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Pearson T, Wall S, Lewis C, Jenkins P, Nafziger A, Weinehall L. Dissecting the ``black box' ' of community intervention: Lessons from community-wide cardiovascular disease prevention programs in the US and Sweden. Scand J Public Health 2017. [DOI: 10.1177/14034948010290022001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- T.A. Pearson
- Department of Community and Preventive Medicine, University
of Rochester Medical Center, Rochester, New York, USA,
| | - S. Wall
- Epidemiology, Department of Public Health and Clinical
Medicine, UmeÅ University, UmeÅ, Sweden
| | - C. Lewis
- The Mary Imogene Bassett Research Institute, Cooperstown,
New York, USA
| | - P.L. Jenkins
- The Mary Imogene Bassett Research Institute, Cooperstown,
New York, USA
| | - A. Nafziger
- The Mary Imogene Bassett Research Institute, Cooperstown,
New York, USA
| | - L. Weinehall
- Epidemiology, Department of Public Health and Clinical
Medicine, UmeÅ University, UmeÅ, Sweden
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2
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Pearson T, Lewis C, Wall S, Jenkins P, Nafziger A, Weinehall L. Dissecting the ``black box' ' of community intervention: background and rationale. Scand J Public Health 2017. [DOI: 10.1177/14034948010290021301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- T.A. Pearson
- Department of Community and Preventive Medicine, University
of Rochester Medical Center, Rochester, New York, USA,
| | - C. Lewis
- The Mary Imogene Bassett Research Institute, Cooperstown,
New York, USA
| | - S. Wall
- Epidemiology, Department of Public Health and Clinical
Medicine, UmeÅ University, UmeÅ, Sweden
| | - P.L. Jenkins
- The Mary Imogene Bassett Research Institute, Cooperstown,
New York, USA
| | - A. Nafziger
- The Mary Imogene Bassett Research Institute, Cooperstown,
New York, USA
| | - L. Weinehall
- Epidemiology, Department of Public Health and Clinical
Medicine, UmeÅ University, UmeÅ, Sweden
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3
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Cheadle A, Psaty BM, Diehr P, Koepsell T, Wagner E, Wickizer T, Curry S. An Empirical Exploration of a Conceptual Model for Community-Based Health-Promotion. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2016; 13:329-63. [DOI: 10.2190/ghny-1jte-w90q-68xu] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Community-based approaches to health promotion and disease prevention are often based on underlying theoretical models of behavior change, but evaluations of these programs have not attempted to assess empirically the validity of these models. This article uses data from the Henry J. Kaiser Family Foundation Community Health Promotion Grants Program (CHPGP) evaluation to examine a conceptual model which guided the program evaluation. The model posits relationships among six theoretical constructs: community activation, program activity, norms, environment, role models, and health behaviors. Correlational analyses using two waves of survey data were used to examine whether the hypothesized relationships were actually present. Positive cross-sectional associations between the constructs at each point in time were found but the associations between changes in the constructs over time were weak. The stability of these cross-sectional patterns suggests that there may be forces leading communities to have an underlying “consistency”
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Many GM, Lutsch A, Connors KE, Shearer J, Brown HC, Ash G, Pescatello LS, Gordish-Dressman H, Barfield W, Dubis G, Houmard JA, Hoffman EP, Hittel DS. Examination of Lifestyle Behaviors and Cardiometabolic Risk Factors in University Students Enrolled in Kinesiology Degree Programs. J Strength Cond Res 2015; 30:1137-46. [PMID: 25647655 DOI: 10.1519/jsc.0000000000000871] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Preventing physical inactivity and weight gain during college is critical in decreasing lifelong obesity and associated disease risk. As such, we sought to compare cardiometabolic risk factors and lifestyle behaviors between college students enrolled in kinesiology and non-kinesiology degree programs to assess whether health and exercise degree programs may influence health behaviors and associated disease risk outcomes. Anthropometrics, fasting blood glucose, insulin, lipid profiles and HbA1c%, blood pressure, and peak oxygen consumption (V[Combining Dot Above]O2peak) were assessed in 247 healthy college students. The homeostasis model assessment of insulin sensitivity (HOMA) was calculated using glucose and insulin levels. Self-reported physical activity from the Paffenbarger questionnaire was collected to estimate the average caloric expenditure due to different types of physical activities. Despite no significant differences in body mass index or waist circumference between groups, kinesiology majors presented with ∼20% lower fasting insulin levels and HOMA (p = 0.01; p < 0.01, respectively) relative to nonmajors. Kinesiology majors reported increased weekly participation in vigorous-intensity sport and leisure activities and, on average, engaged in >300 metabolic equivalent-h·wk, whereas non-kinesiology majors engaged in <300 MET-h wk (p = 0.01). Our data suggest that students enrolled in kinesiology degree programs display improved healthy behaviors and associated outcomes (parameters of glucose homeostasis). Practical outcomes of this research indicate that implementing components of a comprehensive kinesiology curriculum encourages improved health behaviors and associated cardiometabolic risk factors.
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Affiliation(s)
- Gina M Many
- 1Children's National Medical Center, Research Center for Genetic Medicine, Washington, District of Columbia; 2Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; 3Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; 4Human Performance Laboratory, College of Agriculture, Health and Natural Resources, University of Connecticut, Storrs, Connecticut; and 5Human Performance Laboratory, East Carolina University, Greenville, North Carolina
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Maatoug J, Harrabi I, Gaha R, Chaieb L, Mrizek N, Amimi S, Boughammoura L, Jeridi G, Gamra H, Ghannem H. Three Year Community Based Intervention for Chronic Disease Prevention in Epidemiological and Political Transition Context: Example of Tunisia. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojpm.2015.58036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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6
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Feldman DB, Sills JR. Hope and cardiovascular health-promoting behaviour: Education alone is not enough. Psychol Health 2013; 28:727-45. [DOI: 10.1080/08870446.2012.754025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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7
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Affiliation(s)
- Deborah Dowell
- New York City Department of Health and Mental Hygiene, New York City, NY 11101, USA.
