Health Education Research - Advance Access

Tailored lay health worker intervention improves breast cancer screening outcomes in non-adherent Korean-American women

Han, H.-R., Lee, H., Kim, M. T., Kim, K. B. — 2008-05-07

Despite rapidly increasing incidence rates of breast cancer, recent immigrants such as Korean-American (KA) women report disproportionately lower utilization of screening tests compared with other ethnic groups. Early screening of breast cancer for this population may be greatly facilitated by indigenous lay health workers (LHWs). We conducted an intervention trial with a 6-month follow-up. Trained LHWs recruited 100 KA women 40 years of age or older who had not had a mammogram during the past 2 years. Ninety-three completed follow-up questionnaires. A 120-min, in-class education combined with LHW follow-up counseling and navigation assistance through the health care system was provided. Rates of breast cancer screening behaviors significantly increased at 6 months (P < 0.001); changes between pre- and post-intervention were 31.9% for mammography, 23% for clinical breast examination and 36.2% for breast self-examination. Modesty toward screening significantly decreased over time, but we did not find any significant differences in breast cancer knowledge and beliefs before and after the intervention. Results support the efficacy of this neighborhood-based, culturally sensitive intervention. Further research should seek to replicate these findings and to incorporate more self-care skills such as health literacy when designing an intervention program for linguistically and culturally isolated immigrant women.

Transtheoretical model-based dietary interventions in primary care: a review of the evidence in diabetes

Salmela, S., Poskiparta, M., Kasila, K., Vahasarja, K., Vanhala, M. — 2008-04-11

The objective of this study was to review the evidence concerning stage-based dietary interventions in primary care among persons with diabetes or an elevated diabetes risk. Search strategies were electronic databases and manual search. Selection criteria were randomized controlled studies with stage-based dietary intervention, conducted in primary care with at least 6 months of follow-up, and participants with either type 2 diabetes or with an elevated risk. The researchers evaluated trials for inclusion, extracted data and assessed study quality. Seven articles, based on five data sets, were included. These studies concentrated on cardiovascular diseases and being overweight, not diabetes. The quality of the studies was moderate to weak. Inadequacies in the reporting often involved unspecific information on the training of health care providers. Long-term positive outcomes (compared with controls) were found in total and monounsaturated fat intake, diastolic blood pressure, health status and well-being. The existing data are insufficient for drawing conclusions on the benefits of the transtheoretical model. More high-quality studies focusing on diabetes are needed, with greater attention to the training of providers and process evaluation. There is a need for a standardized appraisal tool for study evaluation, focusing separately on education interventions for patients and providers.

Testing the predictive power of the transtheoretical model of behavior change applied to dietary fat intake

Wright, J. A., Velicer, W. F., Prochaska, J. O. — 2008-04-08

This study evaluated how well predictions from the transtheoretical model (TTM) generalized from smoking to diet. Longitudinal data were used from a randomized control trial on reducing dietary fat consumption in adults (n =1207) recruited from primary care practices. Predictive power was evaluated by making a priori predictions of the magnitude of change expected in the TTM constructs of temptation, pros and cons, and 10 processes of change when an individual transitions between the stages of change. Generalizability was evaluated by testing predictions based on smoking data. Three sets of predictions were made for each stage: Precontemplation (PC), Contemplation (C) and Preparation (PR) based on stage transition categories of no progress, progress and regression determined by stage at baseline versus stage at the 12-month follow-up. Univariate analysis of variance between stage transition groups was used to calculate the effect size [omega squared (²)]. For diet predictions based on diet data, there was a high degree of confirmation: 92%, 95% and 92% for PC, C and PR, respectively. For diet predictions based on smoking data, 77%, 79% and 85% were confirmed, respectively, suggesting a moderate degree of generalizability. This study revised effect size estimates for future theory testing on the TTM applied to dietary fat.

A review of similarities between domain-specific determinants of four health behaviors among adolescents

2008-04-04

Schools are overloaded with health promotion programs that, altogether, focus on a broad array of behavioral domains, including substance abuse, sexuality and nutrition. Although the specific content of programs varies according to the domain focus, programs usually address similar concepts: knowledge, attitudinal beliefs, social influences and skills. This apparent conceptual overlap between behaviors and programs provides opportunities for a transfer-oriented approach which will stimulate students to apply the knowledge and skills they have learned in one domain (e.g. skills for resisting tobacco use) to other domains (e.g. alcohol, sex). A requirement for such an approach is that behaviors share at least some determinants. This review addresses this issue by examining similarities between domain-specific determinants of smoking, drinking, safe sex and healthy nutrition among adolescents. Recent empirical studies and reviews were examined. The results show that the following determinants are relevant to all four behaviors: beliefs about immediate gratification and social advantages, peer norms, peer and parental modeling and refusal self-efficacy. Several other determinants have been found to relate to at least two behaviors, e.g. health risk beliefs and parental norms. These results can be used for the development of a transfer-oriented school health promotion curriculum.

Health information styles among participants in a prostate cancer screening informed decision-making intervention

Williams-Piehota, P. A., McCormack, L. A., Treiman, K., Bann, C. M. — 2008-04-02

The purpose of this study was to assess the usefulness of a health information styles segmentation strategy in understanding audience subgroups. We examined the health information styles of men participating in a prostate cancer screening informed decision-making (IDM) intervention and assessed intervention effects on men with distinct health information styles. We classified participants into three health information style groups based on their independence in health decision making (independent versus doctor dependent) and engagement in health enhancement (active versus passive): independent active (IA), doctor-dependent active (DDA) and passive. We developed profiles of men in these groups: IAs tended to be white and more highly educated and to have greater baseline prostate cancer knowledge; DDAs were older, less healthy and more likely to have visited a doctor in the past year and passives tended to be younger, not to have had a recent prostate-specific antigen test and to have lower self-efficacy related to communication with doctors and less positive interactions with doctors. All groups significantly increased their prostate cancer knowledge after the intervention, but passives exhibited the greatest increase in knowledge at a 6-month follow-up. The health information styles segmentation strategy used in this study offers a viable framework for segmenting audiences.

Psychosocial, environmental and behavioral factors associated with bone health in middle-school girls

Sharma, S. V., Hoelscher, D. M., Kelder, S. H., Day, R. S., Hergenroeder, A. — 2008-03-21

The purpose of this study was to identify the psychosocial, environmental and behavioral factors associated with calcium intake, physical activity and bone health in a cohort of adolescent girls. Baseline data (N = 718 girls, mean age: 11.6 ±0.4 years) from the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study conducted in Texas, 2001–03, were utilized for the analyses. Hierarchical linear regression was used to examine the associations of interest. Confounders adjusted for included ethnicity, menarchal status, body mass index and lactose intolerance. Several psychosocial and behavioral factors were significantly associated with bone quality. These included knowledge of calcium content of foods (β = 0.08, P = 0.016), self-efficacy toward consuming calcium-rich foods (β = 0.16, P = 0.047), physical activity self-efficacy (β = 0.20, P = 0.002), physical activity outcome expectations (β = 0.5, P = 0.004), family encouragement to do physical activity (β = 0.96, P = 0.027), friend engagement in physical activity (β = 1.3, P = 0.001) and participation in sports teams (β = 1.7, P < 0.001). Self-efficacy, social support and participation in sports teams appear to be strongly associated with bone health in adolescent girls. Future health education/health promotion programs need to address these factors for effective primary prevention of osteoporosis in this population.

Could pets be of help in achieving health literacy? A media analysis demonstration study

Rock, M., Lail, P. — 2008-03-21

This paper asks whether, when seeking to reach the public, interest in the health of pets merits consideration. Our data set consisted of 128 items from Canadian media coverage, 1996–2006, that dealt with bovine spongiform encephalopathy (BSE) as well as with cats, dogs or both. Three main messages regarding pet health and human health were identified: ‘do not worry’, ‘do worry’ and ‘be cautious’. A minority of articles did not convey a pet health message or a human health message (6%), and contradictory messages regarding human and animal health frequently occurred (32%). While we did not assess how members of the public actually received or interpreted these messages, media coverage dealing with pets does appear to have the potential to influence people. Media reports of British cats being harmed by BSE, in fact, may have influenced public views worldwide. Thus, professionals should give careful consideration to pets when conveying health information. Nevertheless, we do not suggest pet health information substitute for human health information. Rather, interest in pets may provide an opportunity to complement and to reinforce communication about human health.

