Showing papers in "Health Education & Behavior in 1991"

Communicating about Environmental Risks: How the Public Uses and Perceives Information Sources

Abstract: Environmental risk communication is examined as a community-based public health issue in this study. It provides data on information dynamics in six communities prior to the implementation of national community right-to-know legislation. It also provides a baseline for measuring changes in knowledge, attitudes, information gathering activities and other behaviors. Respondents (3,129) from six communities, Albuquerque, New Mexico; Cincinnati, Ohio; Durham, North Carolina; Middlesex County, New Jersey; Racine, Wisconsin; and Richmond, Virginia, provided information about recall of environmental risk information and sources, as well as personal knowledge, attitudes and behaviors related to environmental health risks. Local media are the most pervasive source of environmental information. Interpersonal sources were reported by fewer than 12% of the respondents. Credibility appears to be the most valuable attribute of an environmental information source. Credibility and expertise are perceived as independent c...

The AIDS Rapid Anthropological Assessment Procedures: A Tool for Health Education Planning and Evaluation:

Abstract: Health education is an essential part of efforts to limit and manage the current AIDS pandemic. The information needed to develop meaningful and culturally appropriate educational interventions is often difficult to obtain because topics related to the prevention and treatment of AIDS are invariably culturally and/or personally sensitive. This article describes the data collection guidelines of the HIV/AIDS Rapid Anthropological Assessment Procedures developed by the Social and Behavioural Research Unit of the World Health Organization's Global Programme on AIDS. The guidelines apply anthropological methods of observation, participant observation, informal and formal interviews, and focus group interviews to the collection of information on AIDS-related beliefs and behaviors. When researchers focus on specific issues in countries, cultures, and languages with which they are already familiar, relatively rapid assessments can be made with a high degree of validity. This article briefly discusses these methods and their application to AIDS-related topics, together with the validity and reliability of the various methodological tools available to social and behavioral scientists.

Predictors of Risk Perceptions of Childhood Injury among Parents of Preschoolers

Abstract: This article assesses the relationship between parents' perceived risk of childhood injuries and familial, sociocultural, and situational variables. Data were obtained through a random digit dial telephone survey of 1,200 households with a preschool child in a southeastern metropolitan area. Perceived risks of childhood injury measures were based on social science theory and childhood injury epidemiology. Multiple item measures included dimensions of seriousness and likelihood for both injuries and hazards. When risk perceptions were viewed as individual items, parents underestimated the risk of some hazards and injuries and overestimated the risks of others, and parents whose children have sustained a recent injury had higher risk perception overall. When risk perceptions were viewed as summed scales, sociodemographic variables and parental safety behaviors were not significant predictors. Sociocultural factors of having a child previously injured, the parent reporting stress, having a household with sel...

Tobacco Truths: The Impact of Role Models on Children's Attitudes toward Smoking

Abstract: The present study assessed the impact of parents, peers, siblings, cigarette advertising, and sponsorship as role models influencing attitudes toward smoking and smoking behavior in seventh- and eleventh-grade students. The participants completed an anonymous questionnaire concerning their current and future smoking behavior, attitudes toward a cigarette advertising ban, general attitudes toward smoking, and smoking status of parents and siblings. Fifty-one percent of the smokers reported that they are not likely to be smoking in the future. Smokers were found to have less negative attitudes than never smokers. Seventh-grade students who admitted to being triers or smokers had less negative attitudes toward smoking than eleventh-grade students. Parent smoking had no impact on attitudes. However, if a sibling smoked, the respondents' attitudes toward smoking were less negative. Students appeared to be more aware of sport sponsorship than conventional advertising. Most never smokers favored a total cigarett...

Development of a Health Education Program to Promote the Self-Management of Cystic Fibrosis

Abstract: The creative challenge of health education for chronic illnesses is the translation of theory-based intervention methods into practical strategies that can be organized into a logical series of learning activities to influence changes in environmental, cognitive, or behavioral factors. A case example describing the development and implementation of a comprehensive health-education intervention for the self-management of cystic fibrosis (CF) is presented. The design of intervention strategies began with an assessment of the educational needs for self-management of CF, followed by specification and validation of particular self-management behaviors. Behavioral and learning objectives then were formulated for each of the self-management behaviors. Constructs from social learning theory considered to be important influences on specified self-management behaviors in CF were identified. Taking into consideration the learning needs of the target population and the practical constraints of the system for providin...

