Health Education & Behavior recent issues

Practice Notes

2008-08-04

The Radio Communication Project in Nepal: A Culture-Centered Approach to Participation

Dutta, M. J., Basnyat, I. — 2008-08-04

Considerable research has been conducted on the topic of entertainment-education (EE), the method of using entertainment platforms such as popular music, radio, and television programming to diffuse information, attitudes, and behaviors via role modeling. A significant portion of the recently published EE literature has used the case of the Radio Communication Project (RCP) in Nepal to demonstrate the effectiveness of EE and to argue that EE campaigns can indeed be participatory in nature. In this project, we apply the culture-centered approach to examine the discursive space created by the RCP and its claim of being participatory. A critical examination of RCP discourse brings forth an alternative lens for approaching EE and its participatory claim.

Community Participation, Cultural Discourse, and Health Education Projects in Developing Areas: The Case of the Radio Communication Project in Nepal

Linn, J. G. — 2008-08-04

The Case of the Radio Communication Project in Nepal: A Culture-Centered Rejoinder

Dutta, M. J., Basnyat, I. — 2008-08-04

The Contextual Effects of Gender Norms, Communication, and Social Capital on Family Planning Behaviors in Uganda: A Multilevel Approach

Paek, H.-J., Lee, B., Salmon, C. T., Witte, K. — 2008-08-04

This study hypothesized a multilevel model to examine the contextual effects of gender norms, exposure to health-related radio programs, interpersonal communication, and social capital on family planning behavior in Uganda. The results of hierarchical linear modeling showed that all of the four variables were significant predictors of family planning behavior. The authors found that gender norms as a contextual factor significantly interacted with the individual-level perceived benefit. The significant cross-level interaction effect was also observed between individuals' interpersonal communication and contextual variation in listening to a health-related radio program. Practical implications for family planning communication campaigns are discussed.

Colorectal Cancer Screening, Intentions, and Predictors in Jewish and Arab Israelis: A Population-Based Study

Azaiza, F., Cohen, M. — 2008-08-04

Random samples of 358 Jews and 162 Arabs in Israel aged 50 to 75 were compared by telephone survey for colorectal cancer (CRC) screening performance and intentions. Participants completed questionnaires on CRC screening, health beliefs, health locus of control, and CRC worries; rate of CRC screening and intention to be screened proved lower among Arabs. They received fewer recommendations from physicians, perceived lower severity of CRC and lower benefits of early detection of CRC, and had lower cancer worries, lower internal health locus of control, and higher external health locus of control. Jewish/Arab ethnicity predicted ever undergoing screening and screening intention before cognitive perceptions and worries were entered. After that, perceiving higher susceptibility and more benefits to screening, and having lower external health locus of control predicted CRC screening and screening intention, which was associated with higher cancer worries. Programs should be tailored to address ethnic groups' different health beliefs.

The Effectiveness of a Peer-Led HIV/AIDS and STI Health Education Intervention for Prison Inmates in South Africa

2008-08-04

This article reports on the effectiveness of the first systematically developed health education intervention for the reduction of risky sexual behavior among soon-to-be-released prisoners in South Africa. Data from three out of four prisons are eligible for data analysis including 263 inmates. Using a nested experimental design, short-term evaluation while inmates were still in prison demonstrate that experimental groups showed higher knowledge of sexually transmitted infections and had a more positive intention to reduce risky behavior than the control group in two out of three prisons. Long-term assessment 3 to 6 months after release from prison indicates that experimental groups were more positive about sexual communication, self-efficacy, and intention. Groups educated by an HIV-negative educator perform marginally better than those in groups with an HIV-positive peer educator. It is argued that peer-led health education programs may be effective in reducing risky behavior amongst soon-to-be-released inmates.

Emergence and Robustness of a Community Discussion Network on Mercury Contamination and Health in the Brazilian Amazon

Mertens, F., Saint-Charles, J., Lucotte, M., Mergler, D. — 2008-08-04

Information exchanges, debates, and negotiations through community social networks are essential to ensure the sustainability of the development process initiated in participatory research. The authors analyze the structural properties and robustness of a discussion network about mercury issues in a community in the Brazilian Amazon involved in a participatory research aimed at reducing exposure to the pollutant. Most of the villagers are connected in a large network and are separated from other individuals by few intermediaries. The structure of the discussion network displays resilience to the random elimination of villagers but shows vulnerability to the removal of one villager who has been a long-term collaborator of the project. Although the network exhibits a structure likely to favor an efficient flow of information, results show that specific actions should be taken to stimulate the emergence of a pool of opinion leaders and increase the redundancy of discussion channels.

