Health Education & Behavior recent issues

Practice Notes: Strategies in Health Education

Thu, 12 Nov 2009 12:50:42 PST

Measuring Exposure to Health Messages in Community-Based Intervention Studies: A Systematic Review of Current Practices

Morris, D. S., Rooney, M. P., Wray, R. J., Kreuter, M. W. — Thu, 12 Nov 2009 12:50:42 PST

Accurately measuring exposure is critical to all intervention studies. The present review examines the extent to which best practices in exposure assessment are adhered to in community-based prevention and education studies. A systematic literature review was conducted examining community-based studies testing communication interventions, published in 2003-2007. Of 663 studies identified, 54 met all inclusion criteria and were reviewed for type of exposure assessment conducted (if any), use of exposure data in study analyses, and discussion of biases related to exposure assessment. Although a majority of studies (n = 38; 70%) assessed exposure, most of these used only a simple dichotomous measure (n = 31; 82%), less than half used exposure data to adjust intervention effects (n = 16; 42%), and only six (16%) addressed selective exposure as a possible source of bias. There is substantial room for improvement in measurement and analysis of exposure to communication in community-based disease prevention studies.

The Impact of Removing Snacks of Low Nutritional Value From Middle Schools

Schwartz, M. B., Novak, S. A., Fiore, S. S. — Thu, 12 Nov 2009 12:50:42 PST

Removing low nutrition snacks from schools is controversial. Although the objective is to decrease the consumption of these foods at school, some critics argue that children will compensate by eating more of these foods at home. Others worry that school-based obesity prevention programs will increase student preoccupation with weight. The present study examines these concerns. Three middle schools replaced snacks and beverages that did not meet nutrition guidelines, whereas three comparison schools made no systematic changes. Students were surveyed about dietary intake and weight concerns before and after implementation of the intervention. Findings indicate that removing low nutrition items from schools decreased students’ consumption with no compensatory increase at home. Furthermore, there were no differences in students’ reported weight concerns. These results support the value of strengthening school nutrition standards to improve student nutrition and provide evidence dispelling concerns that such efforts will have unintended negative consequences.

Cultural Views, Language Ability, and Mammography Use in Chinese American Women

Liang, W., Wang, J., Chen, M.-Y., Feng, S., Yi, B., Mandelblatt, J. S. — Thu, 12 Nov 2009 12:50:42 PST

Mammography screening rates among Chinese American women have been reported to be low. This study examines whether and how culture views and language ability influence mammography adherence in this mostly immigrant population. Asymptomatic Chinese American women (n = 466) aged 50 and older, recruited from the Washington, D.C. area, completed a telephone interview. Regular mammography was defined as having two mammograms at age-appropriate recommended intervals. Cultural views were assessed by 30 items, and language ability measured women’s ability in reading, writing, speaking, and listening to English. After controlling for risk perception, worry, physician recommendation, family encouragement, and access barriers, women holding a more Chinese/Eastern cultural view were significantly less likely to have had regular mammograms than those having a Western cultural view. English ability was positively associated with mammography adherence. The authors’ results imply that culturally sensitive and language-appropriate educational interventions are likely to improve mammography adherence in this population.

Disseminating Chronic Disease Prevention "to or With" Canadian Public Health Systems

Masuda, J. R., Robinson, K., Elliott, S., Eyles, J. — Thu, 12 Nov 2009 12:50:42 PST

This article follows a conceptual article published in this journal by Elliott et al. and provides an empirical evaluation of the Canadian Heart Health Initiative—Dissemination Phase. Between 1994 and 2005, seven provincial research teams of the Canadian Heart Health Initiative—Dissemination Phase undertook projects to disseminate and evaluate the uptake of evidence-based chronic disease prevention strategies in their respective health systems. In this study, the authors draw from document and stakeholder interview analyses to assess the influence of strategic decisions about dissemination objects, targets, activities, and relationships between knowledge producers and users on the outcomes of chronic disease prevention programming. The findings show that successful dissemination strategies are not necessarily contingent on a high level of fidelity across these dimensions but depend more on the extent to which they are responsive to contextual variables within highly dynamic health systems.