AIDS Education: The Rhode Island Experience

Abstract: AIDS prevention, by public school education, is designed to change knowledge, attitudes, and future behavior. This study evaluated the impact of a state-mandated educational program on a sample of 2709 adolescents. Changes from pre to posttest were evaluated using standardized change scores and comparisons between the experimental and a delayed education control group were made. The experimental group, but not the control group, changed to a statistically significant degree (p < .001). They became more knowledgeable, endorsed slightly more tolerant attitudes, and reported an increased intention to avoid intercourse as a means of AIDS prevention. The extent of change was substantially greater for knowledge than for attitudes. Age, gender, and AIDS-related anxiety were found to be significant variables in the AIDS education process. The modest changes observed emphasize that the dissemination of AIDS information by public schools is only the first step in changing adolescent behavior as a means to AIDS prev...

Identification of Campaign Recruitment Strategies for a Stepped Smoking Cessation Intervention for a College Campus

Abstract: A rapprochement of the Stepped Approach Model of health care delivery and Ajzen's Theory of Planned Behavior was used to identify campaign recruitment strategies for a stepped smoking cessation intervention for a college campus. The study examines outcome expectancies, outcome evaluations, and interest in participating in smoking cessation programs presented in graduated steps of intervention intensity. Telephone surveys were conducted with a probability sample of 191 student smokers. A significant negative trend indicates that the steps are ordered cost-effectively. Scheffe a posteriori tests also reveal that interest in Step 1 (pamphlets and brochures) was significantly higher than interest in any other step, including those representing traditional health care services (i.e., groups and individual treatments). The two strongest predictors of interest in each step were attitudes about participation and control beliefs; normative expectations about program participation discriminated between respondents ...

The Relationship between Radon Knowledge, Concern and Behavior, and Health Values, Health Locus of Control and Preventive Health Behaviors

Abstract: Understanding similarities between health-related and radon-related knowledge, attitudes, and behaviors may suggest application of effective strategies of radon-related education in targeted populations. A mail survey was returned by 300 randomly selected homeowners in a community at risk for high home radon concentrations (50% response). While 64% were concerned, only 7% tested their homes. The expected association between radon knowledge, radon concern, and information-seeking was identified. In addition, those who tested their homes had greater knowledge and did more information seeking. Health values and radon concern were only weakly related. Environmental concern explained the greatest variance in radon concern (10%). Internal health locus of controls were more likely to have high radon concern. Of the preventive health behaviors, not smoking and seat belt use were the best predictors of variance in radon concern (5%). Segmenting the population is suggested for best educational outcome. Relating information to environmental issues may be helpful. Health-conscious people may need awareness of risks. Issues of self-control and radon testing and reduction may be helpful for some. Synergy between smoke and radon, compounded by smokers lack of concern suggests targeting smokers for education efforts.

Risk Information for Public Consumption: Print Media Coverage of Two Risky Situations

Abstract: This study examines (1) the extent to which newspaper and magazine coverage of two risky situations included the kinds of cognitive information about risks that would help readers make risk judgments and (2) the extent to which the scientific sophistication of the audience would influence such inclusion. The two situations were a nuclear power plant accident that released a small amount of radioactive steam into the atmosphere and a report in the New England Journal of Medicine about a potential relationship between coffee consumption and pancreatic cancer. Stories about each topic in trade magazines, popular science magazines, general magazines, and both prestige and more typical daily newspapers were examined to determine the nature and extent of risk information included. The analysis found more detailed risk information in these stories than has been found in past studies, but it also suggested that sophistication of audience was not a good predictor of the presence/absence of such information. The most pronounced differences in communication strategies were found instead between topics, not across types of media. Closer examination of individual stories suggests that the variance may be attributable to differences in the way stories about the two incidents were framed by journalists.

