Health Education Research - current issue

Using radon risk to motivate smoking reduction II: randomized evaluation of brief telephone counseling and a targeted video

2008-03-19

Radon and cigarette smoking have synergistic effects on lung cancer risk. Electric utility company bill stuffers offered free radon test kits to households with at least one smoker. Participating households (n = 1364) were randomized within a 2 x 2 design to evaluate the main effects of brief telephone counseling and a targeted video on smoking cessation and the establishment of new household smoking bans. Phone counseling was associated with cessation at 3-month follow-up but neither intervention led to 12-month or sustained cessation. While neither intervention had a significant effect on new bans, there were trends in the predicted direction and the combination of the two significantly increased new bans compared with no intervention. The presence of children in the household was associated with new bans. While few households had high levels of radon, such levels were associated with radon mitigation behaviors. Together with a previous study, these results suggest radon risk is a useful and inexpensive way to engage smoking households in risk reduction behaviors, especially the institution of household smoking bans.

Changes in cognitive measures associated with a lifestyle program for treated hypertensives: a randomized controlled trial (ADAPT)

Burke, V., Mansour, J., Mori, T. A., Beilin, L. J., Cutt, H. E., Wilson, A. — 2008-03-19

Cognitive changes are reported infrequently in programs targeting cardiovascular risk. We examined self-efficacy, behavioral barriers and health beliefs in a lifestyle program for drug-treated hypertensives that aimed to reduce blood pressure, antihypertensive drug needs and cardiovascular risk. In a randomized controlled trial, we compared usual care (controls) and a 4-month program focusing on weight loss, diet and exercise. Outcomes were assessed at baseline, 4 months and 1-year follow-up. Of 241 individuals randomized, 102/123 in the program and 90/118 of controls completed follow-up. In the program group, dietary barriers fell by 14% at 4 months (controls 2%, P = 0.025) and by 8% at follow-up (controls 3%, P = 0.010). Exercise barriers fell by 11% at 4 months (controls 3%, P = 0.020) and 17% (controls 4%, P = 0.002) at follow-up. Dietary self-efficacy improved by 3% at 4 months (controls –1%, P = 0.003) and by 2% at follow-up (controls –1%, P = 0.051). Exercise self-efficacy increased by 8% at 4 months (controls 3%, P < 0.001) and by 5% at follow-up (controls 3%, P = 0.130). Changes in cognitive variables predicted changes in health-related behaviors at 4 months and follow-up. A cognitively based lifestyle program in treated hypertensives is associated with improvements in cognitive measures in the shorter and longer term.

Testing the transtheoretical model for fruit intake: comparing web-based tailored stage-matched and stage-mismatched feedback

de Vet, E., de Nooijer, J., de Vries, N. K., Brug, J. — 2008-03-19

A match–mismatch test was conducted to test the transtheoretical model applied to fruit intake. Precontemplators and contemplators were randomly assigned to receive a web-based individualized precontemplation feedback (PCF), contemplation feedback (CF) or action feedback (AF) letter promoting fruit intake. Immediately and 1 week after reading this letter, post-test measures were obtained. Fruit intake increased significantly between pre- and post-test in contemplators, but not in precontemplators. No differences between the feedback conditions were found in fruit intake, stage progression, use or credibility of the feedback in precontemplators and contemplators. In precontemplators, also no differences between the conditions were found in personal relevance of the feedback. Contemplators, however, rated AF as more personally relevant than PCF or CF. To conclude, the present study failed to show superiority of stage-matched information in the promotion of fruit intake.

Food, Fun and Fitness Internet program for girls: influencing log-on rate

2008-03-19

Internet-based interventions hold promise as an effective channel for reaching large numbers of youth. However, log-on rates, a measure of program dose, have been highly variable. Methods to enhance log-on rate are needed. Incentives may be an effective method. This paper reports the effect of reinforcement schedule and recruitment method on log-on rates to an 8-week Internet-based obesity prevention program. It also explores trends in log-on rate. Girls were randomized to receive immediate (weekly) or delayed (program end) incentives ($5). The study was powered to detect a moderate-to-large effect (0.65). Overall log-on rate was 74.5%. A higher but not statistically different log-on rate was observed in the immediate incentive group (79%) than in the delayed incentive group (70%) (P = 0.118), and among girls recruited via media (80%) as opposed to non-media methods (69%) (P = 0.058). Trend analysis indicated a significant drop in log-on rate between weeks 4 and 5 among all participants (P = 0.009). Although an acceptable log-on rate was achieved in this program, there was a substantial drop between weeks 4 and 5. Identifying the reason that this occurred may provide insight into how to further enhance log-on rate. Recruitment method may influence log-on rate.

