Showing papers in "Health Education & Behavior in 1992"

Toward Integrating Qualitative and Quantitative Methods: An Introduction:

Abstract: Both the qualitative and quantitative paradigms have weaknesses which, to a certain extent, are compensated for by the strengths of the other. As indicated in this article, the strengths of quantitative methods are that they produce factual, reliable outcome data that are usually generalizable to some larger population. The strengths of qualitative methods are that they generate rich, detailed, valid process data that usually leave the study participants' perspectives in tact. This article discusses how qualitative and quantitative methods can be combined and it introduces the articles included in this issue.

Attitudes, Norms, and Self-Efficacy: A Model of Adolescents' HIV-Related Sexual Risk Behavior:

Abstract: Using data from a cross-sectional, statewide survey of 1,720 Texas ninth graders in 13 school districts, a model of psychosocial predictors of human immunodeficiency virus (HIV)-related sexual risk behavior was tested. Predictor variables in the model, based on variables from the Theory of Reasoned Action and Social Learning Theory, were attitudes, norms, self-efficacy, and behavioral intentions. Attitudes, norms, and self-efficacy predicted 36.4% of the variance in the intention to limit the number of sexual partners and the same variables plus intention predicted 24.6% of the variance in number of sexual partners in the past year. Attitudes, norms, and self-efficacy regarding condom use predicted 17.0% of the variance in condom use intentions; these variables plus intentions predicted 19.0% of the variance in condom use frequency. Attitudes, norms, and intentions were directly related to the number of sexual partners, while self-efficacy ad condom use intentions were directly related to frequency of condom use.

A Systems Model of Clinical Preventive Care: An Analysis of Factors Influencing Patient and Physician:

Abstract: An ideal model for clinical preventive care must consider the physician, the patient and the many factors which influence each of them. In this paper, we review existing models, examining their strengths and weaknesses. We then propose a new model, the Systems Model of Clinical Preventive Care. This model is unique in its focus on the patient-physician interaction and details the factors impinging on each that promote or inhibit the completion of preventive care activities. These factors include patient and physician predisposing factors, such as health beliefs and attitudes; enabling factors, such as skills and resources; and reinforcing factors, such as social support. Additional factors include health care system organizational factors, such as access or availability; characteristics of the preventive activity, such as cost; and cues to action, such as symptoms or reminders. The proposed model contains components of behavioral, communication, health education and psychosocial theories. We then apply our model to mammography as an example of a screening activity. Finally, we describe the strengths and weaknesses of the proposed model, and identify areas for future research.

What's the Use of Theory?

Abstract: The barriers to the use of theory in health education practice are addressed by exposing common misperceptions of the nature and usefulness of theory. First, the mystique of theory is addressed through a discussion of theory development and the roots of theory in everyday experience. Two characteristics of theory, generalizability across settings or situations and testability, are described and linked to benefits for practice. Second, a guide for practitioners in applying theory to each stage of the intervention process is provided. A case example illustrates how theory can guide practice as well as the benefits to be gained by applying theory to program development. Finally, the bases for common negative misperceptions of theory are identified and clarified, and the beneficial nature of theory reviewed.

Self-efficacy for AIDS preventive behaviors among tenth grade students.

Abstract: To guide acquired immunodeficiency syndrome (AIDS) prevention program planning, 181 tenth grade students residing in or near an AIDS epicenter completed a survey measuring past year involvement in sexual intercourse and condom use, beliefs about self-efficacy for AIDS preventive behaviors, and beliefs about susceptibility to and severity of AIDS, and outcome efficacy of AIDS preventive actions. A degree of uncertainty existed for all areas of self-efficacy surveyed: refusing sexual intercourse under a variety of circumstances, questioning sex partners about past risky behaviors, and correct and consistent condom use. Students were most uncertain of their ability to refuse sex with a desirable partner, under pressure, or after drinking alcohol or using marijuana; to purchase condoms, or use them consistently after drinking alcohol or using marijuana; and to question partners about past homosexual history. Those students with lower self-efficacy for refusing sex were twice as likely to have had sexual intercourse. Similarly, those students with lower self-efficacy for correct, consistent condom use were five times less likely to have used condoms consistently. These associations remained even after adjusting for the influence of other AIDS-related beliefs. Implications of these findings focus on exploiting the link between self-efficacy and behavior by building a prevention program that emphasizes skills-building rather than the traditional knowledge-only approach.