A Comparison of Face-to-Face or Internet-Delivered Physical Activity Intervention on Targeted Determinants

Steele, R. M., Mummery, W.K., Dwyer, T. — Thu, 12 Nov 2009 12:50:42 PST

This article describes the equivalency testing results of a 12-week behavior change program on targeted determinates of physical activity (PA) and self-reported health status. Participants (n = 192) were randomized to face-to-face, combined Internet and face-to-face, and Internet-only groups. Equivalency testing was used to examine differences and statistical equivalency across groups for all outcome measures (social support, self-efficacy, perceived health status, and motivational readiness for PA). Participants were assessed at baseline, postintervention, and 2 and 5 months postintervention. Motivational readiness for PA increased across all groups. The face-to-face and combined groups showed changes in social support; however, they were not statistically different and were equivalent. There were no changes in self-efficacy or physical health status. Overall face-to-face and the Internet delivery modes show similar results. If Internet-based programs can be shown to be as effective as face-to-face, they may in turn be a more efficient and cost-effective delivery method.

Understanding the Role of Numeracy in Health: Proposed Theoretical Framework and Practical Insights

Lipkus, I. M., Peters, E. — Thu, 12 Nov 2009 12:50:42 PST

Numeracy—that is, how facile people are with mathematical concepts and their applications—is gaining importance in medical decision making and risk communication. This article proposes six critical functions of health numeracy. These functions are integrated into a theoretical framework on health numeracy that has implications for risk communication and medical decision-making processes. The authors examine practical underpinnings for targeted interventions aimed at improving such processes as a function of health numeracy. They hope that the proposed functions and theoretical framework will spur more research to determine how an understanding of health numeracy can lead to more effective communication and decision outcomes.

Relationship Between Attitudes and Indicators of Obesity for Midlife Women

Sudo, N., Degeneffe, D., Vue, H., Merkle, E., Kinsey, J., Ghosh, K., Reicks, M. — Thu, 12 Nov 2009 12:50:42 PST

This study uses segmentation analyses to identify five distinct subgroups of U.S. midlife women (n = 200) based on their prevailing attitudes toward food and its preparation and consumption. Mean age of the women is 46 years and they are mostly White (86%), highly educated, and employed. Attitude segments (clusters of women sharing similar attitudes) are a significant predictor of obesity indicators. Mean body mass index and percentage of body fat are lower for the "concerned about nutrition" attitude segment compared with the "guiltridden dieter" and "impulsive eater" attitude segments. Mean waist circumference is highest in "impulsive eater" compared with the "concerned about nutrition" segment. Those in the "busy cooking avoider" segment have a significantly higher energy intake compared with women in other attitude segments. Tailoring a weight management intervention according to attitude segments of midlife women may enhance effectiveness.

The Role of Policy Advocacy in Assuring Comprehensive Family Life Education in California

Brindis, C. D., Geierstanger, S. P., Faxio, A. — Thu, 12 Nov 2009 12:50:42 PST

As part of their 10-year $60 million Teenage Pregnancy Prevention Initiative, The California Wellness Foundation funded 18 state and local organizations to conduct policy advocacy to strengthen teen pregnancy prevention policies. This article describes how some of these grantees accomplished noteworthy goals, including the passage of the California Comprehensive Sexual Health and HIV/AIDS Prevention Education Act (SB71), the prevention of the state’s pursuit of federal "abstinence-only-until-marriage" funding, and the passage of a local school district FLE policy. Grantee progress is presented through a five-stage policy change framework: Institutional Capacity and Leadership Building, Policy Issue Recognition, Policy Prioritization, Policy Adoption, and Policy Maintenance. Implications are shared for advocates, policy makers, and funders who are developing initiatives aimed at improving the health of adolescents.

