.153925] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Multilevel statistical models have become increasingly popular among public health researchers over the past decade. Yet the enthusiasm with which these models are being adopted may obscure rather than solve some problems of statistical and substantive inference. We discuss the three most common applications of multilevel models in public health: (a) cluster-randomized trials, (b) observational studies of the multilevel etiology of health and disease, and (c) assessments of health care provider performance. In each area of investigation, we describe how multilevel models are being applied, comment on the validity of the statistical and substantive inferences being drawn, and suggest ways in which the strengths of multilevel models might be more fully exploited. We conclude with a call for more careful thinking about multilevel causal inference.
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130
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Broderick JE, Stone AA, Smyth JM, Kaell AT. The feasibility and effectiveness of an expressive writing intervention for rheumatoid arthritis via home-based videotaped instructions. Ann Behav Med 2004; 27:50-9. [PMID: 14979863 DOI: 10.1207/s15324796abm2701_7] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Expressive emotional writing has demonstrated efficacy for improving health status in a wide variety of healthy persons and recently in patients with chronic disease. PURPOSE This study was a randomized, controlled effectiveness trial with 4 arms: 2 active treatment writing groups, 1 inactive writing group, and 1 attention control group. It represents the first attempt to translate the expressive writing intervention into a low-cost, community-based intervention in the form of a videotaped program. METHODS Feasibility of the approach and patient adherence were examined in a community rheumatology practice with rheumatoid arthritis patients (N = 373). RESULTS The videotape format was able to convey the intervention instructions accurately and produced the expected and differential ratings of stressfulness and emotional provocation across the 3 writing programs. Seventy-nine percent of eligible patients agreed to take the program home; 49% of these patients reported that they followed the protocol. Physician Disease Activity Rating and the Physical Component Summary of the SF36v2 Health Survey were assessed pre and post program. CONCLUSIONS Intent-to-treat analyses found no effect of the treatment. Pretreatment differences among the protocol-adherent patients complicated treatment outcome interpretation. The standard writing instructions did not yield an effect; a modified set of instructions to extract meaning from the traumatic event yielded equivocal results. Contrasts between efficacy and effectiveness trials and the challenge of achieving significant outcomes in effectiveness trials are discussed.
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Affiliation(s)
- Joan E Broderick
- Department of Psychiatry & Behavioral Science, Stony Brook University, NY, USA.
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131
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Sorensen G, Barbeau E, Hunt MK, Emmons K. Reducing social disparities in tobacco use: a social-contextual model for reducing tobacco use among blue-collar workers. Am J Public Health 2004; 94:230-9. [PMID: 14759932 PMCID: PMC1448233 DOI: 10.2105/ajph.94.2.230] [Citation(s) in RCA: 212] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2003] [Indexed: 11/04/2022]
Abstract
In the United States in 1997, the smoking prevalence among blue-collar workers was nearly double that among white-collar workers, underscoring the need for new approaches to reduce social disparities in tobacco use. These inequalities reflect larger structural forces that shape the social context of workers' lives. Drawing from a range of social and behavioral theories and lessons from social epidemiology, we articulate a social-contextual model for understanding ways in which socioeconomic position, particularly occupation, influences smoking patterns. We present applications of this model to worksite-based smoking cessation interventions among blue-collar workers and provide empirical support for this model. We also propose avenues for future research guided by this model.
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Affiliation(s)
- Glorian Sorensen
- Center for Community-Based Research, Dana-Farber Cancer Institute,and Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA 02115, USA.
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132
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Meissner HI, Vernon SW, Rimer BK, Wilson KM, Rakowski W, Briss PA, Smith RA. The future of research that promotes cancer screening. Cancer 2004; 101:1251-9. [PMID: 15316910 DOI: 10.1002/cncr.20510] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The authors draw on the lessons highlighted in preceding articles in the current supplement to provide recommendations for cancer screening intervention research and to highlight some of the many questions that will require further investigation.