Validation of the worry about sexual outcomes scale for use in STI/HIV prevention interventions for adolescent females

2008-03-18

This study examined the psychometric properties of a new scale to measure adolescents’ worry regarding outcomes of risky sexual behavior (i.e. sexually transmitted infections, including HIV [STI/HIV], and unintended pregnancy). The 10-item worry about sexual outcomes (WASO) scale, resulting in two subscales STI/HIV worry and pregnancy worry, was administered to a sample of 522 African-American female adolescents ranging in age from 14 to 18, residing in the southeast United States and participating in a sexual risk reduction intervention. The WASO demonstrated internal consistency across multiple administrations and yielded satisfactory construct validity. Worry was found to negatively correlate with sexual communication self-efficacy (with a new male partner and a steady male partner), frequency of sexual communication with male partner, attitudes about condom use and social support; worry was positively correlated with perceived barriers to condom use, condom negotiation, locus of control and depression. Overall, the results indicate that the WASO is a reliable and valid measure of assessing adolescents’ worry about STIs, HIV and pregnancy. The WASO represents a brief self-administered instrument that can be easily integrated into sexual risk reduction assessments and interventions. Future studies employing the WASO might consider testing it with more diverse samples in terms of gender, race/ethnicity, age and sexual orientation.

Evaluation of an interactive, Internet-based weight loss program: a pilot study

Booth, A. O., Nowson, C. A., Matters, H. — 2008-03-17

The Internet can access a large number of consumers in a more cost-effective manner than other information delivery channels. In this pilot study, we assessed whether an online weight reduction program including dietary advice plus exercise (ED) was more effective in reducing weight than an exercise-only program (EX) >12 weeks. Participants were randomized to either the ED or EX group and attended a center for anthropometric measurements and dietary assessment. Both groups wore a pedometer and set weekly goals to increase daily steps through an interactive Web site. The ED group set weekly dietary goals via the Web site and received tailored e-mail assistance. Seventy-three participants commenced and 53 (73%) completed the study [EX n = 26; ED n = 27; body mass index—mean (standard deviation): 29.7 (2.5) kg m^–2, age 46.3 (10.8); 21% male]. Percent weight changes were EX, 2.1 (0.6)% and ED, 0.9 (0.6)% (P = 0.15). Both groups increased their daily steps with no difference between groups. Only the ED group significantly reduced their energy intake. Despite a greater fall in energy intake reported by the ED group and a similar increase in physical activity in both groups, setting individual dietary goals did not enhance weight loss.

Understanding tailoring in communicating about health

Hawkins, R. P., Kreuter, M., Resnicow, K., Fishbein, M., Dijkstra, A. — 2008-03-17

‘Tailoring’ refers to any of a number of methods for creating communications individualized for their receivers, with the expectation that this individualization will lead to larger intended effects of these communications. Results so far have been generally positive but not consistently so, and this paper seeks to explicate tailoring to help focus future research. Tailoring involves either or both of two classes of goals (enhancing cognitive preconditions for message processing and enhancing message impact through modifying behavioral determinants of goal outcomes) and employs strategies of personalization, feedback and content matching. These goals and strategies intersect in a 2 x 3 matrix in which some strategies and their component tactics match better to some goals than to others. The paper illustrates how this framework can be systematically applied in generating research questions and identifying appropriate study designs for tailoring research.

Predicting changes in physical activity among adolescents: the role of self-efficacy, intention, action planning and coping planning

Araujo-Soares, V., McIntyre, T., Sniehotta, F. F. — 2008-03-14

This paper aims to test the direct predictors of the theory of planned behaviour (TPB), action planning and coping planning as predictors of changes in physical activity (PA) in 157 adolescents (mean age: 12). TPB measures, the Action Planning and Coping Planning Scales (APCPS) and the International Physical Activity Questionnaires were measured at baseline, 2- and 5-month follow-up. Hierarchical regression analyses were conducted regressing PA at Time 2 or Time 3 onto TPB and APCPS at baseline or Time 2, respectively. Past behaviour accounted for a significant 25–51% of the variance in PA in Step 1 of all three analyses. In Step 2, TPB accounted for an additional 3–10% with intention as a significant predictor. While no main effects for action planning or coping planning (Step 3) were found, all three analyses resulted in a significant amount of incremental variance accounted for by the interaction of action planning and coping planning (Step 4). Results suggest that the combination of high levels of action planning and coping planning is associated with increases in PA. Implications for theory of behaviour change in adolescents are discussed.

Can schools promote the health of children with asthma?

McWhirter, J., McCann, D., Coleman, H., Calvert, M., Warner, J. — 2008-03-05

This report describes the evaluation of a whole-school intervention to improve morbidity and psychosocial well-being in pupils with asthma. In all, 193 children with asthma (7–9 years) from 23 primary/junior schools in the south of England participated. Schools (n = 12) randomly assigned to the intervention group (IV) received a staff asthma training session, advice on asthma policy and practice and an emergency β₂-agonist inhaler with spacer. Pupils participated in an asthma lesson. Staff and pupils in non-intervention (NI) schools (n = 11) received no asthma-oriented input. While wheeze reports improved for all children with asthma, only the IV group showed lower requirement for medication (P = 0.01), clinically significant improvement (P < 0.05) in activity related quality of life (QOL) and increased self-esteem (SE: social P = 0.01; athletic P = 0.05; behaviour P = 0.001) in girls. SE decreased for NI girls but there was no change for non-asthmatic peers in NI or IV schools which had similar baseline levels of SE and QOL. There was a marginal improvement in the establishment of asthma policies/practices and no change in school absence or staff knowledge. The significantly increased peer group understanding of asthma seen in the intervention schools may have mediated increased well-being in the IV group. Primary schools are a potentially important context for improving asthma morbidity and psychosocial well-being of children with asthma.

Perceived condom norms and HIV risks among social and sexual networks of young African American men who have sex with men

Peterson, J. L., Rothenberg, R., Kraft, J. M., Beeker, C., Trotter, R. — 2008-02-16

The association between condom norms and unprotected sexual intercourse was examined within social and sexual networks of young African American men who have sex with men (MSM) in an HIV epicenter of the southern United States. We used a chain-link design to recruit 158 young African American men: 95 initial participants, 56 contacts of participants (alters) and 7 contacts of alters. Men in the high-risk group, compared with those in the no-risk group, perceived significantly lower approval concerning condom use in their social and sexual networks. Also, 100 participants could be connected to each other in 86 dyads of social and sexual networks. Within these dyads, men perceived that their friends and acquaintances approved for them to use condoms but that their friends and acquaintances did not use condoms themselves. Low HIV risk behavior appears associated with perceived social norms that support one's use of condoms, even when perceived norms do not support condom use by network members themselves.

Psychosocial correlates of cigarette smoking among college students in China

Mao, R., Li, X., Stanton, B., Wang, J., Hong, Y., Zhang, H., Chen, X. — 2008-02-16

The objectives are to examine the smoking practice and intention among Chinese college students and to explore the association between cigarette smoking and individual and psychosocial factors. Cross-sectional data were collected from 1874 students from 19 college campuses in Jiangsu province, China. Both bivariate and multivariate analyses were performed to assess the associations of smoking practice and smoking intention with various individual and psychosocial factors. There was a significant gender difference in both smoking practice and smoking intention. Overall, 53% of the participants (70% male and 31% female) reported ever having smoked in their lifetime and 29% of the sample (49% male and 5% female) reported having smoked in the past 30 days. About one-fourth of the sample (44% male and 6% female) thought they were likely to smoke in the next 6 months. Male gender, low family socioeconomic status, perception of more peer smoking, more perceived benefits of smoking, higher level of pro-smoking attitude, higher level of perceived cost of non-smoking and more involvement in other health risk were positively associated with being a past or current smoker. Likewise, male gender, older age, more friends smoking, greater perceived benefits of smoking, higher pro-smoking attitudes and more health risk involvement were associated with the likelihood to smoke in the next 6 months. The data suggest a substantial smoking experimentation among college students in China, which presents both a challenge and an opportunity to prevent a large proportion of experimenters from progressing to regular smokers. The findings in the current study can be used to inform the development of effective smoking intervention prevention programs among college students in China.