Parental Investment, Club Membership, and Youth Sexual Risk Behavior in Cape Town

Camlin, C. S., Snow, R. C. — 2008-08-04

This study examines whether parental investment and membership in social clubs are associated with safer sexual behaviors among South African youth. Participants comprised 4,800 randomly selected adolescents age 14 to 22 living in the Cape Town area in 2002. Logistic regression was used to examine associations between measures of parental investment and associational membership with reported condom use at first and most recent sexual intercourse, net of effects of HIV knowledge, age, education, population group, parental coresidence, and household income. Interaction terms were used to examine gender differences in associations between risk behavior and parental investment and between risk behavior and group membership. Participation in clubs and community groups is associated with safer behaviors. A mother's financial support (for clothing, school fees and uniforms, and pocket money) is negatively associated with condom use, particularly among young women, suggesting that material need impels vulnerability to higher risk behaviors. Social resources in households and communities mediate HIV risk behaviors among youth in Cape Town.

Factors Affecting the Diffusion of Solar Water Disinfection: A Field Study in Bolivia

Heri, S., Mosler, H.-J. — 2008-08-04

This study examines a broad array of theory-based factors derived from diffusion research that affect the current and intended use of solar water disinfection (SODIS), a simple, low-cost technology for treating drinking water at the household level. The perceived attributes of an innovation, the nature of the social system in which it is diffused, the extent of change agents' promotional efforts in diffusing it, and the nature of the communication channels used were operationalized by 16 variables. The aim of the study is to determine the influence of each factor and its predictive power. Eight areas in Bolivia were visited, and 644 families were interviewed on the basis of a structured questionnaire. Simultaneous multiple regression analysis showed that 9 of the 16 factors derived from diffusion research contributed significantly to predicting the current use of SODIS. The implications of the findings for customizing future SODIS diffusion activities are outlined.

An Integrated Multi-Institutional Diabetes Prevention Program Improves Knowledge and Healthy Food Acquisition in Northwestern Ontario First Nations

2008-08-04

This article presents the impact results of a feasibility study in Canada for prevention of risk factors for diabetes in seven northwestern Ontario First Nations. Baseline and follow-up data were collected before and after the 9-month intervention program in schools, stores, and communities that aimed to improve diet and increase physical activity among adults. Regression analyses indicate a significant change in knowledge among respondents in intervention communities (p < .019). There was also a significant increase in frequency of healthy food acquisition among respondents in the intervention communities (p < .003). There were no significant changes in physical activity or body mass index in either intervention or comparison groups. The multi-institutional approach demonstrated promising results in modifying selected risk factors for diabetes First Nations communities.

Application of the PRECEDE Model to Understanding Mental Health Promoting Behaviors in Hong Kong

Mo, P. K. H., Mak, W. W. S. — 2008-08-04

The burdens related to mental illness have been increasingly recognized in many countries. Nevertheless, research in positive mental health behaviors remains scarce. This study utilizes the Predisposing, Reinforcing, and Enabling Causes in Education Diagnosis and Evaluation (PRECEDE) model to identify factors associated with mental health promoting behaviors and to examine the effects of these behaviors on mental well-being and quality of life among 941 adults in Hong Kong. Structural equation modeling shows that sense of coherence (predisposing factor), social support (reinforcing factor), and daily hassles (enabling factor) are significantly related to mental health promoting behaviors, which are associated with mental well-being and quality of life. Results of bootstrap analyses confirm the mediating role of mental health promoting behaviors on well-being and quality of life. The study supports the application of the PRECEDE model in understanding mental health promoting behaviors and demonstrates its relationships with well-being and quality of life.

