Health Education Research - recent issues

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.

African-American caregivers' breast health behavior

Inoue, M., Pickard, J. G., Welch-Saleeby, P., Johnson, S. — Mon, 07 Sep 2009 00:43:19 PDT

This study utilizes a stress and coping framework which includes cognitive appraisal, personal and environmental resources, coping and stress to examine factors related to African-American caregivers’ breast cancer screenings, including mammograms, clinical examinations and self-examinations. Using data from the Black Rural and Urban Caregivers Mental Health and Functioning Study, we performed separate logistic regressions for each type of breast cancer screening. Results reveal that having a regular doctor checkup (coping), care recipients having a cancer diagnosis (cognitive appraisal, and living in urban areas (environment resources) are associated with receiving a mammogram. Having greater income, having at least a high school degree (both personal resources) and having a regular doctor checkup (coping) are associated with receiving a clinical examination. Increased caregiver strain (stress), being 40 years old or older, social support (coping) and living in rural areas are associated with performing a self-examination. Targeting African-American caregivers, particularly in rural areas, for increased education on the importance of receiving breast cancer screenings is crucial to addressing health disparities. Making resources available, encouraging caregivers to get a clinical examination and a mammogram and directing public education toward caregivers are important points of intervention.

Stages of mammography adoption in Asian American women

Wu, T.-Y., Hsieh, H. F., West, B. T. — Mon, 07 Sep 2009 00:43:19 PDT

Asian American women have the lowest mammography screening rate and are often diagnosed at later stages of breast cancer compared with other ethnic groups. This study applied the Transtheoretical Model and examined the relationships between stages of mammography adoption and mammography-related beliefs while controlling for socio-demographic factors. The study consisted of a convenience sample of 315 participants from four populous Asian ethnic groups in Michigan (109 Asian Indians, 51 Chinese, 36 Koreans and 119 Filipinos). In this relatively small sample, Koreans appeared to be more likely to be at the pre-contemplation stage and less likely to be at the maintenance stage. Perceived barriers and decisional balance scores differed by stage, with pre-contemplators reporting highest barriers and lowest scores in decisional balance. In terms of specific barrier items, pre-contemplators also displayed significantly greater agreement for most of the barrier items. Participants in the action stage have less favorable decisional balance than those in two earlier stages (i.e. contemplation and relapse). Common barriers for this sample of Asian participants included the items related to access and modesty issues. Overall, the study supports the notion that assessing differences in mammography-related beliefs by stage of screening behavior may facilitate the development of stage-matched interventions for Asian ethnic groups.

A qualitative exploration of the community partner experience in a faith-based breast cancer educational intervention

Rodriguez, E. M., Bowie, J. V., Frattaroli, S., Gielen, A. — Mon, 07 Sep 2009 00:43:19 PDT

Although community partner engagement is a key component in faith-based health promotion/disease prevention intervention research, the perspective of community partners on their experiences in the intervention process has been infrequently investigated. Semi-structured in-depth interviews were conducted with 12 African-American community partners [i.e. four pastors and eight lay health co-ordinators (LHCs)] from eight churches in greater Baltimore, MD, USA, that engaged in a breast cancer educational intervention that followed a community-based participatory research (CBPR) approach. Audiotaped interviews were transcribed, coded and content analysis was used to identify themes across the codes. Findings show that pastors support a holistic approach to health and that LHCs act as a link between the pastors, participants and academic researchers. In addition, pastors and LHCs emphasized that the religious and/or spiritual program elements should not overpower the importance of reaching participants with critical health information regardless of their religious or spiritual beliefs. Study findings suggest that faith-based educational intervention efforts that follow a CBPR approach are important in promoting cancer awareness in the African-American community. Including community partner assessment can further elucidate critical intervention impacts and helps to address health disparities in underserved communities.

Process evaluation of a school-based weight gain prevention program: the Dutch Obesity Intervention in Teenagers (DOiT)

Singh, A. S., Chinapaw, M. J. M., Brug, J., van Mechelen, W. — Mon, 07 Sep 2009 00:43:19 PDT

Health promotion programs benefit from an accompanying process evaluation since it can provide more insight in the strengths and weaknesses of a program. A process evaluation was conducted to assess the reach, implementation, satisfaction and maintenance of a school-based program aimed at the prevention of excessive weight gain among Dutch adolescents [Dutch Obesity Intervention in Teenagers (DOiT)]. Our process evaluation involved data collections by means of questionnaires among students, teachers, school board and site staff. The results indicated immense difficulties in the recruitment phase and therefore a low reach at school level. However, among adolescents of the schools that participated, the reach was high (84%). Furthermore, the classroom intervention was implemented successfully based on the number of lessons taught. Most teachers rated the DOiT-intervention positively; students rated the intervention 6.6 on a scale of 1–10. The majority of the teachers planned to implement the DOiT-intervention program in the future, as they perceived DOiT feasible for pre-vocational education students.

