Health Education & Behavior

This article presents the findings of a study examining the evolution of a network of health and human service organizations operating in a rural community on the Southwest border. The aim of the networkwas to build the capacity of the community to provide chronic disease education, prevention, and treatment services by developing collaborative relationships among a broad range of organizations. The impetus for the effort was based on receipt of a Turning Point grant. The findings, based on two waves of data collected 1 year apart, demonstrate how network structure and attitudes toward collaboration evolve as a community attempts to build capacity to address its health needs.

Data from the 1995 National Survey of Family Growth have previously shown greater risk of inconsistent contraceptive pill use among Hispanicwomen. We used the same data to test a culturally based model of pill use among the subsample of Hispanicwomen. Hierarchical logit analyses revealed that primary use of Spanish, negative attitudes aboutwomen in theworkplace, two or more recent sex partners, and recent pill adoption were factors that increased the odds of inconsistent use. Living alone or with non-kin was associated with more consistent use, as were showing preference for a stay-at-home model of motherhood, frequent church attendance, and frequent sexual intercourse. Our findings suggest that the strong effects of behavioral variables (e.g., duration of pill use, number of sex partners) are mediated by cultural indicators (e.g., primary use of Spanish, attitudes about sex roles). The extent to which programs address important cultural dimensions of health behaviors could enhance effectiveness.

The public health workforce has been studied, but not health educators specifically. The development of a Master of Public Health (MPH) in community health education inspired research to illuminate the San Francisco MPHhealth educator labor market. Atime-series survey of an employer panelwas conducted between 1995 and 1999 regarding the number of MPH health educators on staff, hiring projections, and importance of selected competencies. In the San Francisco Bay Area, there were 4 MPH health educators per 100, 000 persons in 1999. The majority worked in local health departments and community-based organizations. Although hiring was largely replacement in the late 1990s, employers anticipated an increase in hiring from 2000 to 2004. Employers reported that educational preparationw as adequate, although preparationin specific competencies, such as bilingual competence, was lacking. These results suggest a favorable labor market for MPH health educators in the San Francisco Bay Area.

This investigation sought to determine if Maryland’s new graduated licensing programwas associated with greater levels of parental involvement in, and restriction on, teens’ unsupervised driving. Separate samples of teens with provisional licenses were interviewed by telephone before (n= 424) and after (n= 600) the new program took effect. The findings indicated that teens in the new program reported significant increases in the frequency of parental driving instruction and supervised driving during the permit phase. There were no differences in amounts of instruction or supervised driving after provisional licensure. Also, teens in the new program reported greater overall amounts of parental restriction on their driving; however, few specific restrictions showed increases. Programs that encourage parents to regulate, restrict, monitor, and supervise the driving privileges of their teens during their provisional period of licensure are recommended. Graduated licensing laws and programs benefit from specific behavioral interventions targeted to, and implemented by, parents.

News media are an important and influential part of the social environment, calling attention to certain issues by the amount and nature of their coverage. To better understand howhealth behaviors are covered, we examined more than 80, 000 stories in 1, 354 newspaper issues from four midsize Missouri communities. Health behavior stories were rare. Of 1, 373 stories (1. 7%) that addressed diet, physical activity, or tobacco, few were prominently located in the paper, and only half had a primary prevention focus. A large majority had no local angle, local quotes, or call to action for individuals or the community, and only 10% were generated by local reporters. Because the local newspaper can be especially influential in smaller communities, strategies are needed to help reporters and editors in these settings provide more and better coverage of health behavior-related stories.

Triangulation of methods, sources, and investigators can lead to amultidimensional understanding of a particular issue. In this study, the combination of qualitative and quantitative data collection methods, and information from community and coalition members resulted in the development of a tailored community-specific intervention. Three components were triangulated after analyzing each separately. A household survey of community members between the ages of 25 and 64 years was conducted to identify knowledge, attitudes, and behaviors related to cardiovascular disease and to assess risk factor levels. Focus group discussions were conducted with community members to describe facilitators and barriers to healthy lifestyles, as well as possible interventions. Natural group discussions with coalition members analyzed the relevance, feasibility, affordability, acceptability, and sustainability of specific intervention activities. Results from the different components were compared and contrasted. Areas of added information, validation, and contradiction were analyzed and guided the development of intervention activities.

Although the relationship of psychosocial factors to physical activity has been explored, there is increased interest in how perceptions of the community environment influence behavior.However, few methodological studies have incorporated perceptions of the social and community environment (protective social factors) or addressed key measurement issues.Computer-assisted telephone interviews were administered to a national sample of 1, 818 U.S.adults.Unadjusted and multivariate-adjusted odds ratios were calculated to compare active and inactive participants by Protective Social Factors (PSF) scores and selected sociodemographics. Confirmatory factor analysis and reliability analysis suggested strong PSF scale psychometric properties (• =. 92). After adjustment for potential confounders, a 10-point rise in the PSF score resulted in a 12% increased likelihood of meeting Centers for Disease Control and Prevention/American College of Sports Medicine recommendations. Additional analyses indicated that greater perceived PSFs were associated with meeting these recommendations among Whites but not among African Americans.

Food insufficiency is a major public health problem that has been linked to poor nutritional intake, poor diabetes management, poor cognitive development in children, and other adverse health outcomes. Since the 1960s, antihunger advocacy organizations (AHAOs) have fought to alleviate hunger at the local, state, and federal levels. Few studies have investigated the organizational structure, programs, advocacy activities, and outcomes of these organizations, although many organizations have been instrumental in advocating for state and federal food policy, creating measurements for hunger, and conducting research. Four state-level AHAOs were studied by using multiple case study methodology and grounded theory for analysis to assess organizational effectiveness. The findings highlight a conceptual framework that identified 19 important organizational characteristics that reflect organizational capacity, performance, achievement, and effectiveness. The conceptual framework may be useful in assessing effectiveness of public health organizations and coalitions.

This case study examines a nonlegislative task force as it struggled to reach internal consensus despite external-political constraints. The study highlights the convergence of politics and science, revealing complex issues likely to be confronted by advocates and public health officials. Three themes capture participants’experiences: context, sizing up the opportunities and constraints; task force process, tacit strategy to operate outside the political context and play the science card; and aftermath, a glass half full. The task force took advantage of ambiguous parameters, crafting a comprehensive statewide plan to reduce tobacco use and breaking out of the common public health paradigm of allowing budget considerations to drive program design. These internal victories could not sustain a policy success in the legislature. However, the group’s product sets science-based standards for future program development, and the task force’s process provides valuable insights into other states developing tobacco prevention and control policies.