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American Academy of Health Behavior Abstracts - 2000 Meeting
Using Storytelling to Construct Preferred Futures and Enhance Resiliency in Families: Insights from a Participatory, Dual-vision Methodology Janet R. Grochowski, Meg Wilkes KarrakerPurpose To explore the impact of a promising Delphi, anticipatory, story-based strategy that engaged participants to not only describe their preferred futures but what actions they were willing to take to reach these preferred futures. The primary purpose was to explore what, if any, impact this strategy had on participants" "sense of future." Sense of future has been identified throughout resiliency literature as a fundamental attribute of resiliency.Framework We apply one author's concept, "strategic living communities" (SLO), Antonovsky's salutogenic model, Benard's resiliency attributes, and McCubbin's characteristics of resiliency families to the lived experiences of single mothers. Our paper supports the views that resilient families are proactively deconstructed and reconstructed as their members negotiates the challenges and changes of living. We have heard the stories of 17 single mothers who have completed at least some college.Overview Authentic research involving these women's lives and their dynamic communities demands innovative methodological strategies in which the voices of the women are at the center. Our dual-vision research model emphasizes an exploratory, constructivistic approach with participants" personalized phenomenology as the core. Implicit in our research is a newer paradigm, a particularly feminist ethic: the research process affects and is affected by those who participate.Conclusions In the course of telling their stories about their preferred futures, these single mothers are in fact constructing those futures. Other findings and conclusions reveal that participants are willing to take action today in order to meet their preferred futures, and that exposure to this strategy positively impacted their views of resiliency, health choices, and futures.Creating Compelling Health Futures: Impacts of a Promising Story-Based Strategy on Adolescents' Personal Health Projections Janet R. GrochowskiPurpose This exploratory, qualitative case study examined the impacts of an anticipatory, self-directed, story-based learning strategy on adolescents' personal health projections. This exploratory case study served as an examination of the attributes of resiliency in the context of self-constructed positive health futures.Framework Using a constructivist research approach, thirteen seventeen year-old participants constructed personal health projections including formative and summative evaluations of their learning strategy experiences.Overview Participants' personalized phenomenology was a focus of this case study. The content analysis was carried out on each participant's personal health projections (thirteen StoryLines„ exercises). Observable differences between pre-case study, transitional, and post-case study were complied with their associated analyses. Additional data sources included: the participants' weekly journals; a post evaluation of the learning strategy; a one-year evaluation; a fourteenth personal health projection completed after one year; and the investigator's journal and observations. The findings supported the use of this strategy in positively impacting adolescents' personal health projections.Conclusions Eight conclusions and numerous implications emerged for resiliency enhancement; health education curriculum and pedagogy; and related roles for health professionals, health educator preparation, families, communities, and the individual client. The conclusions: StoryLines revealed a positive impact on adolescents' personal health projections, participants indicated that they enjoyed the use of StoryLines as a learning strategy, participants demonstrated an ability to think in multiple time-focused frames, exposure and practice appeared to assist participants in challenging time-focused exercises, participants' attitudes toward StoryLines played an interactive role in that it impacted their confidence to think about their preferred health futures. Likewise, practice in creating their preferred health futures appeared to enhance their attitude toward futuring, participants stated that StoryLines helped them to think about their preferred futures and plan for them, participants indicated that they enjoyed futuring and question why it is not used throughout health education.Qualitative Analysis of Co-morbid Behaviors Among Youth Taking Mandatory Smoking Education Classes Stacey Stevens, Catherine McMillan, Brian Colwell, Dennis Smith Purpose To analyze drawings and other writing on student workbooks utilized in the Texas Adolescent Tobacco Use Awareness and Cessation Program. The nature of these drawings and writings lends support to anecdotal information that many participants in the program suffer from multiple co-morbid behaviors that increase their risk of illness, injury or premature mortality. Methods 982 workbooks for a six-month period were sampled and examined. All drawings and writings that were not part of class activities were categorized. 73 "items" were included in this study, although some words, phrases and/or drawings frequently appeared more than once. Results In preliminary analysis, the "items" were classified into the following areas by topic referenced: alcohol use, drug use, depression/fatalism/hopelessness, gang-related, violence/anarchy, addiction, music, and other antisocial behaviors. 16 books could be included into multiple categories. Conclusions Facilitators of the ATCP work with adolescents who have a multitude of issues beyond tobacco use. They should have high sensitivity to individuals who may be experiencing significant mental health and/or antisocial problems in order to ensure their referral into early intervention programs as well as to assist their understanding of adolescents with issues beyond tobacco use. Curriculum implications may include the inclusion of activities that include more drawing/writing activities for adolescents who express themselves in this manner, creation of a more streamlined referral process to appropriate services, and incorporating the input of other mental health professionals to assist with program development and curriculum enhancement. Drugs and The College Athlete: An Analysis of Athlete's at Risk Ray Tricker, D. Connolly Purpose To examine the relative importance of selected attitudinal variables that could be used to describe a profile of collegiate athletes who were at risk for using anabolic steroids, human growth hormone, amphetamines, cocaine and marijuana. Methods The King Drugs in Sport Questionnaire was used to gather information from 563 collegiate student athletes who were enrolled in two NCAA Division One institutions. A subgroup of 120 student athletes were selected from this pool based upon their responses to a list of attitudinal scenarios that related to subjective norms, attitude and perceived control (Ajzen and Fishbein). A descriptive profile of at-risk student athletes was established from these data. Results The results of the study indicated that 32% of the student athletes had used marijuana during their lifetime and 19% reported that they had used marijuana during the previous 6 months. Five percent had used amphetamines during their lifetime and 1% during the past 6 months. Eight percent reported using anabolic steroids during their lifetime. Thirty three percent reported that they would use anabolic steroids if they could find ways of not testing positive. Fear of discovery, loss of scholarship were described as major deterrents for not using anabolic steroids. One hundred and seventy five student athletes reported that they used marijuana to cope with the pressures of sport, and 12% reported that they would use anabolic steroids if these drugs would guarantee success in sport. Conclusions Subjective norms and the perceptions that student athletes have of others' use of drugs are an important influence on their decision to use or not use. Therefore, it is important to develop strong networks of support within athletic department that help to buffer external influences and support strong positive internally motivated decision making. Drug testing and athletic department policies should be supplemented by regular opportunities for student athletes to meet and examine their responsibilities in athletics and academics. education should provide opportunities for student athletes to apply their knowledge and ideas in challenging social situations and social settings; for example, by making presentations in public schools in front of their peers. The needs of student athletes in revenue producing sports that emphasize strength and size may be different from individuals who compete in nonrevenue sports. Social Learning Variables as Predictors of Exercise Initiation and Maintenance in Older Women Mark D. Litt Purpose A number of studies have documented the health benefits of exercise in older women, including prevention of bone loss, enhancement of postural mobility, and increased strength. Poor adherence to exercise programs, however, limits the effectiveness of exercise programs. Social learning theory predicts that adherence to a program will be dependent on certain variables, including readiness or motivation to exercise, confidence in ability (self-efficacy), and social support for exercising. The purpose of the present study was to determine whether social learning variables would predict continued adherence to exercise in a group of elderly women at risk for osteoporosis. Methods Subjects were 189 women ranging in age from 60 to 78 years, recruited from the community, and prescribed exercise three times per week, plus daily walking, for the purpose of examining the effects of continued exercise on bone loss. Participants were administered questionnaires at 3-month intervals for 36 months. Results Data from the first 12 months indicated that initial exercise adherence (exercise at 3 months) was predicted by readiness for exercise, general social support and social support that was specific for exercise (R2=.48). Continued exercise at 12 months, however, was predicted only by continued exercise-specific social support (R2=.18). Conclusions It was concluded that those most likely to initiate behavior change are those high in readiness and in social resources, but that the process of maintaining exercise in this population is best accounted for by exercise-specific support. Exercise programs that incorporate continued support for exercise from friends and family may yield better long-term adherence rates. Adherence to Recommendations for Screening Mammography and Follow-up by Race and Ethnicity Jadwiga (Jodi) Strzelczyk, Mark Dignan Purpose To explain differences in screening behaviors and in levels of adherence to follow-up recommendations among six racial/ethnic groups of women from the Colorado Mammography Advocacy Project (CMAP) database for the 1990-1997 period. MethodsData from the records of 167,232 women included sociodemographic factors: race/ethnicity (82.8% White, 3.4% African American, 11% Hispanic, 1.6% Asian, 0.6% Native American, and 0.6% "Other"), age, education, health insurance, and family history of breast cancer (FHBC). Clinical outcome data, stratified by the ACR mammography conclusion codes, were utilized in the evaluation of adherence to recommended follow-up for abnormal mammograms. Results Comparing 1990 and 1997, there was a ten-fold growth in the number of women who had their first screening mammogram. Changes did not occur uniformly. The largest participation increases were observed for Hispanic women (5.5% to 34%), women aged 40-49 (34.9% to 40.5%), and women with postgraduate education (6.4% to 9.9%). Decreases occurred for White women (90% to 60%) and women with FHBC (15.8% to 10.7%). Overall, 80.7% of women adhered to recommended follow-up within 12 months; only 75.4% of those with abnormal mammograms did. Significant differences in adherence were observed between and within groups. Asian and Native American, younger women, those less educated, without FHBC, and those without health insurance were less likely to be adherent. Conclusions The quantitative analyses reported here indicate that culture, age, education, insurance, and FHBC interact with mammogram results to influence the probability of adherence to recommended follow-up. Learning From Our Mistakes: Designing Behavioral Research Protocols in Academic Family Practice Settings Jennifer R. McCarthy, Mary Ann Burg Purpose The purpose of this presentation is to provide the community of health behavior researchers with a descriptive assessment and analysis of some of the barriers we faced in attempting to do behavioral health research in an academic family practice setting. In order to illustrate our points, we use the example of one research protocol we launched but eventually abandoned when the obstacles to conducting the protocol mounted beyond an acceptable cost-benefit ratio. Methods The research protocol we use as an example to illustrate barriers to behavioral health research involved the testing of an audiotape intervention to enhance patient adherence to medical advice about hypertension management. The original protocol included a two-group time series design with random assignment of hypertensive patients to a control and experimental group. The experimental group was to get a take-home audiotape of their physician's discussion with them of self-care approaches to improving their hypertension management. Baseline chart data was to be collected for patients in both groups, and patients were to be surveyed at three-month intervals over the period of a year to collect data on patient adherence to hypertension behavioral management guidelines. Results In our attempt to implement the research protocol in our academic family practice clinic we faced a series of unanticipated obstacles to conducting the research as originally planned. These obstacles included: 1) technical problems with the clinic patient database that interfered with random assignment into control and experimental groups; 2) technical difficulties in tracking clinic patients for study recruitment; 3) local and non-local reasons for patient resistance to study recruitment; 4) research vs. usual clinic work-flow conflicts; 5) external validity limitations. Finally, we will discuss how to "know when to fish and cut bait", ie, determining when the obstacles to completing a research