Health Education Research - current issue

Do we believe the tobacco industry lied to us? Association with smoking behavior in a military population

Mon, 16 Nov 2009 13:59:59 PST

Despite the dangers of smoking, tobacco companies continue to impede tobacco control efforts through deceptive marketing practices. Media campaigns that expose these practices have been effective in advancing anti-industry attitudes and reducing smoking initiation among young people, yet the association between knowledge of industry practices and smoking cessation and relapse has not been studied. In a large military sample entering Air Force Basic Military Training (BMT), where tobacco use is prohibited, we investigated (i) the prevalence of agreement with a statement that tobacco companies have misled the public about the health consequences of smoking and (ii) the association of this acknowledgement with smoking status upon entry into BMT (N = 36 013). At baseline, 56.6% agreed that tobacco companies have been deceptive, and agreement was a strong predictor of smoking status [smokers less likely to agree, odds ratio (OR) = 0.39, P < 0.01]. At 12-month follow-up, we examined the association between industry perception at baseline and current smoking status (N = 20 672). Recruits who had been smoking upon entry into BMT and who had acknowledged industry deception were less likely to report current smoking (OR = 0.84, P = 0.01). These findings suggest that anti-industry attitudes may affect smoking relapse following cessation.

A review of undergraduate university tobacco control policy process in Canada

Mon, 16 Nov 2009 13:59:59 PST

The college years occur during the stage of life when many people develop permanent smoking habits, and approximately one-third go on to become addicted smokers. The 18–24 year demographic that makes up the majority of undergraduate attendees represents the earliest years that the tobacco industry now can legally attempt to lure new customers into smoking. This research investigated the ways in which university tobacco control policies are developed, introduced to students, faculty and staff and how they are implemented and enforced. Findings show that tobacco control initiatives at Canadian undergraduate universities face a wide range of challenges including a lack of dedicated and consistent tobacco control personnel, ownership issues, funding, enforcement and monitoring dilemmas. Participants also reported that the layout and geographic location of the campus can result in difficulties in implementation. Consequently, it appears that there may be a growing, although inadvertent, tolerance for smoking on Canadian campuses.

Efficacy of a single computer-tailored e-mail for smoking cessation: results after 6 months

Te Poel, F., Bolman, C., Reubsaet, A., de Vries, H. — Mon, 16 Nov 2009 13:59:59 PST

To date, few Internet-delivered smoking cessation interventions have been tested. This study tested the efficacy, understandability, credibility and personal relevance of an e-mail-delivered computer-tailored smoking cessation intervention. It included tailored action plan feedback, as recent studies have demonstrated the importance of planning in facilitating quitting smoking. Participants (Dutch adults) were randomly assigned to the intervention (computer-tailored e-mail; N = 224) or the control group (generic, non-tailored e-mail; N = 234). The results 6 months after baseline (N = 195) showed that significantly more participants in the intervention group reported not having smoked in the last 24 hours (21.5%) and 7 days (20.4%) in contrast with participants in the control group (9.8 and 7.8%, respectively). Intention-to-treat analyses revealed similar results, though overall lower quitting percentages. Furthermore, participants in the intervention group appreciated the computer-tailored e-mail significantly more in terms of understandability, credibility and personal relevance. Hence, the computer-tailored intervention is effective for the Dutch smoking population motivated to quit smoking. Further research is needed into the efficacy of the intervention for smokers who are not motivated to quit smoking and into the benefits of (multiple) e-mail-delivered tailored letters with tailored action plan feedback over and above tailoring without action plan feedback.

Implementation fidelity of packaged teen smoking cessation treatments delivered in community-based settings

Sterling, K., Curry, S., Sporer, A., Emery, S., Mermelstein, R. — Mon, 16 Nov 2009 13:59:59 PST

Efficacious ‘packaged’ teen smoking cessation treatment programs, those developed by national organizations, are widely disseminated to local communities to help teens quit smoking. The implementation fidelity of these programs in community settings has not been documented. The efficacy of these programs could be lessened if they are not implemented as intended. Data from Helping Young Smokers Quit describe the frequency and types of modifications made to packaged teen cessation treatment programs for community delivery. A national sample of 591 community-based teen tobacco cessation treatment programs was profiled and 59% used a single packaged treatment program. Bivariate analyses found that 63% of program administrators reported implementing their program as planned; 37% modified their selected program. The most frequently reported modifications were made to the length and format of the program. Of those who modified their programs, >90% reported multiple program modifications (e.g. length and content). Administrators modified their programs to accommodate implementation barriers, such as time constraints and low participant enrollment, and to address the needs of participants with multiple risk behaviors that are co-morbid with tobacco use.