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8
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Ford ES, Capewell S. Proportion of the decline in cardiovascular mortality disease due to prevention versus treatment: public health versus clinical care. Annu Rev Public Health 2011; 32:5-22. [PMID: 21417752 DOI: 10.1146/annurev-publhealth-031210-101211] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mortality rates from coronary heart disease (CHD), which had risen during the twentieth century in many countries, started declining in some countries during the 1960s. Once initial skepticism about the validity of the observed trends dissipated, researchers attempted to generate explanations about the events that had transpired using a variety of techniques, including ecological examinations of the trends in risk factors for CHD and changes in management of CHD, multivariate risk equations, and increasingly sophisticated modeling techniques. Improvements in risk factors as well as changes in cardiac treatments have both contributed to the reductions in CHD mortality, although estimates of their contributions have varied among countries. Models suggest that additional large reductions in CHD mortality are feasible by either improving the distribution of risk factors in the population or raising the percentage of patients receiving evidence-based treatments.
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Affiliation(s)
- Earl S Ford
- Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Carson KV, Brinn MP, Labiszewski NA, Esterman AJ, Chang AB, Smith BJ. Community interventions for preventing smoking in young people. Cochrane Database Syst Rev 2011:CD001291. [PMID: 21735383 DOI: 10.1002/14651858.cd001291.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cigarette smoking is one of the leading causes of preventable death in the world. Decisions to smoke are often made within a broad social context and therefore community interventions using coordinated, multi-component programmes may be effective in influencing the smoking behaviour of young people. OBJECTIVES To determine the effectiveness of multi-component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people. SEARCH STRATEGY The Tobacco Addiction group's specialised register, Medline and other health, psychology and public policy electronic databases were searched, the bibliographies of identified studies were checked and raw data was requested from study authors. Searches were updated in August 2010. SELECTION CRITERIA Randomized and non randomized controlled trials that assessed the effectiveness of multi-component community interventions compared to no intervention or to single component or school-based programmes only. Reported outcomes had to include smoking behaviour in young people under the age of 25 years. DATA COLLECTION AND ANALYSIS Information relating to the characteristics and the content of community interventions, participants, outcomes and methods of the study was extracted by one reviewer and checked by a second. Studies were combined in a meta-analysis where possible and reported in narrative synthesis in text and table. MAIN RESULTS Twenty-five studies were included in the review and sixty-eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short-term smoking prevalence (twelve months or less), while nine studies detected significant long-term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions. AUTHORS' CONCLUSIONS There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws.
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Affiliation(s)
- Kristin V Carson
- Clinical Practice Unit, The Queen Elizabeth Hospital, 4A Main Building, 28 Woodville Road Woodville South, Adelaide, South Australia, Australia, 5011
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Krishnan A, Ekowati R, Baridalyne N, Kusumawardani N, Kapoor SK, Leowski J. Evaluation of community-based interventions for non-communicable diseases: experiences from India and Indonesia. Health Promot Int 2010; 26:276-89. [PMID: 21071458 DOI: 10.1093/heapro/daq067] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
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11
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Karwalajtys T, Kaczorowski J. An integrated approach to preventing cardiovascular disease: community-based approaches, health system initiatives, and public health policy. Risk Manag Healthc Policy 2010; 3:39-48. [PMID: 22312217 PMCID: PMC3270919 DOI: 10.2147/rmhp.s7528] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Cardiovascular disease (CVD) is largely the product of interactions among modifiable risk factors that are common in developed nations and increasingly of concern in developing countries. Hypertension is an important precursor to the development of CVD, and although detection and treatment rates have improved in recent years in some jurisdictions, effective strategies and policies supporting a shift in distribution of risk factors at the population level remain paramount. Challenges in managing cardiovascular health more effectively include factors at the patient, provider, and system level. Strategies to reduce hypertension and CVD should be population based, incorporate multilevel, multicomponent, and socioenvironmental approaches, and integrate community resources with public health and clinical care. There is an urgent need to improve monitoring and management of risk factors through community-wide, primary care-linked initiatives, increase the evidence base for community-based prevention strategies, further develop and evaluate promising program components, and develop new approaches to support healthy lifestyle behaviors in diverse age, socioeconomic, and ethnocultural groups. Policy and system changes are critical to reduce risk in populations, including legislation and public education to reduce dietary sodium and trans-fatty acids, food pricing policies, and changes to health care delivery systems to explicitly support prevention and management of CVD.
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Affiliation(s)
- Tina Karwalajtys
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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12
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Abstract
Review of the community-based CVD intervention programs suggests that a number of components have been successful using varying methods and materials for CVD risk reduction. It should be noted, however, that in multi-intervention programs it is often difficult to determine which components of the intervention were responsible for the overall success of the study. The community-based approach to CVD prevention is generalizable, cost-effective (because of the use of mass communication methods), and has the potential for modifying the environment and influencing health policies. Based on the experiences and successes of a number of community projects, recommendations have been proposed for developing future programs. Although they are not totally comprehensive, it has been suggested that a community-based intervention program should consider the following recommendations: 1) An understanding of the community: the needs and priorities of the community should be assessed, and close collaboration with individuals from the community, including community leaders, opinion leaders, community health care providers, and community organizations from various sectors of the community, should be consulted. Efforts should be focused on underserved and vulnerable populations. 2) Inclusion of community activities: these activities should be integrated within the context of the community environment, including primary health care services, voluntary organizations, grocery stores, restaurants, work sites, schools, and local media. 3) Inclusion mass media messages: the mass media can provide information and reinforcement of the behavior change. 4) Develop cost-effective interventions to assure that the community is exposed to an effective dose of the intervention. 5) Work with community organizations to help change social and physical environments to make them more conducive to health and healthy life-styles changes. 6) Develop a reliable monitoring and evaluation system: monitor the change process and conduct summary evaluations. 7) Disseminate the results to ensure that the benefits from the community program reach all communities. 8) For national implementation, the intervention program should work closely with national policy makers throughout the project.
