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Showing papers in "American Journal of Health Promotion in 1997"


Journal ArticleDOI
TL;DR: If results with stage-matched interventions continue to be replicated, health promotion programs will be able to produce unprecedented impacts on entire at-risk populations.
Abstract: The transtheoretical model posits that health behavior change involves progress through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Ten processes of change have been identified for producing progress along with decisional balance, self-efficacy, and temptations. Basic research has generated a rule of thumb for at-risk populations: 40% in precontemplation, 40% in contemplation, and 20% in preparation. Across 12 health behaviors, consistent patterns have been found between the pros and cons of changing and the stages of change. Applied research has demonstrated dramatic improvements in recruitment, retention, and progress using stage-matched interventions and proactive recruitment procedures. The most promising outcomes to date have been found with computer-based individualized and interactive interventions. The most promising enhancement to the computer-based programs are personalized counselors. One of the most striking results to date for stag...

6,389 citations



Journal ArticleDOI
TL;DR: The unidimensional nature of the Perceived Wellness Survey suggests that perceptions of wellness in various dimensions are intertwined by their affective nature.
Abstract: Purpose. The impact of individual perceptions on health is well-established. However, no valid and reliable measure of individual wellness perceptions exists. Therefore, the purpose was to introduce a measure called the Perceived Wellness Survey (PWS). Design. Convenience sampling facilitated recruitment of a sample large enough to perform factor analysis with adequate power (.85). The appropriateness of factor analysis is supported by Bartlett's test (χ2 = 7110, p ≤ .01) and the Kaiser-Meyer-Olkin measure of sampling adequacy (.91). Setting. The sample (n = 558) was composed of 3M Inc. employees from multiple sites in Austin, Texas (n = 393); employees from MuRata Electronics, Inc., College Station, Pennsylvania (n = 53); and students enrolled at the University of Texas at Austin (n = 112). Subjects. Racial, gender, and age distribution was, respectively, 6.3% African-American (n = 35), 8.2% Asian (n = 46), 73.3% Caucasian (n = 409), 9.5% Hispanic (n = 53), and 2.7% other (n = 15); 47.8% male (n...

431 citations


Journal ArticleDOI
TL;DR: Algorithms using longer, more precise definitions of exercise resulted in larger numbers of subjects being staged in precontemplation and contemplation in comparison to algorithms using shorter definitions, which tended to stage subjects in preparation and action.
Abstract: Purpose. This study retrospectively compared subjects from three unrelated studies using eight algorithms to stage exercise behavior. Subjects and settings. Study One included 936 employees involved in a smoking cessation study at four worksites—a medical center, retail store, manufacturing firm, and a government agency. Study Two included 19,212 members of a New England HMO; and Study Three included a convenience sample of 327 adult New Englanders. Measures. The eight algorithms used different descriptions of stages based on the transtheoretical model, as well as different definitions of exercise and response formats. Results. Algorithms using longer, more precise definitions of exercise resulted in larger numbers of subjects being staged in precontemplation and contemplation in comparison to algorithms using shorter definitions, which tended to stage subjects in preparation and action. Maintenance was the most and preparation the least consistently described stage across algorithms. Conclusions. Alterat...

306 citations


Journal ArticleDOI
TL;DR: Results from well-conducted randomized trials suggest that providing opportunities for individual risk reduction counseling for high risk employees within the context of comprehensive programming may be the critical component of an effective worksite health promotion program.
Abstract: Purpose. The purpose of this article is to critically review evaluation studies of the health-related effects (i.e., health risk modification and reduction in worker absenteeism) of multi-component worksite health promotion programs. Search method. A comprehensive literature search conducted under the auspices of the Centers for Disease Control and Prevention identified 36 articles that examined health-related outcomes of multi-component programs. The authors identified 11 additional articles through manual searches of recent journal issues and through personal contacts with worksite health promotion researchers. Forty-seven studies describing the results of 35 worksite health promotion programs were reviewed. Important findings. The worksite health promotion programs reviewed for this article varied tremendously in the comprehensiveness, intensity, and duration of the intervention activities. All of the programs provided health education to employees. In a majority of the programs, opportunities...