Baseline survey of sun protection policies and practices in primary school settings in New Zealand

Reeder, A. I., Jopson, J. A., Gray, A. — Mon, 07 Sep 2009 00:43:19 PDT

The SunSmart Schools Accreditation Programme (SSAP) was launched as a national programme in October 2005 to help reduce the risk of excessive child exposure to ultraviolet radiation. As part of the need for evaluation, this paper reports the findings of a national survey of a randomly selected sample of approximately 12% of New Zealand primary schools prior to the national launch of the SSAP. Principals at 242 schools completed a mail survey (81% response rate) relating to school sun protection policies, practices, curriculum and environment. Survey responses were evaluated according to the 12 criteria of the SSAP, with schools assigned a score from 0 to 12. No school fully met all 12 accreditation criteria, although 2% of schools attained 11 criteria and another 2% attained 10. Nine per cent of schools attained three or fewer criteria. Overall, 7 was the most common score, achieved by 23%. School socio-economic decile rating and roll size were positively associated with higher scores (both P < 0.02). Continued support and resources are needed to encourage schools to address sun protection across the spectrum of curriculum, practices and environment and through commitment to written policy.

Which patient-related factors determine self-perceived patient adherence to prescribed dyspepsia medication?

Mon, 07 Sep 2009 00:43:19 PDT

Patient adherence to medical treatment for dyspepsia is disappointing, whereas adherence is crucial for a proper evaluation of treatment. This prospective study used elements of the Integrated Change Model and Weiner's Attribution Theory to describe patients’ important cognitions and their interrelationships regarding self-perceived adherence to short-term medical treatment for dyspepsia. Patient questionnaires measured the predictors before treatment and self-perceived adherence after treatment. Approximately one-quarter of the patients indicated that they were non-adherent (n = 347). Univariate and multiple linear regression analyses revealed several significant predictors that explained 44% of the variance in self-perceived adherence. Patients with a low educational level, patients who claimed to regularly forget their medication in general, patients with a low self-efficacy or a low intention were less likely to be adherent. These results may indicate targets for interventions designed to improve adherence to medical treatment for dyspepsia. For instance, asking about expected difficulties in taking acid suppressants (e.g. forgetfulness or medication use at weekends) and making action plans to overcome these difficulties (e.g. using reminders) may result in improved adherence rates. Such an approach may reach a substantial number of patients since one in five patients in our study experienced some difficulties in taking medication.

Daughter-initiated health advice to mothers: perceptions of African-American and Latina daughters

Mosavel, M., Thomas, T. — Mon, 07 Sep 2009 00:43:19 PDT

The prevailing paradigm of health exchange within the family is for health advice to flow from parent to child. Consistent with this pattern of exchange, most research has focused on the one-directional influence of the parent on the child and there is thus an absence of literature that explores the ability of adolescents to influence their parents’ health behaviors. This qualitative study addressed this gap by exploring the feasibility of daughters providing health advice to their mothers. Twelve focus groups were conducted with 78 African–American and Latina daughters between the ages of 12 and 17 from low-income neighborhoods in a Mid-Western city in the United States. This study utilized a grounded theory approach to examine the focus group data. The findings indicate that many daughters report that they are already giving their mothers a wide spectrum of advice, including health advice. Differences were found in the reported willingness of African–American daughters when compared to Latina daughters to provide their mothers with specific cancer advice. These data suggest that some of these daughters have the potential to be valuable health education conveyers in the family.

The compensatory health beliefs scale: psychometric properties of a cross-culturally adapted scale for use in The Netherlands

de Nooijer, J., Puijk-Hekman, S., van Assema, P. — Mon, 07 Sep 2009 00:43:19 PDT

This study assesses the psychometric properties of a measuring scale for compensatory health beliefs (CHBs), culturally adapted for use in the Dutch context. CHBs refer to the idea that people can compensate for unhealthy (mostly pleasant) behaviours with healthy behaviours, e.g. ‘It is OK to eat a chocolate bar, because I am going to the gym tonight’. We are critical towards such beliefs as they may also be an excuse to justify unhealthy behaviours. Before such effects can be studied, an appropriate tool to measure CHBs must be developed. We adapted a Canadian scale, consisting of four factors relating to beliefs about substance use, eating/sleeping habits, stress and weight regulation, translating it according to guidelines for cross-cultural adaptation and testing it among 145 Dutch students. Factor analysis showed that the structure was not entirely identical in the Dutch context, and the internal consistency of the four subscales was also low. The overall scale showed a high internal consistency ( = 0.78), indicating the existence of an underlying construct, and a high Pearson correlation between the first and second measurements (r = 0.82), showing good stability. We recommend using the overall scale and further studying its reliability among other subgroups as well as its validity.