Mammography Usage and the Health Belief Model

Abstract: Regular screening mammograms for asymptomatic women are the most effective method for early detection of breast cancer. This study assessed the relative influence of Health Belief Model (HBM) constructs on prior mammography usage and the intention to obtain mammograms with data from a sample of 1,057 women over the age of 35 years residing in an urban community in the United States. Covariance structure analysis with latent variables was used initially to perform a confirmatory factor analysis of indicators of Socioeconomic Status (SES), Perceived Susceptibility, Perceived Barriers, Perceived Benefits, Cues to Action, Prior Mammography, and Future Intentions. Once a plausible factor structure was confirmed, a predictive path model was tested with Future Intentions and Prior Mammography as the outcome variables. Cues to Action, operationalized as a physician influence variable, particularly impacted Prior Mammography, and Perceived Susceptibility was the most powerful predictor of Future Intentions. SES only related significantly to Perceived Barriers, and Cues to Action, and did not directly influence Prior Mammography and Future Intentions. HBM predictor variables alone accounted for the relationship between previous mammography experience and intentions to obtain mammograms in the future. Health education implications and an applied outreach program are discussed.

A three-year evaluation of the know your body program in Inner-City schoolchildren

Abstract: The impact of the Know Your Body (KYB) comprehensive school health education program was evaluated in a sample of first through sixth-grade students from New York City, using two analytic strategies: a longitudinal cohort and a "posttest only" cohort. In both cohorts, program impact was examined between condition (i.e., KYB vs. no-treatment comparison group) as well as within condition (i.e., low, moderate, and high student exposure). Students in the longitudinal cohort (n = 1,209) who were exposed to high implementation teachers had significantly (p < .05) lower total plasma cholesterol and systolic blood pressure at 3-year posttest than comparison students. Students in the posttest only cohort (n = 3,066) who had high implementation teachers showed significantly (p < .05) lower total plasma cholesterol, systolic blood pressure, self-reported intake of meat and desserts, as well as higher health knowledge and self-reported intake of "heart healthy" foods and vegetables than comparison students. In both cohorts, program effects for several outcome variables were linearly related to level of student exposure to the curriculum, suggesting a dose-response effect. While several methodologic limitations may have influenced study outcomes, these data nonetheless appear to confirm that the KYB program can have a significant positive impact on the knowledge, behavior, and selected risk factors of students in primary grades and that efforts to disseminate and evaluate school health education programs should include strategies to monitor and enhance teacher implementation.

An Action Research Approach to Workplace Health: Integrating Methods

Abstract: Action research, which combines the generation and testing of theory with social system change, demands multiple sources of knowledge about the research setting and encourages the integration of data collection techniques. This article describes the implementation of a longitudinal multi-methodological research and intervention project aimed both at examining the relationship between occupational stress and psychosocial moderating factors (e.g., social support, participation, and influence over decision-making) and health outcomes; and reducing work stress and improving employee health. Combining qualitative and quantitative research techniques such as semi-structured individual and focus group interviews, field notes and survey data increases confidence in research findings and strengthens the process and outcomes of needs assessment, program planning, implementation, and evaluation. Specific examples are provided that illustrate the usefulness of this approach in identifying and understanding problem areas and in developing and evaluating appropriate health education interventions.

The Integration of Theory with Practice: A 12-Year Case Study

Abstract: Although the integration of health education theory with practice has always been taught, this linkage has not always occurred as a systematic part of program or theory development. This paper reflects the 12-year experience of one health education program which started from a base not soundly grounded in theory and moved to one tightly linked with theory. Throughout this process, outcome data were collected allowing for evaluations of both practice and theory.

The Utilization of Qualitative and Quantitative Data for Health Education Program Planning, Implementation, and Evaluation: A Spiral Approach

Abstract: The process of development of a Dutch smoking prevention project is described. An essential feature of the project is the combination and interaction of qualitative and quantitative research methods. It is advocated that each method has its own contribution and can be considered as a separate methodology contributing to social science in general and health education research in particular. Combining the two approaches in a spiral approach will result in a synergistic effect, because of the interaction of both approaches. The results of both methods suggest that qualitative methods enhanced the generation of ideas and theories. Qualitative methods were used to formulate ideas for improving quantitative data gathering, analyzing and comparing ideas with respect to program development, and for testing the internal validity of a quantitative design. The quantitative method enabled testing of results in different groups and detecting detailed differences. It also provided information that one of the assumptions of the program, the development of a teacher independent program, was not completely realized. The major advantage of using both methods is that this provides feedback between assumptions and data, thus enhancing comparison of results and critical reflection during the whole project.