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Affiliation(s)
- Helen I Meissner
- Applied Cancer Screening Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20852, USA.
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133
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Sorensen G, Emmons K, Hunt MK, Barbeau E, Goldman R, Peterson K, Kuntz K, Stoddard A, Berkman L. Model for incorporating social context in health behavior interventions: applications for cancer prevention for working-class, multiethnic populations. Prev Med 2003; 37:188-97. [PMID: 12914824 DOI: 10.1016/s0091-7435(03)00111-7] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND This article proposes a conceptual framework for addressing social contextual factors in cancer prevention interventions, and describes work that operationalizes this model in interventions for working class, multiethnic populations. METHODS The Harvard Cancer Prevention Program Project Includes Three Studies: (1) an intervention study in 25 small businesses; (2) an intervention study in 10 health centers; and (3) a computer simulation modeling project that translates risk factor modifications into gains in life expectancy and number of cancers averted. The conceptual framework guiding this work articulates pathways by which social context may influence health behaviors, and is used to frame the interventions and guide evaluation design. RESULTS Social contextual factors cut across multiple levels of influence, and include individual factors (e.g., material circumstances, psychosocial factors), interpersonal factors (e.g., social ties, roles/responsibilities, social norms), organizational factors (e.g., work organization, access to health care), and neighborhood/community factors (e.g., safety, access to grocery stores). Social context is shaped by sociodemographic characteristics (e.g., social class, race/ethnicity, gender, age, language) that impact day-to-day realities. CONCLUSIONS By illuminating the pathways by which social contextual factors influence health behaviors, it will be possible to enhance the effectiveness of interventions aimed at reducing social inequalities in risk behaviors.
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Affiliation(s)
- Glorian Sorensen
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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134
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Thompson B, Coronado G, Snipes SA, Puschel K. Methodologic advances and ongoing challenges in designing community-based health promotion programs. Annu Rev Public Health 2003; 24:315-40. [PMID: 12471272 DOI: 10.1146/annurev.publhealth.24.100901.140819] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Community intervention trials continue to attract researchers as potential ways to achieve widespread, long-term change in health behaviors. The first generations of community studies were somewhat unsophisticated in design and analysis, and their promise may have been overstated. As design and analysis issues were better defined, as secular trends caught up with the behaviors that researchers were trying to change, or as other unknown variables affected community studies, small effects of interventions were observed in community trials. Discussions were held in professional meetings and reported in the literature: Should community trials be discontinued? In general, the answer was a qualified no. In this paper, we briefly review some of the many advances made in community intervention trials, and address in more detail the challenges ahead.
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Affiliation(s)
- Beti Thompson
- Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, and Department of Health Services, University of Washington, Seattle, USA.
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135
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Kanarek N, Bialek R. Community readiness to meet Healthy People 2010 targets. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2003; 9:249-54. [PMID: 12747323 DOI: 10.1097/00124784-200305000-00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Healthy People 2010 national objectives seek to engage public health systems in health improvement. Focusing on "healthy communities," the article describes the readiness of U.S. counties to meet targets and the technical assistance that may be needed. Using rate comparisons and trends, four readiness-to-improve health categories are calculated for nine mortality rates. Greatest readiness for improvement was found for coronary heart disease mortality, where the fewest jurisdictions (35%) were static, having neither met targets nor improved; least readiness (65%) was observed for colon and rectum cancer and suicide. Nevertheless, some counties (50-1,050) were exemplary, already meeting the target and still improving.