225 citations


Journal ArticleDOI
TL;DR: This study determines the degree of association among stage of exercise and body mass index, cardiorespiratory fitness, exercise behavior, relapse, barriers, and self-efficacy, after controlling for several potential confounders.
Abstract: Purpose. Previous research examining the transtheoretical model of behavior change within the exercise domain has been limited by use of self-report measures exclusively and inconsistent practices with regard to stage of exercise assessment. The present study was designed to partially circumvent these limitations and extend the current literature by determining the degree of association among stage of exercise and body mass index, cardiorespiratory fitness, exercise behavior, relapse, barriers, and self-efficacy, after controlling for several potential confounders. Design. A descriptive, cross-sectional study. Subjects. Two hundred thirty-five adults (M age = 34.7 years) volunteered to participate. Measures. Participants were classified by stage of exercise and compared on two behavioral, two biometrical, and three psychological variables while statistically controlling for social desirability and demographic differences. Results. Significant between-stage differences were found for the overall set of dep...

152 citations


Journal ArticleDOI
TL;DR: The findings suggest that nutrition education aimed at encouraging higher intake of fruits and vegetables might be most effective if it is stage-tailored.
Abstract: Purpose. This study examined whether eating practices and psychosocial factors differed across stages of change for fruit and vegetables. Design. Data were collected using a self-administered written survey among a convenience sample of 739 Dutch adults. Response rate was 92%. Setting. Data were collected as part of the baseline assessment for a nutrition intervention study. Measures. Fruit and vegetable intake was measured as self-reported consumption with a validated eight-item food frequency questionnaire. Psychosocial variables were measured with six items on bipolar seven-point scales and stage-of-change classifications were based on separate four-item algorithms for fruits and vegetables. Differences in psychosocial factors and consumption were analyzed using one-way analysis of variance with Scheffe's multiple-comparison test. Results. Significant differences were found between stages of change in dietary intake, attitudes, self-efficacy, and judgment of one's own intake compared to others. Attitud...

129 citations


Journal ArticleDOI
TL;DR: Preliminary evidence that there is considerable stage specificity across multiple health behaviors is provided, because employees at each stage of change possess differences in terms of their pros, cons, and self-efficacy, wellness programs need to focus on stage-specific interventions.
Abstract: Purpose. This study examined differences in decisional balance and self-efficacy scores across the five stages of change and across four health behaviors (exercise, protection from sun exposure, smoking, and dietary fat consumption), and explored the relationship between the frequency of subjects at each stage across four health behaviors. Design. Data for this study were collected as part of a health behavior survey of employees. Setting. The study was conducted in a municipal government worksite in Arizona. Subjects. A total of 393 employees completed the survey. The sample was predominantly white (84.9%) and male (64.4%), with an average age of 42.2 years and a median annual household income of between $40,000 and $59,999. Measures. Previously validated questions to measure stages of change, decisional balance, and self-efficacy were administered, along with questions about demographic variables. Results. Significant differences were found for decisional balance and self-efficacy scores across the five...

127 citations


Journal ArticleDOI
TL;DR: Assessment of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services offered by hospitals found consumer demand for CAM is motivating more insurers and hospitals to assess the benefits of incorporating CAM.
Abstract: Objectives.To assess the status of managed care and insurance coverage of complementary and alternative medicine (CAM) and the integration of such services offered by hospitals.Methods.A literature review and information search was conducted to determine which insurers had special policies for CAM and which hospitals were offering CAM. Telephone interviews were conducted with a definitive sample of 18 insurers and a representative subsample of seven hospitals.Results.A majority of the insurers interviewed offered some coverage for the following: nutrition counseling, biofeedback, psychotherapy, acupuncture, preventive medicine, chiropractic, osteopathy, and physical therapy. Twelve insurers said that market demand was their primary motivation for covering CAM. Factors determining whether insurers would offer coverage for additional therapies included potential cost-effectiveness based on consumer interest, demonstrable clinical efficacy, and state mandates. Some hospitals are also responding to consumer i...