project have mounted beyond an acceptable cost-benefit ratio. Conclusions Anyone who attempts to do serious behavioral health research is challenged with the problem that sophisticated research design is not always "doable" in the real life context of the primary care clinic. It is better to anticipate potential barriers in designing behavioral research protocols than to proceed with sophisticated research designs that are not adaptable to real-life clinical practice situations. We hope using our own mistakes as an example will help other behavioral health researchers to design realistic protocols that avoid some of the obstacles we faced in completing our research program. Efficacy of Bupropion SR for Smokeless Tobacco Cessation Elbert D. Glover, Judith Whoolery, Gerald Hobbs, Connie L. Cerullo, C. Rolly Sullivan, Penny N. Glover Purpose To determine the potential efficacy of bupropion SR for smokeless tobacco cessation when used in combination with brief counseling. Methods The study was a double blind, placebo-controlled trial that consisted of a 7-week treatment with follow-up out to 3 months. After applying specific inclusion and exclusion criteria, 70 Ss were allowed into the trial and randomly assigned to a treatment of either bupropion SR or placebo to a treatment ration of 1:1 (35 Ss per group). Results The only efficacy results available at the time of abstract submission are end of treatment (7 weeks) data which showed a success rate of 52% for active and 26% for placebo for a Fisher's Exact Test 2-Tail of 0.0486 with an odds ratio of 2.0. Efficacy data at 3 months and data comparing nicotine craving and severity of withdrawal from smokeless tobacco will also be presented. ConclusionFrom preliminary indications, bupropion SR appears to assist with stopping smokeless tobacco use. The Use of Self-Regulation Skills, Exercise Self-Efficacy and Exercise Outcome-Expectancies of Employed Adults Renee Umstattd, Jeffrey S. Hallam, Dale Connally, Melinda McCullough Purpose The purpose of this study was to examine the level exercise self-efficacy, exercise self-regulation, and outcome-expectancy values for exercise at each stage of exercise behavior as defined by the Transtheoretical Model. Methods An exercise stage-of-change instrument was sent to all employees (N=2,200) of two worksites. Employees that returned the stage of change instrument were asked to complete a questionnaire that measures exercise self-efficacy, exercise self-regulation, outcome-expectancy value, stages-of-exercise, current exercise behavior, and demographic information. All instruments had established reliability and validity. Results The results do not show any significant differences (p>.05) between selected stage comparisons on the use of the social cognitive theory variables. The exercise stages of change data were compared with exercise behavior data and 17% of the subjects' behavior did not match their reported stage. Conclusions Since exercise stage determination is based on current exercise behavior, these data indicate that the exercise stage of change instrument may not be valid. Comparisons between regular exercisers and non-regular exercisers on the three social cognitive theory variables were statistically significant (p=.0001). Regular exercisers had significantly higher levels of self-efficacy, self-regulation, and outcome-expectancy value (p=.0001). Future research should examine these variables across the continuum of exercise. Furthermore, the validity of the exercise stage of change model should be examined. Depressive Symptoms and Decision Making Patterns Among Low-income African American Youth Jebose O. Okwumabua, S. P. Wong, Tamala D. Wright Purpose The present study examined the presence of depressive symptoms among low-income, inner-city African American youth in relation to their decision-making and decision coping patterns. Methods Participants comprised a sample of 270 African American male (n=113) and female (n=144) students in sixth through tenth grades drawn from two public schools in West Tennessee. The students ranged in age from 12 to 17 years. All participants were from low socioeconomic inner-city neighborhoods. The Children's Depression Inventory (CDI) was used to assess self-reported depressive symptomatology among participants. A score of 19 or higher suggests the presence of depressive symptoms. The Flinders Adolescent Decision Making Questionnaire (FADMQ) was used to assess participants' decision-making patterns. The instrument consists of decision self-esteem, Vigilance; Hypervigilance; Defensive Avoidance; and Complacency. A high score on vigilance and self-esteem indicates good decision making and confidence in making sound decisions. The maximum possible score is 18. Analyses of variance, t-test, and Chi-square statistical procedures were performed on data to compare the identified variables. Results Of the 257 participants who responded to CDI, approximately nine percent (n=24) screened positive for the presence of depressive symptoms. The older age group (16-17 years) scored slightly higher in reporting of depressive symptoms than the younger age group (12-13 years). There were significant differences among age groups on decision coping patterns. The 12-13 year age group reported the lowest mean score for complacency and avoidance decision coping styles when compared to the two older age groups (14-15 and 16-17 years). The group screenings positive for depressive symptoms were more likely to report low scores for both decision self-esteem and vigilance decision coping style. There were no significant gender differences in the reporting of depressive symptoms and in the mean scores for decision self-esteem and decision-coping styles. Conclusions Depression is associated with maladaptive decision coping patterns. Perhaps increasing competence in decision making may have beneficial effects on overall mood and depressive symptoms among children and youth. The authors will discuss the implications of this study for health behavior research and interventions with children and youth. Age Differences in Children's Theories about Mechanisms of Drug Action Carol K. Sigelman, Lisa J. Bridges, Alberto G. Sorongon, Cheryl Rinehart, Diane Leach, Keisha L. Mack, Elizabeth Davies Purpose Given a lack of research on children's understandings of psychoactive drugs, we used an intuitive theories approach to characterize age differences in children's explanations of the mechanisms through which alcohol and cocaine affect behavior. Methods Individual interviews were conducted with 217 children ages 6 to 12 (one half white, one-third African-American, the rest other). Parallel scores reflecting mastery of propositions contained in a scientifically-correct theory of drug action were formed from open-ended and corresponding closed-ended responses. Common misconceptions were also examined. Results Analysis of theory mastery scores based on open-ended responses suggested that children generally do not know much. In contrast, closed-ended questions revealed more knowledge overall. On both open- and closed-ended items, first and second graders typically displayed less theoretical knowledge than older children did. Gender and racial/ethnic differences were minimal. Conclusions The study illustrates an approach to characterizing children's intuitive understandings of drug action (and other health phenomena), highlights the implications of methodological choices for substantive findings, suggests that even young elementary-school children have reasonable intuitions about how the behavioral effects of drugs come about, and offers empirical data on age-related differences in understanding that can guide the design of drug education programs. Influences of Family and Peer on Drug Use Propensity in Childhood Amy Z. Fan, Mary Ann Pentz, Chih-Ping Chou Purpose To explore the influence of family involvement, family supervision, social competence with peers, support seeking, and parent and peer drug use on drug use propensity in middle childhood. Methods Data were obtained from a longitudinal, school-based drug abuse prevention trial in Indianapolis. Participants were 1639 4th graders collected by classroom from 48 elementary schools. We explored two kinds of possible effect family and peer cohesion factors might take on child drug use propensity, ie, moderating effects and/or mediating effects. Structural Equation Modeling (SEM) was conducted using EQS version 5.7. Results The mediational analysis demonstrated little evidence that family involvement, social competence with peers, and support-seeking are significant mediators between the known risk factors (poor family supervision, parental and peer drug use) and drug use propensity. The moderation analysis indicated that low peer support-seeking skills exacerbates the adverse effects of peer drug use on child drug use propensity; low social competence with peers aggravates the unfavorable effects of poor family supervision and parental drug use. Conclusions The findings suggest that parental/family bonding and social competence with peers may protect against drug use propensity during middle childhood. Research Publication and Access: A Guide to Indexes and Health Education Journals Molly T. Laflin, Stephen M. Horowitz Purpose The purpose of the project was to facilitate the development and dissemination of the body of knowledge in the field of health education (HE). A practical instrument was developed to assist health education researchers in pairing their manuscript submissions with the most appropriate journals. Furthermore, the top indexes in health education literature were examined for the purpose of assisting scholars in maximizing their literature searches and increasing the accessibility of their research. Methods The Delphi method was used to obtain information from HE scholars to determine 1) primary content areas in HE, 2) preeminent journals, and 3) information regarding these journals. Using this information, a frequency count was performed to identify the type and number of indexes covering the identified HE journals. Results Nine broad journal categories and 86 journals pertaining to HE were selected. The following was obtained for each journal: circulation, rejection rate, indexes where cited, number of issues, pages per issue, article length, articles per issue, time between submission and notification, time between acceptance and publication, peer review policy, style, CEUs, and journal descriptions. The indexes Current Contents, PsychINFO, Research Alert, SSCI, and ERIC provided the best coverage of HE journals. Index coverage varied by content areas. Conclusions Understanding the strengths and weaknesses of journals and indexes can help health educators more effectively search the literature, and can assist researchers in making appropriate manuscript submission decisions. Matching manuscripts to appropriate journals, and addressing issues related to indexing, can facilitate the dissemination of quality research in HE. Factors Associated with Heavy Drinking among First Year University Students Michele J. Moore, Chudley E. Werch, Deborah M. Owen, Joan M. Carlson Purpose The purpose of this study was to examine risk and protective factors associated with stage of binge drinking initiation and binge drinking among first year residential university students. This research is part of a larger study of a binge drinking prevention intervention. The influence of various risk and protective factors on binge drinking is important to take into consideration for planning effective prevention programs. Methods At the beginning of fall semester 1998, baseline data were collected from a cohort of first year residential students (n=634). At the close of spring semester 1999, post-test data were collected (n=522). The 68-item survey measured demographics, alcohol use, stage of binge drinking initiation, and alcohol risk and protective factors. Internal reliability coefficients ranged from .71 to .91. Preliminary analyses were conducted measuring the effects of risk and protective factors on post-test binge drinking behavior and stage of initiating binge drinking. Results Data indicate that having positive expectations regarding heavy alcohol use; being influenced by others to drink heavily; perceiving that friends drink heavily and approve of heavy drinking; perceiving that parents approve of drinking heavily; and having more opportunities to drink heavily are significantly (p<.05) associated with binge drinking and progression in the stages of initiating binge drinking. Lower levels of perceived susceptibility and severity of binge drinking; motivation and use of self-control methods to avoid binge drinking; and perceived benefits of avoiding binge drinking were also significantly (p<.05) associated with binge drinking and progression in the stages of initiating binge drinking. Conclusions Multiple risk and protective factors are linked to stage of initiating binge drinking and binge drinking behavior. Additional multivariate analyses will be conducted on the data and implications for alcohol interventions will be discussed. Effects of a Multi-Component Policy Intervention On Adolescent Smoking Susceptibility Maykami L. McClure, Mary Ann Pentz, Terry Huang, Clyde A. Pentz Purpose The Tobacco Program and Policy Trial (TOPP) was designed as a way for schools to increase the potential of school policy to reduce adolescent tobacco use. It was hypothesized that a school-based tobacco intervention program designed to support and enhance school no-smoking policies would lower California adolescent susceptibility to smoking (ie, intentions to smoke). Methods Participants were ethnically diverse students (N=2,053) in 7th grade from middle schools (N=19) in Orange County, California. Schools were randomly assigned to one of two experimental groups: a multi-component policy intervention condition (three-session tobacco-policy curriculum for students, school tobacco-policy review workshop, school tobacco-policy awareness training for parents and the parent teacher organization, and school tobacco-policy review interviews with principals) (n=10), or a control (policy as usual) condition (n=9). The intervention involved a three-session curriculum focusing on school tobacco policy awareness and support, and tobacco influences, consequences, and social norms. Students were asked to complete a questionnaire on cigarette-use, policy awareness, policy support, and risks of tobacco use at baseline, 6-month, and 1-year follow-up. Results Regression analysis was used to obtain adjusted estimates of odds ratios for smoking susceptibility. Participants