The Acceptability of Childhood Immunization to Togolese Mothers: A Sociobehavioral Perspective:

Abstract: A study was conducted in Togo to investigate the lack of acceptance of childhood immunization from a social science perspective. In each village focus group interviews were conducted with approximately 12 mothers to discuss their beliefs and knowledge, social and cultural norms and practices, and experiences with health services that hinder or promote the acceptability of childhood immunization. The problem of failure to complete the immunization series was explained in terms of mothers' lack of knowledge of when to return or their forgetfulness rather than inadequate knowledge about the importance of returning. Other barriers included the requirement to keep and present a vaccination card, waiting time at the clinic, lack of information about available services, and laziness. Rather than endorsing strategies that target individuals, mothers suggested increasing the level of social control exerted by decision makers in their communities (the village chief could direct the town crier to announce the passing of each week to help parents keep track of time between immunizations) and increasing the level of social support by having a meeting to support the importance of completing the vaccination series and to organize mothers who go to the clinic to inform others in their neighborhoods about vaccination.

Training Breast Self-Examination: A Research Review and Critique

Abstract: Despite an increase in knowledge about breast cancer, a relatively low percentage of women practice breast self-examination (BSE) regularly and competently. This article reviews the BSE literature with a focus on training of BSE components, discrimination training, and the effectiveness of training procedures. Methodological issues such as the absence of control groups, lack of criteria for termination of training and reliance on self-reports of BSE frequency are identified weaknesses of BSE training studies. A theoretical analysis of BSE highlights potential difficulties in maintaining regular practice of BSE. Recommendations regarding training of proficient BSE skills and promoting regular practice of BSE are offered, and suggestions for further refinement of BSE training and directions for future research are discussed. Promising avenues of research in BSE training technology include discrimination training (on real or simulated breast tissue) together with computerized assessment of skill proficiency.

The Healthy Cities Project: A Challenge for Health Education

Abstract: The World Health Organization Healthy Cities Project assists participating cities in developing and implementing plans to create health promoting policies, programs, and environmental conditions. The project, which has its origins in the strategy of Health for All by Year 2000, seeks to bring the rhetoric down to earth and ground it in policy and practice. So far the project has been very successful in interesting and involving people at the local level. What began as a small European project in 1986 has become part of a global movement four years later. This movement is based on a recognition of the ecological context of health and the need to reconcile human lifestyles with their environmental and planetary impact. In the process of involving many people from nonmedical sectors in urban health promotion, the continuing relevance of health education to public health is becoming apparent. The challenge to Health Education is to broaden its perspective from the individual and biological, to the social and environmental if it is to play a full part in tackling the ecological crises which confront us.

Etiology of Drinking and Driving among Adolescents: Implications for Primary Prevention

Abstract: A prospective study was conducted to investigate what factors are predictive of self-reported drinking and driving (DD) among adolescents. The study employs a theoretical framework taken from Problem Behavior Theory; environmental, personality, and behavioral factors are explored for their predictability of DD. A cohort of 1482 high school students completed a written survey in spring of 1986 and again in fall of 1986. The findings confirm that Problem Behavior Theory provides a useful theoretical framework with which to identify etiological factors predictive of DD among adolescents. Identified personality, perceived environmental, behavioral, and demographic factors accounted for approximately 50% of the reported variance in DD at baseline. The same factors accounted for approximately 40% percent of the variance in follow-up DD and were predictive both among the students who did not drink and drive at baseline (incidence cases), and among those students who did drink and drive at baseline (continuation versus discontinuation of the behavior). Based on these etiological data, we recommend that school-based, peer-led educational prevention programs be designed to reach young adolescents prior to the age at which a driver's license is obtained. We further recommend that the programs be broad-based and consider DD within the larger context of drinking and driving related behaviors and traffic safety in general.

Healthy Cities: The Indiana Model of Community Development in Public Health

Abstract: While the Institute of Medicine's Report on The Future of Public Health provokes debate on public health issues in the United States, the Healthy Cities movement is one approach to addressing many of these issues. Healthy Cities Indiana began in 1988 and adapts the European and Canadian healthy cities experience within the sociopolitical context of Indiana and the United States. Six Indiana cities are collaborating with Indiana University School of Nursing and the Indiana Public Health Association in a process of urban health promotion. The overall healthy cities process is presented including: city commitment, formation of healthy city committee, community leadership development, city action, provision of data-based information to policy makers, and action research and evaluation. Each step in the healthy cities process is described, highlighting examples from the Indiana experience, including an analysis of selected data describing the cities. The facilitators of a healthy city provide support to city l...