126 citations


Journal ArticleDOI
TL;DR: Despite the recognized benefits of regular physical activity, a mere 22% of the authors' adult population engage in light to moderate physical activity for at least 30 minutes per day, while only 12% regularly participate in vigorous physical activities that promote cardiorespiratory fitness.
Abstract: Nutritional intake is a key determinant of one’s health. Dietary factors are associated with five of the 10 leading causes of death. ~ Although several government documents have recommended a diet that is low in fat and high in complex carbohydrates to promote health, many people continue to consume a high fat diet, with few fruits, vegetables, and grains. Regular physical activity is also an important component of a healthy lifestyle. Regular physical activity offers protection against coronary heart disease (CHD), adultonset diabetes, hypertension, certain cancers, osteoporosis, and depression. 4 The American Heart Association now includes physical inactivity as a major risk factor for CHD. 5 Despite the recognized benefits of regular physical activity, a mere 22% of our adult population engage in light to moderate physical activity for at least 30 minutes per day, while only 12% regularly participate in vigorous physical activities that promote cardiorespiratory fitness. 1

114 citations


Journal ArticleDOI
TL;DR: Intervention should begin in late pregnancy, and smoking networks, including partner smoking, should be addressed.
Abstract: Purpose. Despite high rates of spontaneous and assisted smoking cessation during pregnancy, postpartum maintenance is disappointingly low. Predictors of return to smoking remain unclear, thus limiting the development of interventions that could protect the health of women and their children. This study followed women who had participated in a prenatal smoking cessation intervention trial and successfully stopped smoking to address two aims: (1) describe the probability of relapse in confirmed quitters during the first 6 months after the birth, and (2) identify factors that increase relapse. Design. Prospective design during pregnancy and retrospective report at 6 months postpartum used survival analysis with return to smoking as the dependent variable and the Cox proportional hazards regression technique. Measures. Questionnaires were used at the first prenatal visit and telephone interviews at the 26th week of pregnancy and 6 months postpartum. Nonsmoking after the 20th week was measured by urin...

Journal ArticleDOI
TL;DR: There was a borderline statistically significant 8.4 percentage point increase in the percentage of intervention store shoppers in the action or maintenance stages of dietary change, but there was no corresponding increase in fruit and vegetable consumption.
Abstract: Purpose. The purpose of this study was to evaluate whether a supermarket point-of-purchase intervention could increase shoppers' consumption of fruits and vegetables. Methods. Eight supermarkets in rural Iowa were randomized to receive either an 8-month intervention or no intervention. The intervention consisted of (1) one-page supermarket flyers that identified fruits and vegetables on sale, gave recipes and menu ideas for using sale foods, and gave a store coupon worth 50 cents toward the purchase of any fruit or vegetable; (2) store signage to identify fruits and vegetables featured on the flyer; and (3) consciousness raising activities such as food demonstrations and nutrition related signage. Evaluation was based on exit interviews and take-home surveys, completed by random samples of 120 shoppers from each store at baseline and approximately 1-year post randomization. Results. At follow-up, 42.9% of intervention store shoppers and 6.5% of control shoppers recalled seeing the intervention fl...