Smoking among Dutch elementary schoolchildren: gender-specific predictors

Ausems, M., Mesters, I., van Breukelen, G., De Vries, H. — Mon, 07 Sep 2009 00:43:19 PDT

Higher rates of smoking initiation and continuation by female compared with male adolescents, as found in many developed countries, may call for gender-specific prevention programs. Risk factors of smoking initiation and continuation were examined prospectively (1997–2002) among 3205 Dutch elementary schoolchildren (mean age 11.64) in an intervention trial using written questionnaires and multilevel logistic regression. At baseline, smoking prevalence was lower among girls than among boys; at follow-up, smoking initiation was lower among girls than among boys. Concerning smoking initiation, girls and boys shared the following risk factors: age, modeling from parents and siblings (‘modeling nuclear’), modeling from other members in the social circle (‘modeling diffuse’) and perceived pro-tobacco pressure to smoke. The only gender-specific predictor of smoking initiation was parent origin; girls with non-Dutch parents could be targeted for prevention programs. Concerning continuation, girls and boys shared the following risk factors: older age, more modeling nuclear and diffuse, fewer smoking disadvantages and lower self-efficacy to refrain from smoking. This study confirms that social modeling, smoking attitude and self-efficacy information to refrain from smoking deserve a prominent place in smoking prevention programs for schoolchildren. Besides booster sessions, family-directed programs are suggested. No gender-specific predictors of later smoking initiation were found, apart from parent origin, which is not amenable to intervention.

Everybody's talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women

Love, G. D., Mouttapa, M., Tanjasiri, S. P. — Mon, 07 Sep 2009 00:43:19 PDT

Although Southeast Asian women are at exceedingly high risk for cervical cancer, low rates of the Pap testing necessary for early detection and successful treatment continue among this group. Previous research suggests that discussions about Pap testing with important people in a woman's life, particularly her doctor, may increase the likelihood of screening; therefore increasing women's discussions about cancer screenings is an important step toward behavior change. The purpose of this study was to determine the effectiveness of a culturally sensitive, seven-minute video intervention in reducing barriers to discussions about Pap tests among Thai women. This unique video presented Thai actors, speaking in Thai, in a soap opera format. Participants completed a self-report questionnaire at baseline, immediately after the intervention and at 3-month follow-up. The comparison group received an educational pamphlet. Although the results indicated that both groups experienced reductions in barriers to communicating with others about Pap tests, the intervention group had significantly stronger outcomes than the comparison group for communicating about Pap tests in general as well as to doctors. These findings suggest that intermediate communication effects such as self-efficacy, collective efficacy and perhaps interpersonal communication may reduce barriers to discussion and positive decision making regarding Pap tests.

Smoking cessation and diabetes control in Kerala, India: an urgent need for health education

Thresia, C. U., Thankappan, K. R., Nichter, M. — Mon, 07 Sep 2009 00:43:19 PDT

This study documented the tobacco use among male diabetes patients in a clinic-based population of urban India, patient reports of physician cessation messages and patients’ perception of tobacco use as a risk factor for diabetes complications. All the 444 male diabetes patients who attended three public sector hospitals in Thiruvananthapuram district, Kerala, were surveyed to ascertain their tobacco use as well as the frequency and content of quit messages received from health staff. A significant proportion (59%) of diabetes patients were tobacco users prior to diagnosis and more than half of them continued to use tobacco, many daily, even after diagnosis. Of the 100 current smokers, 75% were asked about their tobacco use at the time of diagnosis; of those, 52% were advised to quit. However, a lack of patient awareness existed regarding the linkages of smoking and diabetes complications. Notably, 52% of patients did not associate smoking with diabetes complications. Given the magnitude of tobacco use among diabetics, there is clearly a need for more proactive cessation efforts. The times of illness diagnosis, illness flare-ups and emerging illness complications are teachable moments when patients are primed to change their behavior and more motivated to quit tobacco.

