Health Education & Behavior

This study assessed the types of research and the statistical methods used in three representative health education journals from 1994 through 2003. Editorials, commentaries, program/practice notes, and perspectives represent 17.6% of the journals’ content. The most common types of articles are cross-sectional studies (27.5%), reviews (23.2%), and analytic studies (i.e., case-control, cohort, and experimental studies) (18.4%). The estimated annual percentage change across the study period in these types of articles was 3.3, -9.3, and 5.5, respectively. A significant increase was observed in use of descriptive statistics (estimated annual percentage change = 2.4), parametric test statistics (4.4), nonparametric test statistics (3.5), epidemiologic statistics (10.3), generalized linear models (6.8), validation statistics (6.7), and other statistics (8.2). Movement toward increasing use of cross-sectional studies, analytic study designs, and statistical methods—representing greater emphasis on needs assessment for health education, health education program development, and program evaluation—indicates the need for better quantitatively trained health educators.

African identity must be central to research on African health and development. This article focuses on three primary themes for advancing a different vision for understanding health issues in Africa. The first is the need to deconstruct conventional assumptions and theories that have been used to frame public health problems and solutions in Africa. The second is to insist that identity be central to how we frame issues of health and behavior in general and in Africa in particular. The third is the importance of the notion of “social cultural infrastructure” in defining African ways of knowing to guide public health research and intervention in Africa. Finally, the metaphor of the “African gate” is used to illuminate these themes while drawing on examples from an HIV- and AIDS-related stigma research in South Africa and its implications for addressing the critical global public-health issues of today.

Despite high smoking rates among those living in poverty, few cessation studies are conducted in these populations. This cluster-randomized trial tested nicotine gum plus motivational interviewing (MI) for smoking cessation in 20 low-income housing developments (HDs). Intervention participants (10 HDs, n = 66) received educational materials, 8 weeks of 4 mg nicotine gum, and 5 MI sessions on quitting smoking. Comparison participants (10 HDs, n = 107) received 5 MI sessions and educational materials addressing fruit and vegetable consumption. Participants had a mean age of 46.3 years and were predominantly female (70%) and African American (83%). Biochemically-verified 7-day abstinence rates at 8 weeks were 6.1% and 5.6% in the intervention and comparison arms, respectively (p = ns); and at 26 weeks were 7.6% and 9.3%, respectively (p = ns). Results suggest that nicotine gum plus MI were not effective for smoking cessation in low-income housing. Programs are needed to enhance the effectiveness of pharmacotherapy and counseling in underserved populations.

Understanding the behaviors and attitudes of at-risk populations is fundamental to controlling the spread of HIV, the virus that causes AIDS. The problem of nonresponse among these populations, however, plagues survey research designed to address these issues. Previous work undertaken to map out the dynamics of nonresponse—bothnoncontacts and refusals—have primarily focused on exploringthe effectiveness of a single method of outreach. This analysis improves on this prior research by comparing the effectiveness of two types of outreach strategies in a follow-up face-to-face survey of individuals seeking HIV prevention services in New Jersey during the period 1999-2001. Case workers from community-based organizations (CBOs) attempted to contact one set of respondents, whereas “outsider” researchers attempted to contact the second set. In brief, the authors find that in contrast to a CBO research affiliation, an outsider researcher status is associated with higher survey response rates.

The purpose of this article is to report the process outcomes of a coaching methodology used in a study designed to increase fruit and vegetable consumption and physical activity in families. Eighty-eight families with second graders were recruited from a rural, biethnic community in Colorado and randomized to intervention and delayed intervention conditions. This article reports on the 27 families in the delayed intervention group. Families received up to 10 home visits over 10 months from a family advisor and completed activities to improve their dietary and physical activity behaviors. Coaching conversations took place during each home visit. Coaching process outcomes were evaluated by analysis of visit documentation, participant survey, and qualitative interviews. Results indicated that coaching, in conjunction with family activities, engaged families in the process of change and facilitated movement toward the achievement of their weekly nutrition or physical activity goals. Coaching methodology may be particularly useful for participatory research.