Obese girls differences in neighbourhood perceptions, screen time and socioeconomic status according to level of physical activity

Mota, J., Ribeiro, J. C., Santos, M. P. — 2008-02-01

The purpose of this study was to investigate perceptions of neighbourhood, amount of screen time and socioeconomic status (SES) in active and non-active ‘overweight/obese girls'. The sample comprised 162 girls aged 14.1 ± 1.5 years old. Girls were assigned as active obese (AO) and non-active obese (NAO). Environmental variables, screen time and SES were assessed by questionnaire. No statistically significant differences were found for screen time between AO and NAO groups. Educational status of father (r = 0.23; P = 0.003) and mother (r = 0.18; P = 0.02) was positively and significantly associated with AO. AO girls reported to more significantly (P < 0.05) agree with living in a neighbourhood with several public recreation facilities and that they see people being physically active in neighbourhood. Logistic regression analysis showed that social environment [odds ratio (OR) = 15.06; P = 0.037] and recreational facilities domain (OR = 11.16; P = 0.042) were associated to likelihood to be more active. Creating social support and providing PA facilities within neighbourhoods, particularly in low SES neighbourhoods, are desirable.

Inequalities in toothbrushing among adolescents in Scotland 1998-2006

Levin, K. A., Currie, C. — 2008-01-31

The aim of this study was to examine trends in toothbrushing and inequalities in toothbrushing among girls and boys in Scotland between 1998 and 2006. A secondary aim was to investigate the association between the health promoting school (HPS) initiative and toothbrushing. Data from the Health Behaviour in School-aged Children 1998, 2002 and 2006 surveys were analysed using multilevel logistic regression for boys and girls aged 11, 13 and 15 years. Girls' twice-a-day toothbrushing increased with age while that of boys' remained stable. Toothbrushing increased significantly between 1998 and 2006 for all but 15-year-old girls. Family structure was significantly associated with toothbrushing for 11-year-old boys and 13-year-old boys and girls. Socio-economic inequalities in toothbrushing were significant for both boys and girls at all ages. Largest inequalities were seen among 13-year-old girls and 15-year-old boys. Inequalities persisted over time for all but 15-year-old boys who saw a significant reduction between 1998 and 2006. The HPS initiative in schools in deprived areas was associated with increased odds of twice-a day toothbrushing among 11-year-old boys and 15-year-old girls.

Predicting transitions from preintentional, intentional and actional stages of change

Schuz, B., Sniehotta, F. F., Mallach, N., Wiedemann, A. U., Schwarzer, R. — 2008-01-31

Stage theories of health behavior change assume that individuals pass through qualitatively different stages on their way to the adoption of health behaviors. Three common stages (preintention, intention and action) can be defined by stage transitions included in current stage theories and supported by evidence. The present study examines whether transitions between these stages can be predicted by social cognition variables derived from prevailing health behavior theories. At two points in time, the motivation for interdental hygiene behaviors and oral self-care was assessed in 288 participants recruited in dental practices. Stage progression and regression over time were analyzed using discriminant function analysis. Progression from preintention to intention was predicted by action planning, whereas coping planning and self-efficacy predicted transitions from intention. Regression from action was predicted by self-efficacy. Results support the distinction of three common stages. Findings are discussed in terms of their contribution to health behavior theory.

Health risks information reaches secondary school smokers

Ridout, F., Charlton, A., Hutchison, I. — 2008-01-31

This cross-sectional study aimed to assess smoking prevention and cessation education delivered as part of the UK National Curriculum and to evaluate the relative effectiveness of health, social influence and other/non-health components. In all, 1789 students aged 11–15 from 12 secondary schools completed online surveys assessing smoking status, factors known to be related to smoking and experience of smoking education. A total of 1421 of 1722 (83%) students remembered some school-based education. Of these, 803 (57%) said that the lessons changed their ideas about smoking. Multinomial logistic regression was used to assess whether lesson recall was associated with smoking status in a model adjusting for age, gender, ethnicity, family and best friend smoking status, socioeconomic status, and school. Quitters were more likely than smokers to report having changed their ideas about smoking as a result of a lesson (OR 5.78, 95% CI 2.44–13.72). The relative effectiveness of 16 lesson themes was assessed. Significantly more students changed their ideas about smoking as a result of ‘health’ compared with ‘social influence’ (² (1) 124.0, P < 0.001) or ‘other/non-health’ (² (1) 63.16, P < 0.001) topics. Mouth cancer was the most effective health topic and may provide a suitable model for both smoking and risky drinking prevention.

Formative research on creating smoke-free homes in rural communities

Escoffery, C., Kegler, M. C., Butler, S. — 2008-01-24

The home is a significant place for exposure to secondhand smoke for children and non-smoking adults. This study explored factors that would convince families to adopt household smoking bans and actions to create and maintain smoke-free homes. Interviews were conducted with adults in 102 households in rural Georgia. Participating families had a young adolescent and included households with a mix of smokers and non-smokers and smoking ban status. Families reported they would consider a total ban to protect children from secondhand smoke and protect family members if they got sick. Few described difficulties in enforcement with over half of smokers accepting the rules. Situations that made it hard to enforce restrictions were if there was a visitor who smoked, a smoker who had cravings, and bad weather outside when the smoker desired to smoke. Smokers explained that family members could assist them in quitting by talking to them, not purchasing cigarettes for them, not smoking around them, and supporting them. Ideas for promoting smoke-free homes were having a no smoking sign, saying no to visitors who want to smoke, removing ashtrays, and creating a place outside for smokers. These findings can inform interventions designed to create and maintain smoke-free households.

Promoting health-enhancing physical activity in the primary school: a pilot evaluation of the BASH health-related exercise initiative

Fairclough, S. J., Stratton, G., Butcher, Z. H. — 2008-01-23

The ‘Be Active Stay Healthy’ (BASH) health-related exercise (HRE) programme was delivered to Year 5 students (age 9–10 years) in two primary schools situated in the same area of a northwest England town. BASH aims to improve students’ participation in and knowledge of HRE through structured physical activities. Fifty-five students completed pre- and post-programme HRE knowledge and understanding questionnaires. Moderate to vigorous physical activity (MVPA) levels of 13 students were assessed using accelerometers during two contrasting lessons focusing on optimal activity levels (active) and cognitive learning (cognitive). Mean percentage of correct questionnaire answers improved from 60.8 to 83.8% (P = 0.0001, effect size (ES) = 1.44), and questionnaire performance was significantly better among students in one of the schools (P = 0.017, ES = 0.72). Boys engaged in MVPA for 11% more time than girls during the active lessons (P = 0.0006, ES = 1.21) but MVPA during cognitive lessons was similar. The BASH programme has potential to use structured physical activity as a medium to enhance students’ HRE knowledge, particularly in relation to the fundamental understanding of healthy and active lifestyles. HRE knowledge may differ between schools, even when they are similarly sized and located, with analogous student catchment areas. Recommendations for the future delivery and evaluation of the programme are made.

Applying cognitive response testing in message development and pre-testing

Lapka, C., Jupka, K., Wray, R. J., Jacobsen, H. — 2008-01-23

Pre-testing messages with audience members is a critical step in the creation of effective health information. Quantitative methods for message testing have limited effectiveness, as they cannot reveal complications with language and comprehension. Cognitive response testing (CRT), a form of qualitative research, allows the interviewer to probe for deeper understanding of comprehension and language by asking participants to paraphrase items, discuss thoughts or emotions that come to mind and offer suggestions for improvement. This study explores the usefulness of CRT in message development and testing, adding to the literature regarding qualitative methods in public health. CRT was employed to evaluate health messages on two topics—bioterrorism and influenza vaccination. This technique effectively identified message terminology and concepts that respondents found unfamiliar or confusing, providing the framework needed for message revision. Commonly misunderstood words were replaced and confusing concepts were explained in the revised messages, making pre-tested messages more likely to be appropriate for the intended audience. These findings are consistent with previous research that establishes the usefulness of CRT in the evaluation and development of health-related messages and surveys.

