A framework of the relationship between knowledge, attitudes, and behavior was described in the context of couple's use of birth control. It was hypothesized that when knowledge of behavioral enactment is present, attitudes and beliefs about susceptibility to pregnancy will be predictive of accurate use of the diaphragm. Respondents were 111 women who participated in a three-wave panel design focusing on diaphragm use. Analyses indicated that the level of knowledge about what a woman should do to use the diaphragm correctly was high. Correct knowledge, however, did not translate into accurate behavior. Motivational factors focusing on attitudes, perceived susceptibility to pregnancy, and normative factors were also relevant.
This article identifies new research and policy directions for the field of worksite health in the context of the changing American workplace. These directions are viewed from an ecological perspective on worksite health and are organized around three major themes: (1) the joint influence of physical and social environmental factors on occupational health, (2) the effects of nonoccupational settings (e.g., households, the health care system) on employee well-being and the implications of recent changes in these settings for worksite health programs, and (3) methodological issues in the design and evaluation of worksite health programs. Developments in these areas suggest that the field of worksite health may be undergoing a fundamental paradigm shift away from individually oriented wellness programs (provided at the worksite and aimed primarily at changing employees' health behavior) and toward broader formulations emphasizing the joint impact of the physical and social environment at work, job-person fit, and work policies on employee well-being.
This article describes one effort to help prevent violence against women by addressing some of the larger societal factors involved. The Dangerous Promises campaign is based on the premise that sexist advertising images contribute to an environment conducive to violence against women. The goal of the campaign is to convince alcohol companies to eliminate sexist alcohol advertising and promotions. Using the tools of community organizing and media advocacy, the campaign pressures the alcohol industry to change the ways in which they portray women in much of their advertising. Media advocacy has been instrumental in the successes of the campaign. This article examines the strategies and outcomes of the Dangerous Promises efforts to date and makes a case for application of media advocacy as a tool for increasing community voice in policy-making processes.
The purpose of media advocacy is to promote public health goals by using the media to strategically apply pressure for policy change. It provides a framework for moving the public health discussion from a primary focus on the health behavior of individuals to the behavior of the policymakers whose decisions structure the environment in which people act. It addresses the power gap rather than just the information gap. Media advocacy focuses on public policy rather than personal behavior. This article uses two case studies to illustrate key aspects of media advocacy. The first is a 5-year statewide violence prevention initiative for young people in California. The second focuses on the activities of a mothers' group working to improve public housing. The "new public health," with its focus on participation, policy development, and political processes, could benefit from incorporating media advocacy.
The authors investigated the effects of a media advocacy program to build support for cardiovascular disease (CVD)-related policy changes and to encourage adoption of heart-healthy behaviors in the Stanford Five-City Project, a long-term trial of community-wide CVD risk reduction. The authors content analyzed 4,824 health articles in two treatment city newspapers and two reference city newspapers between 1977 and 1990. One treatment city newspaper responded well to the program; the other did not. In the Salinas Californian, the number of CVD-related articles increased during the campaign; these articles became more prominent and conspicuous, the focus on prevention increased, and more of these articles were written by local staff. Maintenance of these effects after the campaign was mixed. Results suggest that frequent, regular, systematic contact with media professionals and provision of materials influence newspaper coverage of health-related topics, which has important implications for shaping public opinion and policy change.
This article presents the results of applied ethnographic research aimed at developing a community-based diabetes prevention program in an isolated Ojibway-Cree community in northern Ontario. Using qualitative techniques, the authors describe diabetes in its sociocultural context and underlying belief systems that affect related activity and dietary behaviors. Local concepts of food and illness are dichotomized into "Indian" and "white man's" groupings, with Indian foods perceived as healthy and white man's foods felt to be unhealthy. Diabetes is believed to result from consumption of white man's "junk foods" (sugar, soda); some believe the disease can be avoided by eating traditional Indian foods such as game animals (moose, beaver, duck). While dietary linkages to diabetes are recognized, physical activity as a means of controlling obesity and decreasing the risk for diabetes is not part of the local ethnomedical model. This information is being used to develop culturally appropriate health education interventions.