in the program group were 1.6 times as likely than those in the control group to indicate they will definitely not smoke a cigarette in the next few months (OR=1.6, 95% CI=1.2, 2.0). Conclusions Based on this study, a curriculum-based intervention focusing on increasing policy awareness may also be effective in changing adolescent smoking susceptibility status. Peer Approval and Peer Pressure: Factors Influencing Smoking Intentions Adam Burke Purpose The relationship between peers and smoking is widely observed, but not well understood. To explore this dynamic, this study examined peer influences contributing to the intentions of fifth graders to smoke cigarettes in one year. Of key interest was the distinction between peer approval of smoking and peer pressure to smoke. Methods A sample of 392 fifth grade students was surveyed regarding tobacco use and attitudes using an anonymous 42-item questionnaire. As the main focus was on how peer influences contribute to smoking intention, the dependent variable chosen was behavioral intention to smoke in one year. Behavioral intention has been shown to be a useful predictor of future action. Results In the entire sample (n=392) the majority of students had never tried tobacco (82%, n=320) and had no friends that smoked (81%, n=318). Multiple regression to predict current smoking was run on this whole sample. Peer smoking was found to be the best single predictor of current tobacco use. Multiple regression was then performed on the subsample of students with no smoking experience and no siblings or best friends who smoked (n=259) to determine the best predictors of behavioral intention to smoke in one year. The best predictor of intention to smoke was perceived peer approval. The contribution of perceived peer pressure was not significant. Conclusions These findings support the importance of peer influence. They also suggest that peer influences to smoke cigarettes may be experienced positively (peer approval) rather than negatively (peer pressure). This suggests the need for earlier interventions, with appropriate information on peer attitudes and behaviors. Binge Drinking Initiation and Problems among Incoming Residential College Students Joan M Carlson, Chudley E. Werch, Deborah M. Pappas, Pamela S. Chally Purpose The purpose of this study was to examine the prevalence of binge drinking initiation and problems among incoming residential first-year college students. Methods Eighty-eight percent (n=634) of freshmen residential students attending a southern university completed a standardized questionnaire within the first six weeks of the fall semester of 1998. The questionnaire displayed internal consistency (reliability) alpha coefficients ranging from .58 to .91, with only two measures under .70. Results Stages of binge drinking initiation results reveal 4% of students maintaining binge drinking for longer than 6 months, 24% preparing/initiating binge drinking, 3% thinking of drinking heavily in the near future, and 69% not thinking of drinking heavily. Results also showed that nearly half (49%) of incoming freshmen residential students had occasionally gotten drunk, and almost half (47%) had not received any alcohol or drug education during the past year. Problems associated with binge drinking included 33% experiencing a hangover within the past three months, 22% doing something they regretted, and 13% having unplanned sex after drinking. Problems associated with others' binge drinking included 39% of students taking care of friends who drank too much, 27% had sleep/study interrupted, and 13% reported experiencing unwanted sexual advances. Conclusions Binge drinking initiation and problems associated with heavy alcohol use are fairly common even among students on campus for only a short period. Future research exploring drinking problems of incoming residential freshmen college students and the prevention of binge drinking will be discussed. Using Theoretical Constructs in the Conceptualization and Development of a Curriculum Stephen Nagy, Leslie F. Clark Purpose To share the methodology of curricular design. A developmental, strength-based curriculum to reduce at-risk behaviors for students in grades 6, 7, and 8 utilized the Theory of Possible Selves and Health Education Theory to provide a framework for curriculum development as part of an intervention to address risky behaviors among young adolescents. Framework The theoretical frameworks utilized in this project included the Theory of Possible Selves, Health Education Theory and Social Learning Theory. Constructs within the Theory of Possible Selves included might become (expanding a student's perception of their life possibilities), hope to become (identifying with future possibilities and setting some goals), and afraid of becoming (recognizing environmental deterrents and not identifying with negative role models). The two main constructs from Health Education Theory included wellness (growth activities to enhance physical, social and intellectual well-being) and risk reduction (activities designed to orient the student toward safety issues regarding behavior). The final theoretical contribution was made using Social Learning Theory and a variety of constructs were utilized in preparing the individual learning activities. Overview The methodology utilized to develop the Future Selves Curriculum incorporated a three stage developmental process. Stage one involved the development of the main themes of the curricula for each grade level as well as themes for the four units within each grade level. This activity utilized a strength-based philosophy, centering largely on identifying and building on student's own assets. The second stage determined the emphasis of the theoretical constructs within the curricula. This incorporated a blending of constructs from the Theory of Possible Selves coupled with one of the two Health Education constructs. An outcome of this process was a framework with an emphasis on the desired theoretical constructs. Individual lesson plans were developed in the third stage with full consideration given to attending to main themes, unit themes, and theoretical constructs. Activities in the individual lesson plans were based on Social Learning Theory. A review of the methodology will incorporate a detailed description of the various processes utilized within each stage. Conclusions The development of an intervention should be theoretical driven and theory should be applied in the conceptualization of curriculum materials, unit development and individual lessons. It is important to consider how theoretical constructs are blended together to address the priorities of the project and remain true to the theoretical constructs that were utilized to conceptualize the intervention. This presentation outlines the methodology utilized in the Picken's County Family Life Program and may serve to assist others in application of theory in the design of curriculum. Tobacco Issues in a Regional Health Authority: The Public's Opinion Karen L. Then, James A. Rankin Purpose The Calgary Tobacco Reduction Action Coalition (CTRAC) is a multidisciplinary coalition. The main goal of CTRAC is to improve the health of individuals, families, and communities by preventing and reducing tobacco use through community based initiatives. The purpose of this study (commissioned by CTRAC) was to survey the public's opinion regarding tobacco usage, associated health risks and enactment and enforcement of healthy public policy. Methods A telephone survey conducted over a three month period in Calgary (population approximately 800,000), Canada, using a random digit dialing procedure. A total of 626 respondents (52% female, 48% male) completed the questionnaire for an overall response rate of 68%. The survey was subdivided into eight sections with 34 major items. There were 5 open-ended questions. The survey took a maximum of 20 minutes to complete. Results Results of the public consultation survey revealed that 45% never smoked, 27% are current smokers, and 28% were past smokers, with 53% of respondents having completed college/technical school or university. The major findings indicate: - 88% support initiatives restricting tobacco use, particularly in areas where children may be exposed - 33% would frequent restaurants or cafés more frequently if they were 100% smoke-free - over 90% believe that smoking is associated with lung cancer and heart disease. Just over 42% believe that smoking is associated with ear problems in children and SIDS - 66% believe that tobacco should not be sold in pharmacies Conclusions The results indicate that there is strong support among the public for health initiatives that would restrict tobacco use. There were fairly high rates of support for certain significant items, even among smokers. The implications for healthy public policy and health education are discussed. Experiential Food Education: Cooking with Kids Lynn M. Walters Purpose The purpose of the intervention is to enable elementary school children to make sound nutritional choices by learning to accept a wide variety of healthy foods. Framework The connection between diet and chronic disease has been well documented. Cooking with Kids is based on an ecological model, which suggests that behavior is influenced by intrapersonal, social, cultural, and physical environmental variables and the interactions of these variables. Cooking with Kids was inspired by the award-winning food acceptance research of Dr. Antonia Demas in Trumansburg, NY. Overview Cooking with Kids began in 1995, using interdisciplinary, hands-on methods to increase acceptance of nutritious foods, modeling healthy, culturally diverse food choices in elementary school classrooms and in school cafeterias. The program currently operates in six Santa Fe Public Schools; a satellite recently began in Cimarron, NM. Original curriculum provides a format for each class, integrating language arts, science, math, social studies, music and art. During the 1999-2000 school year, sixteen hundred students, grades K through 6, participated in more than seven hundred hands-on food education classes. Examples include Green and White Fettuccine with Tomato Basil Sauce, Llapingachos, Chinese American Fried Rice, and Black Bean Tamales with Red Chile. Cooking with Kids received a Quality of Education Award by the New Mexico Research and Study Council. Conclusions Conclusions support the hypothesis that student participation in food preparation increases acceptance of new foods. Cooking with Kids is evaluated by classroom teachers, food educators, and students. One girl commented, after preparing and tasting Greek Pastitsio, "There is joy in my mouth now." A Smoke Free Policy in a Regional Health Authority: The Staff's Opinion James A. Rankin, Karen L. Then Purpose In January 1999 the Calgary Regional Health Authority (CRHA) board approved a Tobacco Reduction policy in principle but needed more data. The opinion of staff members was sought in order to determine how the policy should be implemented. The purpose of the study was to obtain the opinions of CRHA staff regarding current smoking practices and the proposed policy changes. Methods The method included a self-administered questionnaire and focus group discussions. A total of 1860 questionnaires were completed and three focus groups were conducted. Results Results of the staff survey revealed that 59% never smoked, 10% are current smokers, and 31% were past smokers. The results of the study indicate: - The largest percentage of current smokers work in either care centers or nursing homes - "Very important" reasons for a smoke-free policy included: protecting patients and employees from second-hand smoke (78%), sending a health message to the community (71%) - Education on how to cope or quit smoking should be provided (75%) - Inform public of policy change by multimedia campaign - Set target dates and phase in implementation plan - 64% stated that there should be exceptions to the policy (eg, long-term care, palliative care and psychiatry) Conclusion There was strong support for the policy change among the CRHA staff, however it is vitally important that the CRHA is seen to be empathic toward smokers and that the policy represents a health initiative. The smoke-free policy should be portrayed as the first step towards a Total Health Management approach to CRHA staff. The implications for healthy public policy and health education are discussed. Adolescent Health Concerns: An Exploratory Qualitative Analysis Robert M. Weiler, Lisa N. Pealer Purpose Inspecting the health concerns of adolescents can help determine the congruence between health problems, as confirmed by epidemiologic data, and issues about which they are concerned. Such knowledge is useful when planning health promotion programs. However, adolescent health concerns are usually assessed using questionnaires that ask adolescents to identify from a preconstructed list, those issues that are concern to them. This approach may introduce bias by accentuating concerns that are inconsequential or concealing genuine concerns. This study assessed the health concerns of adolescents by using an open-ended self-administered question. Methods Data were collected during Spring 1999 from 3,695 (N=6,780) students in grades 9-12 attending eight high schools in two Florida school districts using the Youth Risk Behavior Survey (YRBS) developed by the Centers for Disease Control and Prevention. The data were collected as part of two independent needs assessment projects for two school districts. In addition to completing the 86-item YRBS, students were instructed to respond to an open-ended question, "The greatest concern I have about my health is..." Responses were post-coded using an existing instrument developed to assess the health concerns of adolescents. Results Preparatory results revealed that most students who responded to the question, provided a genuine response. Yet, responses that had either an indifferent or smart aleck tone were found. Most students reported only one health concern. Individual responses are being arranged and ordered into broad topic areas. For example, the response allergy, arthritis, diabetes, colds, stomachs, and so on will comprise the "specified disease experience" content area. Fifty-seven general health concerns have been identified. Though analysis is not complete, the most prevalent health concerns by rank and frequency are weight, general appearance, staying healthy, and nutrition and diet. Conclusions Findings reveal health issues adolescents are personally concerned about, suggesting