What influences youth to operate all-terrain vehicles safely?

The operation of all-terrain vehicles (ATVs) by youth has contributed to the incidence of serious and fatal injuries among children. This study explored factors related to the frequency with which youth wore a helmet and refrained from engaging in three risky driving behaviors (driving at risky speeds, on paved roads and on unfamiliar terrain) while operating an ATV. Youth (n = 248) aged 9-14 from central Ohio and one of their parents completed self-report measures of ATV safety behaviors, youth general propensity for risk taking, protection motivation and parental behaviors to facilitate youth safety. Data from two focus groups provided insight on quantitative results. Analyses revealed considerable variation in the frequency with which youth performed the safety behaviors, with 13- and 14-year-olds reporting less frequent safe behavior than 9- to 12-year-olds. Multiple regression analyses suggested that parental behaviors, such as providing reminders to wear a helmet, were associated with more frequent helmet use but were not associated with risky driving behaviors. Youth's general propensity toward risk taking was not associated with helmet use and only associated with riskydriving behaviors among the 13- and 14-year-olds. Self-efficacy was an important predictor across both age groups and behaviors. Implications for injury prevention are discussed.

Protecting Young Workers in Agriculture: Participation in Tractor Certification Training

Tractor-related injuries among youth are an important public health problem. The major objectives of this study were to (1) provide a rigorous estimate of the number of youth operating tractors in Ohio and (2) assess the extent to which these youth are participating in federally mandated tractor safety training. A self-administered questionnaire was completed by approximately 4,000 students ages 14 or 15 years who were enrolled in a stratified cluster sample of 99 Ohio schools. Almost one-third of the youth (30%) reported having operated tractors, with 19% having operated a tractor on a farm not owned by a parent or guardian. More than half of the youth (52%) reported having operated a tractor and/or other hazardous machinery, with 25% having operated the machinery on a farm not owned or operated by a parent or guardian. Extrapolating from 4-H records and Ohio census data, fewer than 1% of the youth who are operating tractors or other hazardous machinery have participated in tractor certification training. Increasing participation in mandated training may be an important step in protecting the health of our nation's young agricultural workers.

The influence of psychosocial stress, gender, and personality on mechanical loading of the lumbar spine

STUDY DESIGN

The effects of psychosocial stress on muscle activity and spinal loading were evaluated in a laboratory setting.

OBJECTIVE

To evaluate the influence of psychosocial stress, gender, and personality traits on the functioning of the biomechanical system and subsequent spine loading.

SUMMARY OF BACKGROUND DATA

Physical, psychosocial, and individual factors all have been identified as potential causal factors of low back disorders. How these factors interact to alter the loading of the spine has not been investigated.

METHODS

Twenty-five subjects performed sagittally symmetric lifts under stressful and nonstressful conditions. Trunk muscle activity, kinematics, and kinetics were used to evaluate three-dimensional spine loading using an electromyographic-assisted biomechanical model. A personality inventory characterized the subject's personality traits. Anxiety inventories and blood pressure confirmed reactions to stress.

RESULTS

Psychosocial stress increased spine compression and lateral shear, but not in all subjects. Differences in muscle coactivation accounted for these stress reactions. Gender also influenced spine loading; Women's anterior-posterior shear forces increased in response to stress, whereas men's decreased. Certain personality traits were associated with increased spine loading compared with those with an opposing personality trait and explained loading differences between subjects.

CONCLUSIONS

A potential pathway between psychosocial stress and spine loading has been identified that may explain how psychosocial stress increases risk of low back disorders. Psychosocially stressful environments solicited more of a coactivity response in people with certain personality traits, making them more susceptible to spine loading increases and suspected low back disorder risk.

The relationship between psychosocial work characteristics and low back pain: underlying methodological issues

OBJECTIVE

To evaluate the current epidemiological evidence linking psychosocial work characteristics with low back pain.

BACKGROUND

Psychosocial work characteristics have been widely evaluated as potential risk factors for low back injury. However, studies with different study populations and using various types of measures have had conflicting results.

METHODS

This review is the most extensive to date, reviewing 66 articles that have provided empirical evidence about the relationship between psychosocial work characteristics and initial reporting of lower back pain. The studies are reviewed with an emphasis on certain methodological issues: controlling for potential confounding; timing of the data collection; and measurement of the exposures and outcomes.