In Memoriam: Sabra F. Woolley, PhD

Pasick, R. J., Burke, N. J. — Mon, 05 Oct 2009 14:30:54 PDT

Advancing Theory in Cancer Screening and Beyond: A Conversation Across Fields

Kobrin, S., Hall, K. L., Croyle, R. T. — Mon, 05 Oct 2009 14:30:54 PDT

Behavioral Theory in a Diverse Society: Like a Compass on Mars

Mon, 05 Oct 2009 14:30:54 PDT

The behavioral theory constructs most often used to study mammography utilization—perceived benefit, perceived susceptibility, self-efficacy, intention, and subjective norms—have neither been developed nor sufficiently tested among diverse racial/ethnic subgroups. The authors explored these constructs and their underlying assumptions relating to the social context of Filipina and Latina women. The mixed-methods study included testing construct measures in the multilingual surveys of a concurrent intervention study of 1,463 women from five ethnic groups. An intensive inductive investigation then targeted Latina and Filipina women to elucidate connections between social context and individual screening behavior. In-depth interviews were conducted with 11 key informant scholars, 13 community gatekeepers, and 29 lay women, and a supplemental study videotaped and interviewed 9 mother—daughter dyads. Three social context domains emerged: relational culture, social capital, and transculturation and transmigration. The meaning and appropriateness of the five behavioral constructs were analyzed in relation to these domains. In contradistinction to tenets of behavioral theory, the authors found that social context can influence behavior directly, circumventing or attenuating the influence of individual beliefs; contextual influences, synthesized from multiple p erspectives, can operate at an unconscious level not accessible to the individual; and contextual influences are dynamic, contingent on distal and proximal forces coming together in a given moment and are thus not consistent with an exclusive focus at the individual level. This article describes the study methods, summarizes main findings, and previews the detailed results presented in the other articles in this issue.

Behavioral Constructs and Mammography in Five Ethnic Groups

Stewart, S. L., Rakowski, W., Pasick, R. J. — Mon, 05 Oct 2009 14:30:54 PDT

Intention, self-efficacy, perceived susceptibility, perceived benefits, and subjective norms are key constructs of health behavior theories; their predictive validity for cancer screening has not been ascertained in multiethnic populations. Participants were 1,463 African American, Chinese, Filipina, Latina, and White women aged 40 to 74 interviewed by telephone in their preferred languages. The relationship between baseline constructs and mammography 2 years later was assessed using multivariable logistic regression. Intention predicted mammography overall and among Whites (odds ratio [OR] = 5.0, 95% confidence interval [CI] = 2.4, 10), with racial/ethnic differences in association (p = .020). Self-efficacy predicted mammography overall and among Whites (OR = 3.5, 95% CI = 1.1, 11), with no racial/ethnic interaction. Perceived benefits and subjective norms were associated with screening overall and in some racial/ethnic groups. These results generally support cross-cultural applicability of four of the five constructs to screening with mixed predictive value of measures across racial/ethnic groups. Additional in-depth inquiry is required to refine assessment of constructs.

Theorizing Social Context: Rethinking Behavioral Theory

Burke, N. J., Joseph, G., Pasick, R. J., Barker, J. C. — Mon, 05 Oct 2009 14:30:54 PDT

Major behavioral theories focus on proximal influences on behavior that are considered to be predominantly cognitive characteristics of the individual largely uninfluenced by social context. Social ecological models integrate multiple levels of influence on health behavior and are noted for emphasizing the interdependence of environmental settings and life domains. This theory-based article explains how social context is conceptualized in the social sciences and how the social science conceptualization differs from and can broaden the analytic approach to health behavior. The authors use qualitative data from the Behavioral Constructs and Culture in Cancer Screening study to illustrate our conceptualization of social context. We conclude that the incorporation into health behavior theory of a multidimensional socioculturally oriented, theoretical approach to social context is critical to understand and redress health disparities in multicultural societies like the United States.

Perceived Susceptibility to Illness and Perceived Benefits of Preventive Care: An Exploration of Behavioral Theory Constructs in a Transcultural Context

Joseph, G., Burke, N. J., Tuason, N., Barker, J. C., Pasick, R. J. — Mon, 05 Oct 2009 14:30:54 PDT

This article describes how the social context of transculturation (cultural change processes) and transmigration (migration in which relationships are sustained across national boundaries) can directly influence use of mammography screening. The authors conducted semistructured interviews with Latino and Filipino academics and social service providers and with U.S.-born and immigrant Latinas and Filipinas to explore direct and indirect influences of social context on health behavior (Behavioral Constructs and Culture in Cancer Screening study). Iterative analyses identified themes of the transcultural domain: colonialism, immigration, discrimination, and therapeutic engagement. In this domain, the authors examine two key behavioral theory constructs, perceptions of susceptibility to illness and perceptions of benefits of preventive medical care. The findings raise concerns about interventions to promote mammography screening primarily based on provision of scientific information. The authors conclude that social context affects behavior directly rather than exclusively through beliefs as behavioral theory implies and that understanding contextual influences, such as transculturation, points to different forms of intervention.