potential content areas that should be addressed in school health curricula and other health education programs. They also indicate items that should be added to instruments designed to assess adolescent health concerns. Cost-Effective Prevention of Smoking Relapse Thomas H. Brandon, Cathy D. Meade, Thaddeus A. Herzog, Monica S. Webb, Vani Nath, Jennifer E. Irvin Purpose Tobacco smoking cessation has the greatest impact on mortality of any health-related behavior change. Unfortunately, the vast majority of ex-smokers eventually relapse. The goal of this line of research is to develop cost-effective minimal interventions for preventing smoking relapse among self-quit ex-smokers. Methods An initial study that surveyed ex-smokers found that the preferred minimal interventions were a telephone hotline and a series of mailings. We tested these interventions in a crossed 2x2 design. Subjects were 446 ex-smokers who had quit for at least one week. The mailings comprised a series of 8 Stay Quit booklets based on relapse-prevention theory and research. Both interventions were offered over one year. Results At the 12-month follow-up, we found that the hotline was ineffective. However, the repeated mailings reduced relapse versus a control condition in which subjects received only a single booklet. Among recent quitters (<3 months of abstinence at baseline), the booklets reduced relapse by approximately two-thirds (12% vs. 35%). A cost-effectiveness analysis found that the cost of producing a year of abstinence was $126—in contrast to $2000 or more for typical cessation-focused interventions. Conclusions Mailing a series of relapse-prevention booklets proved to be an effective and cost-effective means to maintain abstinence among recent quitters. The main goal of an ongoing study is to determine the potent elements of the mailing intervention: the relapse-prevention content of the booklets versus the extended contact with subjects. This line of research demonstrates how clinic-based interventions can be translated into written formats that increase their accessibility and cost-effectiveness. The Use of the Transtheoretical Model Processes in College Student Exercise Behavior Jeffrey S. Hallam, Danielle Williams, Terrill Saxon, Deborah Johnston Purpose The United States Department of Health and Human Services (2010) specifically identifies post-secondary institutions as settings where young adults should be targeted for exercise promotion. The CDC (1999) reports that even though college students have access to exercise facilities, as well as physical activity classes, there is a decline in total physical activity during college. This decline occurs even though exercise promotion programs (EPP) are offered through coursework, campus recreation, and wellness departments. One explanation for this decline is the lack of theory-based EPPs at the college level. The Transtheoretical Model (TTM) offers a framework to develop EPPs that may increase the adoption and maintenance of college student exercise behavior; yet, the use of the TTM processes by this population is not known. Therefore, the purpose of this study was to describe the use of the TTM processes in a college student population. Methods Seven hundred ninety-four students enrolled in a general health class served as the accessible sample. Questionnaires were distributed to 708 students resulting in 699 useable questionnaires. The Processes of Change questionnaire developed by Marcus (1992) was used to access the use of the TTM Processes (Experiential and Behavioral processes). The Stages of Change questionnaire developed by Marcus and Simkin (1993) was used to determine exercise stage of change. Exercise behavior was also measured using a seven-day recall instrument (Dishman and Steinhardt, 1990). Each instrument has established validity and reliability. MANOVA was used to examine differences in the ten TTM processes across the five stages. Post hoc analysis (Tukey HSD) was used to test difference between stages. Alpha level was set at P=.05 (a priori). Results Fifty-nine percent of participants were categorized in the Action and Maintenance stages. By definition, 59% are regular exercisers - which is different than national data that estimate 39% of college students are regular exercisers. Furthermore, only 15 students were categorized in Precontemplation stage. The MANOVA revealed significant differences for each process across all levels of stage. Post hoc analysis revealed seven different processes that were significant between adjacent stages. Three experiential processes were not significantly different between adjacent stages. There is a linear increase in all processes across stages except for Environmental Reevaluation. Additional analysis revealed that 28% of the subjects; reported exercise behavior did not; match their reported exercise stage of change. Conclusions In developing stage-matched EPPs, health behavior specialists should build on specific processes to help students progress to the next stage. For this sample, targeted processes to help precontemplators move to contemplators are consciousness raising, self-reevaluation, counter-conditioning, and social liberation. To move contemplators to preparers the targeted processes are counter-conditioning, reinforcement management, and social liberation. To move preparers to action, the targeted processes are consciousness raising, self-reevaluation, counterconditioning and helping relationships, and to move those subjects in action to maintenance, the targeted processes are consciousness raising, counterconditioning, social liberation and stimulus control. The experiential processes may play are more useful role in helping students' progress to the next stage. Further research should examine how the changes in the processes subsequently lead to changes in exercise behavior. Furthermore, it is not known how the processes change. Before researchers and practitioners' design staged-match EPPs, they should consider this suggestion. The validity and reliability of the exercise stages of change instrument should be examined. These results show 28% of the sample were not categorized correctly, as measured by the stages of change instrument. Everman (2000) conducted a review of the exercise stage of change literature and found similar results. Bandura (1997) argues there is no need to measure stage. This issue needs further research to explain the utilization of measuring stage of change and subsequently designing staged matched intervention programs. Relationship of School Tobacco Policy to Adolescent Tobacco Use Clyde A. Penz, Mary Ann Pentz, Terry Huang, Maykami McClure Purpose School Policy related to tobacco and drug use has focused on "zero tolerance" with a primary focus on punishment, specifically expulsion or suspension. As part of Project TOPP (Tobacco Program and Policy), this study was designed to evaluate the effects of school policy on tobacco use in 19 middle schools in 3 school districts in Southern California. Methods School principals were interviewed and their tobacco policies were categorized as either punitive (suspend), situational (where the principal determined the schools action depending on the past history of the student), and humanistic (where the principal's response was focused on trying to help the student, including placing the student in a cessation program). During principal interviews, surveys were also collected on 2,434 students in the 7th grade. Questions included lifetime and monthly tobacco use, awareness of school policy, and support for school tobacco policy. Principal interviews and adolescent surveys were repeated in the 8th grade. Results Longitudinal data were analyzed with conditional regression analysis models, using school and individual as the units of analysis, controlling for baseline levels of principal interview variables and student tobacco use and policy support variables. Results showed that changes in policy emphasis toward more prevention and cessation support, were related to lower tobacco use over time. Punishment emphasis and change toward more punishment emphasis, had no effect on tobacco use or policy variables. Conclusions Findings suggest that even in a zero tolerance climate, there is room for change in policy emphasis in schools, and that in emphasis on prevention and cessation support are more effective than punishment. Predictors of Alcohol Consumption among College Students: An Examination of Gender Differences Christine M. Karshin, Patricia B. Koch, Judith R. Vicary Purpose The purpose of this study was to examine whether gender differences exist in relation to the predictive powers of positive alcohol expectancies and perceived friends' use of alcohol on alcohol consumption among college students. In addition, this study examined the degree to which self-efficacy to control drinking mediates these effects. Methods The data for this analysis were drawn from a sample of 369 undergraduate students attending seven introductory health classes at a major northeastern university. The subjects completed the College Health and Academics Survey (CHAS), a 385-item questionnaire, during the fall and spring semesters of the 1997-98 academic year. Results Results indicate that both positive drinking expectancies (p<.01) and perceived friends' use (p<.01) positively predict recent drinking behavior. Positive drinking expectancies were also highly significant predictors of self-efficacy to control drinking (p<.000). Self-efficacy to control drinking was also shown to play an important and key intervening role in the pattern of alcohol use among college students. It was also hypothesized that a gender difference would be evident in the relationship between perceived friends' use and drinking behavior as mediated by self-efficacy to control drinking. Males were expected to place a greater amount of emphasis on their motivation to comply with their reference group's perceived alcohol-related behaviors. The results of this analysis confirm this hypothesis. Conclusions The results of this study lend additional supporting evidence regarding the trends and patterns of alcohol use among college students. The information provided should be considered when planning and implementing alcohol-related intervention programs that target college students. Body Mass Indices in Disabling Hip Arthritis Ray Marks, John P. Allegrante Purpose To determine whether individuals diagnosed as having disabling hip joint arthritis across the lifespan would have body mass indices (BMIs)indicating they were either overweight or obese. Methods The BMIs of 425 males and females ranging in age from 26-92 years, and requiring surgery for hip osteoarthritis, a potentially preventable degenerative joint disease, were recorded by an independent nurse specialist according to standard procedures. Being overweight was defined as having a BMI of at least 25 kg/m2, whilst being obese was defined as having a BMI of 30 kg/m2 or more as per CDC guidelines. Results Body mass indices higher than age-associated norms were recorded for at least 65% of all cases surveyed, regardless of age category studied. At ages 30-39 years, 62.5% of 16 cases in this age category had BMIs >25 with an average BMI of 28.80. Patients who had had previous surgery and complications warranting reimplantation of new surgical devices had BMIs on average in the obese range. Conclusions It is possible that as with disabling knee arthritis, cumulative exposure to excessive body weight during childhood and throughout adult life may contribute to early and continuous degeneration of the hip joint(s) and to a poorer outcome than one might anticipate from joint replacement surgery. As advocated by the CDC and AF, interventions to obviate poor nutritional practices and promote activity in early life, along with weight-loss programs in adult life may be important in efforts to reduce the disability and substantial morbidity of hip osteoarthritis. Knowledge of Risks Associated with Prostate Cancer (CaP) Screening and Treatment Inka Weissbecker, Sally P. Weinrich, Martin C. Weinrich Purpose To contrast knowledge of risks between men who attended a free screening and men who did not attend. Methods A low-income zip code area in Louisville, KY, with a high CaP mortality rate was chosen, and all men over 40 received a letter announcing a free CaP screening. The men who attended the screening (n=25) completed a questionnaire, and randomly selected men who chose not to attend (n=17) were interviewed by telephone. The 42 men were 80% African American with a mean age of 52 years. The Knowledge of Risks and Benefits Scale has eight items, a 5th grade reading level and a reliability (theta) of 0.61 using factor analysis. A three-item Risk Subscale measured knowledge of risks of incontinence, impotence and the lack of agreement among experts about CaP screening. Descriptive analyses and Mann-Whitney tests were performed. Results Surprisingly there were no significant differences in the mean number of items answered correctly between men who came for the screening (M=4.0) and men who did not attend (M=3.76, p>.10). Similarly, there were no significant differences on the Risk Subscale between the two groups (p>.10). Only 19% of the men knew that experts disagree over whether or not they should have a CaP checkup. In contrast, most men knew about the risk of incontinence (57.1%) and the risk of impotence (64.3%). Conclusions This study highlights the need to inform men about the risks of CaP screening and treatment in order to comply with CaP screening guidelines, which emphasize informed decision-making. Seventh to Twelfth Graders' Perceptions of College Student Drinking Dennis L. Thombs, R. Scott Olds, Jennifer Ray Tomasek Purpose To examine relationships between perceptions of college student drinking and substance use risk factors. Methods An anonymous survey was administered to 2,017 Ohio public school students in grades 7-12. Results Only 5% of the sample indicated that they had never heard about alcohol use among college students. The sample perceived very high rates of college student drinking at "typical campus parties," with the mean number of drinks consumed as 9-10. The distribution of the student ratings had a pronounced positive skew. For example, about 14% of the sample perceived that "20 or more drinks" (the most extreme response option) were consumed by typical college students at typical campus parties. A discriminant function analysis showed that this segment of students was at high-risk for tobacco, alcohol, and marijuana use, and were likely to perceive that substance