A multi-city community based smoking research intervention project in the african-american populatio.

OBJECTIVE: To carry out a community-based research approach to determine the most effective educational interventions to reduce smoking among African-American smokers. The intervention included preparation of the community, planning and developing a model of change, and developing a community-based intervention. The study population consisted of 2,544 randomly selected adult African-American smokers residing in four sites in the northeastern and southeastern parts of the United States. The research design provided a comparison of active intervention sites with passive control sites as well as low income and moderate income areas. MAJOR OUTCOME MEASURES: Point prevalence of non-smoking at the time of interview; Period prevalence of non-smoking at the time of interview; Period prevalence of quit attempts in the prior six months; Number of smoke-free days in the prior six months; Number of cigarettes smoked daily at the time of interview. RESULTS: Based upon a survey eighteen months after baseline data was collected, all four measures of cigarette smoking behavior showed a strong statistically significant reduction of personal smoking behavior among those receiving active interventions versus the passive group. On the basis of process variable analysis, direct contact with the project staff in the prior six months was significantly higher in the active intervention areas. There was only a small non-significant increase in personal smoking behavior in moderate income groups as opposed to low income groups. CONCLUSION: An analysis of process variables strongly suggests that, within this African-American Community, "hands on" or "face to face" approaches along with mass media, mailings, and other less personal approaches were more effective in reducing personal smoking behavior than media, mailings, and other impersonal approaches alone addressed to large audiences.

A situation analysis of public family planning service delivery in pakistan.

A nationally representative sample of 8 percent of the Government of Pakistan's primary family planning service facilities, the Family Welfare Centres (FWC), was carried out at the request of the Ministry of Population Welfare in mid-1992. The "situation analysis" approach used involved: 1) observation and inventory of services, facilities, supplies and record keeping reviews; 2) observation of interaction between service providers and FP clients at FWC's; 3) interviews with service providers; and 4) exit interviews with FP clients after service provision. This one-day on-site observation by teams of three interviewers provided a unique overview and baseline assessment of the availability of services, the staff functioning and the quality of service. Significant findings include a low caseload, inadequacies of facilities, some stockouts, lack of educational materials, insufficient outreach, unnecessary medical and social barriers to providing contraception as well as in some cases insufficient information to clients about contraindications to contraceptive usage and possible side-effects. The need to bolster in-service training and supervision is emphasized.

Developing more effective family planning, family health and family welfare programmes: opportunities for government-NGO collaboration. Executive summary and policy implications.

PIP: In the Asia and Pacific region, national and large city governments have provided most family planning, family health, and family welfare services since the early 1950s. The leading reason for government involvement continues to be that governments have adequate resources to set up and administer large enough family planning programs to achieve government objectives of lower fertility and slower population growth. Many of these government programs have indeed increased contraceptive use, reduced population growth, and decreased fertility. On the other hand, these programs often use coercive tactics to persuade couples to accept family planning. Other negative parts of these programs are inadequate monitoring, slow to improve service quality, limited contraceptive choices, improper service provision, inadequate information for and counseling of clients, and inadequate follow up of acceptors. Some reasons for these negative aspects are insufficient resources, too much emphasis on new acceptor recruitment, lack of recognition of the importance of continuing contraceptive prevalence, and too little emphasis on client satisfaction. Nongovernmental organizations (NGOs) have also helped in the evolution of family planning, family health, and family welfare services in the Asia and Pacific regions. They have provided policy and programmatic innovations serving as new models to governments. NGOs can take the political heat off of political leaders who are anxious about those who resist family planning. NGOs tend to provide a broader mix of contraceptive services than do government programs. Increased use of working groups and expansion of operations research on NGO programs can strengthen collaboration between governments and NGOs. The working groups with specialists from government and NGOs could examine service delivery problems and propose solutions.^ieng

Information, education and communication needs in family planning: the case of pakistan.

In spite of three decades of national family planning programmes, Pakistan's contraceptive prevalence rate was only 12 percent in 1991. Furthermore, the government family planning service delivery systems, primarily the family welfare center (FWC), cover less than 10 percent of the people in rural areas. Although there are cultural and religious constraints to social change, it can be argued effectively from recent surveys that there is a considerable need for family planning that has yet to be met. Certain barriers to, and options for, meeting this need are reviewed, particularly in terms of strengthening information, communication and education (IEC) at the community level.

Mass media usage among black smokers: a first look.

This article discusses preliminary results of a National Cancer Institute-sponsored pilot baseline survey in 1989 of smoking knowledge, attitude and habits among black smokers in four major U.S. cities: two in the North (Springfield, Massachusetts and Hartford, Connecticut) and two in the South (Durham, North Carolina and Columbia, South Carolina). It focuses on mass media readership, viewing and listening habits and a preliminary discussion of their application to practice.