Intention, Subjective Norms, and Cancer Screening in the Context of Relational Culture

Mon, 05 Oct 2009 14:30:54 PDT

Research targeting disparities in breast cancer detection has mainly utilized theories that do not account for social context and culture. Most mammography promotion studies have used a conceptual framework centered in the cognitive constructs of intention (commonly regarded as the most important determinant of screening behavior), self-efficacy, perceived benefit, perceived susceptibility, and/or subjective norms. The meaning and applicability of these constructs in diverse communities are unknown. The purpose of this study is to inductively explore the social context of Filipina and Latina women (the sociocultural forces that shape people’s day-to-day experiences and that directly and indirectly affect health and behavior) to better understand mammography screening behavior. One powerful aspect of social context that emerged from the findings was relational culture, the processes of interdependence and interconnectedness among individuals and groups and the prioritization of these connections above virtually all else. The authors examine the appropriateness of subjective norms and intentions in the context of relational culture and identify inconsistencies that suggest varied meanings from those intended by behavioral theorists.

Social and Cultural Meanings of Self-Efficacy

Mon, 05 Oct 2009 14:30:54 PDT

This article describes the influences of social context on women’s health behavior through illustration of the powerful influences of social capital (the benefits and challenges that accrue from participation in social networks and groups) on experiences and perceptions of self-efficacy. The authors conducted inductive interviews with Latino and Filipino academics and social service providers and with U.S.-born and immigrant Latinas and Filipinas to explore direct and indirect influences of social context on health behaviors such as mammography screening. Iterative thematic analysis identified themes (meanings of efficacy, spheres of efficacy, constraints on efficacy, sources of social capital, and differential access to and quality of social capital) that link the domain of social capital with the behavioral construct perceived self-efficacy. The authors conclude that social capital addresses aspects of social context absent in the current self-efficacy construct and that these aspects have important implications for scholars’ and practitioners’ understandings of health behavior and intervention development.

Adult Daughters' Influence on Mothers' Health-Related Decision Making: An Expansion of the Subjective Norms Construct

Washington, P. K., Burke, N. J., Joseph, G., Guerra, C., Pasick, R. J. — Mon, 05 Oct 2009 14:30:54 PDT

This study of mother—adult daughter communication uses qualitative methods to explore the appropriateness of including adult daughters as referents in the measurement of subjective norms (a behavioral theory construct) related to the use of mammography and other health-related tests and services. The methods were chosen to approximate as closely as possible the mother—adult daughter relationship in the context of daily life. This inductive approach contrasts with the deductive origins of the construct. A sample of nine Mexican and Filipina immigrant and U.S.-born mothers and their adult daughters was recruited. Data were collected in two phases: (a) videotaped observations of mother—daughter dyads discussing health-related topics and (b) follow-up interviews designed to obtain an emic (insider) perspective of the videotaped interaction. Results show that adult daughters influence their mothers’ ability to navigate the health care system and contribute to health-related decision making and behavior, suggesting that it may be appropriate to include adult daughters in the assessment of subjective norms.

Theory Building Through Qualitative Research: Marshalling Opportunities to Advance Cancer Screening Efforts

Hay, J. L., Craddock Lee, S. J. — Mon, 05 Oct 2009 14:30:54 PDT

Capitalizing on Opportunities to Refine Health Behavior Theories

Rothman, A. J. — Mon, 05 Oct 2009 14:30:54 PDT

Cultural Context and Modification of Behavior Change Theory

Sanders Thompson, V. L. — Mon, 05 Oct 2009 14:30:54 PDT

Behavioral Theory in the Context of Applied Cancer Screening Research

Zapka, J., Cranos, C. — Mon, 05 Oct 2009 14:30:54 PDT

Behavioral Theory and Culture Special Issue: Authors' Response to Commentaries

Pasick, R. J., Burke, N. J., Joseph, G. — Mon, 05 Oct 2009 14:30:54 PDT

Behavioral Theory in a Diverse Society: Moving Our Field Forward

Kagawa-Singer, M., Emmons, K. M. — Mon, 05 Oct 2009 14:30:54 PDT

Practice Notes: Strategies in Health Education

Fri, 02 Oct 2009 13:01:18 PDT

Technical Assistance as a Prevention Capacity-Building Tool: A Demonstration Using the Getting To Outcomes(R) Framework

Hunter, S. B., Chinman, M., Ebener, P., Imm, P., Wandersman, A., Ryan, G. W. — Fri, 02 Oct 2009 13:01:18 PDT