Journal ArticleDOI
TL;DR: The primary purpose of this experiment was to determine whether focusing on the appearance-based consequences (i.e., the prevention of photoaging) might be an effective technique for getting individuals to use sunscreen more frequently.
Abstract: As the incidence of all types of skin cancer continues to rise, 1 it is important to attempt to increase our arsenal of effective messages for convincing individuals to protect themselves against the primary risk factor for skin cancer: excessive exposure to ultraviolet radiation. 2 Most educational messages, and most research, regarding "safe-sun" practices have focused on the risk of developing skin cancer) However, repeated sun exposure is also responsible for photoaging--premature aging of the skin in the form of wrinkles and age spots. The primary purpose of this experiment was to determine whether focusing on the appearance-based consequences (i.e., the prevention of photoaging) might be an effective technique for getting individuals to use sunscreen more frequently. Emphasizing the prevention of photoaging might be at least as effective for getting individuals to use sunscreen as emphasizing the prevention of skin cancer because (1) individuals may feel relatively more vulnerable to developing wrinkles and age spots because they are more common and more easily noticed4,5; (2) the motivation to get and maintain a tan has been demonstrated to be appearance-based4,6; thus, emphasizing the negative effects of sun exposure on appearance may be important for motivating protective measures; and (3) it may have more impact because the information is likely to be more novel. This study also sought to determine whether individu-

Journal ArticleDOI
TL;DR: A conceptual model is proposed to facilitate design and evaluation of health promotion strategies across the life course of people with disabilities and informs a U.S. disability policy that emphasizes environmental modification, prevention of secondary conditions and functional decline, promotion of independence and autonomy, and improvement in individual quality of life.
Abstract: Health promotion and disease prevention activities tailored to people with disabilities are crucial to fulfilling the goals articulated in the Americans with Disabilities Act (ADA). We propose a conceptual model to facilitate design and evaluation of health promotion strategies across the life course of people with disabilities. Components of the model, described as planes of experience, integrate the individual’s total environment, the disabling process, opportunity, and quality of life. Cost and outcomes research is recommended for the evaluation of prevention effectiveness. This model informs a U.S. disability policy that emphasizes environmental modification, prevention of secondary conditions and functional decline, promotion of independence and autonomy, and improvement in individual quality of life.

Journal ArticleDOI
TL;DR: A 4-year intervention targeting fruit/vegetable consumption by high school students can be guided and enriched by student input via focus groups and media-marketing activities effectively delivered health messages and attracted students' attention.
Abstract: Purpose. To describe a 4-year intervention targeting fruit/vegetable consumption by high school students. Design. This is a cohort study involving six pairs of schools (n = 12) matched on gender, race, enrollment, and location with schools randomly assigned within pairs to intervention or control conditions. Setting. Twelve Archdiocese of New Orleans high schools. Subjects. Cohort was defined as students (n = 2339) who were ninth-graders in the 1993-94 school year who provided baseline data. Intervention. Four components of the intervention are: (1) school-wide media-marketing campaign, (2) school-wide meal and snack modification, (3) classroom workshops and supplementary subject matter activities, and (4) parental involvement. Measures. Focus groups were conducted for target population input and program development. Process evaluation included student feedback on media-marketing intervention materials and activities reported here. Process measures also included school meal participation, student...

Journal ArticleDOI
TL;DR: These investigators found an association between proximity of community exercise facilities and frequency of exercise; those individuals with a greater density of exercise facilities in the vicinity of their home were more likely to report exercising three times per week.
Abstract: These investigators found an association between proximity of community exercise facilities and frequency of exercise; those individuals with a greater density of exercise facilities in the vicinity of their home were more likely to report exercising three times per week. If convenience to exercise facilities is correlated with exercise behavior, it is possible that having exercise equipment available in the home might also be correlated with exercise behavior. Therefore we studied the relationship between the number of pieces of exercise equipment in the home and the degree of physical activity.