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Affiliation(s)
- Norma Kanarek
- Department of Environmental Health Sciences, Bloomberg School of Public Health in Baltimore, Maryland, USA
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136
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Merzel C, D'Afflitti J. Reconsidering community-based health promotion: promise, performance, and potential. Am J Public Health 2003; 93:557-74. [PMID: 12660197 PMCID: PMC1447790 DOI: 10.2105/ajph.93.4.557] [Citation(s) in RCA: 382] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2002] [Indexed: 11/04/2022]
Abstract
Contemporary public health emphasizes a community-based approach to health promotion and disease prevention. The evidence from the past 20 years indicates, however, that many community-based programs have had only modest impact, with the notable exception of a number of HIV prevention programs. To better understand the reasons for these outcomes, we conducted a systematic literature review of 32 community-based prevention programs. Reasons for poor performance include methodological challenges to study design and evaluation, concurrent secular trends, smaller-than-expected effect sizes, limitations of the interventions, and limitations of theories used. The effectiveness of HIV programs appears to be related in part to extensive formative research and an emphasis on changing social norms.
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Affiliation(s)
- Cheryl Merzel
- Center for Applied Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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137
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Mercer SL, Green LW, Rosenthal AC, Husten CG, Khan LK, Dietz WH. Possible lessons from the tobacco experience for obesity control. Am J Clin Nutr 2003; 77:1073S-1082S. [PMID: 12663321 DOI: 10.1093/ajcn/77.4.1073s] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although obesity is increasing to epidemic proportions in many developed countries, some of these same countries are reporting substantial reductions in tobacco use. Unlike tobacco, food and physical activity are essential to life. Yet similar psychological, social, and environmental factors as well as advertising pressures influence the usage patterns of all 3. These similarities suggest that there may be commonalities between factors involved in controlling obesity and tobacco. This review, therefore, seeks to draw lessons from the tobacco experience for the organization of more successful obesity control. Smoking cessation counseling by physicians has been found to be one of the most clinically effective and cost-effective of all disease prevention interventions. When used alone, however, it cannot decrease the cultural acceptability of tobacco and the pressures and cues to smoke. Research and evaluation have shown the key elements of tobacco control to be (1) clinical intervention and management, (2) educational strategies, (3) regulatory efforts, (4) economic approaches, and (5) the combination of all of these into comprehensive programs that address multiple facets of the environment simultaneously. For each element, we present the evidence outlining its importance for tobacco control, discuss its application to date in obesity control, and suggest areas for further research. Viewing all of the elements involved and recognizing their synergistic effects draws researchers and practitioners back from an exclusive concentration on their particular setting to consider how they might seek to influence other settings in which individuals and populations must negotiate desired changes in nutrition and physical activity.
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Affiliation(s)
- Shawna L Mercer
- Office of Extramural Prevention Research, Public Health Practice Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
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138
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Potvin L, Cargo M, McComber AM, Delormier T, Macaulay AC. Implementing participatory intervention and research in communities: lessons from the Kahnawake Schools Diabetes Prevention Project in Canada. Soc Sci Med 2003; 56:1295-305. [PMID: 12600366 DOI: 10.1016/s0277-9536(02)00129-6] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Community public health interventions based on citizen and community participation are increasingly discussed as promising avenues for the reduction of health inequalities and the promotion of social justice. However, very few authors have provided explicit principles and guidelines for planning and implementing such interventions, especially when they are linked with research. Traditional approaches to public health programming emphasise expert knowledge, advanced detailed planning, and the separation of research from intervention. Despite the usefulness of these approaches for evaluating targeted narrow-focused interventions, they may not be appropriate in community health promotion, especially in Aboriginal communities. Using the experience of the Kahnawake Schools Diabetes Prevention Project, in Canada, this paper elaborates four principles as basic components for an implementation model of community programmes. The principles are: (1) the integration of community people and researchers as equal partners in every phase of the project, (2) the structural and functional integration of the intervention and evaluation research components, (3) having a flexible agenda responsive to demands from the broader environment, and (4) the creation of a project that represents learning opportunities for all those involved. The emerging implementation model for community interventions, as exemplified by this project, is one that conceives a programme as a dynamic social space, the contours and vision of which are defined through an ongoing negotiation process.
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Affiliation(s)
- Louise Potvin
- Kahnawake Schools Diabetes Prevention Project, P.O. Box 1000, Kahnawake Territory, Mohawk Nation, Québec, Canada J0L 1B0.