Keeping Kids Smokefree: lessons learned on community participation

Charlier, N., Glover, M., Robertson, J. — Mon, 16 Nov 2009 13:59:59 PST

Community participation in program decision-making and implementation is an ideal that community and academic stakeholders aspire to in participatory research. This ideal, however, can be difficult to achieve. We describe lessons learned about community participation from a quasi-experimental trial aimed at reducing the uptake of smoking among pre-adolescents in a community with a high percentage of Maori and Pacific Island people. The intervention involves students, parents, school teachers and management, extended families and members of the wider community. A total of approximately 4000 students (and their parents) of four urban Auckland schools were enrolled in the study over 3 years. The intervention is carried out through collaborations between public health professionals, academic institutions and school personnel. In order to enhance community participation, we conclude that (i) time commitment is needed to establish long-term ongoing relationships through face-to-face communication, (ii) research team members should ideally share similar cultural and ethnic backgrounds to the target audience and have in-depth understanding of and experience in the community milieu and (iii) collaborative partnerships between academic institutions and public health services are necessary to create strength and cohesion, and assist with clear articulation of the research project mission and objectives.

Community-based health programmes: role perceptions and experiences of female peer facilitators in Mumbai's urban slums

Alcock, G. A., More, N. S., Patil, S., Porel, M., Vaidya, L., Osrin, D. — Mon, 16 Nov 2009 13:59:59 PST

Community-based initiatives have become a popular approach to addressing the health needs of underserved populations, in both low- and higher-income countries. This article presents findings from a study of female peer facilitators involved in a community-based maternal and newborn health intervention in urban slum areas of Mumbai. Using qualitative methods we explore their role perceptions and experiences. Our findings focus on how the facilitators understand and enact their role in the community setting, how they negotiate relationships and health issues with peer groups, and the influence of credibility. We contextualize this within broader conceptualizations of peer-led health interventions and offer recommendations for similar community-based health initiatives.

Extra-team connections for knowledge transfer between staff teams

Ramanadhan, S., Wiecha, J. L., Emmons, K. M., Gortmaker, S. L., Viswanath, K. — Mon, 16 Nov 2009 13:59:59 PST

As organizations implement novel health promotion programs across multiple sites, they face great challenges related to knowledge management. Staff social networks may be a useful medium for transferring program-related knowledge in multi-site implementation efforts. To study this potential, we focused on the role of extra-team connections (ties between staff members based in different site teams) as potential channels for knowledge sharing. Data come from a cross-sectional study of afterschool childcare staff implementing a health promotion program at 20 urban sites of the Young Men's Christian Association of Greater Boston. We conducted a sociometric social network analysis and attempted a census of 91 program staff members. We surveyed 80 individuals, and included 73 coordinators and general staff, who lead and support implementation, respectively, in this study. A multiple linear regression model demonstrated a positive relationship between extra-team connections (β = 3.41, P < 0.0001) and skill receipt, a measure of knowledge transfer. We also found that intra-team connections (within-team ties between staff members) were also positively related to skill receipt. Connections between teams appear to support knowledge transfer in this network, but likely require greater active facilitation, perhaps via organizational changes. Further research on extra-team connections and knowledge transfer in low-resource, high turnover environments is needed.

Identifying influential young people to undertake effective peer-led health promotion: the example of A Stop Smoking In Schools Trial (ASSIST)

Starkey, F., Audrey, S., Holliday, J., Moore, L., Campbell, R. — Mon, 16 Nov 2009 13:59:59 PST

The objective of the study was to develop and evaluate an effective whole-community approach to identifying a diverse group of influential young people to effectively diffuse health promotion messages among their peers. A peer nomination questionnaire, developed through extensive piloting work, was completed by 10 730 Year 8 students (aged 12–13 years) in 59 schools (30 intervention, 29 control) as part of a cluster randomized controlled trial. Influential students identified in 30 intervention schools were trained to disseminate smoke-free health promotion messages through informal contacts with peers. This approach successfully identified, recruited and retained a diverse group of students, broadly representative of their year group, to undertake the role of ‘peer supporter’. Although students and staff expressed doubts about the suitability of some young people recruited as peer supporters, the intervention achieved a 22% reduction in the odds of being a regular smoker in intervention compared with control schools [odds ratio 0.78 (95% CI 0.64–0.96)]. Carefully designed and developed peer-led interventions have potential for delivering effective smoking prevention among adolescents. Paying close attention to the way in which peer educators are identified, and involving young people themselves in this process, may be the key to increasing the effectiveness of peer education.