Journal ArticleDOI
TL;DR: There appears to be an audience for low-contact and telephone-assisted weight- loss programs, and such programs can be delivered easily, however, because the data show only modest weight-loss success, work should continue to identify the optimal content and design of such interventions.
Abstract: Purpose. To evaluate minimal-contact and telephone-assisted weight-loss overweight persons. Design. Participants were randomized to a minimal-contact group or one of two telephone-assisted weight-toss groups. All participants attended two group-based behavioral weight-loss classes and received written educational materials and diaries. For the subsequent 24 weeks, the minimal-contact group received no contact and the telephone-assisted group members received weekly calls to monitor their weight, food intake, and exercise. Setting. Baseline educational sessions and data collection were conducted at a university site. Subjects. Sixty-four healthy subjects (4 men) who were from 120% to 150% of ideal weight and were 25 to 55 years of age participated in the study. Measures. The major outcome of interest was change in measured weight over a 24-week period Data on calories expended in exercise, dietary intake, and demographics were also gathered at baseline and 24 weeks. Results. Weight loss did not di...

Journal ArticleDOI
TL;DR: The results of the present study failed to show any long-term benefit from use of a clinic-based, culturally specific multicomponent smoking cessation intervention for Hispanic smokers relative to a minimal-contact, enhanced self-help control.
Abstract: Purpose. The purpose of this study was to compare a culturally specific, multicomponent behavioral smoking cessation program for Hispanic smokers with a low-intensity, enhanced self-help control condition. Design. Participants who completed pretreatment assessment were randomly assigned to treatment conditions. Smoking status was evaluated at posttreatment, 6-month follow-up, and 12-month follow-up intervals. Setting. The study was based in predominantly Hispanic neighborhoods in Queens, New York. Participants. Ninety-three Hispanic smokers participated: 48 men and 45 women. Intervention. The multicomponent treatment involved a clinic-based group program that incorporated a culturally specific component consisting of videotaped presentations of culturally laden smoking-related vignettes. The self-help control program was enhanced by the use of an introductory group session and follow-up supportive telephone calls. Measures. Smoking outcomes were based on cotinine-validated abstinence and self-rep...

Journal ArticleDOI
TL;DR: Although mammography rates are increasing, most women still are not getting regular mamtnograms, and reasons for this nonadherence are complex, including the belief that a mammogram is unnecessary in the absence of symptoms.
Abstract: Mammography has been shown to reduce breast cancer mortality significantly among women 50 years of age and older. 1,2 Although mammography rates are increasing, most women still are not getting regular mamtnograms? Reasons for this nonadherence are complex, including the belief that a mammogram is unnecessary in the absence of symptoms, lack of physician recommendation, and access barriers. Multistrategy interventions that acknowledge this complexity have been shown to be most effective. 4

Journal ArticleDOI
TL;DR: The results are contrary to predictions from skeptics of broad-based informational interventions, who argue that only the already-health conscious are attentive to health warnings about the risks of alcohol consumption, and suggest that the label is reaching intended target audiences, especially younger people, males, and heavier alcohol consumers.
Abstract: Purpose. Guided by information processing theory and the health belief model, this paper considers the relationship between health consciousness among the general population and attention to environmental health warnings about alcohol consumption. Mechanisms of exposure to three dominant types of impersonal alcohol-related health messages in the environment are explored. Design. Cross-sectional survey using telephone interview data. Subjects. A representative nationwide sample of adults was interviewed in 1993 (n = 1026), with a response rate of 63%. Measures. Key variables include exposure to warning labels on alcoholic beverages, to point-of-sale posters, and to advertisements in the media, as well as respondents' alcohol consumption, health problems (indicative of salience of health warnings), and level of health consciousness assessed by items tapping concern with nutrition and seeking information on health topics. Results. In the total sample, over a third had seen a warning label or poster ...

Journal ArticleDOI
TL;DR: The results demonstrate the effectiveness of the AIDS Community Demonstration Project intervention for reaching injecting drug users in the community and for motivating the adoption of risk-reducing practices.
Abstract: Purpose. To evaluate the impact of the Long Beach AIDS Community Demonstration Project, a community-based HIV-prevention intervention incorporating principles from the Transtheoretical model in its design and evaluation. Design. Repeated cross-sectional sampling with matched intervention and comparison communities. Setting. Neighborhoods in Long Beach, California, having a high prevalence of drug abuse and prostitution. Subjects. 3081 injecting drug users who were sexually active and/or shared injection equipment. Intervention. Trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change. Fliers were packaged with bleaching kits and/or condoms. Measures. Primary outcome measures were exposure to the intervention, condom carrying, and stage of change for disinfecting injection equipment with bleach and for using condoms with main and other partners. Results. Toward the end of the study, 77% of injection drug users in the intervention area reported bei...