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139
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140
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Linnan LA, Emmons KM, Klar N, Fava JL, LaForge RG, Abrams DB. Challenges to improving the impact of worksite cancer prevention programs: comparing reach, enrollment, and attrition using active versus passive recruitment strategies. Ann Behav Med 2002; 24:157-66. [PMID: 12054321 DOI: 10.1207/s15324796abm2402_13] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE The impact of worksite intervention studies is maximized when reach and enrollment are high and attrition is low. Differences in reach, enrollment, and retention were investigated by comparing 2 different employee recruitment methods for a home-based cancer-prevention intervention study. METHODS Twenty-two worksites (N = 10,014 employees) chose either active or passive methods to recruit employees into a home-based intervention study. Reach (e.g., number of employees who gave permission to be called at home), Enrollment (e.g., number of employees who joined the home intervention study), and Attrition (e.g., number who did not complete the 12- and 24-month follow-ups) were determined. Analysis at the cluster level assessed differences between worksites that selected active (n = 12) versus passive (n = 10) recruitment methods on key outcomes of interest. Employees recruited by passive methods had significantly higher reach (74.5% vs. 24.4% for active) but significantly lower enrollment (41% vs. 78%) and retention (54% vs. 70%) rates (all ps < .0001). Passive methods also successfully enrolled a more diverse, high-risk employee sample. Passive (vs. active) recruitment methods hold advantages for increased reach and the ability to retain a more representative employee sample. Implications of these results for the design of future worksite studies that involve multilevel recruitment methods are discussed.
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Affiliation(s)
- Laura A Linnan
- Center for Behavioral & Preventive Medicine, Brown University Medical School, USA.
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141
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Christensen H, Griffiths KM. The prevention of depression using the Internet. Med J Aust 2002; 177:S122-5. [PMID: 12358571 DOI: 10.5694/j.1326-5377.2002.tb04871.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2002] [Accepted: 08/14/2002] [Indexed: 11/17/2022]
Abstract
Efficacy trials suggest that depression is preventable in children and adults. However, current depression prevention interventions are not deliverable to the community en masse. The Internet offers an opportunity to deliver tailored prevention interventions such as those based on cognitive behavioural therapy (CBT) to a large audience, cost-effectively, while preserving intervention fidelity and anonymity. The Internet offers distinct advantages for data collection, which can be used to help refine intervention programs. There are no published randomised controlled trials of the effectiveness of the Internet in delivering depression prevention programs. The feasibility and potential effectiveness of the Internet is indicated by research demonstrating the successful delivery of CBT by computer, the use of the Internet in the delivery of CBT treatment, and the effective prevention of obesity and the promotion of exercise using Internet technologies. Possible limitations to public health interventions using the Internet include selective access, the inability to promote the sites to potential users and the issue of uptake once users access the sites. Randomised controlled trials of CBT delivered by the Internet are required.
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Affiliation(s)
- Helen Christensen
- Centre for Mental Health Research, Australian National University, Canberra, ACT 0200, Australia.
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142
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Parslow RA, Jorm AF. Improving Australians' depression literacy. Med J Aust 2002; 177:S117-21. [PMID: 12358570 DOI: 10.5694/j.1326-5377.2002.tb04870.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2002] [Accepted: 08/15/2002] [Indexed: 11/17/2022]
Abstract
Community awareness and understanding of depression ("depression literacy") underpins successful implementation of prevention, early intervention and treatment programs. Improving depression literacy is a major goal of beyondblue: the national depression initiative. Although other countries have previously attempted to address this issue, there is little evidence to indicate that those attempts have achieved their aims. Work in other areas of health promotion, such as the widely used PRECEDE model, offers a useful framework from which to develop effective depression literacy initiatives in Australia. This model proposes that effective health promotion strategies should focus not on health actions per se, but on the knowledge and attitudes that encourage or impede individuals from taking such actions. We identify the goals of an effective depression literacy campaign and a range of educational strategies for achieving change in each of these areas. Applying these strategies may give a stronger basis for improving depression literacy than previous initiatives.