Home and child safety on reality television

Manganello, J. A., McKenzie, L. B. — 2008-01-23

Injuries, many of which occur at home, are the leading cause of death for children. With such an extensive problem, it is natural to look for outlets such as mass media to reach large numbers of families with educational messages about safety and injury prevention. Mass media has been widely used to educate people about health issues. While studies have examined the portrayal of topics such as substance use and sexual behavior, no study has looked at media content about home and child safety practices. A pilot study with a sample of 10 television shows about home renovation, children or families was examined using content analysis for the presence or absence of home and child safety practices and products and discussion of injury topics. Most practices, like checking the water temperature when bathing a child or having smoke alarms, were never discussed or shown. Results suggest these shows provide information about home or family life, but few role models are shown offering information or examples of safe practices. Promoting safety information in these television programs may be a potentially important way to educate a large number of people, and feasibility of adding safety information to such shows should be explored.

Optimizing the efficacy of smoking cessation contests: an exploration of determinants of successful quitting

van Osch, L., Lechner, L., Reubsaet, A., Steenstra, M., Wigger, S., de Vries, H. — 2008-01-22

The present study describes the short- and long-term efficacy and program evaluation of a Quit and Win smoking cessation campaign, organized in The Netherlands. To be able to fine-tune smoking cessation contests to the needs of the target population, utilization, appreciation and efficacy of various contest elements were investigated. Data from 1551 Quit and Win participants and 244 control respondents were collected by web-based surveys at baseline (pre-contest) and 1 and 12 months after the contest. Demographic and contest predictors of successful quitting were determined by logistic regression analyses. Quit and Win proved to be an effective as well as highly appreciated program among participants. Conservative 1-month (35%) and continuous 12-month abstinence (12%) rates were significantly higher in Quit and Win participants than in the control group (1 month: 11%; continuous: 3%). Use of a supportive e-mail message service predicted short- and long-term abstinence. A buddy support system was the most used and highly appreciated cessation aid, and its use significantly predicted short-term abstinence. Radio commercials and Internet advertisements were the most effective recruitment channels. Although non-exhaustive, implementation of the results and recommendations discussed in this study could lead to an increased use, appreciation and efficacy of future smoking cessation campaigns.

Evaluating a school-based trachoma curriculum in Tanzania

2008-01-21

Trachoma remains a public health problem in a number of sub-Saharan Africa countries; behavioral change and environmental improvements are cornerstones of prevention efforts. Evidence of successful health education are few in Africa. Health education efforts through primary schools have recently been developed and adopted in Tanzania. We evaluated changes from 2004 to 2005 in knowledge and reported behavioral change as well as nasal and ocular discharge and clean faces in selected schools in central Tanzania. This was a mixed-methods study involving both schoolchildren and schoolteachers. We found a significant reduction in nasal discharge (from 4.5% to 0.5%) and dirty faces (from 3.6% to 0.9%) and improvements in some knowledge- and behavior-related indices by primary schoolchildren in the intervention villages. The teachers viewed the trachoma curriculum positively but reported that the lack of water at the schools limited application of the health education messages. The disparity between health education messages and environmental capacities for implementing these messages (no wells at the schools and minimal latrine facilities at the schools and homes) limited usefulness of the curriculum.

Internet-delivered interventions aimed at adolescents: a Delphi study on dissemination and exposure

Crutzen, R., de Nooijer, J., Brouwer, W., Oenema, A., Brug, J., de Vries, N. K. — 2008-01-21

It appears that in practice exposure to Internet-delivered behaviour change interventions, encouraging a healthy lifestyle for adolescents with regard to health risk behaviours, is quite low. There is, however, a lack of evidence-based insight into how to disseminate such interventions and how to reach optimal exposure. A more extensive exploration is therefore timely since this knowledge is crucial to improve the public health impact of such interventions. By means of a three-round Delphi study factors associated with dissemination of and exposure (first visit, stay long enough and revisit) to Internet-delivered interventions aimed at adolescents had been identified, as well as the extent to which experts agree on the importance of these factors. Results showed that there was a high rate of consensus among experts from several disciplines with regard to the importance of factors like word of mouth recommendation, the interface of the intervention and utilization of all features provided by the Internet. Experts do not agree, however, on a gold standard for successful dissemination. Overall, the results of this exploration serve as a handle for the formation of further research questions to be tested and answered in research among adolescents.

Sustaining 'truth': changes in youth tobacco attitudes and smoking intentions after 3 years of a national antismoking campaign

Farrelly, M. C., Davis, K. C., Duke, J., Messeri, P. — 2008-01-17

This study examines how the American Legacy Foundation's ‘truth®’ campaign and Philip Morris's ‘Think. Don't Smoke’ (TDS) campaign have influenced youth's tobacco-related attitudes, beliefs and intentions during the first 3 years of the truth campaign. We use data from eight nationally representative cross-sectional telephone surveys of 35 074 12- to 17-year olds to estimate cross-sectional time series logistic regressions that assess the association between recall of truth and TDS and attitudes, beliefs, and intentions toward smoking. An alternative measure of exposure to TDS was also used. Findings indicate that exposure to truth advertisements (ads) was associated with steady positive changes in attitudes, beliefs and intentions to smoke, whereas exposure to Philip Morris ads was associated with more favorable beliefs and attitudes toward the tobacco industry. Our findings suggest that well-executed antismoking campaigns can positively and consistently change youth's beliefs and attitudes, whereas a tobacco industry-sponsored campaign can have a counterproductive influence.

Effectiveness of health-promoting media literacy education: a systematic review

Bergsma, L. J., Carney, M. E. — 2008-01-17

Media literacy education to promote health among youth involves them in a critical examination of media messages that promote risky behaviors and influence their perceptions and practices. Research on its effectiveness is in its infancy. Studies to date have been conducted with more or less rigor and achieved differing results, leaving many questions about effectiveness unanswered. To elucidate some of these questions, we conducted a systematic review of selected health-promoting media literacy education evaluation/research studies, guided by the following research question: What are the context and process elements of an effective health-promoting media literacy education intervention? Based on extensive analysis of 28 interventions, our findings provide a detailed picture of a small, 16- to 17-year (1990 to July 2006) body of important research, including citation information, health issue, target population/N/age, research design, intervention length and setting, concepts/skills taught, who delivered the intervention and ratings of effectiveness. The review provides a framework for organizing research about media literacy education which suggests that researchers should be more explicit about the media literacy core concepts/skills they are including in their interventions, and should more carefully address who delivered the intervention with what fidelity, in what setting, for how long and utilizing what pedagogical approach.

Does targeting injury prevention towards families in disadvantaged areas reduce inequalities in safety practices?

Kendrick, D., Mulvaney, C., Watson, M. — 2008-01-17

Inequalities in childhood injury and safety practices exist, but there is little evidence that targeted interventions can reduce such inequalities. This study examines the effect of a home safety intervention on reducing inequalities in safety practices using a secondary analysis of data from a randomized controlled trial. Families with children <5 years from disadvantaged areas were randomized to receive a standardized health visitor safety consultation and free or low-cost safety equipment fitted in the home or to usual care. The impact of the intervention in terms of stair gate use and functioning smoke alarms was compared by ethnic group, maternal age, housing tenure, family type and receipt of state-provided means-tested benefits at 1-year follow-up. Marked inequalities were found for both safety practices by each socio-economic characteristic prior to the intervention. The intervention significantly reduced inequalities in stair gate use by housing tenure (P = 0.006) and receipt of benefits (P = 0.04), but did not reduce inequalities in functioning smoke alarms. We conclude that a home safety intervention targeted at deprived areas addressing the barriers of cost and needing help to fit equipment was only partially successful in reducing inequalities in safety practices. Other strategies will be required to reduce inequalities especially in relation to functioning smoke alarms.