Demands on community-based prevention programs for performance accountability and positive outcomes are ever increasing in the face of constrained resources. Relatively little is known about how technical assistance (TA) should be structured to benefit community-based organizations and to lead to better outcomes. In this study, data from multiple sources were used to describe an effective TA model designed to improve the capacity of community-based organizations to plan, implement, and evaluate prevention programming. This article is the first of its kind to provide detailed analyses of the TA delivered to community-based organizations to build substance abuse prevention capacity. The results of this study describe the range of TA services provided and the importance of two-way communication between the TA provider and recipient. TA recipients reported high satisfaction and an improved understanding of targeted TA activities. However, achieving these benefits requires significant program staff time, and not all skills were successfully transferred. Results from this study suggest how TA may be structured to be effective in supporting quality prevention programming in community settings.

Physical Activity Behavior Change Interventions Based on the Transtheoretical Model: A Systematic Review

Hutchison, A. J., Breckon, J. D., Johnston, L. H. — Fri, 02 Oct 2009 13:01:18 PDT

This review critically examines Transtheoretical Model (TTM)—based interventions for physical activity (PA) behavior change. It has been suggested that the TTM may not be the most appropriate theoretical model for applications to PA behavior change. However, previous reviews have paid little or no attention to how accurately each intervention represents the TTM. Findings comprise two sections: sample characteristics of each intervention reviewed and a summary outlining the use of the TTM to develop the interventions. Results reveal numerous inconsistencies regarding the development and implementation/application of TTM-based interventions. Specifically, the majority of interventions reported to be based on the TTM fail to accurately represent all dimensions of the model. Therefore, until interventions are developed to accurately represent the TTM, the efficacy of these approaches and the appropriateness of the underpinning theoretical model cannot be determined.

Social Support Moderates the Relationship Between Gay Community Integration and Sexual Risk Behavior Among Gay Male Couples

Fergus, S., Lewis, M. A., Darbes, L. A., Kral, A. H. — Fri, 02 Oct 2009 13:01:18 PDT

Few studies of partnered gay men consider the social context within which sexual behaviors occur or investigate positive aspects of the social environment that may offset factors that are related to risky sexual behaviors. Fewer still include assessment of both individuals making up couples. Using an ecological framework and an actor-partner multilevel analysis approach, the authors investigate how three dimensions of gay community integration are related to individual sexual risk behavior among 108 individuals in 54 couples. They then investigate how general social support and partner-provided, HIV-specific social support moderate these relationships. An individual’s gay community social engagement and general social support interact to predict sexual risk behavior, such that the apparent protective effect of social support is more pronounced among those with less social engagement. The association between partner-reported general social support and safer sexual behaviors is more pronounced among those whose partners disclose their gay identity to more people.

Health Literacy and Health Actions: A Review and a Framework From Health Psychology

von Wagner, C., Steptoe, A., Wolf, M. S., Wardle, J. — Fri, 02 Oct 2009 13:01:18 PDT

The association between performance on health literacy measures and health outcomes is well established. The next step is to understand the processes through which health literacy affects health. This review introduces a framework drawing on ideas from health psychology and proposing that associations between health literacy and health outcomes could be mediated by a range of health actions involving access and use of health care, patient—provider interactions, and the management of health and illness. The framework outlines routes through which health literacy might affect either health actions themselves or the motivational and volitional determinants that have been identified in social cognition models. The implications of the framework for future research and intervention strategies are discussed.

Effects of a Health Behavior Change Model--Based HIV/STI Prevention Intervention on Condom Use Among Heterosexual Couples: A Randomized Trial

Fri, 02 Oct 2009 13:01:18 PDT

This study examines an intervention for heterosexual couples to prevent human immunodeficiency virus/sexually transmitted infections. It also evaluates the effect of the intervention, which is based on current models of health behavior change, on intermediate outcomes (individual and relationship factors) and consistency of condom use. Eligible couples were administered a baseline interview and randomized to either a 3-session theory-based intervention or a 1-session standard of care comparison condition. Men and women completed 3-month interviews; only women completed 6-month interviews. No significant intervention effect on condom use was found among couples at 3 months (n = 212) or among women (n = 178) at 6 months. However, condom use increased significantly between baseline and 3 months and baseline and 6 months for participants in both treatment conditions. Intervention effects on condom use self-efficacy were found at 3 months and 6 months and on health-protective communication at 3 months. These findings provide valuable information for the design of future studies to help disentangle the effects of intervening with couples.