Eating attitudes, dieting, and bulimia among junior high school students.

Students in a western New England (U.S.) junior high school (ages 11-15) were surveyed in 1986 to identify attitudes and behaviors about eating and dieting which might foster disordered eating habits. Although few students met official criteria for disordered eating habits, at least 12 percent did practice dieting and 28 percent were frequently preoccupied with the desire to be thinner and/or were terrified of being overweight. One-quarter of girls (vs. only 3.2% of boys) mistakenly classified themselves overweight. Perception of one's own weight seems to be more highly correlated with measures of eating attitude and behavior than does actual weight. Differences also were found in how males and females viewed their own weight although both dieted to about the same extent. Females also were more interested in having school classes on eating and dieting. Recommendations were made for prevention and education regarding eating disorders among this age group.

Direct contract public health training between an asian government and a u.s. University: 1984 - 1988.

A one-semester, non-degree public health training program for staff of various levels of health agencies in Taiwan conducted at the School of Public Health, University of Massachusetts, Amherst during 1984-88 is described. The project's evolvement, organization, specific training objectives and methodology, operation, cost, and evaluation are reviewed. Attention is paid to training feasibility and the advantages of avoiding third-party sponsoring agencies in international projects.

Implications for adolescent sex education in Taiwan.

This first Taiwan-wide sample survey of adolescent sexual awareness, knowledge, attitude, and behavior shows that secondary school students there: lack basic knowledge about contraception and reproduction, are often not being taught adequately about these subjects in school, have fairly permissive attitudes about sexual relationships, particularly males, are sexually active, particularly males and those in the private vocational high schools (although less so than their US counterparts), want to learn more about the nature of intimate relationships between males and females, and look to school and public health agencies to be more active sources of information and education.

PIP: A random sample of all 780,000 students in Taiwan's public and private senior and vocational high schools, as well as in 5-year junior colleges was drawn in late 1983. To provide a clearer understanding of the existing social situation among adolescents, the study investigated sexual awareness, knowledge, attitude, and behavior, as well as apparent educational needs. Students were aged 15-20+ years. The following findings resulted: the students lacked basic knowledge about contraception and reproduction; they are often taught these subjects inadequately; males, in particular, have fairly permissive attitudes about sexual relationships; students are sexually active; they want to learn more about the nature of intimate relationships between males and females; and they look to school and public health agencies to be more active sources of information and education. Although only 3.6% of all students surveyed have had sexual intercourse, more than 3 times that proportion approved of sexual intercourse if 2 people loved each other. Nearly 1/2 of the wives aged 20-24 in Taiwan had had sexual intercourse before marriage. The growing trend toward increased premarital sex indicates a need among Taiwan's youth for an educational curriculum that includes contraception and family planning, and extends through the 15-19 year old age group. Enhanced sex education in the schools calls for in-service training of teachers, curriculum review, and preparation of appropriate course materials.

How Basic Beliefs about Human Life Relate to Ethical Judgments about Induced Abortion.

This survey explores family planning field workers' basic beliefs and value assessments related to a new human life and their relationship to their verbal statements of ethical judgments about induced abortion under varying circumstances. It also relates these beliefs to stated experience of abortion referrals. Implications for education and research with application to many international social issues are discussed.

Beyond family planning: incentives in taiwan.

Two large-scale, long-term research projects to test the feasibility of using positive and non-coercive incentives to encourage having fewer children and spacing were carried out in Taiwan during the 1970s. The results of these long-term projects are presented. The Educational Savings Plan, begun in 1971, provided financing for the secondary school education of children whose parents had limited family size to no more than three children. The Spacing Incentive Plan, begun in 1975, encouraged prolonging the interval between first and second births to at least three years by providing free birth delivery of the second child. Although both were less successful than anticipated, much was learned about the social, economic, and practical difficulties of program implementation.

Research needs in family planning program promotion.

