Health Education & Behavior

The Practice Notes section is intended to keep readers informed about health education practice around the country. It is an attempt to spread the word about exemplary strategies, initiatives, and programs and share successes in overcoming obstacles or challenges. Periodically, articles presenting perspectives on practice-related issues are also included in Practice Notes.

The use of qualitative methods is increasing in the health education literature, and there is need for more information on these methods and their use. This investigation looks at qualitative sampling practices as reported in the 93 qualitative or mixed-method studies published in Health Education & Behavior from 1980 to 2000. It focuses particularly on the extensiveness of sampling in this research (i.e., the volume and diversity of information collected about the phenomenon of interest). Among these studies, individual interviews averaged 104 ± 134 informants(range 2 to 720) and 92 ± 39 minutes. Focused group interviews averaged 10 groups (range 1 to 40) and 90 ± 25 minutes. Observational studies usually occurred in multiple sites and involved approximately 16 to 24 months of fieldwork. Document analysis extensiveness varied considerably on a variety of indicators. Future qualitative research would benefit from more complete consideration and fuller reporting of sample extensiveness.

The research examined the influence of parent and school variables on minor aggression among early adolescents. Sixth-grade students (N = 1,081) were interviewed at the beginning of the school year (Time 1) about aggressive behaviors and selected psychosocial variables and at the end of the year (Time 2) about aggressive behaviors. Aggression increased over time and was greater for boys than girls at both time points. In path analyses, Time 1 aggression was directly associated with Time 2 aggression and indirectly associated through affiliation with Time 2 problem-behaving friends. School engagement was associated indirectly with Time 2 aggression through affiliation with problem-behaving friends. Parenting behavior was negatively and directly associated with Time 2 aggression and indirectly through Time 2 affiliation with problem-behaving friends. The findings indicated that selection and previous behavior predicted peer affiliation and parenting and school engagement protected against early adolescent aggression.

This study aimed to identify factors in school physical and social environments that may facilitate or compete with programs and policies to improve student physical activity and nutrition. Focus groups and interviews were conducted with students, faculty, and staff of two public middle schools. Participants identified numerous aspects of the school environments as significant. Competition, teasing and bullying, time, and safety were described as major barriers for students to be physically active during physical education class, on sports teams, and before and after school. The quality of the food served, easy access to nonnutritious snacks, limited time for lunch period, and weight concerns emerged as significant reasons why students do not eat nutritious meals in school. When developing programs and policies to improve the health of students, environmental influences that undermine efforts to improve student health behaviors must be addressed.

The purpose of this study is to evaluate the effect of a preintervention physical activity preparatory course on physical activity, and social, cognitive, and transtheoretical constructs. The sample included 82 low-income, multiethnic women (75% Latina) who completed an 8-week course designed to prepare them to become more active prior to randomization into a 10-month physical activity intervention. Participants completed precourse and postcourse measures. Paired-comparison t tests showed increases in knowledge, perceived social support for exercise, minutes of walking per week, and total cognitive and behavioral processes following the preparatory course. Perceived barriers and self-efficacy for exercise did not change from precourse to postcourse. Preintervention preparatory courses may be an effective way to increase social and cognitive constructs associated with physical activity behavior, potentially yielding a greater effect from subsequent interventions.

The Cafeteria Power Plus project examined whether a cafeteria-based intervention would increase the fruit and vegetable (FV) consumption of children. Twenty-six schools were randomly assigned to either an intervention or control condition. Baseline lunch observations of a sample (N = 1668) of first- and third-grade students occurred in the spring of 2000; follow-up was in the spring of 2002. The intervention took place during two consecutive school years beginning in the fall of 2000 and consisted of daily activities (increasing the availability, attractiveness, and encouragement for FV) and special events (kick-offs, samplings, challenge weeks, theater production, and finale meal). Training of food-service staff and cook managers was ongoing throughout the intervention phase. Students in the intervention schools significantly increased their total fruit intake. Process measures indicated that verbal encouragement by food-service staff was associated with outcomes. The outcomes suggest that multicomponent interventions are more powerful than cafeteria programs alone with this age group.

An evaluation was conducted to compare the impact of an 8-week cardiovascular disease risk reduction group teaching program for 92 individuals with mental retardation (MR; IQ less than 70) and 97 normal learners. The curriculum emphasized exercise, nutritional choices, and stress reduction. Body Mass Index (BMI; weight in kilograms, divided by height in meters, squared), knowledge of healthy eating choices, self-report of fruit and vegetable intake, and exercise were measured before and after the intervention. The mean BMI decreased by .89 for normal learners and not at all for the group with MR. However, BMI decreased by at least .75 units (or approximately 5 pounds) for 18.5% of individuals with MR and 44.3% of normal learners.

Many work-site physical activity interventions use theoretical variables in the design of their programs. Yet, these interventions do not document the degree of change in theoretical variables produced by the intervention. This study examined the construct validity of an intervention designed to affect social cognitive theory variables linked to exercise behavior. Construct validation methods were used to evaluate an instructional intervention composed of four 60-minute sessions delivered across 2 weeks. Increases were found in self-regulation skills, outcome-expectancy values, and self-efficacy for the treatment group. No significant increases were detected for the comparison group on any study variables. Sixty-seven percent of the treatment group was able to maintain exercise behavior across 12 months, whereas the comparison group declined in exercise participation from 68% to 25% across 12 months. The study revealed the intervention effective in producing the intended changes in social cognitive theory constructs. The analysis shows self-regulation-mediated exercise behavior.

This article examines sociocultural expectations of sexual behavior and the reasons why not using condoms may be logical to married heterosexual couples in India. Married women who report monogamous sexual relationships with their husbands are a high-risk group for HIV infection in India. Based on the public health model and a population-based perspective on HIV infection prevention, this article illustrates the underlying mechanisms that link the role of women in society, holistic health beliefs, and cultural beliefs about the transmission of HIV with the precursors to nonuse of condoms. The author concludes that promoting condom use requires an emphasis on family health, not only as contraceptives. Challenges for reducing the social stigma and developing a comprehensive policy on HIV prevention and AIDS treatment and care are discussed.

The Community Trial of Breast Cancer Screening Promotion assessed the effectiveness and cost-effectiveness of mammography promotion by community volunteer groups in rural areas using three different intervention approaches: individual counseling, community activities, and a combined intervention including both. Societal costs of the interventions were calculated and used in conjunction with measures of effectiveness to calculate cost-effectiveness in terms of cost per additional mammogram and cost per year of life saved. Methods of collecting and using cost information to assess the cost-effectiveness of community interventions are described. The Community Activities intervention was found to be the most cost-effective, at approximately $2,000 for each additional regular mammography user in the community. The cost per year of life saved associated with mammography promotion was approximately $56,000 per year of life saved. Exploratory analyses suggest that the most cost-effective method of promoting mammography use may vary with the target population.