An examination of the association between seeing smoking in films and tobacco use in young adults in the west of Scotland: cross-sectional study

Hunt, K., Sweeting, H., Sargent, J., Lewars, H., Cin, S. D., Worth, K. — 2008-01-17

The objective is to examine the association between the amount of smoking seen in films and current smoking in young adults living in the west of Scotland in the UK. Cross-sectional analyses (using multivariable logistic regression) of data collected at age 19 (2002–04) from a longitudinal cohort originally surveyed at age 11 (1994–95) were conducted. The main outcome measure is smoking at age 19. No association was found between the number of occurrences of smoking estimated to have been seen in films (film smoking exposure) and current (or ever) smoking in young adults. This lack of association was unaffected by adjustment for predictors of smoking, including education, risk-taking orientation and smoking among peers. There was no association between film smoking exposure and smoking behaviour for any covariate-defined subgroup. Associations have been found between film smoking exposure and smoking initiation in younger adolescents in the United States. In this study, conducted in Scotland, no similar association was seen, suggesting that there may be age or cultural limitations on the effects of film smoking exposure on smoking. The lack of association could be due to methodological issues or greater sophistication of older adolescents and young adults in interpreting media images or the greater ubiquity of real-life smoking instances in Scotland. If the latter, film smoking exposure could become a more important risk factor for smoking uptake and maintenants in older adolescents following the recent ban on smoking in public places in Scotland.

Predictors of early first sexual intercourse among adolescents in Cape Town, South Africa

Mathews, C., Aaro, L. E., Flisher, A. J., Mukoma, W., Wubs, A. G., Schaalma, H. — 2008-01-17

Early coital debut is a risk factor for HIV. In this paper we investigate the predictors of young adolescents' transition to first intercourse using a social cognition theoretical framework. The analyses reported here were based on a longitudinal study of 2360 students in the schools allocated to the control arm of a cluster-randomized controlled trial to investigate the effect of a school-based HIV prevention programme among Grade 8 students in Cape Town. Structural equation modelling was performed with Mplus version 3.11. Of the 1440 students who were virgins at baseline, 1144 remained virgins 15 months later and 296 (20.6%) reported having had their first sexual intercourse. Transition to first sexual intercourse was more likely among males than females, among older students and among students with a lower socio-economic status. Transition to first sexual intercourse was significantly associated with intentions to have sexual intercourse, poor self-efficacy to negotiate delayed sex and intimate partner violence. The model predicted 35% of the variance in intentions and 16% of the variance in transition. These findings indicate some of the factors that influence young adolescent's transition to first intercourse and that need to be addressed when designing effective interventions.

Electronic monitoring and health promotion: an evaluation of the E-MOVO Web site by adolescents

de Nooijer, J., Veling, M. L., Ton, A., de Vries, H., de Vries, N. K. — 2008-01-10

The explosive increase in Internet accessibility and use offers unique opportunities for providing health information to adolescents via the Internet. The purpose of this evaluation study was to explore the opinions of adolescents regarding an Internet-based health monitoring instrument and its individually tailored electronic feedback so that recommendations for improvement can be provided. A self-administered evaluation questionnaire was completed by 672 adolescents aged 12–18 years the Dutch equivalent of the 8th and 10th grade of secondary education. Semistructured group interviews were conducted with 53 adolescents to obtain more in-depth information regarding the monitoring questionnaire and the individually tailored feedback. All the respondents preferred the electronic monitoring questionnaire to a paper and pencil questionnaire and the individually tailored feedback was appraised rather favorably. However, 28% of the respondents claimed that the information was not new to them and 39% indicated that the information failed to provide them with additional insight into their behavior. In order to increase the number of adolescents reached, we recommend (i) embedding monitoring and feedback in school curriculum, (ii) providing immediate feedback and (iii) adapting tailored messages to educational levels and age. Although several improvements can and should be made, we conclude that the Internet-based monitoring questionnaire and the individually tailored feedback were appreciated by adolescents and are therefore a promising method for engaging adolescents in health promotion.

Can the democratic ideal of participatory research be achieved? An inside look at an academic indigenous community partnership

2008-01-10

Democratic or equal participation in decision making is an ideal that community and academic stakeholders engaged in participatory research strive to achieve. This ideal, however, may compete with indigenous peoples' right to self-determination. Study objectives were to assess the perceived influence of multiple community (indigenous) and academic stakeholders engaged in the Kahnawake Schools Diabetes Prevention Project (KSDPP) across six domains of project decision making and to test the hypothesis that KSDPP would be directed by community stakeholders. Self-report surveys were completed by 51 stakeholders comprising the KSDPP Community Advisory Board (CAB), KSDPP staff, academic researchers and supervisory board members. KSDPP staff were perceived to share similar levels of influence with (i) CAB on maintaining partnership ethics and CAB activities and (ii) academic researchers on research and dissemination activities. KSDPP staff were perceived to carry significantly more influence than other stakeholders on decisions related to annual activities, program operations and intervention activities. CAB and staff were the perceived owners of KSDPP. The strong community leadership aligns KSDPP with a model of community-directed research and suggests that equitable participation—distinct from democratic or equal participation—is reflected by indigenous community partners exerting greater influence than academic partners in decision making.

'Imagine all that smoke in their lungs': parents' perceptions of young children's tolerance of tobacco smoke

Robinson, J., Kirkcaldy, A. J. — 2007-12-20

Despite knowing the risks to their children's health, parents continue to expose their children to tobacco smoke prior to and after their birth. This study explores the factors influencing parent's behaviour in preventing the exposure of their (unborn) children to environmental tobacco smoke (ETS) and any changes to their smoking behaviour in the home during the first years of their children's lives. Whether or not they stopped smoking during pregnancy, the women did not protect themselves from breathing in other people's smoke. Yet once the baby was born, parents actively protected the baby from environmental tobacco, believing that the lungs of newborn babies were too immature to tolerate smoke. This protection lasted only for a matter of weeks for some babies, or stopped when they were 6–12 months old, linked to their parent's belief that older babies could tolerate or avoid smoke. These findings suggest that changes made to smoking during the first weeks of a baby's life are unlikely to be sustained, and key messages about the risks if ETS exposure need to be delivered repeatedly over the first 2 years of life and re-enforced as the child gets older.

Appreciation and implementation of a school-based intervention are associated with changes in fruit and vegetable intake in 10- to 13-year old schoolchildren the Pro Children study

2007-12-20

The purpose was to investigate the degree of implementation and appreciation of a comprehensive school-randomized fruit and vegetable intervention program and to what extent these factors were associated with changes in reported fruit and vegetable intake. The study was conducted among 10- to 13-year old children exposed to the intervention during the school year 2003–04 in Norway, Spain and the Netherlands. Children, parents and teachers completed questionnaires regarding (i) the implementation of the school curriculum, (ii) parental involvement, (iii) distribution of fruit and vegetables at school, (iv) children's appreciation of the project and (v) children's intake levels. Univariate analyses of covariance and multilevel multivariate regression analyses indicated that teacher-reported level of implementation of the school curriculum and schoolchildren's appreciation of the project were important determinants of changes in intake. The results point to the importance of optimal implementation of an attractive school curriculum.

Social comparison and body image in adolescence: a grounded theory approach

Krayer, A., Ingledew, D. K., Iphofen, R. — 2007-12-20

This study explored the use of social comparison appraisals in adolescents' lives with particular reference to enhancement appraisals which can be used to counter threats to the self. Social comparison theory has been increasingly used in quantitative research to understand the processes through which societal messages about appearance influence adolescents' body image. Little is known about the comparison processes used in their daily lives—to whom individuals compare (the target), on what individuals compare (the attribute) and how they compare (comparison appraisal). Based on the analysis of 20 in-depth grounded theory interviews with 12- to 14-year old boys and girls, we suggest that comparison processes are used for the purpose of identity development (core category). Given the opportunity, adolescents spontaneously describe a variety of targets, comparison attributes and comparison appraisals. Peers play an important part in making sense of media images and messages and provide comparison targets themselves. Adolescents are aware of societal standards and pressures and use a range of enhancement appraisals. The positive impact of these might depend on individual characteristics. Findings suggest that enhancement appraisals might have a protective function and should be considered in designing health promotion and prevention programmes.

