Schoolwide effects of a multicomponent HIV, STD, and pregnancy prevention program for high school students.

Few studies have tested schoolwide interventions to reduce sexual risk behavior, and none have demonstrated significant schoolwide effects. This study evaluates the schoolwide effects of Safer Choices, a multicomponent, behavioral theory-based HIV, STD, and pregnancy prevention program, on risk behavior, school climate, and psychosocial variables. Twenty urban high schools were randomized, and cross-sectional samples of classes were surveyed at baseline, the end of intervention (19 months after baseline), and 31 months afterbaseline. At 19 months, the program had a positive effect on the frequency of sex without a condom. At 31 months, students in Safer Choices schools reported having sexual intercourse without a condom with fewer partners. The program positively affected psychosocial variables and school climate for HIV/STD and pregnancy prevention. The program did not influence the prevalence of recent sexual intercourse. Schoolwide changes in condomuse demonstrated that aschool-based program can reduce the sexual risk behavior of adolescents.

Psychosocial predictors of delay of first sexual intercourse by adolescents.

This investigation predicted adolescents' delay of intercourse onset from attitudes, social norms, and self-efficacy about refraining from sexual intercourse. Age, gender, ethnicity, and parental education were also examined as predictors and moderators of the relationships among the 3 psychosocial determinants and onset. The participants (N = 827), part of a cohort initially surveyed in the 9th grade, reported at baseline that they had never engaged in intercourse. The multivariable proportional hazards regression model suggested that adolescents with more positive attitudinal and normative beliefs, as well as those with a parent who graduated from college, were less likely to engage in intercourse in the follow-up period (up to approximately 2 years). Interventions that include an objective to delay onset may benefit from addressing psychosocial determinants, especially attitudes and norms about sexual intercourse.

PIP: This study predicted adolescent's delay of intercourse onset from attitudes, social norms, and self-efficacy about refraining from sexual intercourse. Age, gender, ethnicity, and parental education were also examined as predictors and moderators of the relationships among the three psychosocial determinants and onset. The longitudinal data for the study were obtained from 827 participants in the US who were part of a cohort initially surveyed in the 9th grade. These participants reported at baseline that they had never engaged in intercourse. Utilizing the multivariable proportional hazards regression model, findings suggested that adolescents with more positive attitudinal and normative beliefs were less likely to engage in intercourse in the follow-up period (up to approximately 2 years). This was also the case for those students with a parent who graduated from college. Attitudes and norms were the most robust predictors of intercourse. In addition, a relatively modest increase in either scale was predictive of a 30% reduction in the onset of future intercourse in the most conservative analytic model. Interventions that include an objective to delay onset may benefit from addressing psychosocial determinants, especially attitudes and norms about sexual intercourse.

Factors associated with occupational exposure and compliance with universal precautions in an urban school district.

Factors associated with occupational exposure and universal precautions (UP) compliance were assessed among employees in one urban school district. Half of the employees surveyed reported responding to bleeding injuries and cleaning blood or other body fluids (e.g., vomit, urine) during the previous school year. Also, 1 in 4 custodians and 1 in 10 teachers/teacher's aides had direct contact with blood or body fluids without protection. In multivariate logistic regression analyses, direct contact was most likely among secondary school employees in unpredictable situations who did not have protective equipment or comply with UP. UP compliance was greater among those who had protective equipment available and felt self-confident. Self-confidence was associated with having received training or protective equipment. Routine communications between administrators and employees, staff training, provision of protective equipment, and exposure incident monitoring are essential to effective implementation of UP policies in schools and work settings where occupational exposure could occur.

Behavioral scientists at the Centers for Disease Control and Prevention. Evolving and integrated roles.

The behavioral sciences offer theories and methods that are critical to fulfilling the mission of the Centers for Disease Control and Prevention (CDC). Behavioral scientists have been integrated into the epidemiological and biomedical traditions of the agency, thereby broadening the effectiveness of prevention strategies that rely on behavior change. The diversity and changing nature of the roles of CDC behavioral scientists are presented, along with a discussion of how they connect to ongoing public health efforts. Psychological theories and methods, especially, have relevance for tackling many of the challenges facing public health. Some of these challenges, and the opportunities they present for psychologists and other behavioral scientists, are discussed.

Preventing HIV infection among adolescents: evaluation of a school-based education program.