use was normative behavior among their current schoolmates. Conclusions By seventh grade, judgments about alcohol use on campus appear to be formed in a large majority of students. Frequently, these perceptions of normative drinking behavior appear to grossly exaggerate the extent of drinking on campus when compared to findings from national studies on college student drinking. The presence of these erroneous perceptions may be a marker for alcohol and drug problems in individual youth. The findings suggest that social norm marketing campaigns need directed at middle schools and high schools. The data also challenge universities to incorporate alcohol misuse indicators into their admissions criteria and to educate prospective students about alcohol in their recruitment efforts. Triangulation of Methods for Evaluation of Complex Health Promotion Processes: The Florida Prevention Research Center's Community-Based Prevention Marketing Model Danice K. Eaton, Lauren J. Bailey, Melinda S. Forthofer, Robert J. McDermott Purpose To present the methods used by the Florida Prevention Research Center (FPRC) to evaluate the Community-Based Prevention Marketing (CBPM) model implemented in the demonstration community of Sarasota County, Florida. Framework The CBPM model is a community-directed process for promoting social change by applying marketing strategies and community organization principles to the design, implementation, and evaluation of health promotion and disease prevention programs. A central principal of CBPM is community participation and control. Overview The FPRC is employing a comprehensive evaluation to determine the utility of the CBPM model to prevent alcohol and tobacco use by middle school youth. The evaluation is three-pronged, including context, process and impact measures. Context evaluation assesses events or activities occurring in the community during the project that may influence project outcomes. Strategies used in context evaluation include content analysis of media and relevant local agency/coalition activities and local event logs. Process evaluation assesses the fidelity of the model's implementation. Tools used in process evaluation include monitoring of training and interviews with key informants. Impact evaluation relates the CBPM process to changes in the community's ability to sustain the CBPM process beyond the initial demonstration project period. Key outcome measures assess community capacity at regular intervals. Conclusions Triangulation of research methods will optimize the comprehensiveness and validity of the CBPM model's evaluation. Improving the CBPM model enhances its potential to address other populations and issues. Smoking Cessation Benefits among Managed Care Health Plans Marilyn J. Wells Purpose Smoking costs managed care health plans nearly $20 million in avoidable medical and health care costs annually. Effective smoking cessation treatments including, prescription and over-the-counter medications and behavioral interventions, however, can significantly and positively impact the financial burden of smoking on managed care. Therefore, the purpose of this market research was to determine the extent, to which health maintenance organizations (HMOs) routinely include smoking cessation as a covered benefit. Key-decision makers on health plan benefits, key decision-making steps in the benefit design process, and key influential factors for determining covered benefits also were investigated. Methods From the population of all licensed HMOs in the United States (N=625), a sample of convenience (n=35) was selected based on industry and geographic representation. Data were collected through telephone interviews of HMO management using a structured interview guide, and verified through review of health plan documents and marketing materials. Quantitative and qualitative methods were employed for data analysis. Results Results indicate that approximately 90% of health plans do not include smoking cessation as a core plan benefit, even though nearly three-fourths promote smoking cessation through value-added services. Concerns over the cost-effectiveness, cost-benefit, and efficacy of smoking cessation interventions, as well as lack of competitive-advantage and standardized performance measures were reported as key barriers. Conclusions Recommendations include educating health plan consumers, managed care decision makers, and healthcare professionals on the financial impact of smoking on managed care, smoking cessation guidelines and treatments, and the beneficial outcomes (clinical, economic, and humanistic) of smoking cessation benefits and services. Developing Motivational Practitioners: A Postmodern Approach Rick J. Botelho Purpose To describe how practitioners can adopt a motivational role with patients and use a method of continuing professional development (CPD) to address health behavior change Framework The concept of roles delineates how practitioners can behave differently with patients. First, they need to learn how to change themselves (second order change) before changing others (first order change). Then, practitioners can use a six-step approach in how to adopt a motivational role with patients. This mental map incorporated 12 motivational principles, theories and models in a coherent and pragmatic manner for busy practitioners. Overview Practitioners have been predominantly trained to adopt a "fix-it" role in addressing unhealthy behaviors. Health information and advice works with a minority of patients (5-20%). This role is dysfunctional for resistant patients. Practitioners can learn how to adopt a motivational role with resistant patients, before they learn how to develop motivational skills. Self-directed, lifelong learning methods along with ongoing training opportunities can help practitioners continually develop their skills throughout their professional careers: from novices to masters. Effective education can accelerate their professional development as motivational practitioners. Conclusions CPD can increase practitioner satisfaction and performance in helping resistant patients change over time. They can work with patients when proven interventions of limited effectiveness do not work. A motivational approach can help them engage these patients in dialogues over time. They can develop individualized interventions to meet patients' changing needs over time. Effective interventions help patients change their perceptions and values in ways that they motivate themselves to change. A Prospective Study of Social Cognitive Theory Determinants of Physical Activity Rick A. Petosa, Jason Yost, Melinda Everman, Melissa Grim Purpose The purpose of the study was to prospectively test selected Social Cognitive Theory (SCT) variables in predicting free living physical activity in college students. The study focused on the SCT variables of self-regulation, self-efficacy, outcome expectancy value, and social support. These variables were chosen as potentially modifiable in the context of university exercise promotion programs. Methods The sample consisted of 400 undergraduate students enrolled in an general studies courses at a midwestern university. The subjects were tested over a period of ten weeks. In weeks one and two, the variables of self-efficacy, self-regulation, outcome expectancy value, social support. In weeks three through ten seven-day recall of moderate and vigorous exercise was collected. All instruments have established reliability and validity. Results Only 10% of the sample met recommended levels of physical activity consistently over a period of five weeks. Results revealed a mean of 1.5 days per week (SD =1.4) for vigorous exercise. Multiple regression analysis revealed that the SCT variables accounted for 30% of the variance in total days of vigorous exercise. Significant variables were outcome-expectancy value (p=.008) and self-efficacy (p=.02). Self-regulation and social support were not significant (p>.05). Conclusions Almost all studies of the determinants of free living physical activity are done retrospectively. This prospective study revealed that college students' physical activity varies over a period of five weeks. Social Cognitive Theory was useful in accounting for variance in physical activity. The NOAH Project: New Opportunities to Advance Health R. Paul Thomlinson, Cami Stanley, Todd Schaible Purpose This presentation will describe the rationale, structure, and initial outcomes of the NOAH Project (New Opportunities to Advance Health), a two-year system intervention under way at Cox Health Systems (CHS) in Springfield, Missouri. FrameworkOur assertion is that it should be as easy for a physician's office to schedule a patient for a health education opportunity as it is to schedule a patient for an imaging procedure or lab work-particularly if such offerings have been shown through research to reduce health care costs, enhance health outcomes, and dramatically improve patient satisfaction. A system which achieves this goal has much potential to ameliorate the fragmentation, disruptions, and discontinuity of care often experienced by patients and providers in both managed care and more traditional health care arrangements. Overview The presentation will cover background information and rationale for the project, including such findings as these: (1) conventional clinical activities (eg, diagnostic testing) may be of less value to patients than activities once considered outside the traditional role of the physician (eg, patient counseling and education), (2) one of the initial tasks of the physician practicing in this mode is shifting control to the patient, and (3) among the most effective interventions available to clinicians for reducing the incidence and severity of the leading causes of disease and disability are those that address the personal health practices of patients. Additionally, while health care organizations once focused almost exclusively on helping people overcome illness or injury, on helping patients get well; the focus is of necessity shifting to encompass both, get well and stay well, activities. Beneficially, parallel with this shift in focus of providers, has been a growing consumer interest in fitness, self-help, nutrition, health education, and alternative therapies. And, improvement in patient outcomes and cost offset effects represent compelling reasons for the systematic provision and coordination of a system-wide patient and family education initiative, including the outpatient population. The studies supporting this premise are voluminous, and cover nearly every major cause of disease and disability known to us (eg, asthma, arthritis, cancer, cardiac care, diabetes, etc.). While CHS has the aforementioned wide array of health education services available, with potential for even greater diversity of offerings, not enough has been done to make available these important tools for physicians to extend and enhance patient outcomes by providing their patients with education and guidance regarding self-help and health maintenance. Conclusions In late 1998, CHS was awarded a small grant from the Burrell Foundation to initiate activities to achieve integration of supply and need for health education interventions. Principles, action plans, and personnel are in place for the system-wide coordination of need and resources. Further, a comprehensive evaluative study of the outcomes of this initiative, particularly at the interface of the patient-provider relationship, is ongoing. The basic objectives for this research include evaluating the implementation and outcomes of a coordinated education initiative, with regard to patient health status improvement, self-efficacy enhancement, and health care resource utilization. This paper will provide a detailed look at all aspects of the NOAH Project, including initial outcomes data from the Chronic Disease Self-Management Program. Validity and Reliability of a Self-Regulation for Physical Activity Instrument Rick A. Petosa, Cheryl McGaha Purpose The purpose of this study was to develop a valid and reliable self-report instrument to measure the constructs of self-regulation theory as they pertain to physical activity behavior among adults. The description of Bandura's self-regulation theory provided the conceptual foundation used during item development. Methods A 40-item research instrument was developed through three stages. In the first, face and content validity was established through a two-stage expert review process. During the second, the instrument was pilot tested on 122 adults and established as a reliable measure (internal consistency, =.90 and stability coefficient, r=.86). In the third stage a random sample of 236 adults employed at a large university in the Midwest completed the instrument through mail survey. This sample was used to test the construct validity of the instrument via factor analysis. Results Factor analysis revealed an eight-factor solution represented by the 40-item instrument: 1) Denial of rewards for failing to exercise as intended, 2) Written recordings of exercise, 3) Disappointment for failing to exercise as intended, 4) Mental processes associated with exercise performance and goals, 5) Written setting of goals for exercise, 6) Self rewards for exercise, 7) Bad feelings associated with exercise, and 8) Good feelings associated with exercise. Each of the factors was supported as stable, and items making up the factors were established as internally consistent indicators (indexes ranging from =.88 to =.97). Hierarchical multiple regression analyses revealed that 17% (F=10.10, p<.05) of the variance in moderate physical exercise and 19% (F=10.77, p<.05) of the variance in vigorous physical exercise was uniquely associated with self-regulation constructs. Conclusions The study produced a valid and reliable measure of self-regulation strategies for physical activity. This instrument should be tested against other determinants of physical activity among adults. Values Orientation and Health Behaviors among Adolescents in an alternative high school in New Mexico Keely S. Rees, Sharon Thompson Purpose This study was designed to identify the relationship between values orientation and health-compromising behaviors. Two research questions were used: (1) Will adolescents with a societal, future-based values orientation report participation in fewer health-compromising behaviors than those with a present, self-interest-based values orientation? (2) Among the high-risk adolescents, will there be a significant relationship between values orientation and the four most prevalent health-compromising