Examining the minimal required elements of a computer-tailored intervention aimed at dietary fat reduction: results of a randomized controlled dismantling study

Kroeze, W., Oenema, A., Dagnelie, P. C., Brug, J. — 2007-12-06

This study investigated the minimally required feedback elements of a computer-tailored dietary fat reduction intervention to be effective in improving fat intake. In all 588 Healthy Dutch adults were randomly allocated to one of four conditions in an randomized controlled trial: (i) feedback on dietary fat intake [personal feedback (P feedback)], (ii) P feedback and feedback on one's own behavior relative to that of peers [personal–normative feedback (PN feedback)], (iii) PN feedback and practical suggestions on how to change fat intake [personal—normative—action feedback (PNA feedback)] and (iv) generic information. Data on fat intake, awareness of one's own fat intake and intention to change were collected 1 and 6 months post-intervention. Between-group differences were tested with analysis of variance. Among respondents with high fat intakes at baseline (risk consumers) and those who underestimated their fat intake at baseline (underestimators), differences in awareness and (saturated) fat intake were found between the generic and PNA feedback conditions. Compared with generic information P feedback was more effective in changing awareness and intention among the underestimators, and PN feedback was more effective in changing intention among both risk consumers and underestimators. In conclusion, the combination of personal, normative and action feedback is required for inducing change in fat intake and improving awareness of fat intake.

The recent dramatic decline in road mortality in France: how drivers' attitudes towards road traffic safety changed between 2001 and 2004 in the GAZEL cohort

Constant, A., Salmi, L. R., Lafont, S., Chiron, M., Lagarde, E. — 2007-12-06

A very significant decline in the number of road casualties has been observed recently in France, concomitantly with a dramatic increase in law enforcement. The aim of this study was (i) to assess changes in attitudes about road traffic accident (RTA) prevention initiatives in France from 2001 to 2004 and (ii) to identify factors associated with an increase in positive attitudes towards RTA prevention initiatives. In 2001 and 2004, 9216 participants reported their attitudes towards traffic safety using the same self-administered Driving Behaviour and Road Safety Questionnaire. Sociodemographic, psychological and behavioural data were also available. The mean change in scores analysis showed that support for relaxing existing regulations decreased significantly during this period, while support for heightened enforcement and stricter regulations showed some decrease but remained high overall, especially concerning blood alcohol content and speed controls. Multivariate analyses suggest that highly educated drivers changed their attitudes towards road safety regulations more than other categories. Our results suggest that increased traffic law enforcement measures led to increasing support for current restrictions. Even if support for additional traffic law enforcement began to wane slightly in 2004, a large part of our population remained in favour of strengthening law enforcement related to speeding and drunk driving.

General parenting, anti-smoking socialization and smoking onset

Otten, R., Engels, R. C. M. E., van den Eijnden, R. J. J. M. — 2007-11-27

A theoretical model was tested in which general parenting and parental smoking predicted anti-smoking socialization, which in turn predicted adolescent smoking onset. Participants were 4351 Dutch adolescents between 13 and 15 years of age. In the model, strictness and psychological autonomy granting were related to lower likelihood of smoking onset, and parental smoking was positively related to smoking onset. Involvement and strictness were positively related to anti-smoking socialization, whereas parents who smoke where less likely to be engaged in anti-smoking socialization. In turn, anti-smoking socialization was negatively related to adolescent smoking. To test mediation, an asymptotic resampling method was used (bootstrapping); anti-smoking socialization appeared to mediate the links between involvement and smoking onset, strictness and smoking onset and parental smoking and smoking onset. In addition, parental smoking appeared to moderate the link between anti-smoking socialization and smoking onset. Implications for prevention were addressed.

Children's active free play in local neighborhoods: a behavioral mapping study

Veitch, J., Salmon, J., Ball, K. — 2007-11-26

Many Australian children are more sedentary than they should be, and almost one in five are currently overweight or obese. Some children may face difficulties finding opportunities to be active, having poor access to safe public open spaces or having low independent mobility limiting their access to places to play. This study aimed to examine children's access to places in their neighborhood for active free play and how these vary by age, sex and socioeconomic status (SES). Behavioral maps of the local neighborhood were completed by children (8–12 years) from five primary schools across different areas of Melbourne. Children living in low SES outer-urban neighborhoods had to travel greater distances to access local parks compared with those in inner-urban mid and high SES areas. One-third (32%) of children reported an independent mobility range of <100 m from home. In conclusion, for some children opportunities to engage in active free play in the local neighborhood may be limited due to lack of parks in close proximity to home and restricted independent mobility. It is important to collaborate with local governments, urban planners and community groups to improve access to neighborhood parks and to promote a sense of neighborhood safety.

The impact of an appearance-based educational intervention on adolescent intention to use sunscreen

Olson, A. L., Gaffney, C. A., Starr, P., Dietrich, A. J. — 2007-11-26

During adolescence, there is a steady decline in the use of sun protection and increased use of indoor tanning lights. Previous health education efforts have changed knowledge but not these behaviors. Middle school students (n = 113) received a single educational class that included personal viewing of skin changes visible under ultraviolet (UV) filtered light. Pre-/post-surveys assessed past, current and future intent to use sunscreen, as well as sun benefit and sun risk attitudes. Prior to the session, 42% were sunscreen non-users and 21% were consistent users. At post-test, one-third of students who had not previously intended to use sunscreen in the next month now intended to use it. Among students who had seen skin damage, 59% reported intention to use sunscreen in the next month versus 35% who did not see skin changes (P = 0.04). Viewing sun damage was an independent predictor of intent to use sunscreen in the next month (OR 2.9, P = 0.04), as was older age (OR 2.6, P = 0.04) and previous consistent sunscreen use (OR 6.1, P = 0.004). A brief educational intervention that emphasizes risk-to-appearance and personalizes the risks of UV exposure has the potential to influence early adolescent sun protection. Long-term studies of this approach are needed.

Changing health behaviors to improve health outcomes after angioplasty: a randomized trial of net present value versus future value risk communication

2007-11-19

Patients who have undergone angioplasty experience difficulty modifying at-risk behaviors for subsequent cardiac events. The purpose of this study was to test whether an innovative approach to framing of risk, based on ‘net present value’ economic theory, would be more effective in behavioral intervention than the standard ‘future value approach’ in reducing cardiovascular morbidity and mortality following angioplasty. At baseline, all patients completed a health assessment, recieved an individualized risk profile and selected risk factors for modification. The intervention randomized patients into two varying methods for illustrating positive effects of behavior change. For the experimental group, each selected risk factor was assigned a numeric biologic age (the net present value) that approximated the relative potential to improve current health status and quality of life when modifying that risk factor. In the control group, risk reduction was framed as the value of preventing future health problems. Ninety-four percent of patients completed 2-year follow-up. There was no difference between the rates of death, stroke, myocardial infarction, Class II–IV angina or severe ischemia (on non-invasive testing) between the net present value group and the future value group. Our results show that a net present risk communication intervention did not result in significant differences in health outcomes.

Health literacy and adolescents: a framework and agenda for future research

Manganello, J. A. — 2007-11-17

Health literacy is an important issue in public health today, especially as patients are taking a greater role in obtaining information about their health. Health literacy is commonly defined as ‘the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions’. While there is a large body of literature concerning health literacy and adults, few studies have focused on adolescents. Adolescents may have less interaction with the health care system and lower health care costs than adults, but they are increasingly involved with their health care, especially those with chronic illness. They are frequent users of mass media and other technology to access health information and are a target group for many health-related educational interventions. Adolescents are also at a crucial stage of development, learning skills they will carry with them into adulthood. The goal of this paper is to provide a summary of issues justifying the importance of studying health literacy as it relates to adolescents and to provide a framework and suggestions for future research.