BACKGROUND: This article reports the results of the impact of a school-based HIV prevention intervention on students' knowledge, attitudes, and behavior related to HIV infection. METHODS: Seventeen schools within six Colorado school districts were assigned to either intervention or comparison conditions. Students in 10 schools received a 15-session, skills-based HIV prevention curriculum implemented by trained teachers. A total of 2,844 students completed at least one survey during the study period; surveys were matched using demographic questions, yielding a cohort of 979 students who had baseline and 6-month follow-up data. RESULTS: Intervention students exhibited greater knowledge about HIV and greater intent to engage in safer sexual practices than the comparison students. Among sexually active students at the 6-month follow-up, intervention students reported fewer sexual partners within the past 2 months, greater frequency of using condoms, and greater intentions to engage in sex less frequently and to use a condom when having sex. Intervention students were also more likely to believe that teens their age who engage in HIV risk behaviors are vulnerable to infection. The intervention neither delayed the onset nor decreased the frequency of sexual intercourse and the frequency of alcohol and other drug use before sex by the 6-month follow-up assessment. CONCLUSIONS: The results suggest that skills-based risk reduction programs can have an effect on student behavior. Among sexually active students, evidence suggests that school-based interventions can reduce behavior associated with risk of HIV infection.

A processes of change model for weight control for participants in community-based weight loss programs.

The processes of change model has been successful in predicting behavior change across a wide range of both addictive and nonaddictive problem behaviors. This study was designed to examine the application of the processes of change model to weight control. Study participants included 285 women and men enrolled in three community-based weight loss programs. Results based on structural equation analyses showed that the processes of change model fit the data better than several plausible alternative models. In addition, structural analyses revealed the existence of two general (higher order) processes of change for weight control, the experiential and behavioral processes. These results are similar to those previously reported for eight other problem behaviors. Limitations of the current work and future directions for this line of research are discussed.

Three-year follow-up of Pawtucket Heart Health's community-based weight loss programs.

PURPOSE: The purpose of the study was to evaluate the effectiveness of a community-based weight loss program. DESIGN: A questionnaire was administered by telephone to subjects one to three years following participation in a weight loss program. SETTING: The study took place in Pawtucket, Rhode Island. The Pawtucket Heart Health Program is part of this setting. SUBJECTS: A stratified sample of 400 subjects was randomly selected from 2,186 people who participated in weight loss programs between 1985 and 1987. A total of 285 subjects completed the questionnaire; 229 subjects provided sufficient information to be included in the study. INTERVENTION: The subjects participated in community-based and worksite-based weight loss programs. MEASURES: Self-reported heights and weights before and after intervention and demographic data were collected. Desirable body weight and Garrow's health risk classifications were calculated. RESULTS: Overall, there was a 3.2% reduction in body weight between time of entrance into weight loss programs and time of interview. Eighty percent of the participants lost weight in the program; mean weight loss was 11 pounds. At time of follow-up interview one to three years later, 65% of subjects weighed less than at entrance into the community programs; on average, subjects weighed six pounds less. Sixty-nine percent of the sample was above 20% desirable body weight at entrance and 26% of this group lost enough weight to lower their health risk category. CONCLUSIONS: Weight loss in this community-based program compares favorably with those reported by more intense and expensive clinic-bound programs.(ABSTRACT TRUNCATED AT 250 WORDS)

Self-reported and measured weights and heights of participants in community-based weight loss programs.

Self-reported weights and heights of 82 adults were compared with measured weights and heights 1 to 3 years after participation in community weight loss programs. The mean self-reported weight was 2.3 +/- 1.9 kg lower than measured weight (P < .05). Differences in underreporting were not significant for gender or age group. Heavier individuals misreported their weight to a greater extent (P < .05) than lighter persons, and individuals who had not recently weighed themselves underreported their weight to a greater extent than those who had weighed recently (P < .05). On the average, height was overreported by a mean of 1.8 +/- 2.7 cm. Overreporting increased with increasing height, and men overestimated their height to a greater extent than women (P < .05). Younger subjects reported their height more accurately than those older than 60 years. Results of our study are similar to those of previous investigations that examined self-reporting bias in subjects enrolled in weight loss programs. The mean discrepancy in body weight, however, was greater than that reported in samples drawn from the general population. Our findings indicate that self-reported weight and height values in overweight populations should be interpreted with caution.

The FPbase microcomputer system for managing community health screening and intervention data bases.