Mobilizing men as partners: the results of an intervention to increase dual protection among Nigerian men

Mon, 07 Sep 2009 00:43:19 PDT

This quasi-experimental, proof-of-concept study evaluated the effects of an intervention designed to help Nigerian men decrease risk for HIV/sexually transmitted infections and unintended pregnancy. The intervention was delivered in groups during two 5-hour workshops, with a monthly 2-hour check-in session. A comparison condition consisted of a group-based half-day didactic workshop. Based on recruitment area, 149 men were assigned to the intervention and 132 to the comparison. Men were evaluated at baseline and 3-month post-intervention. At follow-up, men assigned to the intervention were almost four times more likely than comparison men to report condom use at last intercourse (P < 0.001) and to report fewer unprotected vaginal sex occasions, greater self-efficacy for negotiation, a more egalitarian power dynamic in their primary relationship, more positive expectations for condom use and greater intention for future consistent condom use (all P values < 0.05). Findings suggest that this intervention is both feasible and effective.

Secretos de la Buena Vida: processes of dietary change via a tailored nutrition communication intervention for Latinas

Mon, 07 Sep 2009 00:43:19 PDT

Secretos de la Buena Vida was a successful tailored nutrition communication intervention delivered to Latinas living along the US–Mexico border in California. The intervention was delivered over a 14-week period and consisted of three intervention conditions: weekly home visits with promotoras + weekly tailored mailed newsletters in the first condition, weekly tailored mailed newsletters in the second condition and targeted materials in the attention control condition. The current study examined what elements of the promotora + tailored newsletter and tailored newsletter-only conditions were most effective for behavioral adoption and maintenance in a sample of 238 Latina women. Process evaluation measures assessed the implementation, fidelity and dose of these two intervention conditions. Results indicate that there was high fidelity to program implementation and delivery. Perceived effort, perceived support and intervention length predicted adoption of a lower fat diet at the 15-month follow-up. In the promotora + tailored newsletter condition, married women were four times more likely to be adopters of dietary fat changes than single women. These findings highlight the importance of process evaluation measures and help us understand the mechanism by which tailored print materials and interpersonal health communication via promotoras can facilitate health behavior change.

Mass media campaign improves cervical screening across all socio-economic groups

Anderson, J. O., Mullins, R. M., Siahpush, M., Spittal, M. J., Wakefield, M. — Mon, 07 Sep 2009 00:43:19 PDT

Low socio-economic status (SES) has been associated with lower cervical screening rates. Mass media is one known strategy that can increase cervical screening participation. This study sought to determine whether a mass media campaign conducted in Victoria, Australia, in 2005 was effective in encouraging women across all SES groups to screen. Data were obtained from the Victorian Cervical Cytology Registry for each Pap test registered during 2005 and categorized into SES quintiles using the Index of Socio-Economic Advantage/Disadvantage. Negative binomial regression was used to determine the impact of the campaign on the weekly number of Pap tests and whether the media campaign had a differential effect by SES, after adjusting for the number of workdays per week, age group and time since previous test. Cervical screening increased 27% during the campaign period and was equally effective in encouraging screening across all SES groups, including low-SES women. Mass media campaigns can prompt increased rates of cervical screening among all women, not just those from more advantaged areas. Combining media with additional strategies targeted at low-SES women may help lessen the underlying differences in screening rates across SES.

Use of focus group data to develop recommendations for demographically segmented colorectal cancer educational strategies

Mon, 07 Sep 2009 00:43:19 PDT

Screening is available and effective in colorectal cancer (CRC) control, but underutilized. The purpose of this study was to use focus group data to develop recommendations for the development of educational interventions to increase CRC screening, using an audience segmentation strategy. Demographic segments were based on urban–rural residence, race (African-American, White) and sex. One hundred and sixty-five participants age 50+, with no history of CRC participated in 17 focus groups in Alabama urban and rural communities. Transcripts were examined by independent coders. Knowledge among participants was limited regarding age to begin screening, insurance coverage and risk factors for CRC. Perceived barriers to screening included lack of physician recommendation, cost/lack of insurance coverage, pain/discomfort and embarrassment. African-American men reported postponement in seeing their physicians. White women were proactive at initiating discussion of CRC screening with their providers while African-American women felt that providers should drive the process. No urban–rural differences were identified. This study identified cultural and gender characteristics and perceptions that can be used in the development of demographically segmented health communication interventions to increase CRC awareness and screening.

Compensatory beliefs about glucose testing are associated with low adherence to treatment and poor metabolic control in adolescents with type 1 diabetes

Rabiau, M. A., Knauper, B., Nguyen, T.-K., Sufrategui, M., Polychronakos, C. — Mon, 07 Sep 2009 00:43:19 PDT

The goal of this research was to investigate whether compensatory beliefs (CBs) regarding glucose testing predict blood glucose levels and adherence to treatment in adolescents with type 1 diabetes. CBs are convictions that the negative effects of one behavior (e.g. not testing one's glucose level) can be compensated for by engaging in another behavior (e.g. not eating any sweets). Adolescent patients from the Diabetes Clinic at the Montreal Children's Hospital and their parents filled out scales while coming for a regular visit. Results from their HbA_1c blood test from that visit and prior visits were obtained from their medical records. Results showed that holding glucose testing CBs was associated with poorer HbA_1c and poorer adherence to self-care behaviors. Hierarchical regression analyses showed that glucose testing CBs predicted blood glucose control and adherence to treatment above and beyond a number of other constructs including diabetes knowledge. Addressing CBs in diabetes education, in particular targeting those concerning glucose testing, could improve the adherence to treatment and thereby the long-term health of people with diabetes.