PIP: Areas of family planning promotion which need to be further researched are identified. The effectiveness of diverse information, education, and communication approaches needs to be evaluated, feasible ways to increase contraceptive continuation rates must be identified, the relative merits of providing fieldworkers with salaries or incentives should be assessed, different styles of interactions between providers and clients should be identified and evaluated and research directed toward improving training programs, field supervision, and supply logistics should be undertaken. A number of more detailed research suggestions with special reference to Taiwan and other Asian and Pacific countries are also provided. Little is known, for example, about provider and user interaction patterns in Asia, and the impact of these patterns on contraceptive acceptance and continuance. These patterns could be analyzed using diverse research techniques ranging from observation to experimental manipulation. Despite the fact that approximately 50% of all acceptors discontinue use within 2 years, researchers tend to focus on identifying acceptor characteristics while ignoring the discontinuation process. Researcher should 1) identify the best time for providing postacceptance followup services, 2) identify training strategies which provide fieldworkers with the highest level of confidence in specific contraceptive methods, 3) experiment with the use of newspaper columns and telephone advisory services to provide users with information about side effects, 4) assess the merits of involving both partners in the contraceptive counseling process, 5) develop and evaluate postacceptance educational materials, and 6) assess the impact of various supply systems on contraceptive continuance. Another neglected area of research is the public's attitude toward different contraceptive knowledge sources. For example, receptivity to family planning messages may vary depending on wether the message is delivered by a physician or by a local trained worker. Research is also needed to assess the feasibility of using advertising approaches to encourage acceptors to switch to more effective methods of contraception. The psychosocial needs of acceptors and cultural differences in response to family planning promotional activities should also be explored. Research barriers include a lack of field-trained researchers, limited interest in family planning among scholars, inadequate government and donor support and funding, a failure to provide funds for longterm research, and inadequate communication between researchers. In Taiwan there is a need to 1) conduct more operations research; 2) make more use of previous research findings; 3) focus attention on research aimed at increasing contraceptive use among young people, improving fieldworker and client communication, and expanding the role of nongovernment agencies in family planning; and 4) develop a national population research institute.^ieng

Community health education literature from the seventies: a field practitioner survey-part 2.

A national sample of community health education practitioners in the United States was surveyed by mail and asked to select five articles published during the 1970's that they would recommend their colleagues read. The study was conducted in late 1979 after a comparable national survey of university health education faculty by Cernada and Chen (International Quarterly of Community Health Education, 1:2 and 2:1). The recommended readings were collected and abstracted, and are presented in annotated bibliographic form. This annotated bibliography follows up on the collection published in Volume 4, Number 4, of the International Quarterly of Community Health Education which covered Community Health Education Policy, Theory, and Social Issues-its focus is on Applied Research, Evaluation, and Case Studies.

Continuing Evaluation and Research Needs in National Family Planning Promotion: Plus a Change, Plus C'est La M me Chose.

A priority listing of existing health promotion research needs in large-scale family planning programs in East and Southeast Asia is presented. Areas of needed research include: family planning Provider/User Interaction; Contraceptive Use Continuation; Perceptions of Service Source; Comparative Educational and Social Marketing Approaches; and Psyco-Social Needs. Interestingly, many of the present needs were identified by researchers and program planners in national and international agencies more than a decade ago. Possible reasons for their not being implemented are discussed.

A survey of eating/dieting attitudes and bulimic behavior among university undergraduate women.

A random sample of female undergraduates at a large New England state university was surveyed by mail in 1983 to determine their attitudes and behavior relating to eating, dieting, and body weight. Results indicated dissatisfaction with and negative attitudes about eating habits and body weight. Forty-five percent had ever experienced uncontrolled binge-eating; 18 percent had a combination of bulimia symptoms, and 10 percent had used self-induced vomiting for weight control. The health education needs and interests of these students also were assessed and recommendations for university programs were made.

Training of trainers for community primary health care workers.

Training community-based health care workers in "developing" countries is essential to improving the quality of life in both rural and urban areas. Two major obstacles to such training are the tremendous social distance gap between these community workers and their more highly-educated and upper-class trainers (often medical officers) and the didactic, formal educational system. Bridging this gap demands a participant-centered, field-oriented approach which actively involves the trainee in the design, implementation and evaluation of the training program. A description of a philosophic learning approach based on self-initiated change, educational objectives related to planning, organizing, conducting and evaluating training, and specific learning methodologies utilizing participatory learning, non-formal educational techniques, field experience, continuing feedback and learner participation are reviewed. Included are: role playing, story telling, case studies, self-learning and simulation exercises, visuals, and Portapak videotape.

Community health education literature from the seventies: a field practitioner survey.

A national sample of community health education practitioners in the United States was surveyed by mail and asked to select five articles published during the 1970's they would recommend that their colleagues read. The study was conducted in late 1979 after a comparable national survey of university health education faculty by Cernada and Chen (International Quarterly of Community Health Education, 1:2 and 2:1). The recommended readings were collected and abstracted, and are presented in annotated bibliographic form. A comparison of practitioner and academic selections is in preparation.

Getting research utilized: the taichung study revisited.

This case study describes how an action-oriented research program served as the base for national expansion of the Taiwan family planning program; what kind of organizational setup and approaches expedited getting research results utilized; and how the results were disseminated to other countries considering starting similar programs.

Verbal judgments of Taiwanese family planning field workers about induced abortion.

Four hundred female governmental family planning field workers in Taiwan were asked by questionnaire whether women should or should not have an induced abortion under certain circumstances. Major findings were that although most workers were favorable to induced abortion under most circumstances, many were unfavorable when marital status, parity, and contraceptive usage of the woman were considered. Furthermore, cumulative judgment scales were shown to exist which have important implications for program approaches elsewhere.