behaviors? Methods This descriptive study used inferential statistics and correlational survey methods. The population included students attending an alternative high school in New Mexico. Forty students, 15-20 years of age, completed a combined survey that determined their value orientation and their past health-compromising behaviors. The instrument included six demographic questions, a modified Youth Risk Behavior Survey, and the Rokeach Values Survey. Results An ANOVA was selected to test the differences of the values orientation and health-compromising behaviors among the adolescents. The data for the first research question posed was not found statistically significant. The second research question was addressed by running a Spearman rho rank correlation on the overall risk-taking behavior category (low, medium, and high risk) and the four health-compromising behaviors risk classification and were not found statistically significant. There was a significant relationship (r=.288; p=<.05) found between violent and unsafe sexual practices using a one-tailed test. Conclusions The most prevalent problems reported for youth in rural New Mexico are drinking alcohol, physical violence, and other behavioral problems ("Study: Rural teens," 1993). Based on the previous literature, however, the results of these adolescents' value orientations and health risk did not concur with what others have hypothesized about `high-risk' populations. The nature of this study's results may have interesting implications for future research with similar populations. Relationship of Age-Grade Status Congruency And Health Risk Behaviors in High School Students: An Analysis of 1997 Youth Risk Behavior Survey Data Teresa J. Byrne, Laurie M. Yoo, Deborah D. Shama Purpose The purpose of this study is to examine the relationship between age-grade status congruency and six categories of risk behaviors (behavIors that contribute to unintentional and intentional injuries, tobacco use, alcohol and other drug use, sexual behaviors, unhealthy dietary behaviors, and physical inactivity). Methods By combining two variables(age and grade)as collected on the 1997 YRBS for high school students, three age-grade status groups were established: age-grade congruent and age-grade incongruent (overage and underage). A series of four-way analyses of variance were used to analyze the differences on the risk behaviors among age-grade status groups, actual grade, and the demographic characteristics of gender and ethnicity. Results The results showed that there were significant differences between age-grade congruent and age-grade incongruent students on a number of health behaviors, particularly in the areas of unintentional and intentional injuries, tobacco use, alcohol and other drug use, and sexual behaviors. Furthermore, differences were found for actual grade, gender, and ethnicity. Numerous interactions were also obtained. Conclusions The practices of delayed and early school entry, as well as grade retention and acceleration, are based on incomplete and inconsistent data gained primarily through research on the early grades and on academic achievement. Findings from the YRBS indicate that the age-grade status congruency in high school has significant implications for behavioral risk factors. These findings support the seminal work of Byrd, Weitzman, and Doniger (1996) and the earlier work of Peterson and Crockett (1985) and add to this fairly meager body of research. The Protective Role of Decision Making Skill Level in the Relationship between Socioeconomic Status and Rural Adolescent Smoking Kimberly L. Henry, Daphne Minner, Judith Vicary, Lori Bechtel Purpose The purpose of this study was twofold. The first objective was to investigate the ability of poor emotional tone and positive attitudes(believes substance use has benefits) toward alcohol, tobacco and other drug (ATOD) use to mediate the relationship between low socioeconomic status (SES) and rural adolescent smoking. Secondly, to investigate the protective role of high level decision-making ability. Methods The data for this study were taken from the ADAPT project, a five year program funded by NIDA. The first wave of data for 711 7th graders in nine rural Pennsylvania schools was used. The hypotheses were tested using structural equation modeling. Results The overall direct effect of low SES leading to increased incidence of smoking was significant. SES was also found to be a significant predictor of emotional tone and positive attitudes toward ATOD. In addition, a positive attitude toward ATOD was found to be a significant mediator between SES and smoking. Path differences for good compared to poor decision makers revealed that the relationship between SES and smoking status and positive attitude and smoking status was significantly stronger for the poor decision makers. Conclusions These results support previous findings suggesting that lower SES adolescents are more likely to possess a positive attitude toward ATOD and use substances than their non-rural peers are. This study found that decision making skill level can partially buffer this relationship, suggesting that increasing cognitive behavioral skills such as decision making may help to delay the initiation of smoking. The Relationship between Exercise Self-efficacy and the Stages of Behavior Change in College Students Bradley R. A. Wilson, Amy E. Pawlak, Amy L. Bernard Purpose The purpose of this study was to examine the relationship between exercise self-efficacy and an individual's stage of change as related to exercise behavior among college students. Methods A questionnaire containing several self-efficacy scales (assessment, expectation, and outcome), a perceived health scale, and a stage of scale was distributed to 733 college students. Results Results indicated a significant relationship between exercise self-efficacy and stage of change, assessment r=.245 (p<.0001), expectation r=.554 (p<.0001), and outcome r=.245 (p<.0001). As the stage of change increased toward maintenance, self-efficacy also increased. An ANOVA demonstrated significant differences in self-efficacy scores based on the stage of change: assessment (F(4,728)=55.56, p<.0001), expectation (F(4,728)=82.33, p<.0001), and outcome (F(4,728)=12.01, p<.0001). A Scheffe' post hoc found no differences between the stages precontemplation and contemplation, or preparation and action for the assessment sub-scale. The maintenance stage was significantly different from the other four stages. For the sub-scale expectation all five groups were significantly different from one another. The outcome sub-scale showed the most similarities. A Pearson Correlation found perceived health was positively correlated with stage of change, r=.497 (p<.0001). Conclusions These data are useful for targeting students with exercise information based on the individual's stage of change status. Since students at different stages of change have different self-efficacy for exercise, program promotional materials targeted at specific stages of change may be warranted. Using Theoretical Constructs in the Conceptualization and Development of a Curriculum Stephen Nagy, Leslie F. Clark Purpose To share the methodology of curriculum design employing a theoretical framework. Framework A developmental, strength-based curriculum to reduce at-risk behaviors for students in grades 6, 7, and 8 utilized the Theory of Possible Selves and Health Education Theory to conceptualize a 20-day curriculum for each grade level. Constructs from Possible Selves, might become, hope to become, and afraid to become were blended with the two main health education approaches; risk reduction and growth (Wellness). Overview The methodology incorporated a three-stage process. Stage one involved the development of the main themes of the curricula as well as the unit themes. This was based on the theoretical constructs. The second stage determined the emphasis of the theoretical constructs within the curricula. The third stage was the development of actual lesson plans through the use of social learning activities. Conclusions The development of an intervention should be theoretically driven and theory should be applied in the conceptualization of curriculum materials, unit development and individual lessons. This process will ensure that day-to-day activities in the program will address the program objectives. Association Between Exercise and Quality of Life in a Population-based Sample Natalie Colabianchi, Elaine A. Borawski Purpose To explore the association between exercise and quality of life (QoL) (ie, number of days of depression, sleeplessness, anxiety, pain, and vitality in the past thirty days) using a population-based sample of adults, aged 18 years and older. Methods Data from the 1998 Behavioral Risk Factor Surveillance System (BRFSS) were used. Exercise questions are included in an optional module and therefore only 14 states participated (N=42,631). Exercise was defined as physical activity for at least 20 minutes/3 times a week. Regression models were used to examine the primary association between exercise and QoL. In addition, the study examined interactions between exercise and three major covariates, self-reported health, age and gender. Additional covariates included education, employment and race, however their interaction with exercise was not examined. Separate models were run for each of the five outcomes for those in excellent-good health and fair-poor health. Adjusted means and 99% confidence intervals were calculated for each model. Due to the large sample size and number of analyses, non-overlapping 99% confidence intervals for the adjusted means were used to designate significant differences between exercisers and non-exercisers. Analyses were performed using STATA (release 6) to account for the sampling design and the use of clustering and stratification. Results In the multivariate analyses, exercise was significantly associated with three of the five quality of life measures including depression, pain, and vitality. Stratified analyses demonstrated that the benefit of exercise varied by age, gender and/or self-reported health for four of the five quality of life measures (depression, pain, sleeplessness, and vitality). Conclusions Identification of life-style behaviors that increase quality of life is an important part in reaching the goals for Healthy People 2010. This study shows that exercise is associated with higher quality of life for those in excellent-good health as well as for those in fair-poor health and that exercise may be particularly important for older adults. Substantiating Pregnancy Risk Factors for Adolescent Males Stephen Nagy, Christine Nagy, Graham Watts Purpose To examine pregnancy risk factors for adolescent males and identify a theoretical framework for future intervention. Methods Data were obtained from the 1998 Alabama Adolescent Survey, a paper and pencil measure that utilized 8 school districts. Approximately 2200 students completed the survey. 931 male Caucasian and African-Americans completed the survey item asking whether the student had caused a pregnancy or thought they had done so. Logistic regression was used with the dependent measure, 4 violence measures, 3 drug use measures, one academic aspiration item, and two items on friends. Results Demographic and peer measures were modest predictors with significant odds ratios (OR) below 2. Academic aspirations were good predictors (OR=3.7). The best predictors were substance use and violence measures with OR between 4 and 8. Conclusions Jessor's theory of problem behaviors predicts that problem behaviors are inter-related. Conceptually this implies intervention addressing multiple risky behaviors and their antecedents. The data from this study support problem behavior theory in that, risky behavioral items were powerfully linked with having caused a pregnancy. Demographic, items on peers and academic aspiration variables did not have the same predictive power. This has major implications for pregnancy prevention interventions designed for males. Programs need to identify at risk students and address the cluster of risky behaviors to impact on pregnancy prevention. A "one size fits all" approach is unlikely to succeed. Feasibility of Virtual Health & Wellness Center Catherine Salveson, Deborah C. Messecar Purpose The purpose of this study was to examine the feasibility of implementing a virtual health and wellness center in the Oregon Air National Guard (ORANG) The specific aims of the study were to describe Air Guard Members goals for making health behavior changes and their preferred formats for receiving information that will assist them. Methods A survey was constructed with ORANG member focus group input. The survey asked about the health behaviors members wanted to change, and explored their current access to, and use of the Internet to make these changes. Surveys were mailed to 1,368 persons, and 540 surveys were returned for a response rate of approximately 40%. Results 89% of respondents answered that they had thought of making one or more health behavior changes in the past year. Among those that had contemplated making changes, the most popular change was becoming more physically active (94.6%) followed by improving eating habits (86%), or losing weight (81%), and improving stress management (62%) and reduction of tobacco use (46%). Popular sources of health behavior change information used included reading material (95.5%) and the Internet (91.3%). Health care providers were the most important resource participants reported using (90%) when seeking personal service help with making a behavior change. Conclusions According to the respondents of this survey, use of the Internet by health professionals to promote health behavior change seems feasible and desirable Oral Sexual Behavior in Adolescents Bradley O. Boekeloo, Donna Howard, Kathy O'Connor Purpose Adolescents are at risk for sexually transmitted diseases (STDs) including HIV through various unsafe sexual behaviors. Most surveys on the sexual risk behaviors of adolescents are vague in regard to which risk behaviors are being measured. Oral sexual behaviors are often ignored in surveys on sexual risk in adolescents. It is not known to what extent risk identification could be improved if oral sex were measured. Methods In 1995, adolescents age 12 through 15 years old were surveyed regarding their sexual behaviors when they visited their pediatrician for a general health examination. The survey was part of a larger risk reduction demonstration project. Study sites were six pediatric practices