Program characteristics and organizational factors affecting the implementation of a school-based indicated prevention program

Thaker, S., Steckler, A., Sanchez, V., Khatapoush, S., Rose, J., Hallfors, D. D. — 2008-03-19

Reconnecting Youth (RY) is a school-based drug prevention program designed to address academic, substance use and mood management goals among youth at risk of dropping out of high school. This paper presents the organizational factors and RY program characteristics that either promoted or hindered the implementation of the program during a randomized controlled effectiveness trial in 10 schools in two school districts in the United States. Data were collected using surveys and interviews from teachers and school and district staff who participated in the implementation of the RY program in these schools. Results suggest that certain RY program characteristics made it difficult to implement. Small class size, resource-intensive procedures for student selection and recruitment and special training, qualities and skills needed to be an effective RY teacher meant that schools had to significantly change their usual practices to implement the program. Organizational barriers included a lack of financial resources and leadership support for program implementation, and low priority for non-academic courses for high-risk students. Transient student populations, staff turnover and district-wide scheduling and curriculum changes all resulted in high levels of organizational turbulence at most schools, further hindering program implementation.

Health information seeking among Mbararan adolescents: results from the Uganda Media and You survey

Ybarra, M. L., Emenyonu, N., Nansera, D., Kiwanuka, J., Bangsberg, D. R. — 2008-03-19

To maximize scarce intervention dollars, pediatricians and other adolescent health professionals must position health promotion efforts in mediums that most effectively reach youth. This may be especially true in resource-limited settings where access to primary health care and medications is limited. To improve the efficiency and impact of disease prevention and health promotion efforts in resource-limited settings, we examine sources of health information cited by adolescents in Mbarara Uganda. Participants in the Uganda Media and You survey were students aged 12–18 (n = 500) randomly identified in five secondary schools in Mbarara municipality, Uganda. Ninety-three percent of eligible and invited youth completed the cross-sectional, pencil-and-paper survey. Four in five adolescents (81%) indicated they turned to parents, teachers, and other adults while around half read a book/went to the library (56%) or turned to siblings and friends (50%) for information about health and disease. More than one in three (38%) indicated that they used the computer and Internet to search for health information. Older versus younger respondents tended to rely upon siblings and friends for all types of health questions. On the other hand, younger versus older youth were significantly more likely to turn to parents, teachers, and other adults for their questions about sexual health. Adults may be an important component of effective disease prevention and health promotion campaigns. Multiple delivery methods may be especially effective for reaching older adolescents. Technology also may be an important health promotion tool in resource-limited settings.

School policies and binge drinking behaviours of school-aged children in Wales--a multilevel analysis

Desousa, C., Murphy, S., Roberts, C., Anderson, L. — 2008-03-19

Research has highlighted increased and earlier alcohol consumption among young people. This study aims to explore whether the type of school alcohol policy employed is associated with the frequent binge drinking behaviours of adolescents, after adjusting for known demographic and social factors. Integrated cross-sectional data were used from Welsh school surveys that assess the health behaviours of adolescents and school health policies. Frequent binge drinking was more likely to occur among older pupils, those living with one parent and pupils from more affluent backgrounds. Frequent binge drinking was also associated with pupils who bullied others, those with greater peer involvement and who felt pressured by schoolwork. The results suggested that strong parental and school bonds were protective factors against frequent binge drinking as were greater life satisfaction. Pupils who were bullied were less likely to have frequently binge drank. There was some evidence to suggest that written school policies are associated with lower likelihood of frequent binge drinking, in particular among boys and pupils with lower school attachment. However, there is a need for greater understanding of the differential population influence of school alcohol polices and an evaluation of their effectiveness.

Process evaluation of a multi-institutional community-based program for diabetes prevention among First Nations

2008-03-19

Epidemic rates of diabetes among Native North Americans demand novel solutions. Zhiiwaapenewin Akino'maagewin: Teaching to Prevent Diabetes was a community-based diabetes prevention program based in schools, food stores and health offices in seven First Nations in northwestern Ontario, Canada. Program interventions in these three institutions included implementation of Grades 3 and 4 healthy lifestyles curricula; stocking and labeling of healthier foods and healthy recipes cooking demonstrations and taste tests; and mass media efforts and community events held by health agencies. Qualitative and quantitative process data collected through surveys, logs and interviews assessed fidelity, dose, reach and context of the intervention to evaluate implementation and explain impact findings. School curricula implementation had moderate fidelity with 63% delivered as planned. Store activities had moderate fidelity: availability of all promoted foods was 70%, and appropriate shelf labels were posted 60% of the time. Cooking demonstrations were performed with 71% fidelity and high dose. A total of 156 posters were placed in community locations; radio, cable TV and newsletters were utilized. Interviews revealed that the program was culturally acceptable and relevant, and suggestions for improvement were made. These findings will be used to plan an expanded trial in several Native North American communities.