Explaining Fruit and Vegetable Intake Using a Consumer Marketing Tool

Della, L. J., DeJoy, D. M., Lance, C. E. — Fri, 02 Oct 2009 13:01:18 PDT

In response to calls to reinvent the 5 A Day fruit and vegetable campaign, this study assesses the utility of VALS^TM, a consumer-based audience segmentation tool that divides the U.S. population into groups leading similar lifestyles. The study examines whether the impact of theory of planned behavior (TPB) constructs varies across VALS groups in a cross-sectional sample of 1,588 U.S. adults. In a multigroup structural equation model, the VALS audience group variable moderated latent TPB relationships. Attitudes, subjective norms, and perceived behavioral control explained 57% to 70% of the variation in intention to eat fruit and vegetables across 5 different VALS groups. Perceived behavioral control and intention also predicted self-reported consumption behavior (R² = 20% to 71% across VALS groups). Bivariate z tests were calculated to determine statistical differences in parameter estimates across groups. Nine of the bivariate z tests were statistically significant (p ≤ .04), with standardized coefficients ranging from .05 to .70. These findings confirm the efficacy of using the TPB to explain variation in fruit and vegetable consumption as well as the validity of using a consumer-based algorithm to segment audiences for fruit and vegetable consumption messaging.

Perspectives of Mothers in Farmworker Households on Reducing the Take-Home Pathway of Pesticide Exposure

Strong, L. L., Starks, H. E., Meischke, H., Thompson, B. — Fri, 02 Oct 2009 13:01:18 PDT

Farmworkers carry pesticide residue home on their clothing, boots, and skin, placing other household members at risk, particularly children. Specific precautions are recommended to reduce this take-home pathway, yet few studies have examined the perspectives of farmworkers and other household members regarding these behaviors and the reasons for or against adoption. The authors conducted semistructured interviews with 37 Mexican/Mexican-American women in farmworker households to explore the family and cultural context in which pesticide safety practices are performed and to identify factors that facilitate or hinder their adoption. Whereas women could describe the take-home pathway, they were less able to connect it with their family’s susceptibility to pesticide exposure. Women experienced difficulty integrating the prevention behaviors into their everyday lives because of competing responsibilities, conflicts with their husbands’ intentions and with cultural health beliefs, perceived lack of control, and community barriers that interfered with women’s motivations. Implications for practice are discussed.

Community Perspectives on Factors That Influence Collaboration in Public Health Research

Pinto, R. M. — Fri, 02 Oct 2009 13:01:18 PDT

Community collaboration in research may lead to better methods, results, and dissemination of interventions. Little systematic research has examined specific factors that influence community-based organizations (CBOs) to collaborate in public health research. There is an urgent need to advance knowledge on this topic so that together, researchers and CBOs can minimize barriers to collaboration. This study advances a CBOfocused characterization of collaboration in HIV-prevention research. By focusing on the perspectives of 20 key informants in 10 HIV-prevention CBOs, qualitative data revealed factors that influenced their collaborations in four domains: (a) Researchers’ Characteristics (expertise, availability), (b) Collaborative Research Characteristics (ought to improve services and CBO infrastructure); (c) Community Partner—Researcher Relationships (resolving social and professional issues); and (d) Barriers to HIV-Prevention Research Collaboration (cultural and social disconnect between CBO and academia). To reduce barriers, researchers ought to enhance motivators that facilitate collaboration. To use the advantages of community-based research, prevention scientists and policy makers ought to embrace CBOs’ characterization of what makes health research genuinely collaborative.

Seriously Mentally Ill Women's Safer Sex Behaviors and the Theory of Reasoned Action

Fri, 02 Oct 2009 13:01:18 PDT

Seriously mentally ill women at risk for HIV infection (n = 96) participated in structured interviews assessing sexual and substance-use behavior over a 3-month period. The majority of the women (63.5%) did not use condoms. Consistent with the theory of reasoned action, attitudes toward condom use and perceived social norms about safer sex were associated with safer sex intentions. Supplementing variables from the theory of reasoned action with safer sex self-efficacy explained additional variance in safer sex intentions. Greater safer sex intentions were related to both greater condom use and less frequent unprotected intercourse. In addition, less frequent sex after drug use and a less fatalistic outlook were associated with less frequent unprotected intercourse. Life circumstances specific to this population are particularly important to examine to improve the effectiveness of risk reduction interventions for seriously mentally ill women.