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Affiliation(s)
- Donna R Parker
- Department of Community Health, Brown Medical School, Providence, RI 02912, USA.
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Verheijden MW, Kok FJ. Public health impact of community-based nutrition and lifestyle interventions. Eur J Clin Nutr 2005; 59 Suppl 1:S66-75; discussion S76. [PMID: 16052198 DOI: 10.1038/sj.ejcn.1602176] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Community-based interventions have increasingly received attention since researchers and public health professionals have come to acknowledge the importance of an environment that makes the healthy choice the easy choice. All stakeholders including the target community are involved to achieve changes in legislation, in people's social and physical context, and in individual characteristics that support healthy diets and other lifestyles. Some early large-scale community-based heart health interventions showed promising results. The Stanford Five City Project, for example, showed net improvements in knowledge of coronary heart disease risk factors of approximately 12%. Net declines in smoking prevalence (14%), cholesterol (2%), and systolic (3%) and diastolic (5%) blood pressure were also observed. Most later studies did not replicate these findings and it was therefore suggested that community-based interventions, which require substantial commitment and resources, may be less effective than approaches targeting high-risk groups. We present the rationale and theories for community-based interventions, and then elaborate on the methodological challenges in the design and the outcome and process evaluation of community-based interventions. We provide an overview of some of the evidence on the effectiveness of community-based heart health interventions and conclude with the perspectives for community-based interventions in future research and practice.
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Affiliation(s)
- M W Verheijden
- TNO Quality of Life/Work and Employment, Hoofddorp, The Netherlands.
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Schwamm LH, Pancioli A, Acker JE, Goldstein LB, Zorowitz RD, Shephard TJ, Moyer P, Gorman M, Johnston SC, Duncan PW, Gorelick P, Frank J, Stranne SK, Smith R, Federspiel W, Horton KB, Magnis E, Adams RJ. Recommendations for the establishment of stroke systems of care: recommendations from the American Stroke Association's Task Force on the Development of Stroke Systems. Circulation 2005; 111:1078-91. [PMID: 15738362 DOI: 10.1161/01.cir.0000154252.62394.1e] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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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Schwamm LH, Pancioli A, Acker JE, Goldstein LB, Zorowitz RD, Shephard TJ, Moyer P, Gorman M, Johnston SC, Duncan PW, Gorelick P, Frank J, Stranne SK, Smith R, Federspiel W, Horton KB, Magnis E, Adams RJ. Recommendations for the Establishment of Stroke Systems of Care. Stroke 2005; 36:690-703. [PMID: 15689577 DOI: 10.1161/01.str.0000158165.42884.4f] [Citation(s) in RCA: 232] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nishtar S, Mirza YA, Jehan S, Hadi Y, Badar A, Yusuf S, Shahab S. Newspaper articles as a tool for cardiovascular prevention programs in a developing country. JOURNAL OF HEALTH COMMUNICATION 2004; 9:355-369. [PMID: 15371087 DOI: 10.1080/10810730490468603] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The purpose of this study was to evaluate changes in knowledge and attitudes as intermediate measures of community impact of a health education campaign using newspaper articles. The intervention involved prominently placed, illustrated newspaper articles by Heartfile (heartfile.org) with nationwide urban outreach, posted regularly in the largest English newspaper in Pakistan using newspaper donated space for a period of 130 consecutive weeks. The post intervention evaluation involved a cross sectional telephone survey in a major city. In the total sample, 26.5% were readers of the newspaper and majority of them (72%) stated that they were regular readers. These 500 persons were eligible for the interview; of these, 93% remembered having seen the Heartfile articles. In this group, 87% of the respondents stated that the articles significantly supplemented their knowledge about diet, and in 5% they were the sole source of information. With respect to exercise, these articles supplemented the knowledge of 77% of the respondents and were the sole source of information for 9% whereas in the case of smoking, knowledge was supplemented in 85% and the articles were the sole source of information in 4% of the cases. Of those interviewed, 40% reported that they had made some dietary changes, 39% made some changes in their exercise habits and 8% reduced the amount of tobacco consumption as a result of reading these articles. In relation to newspaper articles, the per article production cost was US$ 169 and the articles were read regularly by an estimated 0.66 million and occasionally by 0.79 million individuals all over the country. Newspaper articles are a useful supplement to other health education activities as part of cardiovascular disease prevention programs. Lessons from the Heartfile experience in Pakistan could be useful for other similar initiatives in low resource settings.
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Nakkash R, Afifi Soweid RA, Nehlawi MT, Shediac-Rizkallah MC, Hajjar TA, Khogali M. The development of a feasible community-specific cardiovascular disease prevention program: triangulation of methods and sources. HEALTH EDUCATION & BEHAVIOR 2004; 30:723-39. [PMID: 14655866 DOI: 10.1177/1090198103255521] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Triangulation of methods, sources, and investigators can lead to a multidimensional understanding of a particular issue. In this study, the combination of qualitative and quantitative data collection methods, and information from community and coalition members resulted in the development of a tailored community-specific intervention. Three components were triangulated after analyzing each separately. A household survey of community members between the ages of 25 and 64 years was conducted to identify knowledge, attitudes, and behaviors related to cardiovascular disease and to assess risk factor levels. Focus group discussions were conducted with community members to describe facilitators and barriers to healthy lifestyles, as well as possible interventions. Natural group discussions with coalition members analyzed the relevance, feasibility, affordability, acceptability, and sustainability of specific intervention activities. Results from the different components were compared and contrasted. Areas of added information, validation, and contradiction were analyzed and guided the development of intervention activities.