in Washington D.C. Adolescents were confidentially administered questions by a research interviewer about their lifetime involvement in vaginal and oral sexual behaviors. Results Vaginal intercourse was reported by 24% of adolescents. The rates of passive and active oral sex, respectively, were 14% and 8% for males vs. 20% and 13% for females. Rates were higher among the older age groups. Had only vaginal sex been assessed, 4% of adolescents at risk due to passive oral sex and 3% due to active oral sex would not have been identified. Again, rates were higher in the older age groups. Oral sex was associated with other risk behaviors such as alcohol use. Conclusions This study suggests that young adolescents may be involved in oral sexual behaviors that may put them at risk for STDs and HIV. Although asking about specific oral sexual behaviors may be difficult logistically, politically, and interpersonally, thorough risk assessment may require this measurement. The Influence of Demographic Variables on Stress in Graduate Teaching Assistants Maureen K. Morrissey, Mark J. Kittleson Purpose Graduate students are vulnerable to stress, particularly those employed as teaching assistants. Teaching assistants (TA's) may be overwhelmed with having to provide quality instruction to undergraduates while simultaneously attending to their own academic and professional growth. Because of these demands, TA's may exhibit physical and psychological symptoms of stress, possibly resulting in serious illness. The purpose of this study is to examine the effects of several demographic variables on stress in graduate teaching assistants. Methods The sample consisted of 515 graduate teaching assistants (TA's) from a midwest university. The TA's were employed in the College of Liberal Arts, Education, or Science during the fall 1998 and spring 1999 semesters. Two hundred twelve TA's completed and returned the instrument. Results The resulting probability level of .213 indicated there was no significant difference in stress between male TA's and female TA's. For the research question examining ethnicity as a predictor of stress, the distribution of TA's by ethnic groups were as follows: 11 were African or African American, 18 were Asian or Asian American, 163 were Caucasian, three were Hispanic, and five described themselves as "other". An ANOVA was used to compare the stress between groups. The resulting probability of .173 indicated there was no significant difference in stress between ethnic groups. Of the participating TA's, 131 were in the College of Liberal Arts, 24 were in the College of Education, and 45 were in the College of Science. The resulting p-value was .48, indicating there was no significant difference in stress between TA's of different colleges. Conclusions Since there was no significant difference between the two groups, it can be concluded that both male and female teaching assistants effectively manage their stress. Also, neither males of females are the dominant gender, as the number of TA's in both groups is relatively equal. Although there were no significant differences in stress between TA's of different ethnic groups, this study considered stress as subjective and occurring within a time period of one month. However, the differences in stress may change with the time of the semester, such as "finals week". Also, differences in stress may between the different ethnic groups if stress were defined in terms of specific symptoms or life events rather than as a global, subjective concept. Regardless of academic college, teaching assistants face many demands in their dual roles as student and educator. This may account for the similarity in stress between teaching assistants of different academic colleges. Although academic colleges other than education employed many teaching assistants, they may actually enjoy teaching and may not feel the pressure of working in an environment they dislike. In conclusion, this study examines the influence of several demographic variables on stress in graduate teaching assistants. These demographic variables may compound the difficulties already faced by teaching assistants, who must excel both as students and educators. Additional studies predicting stress in teaching assistants should be conducted, as stress that is not effectively managed can result in inferior instruction for undergraduates and in serious illness for the teaching assistants themselves. Effectiveness of AbstinenceOnly and SaferSex Curricula Among Middle School Adolescents Elaine A. Borawski, Loren Lovegreen, Carolyn Tung, Katy Abbott Purpose To examine the effectiveness of two alternative HIV prevention curricula taught in six urban middle schools: abstinenceonly (focus on benefits of abstinence until marriage) and safersex (focus on condoms and building negotiation and resistance skills). A pair of schools each received one of the intervention curricula, the remaining pair served as controls (received delayed intervention). The goal of the study was to determine whether interventionexposed students would report changes in knowledge, efficacy, beliefs, peer norms, intentions and sexual activity, when compared to a control group and to each other. Methods A total of 910 8th graders completed a pretest and 12week posttest (72% followup): 378 (42%) received the safersex curriculum, 280 (31%) received the abstinenceonly curriculum, and 252 (28%) served as controls. Followed students were significantly more likely to be younger, female and less sexually experienced at baseline than those not followed. Results Multivariate analyses examined the change in cognitive and behavioral outcomes, controlling for baseline measures of the outcome, demographics and prior sexual experience. When compared to controls, students from both interventions demonstrated increases in knowledge, abstinence beliefs, and efficacy to resist sexual advances. SS students demonstrated an increase in condomuse efficacy while AO students showed a decrease. However, AO students reported lower sexual intentions, and were marginally less likely (p=0.06) to have sex during the evaluation period. These behavioral results were more pronounced among female and sexually inexperienced students than males or those sexually experienced prior to the intervention. Conclusions While both interventions had an effect on knowledge, attitudes, and efficacy, the AO program had a more consistent effect (albeit short term) on intentions and behavior. However, due to the low condomuse efficacy in the AO group, there is concern that these students will be at higher risk when they initiate sexual activity in the future. Social Support and Prenatal Care on the U.S./Mexico Border Sharon E. Thompson, Keely S. Rees Purpose The purpose of the study was to gather information about perceived satisfaction of social support during pregnancy and participation in prenatal care. Methods The proposed research method for this study was a cross sectional survey. A convenience sample of 106 participants was obtained at four Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites in El Paso, Texas. The research question examined for this study, will there be a difference between mean social support scores and level of prenatal care among participating women, was explored by a one-way analysis of variance. The alpha level for detecting statistically significant mean differences for this study was set at p<0.05. Results A significant difference between mean social support scores and level of prenatal care was found to exist. The Social Support Apgar Score (SSAS) for participants varied significantly with the level of prenatal care (F =4.175, df=2, 89, p<0.05). The mean SSAS for women of inadequate prenatal care was 24.2500 (n=16). The mean SSAS of participants of intermediate prenatal care was 22.0909 (n=11), and the mean SSAS of women with adequate levels of prenatal care was 30.5692 (n= 65). Conclusions Women who reported receiving social support in the form of adaptation, partnership, growth, affection, and resolve/commitment, reported adequate prenatal care. More supportive environments may be more conducive in overcoming obstacles that could impede the acquisition of adequate prenatal care. Social support programs continue to be a simple and cost-effective method of improving various health outcomes, including but not limited to birth and natality outcomes. Based on the present study and existing maternal and child health literature, it would appear to be reasonable for facilities and agencies working with pregnant women to administer the Social Support Apgar or like-instrument so that estimates of social support, as an important variable in birth outcomes, can be documented. Women reporting low-levels of informal social support could be directed to an agency-sponsored formal social support network Sexual Self-Disclosure: What We Tell, What We Don't Tell and Why Margit B. Gerardi, Andrea Berndt Purpose Don't ask and don't tell may or may not work in the military, but adolescents must learn how to disclose and inquire about their sexual history and that of potential partners. To date, research has primarily examined adult self-disclosure in friendships, with strangers, and within relationships including physical intimacy. Less is known about adolescent sexual self-disclosure in general. Beyond that, unique factors that explain adolescent sexual self-disclosure such as peer pressure, values, and developing morality need to be explored. Methods Established surveys were used to assess adolescent disclosure, demographics, and characteristics such as age and education. New surveys were developed to examine adolescent perceptions about appropriate sexual practices as well as their self-reported corresponding behaviors. Results Factor analysis indicated some unique adolescent self-disclosure patterns. However, results also support some similarities to previously published adult disclosure. A MANOVA indicated females were more likely than males to disclose perceptions of appropriate practices. Further, the MANOVA results suggested disclosure increased with age and was influenced by acculturation. Finally, a discriminant function analysis reveals specific patterns of actual behaviors and perceptions that reliably separated adolescents. Conclusions This study indicates that adolescent self-disclosure in some ways is different from adult self-disclosure. Health care professionals can benefit from this information by tailoring health and educational interventions to adolescents. Finally, this research may have interdisciplinary value that provides shared relevance for professionals from clinical, community, health care, and academic settings. Construct Validation of a Four-Session Worksite Intervention on Selected Social Cognitive Theory Variables Linked to Adult Exercise Adherence Jeffrey S. Hallam, Rick Petosa Purpose Exercise interventions delivered at the worksite have produced inconsistent results. While some studies produced modest, short-term increases in exercise behavior, other studies produced little effect. It is suggested that the careful use of behavioral theories can increase the effectiveness of health promotion programs. In response, many worksite interventions now claim to be based on theory. Yet, a careful reading of these articles makes it difficult to determine precisely how theories are incorporated into the intervention. Most important, few of these evaluations have documented the impact of the intervention on targeted theoretical constructs. The purpose of this study was to test the construct validity of a four-session worksite exercise intervention on selected Social Cognitive Theory variables linked to adult exercise adherence. The Social Cognitive Theory variables measured were exercise self-efficacy, outcome-expectancy values for exercise and the use of self-regulation skills for exercise. The intervention was designed to produce enduring changes in the Social Cognitive Theory variables. Ergo, observations were collected at six weeks, six months, and 12 months. Testing construct validity of the treatment establishes a foundation upon which causal linkages between theoretical variables and subsequent exercise behavior can be based. Methods To recruit participants into the experimental group, a two-page flyer was distributed to all employees of a service-type industry (N=7,000). The flyer promoted an exercise class for employees that wanted to begin exercising or had just begun and needed help to stay with their program. The exercise stages-of-change instrument was used to screen employees into the study. If employees were categorized in the Contemplation, Preparation, or Action stages, they were eligible for enrollment. Five hundred and ninety-eight employees returned an enrollment form and an exercise stages-of-change instrument. The first 60 employees that met the selection criteria were notified through interoffice mail of confirmation of enrollment in the class. The comparison group was formed by randomly selecting 120 employees that joined the company's fitness center no longer than 30 days before the beginning of the intervention. This group was chosen to compare the theory-based intervention with the program that was normally offered to employees that join the fitness center. The treatment group was formed by self-selection and equivalency between the treatment group and the comparison group cannot be assumed. Therefore, a nonequivalent pretest/posttest design was employed with observations made at six weeks, six months, and 12 months. Three SCT variables were measured for all observations: (1) outcome-expectancy value, (2) exercise self-efficacy, and (3) the use of self-regulation strategies for exercise. Each instrument used in this study had established reliability and validity. Results Only those participants that completed all four observations were included in the analysis. The results show a significant increase in the use of self-regulation for exercise from pretest to posttest. The treatment group was able to maintain the use of the self-regulation skills over 12 months. There was no difference between the groups on self-regulation for the pretest, but the treatment group increased their use of self-regulation strategies and maintained that use while the comparison group continued to decrease in their use of self-regulation strategies. No significant increase in exercise self-efficacy was found. No significant differences in Social Cognitive Theory variables were detected for the comparison group. Each Social Cognitive Theory variable score decreased for the comparison group for all posttest