Practice Notes

2008-05-05

Development of Scales Measuring the Capacity of Community-Based Initiatives

Lempa, M., Goodman, R. M., Rice, J., Becker, A. B. — 2008-05-05

This article describes the development of two measures for the capacity of local public health initiatives. Data obtained from a qualitative study of eight community-based initiatives served as the basis for the development of a survey instrument. It was administered to a national sample of both leaders and nonleaders of 291 such initiatives. Because survey results for leaders and nonleaders differed, results could not be combined into a single data set for analysis. Results for each data set were analyzed by employing exploratory principal components and factor analyses. A 44-item, six-factor scale resulted for leaders and a 38-item, five-factor scale resulted for nonleaders. The high degree of overlap (22 items) between the two scales resulted in a combined 60-item instrument that can be administered to both leaders and nonleaders but analyzed separately.

Physical Activity Belief Scales for Diabetes Risk: Development and Psychometric Testing

Blue, C. L., Marrero, D. G., Black, D. R. — 2008-05-05

This article describes the development and psychometric evaluation of behavioral belief, normative belief, and control belief scales, derived from the theory of planned behavior to predict physical activity intentions of persons at risk for diabetes. In Study 1, belief statements from interviews were categorized, ranked, and evaluated for item construction. Content validity was established by 96.1% agreement among a five-member expert panel. In Study 2, items developed from the belief statements were administered to 106 adults at risk for diabetes. Psychometric analyses provided evidence of construct validity and reliability of the three scales. Internal consistency was sufficient ( = .76-.95), and test-retest evaluations indicated scale stability (r = .79-.91). Factor analyses and confirmatory factor analysis using structural equation modeling provided evidence that the items were appropriately grouped under each construct. Researchers and practitioners can use these measures to assess behavioral, normative, and control beliefs about physical activity among persons at risk for diabetes.

Validation of a Parent-Adolescent Communication Scale for Use in STD/HIV Prevention Interventions

2008-05-05

This study reports on the validation of a scale to assess adolescent girls' frequency of sexual communication with their parents. The Parent-Adolescent Communication Scale (PACS) was administered to 522 African American female adolescents ranging in age from 14 to 18. The PACS demonstrated satisfactory internal consistency (across multiple administrations) and acceptable test-retest reliability over a 12-month follow-up period. Concurrently, scores on the PACS were correlated with frequency of sexual communication with partner, sexual communication self-efficacy (boyfriend), perceived parental knowledge, family support, depression, and condom use with steady male sex partners. Prospectively, baseline PACS scores were correlated with frequency of sexual communication with partner and condom use. The present investigation indicates that the PACS is a reliable and valid measure of frequency of sexual communication between female adolescents and their parents. Utility of the PACS for researchers and practitioners is discussed.

A Validation and Reliability Study of the Physical Activity and Healthy Food Efficacy Scale for Children (PAHFE)

Perry, C. M., De Ayala, R.J., Lebow, R., Hayden, E. — 2008-05-05

The purpose of this study was to obtain validity evidence for the Physical Activity and Healthy Food Efficacy Scale for Children (PAHFE). Construct validity evidence identifies four subscales: Goal-Setting for Physical Activity, Goal-Setting for Healthy Food Choices, Decision-Making for Physical Activity, and Decision-Making for Healthy Food Choices. The scores on each of these subscales show a moderate to high degree of internal consistency (0.59 ≤ ≤ 0.87). The Decision-Making for Healthy Food Choice subscale and the Decision-Making for Physical Activity subscale scores show significant convergent validity evidence. These results provide support for using this self-efficacy scale to measure children's perceived confidence to make decisions about healthy eating and physical activity. The PAHFE may be considered to be a useful predictor of both physical activity and eating behaviors.

Developing and Validating a Measure of Chinese Cultural Views of Health and Cancer

2008-05-05

To develop and validate quantitative scales that measure Chinese cultural views about health and cancer, cultural views were assessed by a 30-item scale through telephone interviews with 438 Chinese-American women aged 50 and older. Cultural subscales were identified using principal component analysis and validated by their associations with age at immigration and breast, cervical, and colorectal cancer (CRC) screening patterns. The overall scale had good reliability (Cronbach's alpha = .79). Factor analysis yielded seven cultural subscales—fatalism, hot-cold balance, use of herbs, self-care, medical examination, lifestyle, and Western medicine (alpha = .39 to .82). The majority of the cultural subscales were significantly associated with age at immigration (p < .001). Fatalism, Self-Care, and Medical Examination subscales consistently predicted nonadherence to breast, cervical, and CRC screening recommendations, even after considering other factors. Chinese cultural views consist of at least seven domains and may influence older women's breast, cervical, and CRC screening.