Practice Notes: Strategies in Health Education

Mon, 27 Jul 2009 10:43:00 PDT

Mass Media for Smoking Cessation in Adolescents

Mon, 27 Jul 2009 10:43:00 PDT

Theory-driven, mass media interventions prevent smoking among youth. This study examined effects of a media campaign on adolescent smoking cessation. Four matched pairs of media markets in four states were randomized to receive or not receive a 3-year television/radio campaign aimed at adolescent smoking cessation based on social cognitive theory. The authors enrolled 2,030 adolescent smokers into the cohort (n = 987 experimental; n = 1,043 comparison) and assessed them via annual telephone surveys for 3 years. Although the condition by time interaction was not significant, the proportion of adolescents smoking in the past month was significantly lower in the experimental than comparison condition at 3-year follow-up when adjusted for baseline smoking status. The media campaign did not impact targeted mediating variables. A media campaign based on social cognitive constructs produced a modest overall effect on smoking prevalence among adolescents, but the role of theory-based constructs is unclear.

Cognitions About Smoking and Not Smoking in Adolescence

ter Doest, L., Dijkstra, A., Gebhardt, W. A., Vitale, S. — Mon, 27 Jul 2009 10:43:00 PDT

The theory of planned behavior identifies important proximal determinants of behavior, including attitude toward the behavior, perception of subjective norms exerted by significant others, and perception of perceived control over performance of the behavior. Because research in the planned behavior tradition has focused on desirable target behaviors, it is not clear how these determinants can best be conceptualized to account for adolescents' acquisition of health risk behaviors such as smoking. This cross-sectional study compared the explanatory power of planned behavior constructs assessed in relation to "smoking" and "not smoking" in a sample of 248 Dutch secondary students (aged 12 to 17 years; 56% girls). The results indicated that four variables—attitude toward smoking, perceived subjective norm, and perceived behavioral control over both smoking and not smoking—best explained the adolescents' smoking intentions and smoking behavior. Methodological and practical implications for smoking interventions are discussed.

Sixth Grade Students Who Use Alcohol: Do We Need Primary Prevention Programs for "Tweens"?

Pasch, K. E., Perry, C. L., Stigler, M. H., Komro, K. A. — Mon, 27 Jul 2009 10:43:00 PDT

Young adolescent alcohol users drink at higher rates than their peers throughout adolescence and appear to be less amenable to intervention. This study compares those who reported alcohol use in the past year to those who reported no use in a multiethnic, urban sample of sixth graders in 61 schools in Chicago in 2002 (N = 4,150). Demographic, behavioral, intrapersonal, and socioenvironmental factors were identified based on behavioral theories and potential mediators of the Project Northland Chicago intervention. Single and multiple regression models were created for users and nonusers to determine associations between these factors and alcohol use behavior and intentions. The multiple regression models explained 35% and 56% of the variance in alcohol use behavior and intentions between students for nonusers and users, respectively. Results suggest that primary prevention programs for alcohol use should occur prior to sixth grade, particularly for the substantial group at high risk for early use.

The Potential of Coaching as a Strategy to Improve the Effectiveness of School-Based Substance Use Prevention Curricula

Mon, 27 Jul 2009 10:43:00 PDT

Research-based substance use prevention curricula typically yield small effects when implemented by school teachers under real-world conditions. Using a randomized controlled trial, the authors examined whether expert coaching improves the effectiveness of the All Stars prevention curriculum. Although a positive effect on students' cigarette use was noted, this finding may be attributed to marked baseline differences on this variable across the intervention and control groups. No effects were found on students' alcohol or marijuana use or on any of several variables thought to mediate curriculum effects. The effects of coaching on teachers may not become evident until future years, when they have moved beyond an initial mechanical delivery of the curriculum.

Focus Groups of Alaska Native Adolescent Tobacco Users: Preferences for Tobacco Cessation Interventions and Barriers to Participation

Mon, 27 Jul 2009 10:43:00 PDT

Tobacco cessation interventions developed for Alaska Native adolescents do not exist. This study employed focus group methodology to explore preferences for tobacco cessation interventions and barriers to participation among 49 Alaska Natives (61% female) with a mean age of 14.6 (SD = 1.6) who resided in western Alaska. Using content analysis, themes from the 12 focus groups were found to be consistent across village, gender, and age groups. Program location or site (e.g., away from the village, hunting, fishing), a group-based format, and inclusion of medication and personal stories were reported to be important attributes of cessation programs. Motivators to quit tobacco were the perceived adverse health effects of tobacco, improved self-image and appearance, and the potential to be a future role model as a non—tobacco user for family and friends. Parents were perceived as potentially supportive to the adolescent in quitting tobacco. The findings will be used to develop tobacco cessation programs for Alaska Native youth.