Promotion of safe sex: evaluation of a community-level intervention programme in gay bars, saunas and sex shops

Godin, G., Naccache, H., Cote, F., Leclerc, R., Frechette, M., Alary, M. — 2008-03-19

This study was an evaluation of a safe sex promotion programme in gay bars, saunas and sex shops in Québec City. The impact of the intervention on safe sex was assessed by means of an interrupted sequential pre-interventions and post-interventions quasi-experimental design with independent samples. At each measurement time, ~320 individuals were recruited in gay bars and saunas and were invited to complete a self-administered questionnaire. The intervention had a significant impact on safe sex mainly among the 18–29 age group (relative risk = 0.71; 95% confidence interval [CI_95%] = 0.55–0.92), even after controlling for the effect of gay venue frequentation. Thus, the effect size of the intervention corresponds to a significant reduction of 29% in risky unprotected anal sex among this age group. Implementation of a theory-based community-level intervention has a positive impact on reducing unsafe sex practices, particularly among the 18–29 age group. However, if the preventive activities are not maintained on a regular basis, there is recrudescence in unsafe sex practices.

Starting young? Children's experiences of trying smoking during pre-adolescence

Milton, B., Woods, S. E., Dugdill, L., Porcellato, L., Springett, R. J. — 2008-03-19

Although the risks smoking poses to health are now well known, many young people continue to take up the habit. While numerous cross-sectional studies of adolescents have identified correlates of smoking initiation, much less prospective, longitudinal research has been conducted with young children to gather their accounts of early experiences of smoking, and this study fills that significant gap. Quantitative and qualitative data, collected using questionnaires, interviews and focus groups, are presented from the pre-adolescent phase of the Liverpool Longitudinal Study of Smoking. By age 11, 27% of the cohort had tried smoking, 13% had smoked repeatedly and 3% were smoking regularly. Rates of experimentation increased over time. Qualitative data revealed that curiosity and the role of peers were central to children's accounts of early smoking. By pre-adolescence, children are at different stages in their smoking careers, therefore interventions must be targeted to their varied experiences. Current prevention strategies often focus on restricting access to cigarettes, but a broad range of intervention measures is required which take account of the multifactorial nature of smoking onset. To be effective, policies that aim to prevent smoking must be grounded in children's lived experiences.

Cost-effectiveness analyses of health promotion programs: a case study of smoking prevention and cessation among Dutch students

2008-03-19

Little research has been done to connect health promotion programs to outcomes in terms of life expectancy, health care costs and cost-effectiveness. For a policy maker, economic evaluation may be an important tool to support decisions on how to allocate the health care budget. The aim of this paper was to determine the cost-effectiveness of a Dutch school-based smoking education program. The incremental cost-effectiveness ratio of the school program was estimated at 19 900 per quality adjusted life year gained. For a complete analysis, not only intervention costs but also savings for smoking-related diseases and differences in total health care costs should be taken into account. As several assumptions had to be made in order to estimate cost-effectiveness, the study outcomes should be interpreted with caution. Main problem in estimating the cost-effectiveness was the lack of proper effectiveness data on daily smokers among adolescents. Absence of specific effectiveness data often is an obstacle in the economic evaluation of public health interventions. While some problems may be the result of insufficient sample size or follow-up, another possible explanation might be the different basic principles of analysis of health promoters and economists.

The forgotten dimensions in health education research

Hawks, S. R., Smith, T., Thomas, H. G., Christley, H. S., Meinzer, N., Pyne, A. — 2008-03-19

This paper evaluates the content focus of health education research as presented in the professional literature over a 6-year period (2000–2005). The majority of research (1365 papers) addresses the physical dimension of health (79%), while other health dimensions receive less attention. It is argued that the current content focus of research in health education fails to harmonize with the multidimensional, dynamic and functional nature of health as generally defined. The goal of health education, positive behavior change, also seems less reachable without a better understanding of how nonphysical dimensions of health influence wellness behaviors. At present, there exists an opportunity for health educators to move toward research agendas that more fully appreciate the interconnectedness of various dimensions of health and that evaluate them evenhandedly. Practical application of this approach will require a partial break from the biological orientations of other health professions, new research agendas that clarify multidimensional health relationships and new programs that seek to influence outcomes in a variety of dimensions.