Evaluation of Community Action Against Asthma: A Community Health Worker Intervention to Improve Children's Asthma-Related Health by Reducing Household Environmental Triggers for Asthma

2008-05-05

This article describes the evaluation of a community-based participatory research (CBPR) community health worker (CHW) intervention to improve children's asthma-related health by reducing household environmental triggers for asthma. After randomization to an intervention or control group, 298 households in Detroit, Michigan, with a child, aged 7 to 11, with persistent asthma symptoms participated. The intervention was effective in increasing some of the measures of lung function (daily nadir Forced Expiratory Volume at one second [p = .03] and daily nadir Peak Flow [p = .02]), reducing the frequency of two symptoms ("cough that won't go away," "coughing with exercise"), reducing the proportion of children requiring unscheduled medical visits and reporting inadequate use of asthma controller medication, reducing caregiver report of depressive symptoms, reducing concentrations of dog allergen in the dust, and increasing some behaviors related to reducing indoor environmental triggers. The results suggest a CHW environmental intervention can improve children's asthma-related health, although the pathway for improvement is complex.

A Socioecological Approach to Improving Mammography Rates in a Tribal Community

2008-05-05

This article highlights the processes and intermediate outcomes of a pilot project to increase mammography rates of women in an American Indian tribe in New Mexico. Using a socioecological framework and principles of community-based participatory research, a community coalition was able to (a) bolster local infrastructure to increase access to mammography services; (b) build public health knowledge and skills among tribal health providers; (c) identify community-specific knowledge, attitudes, and beliefs related to breast cancer; (d) establish interdependent partnerships among community health programs and between the tribe and outside organizations; and (e) adopt local policy initiatives to bolster tribal cancer control. These findings demonstrate the value of targeting a combination of individual, community, and environmental factors, which affect community breast cancer screening rates and incorporating cultural strengths and resources into all facets of a tribal health promotion intervention.

Perceptions and Beliefs About Body Size, Weight, and Weight Loss Among Obese African American Women: A Qualitative Inquiry

Befort, C. A., Thomas, J. L., Daley, C. M., Rhode, P. C., Ahluwalia, J. S. — 2008-05-05

The purpose of this qualitative study was to explore perceptions and beliefs about body size, weight, and weight loss among obese African American women in order to form a design of weight loss intervention with this target population. Six focus groups were conducted at a community health clinic. Participants were predominantly middle-aged with a mean Body Mass Index of 40.3 ± 9.2 kg/m². Findings suggest that participants (a) believe that people can be attractive and healthy at larger sizes; (b) still feel dissatisfied with their weight and self-conscious about their bodies; (c) emphasize eating behavior as the primary cause for weight gain; (d) view pregnancy, motherhood, and caregiving as major precursors to weight gain; (e) view health as the most important reason to lose weight; (f) have mixed experiences and expectations for social support for weight loss; and (g) prefer treatments that incorporate long-term lifestyle modification rather than fad diets or medication.

Practice Notes: Strategies in Health Education

2008-03-25

Using a Naturalistic Ecological Approach to Examine the Factors Influencing Youth Physical Activity Across Grades 7 to 12

2008-03-25

High levels of inactivity in youth have led researchers and practitioners to focus on identifying the factors that influence physical activity behaviors in young people. The present study employed a qualitative ecological framework to examine the intrapersonal, social, and environmental factors influencing youth physical activity. In grade-specific focus group settings, 160 youth in grades 7 through 12 (aged 12 to 18) were asked how they would increase the physical activity levels of youth their age. Participants identified eight factors that they felt should be addressed in programs and interventions designed to increase the physical activity behaviors of youth. These factors included the importance of fun, having the time to be physically active, the benefits of activity, being active with friends, the role of adults, and the importance of being able to access facilities in their neighborhood.