Identifying cluster subtypes for intentions to have colorectal cancer screening among non-compliant intermediate-risk siblings of individuals with colorectal cancer

Mon, 07 Sep 2009 00:43:19 PDT

Although first-degree relatives of colorectal cancer (CRC) patients diagnosed at an early age are at increased risk for CRC, their compliance with colorectal cancer screening (CRCS) is not high. Relatively little is known about why these intermediate-risk family members do not comply with CRCS. Study aims were to identify subgroups of siblings of individuals diagnosed with CRC prior to age 61 who were not compliant with CRCS using cluster analysis and to identify demographical, medical and attitudinal correlates of cluster membership. A total of 421 siblings completed measures of pros, cons, processes of change, CRCS knowledge, physician and family CRCS support, CRC risk, severity, preventability, curability, closeness with the affected sibling, distress about the sibling's cancer and screening intentions. Three clusters characterized as ‘Positive about Screening’, ‘Uncertain about Screening’ and ‘Negative about Screening’ were identified. External validation revealed that those in the Positive about Screening cluster reported significantly stronger CRCS intentions than those who are Uncertain about Screening and Negative about Screening clusters. Results provide an empirical typology for understanding motivations for CRCS among at-risk family members and may lead to the development of more effective interventions to improve screening uptake.

Evaluation of HIV/AIDS secondary school peer education in rural Nigeria

van der Maas, F., Otte, W. M. — Mon, 06 Jul 2009 06:52:30 PDT

In this study, we assessed whether peer education is an effective method of HIV/AIDS awareness, in terms of knowledge, misconception and behavior, among adolescents in the rural area of Nigeria. A comparative case series (n = 250), cross-sectional structured survey (n = 135) and focus group discussions (n = 80) were undertaken among adolescents. In both the case series and structured survey, a questionnaire was used which addresses the following issues: socio-demography, knowledge on transmission and prevention of HIV/AIDS, accessibility to different sources of HIV/AIDS information, stigmatization and sexual behavior. Binary logistic regression was applied to compare responses from the peer-educated and not peer-educated populations. The model was adjusted for confounders. We demonstrated increased knowledge and decreased misconception and sexual risk behavior in adolescents receiving peer education as compared to adolescents not receiving peer education. These differences are apparent both over time (2005–2007) and cross-sectional (2007). In conclusion, peer education in rural areas can be effective in HIV/AIDS prevention. Knowledge and behavior can be influenced positively.

Developing nutrition education resources for a multi-ethnic population in New Zealand

Mon, 06 Jul 2009 06:52:30 PDT

In New Zealand, the burden of nutrition-related disease is greatest among vulnerable and disadvantaged groups, including Maori and Pacific peoples. However, little research is currently available on effective ways to improve nutrition in these communities. This paper describes the development of six paper-based nutrition education resources for multi-ethnic participants in a large supermarket intervention trial. Six focus groups involving 15 Maori, 13 Pacific and 16 non-Maori, non-Pacific participants were held. A general inductive approach was applied to identify common themes around participants' understanding and thoughts on relevance and usefulness of the draft resources. Feedback from focus groups was used to modify resources accordingly. Five themes emerged across all focus groups and guided modification of the resources: (i) perceived higher cost of healthy food, (ii) difficulty in changing food-purchasing habits, (iii) lack of knowledge, understanding and information about healthy food, (iv) desire for personally relevant information that uses ethnically appropriate language and (v) other barriers to healthy eating, including limited availability of healthy food. Many issues affect the likelihood of purchase and consumption of healthy food. These issues should be taken into account when developing nutritional materials for New Zealanders and possibly other multi-ethnic populations worldwide.

Effective contraceptive use: an exploration of theory-based influences

Peyman, N., Oakley, D. — Mon, 06 Jul 2009 06:52:30 PDT

The purpose of this study was to explore factors that influence oral contraceptive (OC) use among women in Iran using the Theory of Planned Behavior (TPB) and concept of self-efficacy (SE). The study sample consisted of 360 married OC users, aged 18–49 years recruited at public health centers of Mashhad, 900 km east of Tehran. SE had the strongest association with the intent to use after the clinic visit (r = 0.784) and with actual use (r = 0.452). Family planning self-efficacy combined with TPB variables accounted for 65% of the variance for intent and 27% of the variance in behavior. The results provide support for a theory-based approach to improved family planning care that specifically addresses more effective use. Development and evaluation of culturally appropriate public education and changes in clinical efforts designed to enhance the sense of SE are discussed.