RESULTS

The results of this review suggest that controlling for potential confounding from occupational biomechanical demands had a large influence on the associations found between psychosocial work characteristics and lower back pain. In addition, the use of accurate and reliable measures for the occupational exposures (biomechanical and psychosocial) and the lower back pain outcomes appears to influence the strength of the associations found between psychosocial work characteristics and lower back pain.

CONCLUSION

Given the methodological concerns discussed in this review, it is difficult to draw strong causal inferences from this literature. However, it does appear that psychosocial characteristics are related to some lower back pain outcomes, and that employees' reactions to psychosocial work characteristics (e.g., job dissatisfaction and job stress) are more consistently related to lower back pain than are the psychosocial work characteristics themselves (e.g., work overload, lack of influence over work, quality of relationships with coworkers).

RELEVANCE

This review attempts to identify and address methodological issues in the literature evaluating the relationship between psychosocial work characteristics and lower back pain. Implications for future research are presented.

Shaping advanced nursing practice in the new millennium

OBJECTIVES

To provide a review of converging themes and trends that are shaping advanced practice nursing roles in oncology nursing.

DATA SOURCES

Review and research articles, text-books, and organization documents.

CONCLUSIONS

The current managed care environment provides many opportunities and challenges for oncology advanced practice nurses. Advanced practice nurses have both clinical and organization competencies that enable them to mediate the clinical needs of patients and organization goals within the health care system.

IMPLICATIONS FOR NURSING PRACTICE

Advanced practice nurses can help shape their roles and practice by active participation in the development of systems to support access to clinical and financial information for effective decision making, collaboration among disciplines, and incorporating evidence-based care in their clinical practices.

Evaluation of a brief intervention based on social cognitive theory to develop problem-solving skills among sixth-grade children

This study evaluated an intervention based on social cognitive theory (SCT) intended to develop problem-solving skills (PSS) in sixth graders. Psychometrically tested measures were developed for (1) constructs of SCT (situational perception of stressors, expectations of PSS, self-efficacy for PSS, self-efficacy in overcoming barriers, and self control when applying PSS), (2) PSS, and (3) application of PSS to real-life problems. Five classrooms (n = 133) were randomly assigned to the SCT-based intervention and five classrooms (n = 127) to an equivalent knowledge-based intervention. Using a partial nested design, statistically significant improvements for expectations of PSS, self-efficacy for PSS, and PSS were found in the SCT-based intervention. At posttest, 36% of the students in the SCT-based intervention reported applying PSS to real-life problems as compared with 1% in the knowledge-based group. This pilot study suggested that an SCT-based intervention was more efficacious in developing PSS than a knowledge-based intervention.

Assessing decisional balance for smoking cessation among Southeast Asian males in the US

This study examines the relationship of positive and negative perceptions of smoking to self-reported readiness to quit smoking among Southeast (SE) Asian males of Cambodian, Laotian or Vietnamese descent. In order to investigate this relationship, measures of decisional balance constructs (i.e. the pros and cons of smoking) appropriate for these ethnic groups were developed. Decisional balance was calculated by subtracting the cons from the pros. Following the criteria established by Prochaska and DiClemente, subjects were categorized into four levels of readiness to quit smoking (precontemplation, contemplation, preparation/action and maintenance). The expected pattern of relationship between decisional balance and stages of change included: (1) the cons of smoking being of less importance than the pros of smoking for those smokers in the precontemplation stage, (2) the pros and cons intersecting at the contemplation stage, and (3) the cons being of greater importance than the pros in the later stages of change. The SE Asian men in this study did not exhibit these decisional balance patterns, although mean decisional balance scores for precontemplators and contemplators were significantly more positive than mean scores for those in the preparation/action and maintenance stages. Decisional balance patterns differed across the three ethnic groups included in the sample.

