Community demonstration project initiative: technical support for program development at the community level.

Select population groups are at greater than average risk for cancer incidence and mortality. Lack of experience reaching high-risk populations, particularly those characterized by high proportions of the socioeconomically disadvantaged, presented a challenge to the American Cancer Society (ACS). A partial solution was to integrate outreach to high-risk populations into ACS national priorities and to fund community demonstration projects consistent with these priorities. Technical assistance (TA), which includes expert advice and problem solving, was provided during the first phase to facilitate the development of these projects into "model" projects to learn what initiatives can best be disseminated, or diffused, into target populations. TA also was used to assess how it can enhance the potential for replication. Evaluation of this initiative resulted in a plan to disseminate model projects to selected ACS divisions with varied resources and capabilities (e.g., outreach to high-risk populations, planning, program development, and evaluation) for replication. During the next phase, projects will be evaluated to document the role of TA in facilitating local empowerment and nationwide diffusion of effective cancer prevention and control programs.

Public attitudes about cigarette smoking: results from the 1990 Smoking Activity Volunteer Executed Survey.

The 1990 Smoking Activity Volunteer Executed Survey collected information on a wide range of policy-relevant issues concerning public attitudes about cigarette smoking. These issues include cigarette taxes, advertising restrictions, minors' access to tobacco products, school-based prevention, and exposure to environmental tobacco smoke in workplaces and public areas. Survey data were collected during the spring and summer months of 1990 from random samples of adults from Arizona, Michigan, Pennsylvania, and Texas. Telephone interviews were conducted by trained American Cancer Society volunteers using standardized questionnaires. Cluster sampling techniques, interviewer training and supervision, and data collection procedures were designed in conformity with the methodology of the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention. Smoking prevalence ranged from a low of approximately 20 percent in Texas to a high of 31 percent in Michigan. Between 60 and 69 percent of the respondents in the four States, including between 44 and 71 percent of current smokers, believe tobacco should be classified as a drug. Around 65 percent of the respondents would support an extra tax on tobacco to finance public campaigns against smoking, and between 61 percent and 69 percent favor banning cigarette advertising in the print media and on billboards. More than 82 percent of the respondents believe that stronger laws should be enacted to prevent the sale of tobacco products to minors, and more than 86 percent believe that existing laws should be better enforced. Current smokers were only slightly less likely than were former and never smokers to indicate support of policy changes to prevent minors'access to tobacco products; the two groups had somewhat more disagreement in the amount of support for the other smoking control policies.Finally, although between 62 and 88 percent of working respondents reported the presence of smoking restrictions at their workplace, between 26 and 48 percent still reported being bothered by smoking at work.These study findings suggest that existing smoking control policies are not restrictive enough or are inadequately enforced. The study documents strong public concern in the four States about the in adequacy of current policies and support for the enactment of stronger legislation to control smoking behavior.

A formative evaluation of the American Cancer Society Changing the Course nutrition education curriculum.

A formative evaluation was conducted of Changing the Course, a behaviorally oriented, activity-based nutrition education curriculum for elementary students from the American Cancer Society, to assess feasibility of program implementation. Sixteen teachers in six schools in the Northeast taught the 15-16 session lower and upper elementary curricula to 702 students. Teacher satisfaction with the curriculum was high. Fidelity of implementation of the curriculum also was high and relatively few modifications to learning activities were made. Teachers reported the one day of training they received was adequate. They also reported a positive influence of the curriculum on themselves and their students. Student achievement results showed most children achieved most of the learning objectives at posttest--80% giving the correct answers on more than 75% of the test items. An examination of children's item-by-item answers on the posttest and of teachers' logs provided information useful for the final stages of development of the curricula and teacher training procedures, before national dissemination.

Needs and recommendations for behavior research in the prevention and early detection of cancer.

Because life-style patterns affect many cancer risks, research on health-risk behavior and behavior change is critical to cancer prevention. This report recommends priorities for the next decade of psychosocial research on cancer prevention and detection. The leading priority for future research is to fill gaps in basic knowledge left by the rush to intervention and outcome studies. Such research must be theoretically driven and should aim to develop broad principles applicable to diverse health behaviors. Studies that include relevant process data on various stages of behavior change are considered more desirable than simple outcome studies. Epidemiologic investigations should be expanded to include measures of relevant behaviors, so that their impact on clinical outcomes might be established. More research is needed on lay perception of health risks and on individual and health-system barriers to effective cancer prevention and detection. Studies that address the needs of minority and underprivileged populations are crucial. Funding agencies' narrow categorical mandates impede interdisciplinary research on multiple risk factors and their interactions; these boundaries must be relaxed to promote such approaches. Funding agencies should also consider basic research as a long-term investment towards the development of effective interventions.

Vocational education students: a difficult-to-reach population at risk for smoking-related cancer.

Vocational education high school students comprise a significant proportion of the school-based population. Recent studies indicate vocational education students are at greater risk for cigarette smoking behavior than their non-vocational education counterparts. Vocational students have higher prevalence rates of smoking than do non-vocational students and are more likely to report that they expect to be smoking in the future. Characteristics of adolescents who participate in vocational education and their cigarette smoking behavior are reviewed, as well as the need to develop, implement, and evaluate new educational approaches designed to prevent cigarette smoking and the use of other tobacco products in this difficult-to-reach population.

Risk reduction through comprehensive cancer education: the American Cancer Society Plan for Youth Education.

The American Cancer Society (ACS) Plan for Youth Education for the Year 2000 is discussed in consideration of other health initiatives such as the U.S. Dept. of Health and Human Services' Objectives for the Nation and the National Cancer Institutes' Cancer Control Objectives for the Year 2000. Objectives of the ACS Plan are detailed with corresponding data sources to monitor progress. The Plan is designed to serve as a framework for ACS program planning, implementation, and evaluation in substance use, nutrition and eating patterns, cancer-early detection, cancer-the disease, and the environment. Justification for selecting the priority program areas also is described.