Measurement characteristics of dietary psychosocial scales in a Weight Gain Prevention Study with 8- to 10-year-old African-American girls

Mon, 06 Jul 2009 06:52:30 PDT

Few measurement instruments for children's eating behaviors and beliefs have been specifically validated for African-American children. Validation within this population is important because of potential cultural and ethnic influences. Objectives were to evaluate established and newly developed or adapted dietary psychosocial measures in a sample of 303 preadolescent African-American girls and their caregivers. Acceptable internal consistency (Cronbach's ≥ 0.70) was found for measures of girls’ self-efficacy for healthy eating, outcome expectancies for healthy eating, positive family support for healthy eating and household availability of low-fat food and fruit, juice and vegetables (FJV). Evidence for concurrent validity was found with significant associations between self-efficacy for healthy eating and lower intake of energy (r = –0.17) and fat grams (r = –0.16). Greater FJV availability was associated with greater FJV intake (r = 0.14) and lower body mass index (BMI) in girls (r = –0.12). Positive family support for healthy eating was associated with higher BMI in girls (r = 0.41). These results contribute to the development of scales to evaluate prevention interventions related to dietary intake in African-American children.

Prediction of stage transitions in fruit and vegetable intake

Mon, 06 Jul 2009 06:52:30 PDT

Stage theories propose that individuals pass through different stages on their way toward behavior change. The present study examines stage-specific prediction patterns of social–cognitive variables (risk perception, outcome expectancies, perceived self-efficacy, action planning and social support) regarding transitions between the three stages of the Health Action Process Approach (HAPA; preintention, intention and action stage). In an online study (n = 494) on fruit and vegetable intake, social–cognitive variables and stages were assessed at baseline and stage transitions 4 weeks later. Transitions between the preintention, intention and action stage were predicted by social–cognitive variables using binary and multinomial logistic regression analyses. Stage-specific prediction patterns emerged for stage progression and stage regression. Outcome expectancies predicted progression from the preintention stage, whereas social support predicted progression to the action stage. Low levels of planning were associated with relapse to the preintention and the intention stage. Self-efficacy emerged as a universal predictor of stage transitions. Findings support not only the usefulness of the stage construct for describing health behavior change but also the validity of the HAPA variables as predictors of stage transitions. Stage-matched interventions targeting the variables identified as stage-specific predictors might support stage progression toward the goal behavior.

Adolescents' impressions of antismoking media literacy education: qualitative results from a randomized controlled trial

Primack, B. A., Fine, D., Yang, C. K., Wickett, D., Zickmund, S. — Mon, 06 Jul 2009 06:52:31 PDT

Although media literacy represents an innovative venue for school-based antismoking programming, studies have not systematically compared student impressions of these and traditional programs. This study utilized data from a randomized trial comparing these two types of programs. After each program, students responded to three open-ended questions related to their assigned curriculum. Two coders, blinded to student assignments, independently coded these data. Coders had strong inter-rater agreement (kappa = 0.77). Our primary measures were spontaneously noted overall assessment, enjoyment/interest and the likelihood of changing smoking behavior. Of the 531 participants, 255 (48.0%) were randomized to the intervention (media literacy) group. Intervention participants had more net positive responses [rate ratio (RR) = 1.27, 95% confidence interval (CI) = 1.05, 1.54], more responses rating the program as compelling (RR = 1.63, 95% CI = 1.16, 2.29) and fewer responses rating the program as non-compelling (RR = 0.62, 95% CI = 0.39, 0.97). However, the intervention group was not more likely to suggest that the curriculum was likely to change behavior positively (RR = 0.57, 95% CI = 0.30, 1.06). Findings suggest that although media literacy provides a compelling format for the delivery of antitobacco programming, integration of components of traditional programming may help media literacy programs achieve maximal efficacy.

A Community Health Advisor Program to reduce cardiovascular risk among rural African-American women

Mon, 06 Jul 2009 06:52:31 PDT

The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and training, community intervention and maintenance. Formative data collected to develop the training, intervention and evaluation methods and materials indicated the need for programs to increase knowledge, skills and resources for changing behaviors that increase the risk of CVD. CHAs worked in partnership with staff to develop, implement, evaluate and maintain strategies to reduce risk for CVD in women and to influence city officials, business owners and community coalitions to facilitate project activities. Process data documented sustained increases in social capital and community capacity to address health-related issues, as well as improvements in the community’s physical infrastructure. This project is unique in that it documents that a comprehensive CHA-based intervention for CVD can facilitate wide-reaching changes in capacity to address health issues in a rural community that include improvements in community infrastructure and are sustained beyond the scope of the originally funded intervention.