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Affiliation(s)
- Ruth A Parslow
- Centre for Mental Health Research, Australian National University, Canberra, ACT 0200, Australia.
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143
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Oldenburg B. Preventing chronic disease and improving health: broadening the scope of behavioral medicine research and practice. Int J Behav Med 2002; 9:1-16. [PMID: 12112993 DOI: 10.1207/s15327558ijbm0901_01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
There has been much progress made over the past 50 years in developing and applying the behavioral medicine evidence base to improve the health of individuals and populations. In particular, there has been progress made in applying behavioral and social science research and theories to the challenge of promoting health and disease prevention. These gains notwithstanding, not all sections of the population have benefited equally, either within or between countries. The disparities in social, mental, and physical health between the most advantaged and the most disadvantaged population groups are in the main, as great as, if not greater, than ever. This represents a tremendous challenge to all of us as behavioral medicine practitioners, teachers, and researchers. Although understanding more about the so-called upstream determinants of health that generate such health disparities is clearly very important, this knowledge will only make a difference if it is used to generate appropriate multilevel intervention strategies over a long and sustained period of time. However, such outcomes will also be affected by diverse aspects of the global natural ecological environment, and by striving for what has been described as a health-sustaining environment. With the increasing impact of globalization on most aspects of our lives, including health, it is important to consider the implications of this for preventing disease and promoting health across traditional national borders. This should challenge us to think about the importance of appropriate dissemination and diffusion of effective interventions at an institutional or policy level not only within a single country, but also between countries. Given the rapid economic and social changes occurring globally, and the tremendous impact of global environmental change on health, there is a need to broaden the scope and practice of behavioral medicine.
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Affiliation(s)
- Brian Oldenburg
- School of Public Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove QLD 4059, Australia
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144
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Abstract
BACKGROUND Women with children are less likely to engage in adequate physical activity (PA) than women without children. This study aimed to evaluate the efficacy of two strategies for promoting increased PA among mothers of preschool-aged children, and to explore the mediators of any resulting change in PA behavior. DESIGN Controlled intervention trial incorporating repeated data collection from 554 women, randomized to one of three experimental conditions. Intervention Group 1 served as a control, while women in Groups 2 and 3 were given print information about overcoming PA barriers. Women in Group 3 were also invited to discuss the development of local strategies for the promotion of PA among mothers of young children. The primary strategies included increasing partner support, social advocacy, and capacity building, and were implemented through collaboration among participants, researchers, and community organizations. MAIN OUTCOME MEASURES Adequate physical activity (PA), self-efficacy (SE) and partner support (PS). RESULTS Following the intervention, women in Group 3 were significantly more likely to meet guidelines for PA than controls (odds ratio [OR]=1.71, confidence interval [CI]=1.05-2.77)] after controlling for age and PA at baseline. After controlling for baseline PA, residualized change in SE (OR=1.86, CI=1.17-2.94) and PS (OR=2.29, CI=1.46-3.58) significantly predicted meeting guidelines. After controlling for residual change in PS and SE, the significant intervention effect was attenuated (Group 3 OR=1.40, CI=0.76-2.36), indicating that partner support and self-efficacy may be mediators of physical activity behavior change. CONCLUSIONS The findings indicate that community participation approaches that facilitate increased self-efficacy and partner support can be effective in increasing PA among mothers of young children.
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Affiliation(s)
- Yvette D Miller
- School of Human Movement Studies, University of Queensland, St. Lucia, Australia.