Within a single firm it is common to find both occupational safety and health and worksite health promotion interventions operating in isolation from one another, with different intervention targets, methods, and personnel. Overcoming the segmentation of the two fields will require, among other things, the promulgation of an overarching model of work and health. The purpose of this article is to describe an integrated model and to show how it can be applied to improve worksite health interventions for both occupational safety and health and worksite health promotion. Practice examples from both fields are used to illustrate interventions that focus on different areas of the model (individual behavior, psychosocial, organization, and contextual factors). It is argued that occupational safety and health and worksite health promotion practitioners need to develop more comprehensive interventions and rigorously evaluate these programs to determine if they are more effective than programs with a more narrow focus.
A school-based sex education program was developed in order to prevent sexually transmitted diseases and unwanted pregnancies. A Solomon four-group design, with random assignment to the different conditions, was used to evaluate an intervention based on cognitive social learning theory and social influence theory. The main goal of the intervention was to increase use of condoms. A stratified sample of 124 classes (2,411 students) was drawn at random from all the upper secondary schools (high schools/colleges) in one county in Norway. The results indicate a consistent interaction between pretest and intervention, which seems to have an effect on condom use. Pretest or intervention alone did not contribute to this effect. The interaction effect appeared among the students with few sexual partners. Several possible explanations to the observed interaction effect and the implication for future interventions are discussed.
The high rates of teen pregnancy have been widely documented.Each year in the United States, more than 1 million pregnancies occur to women 20 years of age or younger,1 and the rates among the youngest of these women have increased dramatically during the past decade.1-3 Most pregnant adolescents choose to keep their children rather than receive abortions or give their babies up for adoption,4 but doing so typically results in negative social consequences, including school dropout and long-term economic and vocational problems .5As a result of this social crisis, many commu- nities have implemented pregnancy prevention programs.Preventing Adolescent Pregnancy is an edited book presenting evaluations of state-of-the-art pregnancy prevention programs from re- searchers around the United States.The first chapter, authored by Card, Peterson, and Greeno, helpfully discusses some of the pitfalls and problems associated with implementing and evaluating these programs.These authors offer useful strategies to increase program effectiveness-for example, the developmental timing of the program, the importance of a comprehensive, intense program, and the like.The authors also make a case for assessing the process and impact of the program once it is implemented; however, they emphasize the fact that impact assessment is extremely difficult and requires considerable expertise.The final few pages of the chapter point the reader to important additional resources in the area of pregnancy prevention.As a broad overview, this chapter is useful for the uninitiated program evaluator.Unfortunately, some of the topics discussed, if not followed by further study, may be misleading.For example, the authors note that &dquo;poverty, family instability, minority status, and failure in school are important risk factors in adolescent pregnancy&dquo; (p. 9).The authors fail to note that these same factors are risk factors for most social problems.Further, they do not cite research indicating that studies attempting to examine risk factors for teenage pregnancy are not
With increasing frequency, public health education includes discussion about the role of community in disease prevention. For example, public health educators and prevention researchers are (re)discovering the relevance of community mobilization, citizen empowerment, and communitylevel theory to the goal of building healthy communities. The emerging prominence of community in public health is in large part a result of the HIV pandemic. Because epidemiologic categories do not constitute communities, people have formed organized &dquo;associations of interest&dquo;} in response to this global threat. Unlike any other public health crisis in history, HIV has generated an unusually powerful grassroots response. The mobilization of sectors of the North American, Australian, and Western European gay communities is widely credited with an unprecedented decline in HIV incidence
According to prior reports, blue-collar workers are less likely to participate in worksite health promotion programs than are white-collar workers, This study examined worker participation in the WellWorks worksite cancer prevention intervention, which integrated health promotion and health protection Analyses were conducted to assess relationships among participation in health promotion and health protection programs, and workers' perceptions of management changes to reduce potential occupational exposures. Results indicate that blue-collar workers were less likely to report participating in health promotion activities than white-collar workers. A significant association was observed between participation in nutrition- and exposure-related activities, suggesting that participation in programs to reduce exposures to occupational hazards might contribute to blue-collar workers' participation in health promotion activities, Furthermore, when workers were aware of changes their employer had made to reduce exposures to occupational hazards, they were more likely to participate in both smoking control and nutrition activities, even when controlling for job category. These findings have clear implications for future worksite cancer prevention efforts.