Factors associated with children being driven to school: implications for walk to school programs

Wen, L. M., Fry, D., Rissel, C., Dirkis, H., Balafas, A., Merom, D. — 2008-03-19

In this study, we examined factors associated with children being driven to school. Participants were 1603 students (aged 9–11 years) and their parents from 24 public primary schools in inner western Sydney, Australia. Students recorded their modes of travel to and from school for 5 days in a student survey. Parents recorded their demographic data, their attitudes to travel, and their modes of travel to work, using a self-administered survey. An analysis of the two linked data sets found that 41% of students travelled by car to or from school for more than 5 trips per week. Almost a third (32%) of students walked all the way. Only 1% of students rode a bike and 22% used more than one mode of travel. Of those who were driven, 29% lived less than 1 km and a further 18% lived between 1 and 1.5 km from school. Factors associated with car travel (after adjusting for other potential confounders) were mode of parents’ travel to work, parent attitudes, number of cars in the household, and distance from home to school. To be effective, walk to school programs need to address the link between parent journey to work and student journey to school.

Tailored behavioral support for smoking reduction: development and pilot results of an innovative intervention

2008-03-19

Reduction of smoking may increase the likelihood of eventual smoking cessation among those not ready to quit. We describe the development and acceptance of a smoking-reduction intervention that integrates telephone counseling sessions with newsletters. A computer-assisted telephone interviewing program generates real-time-tailored counseling delivered by lay interviewers. Pilot participants (n = 53) were adult smokers scheduled for outpatient procedures in a health maintenance organization, randomized to intervention or a control condition (quarterly mailings). Smoking levels were measured by self-report and biochemically. Among intervention participants continuing at 3 months, all but one rated their telephone support person positively on all dimensions. Counseling calls were ‘about right’ in number, and newsletters were perceived as quite personal. Intervention recipients reported smoking significantly fewer mean cigarettes per day at 3 months than at baseline, and significantly fewer than control participants. Comparisons were non-significant under intent-to-treat analyses and on biochemical measures. The program was well received by outpatients who were not ready to quit smoking, and was implemented successfully by telephone staff who had no previous smoking cessation counseling experience. An ongoing trial is evaluating effectiveness, cost and relationship to eventual cessation.

Weight stigmatization and bias reduction: perspectives of overweight and obese adults

Puhl, R. M., Moss-Racusin, C. A., Schwartz, M. B., Brownell, K. D. — 2008-03-19

This study employed qualitative methods with a sample of overweight and obese adults to identify and describe their subjective experiences of weight bias. Participants (274 females and 44 males) completed an online battery of self-report questionnaires, including several open-ended questions about weight stigmatization. These questions asked them to describe their worst experiences of weight stigmatization, their perceptions of common weight-based stereotypes, their feelings about being overweight and their suggestions for strategies to reduce weight stigma in our culture. Participants reported experiencing weight stigma across a range of contexts and involving a variety of interpersonal sources. Close relationship partners (such as friends, parents and spouses) were the most common source of their worst stigmatizing encounters. Participants challenged common weight-based stereotypes (notably, that obese individuals are ‘lazy’) and reported that they would like the public to gain a better understanding of the difficulties of weight loss, the causes of obesity and the emotional consequences of being stigmatized. Education was reported as the most promising avenue for future stigma-reduction efforts. The experiences and opinions expressed were not significantly different for men versus women or overweight versus obese individuals. A minority of participants expressed beliefs suggestive of self-blame and internalization of weight-based stereotypes. These results indicate that while obese individuals experience weight bias across many domains, more stigma-reduction efforts should target stigmatizing encounters in close relationships, including parents, spouses and friends of obese persons.

Factors associated with recruitment and retention of youth into smoking cessation intervention studies--a review of the literature

2008-03-19

This paper examines factors associated with high levels of recruitment and retention of youth into smoking cessation interventions. Fifty-five articles published from 1976 to June 2004 reported cessation outcomes were analyzed to examine the associations between selected variables and recruitment and retention rates. Studies with participants who smoked ≤5 cigarettes per day (cpd) were more likely to have recruitment rates ≥85%. Yet, studies with participants who smoked ≥6 cpd were more likely to have high retention rates. Studies that did not use incentives were more likely to have retention rates at end of intervention ≥85%. Findings indicate a lack of information reported about recruitment and retention procedures in adolescent tobacco cessation studies. Additional analyses and research need to be conducted to identify successful methods.