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Affiliation(s)
- Rima Nakkash
- Department of Family Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
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Knox KL, Conwell Y, Caine ED. If suicide is a public health problem, what are we doing to prevent it? Am J Public Health 2004; 94:37-45. [PMID: 14713694 PMCID: PMC1449822 DOI: 10.2105/ajph.94.1.37] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2003] [Indexed: 11/04/2022]
Abstract
Although not a disease, suicide is a tragic endpoint of complex etiology and a leading cause of death worldwide. Just as preventing heart disease once meant that specialists treated myocardial infarctions in emergency care settings, in the past decade, suicide prevention has been viewed as the responsibility of mental health professionals within clinical settings. By contrast, over the past 50 years, population-based risk reduction approaches have been used with varying levels of effectiveness to prevent morbidity and mortality associated with heart disease. We examined whether the current urgency to develop effective interventions for suicide prevention can benefit from an understanding of the evolution of population-based strategies to prevent heart disease.
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Affiliation(s)
- Kerry L Knox
- Department of Community and Preventive Medicine, University of Rochester, Rochester, NY 14642, USA.
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Burnet D, Plaut A, Courtney R, Chin MH. A practical model for preventing type 2 diabetes in minority youth. DIABETES EDUCATOR 2003; 28:779-95. [PMID: 14625964 DOI: 10.1177/014572170202800519] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This article proposes a model grounded in behavioral theory and empirical evidence for use when developing a program to prevent type 2 diabetes in high-risk minority youth. METHODS The model is based on key concepts of 4 behavioral theories: the Health Belief Model, Social Learning Theory, the Theory of Planned Behavior, and the Ecological Model. Determinants of behavior to target for change are selected based on their theoretical link to behavior change, their success in changing behavior in past programs, and through thorough formative research in the target community. RESULTS Diabetes prevention in children requires modifying a complex set of behavior patterns. Social norms and the environment are especially important in children in whom cognitive processes have not fully developed. Family and community involvement is essential for developing a health program and providing a supportive environment in which to change behavior and ongoing reinforcement to maintain behavior changes. CONCLUSIONS Behavioral theory informs the selection of factors to target in a behavioral intervention. Special considerations apply when working with children. A program to target risk must be based in behavioral theory, supported by practical data, and tailored to the needs and beliefs of the target community.
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Affiliation(s)
- Deborah Burnet
- The University of Chicago Departments of Medicine and Pediatrics, Chicago, Illinois (Dr Burnet)
| | - Andrea Plaut
- The University of Chicago Diabetes Research and Training Center, Chicago, Illinois (Ms Plaut and Dr Chin)
| | - Rachel Courtney
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois (Ms Courtney)
| | - Marshall H Chin
- The University of Chicago Diabetes Research and Training Center, Chicago, Illinois (Ms Plaut and Dr Chin)
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Affiliation(s)
- Kenneth McLeroy
- Kenneth McLeroy, James Burdine, and Ciro Sumaya are with the Texas A&M University System School of Rural Public Health, Bryan. Barbara Norton is a doctoral candidate at the University of Oklahoma School of Public Health, Oklahoma City. Michelle Kegler is with Emory University School of Public Health, Atlanta, Ga
| | - Barbara Norton
- Kenneth McLeroy, James Burdine, and Ciro Sumaya are with the Texas A&M University System School of Rural Public Health, Bryan. Barbara Norton is a doctoral candidate at the University of Oklahoma School of Public Health, Oklahoma City. Michelle Kegler is with Emory University School of Public Health, Atlanta, Ga
| | - Michelle Kegler
- Kenneth McLeroy, James Burdine, and Ciro Sumaya are with the Texas A&M University System School of Rural Public Health, Bryan. Barbara Norton is a doctoral candidate at the University of Oklahoma School of Public Health, Oklahoma City. Michelle Kegler is with Emory University School of Public Health, Atlanta, Ga
| | - James Burdine
- Kenneth McLeroy, James Burdine, and Ciro Sumaya are with the Texas A&M University System School of Rural Public Health, Bryan. Barbara Norton is a doctoral candidate at the University of Oklahoma School of Public Health, Oklahoma City. Michelle Kegler is with Emory University School of Public Health, Atlanta, Ga
| | - Ciro Sumaya
- Kenneth McLeroy, James Burdine, and Ciro Sumaya are with the Texas A&M University System School of Rural Public Health, Bryan. Barbara Norton is a doctoral candidate at the University of Oklahoma School of Public Health, Oklahoma City. Michelle Kegler is with Emory University School of Public Health, Atlanta, Ga
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Merzel CR. MERZEL RESPONDS. Am J Public Health 2003. [DOI: 10.2105/ajph.93.8.1201-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Cheryl R. Merzel
- The author is with the Center for Applied Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
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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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Abstract
BACKGROUND Decisions to smoke are made within a broad social context. Community interventions use co-ordinated, widespread, multi-component programmes to try and influence behaviour. OBJECTIVES To determine the effectiveness of community interventions in preventing the uptake of smoking in young people. SEARCH STRATEGY The Tobacco Addiction group specialised register, Medline and other health, psychology and public policy electronic databases were searched, the bibliographies of identified studies were checked and contact was made with content area specialists. Searches were updated in September 2002. SELECTION CRITERIA Randomised and non randomised controlled trials that assessed the effectiveness of multi-component community interventions compared to no intervention or to single component or school-based programmes only. Reported outcomes had to include smoking behaviour in young people under the age of 25 years. DATA COLLECTION AND ANALYSIS Information relating to the characteristics and the content of community interventions, participants, outcomes and methods of the study was extracted by one reviewer and checked by a second. Studies were combined using qualitative narrative synthesis. MAIN RESULTS Seventeen studies were included in the review, 46 studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with six using random allocation of schools or communities. Of thirteen studies which compared community interventions to no intervention controls, two, which were part of cardiovascular disease prevention programmes, reported lower smoking prevalence. Of three studies comparing community interventions to school-based programmes only, one found differences in reported smoking prevalence. One study reported a lower rate of increase in prevalence in a community receiving a multi-component intervention compared to a community exposed to a mass media campaign alone. One study reported a significant difference in smoking prevalence between a group receiving a media, school and homework intervention compared to a group receiving the media component only. REVIEWER'S CONCLUSIONS There is some limited support for the effectiveness of community interventions in helping prevent the uptake of smoking in young people.
