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The American Academy of Health Behavior--An Organization Whose Time Has Come*
The American Academy of Health Behavior (AAHB) held its inaugural conference in Santa Fe, New Mexico, September 24-27, 2000. About 120 persons attended, including some 40 of the fellows and members of the AAHB. Other registrants were health education and health promotion professionals, health psychologists, researchers from other social and behavioral sciences, physicians, nurses, other health professionals, and health education graduate students. The conference was a showcase for state-of-the-art health education and health behavior research in the areas of tobacco, alcohol, and nutrition. Moreover, it provided conference attendees intermediate level training in research methods. In the nearly four years since the formation of the AAHB by Elbert D Glover and a group of other academic health educators subscribing to strong research values for health education, the merits of founding a new professional organization have been questioned by other academic health educators, practitioners, and other members of the traditional rank and file. In a previous editorial, Werch1 attempted to address the mission and objectives of the AAHB, and to show their relevance in bridging the research-to-practice gap, and enhancing the status of research performed by health educators. Werch1(p.5) stated:
As one person from the National Academy of Sciences who attended the inaugural AAHB conference remarked: "In my circles, health education research is, unfortunately, not taken seriously." In a different forum, I provided my thoughts on the "deadly sins" committed by the health education profession where research is concerned, including that our profession lacks consensus on what constitutes research excellence.2 The question of how many organizations a given profession can sustain is a valid one raised by some health educators, who through the Health Education Directory (HEDIR) listserv and other formal and informal venues, have argued that the AAHB overlaps roles of existing health educator-comprised professional organizations such as the Society for Public Health Education (SOPHE), the American Association for Health Education (AAHE), and others. Since all health educators have not embraced the creation of the AAHB, or have lingering doubts about its necessity, and even concerns that its existence will compartmentalize the profession further, I moderated an open forum in town meeting style at the Santa Fe conference in which some of the issues raised by AAHB skeptics were aired. A summary of this town meeting, including my facilitator thoughts, participant input, and post-conference reflections and ruminations is provided below. Why The Academy? The objectives of The Academy are stated in its bylaws, which can be found on-line at www.aahb.org. In addition, an editorial by Werch1 succinctly articulated four key purposes of the AAHB. Although it is difficult to improve upon the clarity of those stated functions, their additional breakdown might augment their meaning, especially now that the AAHB has held its first meeting. Therefore, this iteration is provided below to answer the question _ why The Academy? 1. Provide an intimate forum (annual conference) for sharing and learning by experienced as well as novice health education researchers. 2. Augment the skills of researchers in health education regardless of their level of expertise. 3. Enter into mentoring relationships _ established researcher and novice researcher. 4. Promote the health education profession through excellence in research. 5. Promote health educator research skills consistent with the development and evolution of nationally prescribed professional responsibilities and competencies. 6. Promote and nurture the research base for health education and health promotion specialists. 7. Identify and advance the richness of research in health education. 8. Expand opportunities for "elite research" in health education but not create a legion of elitists. 9. Foster a concept of research "connoisseurship" among health educators regardless of setting. 10. Foster a translation of health education research into evidence-based practice. 11. Take on a "spokesperson" role through health education research. The first three items in this list are particularly applicable to the conference setting since it is the intent of The Academy to keep its annual program relatively small and streamlined, and focused on skill building and presentation of state-of-the-art research findings and methods. Although a commonly stated theme among most participants, students and novice researchers in attendance especially commented on the conference's intimate setting and size, the absence of the "typical" concurrently scheduled business meetings that conflict with, and detract from, scientific sessions, and the numerous informal networking and mentoring opportunities. Curiously, even fairly seasoned professionals commented that despite their years in the profession, they had rarely or never interacted at length with some of health education's research leaders and more celebrated personalities, particularly to the degree that opportunities at this conference afforded them. The next four items on the list (4 through 7) are directed efforts to advance the health education profession. Moreover, each of these ambitions is faithful to initiatives of the National Commission for Health Education Credentialing, Inc. (NCHEC) to improve entry level and advanced preparation of health educators, as well as active practice. Item 8 is also ambitious but challenges us to "hybridize" our research, and as Charles Deutsch, Director of Harvard University's Prevention Research Center, once remarked to me, to "take the emphasis off of small, local studies and bring [our] research to scale" (Personal communication, January 1999). Item 9 challenges health educators to improve their connoisseurship of research findings based on better discrimination of research methods, thereby not treating all published studies as having nearly equal valences. With item 10, the hope is to dispel fears or misunderstandings that the AAHB is interested in separating health education researchers and practitioners. To the contrary, the AAHB recognizes the linkage between these endeavors (research and practice), echoing the Institute of Medicine's3 criticism of the early efforts of the CDC's Prevention Research Center program. Finally, item 11 expresses the hope that societal institutions such as news media will turn to health educators in the future for their expert opinion on matters related to health behavior, rather than routinely seeking out only physicians, deans of schools of public health, other health professionals, or scientists in other disciplines. Health educators, even at the highest levels of achievement, are rarely sought out as "authoritative spokespersons." If we (ie, AAHB members) have a bias, it is that we believe that our (ie, health education's) performance of high quality research provides the best opportunity for this objective to come to fruition. Frequently Posed Concerns About the Academy The following remarks perhaps need to be prefaced here by recognizing that other health education and health promotion professional organizations have multiple and complex missions. However, one consequence of having a varied mission is that an organization is restricted in its ability to focus attention on any one area without, to some extent, excluding others. For reasons that have been stated by Werch1 and embellished earlier in this paper, founders