The Use of Ethnographic Interviewing to Inform Questionnaire Construction

Abstract: Many researchers planning a quantitative study begin by conducting qualitative interviews to enhance their understanding of the phenomenon under study and to prepare for constructing a questionnaire. The rich insights that in-depth interviews provide into attitudes, values, and behaviors can be invaluable for survey design and measurement decisions. We incorporated a relatively unusual technique, the ethnographic interview, in developing a survey. In this paper, we describe what an ethnographic interview is, compare it to four other kinds of qualitative interviewing styles, and identify specific ways it can contribute to constructing surveys. We illustrate these points with examples from 10 ethnographic interviews that were conducted for a study of social support among inner-city mothers of children who had chronic illnesses.

An Uneasy Alliance: Combining Qualitative and Quantitative Research Methods

Abstract: The paper describes the difficulties encountered in trying to combine qualitative and quantitative research methods in a study of the relationship between moral reasoning and teenage drug use. Four problems that arose in the attempt to reduce qualitative data to a quantitative format are described. These problems are: (1) making analytic sense of singular responses; (2) a mistaken logical inference that demands that each pattern of judgment should have discrete behavioral indicators; (3) the construction and use of ideal types; and (4) making analytic sense of universal responses. The roots of these problems are then traced to the underlying philosophical premises that distinguish the qualitative and quantitative research paradigms. The implications of the different goals, assumptions, and standards of evaluation informing each of the respective methods for future research are discussed.

Theory in Health Education Practice

Abstract: Although social and behavioral science theories are claimed to be able to contribute greatly to the effectiveness of health education programs, most practitioners in the profession seem to doubt this, and very few ever deliberately use theories in their work. Some reasons for such diverse views reside in the nature of the theories, in the very different roles they play in the worlds of theory-minded and practice-oriented health educators, respectively, in widespread unrealistic expectations of what theories can and cannot contribute to practice, and in lack of appropriate training in theories and their uses. Suggestions are offered to both practicing and academic health educators on ways to bridge the gap between the two camps, to render theories more useful to practitioners, and to train practitioners and health education students to appreciate the potentials of theories and to acquire skills needed to utilize such potentials.

Self-Regulation of Health Behavior: The "take PRIDE" Program

Abstract: Social cognitive theory, in particular, the construct of self-regulation was the basis for developing an educational program for older adults with heart disease. This paper dis cusses the theoretical principles utilized and describes the program activities based on them. Data from an evaluation conducted with 246 older heart patients who took part in the education are used to illustrate how social cognitive theory constructs operated empirically.

Hey Girlfriend: An Evaluation of AIDS Prevention among Women in the Sex Industry

Abstract: Increasingly, acquired immunodeficiency syndrome (AIDS) prevention programs have been developed to reach and influence street-based populations. Standard methods of evaluation do not fit the conditions of such programs. This article describes a process and outcome evaluation of an AIDS prevention program for sex workers in which qual itative and quantitative methods were combined in order to mediate research problems endemic to street-based populations. Methods included epidemiological questionnaires, open-ended interviews with participants, and ethnographic field notes. Process evaluation findings show that field staff who were indigenous to the neighborhood and population readily gained access to the community of sex workers and simultaneously became role models for positive behavior change. Outcome findings show that sex workers do feel at risk for AIDS, but usually from clients rather than from husbands or boyfriends. Ac cordingly, they use condoms more frequently with clients than with steady partner...

A Health Belief Model-Social Learning Theory approach to adolescents' fertility control: findings from a controlled field trial

Abstract: We evaluated an 8- to 12-hour Health Belief Model-Social Learning Theory (HBM-SLT)-based sex education program against several community- and school-based interventions in a controlled field experiment. Data on sexual and contraceptive behavior were collected from 1,444 adolescents unselected for gender, race/ethnicity, or virginity status in a pretest-posttest design. Over 60% completed the one-year follow-up. Multivariate analyses were conducted separately for each preintervention virginity status by gender grouping. The results revealed differential program impacts. First, for preintervention virgins, there were no gender or intervention differences in abstinence maintenance over the follow-up year. Second, female preintervention Comparison program virgins used effective contraceptive methods more consistently than those who attended the HBM-SLT program (p less than 0.01); among males, the intervention programs were equally effective. Third, both interventions significantly increased contraceptive efficiency for teenagers who were sexually active before attending the programs. For males, the HBM-SLT program led to significantly greater follow-up contraceptive efficiency than the Comparison program with preintervention contraceptive efficiency controlled (p less than 0.05); for females, the programs produced equivalent improvement. Implications for program planning and evaluation are discussed.