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145
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Johansson M, Partanen T. Role of trade unions in workplace health promotion. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2002; 32:179-93. [PMID: 11913856 DOI: 10.2190/5x81-4gkn-t905-4ett] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Since the 19th century, workers have organized in trade unions and parties to strengthen their efforts at improving workplace health and safety, job conditions, working hours, wages, job contracts, and social security. Cooperation between workers and their organizations and professionals has been instrumental in improving regulation and legislation affecting workers' health. The authors give examples of participatory research in occupational health in Denmark and Finland. The social context of workplace health promotion, particularly the role of unions and workers' safety representatives, is described in an international feasibility study. Health promotion is rife with fundamental political, socioeconomic, philosophical, ethical, gender- and ethnicity-related, psychological, and biological problems. Analysis of power and context is crucial, focusing on political systems nationally, regionally, and globally. The authors advocate defending and supporting workers and their trade unions and strengthening their influence on workplace health promotion. In the face of rapid capitalist globalization, unions represent a barricade in defense of workers' health and safety. Health promoters and related professionals are encouraged to support trade unions in their efforts to promote health for workers and other less privileged groups.
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146
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Earp JA, Eng E, O'Malley MS, Altpeter M, Rauscher G, Mayne L, Mathews HF, Lynch KS, Qaqish B. Increasing use of mammography among older, rural African American women: results from a community trial. Am J Public Health 2002; 92:646-54. [PMID: 11919066 PMCID: PMC1447131 DOI: 10.2105/ajph.92.4.646] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older. METHODS A stratified random sample of 801 African American women completed baseline (1993-1994) and follow-up (1996-1997) surveys. The primary outcome was self-reported mammography use in the previous 2 years. RESULTS The intervention was associated with an overall 6 percentage point increase (95% confidence interval [CI] = -1, 14) in community-wide mammography use. Low-income women in intervention counties showed an 11 percentage point increase (95% CI = 2, 21) in use above that exhibited by low-income women in comparison counties. Adjustment for potentially confounding characteristics did not change the results. CONCLUSIONS A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations.
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Affiliation(s)
- Jo Anne Earp
- Department of Health Behavior and Health Education, CB #7400, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7400, USA.
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147
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Christensen H, Griffiths KM, Korten A. Web-based cognitive behavior therapy: analysis of site usage and changes in depression and anxiety scores. J Med Internet Res 2002; 4:e3. [PMID: 11956035 PMCID: PMC1761927 DOI: 10.2196/jmir.4.1.e3] [Citation(s) in RCA: 179] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2001] [Accepted: 02/06/2002] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive behavior therapy is well recognized as an effective treatment and prevention for depression when delivered face-to-face, via self-help books (bibliotherapy), and through computer administration. The public health impact of cognitive behavior therapy has been limited by cost and the lack of trained practitioners. We have developed a free Internet-based cognitive behavior therapy intervention (MoodGYM, http://moodgym.anu.edu.au) designed to treat and prevent depression in young people, available to all Internet users, and targeted to those who may have no formal contact with professional help services. OBJECTIVE To document site usage, visitor characteristics, and changes in depression and anxiety symptoms among users of MoodGYM, a Web site delivering a cognitive-behavioral-based preventive intervention to the general public. METHODS All visitors to the MoodGYM site over about 6 months were investigated, including 2909 registrants of whom 1503 had completed at least one online assessment. Outcomes for 71 university students enrolled in an Abnormal Psychology course who visited the site for educational training were included and examined separately. The main outcome measures were (1) site-usage measures including number of sessions, hits and average time on the server, and number of page views; (2) visitor characteristics including age, gender, and initial Goldberg self-report anxiety and depression scores; and (3) symptom change measures based on Goldberg anxiety and depression scores recorded on up to 5 separate occasions. RESULTS Over the first almost-6-month period of operation, the server recorded 817284 hits and 17646 separate sessions. Approximately 20% of sessions lasted more than 16 minutes. Registrants who completed at least one assessment reported initial symptoms of depression and anxiety that exceeded those found in population-based surveys and those characterizing a sample of University students. For the Web-based population, both anxiety and depression scores decreased significantly as individuals progressed through the modules. CONCLUSIONS Web sites are a practical and promising means of delivering cognitive behavioral interventions for preventing depression and anxiety to the general public. However, randomized controlled trials are required to establish the effectiveness of these interventions.