Development and Evaluation of a Theory-Based Physical Activity Guidebook for Breast Cancer Survivors

2008-03-25

This study's objective was to develop and evaluate the suitability and appropriateness of a theory-based physical activity (PA) guidebook for breast cancer survivors. Guidebook content was constructed based on the theory of planned behavior (TPB) using salient exercise beliefs identified by breast cancer survivors in previous research. Expert judges completed the Maine Area Health Education Center's 18-item attribute checklist for evaluating written health information. Judges indicated that the PA guidebook achieved desirable attributes for the suitability and appropriateness of the guidebook. A subset of TPB expert judges completed items designed to determine the degree of match between the guidebook content and the respective TPB components. Mean item-content relevance ratings indicated at least a "very good match" between the PA guidebook content and the keyed TPB domains. Theoretically based PA information may be an effective strategy for increasing PA in breast cancer survivors at the population level.

Personal Involvement of Young People in HIV Prevention Campaign Messages: The Role of Message Format, Culture, and Gender

2008-03-25

To examine young people's reactions to and understanding of HIV prevention messages developed for MTV's global HIV prevention campaign Staying Alive, videotaped campaign materials were shown to focus group discussion (FGD) participants living in urban areas of Brazil, Kenya, Nepal, and Senegal. Responses related to "personal involvement" with the message were identified in the data from these FGDs and were examined in relationship to the emerging message themes, the message format (public service announcements [PSAs] vs. documentary), cultural context (site), and participant gender. Across groups, greater personal involvement (measured by personal connections, emotional reactions, and lessons learned) was found in responses about the documentary format compared to the PSA format. Exceptions were found for specific PSAs that were considered more relevant within specific gender or cultural contexts. Implications of findings for global campaigns were considered.

Attitudinal and Relational Factors Predicting the Use of Solar Water Disinfection: A Field Study in Nicaragua

Altherr, A.-M., Mosler, H.-J., Tobias, R., Butera, F. — 2008-03-25

Solar water disinfection (SODIS) is an uncomplicated and cheap technology providing individuals with safe drinking water by exposing water-filled plastic bottles to sunlight for 6 hours to kill waterborne pathogens. Two communities were visited, and 81 families (40 SODIS users and 41 nonusers) were interviewed. The relationship between several factors and the intention to use SODIS in the future and actual use were tested. The results showed that intention to use and actual use are mainly related to an overall positive attitude, intention to use is related to the use of SODIS by neighbors, and actual use is related to knowledge about SODIS; SODIS users reported a significantly lower incidence in diarrhea than SODIS nonusers. These results suggest that promotion activities should aim at creating a positive attitude, for example, by choosing a promoter that is able to inspire confidence in the new technology.

Barriers to and Facilitators of Walking and Bicycling to School: Formative Results From the Non-Motorized Travel Study

Ahlport, K. N., Linnan, L., Vaughn, A., Evenson, K. R., Ward, D. S. — 2008-03-25

Barriers to and facilitators of walking and bicycling to school were explored through 12 focus groups made up of fourth- and fifth-grade students and their parents who lived near their respective schools. The barriers and facilitators reported by parents and children generally fell into one of three categories: intrapersonal and interpersonal characteristics of parents and children, environmental characteristics of the neighborhood, and environmental and policy characteristics of the school. Findings indicate that a supportive environment is a necessary but insufficient condition to increase walking and biking to school. Initiatives to increase active school travel may need to include multiple levels of intervention to be effective.

HIV/AIDS Misconceptions Among Latinos: Findings From a Population-Based Survey of California Adults

Ritieni, A., Moskowitz, J., Tholandi, M. — 2008-03-25

Misconceptions about HIV/AIDS among Latino adults (N = 454) in California were examined using data from a population-based telephone survey conducted in 2000. Common misconceptions concerning modes of HIV transmission included transmission via mosquito or animal bite (64.1%), public facilities (48.3%), or kissing someone on the cheek (24.8%). A composite misconceptions score was constructed. Correlations between the composite measure and other HIV/AIDS-related beliefs were examined. Latinos with a higher level of misconceptions were more likely to report higher self-perceived risk of HIV infection, and discomfort with infected individuals in a school and in a food setting. Results from multiple linear regression analysis indicated that individuals 45 years and older, those who were interviewed in Spanish, and those with lower education or income levels had a higher degree of misconceptions. The results suggest the need for targeted education efforts to reduce HIV/AIDS misconceptions among Latino adults in California.