The role of designated driver programs in the prevention of alcohol-impaired driving: a critical reassessment.

Abstract: We review the "designated driver" concept and the current debate over its role in preventing alcohol-impaired driving. In our view, the focus on this strategy by broadcasters, the alcohol industry, and various public service groups has deflected attention from other alcohol-related problems that account for the vast majority of deaths and injuries associated with alcohol use. This focus has also distracted many public health advocates and policymakers from the bigger and more important jobs of increasing public awareness of the social, environmental, and economic factors that influence alcohol consumption and promoting debate on legislation and other public policy solutions to alcohol-impaired driving. As part of a comprehensive strategy, we strongly encourage a renewed focus on "sobriety checkpoints," strict enforcement of laws against alcohol sales to minors, alcohol advertising reform, increased excise taxes, and other public policy initiatives supported by the Surgeon General. These measures will curb...

The Impact of Tailored Self-Help Smoking Cessation Guides on Young Mothers

Abstract: It has been suggested that tailoring self-help materials for specific target populations will increase their effectiveness. This study tested the value of a self-help guide tailored specifically for women with young children. These women were recruited through a media campaign that encouraged smokers to call the Cancer Information Service (CIS) for assistance in stopping smoking. Women smokers with young children (under the age of 6) who called the CIS were given telephone counseling on quitting and were mailed one of three stop smoking guides. One third of callers received Quitting Times, a guide written specifically for women with young children; one third received the American Lung Association guide, Freedom from Smoking for You and Your FamilyR; and one third received Clearing the Air, a guide developed by the National Cancer Institute. Six months after calling the CIS, these women were contacted by telephone to assess changes in smoking behavior. Overall, 12.5% of the women reported not smoking for a...

Health Education and Injury Control: Integrating Approaches

Abstract: The prevention of injuries, a major public health problem, is of interest to a growing number of public health professionals from a variety of disciplines. Historically, there has been tension between those who propose injury prevention strategies that focus on the adoption of protective behaviors by individuals and those who propose strategies that circumvent the role of individual behavior by providing automatic or passive protection. This tension may be counterproductive to finding comprehensive solutions to injury problems, and a better understanding of the inherent strengths and limitations of each of these approaches is needed. The purposes of this paper are to: (1) describe the arguments over individual liberties and individual behavior that can occur in the design of injury prevention programs; (2) review the principles that typically guide the development of injury control programs and health education programs; and (3) integrate the two most widely used approaches in injury control and health education programs--Haddon's injury countermeasures and Green's PRECEDE framework--into one program planning framework that addresses both behavioral and nonbehavioral components of an injury problem. This unified framework is offered in the hope that its use will facilitate multidisciplinary, comprehensive approaches to developing injury prevention programs that are efficient and effective.

Patient Attitudes Concerning Health Behaviors during Pregnancy: Initial Development of a Questionnaire

Abstract: The major determinant of infant mortality in the United States is low birthweight (LBW). Health behaviors related to LBW are inadequate prenatal care, poor nutrition, smoking, and moderate to heavy alcohol use. Before interventions can be designed to assist women in modifying these health behaviors, more must be understood about their causes. The Health Belief Model (HBM) is a framework for analyzing beliefs that motivate health behaviors and is well established as a model for understanding health behavior decisions. The chief aim of this study was to develop an instrument to assess women's health beliefs during pregnancy. Questions for the instrument were generated around the four major constructs of the HBM: perceived susceptibility, seriousness, benefits, and barriers. Four focus group interviews, a literature review, and consultation with an HBM expert provided content for questions. The questionnaire was administered to a convenience sample of 127 women. The measurement models were tested using confirmatory factor analysis. Parsimony was achieved by reducing the original 106-item scale to 64 items. The final instrument provides support for the HBM but not for all of its discrete constructs.