A cluster-analytical approach towards physical activity and eating habits among 10-year-old children

Sabbe, D., De Bourdeaudhuij, I., Legiest, E., Maes, L. — 2007-11-17

The purpose was to investigate whether clusters—based on physical activity (PA) and eating habits—can be found among children, and to explore subgroups' characteristics. A total of 1725 10-year olds completed a self-administered questionnaire. K-means cluster analysis was based on the weekly quantity of vigorous and moderate PA, the excess index (weekly consumption of sugar and/or fat) and the daily diversity index. Chi-squares tested gender differences in clusters and associations with socio-economic status (SES), overweight, controlling for gender. Following distribution was reliable: Sporty Healthy Eaters (n = 242; high vigorous PA, average moderate PA, low excess, higher diversity), Sporty Mixed Eaters (n = 288; high overall PA, very high excess, high diversity), Moderate Active Healthy Eaters (n = 221; average vigorous PA, highest moderate PA, lower excess, higher diversity), Unsporting Unhealthy Eaters (n = 276; below average on all indexes, diversity extremely low) and Sedentary Healthy Eaters (n = 318; lowest overall PA, higher excess, highest diversity). The Sporty Healthy Eaters and Sporty Mixed Eaters comprised more males, Sedentary Healthy Eaters more females. No associations with SES or overweight were found for the clusters. Co-occurrence of healthy and unhealthy behaviour exists. Only Sporty Healthy Eaters combine high levels of PA with low excess index and higher dietary diversity index. Effective ways of directing children to selective, individual relevant recommendations should be developed.

Portrayal of tanning, clothing fashion and shade use in Australian women's magazines, 1987 2005

Dixon, H., Dobbinson, S., Wakefield, M., Jamsen, K., McLeod, K. — 2007-11-13

To examine modelling of outcomes relevant to sun protection in Australian women's magazines, content analysis was performed on 538 spring and summer issues of popular women's magazines from 1987 to 2005. A total of 4949 full-colour images of Caucasian females were coded for depth of tan, extent of clothing cover, use of shade and setting. Logistic regression using robust standard errors to adjust for clustering on magazine was used to assess the relationship between these outcomes and year, setting and model's physical characteristics. Most models portrayed outdoors did not wear hats (89%) and were not in shade (87%). Between 1987 and 2005, the proportion of models depicted wearing hats decreased and the proportion of models portrayed with moderate to dark tans declined and then later increased. Younger women were more likely to be portrayed with a darker tan and more of their body exposed. Models with more susceptible phenotypes (paler hair and eye colour) were less likely to be depicted with a darker tan. Darker tans and poor sun-protective behaviour were most common among models depicted at beaches/pools. Implicit messages about sun protection in popular Australian women's magazines contradict public health messages concerning skin cancer prevention.

Marketing hygiene behaviours: the impact of different communication channels on reported handwashing behaviour of women in Ghana

Scott, B. E., Schmidt, W. P., Aunger, R., Garbrah-Aidoo, N., Animashaun, R. — 2007-11-13

In 2003—04, a National Handwashing Campaign utilizing mass media and community events took place in Ghana. This article describes the results of the evaluation of the campaign in a sample of 497 women with children <5 years. The unifying message across all communication channels was that hands were not ‘truly’ clean unless washed with soap. The campaign reached 82% of the study population. Sixty-two per cent of women knew the campaign song, 44% were exposed to one channel and 36% to two or more. Overall, TV and radio had greater reach and impact on reported handwashing than community events, while exposure to both a mass media channel and an event yielded the greatest effect, resulting in a 30% increase in reported handwashing with soap after visiting the toilet or cleaning a child's bottom. Our evaluation questions wide-held belief that community events are more effective agents of behaviour change than mass media commercials, at least in the case of hygiene promotion. However, failure of mass media to reach the entire target audience, particularly in specific regions and lower socio-economic groups, and the additive effect of exposure, underscores the need to implement integrated communication programmes utilizing a variety of complementary channels.

Who is providing and who is getting asthma patient education: an analysis of 2001 National Ambulatory Medical Care Survey data

2007-11-05

Patient education in asthma management is important; however, there is little known about the characteristics of patients receiving asthma education or how often primary care physicians provide it. The objective of the study was to identify the characteristics of patients receiving asthma education. It was a cross-sectional study using 2001 National Ambulatory Medical Care Survey data. The study included 1230 physicians providing office-based ambulatory medical care in the United States. Patients in the study (weighted n = 11 279 952) were those diagnosed with asthma based on International Classification of Diseases, 9th Revision code receiving care from a pediatrician, internist or a family physician. Main and secondary outcome measures were asthma education ordered or provided. Multivariate analysis indicated that asthma patients receiving education were more likely to have office visits > 20 min [odds ratio (OR) = 3.934], be seen for an acute reason (OR = 2.268), be seen in follow-up rather than an initial visit (OR = 1.780), live in rural rather than metropolitan areas (OR = 1.507), have public rather than private insurance (OR = 1.276) and be seen in privately owned practices (OR = 1.248). Bivariate analyses indicated that patients seeing family physicians were more likely than those seeing internists or pediatricians to receive education. Patient education was not uniformly provided. Family physicians provided more asthma education than either pediatricians or internists. Future research should investigate the quality of education provided.

Young people and mental health: novel methods for systematic review of research on barriers and facilitators

Oliver, S., Harden, A., Rees, R., Shepherd, J., Brunton, G., Oakley, A. — 2007-11-05

This paper describes how barriers to, and facilitators of, good mental health amongst young people (11–21 years) were elucidated from a systematic review of studies of young people's views and how these barriers and facilitators were compared with effectiveness studies to identify effective and appropriate interventions, promising interventions needing further evaluation and the need for further intervention. All studies were published before 2000. No clear pattern for effectiveness emerged in terms of mental health promotion focus, the type of intervention, intervention provider or young people. Well-evaluated interventions neither always target what we know young people themselves see as important barriers to their mental health (for instance, loss of friends and family, violence and bullying) nor always build on what they see as key facilitators, particularly their preferred coping strategies. In particular, while young people see material and physical resources as major influences on their mental health, few evaluated interventions targeted these. Rigorously evaluated interventions more often addressed priorities not raised by young people themselves and populations at low risk for mental health problems. These innovative review methods can inform intervention development and evaluation in a new way based on the strengths and needs identified by the target population.

Food pyramids, keeping clean and sex talks: pre-service teachers' experiences and perceptions of school health education

Sinkinson, M, Hughes, D — 2007-11-01

This paper reports findings from the first stage of an anticipated four-stage research project investigating the effectiveness of teacher education in health education. Prior to receiving any teacher education in health education, pre-service teachers (student teachers) were surveyed for their experiences of secondary school health education, and their beliefs about and attitudes towards the subject. Data were collected from questionnaire surveys (n = 295) and focus group interviews (n = 61). Results showed that student teachers had more exposure to school health education than had been assumed and had more positive attitudes towards the subject area than indicated by other studies into school health education. Many reported having had sexuality education and drug and alcohol programmes, but these were commonly described in contexts of safety rules and risk avoidance behaviours. Participants had greater understanding of and more exposure to mental health education than had been predicted. Those aged 20 years and younger reported significantly greater exposure to a range of school health education topics than did those aged 21–30 years or 30+ years. This difference is attributed to the younger participants receiving health education based on the Health and Physical Education in the New Zealand Curriculum, introduced into schools in 1999.

Researching special populations: retention of Latino gay and bisexual men and transgender persons in longitudinal health research

Kuhns, L. M., Vazquez, R., Ramirez-Valles, J. — 2007-10-31

Few studies have sought to assess predictors of retention of racial/ethnic or sexual minorities in longitudinal health research. The purpose of this study is to investigate predictors of retention of Latino gay and bisexual men and transgender (GBT) research participants after the baseline interview. Data come from a sample of 643 Latino GBT individuals in two cities (Chicago and San Francisco). We assessed potential predictors of retention (operationalized as successful re-contact) using binary logistic regression of retention on five factors (sociodemographic/health, residential stability, acculturation/attachment to the United States, gay community attachment/stigmatization and research process/design). Our overall follow-up rate was 83 and 80% at 3 and 6 months, respectively. We found that traditional factors (e.g. education, income) were not associated with retention among Latino GBT. The strongest predictors of successful retention were the number of pieces of contact information provided by participants and city of residence (San Francisco). Furthermore, successful methods of contact (i.e. telephone, email) varied by city. We conclude that a largely immigrant urban population of Latino GBT individuals can be successfully followed in longitudinal research. The strong relationship between study design variables and successful retention indicates that collection of thorough contact information is vital to successful follow-up with this population.