'My friends love to tan': examining sensation seeking and the mediating role of association with friends who use tanning beds on tanning bed use intentions

Banerjee, S. C., Greene, K., Bagdasarov, Z., Campo, S. — Mon, 16 Nov 2009 13:59:59 PST

This paper explored how sensation seeking contributes to the likelihood of tanning bed use intentions both directly and indirectly through the way it shapes interaction with peers who use tanning beds and attitudes toward tanning bed. Eight hundred and ninety six (n = 896) male and female college students were recruited for the study. Measured variables included sensation seeking, association with friends who use tanning beds, attitudes toward tanning and tanning bed use intentions. Structural equation modeling was performed to test the hypotheses. In general, results supported the proposed hypotheses and documented that sensation seeking is indirectly associated with tanning bed use intentions through the mediation of association with peers who use tanning beds and attitudes toward tanning. The article discusses theoretical and methodological implications of the findings demonstrating the pathways of influence of sensation seeking on tanning bed use intentions.

Early fatherhood: a mapping of the evidence base relating to pregnancy prevention and parenting support

Trivedi, D., Brooks, F., Bunn, F., Graham, M. — Mon, 16 Nov 2009 13:59:59 PST

Teenage pregnancy prevention programmes targeted at young women have received considerable attention from researchers and programme developers. However, to date, relatively limited information is available on preventing teenage fatherhood or improving outcomes for young fathers. A notable gap is concerned with understanding the forms of sexual health programmes that are most effective from the perspective of young men. We conducted a systematic mapping to identify studies involving young men aimed at preventing teenage pregnancy, improving outcomes for teenage fathers or exploring the perspectives of young men around pregnancy and fatherhood. We searched a wide range of electronic databases from January 1996 to August 2008. Three quantitative and 15 qualitative studies were identified, of which nine were UK based. Key themes related to the inappropriateness of current sexual health promotion to respond to the needs of young men. While young men often possessed very similar ideals to young women, existing programmes were problematic when they negatively stereotyped young men and ineffectively addressed models of masculinity or the difficulties young men may have forming meaningful relationships. Further investigations are required on programme development for young men, particularly on sexual health promotion interventions for ‘looked-after’ young men and those from unstable childhoods.

Developing parenting programs to prevent child health risk behaviors: a practice model

Jackson, C., Dickinson, D. M. — Mon, 16 Nov 2009 13:59:59 PST

Research indicates that developing public health programs to modify parenting behaviors could lead to multiple beneficial health outcomes for children. Developing feasible effective parenting programs requires an approach that applies a theory-based model of parenting to a specific domain of child health and engages participant representatives in intervention development. This article describes this approach to intervention development in detail. Our presentation emphasizes three points that provide key insights into the goals and procedures of parenting program development. These are a generalized theoretical model of parenting derived from the child development literature, an established eight-step parenting intervention development process and an approach to integrating experiential learning methods into interventions for parents and children. By disseminating this framework for a systematic theory-based approach to developing parenting programs, we aim to support the program development efforts of public health researchers and practitioners who recognize the potential of parenting programs to achieve primary prevention of health risk behaviors in children.

Prevention of adolescents' music-induced hearing loss due to discotheque attendance: a Delphi study

Vogel, I., Brug, J., Van der Ploeg, C. P. B., Raat, H. — Mon, 16 Nov 2009 13:59:59 PST

Noise-induced hearing loss is a significant social and public health problem, which is found in increasing numbers of adolescents. Young people are particularly likely to expose themselves to potentially damaging loud sounds during leisure activities. Visiting discotheques is one of the most popular leisure activities of young people. Only a few minutes exposure to the sound levels played in discotheques can cause permanent hearing loss. Since little is known about what constitutes effective prevention strategies, we explored the opinions and ideas of 30 experts in a qualitative study consisting of a three-round web-based Delphi study. The main parties involved in the prevention of music-induced hearing loss due to discotheque attendance are as follows: the adolescents themselves, followed by the government, discotheque owners, decorators of discotheques and disk jockeys (DJs). None of the identified protective behaviors of adolescents was considered to be feasible. Five environmental interventions were identified as being both relevant and feasible; of these, the most important were that loudspeakers must be placed further away from the visitors and that discotheques have attractive, low-volume and clearly indicated ‘chill-out rooms’. Effective prevention strategies to avoid music-induced hearing loss among adolescents due to discotheque attendance need to be taken primarily by discotheque owners and disk jockeys.