Developing effective helping relationships in health education practice

Health educators who interact directly with the people they serve must be able to establish effective relationships. Helping relationships are effective if they facilitate clients' progress toward health-promoting goals. Health educators are usually well versed in learning activities and spend a significant proportion of their time interacting with clients. However, many health educators have never received explicit training in how to establish effective formal helping relationships. Research on social influence processes has provided a set of empirical findings that suggest interpersonal behaviors that are likely to maximize the effectiveness of formal helping relationships. This literature indicates that formal helping relationships characterized by interpersonal behaviors that enhance client self-esteem and feelings of control are most effective in helping clients achieve specific goals. Interestingly, enhancement of self-esteem and feelings of control are consistent with many definitions of personal empowerment. Since the social influence and empowerment literatures come from very different intellectual roots and have different approaches to power and influence, their convergence is especially notable. These literatures combine to establish the bases for proposing two essential components of effective helping relationships: (1) providing unconditional acceptance and positive regard for clients, and (2) sharing power and control through participatory processes.

Employee stress levels and the intention to participate in a worksite smoking cessation program

This study examines the nature and extent of the relationship between stress levels and intentions to participate in a worksite smoking cessation program among male current smokers (n = 220) employed in an automobile manufacturing plant. A plantwide survey was conducted which measured job stress, nonjob stress, smoking behavior, and intent to participate. The results of polychotomous logistic regressions suggest that among the current smokers in this plant, job and nonjob stress were positively associated with workers' intentions to participate in a worksite smoking cessation program. Thus, contrary to the popular notion that stress diminishes the motivation to quit, employees under high levels of stress may be most receptive to educational interventions intended to persuade smokers to commit to quitting.

A review of health-related outcomes of multi-component worksite health promotion programs

PURPOSE

The purpose of this article is to critically review evaluation studies of the health-related effects (i.e., health risk modification and reduction in worker absenteeism) of multicomponent worksite health promotion programs.

SEARCH METHOD

A comprehensive literature search conducted under the auspices of the Centers for Disease Control and Prevention identified 36 articles that examined health-related outcomes of multi-component programs. The authors identified 11 additional articles through manual searches of recent journal issues and through personal contacts with worksite health promotion researchers. Forty-seven studies describing the results of 35 worksite health promotion programs were reviewed.

IMPORTANT FINDINGS

The worksite health promotion programs reviewed for this article varied tremendously in the comprehensiveness, intensity, and duration of the intervention activities. All of the programs provided health education to employees. In a majority of the programs, opportunities to learn and practice new skills were also offered. A smaller number of programs incorporated modifications in organizational policy or the physical work environment. Results from well-conducted randomized trials suggest that providing opportunities for individual risk reduction counseling for high risk employees within the context of comprehensive programming may be the critical component of an effective worksite health promotion program. Just offering low intensity, short duration programs aimed at increasing awareness of health issues for the entire employee population may not be sufficient to achieve desired outcomes.

MAJOR CONCLUSIONS

The results of the studies reviewed provide both cautious optimism about the effectiveness of these worksite programs and some general guidance as to the critical components and characteristics of successful programs. Overall, the evidence suggests that a rating of indicative/acceptable may best characterize this literature.

Occupational stress, safety, and health: conceptual framework and principles for effective prevention interventions

The authors present an overarching conceptual model of occupational stress, safety, and health, incorporating multiple factors from diverse disciplines. They examine specific implications of the model for the development of prevention interventions (e.g., context-specific interventions and primary, secondary, and tertiary prevention). They review prevention interventions and describe and analyze 4 case studies that address exposure to environmental, ergonomic, and psychosocial stressors and a combination of physical-environmental and psychosocial stressors. The authors examine lessons learned from these interventions in light of the conceptual model (e.g., role of top management and integrating research and intervention).

Occupational stress, physician-excused absences, and absences not excused by a physician

PURPOSE

This study explores two possible mechanisms through which occupational stress is linked to absenteeism. The extent to which physician-excused absenteeism and absenteeism not excused by a physician are related to employee reports of perceived stress is assessed.

DESIGN

A plant wide survey was conducted in January 1990. Employee reports of occupational stress gained from this survey were linked with 1990 absenteeism data from the employees' records.

SETTING

A mid-sized manufacturing plant.

SAMPLE

Complete data were available for 998 of the 1534 (65%) unionized employees in the plant.

MEASURES

Measures of both physician-excused absences and absences not excused by a physician were created. Stressors included role ambiguity, lack of control over work pace, and being paid on a piece-rate basis. Perceived stresses included role conflict, physical environment stresses, and overall work stress.