Randomized Trials on Consider This, a Tailored, Internet-Delivered Smoking Prevention Program for Adolescents

2008-03-25

The Internet may be an effective medium for delivering smoking prevention to children. Consider This, an Internet-based program, was hypothesized to reduce expectations concerning smoking and smoking prevalence. Group-randomized pretest-posttest controlled trials were conducted in Australia (n = 2,077) and the United States (n = 1,234) in schools containing Grades 6 through 9. Australian children using Consider This reported reduced 30-day smoking prevalence. This reduction was mediated by decreased subjective norms. The amount of program exposure was low in many classes, but program use displayed a dose-response relationship with reduced smoking prevalence. American children only reported lower expectations for smoking in the future. Intervening to prevent smoking is a challenge, and this data suggest small benefits from an Internet-based program that are unlikely to be of practical significance unless increased by improved implementation. Implementation remains the major challenge to delivering interventions via the Internet, both for health educators and researchers.

Practice Notes: Strategies in Health Education

2008-02-15

Evaluation and Community Prevention Coalitions: Validation of an Integrated Web-Based/Technical Assistance Consultant Model

Feinberg, M. E., Gomez, B. J., Puddy, R. W., Greenberg, M. T. — 2008-02-15

Community coalitions (CCs) have labored with some difficulty to demonstrate empirical evidence of effectiveness in preventing a wide range of adolescent problem behaviors. Training and technical assistance (TA) have been identified as important elements in promoting improved functioning of CCs. A reliable, valid, and inexpensive method to assess functioning of CCs has been developed and is tested in this article in the context of Pennsylvania's Communities That Care (CTC) model. A CC Web-based questionnaire was developed and administered to more than 79 communities (867 participants) and the validity and reliability were assessed through multiple means, including the use of a companion TA implementation feedback questionnaire completed by TAs assigned to each of the sites. Results indicated adequate to good psychometric properties on internal reliability of the Web-based questionnaire, moderate construct validity across different reports of functioning, and relative stability throughout the course of 1 year. Implications for a variety of community prevention coalitions interested in a relatively low-cost, user friendly, and suitable methodology for evaluating coalition functioning are discussed. In addition, areas of application for future research including linking coalition functioning with the quality and nature of technical assistance, levels of risk and protective factors, and large data sets of youth risk factor and problem behavior data are highlighted.

The Dose-Response Relationship of Adolescent Religious Activity and Substance Use: Variation Across Demographic Groups

Steinman, K. J., Ferketich, A. K., Sahr, T. — 2008-02-15

This article addresses two inconsistent findings in the literature on adolescent religious activity (RA) and substance use: whether a dose-response relationship characterizes the association of these variables, and whether the association varies by grade, gender, ethnicity, family structure, school type, and type of substance. Multinomial logistic regression analyses of a large, diverse data set of high school students in metropolitan Columbus, Ohio ( n = 33,007), found marked differences in alcohol, marijuana, and cigarette use among youths who never, occasionally, or regularly participated in RA. Weekly RA was consistently associated with less substance use, yet occasional RA sometimes was associated with greater use. Four groups accounted for variations in the RA-substance use relationship: African American youths, younger White youths, 12th-grade White males, and 12th-grade White females. Researchers should avoid assuming the RA-substance use relationship is dose-response and consider the implications of this complexity for theory and practice.

Applying Community-Based Participatory Research Principles to the Development of a Smoking-Cessation Program for American Indian Teens: "Telling Our Story"

Horn, K., McCracken, L., Dino, G., Brayboy, M. — 2008-02-15

Community-based participatory research provides communities and researchers with opportunities to develop interventions that are effective as well as acceptable and culturally competent. The present project responds to the voices of the North Carolina American Indian (AI) community and the desire for their youth to recognize tobacco addiction and commercial cigarette smoking as debilitating to their health and future. Seven community-based participatory principles led to the AI adaptation of the Not On Tobacco teen-smoking-cessation program and fostered sound research and meaningful results among an historically exploited population. Success was attributed to values-driven, community-based principles that (a) assured recognition of a community-driven need, (b) built on strengths of the tribes, (c) nurtured partnerships in all project phases, (d) integrated the community's cultural knowledge, (e) produced mutually beneficial tools/products, (f) built capacity through co-learning and empowerment, (g) used an iterative process of development, and (h) shared findings/ knowledge with all partners.