Health behavior interests of adolescents with unhealthy diet and exercise: implications for weight management

Thunfors, P., Collins, B. N., Hanlon, A. L. — Mon, 06 Jul 2009 06:52:31 PDT

This study sought to determine individual factors that may influence adolescents’ interests in various health behaviors and, by extension, their potential interest in programs that promote healthy lifestyles and reduce obesity. The sample consisted of 737 rural Pennsylvania (United States) middle and high school students not involved in either healthy exercise or dietary behaviors (a target group for health-promoting interventions). Participants completed a self-report measure of their general health functioning, including their interests in sports programs, outdoor recreation programs, weightlifting, weight loss and healthy eating/cooking. Nurses measured body mass indices (BMIs). The vast majority of the sample endorsed self-efficacy in healthy eating and physical activity, and this self-efficacy was associated with interest in a healthy diet and outdoor recreation. Interest in healthy activities was consistently higher among 7th graders (age mean = 12.6 years) than 11th graders (age mean = 16.3 years). Females were more interested in weight loss and healthy eating/cooking, whereas males were more interested in weightlifting. Higher BMI only predicted interest in weight loss. These results indicate that adolescent health interests vary on the basis of their gender, grade level, BMI and self-efficacy. These trends are potentially important to consider when seeking to match intervention programs to adolescent interests.

The health impact of an online heart disease support group: a comparison of moderated versus unmoderated support

Lindsay, S., Smith, S., Bellaby, P., Baker, R. — Mon, 06 Jul 2009 06:52:31 PDT

The aim of this study was to assess whether our online closed community heart care support group and information resource could sustain changes in health behaviour after the moderators withdrew their support. Heart patients (n = 108) living in a deprived area of Greater Manchester were recruited from general practitioners’ coronary heart disease registries. The sample for this randomized controlled trial was divided in half at random where half of the participants received password-protected access to our health portal and the other half did not. At 6 months follow-up (based on the moderated phase), there was a significant difference between the experimental group and the controls in terms of self-reported diet (eating bad foods less often). This change in behaviour was not sustained during the 3-month unmoderated phase. During this unmoderated phase of the intervention, the experimental group had significantly more health care visits compared with the controls. There was no significant difference between the two phases for either group in terms of exercise, smoking or social support. This study offers insight into the potential implications for health changes of moderating arrangements for online health communities.

Planned, motivated and habitual hygiene behaviour: an eleven country review

Curtis, V. A., Danquah, L. O., Aunger, R. V. — Mon, 06 Jul 2009 06:52:31 PDT

Handwashing with soap (HWWS) may be one of the most cost-effective means of preventing infection in developing countries. However, HWWS is rare in these settings. We reviewed the results of formative research studies from 11 countries so as to understand the planned, motivated and habitual factors involved in HWWS. On average, only 17% of child caretakers HWWS after the toilet. Handwash ‘habits’ were generally not inculcated at an early age. Key ‘motivations’ for handwashing were disgust, nurture, comfort and affiliation. Fear of disease generally did not motivate handwashing, except transiently in the case of epidemics such as cholera. ‘Plans’ involving handwashing included to improve family health and to teach children good manners. Environmental barriers were few as soap was available in almost every household, as was water. Because much handwashing is habitual, self-report of the factors determining it is unreliable. Candidate strategies for promoting HWWS include creating social norms, highlighting disgust of dirty hands and teaching children HWWS as good manners. Dividing the factors that determine health-related behaviour into planned, motivated and habitual categories provides a simple, but comprehensive conceptual model. The habitual aspects of many health-relevant behaviours require further study.

Understanding the role of self-identity in habitual risky behaviours: pedestrian road-crossing decisions across the lifespan

Holland, C. A., Hill, R., Cooke, R. — Mon, 06 Jul 2009 06:52:31 PDT

Self-identity as a careful pedestrian has not been fully considered in previous work on predicting intention to cross the road, or actual crossing behaviour, in non-optimal situations. Evidence suggests that self-identity may be a better predictor than attitudes in situations where decision-making styles have become habitual ways to respond. This study compared contributions of self-identity and attitudes to the prediction of intentions in two situations differing in level of habitual crossing expectation, and to crossing behaviour. Three hundred and sixty-two adults (17–92 years) completed a questionnaire measuring self-identity, attitudes, intentions, experience, social identity variables (e.g. age, gender) and personal limitations (mobility). Two hundred and five participants also completed a road-crossing simulation. Self-identity and attitude were both shown as significant independent predictors of intention in both situations. However, self-identity was less effective as a predictor in the higher risk scenario, where intention to perform the behaviour was lower, and for participants aged >75 years who had lower intention across scenarios. Self-identity strongly predicted intention to cross, which in turn predicted behaviour, but self-identity did not directly predict behaviour. Self-identity was strongly predicted by age. Implications for theories of compensation in older age and for design and targeting of pedestrian safety education are discussed.