Psychosocial Factors and Enrollment in a Televised Smoking Cessation Program

Abstract: Registrants for a smoking cessation program on the evening television news in the Chicago metropolitan area were compared with other smokers in the population to identify psychosocial factors that distinguished registrants. Telephone interviews were conducted before the intervention with random samples of 641 registrants and 2,398 smokers who regularly viewed the evening news. A nested series of three contrasts compared registrants with (1) smokers who regularly viewed the evening television news on any channel, (2) smokers who were regular viewers of the evening news on the intervention channel, and (3) smokers who were regular viewers of the evening news on the intervention channel and were planning to quit smoking. Registration was associated with a smoker's cognitive appraisal of the quitting process, with registrants distinguished by (1) recognition of a need to act (perceived severity of and susceptibility to lung cancer), (2) high outcome expectancies for quitting as an effective means for health promotion, (3) realistic expectations about the effort required to quit, (4) concern about the burden of lung cancer on significant others and related social influence factors, and (5) motivation to quit smoking. The findings suggest that the effectiveness of minimal-contact intervention programs may be enhanced by targeting smokers according to their psychosocial characteristics and by cognitively preparing smokers to attempt to quit.

Book Reviews : Health Behavior and Health Education: Theory, Research, and Practice, K. Glanz, F.M. Lewis, and B.K. Rimer, Eds., San Francisco, Jossey-Bass, 1990:

Abstract: lems of social health such as income maintenance, social isolation, and personal loss are discussed as a basis for establishing indicators. Without exception, the authors stress the great need for basic research to define health promotion indicators. It is no wonder, then, that the editor undertook the task of developing a tool to help researchers meet that need. Utilizing the contributions of all the authors, Kar presents a health promotion indicator model in his concluding chapter. I predict that this conceptual framework will be used by researchers for years to come, probably forming the basis for many a doctoral dissertation.

Critical Thinking for Environmental Health Risk Education

Abstract: This article proposes an approach for helping school-age children to think critically about environmental health risks. It discusses three key elements of a school curriculum— defining a decision perspective, making choices under uncertainty, and thinking about consequences—and recommends procedures to aid in classroom implementation of the proposed ideas. Critical thinking skills are shown to enhance childrens' ability to anticipate the health or safety consequences of a decision by distinguishing automatic from decision thinking, by detecting inconsistent objectives or neglected consequences, and by making explicit value-based tradeoffs. Training in critical thinking also should empower children because it acknowledges the power of personal initiatives in decreasing health risks and, in general, because it focuses the classroom experience on learning about how to think rather than merely learning about what to think.

Newspaper Coverage of Cancer Clusters

Abstract: This study reports an analysis of 176 newspaper articles about cancer clusters. The type of diseases, number of diseases, and status of ongoing health investigations were reported in the majority of articles. But background information such as, comparison of actual and expected number of cases, environmental causes and their confounders, and the existence of other clusters were not reported as often. Statements about risk were reported in most articles and, contrary to our expectations, were relatively balanced among risk asserting, risk denying, and mixed opinions. We noted a preponderance of risk asserting statements in the beginning of stories. Cluster stories cited an average of three sources, and two of these three sources were usually government officials. The remaining sources were divided among citizens, representatives of environmental advocacy groups and industry, and unaligned experts. Drawing on these data, we offer some suggestions to improve communication between scientists and journalists.

Normative Beliefs about Factors That Affect Health and Longevity

Abstract: Since the release of the Surgeon General's report, Healthy People,1 the general public has been barraged with health information and advice by the popular media. Accordingly, this article introduces a method for examining the public's beliefs about the importance of behavioral risk factors associated with health and longevity. The factorial survey approach—a technique appropriate for studying normative beliefs—seems uniquely suited to measuring the degree of public consensus regarding complex social phenomena. Data collected using this experimental vignette methodology suggest that there is much public agreement about the sources of good health. Information described in hypothetical vignettes about smoking, body weight and alcohol consumption are judged most important in promoting health and longevity even when controlling for other behavioral factors such as exercise activity, diet, amount of rest, stress, personality type, and coping strategies. The implications of these findings are briefly discussed.