The Healthy Directions–Small Business randomized, controlled study aimed to reduce cancer risk among multiethnic workers in small manufacturing businesses by increasing fruit and vegetable consumption, physical activity, and daily multivitamin in take and decreasing consumption of red meat. The intervention incorporated participatory strategies and was built on a social-contextual framework that addressed people with varying cultural backgrounds and literacy levels. In addition, the intervention aimed to reduce worker exposure to occupational hazards. Process evaluation was conductedusing quantitative and qualitative research methods. Quantitative results showed high levels of worker awareness of and participation in programs. Qualitative findings suggested that management support, worker input, and a history of social interaction between workers and management may have contributed to high participation rates. Future studies need to examine characteristics associated with participation and nonparticipation of both managers and nonmanagers to increase the likelihood of participation and ultimately improve health behavior.

This study forms part of the preparation of communities for HIV-preventive vaccine trials in South Africa. On the basis of the assumption that attitudes to any HIV vaccine or vaccine trials will partly be influenced by experiences of vaccination in general, this study aimed to investigate knowledge of, attitudes to, and experiences of vaccination in a small semirural community in KwaZulu-Natal, South Africa. The study also sought to investigate the effect of traditional, cultural, and religious beliefs on attitudes to vaccination, as well as to get some indication of willingness to participate in potential HIV vaccine trials. Overall, the findings reveal a good knowledge of, and positive attitudes to, vaccination, with little negative effect of traditional, cultural, and religious beliefs. The findings also reveal a generally positive attitude to HIV vaccines and vaccine trials. Barriers identified, such as anxiety about safety, were not surprising.

Given both the importance and difficulty of promoting community-based public health coalitions, their capacity for sustainable action merits systematic examination. The current study addresses this need, focusing specifically on the relational dimension of capacity, that is, how relationships both among members and with external actors affect coalition-level activity. The context is a multimethod comparative case study of two rural cancer control coalitions. The authors began by using quantitative and qualitative data to characterize relational capacity in each coalition and then assessed the association between coalition-level relational capacity and level of subsequent interventions. The more active coalition had a more inclusive relational structure than did its less active counterpart but also placed less emphasis on personal friendships. The authors conclude that coalitions’ relational structures are measurable and that this dimension of capacity may affect sustainable capacity for health promotion.

Cancer is the number one cause of death for Asian American women, yet they have the lowest rates of cancer screening. Contributing factors, particularly for Hmong women, include the lack of culturally and linguistically appropriate educational interventions. This study aimed to develop a culturally and linguistically appropriate intervention to improve the breast cancer screening rates among Hmong women in Fresno and San Diego, California. Intervention elements included the development of a flipchart, brochure, and video that presented basic breast health and screening information, along with the targeting of not only women but men to support their wives’ breast cancer screenings. Analyses of pre- and post workshop surveys showed increases in knowledge and more positive attitudes among all participants, behavioral intentions for clinical breast examinations and mammograms among women, and support for such exams and possible cancer treatment among men. Implications for further research and practice are discussed.

Nutritional well-being among older adults is critical for maintaining health, increasing longevity, and decreasing the impact of chronic illness.However, few well-controlled studies have examined nutritional behavior change among low-income older adults. A prospective, controlled, randomized design examined a five-session nutrition education module delivered to limited-resource older adults (N = 703) in Congregate Nutrition sites by Cooperative Extension agents. Experimental group participants were significantly more likely than control group participants to increase multivitamin use, to increase calcium supplement use, to read labels of dietary supplements, to carry a supplement and/or medication list, and to discuss such use with their health care professional. The study addresses weaknesses in the literature by using a theoretically derived education component, implementing the intervention within a setting regularly used by low-income older adults, employing randomized assignment to intervention and control conditions, and using hierarchical linear modeling to deal with “nested” data.