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Affiliation(s)
- A Sowden
- NHS Centre for Reviews and Dissemination, University of York, York, UK, YO10 5DD.
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Ades PA, Kottke TE, Miller NH, McGrath JC, Record NB, Record SS. Task force #3--getting results: who, where, and how? 33rd Bethesda Conference. J Am Coll Cardiol 2002; 40:615-30. [PMID: 12204491 DOI: 10.1016/s0735-1097(02)02084-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Philip A Ades
- Division of Cardiology, Medical Center Hospital Vermont, Burlington 05401, USA
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Richard L, Gauvin L, Potvin L, Denis JL, Kishchuk N. Making youth tobacco control programs more ecological: organizational and professional profiles. Am J Health Promot 2002; 16:267-79. [PMID: 12053438 DOI: 10.4278/0890-1171-16.5.267] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify the organizational and professional correlates of the integration of the ecological approach in Canadian public health organizations' tobacco control programs for youth. DESIGN Cross-sectional survey. SETTING Canadian public health organizations. SUBJECTS One hundred and ten tobacco control programs implemented in 90 organizations. The response rate for the organizations was 87%. MEASURES Descriptions of programs were obtained by telephone interviews. An analytical procedure was applied to the program data to identify intervention settings, targets and strategies for each program. Using this information, a summary score of the integration of the ecological approach was estimated for each program. Organizational and professional variables were assessed by self-administered questionnaires to managers and professionals involved in these programs. RESULTS The level of integration of the ecological approach in programs was related to organizational (frequency of contacts and collaborations with external partners, team composition) and extraorganizational factors (size of the city in which the public health unit is located). Cognitive attributes of the practitioners (knowledge and beliefs) also emerged as significant predictors. Finally, positive associations were observed between practitioners' personal characteristics (educational achievement, working status in health promotion [full vs. part-time], previous experience, gender, and disciplinary/professional background) and cognitive predictors. CONCLUSIONS Organizational environment and staff preparation play a critical role in the adoption of the ecological approach in tobacco control programs.
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Affiliation(s)
- Lucie Richard
- Université de Montréal, Faculty of Nursing, PO Box 6128, Station Centre-Ville, Montréal, Québec, H3C 3J7 Canada
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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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Record NB, Harris DE, Record SS, Gilbert-Arcari J, DeSisto M, Bunnell S. Mortality impact of an integrated community cardiovascular health program. Am J Prev Med 2000; 19:30-8. [PMID: 10865161 DOI: 10.1016/s0749-3797(00)00164-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Preventing cardiovascular disease through community interventions makes theoretical sense but has been difficult to demonstrate. We set out to determine whether a community cardiovascular health program had an impact on mortality. DESIGN Program evaluation plus ecologic observational analysis of program encounters and mortality rates with external comparisons. SETTING Franklin County and two comparison counties in rural Maine. PARTICIPANTS Program encountered >50% of regional adults, broadly distributed by site, gender, and age. INTERVENTIONS From 1974 to 1994, a community program, integrated with primary medical care and staffed by professional nurses, provided education, screening, counseling, referral, tracking, and follow-up for cardiovascular risk factors. MAIN OUTCOME MEASURES Age-adjusted mortality rates (total, heart, coronary, cerebrovascular, cancer) for three counties and Maine, plus annual program encounters. RESULTS Relative to Maine, the Franklin heart disease death rate was 0.97 at baseline (1960-1969; 95% confidence interval, 0.91 to 1.03), 0.91 during the program (0.85 to 0.97), 0.83 during the 11 years of program growth (0.78 to 0.88), but 1.0 during the 10 years of decreasing encounters. Franklin's total death rate was 1.01 at baseline, 0.95 during the program (0.92 to 0.98), and 0.90 during program growth (0.86 to 0. 94). Results were similar for coronary disease, stroke, and cancer. Relative death rates did not fall in either comparison county. Nurse-client encounters totaled 120,280 over 21 years. Relative to Maine, heart disease death rates correlated inversely with program encounters (r = -0.53) but not with unemployment or physician supply. CONCLUSIONS Integrated with primary medical care, a comprehensive, nurse-mediated community cardiovascular health program in rural Maine has been associated with significant time-dependent and dose-dependent reductions in cardiovascular and total mortality.
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Affiliation(s)
- N B Record
- Western Maine Center for Heart Health, Franklin Memorial Hospital, Farmington, Maine 04938, USA.