Health Education through Interactive Radio: A Child-to-Child Project in Bolivia

Abstract: In developing countries it is common for older children to assume much of the responsibility for care of their younger siblings. Based on this observation, the "child-to-child" approach to health education targets these older children as a means of improving child health. As the initial phase in the development of a radio health curriculum in Bolivia, a module on diarrheal disease was developed and field-tested among fourth- and fifth-grade students in Cochabamba. The module consists of 10 interactive radio lessons in which the students respond orally to drill and practice, sing songs, or write key concepts in their notebooks. Following the 25-minute radio broadcast, the teacher conducts a 20-minute session that focuses on application and practice of the new behaviors. The module includes lessons on personal hygiene, water and oral rehydration, home sanitation, and nutrition. The field evaluation revealed the need for modifications in the teachers' role and greater attention to teacher training. Students ...

Reexamination of Eisen, Zellman, and McAlister's Health Belief Model Questionnaire

Abstract: Eisen, Zellman, and McAlister 1 proposed a 22-item scale to measure four Health Belief Model (HBM) constructs as applied to adolescent contraceptive behavior. Their factor analysis led them to conclude that there were several discrepancies in their proposed scales. We suggest that they were unduly pessimistic. Although their proposed scales could stand improvement, they are adequate preliminary tools. The major reason they concluded that the scales were deficient was that they applied criteria that are generally appropriate for continuous data to their inherently discrete (categorical) item response data. A secondary consideration is that confirmatory methods of factor analysis can yield results that bear more directly on their proposed organization of items than the traditional exploratory methods that they used. A reanalysis of their data suggests that their proposed scales have fewer problems than they believed they had. Our results increase the likelihood of standardizing HBM measures.

Book Reviews : Focus Groups as Qualitative Research, by Davis L. Morgan. Newbury Park, CA, Sage Publications, 1988, 88 pp. Focus Groups: A Practical Guide for Applied Research, by Richard A. Krueger. Newbury Park, CA, Sage Publications, 1988, 200 pp:

Abstract: 1. Office of the Assistant Secretary for Health: Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention. Department of Health Education, and Welfare, Public Health Service. Washington, DC, Government Printing Office, 1979. 2. McLeroy K, Bibeau D, Steckler A, Glanz K: An ecological perspective on health promotion programs. Health Education Quarterly 15:315-377, 1988. 3. Kizer K: Health Promotion at Work in California: An Employer’s Guide to Assessing Quality in Worksite Health Promotion Programs. California Department of Health Services: Health Promotion Section, Sacramento CA, 1988. 4. Herzlinger R, Schwartz: How companies tackle health care costs: Part I. Harvard Business Review 63 (July-August):69-81, 1985. 5. Fielding J, Piserchia P: Frequency of worksite health promotion activities. American Journal of Public Health 79:16-38, 1989. 6. Fielding J: Effectiveness of employee health improvement programs. Journal of Occupational Medicine 24:907-915, 1982. 7. Grana J: Preventive medicine and employee productivity. Harvard Business Review 63(2):18-29, 1985. 8. Kristein M: The economics of health at the workplace. Health Education Quarterly 9:27-36, 1982.

Ghana Social Mobilization Analysis

Abstract: In order to increase communication channels for child survival and development, the government and UNICEF Ghana undertook a "social mobilization analysis." This analysis included three studies that aimed to identify individuals and existing organizations with the potential to serve as health communicators and to determine the type of assistance that they needed to maximize their effectiveness in this role. The first study surveyed governmental institutions, trade unions, revolutionary organizations, traditional leaders, and others and found a largely untapped reservoir of capacities to promote child health, with varying levels of current involvement. The primary need identified was for information and training materials. The second study focused on the mass media and revealed a low coverage of maternal and child health topics and the need for better cooperation between journalists and health professionals. The third study assessed sources of health information for parents and found several sources, such a...