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Affiliation(s)
- Helen Christensen
- The Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia.
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148
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Rychetnik L, Frommer M, Hawe P, Shiell A. Criteria for evaluating evidence on public health interventions. J Epidemiol Community Health 2002; 56:119-27. [PMID: 11812811 PMCID: PMC1732065 DOI: 10.1136/jech.56.2.119] [Citation(s) in RCA: 540] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.
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Affiliation(s)
- L Rychetnik
- Effective Healthcare Australia, School of Population Health and Health Services Research, University of Sydney, Australia.
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149
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Secker-Walker RH, Gnich W, Platt S, Lancaster T. Community interventions for reducing smoking among adults. Cochrane Database Syst Rev 2002; 2002:CD001745. [PMID: 12137631 PMCID: PMC6464950 DOI: 10.1002/14651858.cd001745] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Since smoking behaviour is determined by social context, the best way to reduce the prevalence of smoking may be to use community-wide programmes which use multiple channels to provide reinforcement, support and norms for not smoking. OBJECTIVES To assess the effectiveness of community interventions for reducing the prevalence of smoking. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group specialised register, MEDLINE (1966-August 2001) and EMBASE (1980-August 2001) and reference lists of articles. SELECTION CRITERIA Controlled trials of community interventions for reducing smoking prevalence in adult smokers. The primary outcome was smoking behaviour. DATA COLLECTION AND ANALYSIS Data were extracted by one person and checked by a second. MAIN RESULTS Thirty two studies were included, of which seventeen included only one intervention and one comparison community. Only four studies used random assignment of communities to either the intervention or comparison group. The population size of the communities ranged from a few thousand to over 100,000 people. Change in smoking prevalence was measured using cross-sectional follow-up data in 27 studies. The estimated net decline ranged from -1.0% to 3.0% for men and women combined (10 studies). For women, the decline ranged from -0.2% to + 3.5% per year (n=11), and for men the decline ranged from -0.4% to +1.6% per year (n=12). Cigarette consumption and quit rates were only reported in a small number of studies. The two most rigorous studies showed limited evidence of an effect on prevalence. In the US COMMIT study there was no differential decline in prevalence between intervention and control communities, and there was no significant difference in the quit rates of heavier smokers who were the target intervention group. In the Australian CART study there was a significantly greater quit rate for men but not women. REVIEWER'S CONCLUSIONS The failure of the largest and best conducted studies to detect an effect on prevalence of smoking is disappointing. A community approach will remain an important part of health promotion activities, but designers of future programmes will need to take account of this limited effect in determining the scale of projects and the resources devoted to them.
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Affiliation(s)
- R H Secker-Walker
- Health Promotion Research, University of Vermont, 1 South Prospect Street, Burlington, Vermont 05401-3444, USA.
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150
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Linnan LA, Sorensen G, Colditz G, Klar DN, Emmons KM. Using theory to understand the multiple determinants of low participation in worksite health promotion programs. HEALTH EDUCATION & BEHAVIOR 2001; 28:591-607. [PMID: 11575688 DOI: 10.1177/109019810102800506] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low participation at the employee or worksite level limits the potential public health impact of worksite-based interventions. Ecological models suggest that multiple levels of influence operate to determine participation patterns in worksite health promotion programs. Most investigations into the determinants of low participation study the intrapersonal, interpersonal, and institutional influences on employee participation. Community- and policy-level influences have not received attention, nor has consideration been given to worksite-level participation issues. The purpose of this article is to discuss one macrosocial theoretical perspective--political economy of health--that may guide practitioners and researchers interested in addressing the community- and policy-level determinants of participation in worksite health promotion programs. The authors argue that using theory to investigate the full spectrum of determinants offers a more complete range of intervention and research options for maximizing employee and worksite levels of participation.
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Affiliation(s)
- L A Linnan
- University of North Carolina at Chapel Hill, School of Public Health, 27599, USA.
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