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Giesbrecht N, Rankin J. Reducing alcohol problems through community action research projects: contexts, strategies, implications, and challenges. Subst Use Misuse 2000; 35:31-53. [PMID: 10677874 DOI: 10.3109/10826080009147685] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Community-based action research projects may include a number of challenges. The secular context may impede a project; for example, reducing aggregate rates of drinking-related problems may involve curtailing very popular high-risk drinking occasions. These projects may also embrace important but unrealistic goals, require matching competing goals emerging from multifoci project teams, or involve convoluted funding arrangements. Attention to team development, priority setting, and project design and evaluation issues is essential. Many projects downplay conceptual issues, such as understanding the nature of communities, organizations, systems, their operation, and social change and prevention models. Focus populations, community members and leaders, change agents team members, funding agencies, and policymakers can benefit from these projects.
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Affiliation(s)
- N Giesbrecht
- Addiction Research Foundation Division, Centre for Addiction & Mental Health, Toronto, Ontario, Canada.
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Wallerstein N. Power between evaluator and community: research relationships within New Mexico's healthier communities. Soc Sci Med 1999; 49:39-53. [PMID: 10414839 DOI: 10.1016/s0277-9536(99)00073-8] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The relationship between evaluators and communities has been changing in the last two decades to a model of research 'with' the community, instead of research 'on' the community. This shift has paralleled increasing community demands for accountability and authority as community participation rhetoric has given way to words such as partnership, collaboration and community empowerment. Despite the rhetoric, there has been little reflection on the problematic and contradictory relationships between communities and researchers, specifically as related to their differing positions of power. This article provides a reflective examination of the contested power dynamics of the research relationship within a participatory evaluation process of the Healthier Communities initiative in New Mexico. An in-depth literature review of the philosophical principles and the complex realities of evaluations based on participatory, community-driven and post-modern inquiry precedes the case study. Without ongoing consideration of power issues, the article argues that evaluation design, implementation and utilization of findings will be compromised.
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Affiliation(s)
- N Wallerstein
- Department of Family and Community Medicine, University of New Mexico, Albuquerque 87131, USA.
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Weber Cullen K, Kay Bartholomew L, Parcel GS, Kok G. Intervention Mapping: Use of Theory and Data in the Development of a Fruit and Vegetable Nutrition Program for Girl Scouts. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0022-3182(98)70318-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sorensen G, Emmons K, Hunt MK, Johnston D. Implications of the results of community intervention trials. Annu Rev Public Health 1998; 19:379-416. [PMID: 9611625 DOI: 10.1146/annurev.publhealth.19.1.379] [Citation(s) in RCA: 182] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper examines the results of population-level interventions conducted in three settings: entire communities, worksites, and schools. Four major conclusions are discussed: (a) Directions for the next generation of community-based interventions include targeting multiple levels of influence; addressing social inequalities in disease risk; involving communities in program planning and implementation; incorporating approaches for "tailoring" interventions; and utilizing rigorous process evaluation. (b) In addition to randomized controlled trials, it is time to use the full range of research phases available, from hypothesis generation and methods development to dissemination research. (c) The public health research agenda may have contributed to observed secular trends by placing behavioral risk factors on the social and media agendas. (d) The magnitude of the results of community intervention trials must be judged according to their potential public health or population-level effects. Small changes at the individual level may result in large benefits at the population level.
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Affiliation(s)
- G Sorensen
- Dana-Farber Cancer Institute, Center for Community-Based Research, Boston, Massachusetts 02115, USA.
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33
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Schooler C, Farquhar JW, Fortmann SP, Flora JA. Synthesis of findings and issues from community prevention trials. Ann Epidemiol 1997. [DOI: 10.1016/s1047-2797(97)80008-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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34
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Sellers DE, Crawford SL, Bullock K, McKinlay JB. Understanding the variability in the effectiveness of community heart health programs: a meta-analysis. Soc Sci Med 1997; 44:1325-39. [PMID: 9141165 DOI: 10.1016/s0277-9536(96)00263-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Over the past 25 years, community interventions to reduce cardiovascular disease (CVD) have been conducted around the world with very mixed results. This study uses meta-analysis to assess whether the variation in the observed effectiveness of community heart health programs (CHHP) is related to characteristics of the intervention program, the population under study, or the evaluation methods. A CHHP is defined as any primary prevention program that attempted to reduce the population burden of CVD by shifting the distribution of risk factors in a general population. To be included in the meta-analysis, a study must have utilized a reference group in the evaluation, employed a repeated independent cross-sectional measurement design, and reported sufficient outcome information for at least one of four major risk factors: smoking, total cholesterol, blood pressure, and body weight. Results of these studies are summarized with the effect size measure (Yi1-Yi2)-(Yr1-Yr2)Sr1 where Y = outcome measure, S = standard deviation of the outcome measure, 1 = baseline, 2 = follow-up. i = intervention, and r = reference community. This measure, which reports the net change in the intervention group in terms of the variability in the reference population before the start of the intervention, permits comparison across different outcome measures and facilitates the aggregation of effects across studies. Generalized least squares regression, which permits the incorporation of multiple, dependent effect sizes from a single study, was used to assess the impact of characteristics of the intervention (prevention strategy, type of mass communication, community organization, and environmental change), the population (setting, gender, year of follow-up measurement), and the evaluation design and implementation (the number of communities, matching of communities, the follow-up time, the response rate, and covariate adjustment in the analysis) on the effect sizes. The results of this analysis suggest that the characteristics of the evaluation method account for much of the heterogeneity in the outcome of CHHPs, though some intervention characteristics also play a role.
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Affiliation(s)
- D E Sellers
- New England Research Institutes, Watertown, MA 02172, USA
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35
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Patterson RE, Kristal AR, Shannon J, Hunt JR, White E. Using a brief household food inventory as an environmental indicator of individual dietary practices. Am J Public Health 1997; 87:272-5. [PMID: 9103109 PMCID: PMC1380806 DOI: 10.2105/ajph.87.2.272] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study examined whether foods in household pantries are an indicator of house-hold members' diet. METHODS In a random-digit-dial survey, the presence in the house of 15 high-fat foods was assessed with whoever answered the phone. A randomly selected household member was surveyed about diet-related behaviors (n = 1002). RESULTS Individuals in the precontemplation stage of dietary change had more high-fat foods in their pantry than those in maintenance (means of 7.4 and 5.8, respectively). Individuals with low-fat pantries had an intake of 32% energy from fat vs 37% for those with high-fat pantries. CONCLUSIONS Household food inventories are a practical and valid approach to monitoring dietary behaviors in community-based studies.