Book Reviews : Risk Communication: Proceedings of the Conference on Risk Communication, J. Clarence Davies, Vincent T. Covello, and Frederick W. Allen (Eds), Washington, D.C., The Conservation Foundation, 1987, 143 pp. Improving Risk Communication, National Research Council, Washington, D.C., National Academy Press, 1989, 332 pp

Abstract: Over the past four decades, awareness of the risks to the public’s health and to the environment caused by technology-driven production and development has increased dramatically. Risks from ionizing radiation, poorly designed automobiles, airplanes, or children’s toys, chemical leaks to the environment, dangerous waste disposal practices, ecologically unsound fishing, farming and industrial practices, acid rain, or even radon gas have spawned a deluge of information for the general public. At the same time much organized activityfocussed and disseminated within the scientific, political, and economic communities-has been initiated to try to control, contain, or minimize these risks. Corporations, governmental agencies, scientific experts, typically with greater research funding than private citizens, vie with each other and with increasingly strident citizen-interest groups and media for the last word in risk management, decision-making and policy formation. And divergent views of institutions and

The Impact of a Health Education Course on Maternal Knowledge: A Comparative Study in a Low Socioeconomic Rural Region:

Abstract: A comprehensive health education course was designed for mothers in West Bank villages, a relatively low socioeconomic population. The course focused on nutrition, hygiene, child development, and first aid. It was taught by specially trained local instructors in small classes characterized by an individualized teaching method. To evaluate the contribution of the course, the level of knowledge in topics taught in the course was tested. The test was personally administered by trained interviewers to 241 course participants and to a comparison group of 284 mothers who had not participated. As expected, participants demonstrated higher level of knowledge than nonparticipants, regardless of the time since having taken the course. The course seems to have contributed to all participants, but mostly to women of lower education. In a multiple linear regression the two most significant predictors of knowledge were course participation and level of maternal formal education.

Book Reviews : Marshaling Social Support: Formats, Processes, and Effects, Benjamin H. Gottlieb, Ed. Newbury Park, CA, Sage Publications, Inc., 1988, 337 pp:

Abstract: By current definition, focus groups are typically characterized by bringing a carefully selected group of participants together that do not know each other. This, however, ought not to be viewed as a limiting requirement for health educators and other applied researchers working with existing groups or people that know each other in a community or work setting. True, more attention may have to be paid to existing group dynamics that may influence participants’ interactions. The use of the focus group method in this reviewer’s experienceparticularly in conjunction with other data sources-can provide meaningful insights into the nature of organizational culture and organizational members’ concerns. It can also help identify psycho-social and structural barriers to change and thus provide important information for directing interventions.

Foreword Strategies to Improve Risk Communication

Abstract: Do any of these newspaper headlines look familiar: &dquo;So, What Is ’Environmentally Friendly’?&dquo;; &dquo;Defining Risks Is Challenge for Quality of Life&dquo;; &dquo;Limited Environmental Funds Force Hard Choices on the ’Risk Factor&dquo;’ ; &dquo;Hazardous Waste Spill on Route 80&dquo;; or &dquo;EPA Acts to Reshuffle Environment Priorities&dquo;? In news publications across the nation, recent headlines concerning the environment have targeted issues that are not well understood by the public. While environmental awareness by the public has greatly increased during the past decade, small gains have been made in the communication of how &dquo;risky,&dquo; for example, dimethyl-chickenwire really is to one’s health. The chal-

Book Reviews : Health Risks and the Press, Washington, D.C., Media Institute, and Chicago, American Medical Association, 1989, 111 pp. Reporting on Risk: Getting It Right in an Age of Risk, Washington, D.C., Media Institute, 1990, 65 pp:

Abstract: terpreted to hold out great promise for the increased involvement of health educators in risk communication over the next decade-if health educators actively seek to become involved. From a public health education perspective risk communication issues have not typically been well-incorporated into teaching, research, and practice. Rather environmental and safety risks have been the domain of environmental engi-

Book Reviews : AIDS and IV Drug Abusers: Current Perspectives, Robert P. Galea, Benjamin F. Lewis and Lori A. Baker, Eds. Owings Mills, MD, National Health Publishing, 1988, 328 pp:

Abstract: 1. Broadhead WE, Kaplan BH, James SA et al.: The epidemiological evidence for a relationship between social support and health. American Journal of Epidemiology 117:521-537, 1983. 2. Berkman LF: Assessing the physical health effects of social networks and social support. Annual Review of Public Health 5:413-432, 1984. 3. Israel BA, Rounds KA: Social networks and social support: A synthesis for health educators. Advances in Health Education and Promotion 2:311-351, 1987. 4. Cohen S, Wills TA: Stress, social support, and the buffering hypothesis. Psychological Bulletin 98:310-357, 1985. 5. Gottlieb BH: Social Support Strategies: Guidelines for Mental Health Practice, Beverly Hills, Sage, 1983.