To promote breast and cervical screening among Vietnamese women, a neighborhood-based intervention was developed that included small-group education, distribution of Vietnamese-language educational materials, and health fairs. The rationale for these modes of intervention is described. A pretest/posttest controlled trial is used to evaluate the intervention. San Francisco, California, is the experimental community; Sacramento, California, is the comparison community. The study hypothesizes that postintervention measurements of screening rates will reflect significantly greater increases among women in the experimental community than in the comparison community. This article reports results from the 1992 baseline household survey of 306 Vietnamese women in San Francisco and of 339 Vietnamese women in Sacramento. There were no significant differences in screening rates between the two communities. Only 50-54% of women had received routine checkups; 44-55%, mammograms; 40-45%, clinical breast examinations; 40-46%, Pap smear tests; and 58-65%, pelvic examinations.
In 1991, the Massachusetts legislature considered a bill that would have allowed a drunk driving defendant's refusal to take a breathalyzer test to be admitted as evidence in a criminal trial. After the measure passed in both houses, a state senator used a parliamentary maneuver to prevent it from being prepared for the governor's signature. Mothers Against Drunk Driving (MADD) employed media advocacy techniques to alert the public, but the senator was unyielding and the legislative calendar ran out with the bill unsigned. Because of MADD's efforts, however, the senate president put the bill on a "fast track" the following year. The news media's focused attention on MADD's protests exposed deep schisms among its volunteer leadership regarding the nature and purpose of the organization and the appropriateness of using confrontational media strategies to advance its agenda. Paralyzed by the lack of consensus, MADD Massachusetts was rendered a far less effective advocate for policy change.
Indigenous lay health workers are presumed to be effective communicators in their communities due to their cultural competence. Lay health worker programs in Vietnamese and Latino communities show the influence of each community's culture and structure on the intervention designs and recruitment and training of lay health workers. To promote cancer screening. Vietnamese lay health workers conducted educational sessions in neighborhoods, while Latina lay health workers served as networkers and media role models. The studies demonstrated ways to build upon cultural strengths of the community and to tailor interventions to meet community expectations and needs. The authors conclude that ongoing responsiveness to both cultural norms and structural conditions in the community is the sine qua non of successful community programs.
This article argues that there has been a tendency to empower the "conventional" positivist paradigm in health promotion research, often at the expense of confounding or ignoring much of health promotion practice. This article argues further that a "constructivist" research paradigm not only has the potential to resolve some of the tensions between research and practice in health promotion but also is inclusive of knowledge generated by the conventional paradigm. The usefulness of a constructivist paradigm is demonstrated through the use of four practice-based case examples drawn from actual community-based health promotion efforts. The congruence of a constructivist paradigm with the health promotion principles of empowerment and community participation are discussed. Finally, this article argues for the acceptance of the legitimacy of knowledge generated from the constructivist paradigm and concludes that this paradigm is more suited to the goals of current health promotion.
A survey instrument was developed to assess the anticipated impact of smoke-free university policy on faculty and staff and to recommend health education interventions based on stages of change theory and employee interest. Four months before the policy was implemented, the 25-item anonymous questionnaire was sent to a random sample of 1,000 faculty/staff. A majority of university workers (85.5%) are not smokers and approve of the no-smoking policy. Smokers (14.5%) are older than nonsmokers, are more likely to have a high school versus higher education, and are more likely to be maintenance or clerical workers. Most smokers smoke less than one packper day and smoke outdoors during workhours. More smokers were in later stages of change (planning to stop soon) than expected. Interest in availability of smoking cessation activities differed by smoking status and change stage.