Is the Receptivity of Substance Abuse Prevention Programming Affected by Students' Perceptions of the Instructor?

Mon, 27 Jul 2009 10:43:00 PDT

Drawing on the elaboration likelihood model of persuasive communication, the authors examine the impact of the perceptions of the instructor or source on students' receptivity to a new substance abuse prevention curriculum. Using survey data from a cohort of students participating in the Adolescent Substance Abuse Prevention Study, the authors use structural equation modeling to determine the effects of the perceptions students have of their program instructor on measures of the targeted program mediators and the use of cigarettes, alcohol, and marijuana. They test these instructor effects after each component of a two-part curriculum is administered (during the seventh and ninth grades). They find that the perceptions of the instructor significantly affect refusal, communication and decision-making skills, normative beliefs, perceived consequences of use, and substance use. The authors discuss the implications of these findings for school-based prevention programming and indications for further research.

Adolescents' Perceptions of Smoking and Stress Reduction

Mon, 27 Jul 2009 10:43:00 PDT

The present study examined how adolescents perceive the relationship between smoking and stress and where they learn that smoking cigarettes may be an effective stress-reduction mechanism. Eight focus groups were conducted with low-income African American and European American 14- to 16-year-olds in urban and rural locations, in which they suggested that the primary reasons why they smoked—namely, as a coping mechanism (to calm nerves), for social acceptance, and because of environmental influences. Family issues, boyfriend/girlfriend problems, and school were common stressors. Although participants overwhelmingly believed that people smoke to reduce their stress, a few believed that cigarettes do not actually reduce stress. When asked for examples of smoking in popular media, teens predominantly generated examples of individuals smoking to reduce stress. Ethnic and gender differences were found among the types of media in which they had seen smoking, their opinions of anti-smoking messages, and the media's perceived influence.

If Parents Establish a No-Smoking Agreement With Their Offspring, Does This Prevent Adolescents From Smoking? Findings From Three Dutch Studies

den Exter Blokland, E. A. W., Engels, R. C., Harakeh, Z., Hale, W. W., Meeus, W. — Mon, 27 Jul 2009 10:43:00 PDT

Data from three studies were used to investigate whether the establishment of a no-smoking agreement is related to lower odds of adolescent smoking. The prevalence of a no-smoking agreement was first explored by using a national sample involving 4,501 Dutch adolescents. Second, data from a longitudinal study among 595 early adolescents and their parents were used to test whether establishing a no-smoking agreement prevents adolescents from smoking. Third, the authors tested among 856 early- and mid-adolescents and their parents, whether in addition to the establishment of a no-smoking agreement, the frequency and quality of communication on smoking issues had an effect on adolescent smoking. The findings do not support that establishing a no-smoking agreement is an effective deterrent with regard to adolescent smoking. Parents who want to prevent smoking might consider focusing their efforts on establishing a good quality of communication on smoking issues whereas parents who just talk a lot about smoking issues without considering the quality of their communication might do more harm than good.

The Home Smoking Environment: Influence on Behaviors and Attitudes in a Racially Diverse Adolescent Population

Mon, 27 Jul 2009 10:43:00 PDT

Although studies indicate that public policy can influence the decrease in smoking behaviors, these policies have not necessarily transferred to home environments at the same rate. The authors surveyed 4,296 students in a southern urban area. African American students were 76.3% of the respondents and Caucasians accounted for 23.7%. African American homes are less likely to have full bans on smoking inside the home. Home smoking bans impact smoking behaviors, acceptance of smoking, susceptibility to smoking, smoking beliefs, and motivation to quit smoking. Along with home smoking bans, there are differences among African American and Caucasian youth in smoking exposure, behaviors, beliefs, and motivation to quit smoking. This study suggests that particularly in African American youth, educational efforts should be directed toward more restrictive home smoking policies to thwart the initiation of smoking in adolescents and to encourage positive attitudes toward smoking behaviors.