Journal ArticleDOI
TL;DR: It is important to understand the correlates and predictors of suicidal behavior as well as the factors that may protect adolescents against suicidal behavior to identify those adolescents at high risk of attempting suicide or to design school-based suicide prevention programs targeted toward all students.
Abstract: Suicide is the second-leading cause of death in adolescents. ] Suicide rates in 1990 for youth aged 15 to 19 were 18.1 per 100,000 for boys and 3.7 per 100,000 for girls; although girls attempt suicide more often than boys, boys more frequently succeed in their suicide attempts. 2 Nearly one-third of all students in grades 9 through 12 in 1991 had seriously thought about committing suicide, 16% had made a specific plan to commit suicide, and 8% had actually attempted suicide) Because suicidal thoughts and suicide attempts are so prevalent in adolescents, it is important to understand the correlates and predictors of suicidal behavior as well as the factors that may protect adolescents against suicidal behavior. If these risk and protective factors can be identified, it may be possible to identify those adolescents at high risk of attempting suicide or to design school-based suicide prevention programs targeted toward all students. Physical activity is positively associated with self-esteem, well-being, and self-efficacy 4 and negatively associated with depression, 5 anxiety, 6 loneliness, shyness, and hopelesshess. 7 Psychological treatment programs for adolescents 5,s,9

Journal ArticleDOI
TL;DR: Job types with high demand and low control were associated with increased stress, increased absenteeism, and poorer self-concept of health and the demand/control model of Karasek and Theorell was validated in this setting with respect to stress.
Abstract: Purpose To apply Karasek's Job Content Model to an analysis of the relationships between job type and perceived stress and stress behaviors in a large company during a period of reorganization and downsizing. Design. Cross-sectional mail-out, mail-back survey. Setting. A large Canadian telephone/telecommunications company. Subjects. Stratified random sample (stratified by job category) of 2200 out of 13,000 employees with a response rate of 48.8%. Measures. Responses to 25 of Karasek's core questions were utilized to define four job types: low demand and high control = “relaxed”; high demand and high control = “active”; low demand and low control = “passive”, and high demand with low control = “high strain.” These job types were compared against self-reported stress levels, perceived general level of health, absenteeism, alcohol use, exercise level, and use of medications and drugs. Similar analyses were performed to assess the influence of shift work. Results. Employees with “passive” or “high s...

Journal ArticleDOI
TL;DR: In the next phase of this project, the intent is to refine the questionnaire, extend the intervention protocols for longitudinal application, and evaluate its impact on health-related behaviors, medical care utilization, and functional decline.
Abstract: The purpose of this project is to develop a health risk appraisal for the elderly (HRA-E) and test its application in both medical and nonmedical settings. The HRA-E system consists of a questionnaire and software for computer-generation of personalized reports to participants, 55 years and older, and their physicians. Items in the questionnaire cover a comprehensive range of content domains relevant to health promotion in the elderly. The goal of the HRA-E system is to prevent functional decline. Samples of eligible subjects from the American Association of Retired Persons (AARP), a group practice, and a senior center were extended invitations to participate. Those responding affirmatively to the invitation were given a questionnaire and evaluation form. Each person who returned the questionnaire received his or her personal report and a second evaluation form. Four months after receiving their reports, respondents were questioned about behavior changes during the interim. Preliminary findings, based on 1895 respondents, indicate that nearly all participants found the questionnaire easy to complete and were pleased with its overall length. In addition, most participants read their reports, and many planned to take action, based on report recommendations. In the next phase of this project, the intent is to refine the questionnaire, extend the intervention protocols for longitudinal application, and evaluate its impact on health-related behaviors, medical care utilization, and functional decline.