Diabetes awareness and body size perceptions of Cree schoolchildren

Willows, N. D., Marshall, D., Raine, K., Ridley, D. C. — Mon, 16 Nov 2009 13:59:59 PST

Native American Indians and First Nations are predisposed to obesity and diabetes. A study was done to understand Cree schoolchildren's diabetes awareness and body size perceptions in two communities that had diabetes awareness-raising activities in the Province of Quebec, Canada. Children (N = 203) in grades 4–6 were classified into weight categories using measured heights and weights and grouped on diabetes awareness based on dichotomous responses to the question ‘Do you know what diabetes is?’ Children selected a drawing of an American Indian child whom they felt most likely to get diabetes and described their body size perception using a closed response question. Although 64.5% of children were overweight or obese, most (60.1%) children considered their body size to be ‘just right’, with 29.6% considering it ‘too big’ and 10.3% considering it ‘too small’. A minority (27.6%) of children had diabetes awareness. These children were more likely than children without diabetes awareness to consider their body size too big (42.9 versus 24.5%) and to choose an obese drawing as at risk for diabetes (85.7 versus 63.3%, odds ratio 3.48 and 95% confidence interval 1.53–7.91). Culturally appropriate health education programs to increase schoolchildren's diabetes awareness and possibility to have a healthy body weight are important.

Body image and obesity among Australian adolescents from indigenous and Anglo-European backgrounds: implications for health promotion and obesity prevention among Aboriginal youth

Cinelli, R. L., O'Dea, J. A. — Mon, 16 Nov 2009 13:59:59 PST

This study examines the relationship between body image and obesity, among 4367 indigenous and Anglo-European adolescents in Australia in 2006. It shows that indigenous adolescents, male and female, were more likely than their non-indigenous counterparts to desire and pursue weight gain. Indigenous males showed the greatest tendencies to gain weight and to perceive that they should build up their bodies. They also received the strongest parental advice to eat more, lose weight, do more exercise, do less exercise, and heed warnings that they were not eating enough. The percentage distribution of weight, from obese through to underweight, was not significantly different between indigenous and Anglo-European adolescents. Poor body image among obese adolescents was similar in all groups. This article concludes that indigenous Australian adolescents are more likely to desire weight gain and receive more parental and family advice about the desirability of gaining weight. Indigenous adolescents from around the world may have to grapple with conflicting cultural perceptions involving their own self-image, parental coercion and peer group pressure. Therefore, before planning and designing health education programs for indigenous young people, educators and health professionals should consider cultural attitudes lest they inadvertently create weight concerns, confuse or contradict healthy lifestyle messages.

Impact of a mass media campaign linking abdominal obesity and cancer: a natural exposure evaluation

Morley, B., Wakefield, M., Dunlop, S., Hill, D. — Mon, 16 Nov 2009 13:59:59 PST

A mass media campaign aired in the Australian state of Victoria aimed to increase awareness and encourage identification of the abdominal circumference for men and women that placed them at increased risk of cancer. The evaluation assessed the extent to which ad exposure was associated with improvement in awareness, intentions and behaviours with respect to weight and cancer. Respondents were overweight or obese adults aged 30–69 years and exposure to the advertisement occurred via commercial television programmes in a natural setting. Questionnaire assessment occurred before, immediately after and 2 weeks following exposure to the advertising, and a comparison group who did not recall the ad completed the same interviews. For the main analyses, the exposure group was those who recalled the advertisement at post-exposure and follow-up (n = 101). Those who did not recall it at either stage comprised the unexposed group (n = 81). The campaign achieved its primary objective of increased awareness of the link between obesity and cancer and the specific waist sizes indicative of risk, as well as increased behavioural intentions with respect to weight and cancer. However, it did not have an effect on self-awareness of weight status, perceived personal risk of cancer or weight loss behaviour.

Disclosing donation decisions: the role of organ donor prototypes in an extended theory of planned behaviour

Hyde, M. K., White, K. M. — Mon, 16 Nov 2009 13:59:59 PST

This study explored the role of donor prototype evaluations (perceptions of the typical organ donor) in organ donation communication decisions using an extended theory of planned behaviour (TPB) model. The model incorporated attitude, subjective norm, perceived behavioural control, moral norm, self-identity, and donor prototype evaluations to predict intentions to record consent on an organ donor register and discuss the organ donation decision with significant others. Participants completed surveys assessing the extended TPB constructs related to registering (n = 359) and discussing (n = 282). Results supported a role for donor prototype evaluations in predicting discussing intentions only. Both extended TPB structural equation models were a good fit to the data, accounting for 74 and 76% of the variance in registering and discussing intentions, respectively. Participants’ self-reported discussing behaviour (but not registering behaviour given low numbers of behavioural performers) was assessed 4 weeks later, with discussing intention as the only significant predictor of behaviour (Nagelkerke R² = 0.11). These findings highlight the impact of people's perceptions of a typical donor on their decisions to discuss their organ donation preference, assisting our understanding of the factors influencing individuals' communication processes in efforts to bridge the gap between organ supply and demand.