The effect of a handwashing intervention on preschool educator beliefs, attitudes, knowledge and self-efficacy

Rosen, L., Zucker, D., Brody, D., Engelhard, D., Manor, O. — Mon, 06 Jul 2009 06:52:31 PDT

This paper describes the effect of a preschool hygiene intervention program on psychosocial measures of educators regarding handwashing and communicable pediatric disease. A cluster-randomized trial, with randomization at the level of the preschool, was run in 40 Jerusalem preschool classrooms. Eighty preschool educators participated. The program used a multipronged approach which included elements aimed at staff, children, parents, school nurses and the classroom environment. Frontal lectures by medical, epidemiological and educational experts, along with printed materials and experiential learning, were provided to staff. Responses from a validated survey instrument were used to build four scales for each respondent regarding beliefs, attitudes, self-efficacy and knowledge. The scales were built on a Likert-type 1–7 scale (1 = minimum, 7 = maximum). The effect of the intervention was tested using mixed model analysis of variance. Response was received from 92.5% of educators. Educators believed that handwashing could affect health (mean = 5.5, SD = 1.1), had high levels of self-efficacy (mean = 6.1, SD = 0.9) and had positive attitudes toward handwashing (mean = 5.7, SD = 1.2). Knowledge was affected by the intervention (intervention: mean = 6.2, SD = 0.7; control: mean = 5.8, SD = 0.8). The combination of positive attitudes toward handwashing among educators and the program's effectiveness in imparting knowledge helped to create a sustained social norm of handwashing among many children in disparate locations.

Computer-tailored dietary behaviour change interventions: a systematic review

Neville, L. M., O'Hara, B., Milat, A. J. — Mon, 06 Jul 2009 06:52:31 PDT

Improving dietary behaviours such as increasing fruit and vegetable consumption and reducing saturated fat intake are important in the promotion of better health. Computer tailoring has shown promise as a strategy to promote such behaviours. A narrative systematic review was conducted to describe the available evidence on ‘second’-generation computer-tailored primary prevention interventions for dietary behaviour change and to determine their effectiveness and key characteristics of success. Systematic literature searches were conducted through five databases: Medline, Embase, PsycINFO, CINAHL and All EBM Reviews and by examining the reference lists of relevant articles to identify studies published in English from January 1996 to 2008. Randomized controlled trials or quasi-experimental designs with pre-test and post-test behavioural outcome data were included. A total of 13 articles were reviewed, describing the evaluation of 12 interventions, seven of which found significant positive effects of the computer-tailored interventions for dietary behaviour outcomes, one also for weight reduction outcomes. Although the evidence of short-term efficacy for computer-tailored dietary behaviour change interventions is fairly strong, the uncertainty lies in whether the reported effects are generalizable and sustained long term. Further research is required to address these limitations of the evidence.

The influence of tobacco marketing on adolescent smoking intentions via normative beliefs

Brown, A., Moodie, C. — Mon, 06 Jul 2009 06:52:31 PDT

Using cross-sectional data from three waves of the Youth Tobacco Policy Study, which examines the impact of the UK's Tobacco Advertising and Promotion Act (TAPA) on adolescent smoking behaviour, we examined normative pathways between tobacco marketing awareness and smoking intentions. The sample comprised 1121 adolescents in Wave 2 (pre-ban), 1123 in Wave 3 (mid-ban) and 1159 in Wave 4 (post-ban). Structural equation modelling was used to assess the direct effect of tobacco advertising and promotion on intentions at each wave, and also the indirect effect, mediated through normative influences. Pre-ban, higher levels of awareness of advertising and promotion were independently associated with higher levels of perceived sibling approval which, in turn, was positively related to intentions. Independent paths from perceived prevalence and benefits fully mediated the effects of advertising and promotion awareness on intentions mid- and post-ban. Advertising awareness indirectly affected intentions via the interaction between perceived prevalence and benefits pre-ban, whereas the indirect effect on intentions of advertising and promotion awareness was mediated by the interaction of perceived prevalence and benefits mid-ban. Our findings indicate that policy measures such as the TAPA can significantly reduce adolescents’ smoking intentions by signifying smoking to be less normative and socially unacceptable.