Explaining Differences between Qualitative and Quantitative Data: A Study of Chemoprophylaxis during Pregnancy

Abstract: Experts acknowledge that communication projects would benefit from the use of open-ended interviews, focus groups, surveys, trials of behaviors, observation, and other research techniques to identify community and individual knowledge, beliefs, preferences, actual behavior, as well as a host of sociodemographic and economic characteristics necessary for planning and implementation. Communication planners often rely exclu sively on survey research for program planning, claiming ease of administration and reliability of results. Reliance on this single research method often results in less appro priate interventions than could be developed with multiple research methods. This article reports the use of multiple methods to examine the cultural and behavioral factors which influence the use of antimalarial chemoprophylaxis during pregnancy in Malawi, Central Africa. This article will demonstrate how quantitative techniques such as cross sectional interviews and chemical tests as well as qualitative ethnograph...

Evaluation of the Health Belief Model and Decision Making Regarding Amniocentesis in Women of Advanced Maternal Age

Abstract: The Health Belief Model (HBM) was developed as an attempt to explain an individual's decision regarding obtaining preventive health care. This model was applied to predict the decisions of women of advanced maternal age regarding their obtaining amniocentesis in a one-year study conducted in Toledo, Ohio. A questionnaire based on the HBM was administered to a sample of 98 pregnant women of advanced maternal age. A total of 96 questionnaires were eligible for inclusion in the study. Sixty-one women reported that they would have amniocentesis, 22 would not, and 13 were unsure. A multivariate analysis of variance among amniocentesis decision groups was performed using the health belief components (perceived susceptibility, perceived seriousness, perceived benefit, perceived barrier) and knowledge as variables. There was a significant difference (Wilks' criterion, p less than .0001) among the three decision groups, but the differences were in the health belief components and not in knowledge. A stepwise discriminant function analysis was used to classify subjects on the amniocentesis decision. Of the variables examined, only the HBM component perceived benefit factor was a significant discriminant (p = .0001). It is not necessarily the lack of knowledge that prevents women who are at risk because of advanced maternal age from having amniocentesis but their perceptions regarding amniocentesis. Genetic counselors need to focus more on exploring the perceptions of amniocentesis benefits in this population to facilitate the decision making process.

Theory and the Empowerment of Health Education Practitioners

Abstract: Both the nature of theory and the way it is taught can overpower health education practitioners. As a consequence, myths which maintain theory and practice in separate realms may develop. This paper argues that to remedy this situation, practitioners must be helped to gain greater control of theory. Specific suggestions for accomplishing this goal are offered in a three-part prescription. First, concepts and teaching methods are introduced to dismantle myths about theory and to help practitioners understand its origins, nature, and functions. Second, health educators are encouraged to acknowledge limitations in theories currently guiding their practice. Third, they are shown ways they can exert leadership in developing theory to fill these gaps and build a more adequate knowledge base for confronting contemporary practice problems. Through this exercise of power, health educators will gain control over theory and expand the boundaries of practice, while also enhancing their professional status.

The Implementation of a Restrictive Worksite Smoking Policy in a Large Decentralized Organization

Abstract: This study investigates the implementation of a restrictive smoking policy in decen tralized worksites. A model which includes four elements—concept, context, process, and outcomes—is used as a framework for identifying characteristics that influence im plementation. The organization studied was a state human services agency with approx imately 400 worksites spread across 12 geographic regions. Quantitative data collection included three cross-sectional surveys of employees and supervisors administered before and after the date the policy became effective. Qualitative data were collected from three sources, including written comments on surveys, focus groups, and structured interviews with supervisors and top administrators. Tabular analyses and one-way analyses of vari ance were used to analyze quantitative data. Qualitative data were examined for key themes and have been used to elucidate findings. Those characteristics related to concept, context, and process which appeared to have the strongest influe...

The Uses of Theory in Health Advocacy: Policies and Programs:

Abstract: This paper illustrates the utility of theory for health educators who advocate for health promotion policies and programs. It describes how diffusion of innovation and other social science theories were employed by a statewide coalition called the Health Promotion and Education Council of Virginia in its effort to reduce premature and preventable death and disability in the state. To this end the Council sought legislative action to accelerate the diffusion of health promotion throughout the state. Discussing elements of diffusion theory such as working through opinion leaders, creating information-exchange relationships, and tailoring the attributes of the innovation to achieve its objectives, the paper reviews the process through which the Council became an effective advocate, and the strategies it devised to communicate the innovation of health promotion to legislators. The legislation that was generated by the work of the legislative study committee and future uses of theory are also discussed.