of the AAHB are fearful that one of the areas receiving less attention is research. Let us examine at least some of the major beliefs and concerns that have been raised following the creation of the AAHB. The Academy will further fracture or fragment the health education profession. In his editorial, Werch1 counts at least 13 national organizations (excluding the AAHB) that are health education-related, 8 of which are part of the National Coalition of Health Education Organizations (NCHEO). Many of the existing organizations do sponsor research programs at their conferences and, among organizations having affiliated journals, publish research papers. However, research is just a portion (sometimes a small portion) of what is offered, and there is little history of sponsoring intermediate or advanced training in research of the type that culminates in the connoisseurship to which I referred earlier. If you will indulge me further, there have been events that signal that traditional forums for reporting health education research have declined in prestige or, have been forced to diversify their offerings in ways that de-emphasize research. The American School Health Association's Research Council, once a prominent group, is now just one amongst a plethora of Association councils. And, though the Journal of School Health is a respected outlet for the reporting of school health research, authors of research papers are at least as likely to turn to any number of other publication outlets, including ones less likely to be read routinely by health educators. Despite the existence of two sections of the American Public Health Association that profess health education themes, little research authored by health educators appears in the American Journal of Public Health. According to its editor, the Journal of Health Education has almost eliminated its backlog of research manuscripts (James H Price, Personal communication, September 2000). Though I cannot offer quantitative documentation, my impression (shared by a number of others) is that some of health education's most prominent researchers are featured less often now than in former times on AAHE's annual conference program. Even SOPHE has had to be responsive to its membership by featuring a new journal devoted primarily to practice. The bottom line is that we need all of our professional organizations, but we also need at least one whose primary mission is advancing the status of research performed by health educators for health educators. The Academy will compartmentalize health education research rather than increase its accessibility. My sarcastic inclinations make me think that anything we do to unshroud health education research and get it on public display for the layman's eyes potentially enhances respect for the profession and improves the prestige of its practitioners. Sarcasm aside, the development of an academy comprised of a group of scholars committed to advancing research methods, improving research teaching, and expanding research dissemination is hardly an objective with which it seems prudent to protest or argue. The Academy will be elitist and overshadow, denigrate, or marginalize other health education organizations and professional groups. This concern might well be one that occurs anytime a new group emerges. I am reminded of the fables that have been passed on regarding the founding of SOPHE -- a group of public health degreed people bent on casting an elitist shadow on the profession that will fragment it so badly that it will never recover. Some 50+ years later, SOPHE is one of our leading organizations, yet only one of a complex of organizations comprising the NCHEO. More to the point, health education, though not perfect, is probably stronger than it has ever been. Even if the AAHB intended to do so, it is hardly likely that a group numbering fewer than 80 members, and whose interest is focused primarily on advancing basic research and research-to-practice values, will overtake more established organizations any time in the foreseeable future. Moreover, at least between the founding and charter members of the Academy, each individual belongs to one or more of the organizations that make up the NCHEO. In addition, several AAHB Board of Directors members are current or former leaders of one or more of the traditional health education associations, and feel extreme loyalty to these groups. AAHB Board of Directors meetings are replete with reminders that full-scale meetings of the Academy should make every effort to avoid scheduling conflicts with other organizations. The Academy members and group of fellows is skewed by gender and ethnicity. The Academy is a meritocracy and is open to anyone who meets the qualifications (based on research accomplishments) stated in the Academy's bylaws. As of December 31, 2000, 5 of the 7 members of the Board of Directors are men, but 50% of the Council and Committee chairpersons are women. Of the 73 members and fellows, 26 (35.6%) are women. Aside from anecdotal information acquired through personal acquaintance with some of The Academy members, I can report nothing else about the gender or ethnic breakdown of The Academy, since neither gender nor ethnicity data are requested when one completes a membership application. The data above are deduced from the membership directory (also available at www.aahb.org). The Academy is "too inclusive" -- persons not professionally prepared as health educators will overshadow those who are. I hope this statement doesn't mean that people are worried that non-health educators admitted as Academy members will outperform those of us who are health educators. If it does, then we have much bigger problems that just fears about an upstart organization. What I think it means is that people are concerned that persons admitted to The Academy who do not possess at least one health education degree (ie, Associate members) will grow in numbers so that at some point in time, they will overwhelm the degreed health educators through the power of the vote. As stated in the active bylaws, however, the number of Associate members will never rise above 25%, thereby, making it unlikely that the stated concern can ever become a reality. The Academy is "too exclusive" --persons not in settings where research is a job expectation will always be "outsiders" looking in. This concern probably can be dismissed since persons selecting these types of occupational settings may in fact be served better by health education organizations that are more encompassing in their mission. Furthermore, even as non-members of The Academy, they still can attend AAHB conferences and other AAHB-sponsored events, and benefit from reading the official publication of the AAHB, the American Journal of Health Behavior. Persons in these settings may eventually be Qualified (ie, Full) members if they continue to perform and publish research (even if at a somewhat slower pace), or may attain and maintain a status of Affiliate member. And So? The existence of an Academy dedicated to high ideals in research training, research performance, and research dissemination enhances a profession that has undergone extraordinary development and change in the past two decades. The creation of the Academy neither diminishes the fine work being done by older organizations, nor does it threaten their ideals. Moreover, it has the potential to provide the kind of "hybrid vigor" that will grow and sustain the prestige of the profession for a long time to come. References 1.Werch
CE. What use the American Academy of Health Behavior? American
Journal of Health Behavior 2000;24(1):3-5. |