Self-efficacy and environmental correlates of physical activity among older women and women with multiple sclerosis

Morris, K. S., McAuley, E., Motl, R. W. — 2007-10-24

Physical inactivity is a major health problem in the United States, particularly in elderly and disabled populations. Little research exists examining the relationships between aspects of the built environment and physical activity in older adults and individuals with multiple sclerosis (MS). We adopted a social cognitive perspective to examine the independent roles of perceptions of the environmental, self-efficacy and functional limitations in understanding physical activity levels among elderly women and women with MS. Older women (n = 136) and women diagnosed with MS (n = 173) were recruited to participate in separate cross-sectional studies. Individuals completed a battery of questionnaires and wore an activity monitor for 7 days. All measures were issued and collected through the mail with the use of self-addressed, pre-paid envelopes. Initial correlational analyses indicated that self-efficacy, functional limitations and environmental perceptions were significantly related to physical activity. Among older women, self-efficacy, functional limitations and street connectivity demonstrated independent contributions to physical activity behavior. Only self-efficacy and functional limitations demonstrated significant associations among women with MS. The prospective contributions of the environment and individual factors to changes in physical activity need to be determined.

Developing tailored immunization materials for concerned mothers

Gust, D. A., Kennedy, A., Wolfe, S., Sheedy, K., Nguyen, C., Campbell, S. — 2007-10-23

The objectives of this study were to (i) identify ‘Worried’ and ‘Fencesitter’ mothers through the use of screening questions; (ii) obtain detailed information from participants about their attitudes and beliefs regarding vaccines and their interactions with their child's main health care provider, including availability of immunization information; (iii) solicit comments on draft educational materials that were developed specifically for this study and (iv) solicit comments on revised educational materials. Focus groups of mothers were conducted in two phases (Phase 1: n = 17 groups; Phase 2: n = 12 groups) and in three cities across the United States. Phase 1 focus group discussions suggested that perceived necessity and safety of vaccines contributed to mothers’ attitudes about having their child receive immunizations. Participants relied on their children's main health care provider for immunization information; however, mothers often perceived that providers did not supply enough information about vaccinations. In Phase 2, comments on the revised educational materials (brochures) were generally positive, with many mothers noting that the new brochures provided more relevant information and conveyed it in a respectful way. Science-based tailored immunization materials may assist health care providers in addressing unique information needs and may improve vaccine acceptance among specific types of mothers.

Healthwise South Africa: cultural adaptation of a school-based risk prevention programme

Wegner, L., Flisher, A. J., Caldwell, L. L., Vergnani, T., Smith, E. A. — 2007-10-22

There is a need for effective prevention programmes aimed at reducing risk behaviour among South African adolescents. HealthWise South Africa is a school-based programme designed to reduce sexual and substance use risk behaviour, and promote positive use of leisure time among high-school learners (students). Based on successful programmes in the United States of America, HealthWise was developed for use in South Africa and pilot tested in four South African high schools. We carried out a process evaluation to establish the fidelity of implementation and make sure HealthWise was culturally relevant. Data sources comprised focus groups with educators and learners, lesson evaluations and observations, and interviews with school principals. Qualitative analysis of data highlighted pertinent cultural and contextual factors and identified areas for modifying HealthWise in order to promote better programme-consumer fit. These areas centred on time, language, and leisure. We noted a dynamic tension between the educators' desire to adhere to plan, and to make adaptations in accordance with learners' needs and the context. Ultimately, researchers need to find a balance between fidelity of implementation and programme adaptation to obtain effective programmes that are culturally acceptable to local consumers.

Policies related to active transport to and from school: a multisite case study

2007-10-22

Active transportation to and from school (ATS) is a viable strategy to help increase physical activity among youth. ATS can be challenging because initiatives require transdisciplinary collaboration, are influenced by the built environment and are affected by numerous policies. The purpose of this study is to identify policies and factors that influence ATS initiatives. Nine elementary schools in seven states participated in this case study. Sixty-nine stakeholders were interviewed. The interviews were transcribed, coded and analyzed using a master thematic codebook. This study identified two distinct aspects of policies: ‘influential factors’ which are factors that might impact policies related to ATS and ‘policy actions’ which are policies reported by people involved in ATS initiatives that directly affected their success. Influential factors included sidewalks, crosswalks/crossing guards, funding, personal safety concerns, advocacy group involvement and others. Policy actions included policies on school speed zone, drop-off, no-transport zones, school siting, school start/dismissal time and school choice. Despite the diversity of the schools studied, similarities included influence of built environment, safety concerns, funding and transdisciplinary collaboration. Stakeholders need to work together to stimulate action and ensure successful initiatives. Influential factors appear to be important to this process.

Process evaluation of the Pool Cool Diffusion Trial for skin cancer prevention across 2 years

Escoffery, C., Glanz, K., Elliott, T. — 2007-10-22

Though process evaluation of health programs has received growing attention, few interventions have reported process evaluation over multiple years. This article describes 2 years of process evaluation (2003–04) for the Pool Cool Diffusion Trial. Pool Cool is a skin cancer prevention program designed to increase sun protection habits among children and improve organizational and environmental supports for sun protection at swimming pools. Each year, 80 telephone interviews and 40 site visits at pools across the United States were completed, to examine how fully the program was implemented and the extent of use of program components between the two study conditions. Major components of the Pool Cool program, including sun safety lessons, sun safety signs and sunscreen use, had high implementation. Between the 2 years, most of the core elements were either maintained or increased in use. There were no significant differences between the basic and enhanced conditions on implementation. Reasons given for successful implementation were the provision of a toolkit, ease of implementing the program, pool staff and children enjoying the program and the field coordinators' support. These data provide information on programmatic factors that contribute to successful program diffusion.

Grounds for movement: green school grounds as sites for promoting physical activity

Dyment, J. E., Bell, A. C. — 2007-10-22

An environmental factor of particular importance to children's physical activity levels appears to be the presence of parks and open space. Thus, in promoting children's health, school grounds merit consideration as a potential setting for intervention. This paper explores how ‘green’ school grounds, which contain a greater diversity of landscaping and design features, affect the quantity and quality of physical activity among elementary school children. Teachers, parents and administrators associated with 59 schools across Canada completed questionnaires (n = 105). Analysis reveals that through greening, school grounds diversify the play repertoire, creating opportunities for boys and girls of all ages, interests and abilities to be more physically active. Complementing the rule-bound, competitive games supported by asphalt and turf playing fields, green school grounds invite children to jump, climb, dig, lift, rake, build, role play and generally get moving in ways that nurture all aspects of their health and development. Of particular significance is the potential to encourage moderate and light levels of physical activity by increasing the range of enjoyable, non-competitive, open-ended forms of play at school. Seen in this light, green school grounds stand to be an important intervention to be included in school health promotion initiatives.

Assessing psychosocial correlates of parental safety behaviour using Protection Motivation Theory: stair gate presence and use among parents of toddlers

2007-10-18

Unintentional injury due to falls is one of the main reasons for hospitalization among children 0–4 years of age. The goal of this study was to assess the psychosocial correlates of parental safety behaviours to prevent falls from a staircase due to the lack of or the lack of adequate use of a stair gate. Data were collected from a cross-sectional survey using self-administered questionnaires mailed to a population sample of 2470 parents with toddlers. Associations between self-reported habits on the presence and use of stair gates and family and psychosocial factors were analysed, using descriptive statistics and multiple regression models, based on Protection Motivation Theory. The presence of stair gates was associated with family situation, perceived vulnerability, response efficacy, social norms and descriptive norms. The use of stair gates was associated with family situation, response efficacy, self-efficacy and perceived advantages of safe behaviour. The full model explained 32 and 24% of the variance in the presence of stair gates and the use of stair gates, respectively, indicating a large and medium effect size. Programmes promoting the presence and adequate use of stair gates should address the family situation, personal cognitive factors as well as social factors.