The effect of a communications campaign on middle school students' nutrition and physical activity: results of the HEALTHY study.

The HEALTHY Study was a 3-year school-based intervention designed to change the behaviors of middle school students to reduce their risk for developing type 2 diabetes mellitus. This report examines the relation between exposure to communications campaign materials and behavior change among students in the HEALTHY intervention schools. Using data from campaign tracking logs and student interviews, the authors examined communications campaign implementation and exposure to the communications campaign as well as health behavior change. Campaign tracking documents revealed variability across schools in the quantity of communications materials disseminated. Student interviews confirmed that there was variability in the proportion of students who reported receiving information from the communication campaign elements. Correlations and regression analysis controlling for semester examined the association between campaign exposure and behavior change across schools. There was a significant association between the proportion of students exposed to the campaign and the proportion of students who made changes in health behavior commensurate with study goals. The results suggest that, in the context of a multifaceted school-based health promotion intervention, schools that achieve a higher rate of exposure to communication campaign materials among the students may stimulate greater health behavior change.

Delivery of an HIV prevention counseling program in an infectious diseases clinic: implementation process and lessons learned.

Current national guidelines recommend that all HIV care providers routinely counsel their HIV-infected patients about reducing HIV transmission behaviors. In this article we identify the challenges and lessons learned from implementing a provider-delivered HIV transmission risk-reduction intervention for HIV-infected patients (Positive Steps). Based on a multi-site Centers for Disease Control and Prevention (CDC) initiative, we integrated the Positive Steps program into an infectious diseases clinic in North Carolina. Of the nearly 1200 HIV-infected patients, 59% were African American, 44% were white, 33% were women, and over 50% were between 25 and 44 years of age. We obtained feedback from a community advisory board, input from clinic staff, and conducted formative interviews with clinic patients and providers to achieve overall acceptance of the program within the clinic. Clinic providers underwent training to deliver standardized prevention counseling. During program implementation we conducted a quality assessment of program components, including reviewing whether patients were screened for HIV transmission risk behaviors and whether providers counseled their patients. Once Positive Steps was implemented, on average, 69% of patients were screened and 77% of screened patients were counseled during the first 12 months. In analyses of quarterly exit surveys of patients after their medical exams, on average, 73% of respondents reported being asked about safer sex and 51% reported having safer-sex discussions with their providers across six quarterly periods. Of those who had discussions, 91% reported that those discussions were "very" or "moderately helpful." Providers reported time and competing medical priorities as barriers for discussing prevention with patients, however, provider-delivered counseling was routinely performed for 12 months. Overall, the findings indicate that the Positive Steps program was successfully integrated in an infectious diseases clinic and received well by patients.