Journal ArticleDOI
TL;DR: Results showed that continued intervention students reported significantly less smoking than continued control students and lapsed intervention students, which underscores the importance of continuing smoking prevention activities, as well as initiating these activities, in senior high school years.
Abstract: The relative effectiveness of continued, lapsed, and delayed smoking prevention intervention was tested with senior high school students. The original intervention was conducted during Grades 7 through 9, with significantly fewer intervention students reporting smoking than control students. The intervention was reintroduced in the 11th grade to one-half of intervention students (continued intervention), was withdrawn from the other half (lapsed intervention), and was initiated with one-half of control students (delayed intervention). The 11th-grade smoking rates of these three groups were compared to those of a fourth group, a continued control group. Results showed that continued intervention students reported significantly less smoking than continued control students and lapsed intervention students. Additionally, the delayed intervention group exhibited smoking rates lower than the lapsed intervention and continued control groups. This finding underscores the importance of continuing smoking ...

Journal ArticleDOI
TL;DR: The number of occupational illnesses due to repeated trauma rose from 23,000 in 1981 to 281,800 in 1992, a more than tenfold increase.
Abstract: Cumulative trauma disorders (CTDs) related to computer use are among the fastest-growing and most costly health and safety problems in the workplace. As the number of workers using keyboards and visual display terminals (VDTs) on the job has increased to more than million, data from the Bureau of Labor Statistics indicates that the number of occupational illnesses due to repeated trauma rose from 23,000 in 1981 to 281,800 in 1992, a more than tenfold increase. ] This rise is thought to be the result of several factors, including heightened awareness by both employees and employers, advances in diagnosis and improved accuracy of reporting, and the ever-accelerating pace of work, especially the increasing use of computers for performing job tasks. Employees affected by CTDs often experience substantial pain and functional impairment, while employers are affected by loss of productivity and increased costs in the form of higher medical expenses and disability payments for injured workers. 2

Journal ArticleDOI
TL;DR: While there was no statistical difference between the intervention and control groups, the overall relapse rate was lower compared to most of the published data from other studies.
Abstract: While there was no statistical difference between the intervention and control groups, the overall relapse rate of 22% (78% nonsmoking), was lower compared to most of the published data from other studies. Results from the historical comparison group from the smoking cessation trial confirmed a 35% relapse rate during pregnancy in this population.

Journal ArticleDOI
TL;DR: Pregnancy may be an optimal opportunity for targeting smoking in women, since this may be the only time in a woman’s life she receives frequent contacts with health care providers with a primary focus on initiating or maintaining health-enhancing behavior in herself.
Abstract: Pregnancy may be an optimal opportunity for targeting smoking in women, since this may be the only time in a woman’s life she receives frequent contacts with health care providers with a primary focus on initiating or maintaining health-enhancing behavior in herself. Therefore, prenatal health care may serve as a natural opportunity or powerful "teachable moment" to decrease cigarette smoking, especially in underserved women. An innovative stage-matched intervention program based on the Transtheoretical model is currently being implemented in six public maternity clinics in a southern New England city. These prenatal settings serve culturally diverse and economically disadvantaged individuals.

Journal ArticleDOI
TL;DR: For decades, the majority of health care providers operated through a fee-for-service system, where the more physicians did, the more they were paid and the greater the revenue.
Abstract: An opportunity has been presented to the health promotion and disease prevention community by traditional mainstream medicine. For decades, the majority of health care providers operated through a fee-for-service system. It was a blank check policy with few, if any, controls. The more physicians did, the more they were paid. The more services delivered, the greater the revenue. As a result, the cost of health care increased an average of 20% per year during the 1980s. 1 This has caused the health care delivery system to undergo unprecedented changes. They range from a failed attempt at sweeping federal control 2