RESULTS

For physician-excused absenteeism, role conflict (OR, 1.54, p < .01), overall work stress (OR, 1.24, p < .05), and physical environment stress (OR, 1.34, p < .05) had significantly elevated odds ratios, even after adjusting for demographics. For absences not excused by a physician, none of the stressors or stresses had significant odds ratios after controlling for demographic characteristics.

CONCLUSIONS

Employees in this plant were not using short-term voluntary absenteeism as a way of coping with work stress. However, high levels of perceived work stress were associated with subsequent physician-excused absences.

Ideologies of care in community residential services: what do caregivers believe?

Ideologies of care, or systems of beliefs about the importance of particular goals and activities, help guide how care is provided. One currently pervasive ideology of care is that of normalization. In this paper, the ideologies of care of both house managers and direct care staff in group homes are contrasted. Results indicate that the ideology of direct care staff is less differentiated than that of the house managers. In addition, house managers are more likely to subscribe to a normalization ideology and less likely to subscribe to a family orientation ideology than are direct care staff. Ideological differences between house managers and direct care staff are only partially explained by differences in the demographic composition of the two groups.

Evaluation of health education programs: current assessment and future directions

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

Are employees who are at risk for cardiovascular disease joining worksite fitness centers?

To effectively serve disease prevention purposes, worksite fitness centers need to attract a large proportion of eligible employees who are at risk for CVD. The results of studies linking risk factor status and the propensity to join worksite fitness centers have been inconsistent and, to a certain extent, methodologically flawed. This study prospectively follows 294 newly hired employees at a large insurance company in the Midwest. Risk factor status was determined during their orientation week. It was then determined if the employees joined the fitness center during their first year of employment. Results indicate that, overall, risk factor status had little impact on employees' decisions to join the worksite fitness center. However, two of the risk factors (being 20% or more overweight and having elevated systolic blood pressure) had opposite influences on the decisions of male and female employees.

Chronic job insecurity among automobile workers: effects on job satisfaction and health

Work conditions characterized by uncertainty and ambiguity are potential stressors for employees. One such stressor is job insecurity. This longitudinal study of 207 automobile manufacturing workers indicates that chronic job insecurity is predictive of changes over time in both job satisfaction and physical symptoms. Extended periods of job insecurity decrease job satisfaction and increase physical symptomatology, over and above the effects of job insecurity at any single point in time. These results indicate that job insecurity acts as a chronic stressor whose effects become more potent as the time of exposure increases. Worksite health professionals should develop strategies for reducing the impact of job insecurity on employee well-being, particularly in industries where employment opportunities are declining.

What's the use of theory?

The barriers to the use of theory in health education practice are addressed by exposing common misperceptions of the nature and usefulness of theory. First, the mystique of theory is addressed through a discussion of theory development and the roots of theory in everyday experience. Two characteristics of theory, generalizability across settings or situations and testability, are described and linked to benefits for practice. Second, a guide for practitioners in applying theory to each stage of the intervention process is provided. A case example illustrates how theory can guide practice as well as the benefits to be gained by applying theory to program development. Finally, the bases for common negative misperceptions of theory are identified and clarified, and the beneficial nature of theory reviewed.

Enhancing social support at the workplace: assessing the effects of the caregiver support program

Although the health-enhancing effects of social support have been well documented, little is known about how to increase the flow of social support among network members. This article describes and evaluates the Caregiver Support Program, a worksite program that attempts to improve the quality of work relationships among house managers and direct care staff who work in group homes for the developmentally disabled. The program incorporates three strategies for increasing social support: (1) adding a new person or group of persons to the employee's social network, (2) enhancing existing relationships by improving the focal employee's skills for maintaining strong networks and mobilizing support, and (3) enhancing existing relationships by training members of the employee's social network in ways to be more supportive. The Caregiver Support Program was evaluated in a randomized field trial. Results indicate that the program was effective in improving the relationships between direct care staff participants and their house managers. However, other work relationships remained unaffected. The relationship between direct care staff and their house managers was the only work relationship for which both members of the interpersonal dyad participated in the program. The implications of these findings for health education practice and future research are discussed.