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Affiliation(s)
- R E Patterson
- Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98104, USA
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Abstract
In this article, human ecology is defined; its historical and intellectual roots are traced through various disciplines to its applications in public health and health promotion today; its strengths and limitations are described; some potential contributions of systems theory are suggested; and some emerging ecological models of health promotion are anticipated.
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Affiliation(s)
- L W Green
- Institute of Health Promotion Research, Vancouver, Canada
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37
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Brownson RC, Smith CA, Pratt M, Mack NE, Jackson-Thompson J, Dean CG, Dabney S, Wilkerson JC. Preventing cardiovascular disease through community-based risk reduction: the Bootheel Heart Health Project. Am J Public Health 1996; 86:206-13. [PMID: 8633737 PMCID: PMC1380329 DOI: 10.2105/ajph.86.2.206] [Citation(s) in RCA: 134] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES The purpose of this study was to determine whether a community-based risk reduction project affected behavioral risk factors for cardiovascular disease. METHODS Community-based activities (e.g., exercise groups, healthy cooking demonstrations, blood pressure and cholesterol screenings, and cardiovascular disease education) were conducted in six southeastern Missouri counties. Evaluation involved population-based, cross-sectional samples of adult residents of the state and the intervention region. Weighted prevalence estimates were calculated for self-reported physical inactivity, cigarette smoking, consumption of fruits and vegetables, overweight, and cholesterol screening. RESULTS Physical inactivity decreased within the intervention region, that is, in communities where heart health coalitions were developed and among respondents who were aware of these coalitions. In addition, the prevalence rates for reports of cholesterol screening within the past 2 years were higher for respondents in areas with coalitions and among persons who were aware of the coalitions. CONCLUSIONS Even with modest resources, community-based interventions show promise in reducing self-reported risk for cardiovascular disease within a relatively brief period.
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Affiliation(s)
- R C Brownson
- Department of Community Health, Saint Louis University, Mo., USA
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38
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Shea S, Basch CE, Wechsler H, Lantigua R. The Washington Heights-Inwood Healthy Heart Program: a 6-year report from a disadvantaged urban setting. Am J Public Health 1996; 86:166-71. [PMID: 8633731 PMCID: PMC1380323 DOI: 10.2105/ajph.86.2.166] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES This report summarizes 6 years of experience in a large community-based cardiovascular disease prevention program in a predominately minority, urban setting. METHODS The program seeks to reduce cardiovascular disease risk factors in an area of approximately 240,000 people in New York, NY; this population includes many Latino immigrants of low educational attainment and socioeconomic status. All program materials were in Spanish and English and at a low literacy level. RESULTS Major elements that achieved high levels of reach and support were a marketing campaign promoting low-fat milk, exercise clubs, and a Spanish-language smoking cessation video. Program elements that did not meet expectations or were abandoned were school-based smoking prevention initiatives, cholesterol screening, and efforts to involve local physicians. At the end of 6 years, the program was transferred to a local community organization. CONCLUSIONS Conclusions are that it is feasible to implement a complex cardiovascular disease prevention program in a socially disadvantaged urban community; that additional evaluation research is needed; that such programs can be transferred from an academic center to a community organization; and that such programs are unlikely to be sustained effectively without external resources.
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Affiliation(s)
- S Shea
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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40
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Gorman DM, Speer PW. Preventing alcohol abuse and alcohol-related problems through community interventions: A review of evaluation studies. Psychol Health 1996. [DOI: 10.1080/08870449608401978] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Speers MA, Schmid TL. Policy and environmental interventions for the prevention and control of cardiovascular diseases. HEALTH EDUCATION QUARTERLY 1995; 22:476-7. [PMID: 8550371 DOI: 10.1177/109019819502200405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M A Speers
- Division of Chronic Disease Control and Community Intervention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Bruhn JG. Beyond discipline: creating a culture for interdisciplinary research. INTEGRATIVE PHYSIOLOGICAL AND BEHAVIORAL SCIENCE : THE OFFICIAL JOURNAL OF THE PAVLOVIAN SOCIETY 1995; 30:331-41. [PMID: 8788229 DOI: 10.1007/bf02691605] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Interdisciplinary research is not a common research paradigm. To venture from their customary disciplinary tenets and methods and risk new methodological approaches, or to compromise in order to accommodate the differences in the way disciplines approach research, requires the commitment of investigators. This paper discusses the interdisciplinary research paradigm, its culture, and how it differs from traditional research methods, and provides examples of successful and unsuccessful interdisciplinary research projects.
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Affiliation(s)
- J G Bruhn
- Penn State, Harrisburg, Middletown 17057-4898, USA
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Schmid TL, Pratt M, Howze E. Policy as intervention: environmental and policy approaches to the prevention of cardiovascular disease. Am J Public Health 1995; 85:1207-11. [PMID: 7661226 PMCID: PMC1615578 DOI: 10.2105/ajph.85.9.1207] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This paper describes the evolution of efforts to prevent cardiovascular disease, from individual health education approaches to broader community education efforts and, finally, to comprehensive and integrated programs addressing environmental, policy, and individual behavior change. Policies are divided into two areas: legislation/regulation and organizational policy. Environmental strategies are measures that alter or control the physical or social environment. Dimensions along which these strategies might be implemented are provided. Policy and environmental approaches can be justified on economic, strategic, and theoretical grounds. Experiences from other fields and other countries provide a framework for conceptualizing cardiovascular disease prevention approaches.