Who Benefits From Community-Based Participatory Research? A Case Study of the Positive Youth Project

Flicker, S. — 2008-02-15

Community-based participatory research (CBPR) has evolved as a popular new paradigm in health research. This shift is exciting, yet there is still much to discover about how various stakeholders are affected. This article uses a critical social science perspective to explore who benefits from these changes through an analysis of a CBPR case study (The Positive Youth Project). Two major categories of beneficiaries emerged: the research itself and the partner-stakeholders. The benefits, however, were not gained without substantial human resource investment, nor were they necessarily equitably spread. Participation costs included heavy demands of time, an added burden of work, frustration with the process, missing other opportunities, risking loss of anonymity, and loss of control. Care needs to be taken to ensure that concrete benefits accrue for all project partners and costs are minimized. Another way of framing benefits is to look at the community capacities built to address future health and social issues.

"You Must Do the Test to Know Your Status": Attitudes to HIV Voluntary Counseling and Testing for Adolescents Among South African Youth and Parents

MacPhail, C. L., Pettifor, A., Coates, T., Rees, H. — 2008-02-15

Reduced HIV risk behavior and increased use of care and support services have been demonstrated among adults accessing HIV voluntary counseling and testing (VCT). The impact of VCT on adolescents is, however, not known. Focus group discussions were held with adolescents and parents in two South African townships to establish the perceptions of and needs for VCT among young people. Ecological theory informed the analysis. Adolescents had limited experience of VCT, were afraid of knowing their HIV status, and felt that testing was only for symptomatic individuals. Youth felt that they would disclose their HIV status to family members who they felt would be most supportive. Youth were afraid of stigma and discrimination; rarely referring to the community as a source of support. Discussions highlighted the inappropriateness of clinical facilities for youth VCT. We conclude with recommendations for youth-friendly VCT services.

Knowledge of the Effects of Indoor Air Quality on Health Among Women in Jordan

Madanat, H., Barnes, M. D., Cole, E. C. — 2008-02-15

Objective: To assess the extent of knowledge about symptoms relating to respiratory illnesses and home environments among a random sample of 200 urban Jordanian women. Method: This customized, validated, cross-sectional questionnaire evaluated the knowledge of these women about the association between the indoor environment and health, the presence or absence of indoor discomforts, symptoms of respiratory illnesses, and behaviors related to the home environment such as cleaning practices. Results: Results showed an alarming rate of smoking in the homes; the extent of knowledge was moderate but higher among those exhibiting symptoms and those with children. Cleaning practices associated with healthy home environments were reported at a high rate but seemed to be based on cultural influences. Conclusions: This type of information is crucial to the formation of health education programs and policy recommendations for pollutant source and exposure reductions in homes in the Middle East and other developing countries.

Promoting Environmental Justice Through Community-Based Participatory Research: The Role of Community and Partnership Capacity

Minkler, M., Vasquez, V. B., Tajik, M., Petersen, D. — 2008-02-15

Community-based participatory research (CBPR) increasingly is being used to study and address environmental justice. This article presents the results of a cross-site case study of four CBPR partnerships in the United States that researched environmental health problems and worked to educate legislators and promote relevant public policy. The authors focus on community and partnership capacity within and across sites, using as a theoretical framework Goodman and his colleagues' dimensions of community capacity, as these were tailored to environmental health by Freudenberg, and as further modified to include partnership capacity within a systems perspective. The four CBPR partnerships examined were situated in NewYork, California, Oklahoma, and North Carolina and were part of a larger national study. Case study contexts and characteristics, policy-related outcomes, and findings related to community and partnership capacity are presented, with implications drawn for other CBPR partnerships with a policy focus.

Acknowledgment of Members of Health Education & Behavior's Review Panel

2008-02-15

The Lawrence W. Green Paper of the Year Award

2008-02-15