Promoting adolescent health: worksite-based interventions with parents of adolescents.

A promising public health approach for reducing adolescent risk behavior is to recognize and support the role of parents in promoting healthful behaviors. Although there are various settings where parents can be reached, this article focuses on one particular setting--the parent's place of employment. The article discusses the development and implementation of parenting programs for parents of adolescents. Such programs are new and should be evaluated to determine whether they are effective.

Behavioral factors in the health status of urban populations.

Overwhelming evidence indicates the strong adverse health impact of several personal behaviors, including smoking, immoderate use of alcohol, too little physical exercise, and excessive caloric consumption. These behaviors have arisen on a mass scale in the industrialized nations during the 20th century, thus generating the epidemics of our time. The macrosocial environment--specifically, new (relative) affluence, technological innovations, and commercialization--encourages these behaviors. To advance health, particularly in inner cities of America, a systematic approach to dealing with these major forces on health-related behavior is necessary. Such an approach is briefly outlined.

Musings on sixty years in public health.

These reflections on six decades in public health work come from both personal experiences and observations in the field. Attention is given to changes in health problems during the period and how public health workers have responded to them. The commentary also touches on how one proceeds in public health, includes suggestions for effectiveness, notes some difficulties encountered, and briefly describes health progress. The evolution of public health to encompass a much broader scope of activity than in the 1930s and how that has come about is emphasized.

Getting key players to work together and defending against diversion--California.

In 1988, Californians passed Proposition 99, which raised the tobacco tax from 10 cents to 35 cents and allocated 20% of the resulting revenues, approximately $100 million, for tobacco education and 5% for tobacco-related research. Seventy percent was allocated for health care costs and 5% for the environment. In this report, the authors provide an overview of the process of implementing the tobacco education program, which is followed by a more detailed review and analysis of the major impediments to the program, i.e., the diversion of a significant portion of the funding voters had earmarked for tobacco education and research and the battles for legislative reauthorization of Proposition 99 in the 1990s.

Development of a health risk appraisal for the elderly (HRA-E).

The purpose of this project is to develop a health risk appraisal for the elderly (HRA-E) and test its application in both medical and nonmedical settings. The HRA-E system consists of a questionnaire and software for computer-generation of personalized reports to participants, 55 years and older, and their physicians. Items in the questionnaire cover a comprehensive range of content domains relevant to health promotion in the elderly. The goal of the HRA-E system is to prevent functional decline. Samples of eligible subjects from the American Association of Retired Persons (AARP), a group practice, and a senior center were extended invitations to participate. Those responding affirmatively to the invitation were given a questionnaire and evaluation form. Each person who returned the questionnaire received his or her personal report and a second evaluation form. Four months after receiving their reports, respondents were questioned about behavior changes during the interim. Preliminary findings, based on 1895 respondents, indicate that nearly all participants found the questionnaire easy to complete and were pleased with its overall length. In addition, most participants read their reports, and many planned to take action, based on report recommendations. In the next phase of this project, the intent is to refine the questionnaire, extend the intervention protocols for longitudinal application, and evaluate its impact on health-related behaviors, medical care utilization, and functional decline.

Hospital information system and patterns of cancer screening.

Relative ease, implied accuracy, and unprecedented possibilities of computerized health care information systems, is very tempting for researchers. Attempts at determining the referral patterns for cancer screening at a large county hospital through the use of computerized administrative and clinical files, and some of the problems encountered is reported here. Only 17% of women over 18, and 16% of women over 50 who visited this hospital were referred and received screening for cervical and breast cancer, respectively. Pap testing was concentrated at clinics dealing with reproductive health, and women with higher visit frequencies had a higher referral rate. Major problems encountered were lack of uniformity in capturing information for similar variables in different files, inconsistency in capturing data elements, and partial coverage. To enhance capabilities of computerized health information system, following principles must be incorporated in the designs: complete coverage, uniform collection of data across time and files, and inclusion of linking capabilities.

Health practices and disability: some evidence from Alameda County.

With greater longevity people are increasingly concerned about how to avoid disability during their longer lives. Policy decisions concerning ways to extend health as well as life have become part of the nation's health agenda. Opportunity to examine that issue has arisen in the Alameda County Human Population Laboratory. Earlier studies there established seven health practices as risk factors for higher mortality: excessive alcohol consumption, smoking cigarettes, being obese, sleeping fewer or more than 7-8 hours, having very little physical activity, eating between meals, and not eating breakfast. Observation now reveals that, taking into account age, gender, physical health status, and social network index in 1965, the occurrence of disability was only about one-half as great among the cohort survivors in 1974 who reported good health practices in 1965 as among those with poor health practices; those with an intermediate level of health practices experienced about two-thirds the relative disability risk of those with poor health practices. Essentially similar relationships prevailed for the 1982/1983 survivors of the original (1965) cohort who, upon requestioning, had been found to be without disability in 1974.