observations except for self-efficacy which increased one point from the six-week posttest to the six-month posttest. Outcome expectancy-value changed significantly from the pretest to posttest for the treatment group. When outcome expectations and outcome expectancies were examined independently, the results showed a statistically significant increase for outcome expectations for the treatment group, but no statistically significant difference for outcome expectancies. Conclusions This study shows that selected Social Cognitive Theory variables are changeable in a relatively brief intervention. Specifically, the use of self-regulation techniques to support regular exercise was found amenable to change. The intervention provides a model program of how to elicit changes in self-regulation techniques and outcome expectancy-value (specifically outcome expectations). The intervention was a classroom-based program that produced statistically significant changes in two of three selected Social Cognitive Theory variables. The comparison group reported small, non-significant decreases in all Social Cognitive Theory variables measured in this study. The comparison group received a program of assessment, instruction and access to facilities, which is common to many worksite based fitness promotion programs. Clearly, this approach did not have a favorable impact on psychosocial variables associated with exercise adherence. These results may be explained by a reevaluation of beliefs and perceived capabilities to exercise once faced with the real experiences related to the adoption of an exercise program. This observation warrants further study. With the limited contact hours health promotion specialists have with employees, this intervention shows that a short-term intervention can be successful in changing self-regulation skills and outcome-expectancy values. Future research should examine what level of use of self-regulation skills and what level of outcome-expectancy values are necessary and sufficient for the adoption and maintenance of exercise behavior. Moreover, future research should study the relationship between changes in theoretical variables and subsequent changes in exercise behavior. How Alienation and Declines in Social Capital are Affecting Adolescent Well-being Donna E. Howard Purpose Social indicators suggest a rise in alienation and decline in social capital. How these affect personal and collective well being is examined, with specific reference to U.S. adolescents. Framework Sociologic constructs such as social integration, social capital, and alienation are integrated with interpersonal health behavior theories to model pathways by which youth either disengage from the social fabric of society or engage in subcultures that promote risk and anti-social behavior, such as violence. Overview For poor, urban, minority families the pronounced and widening gap in the distribution of income and other resources may give rise to social disorganization, low social cohesion, and perceptions of marginalization. It is within this context that youth attempt to realize developmental goals such as mastery, self-esteem and self-identity. The destabilizing effects of such inequities allow violence and other forms of antisocial and delinquent behavior to flourish and may lead to the experience of hopelessness and despair. For suburban higher income youth, the increase in dual working parent households has lead to a growing number of adolescents in unsupervised activities with declining adult contact, supervision and guidance. This may lead some youth to experiment with risk behaviors, and others to explore internet sites which, while appealing to youthful desires for connection and validation, espouse hate and violence. Conclusions Social integration at the personal and community level is an important protective factor for adolescent well being. Why Girls Smoke: A Community-based, Peer-led Program: Helping Each Other Resist Smoking (HERS) Mary Ann Faucher, Sherry Carter Purpose The purpose of this project is to review literature findings related to why teenaged girls begin to smoke. In addition, evidence about smoking prevention program's strengths and weaknesses is summarized and incorporated into a new and innovative smoking prevention program specifically targeted at teenaged girls ages 13 to 15. The poster will highlight the evidence and describe a community-based, peer-led smoking prevention program, The HERS (Help Each Other Resist Smoking) Program, which is based on research findings and constructs of the theory of reasoned action and the theory of planned behavior. Framework Ajzen and Fishbein's (1986) theory of reasoned action and theory of planned behavior is particularly suitable for a successful smoking prevention program designed specifically for adolescent girls. This theory matches well with the knowledge that females are more likely to report social norms and peer pressure as reasons to initiate smoking as compared to their male counterparts (Sarason, et al. 1992). In addition, the construct of behavioral beliefs provides the avenue for addressing the strong association between weight control and perceived body image as reasons young women report for initiating and continuing smoking (Hynes, 1989). Moreover, the model constructs of perceived behavioral control and perceived power can be applied to develop aspects of the program that will increase the young women's feelings of accomplishment and self-respect (eg, physical fitness and cooking classes). Both constructs have been demonstrated to be inversely related to smoking in young women (Allen, Leadbeater, and Aber, 1990; Clayton, 1991; Grube et al., 1984; Hynes, 1989). Battjes's (1985) four-fold classification system provided the framework for developing methods suitable for social-influence programs and Atkinson's (1964) third principle of motivation, the value of incentive, is included in both phase I and phase II of the HERS program. Overview A large suburban community with an organized program of recreation centers is the location of this proposed smoking prevention program. The program consists of 2 phases, each one year in length. Behavioral and normative beliefs elucidated in focus groups will be used to design program content. In addition, recommendations from the 1987 expert advisory panel of The National Cancer Institute will be incorporated. In Phase II, relapse prevention, evidence obtained from the literature guides development of multimedia strategies. Conclusions Recent statistics demonstrate the rising use of cigarettes in young women along with the proportional increase in morbidity and mortality in girls that smoke (ACS, 1997). This combination clearly merits a focused and gender specific approach towards prevention. The evidence suggests that prevention programs with strong social influence components directly target the reasons girls initiate smoking. Ajzen and Fishbein's theory of reasoned action provides a suitable framework and the incentives enhance motivation. Structured classroom time with role-playing is intended to influence attitudes toward the behavior of smoking. Reasonable target goals for physical fitness and opportunities to practice healthy eating should instill feelings of accomplishment and provide healthy substitutes to smoking. This program, in entirety, should increase the likelihood of the participants moving into a phase of planned behavior, which is to resist smoking. Integrating Substance Abuse Prevention and Health Promotion: Ten Years of Research James V. Trudeau, Royer F. Cook Purpose This presentation describes a program of research showing that integrating substance abuse prevention into workplace-based health promotion enhances the former without diluting the latter. A sophisticated yet practical social-learning approach raises awareness, knowledge and motivation about health and substance use while bolstering needed skills. Five studies conducted in varied industries over ten years are summarized. Methods The studies used rigorous research designs and methods, including random assignment to condition (intervention/comparison), staggered implementation in which comparison subjects subsequently received the intervention, and sophisticated multivariate analysis of pre/post data. Settings included manufacturing (evaluation of the SAY YES! program), publishing (Working People program), construction (Power Tools program) and insurance (Connections and Prime Life 2000 programs). Participants completed confidential Health Behavior Questionnaires addressing attitudes, behavioral intentions and behaviors related to various aspects of substance use, health and behavioral health. The latest study included human resources data (eg, employee performance ratings) and healthcare claims data. Results Workplace-based health promotion activities were shown to improve various health-related outcomes, including perceived health control, health behaviors, stress management, and healthy eating. Moreover, subjects receiving integrated substance abuse prevention materials improved relative to comparison subjects on outcomes including perceived risks, substance use to relieve stress, and alcohol use. One study found increased post-intervention utilization of behavioral healthcare. Conclusion Integrating substance abuse prevention into workplace-based health promotion increases participation and provides a context for discussing the connections between substance use and health. This approach offers considerable promise for reaching millions of working adults with substance abuse prevention messages and materials. This is an important point because the majority of substance abusers are working adults, and workplace programs are the best way to reach them. An Evaluation of an Abstinence Education Curriculum Series Michael E. Young, George Denny, Susan Rausch, Caile Spear Purpose The purpose of the study was to examine the effects of an abstinence education curriculum series on student outcomes, including measures of sexual behavior. Methods The curriculum was taught by trained school personnel at three levels: upper elementary, junior high and high school. Project staff administered a questionnaire to all students before the curriculum was implemented and after completion of the curriculum six weeks to two months later. Comparison group students also completed the questionnaire at the same times, but did not participate in the curriculum. The analysis was based on 386 upper elementary students, 698 junior high school students, and 337 high school students. Data were analyzed using ANCOVA, with pretest scores serving as covariates, and logistical regression. Results Upper elementary - the curriculum group had significantly better outcomes on knowledge, self-esteem, and self-efficacy. Middle school - no significant differences between the two groups. High School - findings favored the curriculum group on attitude, intent to remain abstinent, and on the sexual behavior variables (sexual intercourse ever and sexual intercourse in the last month). Conclusion Results indicated that the high school program may be of benefit in helping young people abstain from sexual intercourse. We did not expect behavior change to occur at any grade level during the relatively short time from pre-test to posttest. That such changes were noted at the high school level is encouraging. Long-term follow-up is needed to determine the effect of the program on the behavior of the younger students. Risk Factors as Predictors of Adolescent Alcohol Involvement Michael S. Dunn, Chudley E. Werch Purpose The purpose of this study was to determine predictors of three alcohol use measures (ever tried, stage of initiation, and current use) among middle school students. Methods Data were obtained from a three-wave cohort of sixth - eighth grade students participating in a school-based alcohol use prevention program. From the Fall of 1996 to the Spring of 1998, 650 students completed the Youth Alcohol and Drug Survey. This instrument measures alcohol and drug consumption and alcohol-related cognitive, social and behavioral risk and protective factors. Linear Regression analysis procedures were used to determine predictors of the dependent variables: 1) ever tried alcohol, 2) stage of initiation, and 3) current use alcohol use. Results Results of this study found that risk factors tended to increase as students progressed to higher grade levels. Mother's alcohol use, situation, emotional coping, and environmental influencibilty were found to be strongly predictive of ever tried alcohol among seventh and eighth graders. Emotional coping, cigarette use, and marijuana use were found to be predictive of stage of initiation and current use among seventh and eighth graders. Conclusions Risk factors were found to increase with grade level, as such preventive efforts should be designed to provide support on how to effectively deal with peer pressure. As students progress to higher grades, they are faced with more peer pressure and influencing factors. Students need to be taught strategies that reinforce developmentally appropriate skills that enhance personal competency as effective barriers against risk factors. Body Weight and Physical Activity Levels in Cancer Patients Undergoing Elective Hip Surgery: Implications for Prevention and Rehabilitation Sandra G. Avila, Ray Marks, John P. Allegrante Purpose To evaluate whether patients with a past history of cancer, undergoing total hip arthroplasty (THA), would be overweight and have lower physical capacity compared to patients undergoing THA with no history of cancer. Methods Body Mass Indices (BMI's) and Ideal Weights of 95 individuals with a cancer history undergoing THA were compared to 55 THA patients in the same age range, with no cancer history. Pre and post-surgical physical capacity as indicated by measures of walking distance was also assessed. Results Analysis of medical records showed that: 1) 66.3% of 95 THA patients with a cancer history were overweight or obese, a figure comparable to those without any disease, where weight may be a risk factor. 2) THA patients with a cancer history had a lower physical capacity immediately before and after surgery compared to THA patients with a cancer history. Conclusion Excess body weight and low physical capacity, which are implicated factors for cancer and osteoarthritis, are common findings in cancer survivors undergoing THA for painful hip arthritis. This finding has not previously been reported, and has important public health and clinical implications.
Reviewers: Gregory
H. Frazer Am J Health Behav 2001;25(4):318-341 |