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Affiliation(s)
- T L Schmid
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA
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Crowley S, Dunt D, Day N. Cost-effectiveness of alternative interventions for the prevention and treatment of coronary heart disease. AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1995; 19:336-46. [PMID: 7578533 DOI: 10.1111/j.1753-6405.1995.tb00384.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although mortality from coronary heart disease (CHD) in Australia has fallen dramatically since the 1960s, it still remains the major cause of death in Australia and poses a significant burden on the economy. Even though a number of studies have concluded that prevention has been the main determinant of the declines in CHD, a disproportionate amount of health-care expenditure is devoted to treatment rather than prevention. This paper reviews the international literature on the economic appraisal (costs and benefits) of alternative interventions for the treatment and prevention of CHD with the view of assessing whether there is sufficient evidence to justify a reallocation of resources away from treatment to prevention. First, few studies on the economic evaluation of CHD prevention and treatment programs have been undertaken in Australia, with most being from the United States and Europe. Second, assumptions about the specification, measurement and valuation of costs, and the epidemiological evidence on program effectiveness have varied. Third, health promotion and prevention programs are not necessarily more cost-effective than drug or surgical treatments for CHD. Individual interventions must be judged on their own merits. There is a need for a systematic evaluation of interventions for CHD using primary Australian data to better inform decision making on resource-allocation priorities. Such an evaluation should incorporate economic evaluation techniques.
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Affiliation(s)
- S Crowley
- NHMRC Centre for Health Program Evaluation, Melbourne
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45
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Diehr P, Martin DC, Koepsell T, Cheadle A. Breaking the matches in a paired t-test for community interventions when the number of pairs is small. Stat Med 1995; 14:1491-504. [PMID: 7481187 DOI: 10.1002/sim.4780141309] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
There is considerable interest in community interventions for health promotion, where the community is the experimental unit. Because such interventions are expensive, the number of experimental units (communities) is usually small. Because of the small number of communities involved, investigators often match treatment and control communities on demographic variables before randomization to minimize the possibility of a bad split. Unfortunately, matching has been shown to decrease the power of the design when the number of pairs is small, unless the matching variable is very highly correlated with the outcome variable (in this case, with change in the health behaviour). We used computer simulation to examine the performance of an approach in which we matched communities but performed an unmatched analysis. If the appropriate matching variables are unknown, and there are fewer than ten pairs, an unmatched design and analysis has the most power. If, however, one prefers a matched design, then for N < 10, power can be increased by performing an unmatched analysis of the matched data. We also discuss a variant of this procedure, in which an unmatched analysis is performed only if the matching 'did not work'.
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Affiliation(s)
- P Diehr
- Department of Biostatistics SC-32, School of Public Health and Community Medicine, University of Washington, Seattle 98195, USA
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46
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Heede FAV, Pelican S. Reflections on marketing as an inappropriate model for nutrition education. ACTA ACUST UNITED AC 1995. [DOI: 10.1016/s0022-3182(12)80807-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
This paper provides a rationale for intervening on shared determinants of health at the community level of analysis, presents strategies for intervening on shared determinant risks at the community-level of analysis, and illustrates through a case study of a youth program how a small-scale community intervention on shared determinants might work in practice. Although there is a long history of community intervention to improve health, high quality research on these interventions has been conducted only recently. In evaluating the usefulness of a community intervention, the distinction between relative risk and population-attributable risk is not always made clear. These two distinct types of risk are reviewed considering their implications for what risk factors are targeted by community interventions and what criteria are reasonable to apply in evaluating the utility of these interventions. A role for linking root cause analysis with attributable risk and interventions to reduce risk is presented.
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Affiliation(s)
- D G Altman
- Bowman Gray School of Medicine, Department of Public Health Sciences, Winston-Salem, NC 27157-1063, USA
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Knuiman MW, Cullen KJ, Bulsara MK, Welborn TA, Hobbs MS. Mortality trends, 1965 to 1989, in Busselton, the site of repeated health surveys and interventions. AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1994; 18:129-35. [PMID: 7948327 DOI: 10.1111/j.1753-6405.1994.tb00213.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The community of Busselton in Western Australia has participated in repeated cross-sectional health surveys and other health interventions since 1966. Health surveys of adults were conducted every three years from 1966 to 1981. Health interventions, including programs for high blood pressure, smoking, high blood cholesterol levels and obesity, were implemented in the community. Mortality rates for the Busselton area are compared with rates for the remainder of the southwest region of Western Australia in an attempt to determine if the surveys and associated interventions have had any impact on survival. Statistical comparisons via Poisson regression analysis showed that mortality rates for males over the period 1965 to 1989 in Busselton declined at a similar rate to the southwest. However, for females, especially those aged 45 to 74 years, mortality rates declined significantly faster in Busselton than in the southwest, suggesting a beneficial impact on survival of the surveys and associated interventions.
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Affiliation(s)
- M W Knuiman
- Department of Public Health, University of Western Australia, Perth
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49
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Brown LF. Research in dental health education and health promotion: a review of the literature. HEALTH EDUCATION QUARTERLY 1994; 21:83-102. [PMID: 8188495 DOI: 10.1177/109019819402100109] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
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 post-intervention 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.
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Affiliation(s)
- L F Brown
- School of Dental Science, University of Melbourne, Parkville, Victoria, Australia
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Green LW, Richard L. The need to combine health education and health promotion: the case of cardiovascular disease prevention. PROMOTION & EDUCATION 1993; Spec No:11-8. [PMID: 8186939 DOI: 10.1177/175797599300100407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- L W Green
- Department of Health Care and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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