Health promotion and intervention projects at State and community levels need computerized data bases to assist in making policy decisions and in operating the projects. Computer data base systems are used in entering, storing, retrieving, and analyzing information about health project activities and their participants in a timely and cost-effective manner. Computer support is essential for such labor-intensive tasks as post-screening followup of participants, identifying subpopulations, and evaluating recruitment efforts and behavior change programs. The Pawtucket Heart Health Program developed a microcomputer software package, FPbase, for community health project data base management. FPbase is described and is available for use by other organizations. FPbase incorporates formative and process interactive data base activities and is suitable for use in operating intervention and screening programs at State and local levels. The system accommodates management of data for social marketing, evaluation, followup, and promotional activities.

Using the stages of change model to increase the adoption of physical activity among community participants.

PURPOSE: This study examined the use of the stages of change model to design an exercise intervention for community volunteers. DESIGN: The "Imagine Action" campaign was a community-wide event incorporating the involvement of local worksites and community agencies. Community members registering for the campaign were enrolled in a six-week intervention program designed to encourage participation in physical activity. SUBJECTS: Six hundred and ten adults aged 18 to 82 years old enrolled in the program. Seventy-seven percent of the participants were female and the average age was 41.8 years (SD = 13.8). SETTING: The campaign was conducted in a city with a population of approximately 72,000 and was promoted throughout community worksites, area schools, organizations, and local media channels. MEASURES: One question designed to assess current stage of exercise adoption was included on the campaign registration form as were questions about subject name, address, telephone number, birthdate, and gender. INTERVENTION: The intervention included written materials designed to encourage participants to initiate or increase physical activity, a resource manual describing activity options in the community, and weekly "fun walks" and "activity nights." RESULTS: A Stuart-Maxwell test for correlated proportions revealed that subjects were significantly more active after the six-week intervention. Sixty-two percent of participants in Contemplation became more active while 61% in Preparation became more active. CONCLUSIONS: Most participants increased their stage of exercise adoption during the six-week intervention. This study provides preliminary support for use of the stages of change model in designing exercise interventions.

Enhancing adherence to referral advice given at blood cholesterol screenings: impact on participant follow-up and physician behavior.

Adherence to referral recommendations given to participants at blood cholesterol screening programs is a critical aspect of these efforts to help detect and control high blood cholesterol in the US adult population. In this study, 386 participants who had received two consecutive blood cholesterol measurements above 240 mg/dl (6.21 mmol/l) were interviewed by telephone 3 months after their second measurement (May 1987 - May 1988). Approximately 40% of respondents had seen a physician by the time of the interview; another 30% reported having scheduled an appointment. There was no significant difference in adherence behavior between participants who received a letter reiterating the referral and those who did not. However, participants who received the letter reported greater physician attention to the evaluation and treatment of their high blood cholesterol, primarily because these participants stated that they visited their physician for their high blood cholesterol. Significantly higher rates of further blood tests, cholesterol education material distribution, cholesterol-lowering medication prescription and patient-physician discussions about cholesterol were the result. These findings suggest that consumers can be effective in stimulating and reinforcing physician practice behaviors related to cholesterol control. However, strategies must be crafted so that consumers are aware of, and appreciate, the necessity of seeking physician care when they become aware of a high blood cholesterol level.

Pawtucket Heart Health Program point-of-purchase nutrition education program in supermarkets.

Point-of-purchase nutrition education in supermarkets is one intervention strategy of the Pawtucket Heart Health Program, a community cardiovascular disease prevention program in Pawtucket, Rhode Island. Using consumer intercept interviews, awareness of shelf labels and their effect on purchase behavior have been continuously evaluated. Between 1984 and 1988, the percent of shoppers who could identify correct labels increased from 11 percent to 24 percent (95% confidence intervals of difference: 7.17). The percent who reported they were encouraged to purchase the identified foods increased from 36 percent to 54 percent (95% CI of difference: 5.41).

Impact of public education and continuing medical education on physician attitudes and behavior concerning cholesterol.

Current physician attitudes and behavior concerning elevated blood cholesterol, recent changes, and reasons for change were measured in a survey of physicians in two cities. Those in a community with both continuing medical and public education programs reported changing their practice significantly over the past two years, more so than those in a comparison community. The physicians did not identify specific elements of a continuing medical education program as important in these differences. Physicians in Pawtucket, Rhode Island, identified requests from the public as important and statistically significant factors in their changed behavior, suggesting that the public education program has become an important influence on physician behavior.