The Role of Community Organizations in AIDS Prevention in Two Latino Communities in New York City

Abstract: Black and Latino community organizations can play a major role in acquired immunodeficiency syndrome (AIDS) prevention. Their ongoing relationships with their constituents, knowledge of relevant cultural values and channels of communication, and commitment to safeguard the well-being of their neighborhoods are an important resource for AIDS prevention campaigns.In order to better understand the process by which community groups have taken on the issue of AIDS, investigators conducted in-depth interviews with a convenience sample of 47 neighborhood organizations in two primarily Latino communities in New York City. Researchers also attended community meetings, interviewed AIDS educators, and conducted focus groups with respondents.More than half the groups had already sponsored some AIDS prevention activities prior to the first interview. More active groups were more likely to have multiple missions, previous experience with the target population, and prior experience working with people with AIDS.Responde...

Designated Driver Programs: A Commentary on the DeJong and Wallack Article:

Abstract: Designated driver programs have received extensive attention and dissemination by public and private individuals and organizations. However, there are few theoretical or empirical papers in the scientific literature on the design and effectiveness of such programs. DeJong and Wallack’ provide an important service by raising a number of important issues concerning designated driver programs and their potential role in preventing injury and death resulting from alcohol-involved traffic crashes.

Process Evaluation of a Home-Based Program to Reduce Diet-Related Cancer Risk: The "WIN At Home Series"

Abstract: A random mailed survey (response N = 226; 75.3%) of participants in diet-related home-based learning evaluated exposure to recruitment channels and impact on salience, utility, level of participation, sharing the course with others, knowledge, and performing recommended behaviors. A post-only design, the study was conducted in a small Minnesota city (population = 20,000), part of the Cancer and Diet Intervention (CANDI) project.About 18.5% of residents (3,711) enrolled during an 8-week media campaign; women, college graduates, and those over 44 years old were overrepresented. Participants learned about the program through mass media (97%); small media (41.9%); and interpersonal sources (50%). Women were more likely to learn about the course through interpersonalsources. In analysis of variance (ANOVA) modeling, salience and utility predicted level of participation in course activities. Level of participation in turn predicted nutrition knowledge and with salience predicted performance of recommended behav...

Book Review : Preventing AIDS in Drug Users and Their Sexual Partners, J.L. Sorensen, L.A. Wermuth, D.R. Gibson, C. Kyung-Hee, J.R. Guydish, and S.L. Batki, (Eds), New York, The Guilford Press, 1991, 220 pp

Abstract: Preventing AIDS in Drug Users and Their Sexual Partners, J.L. Sorensen, L.A. Wermuth, D.R. Gibson, C. Kyung-Hee, J.R. Guydish, and S.L. Batki, (Eds), New York, The Guilford Press, 1991, 220 pp. As drug users, their partners, and families have come to be recognized as categories of people at extremely high risk for acquired immunodeficiency syndrome (AIDS) infection, a new subgenre has emerged within the burgeoning AIDS literature. Like Preventing AIDS, this body of work by researchers and intervention staff consists primarily of multiauthored readers, edited volumes, and special journal issues on various aspects of AIDS prevention for hard-toreach or hidden populations.1-5 For those who are new to the AIDS field and are unfamiliar with this existing literature, Preventing AIDS includes a wealth

Book Review : Microcomputer Applications in Health Education, Robert S. Gold, Dubuque, IA, Wm. C. Brown Publishers, 1991, 285 pp

Abstract: Microcomputer Applications in Health Education, Robert S. Gold, Dubuque, IA, Wm. C. Brown Publishers, 1991, 285 pp. What do health educators need to know about computers? How can computers best be used to improve the quality of our professional practice? These are the key questions addressed by Gold in Microcomputer Applications in Health Education. The need for a book on this topic is clear to me from my own experience in training health educators through university, continuing education, and now state government settings about the potential use of computers. Many health educators are unaware of the multiple ways in which computers can aid them in their practice. Others hold the misconception that public health populations are uncomfortable with computer instruction (numerous studies have documented their acceptance).’-6 Gold’s book begins with an &dquo;Overview of Computing,&dquo; providing a history of computers, general information on computer systems, and an overview of