Public attitudes regarding the donation and storage of blood specimens for genetic research.

OBJECTIVE: As sequencing of the human genome is completed, there is a need for population-based research to assess frequencies of genetic variants and their associations with human diseases. The authors therefore assessed the current climate regarding the donation and storage of blood for genetic research. METHODS: Data from the American Healthstyles Survey fo health attitudes and behavior were examined. In the 1998 survey, four questions regarding blood donation and storage for genetic research were posed to the participants. RESULTS: Of 3,130 participants, 2,621 (84%) completed these questions. Of the respondents, 42% were in favor of both blood donation and long-term storage for genetic research, 37% were in favor of either blood donation or storage but not both and 21% were not willing to donate blood or have it stored for genetic research under any circumstances. Loglinear analysis demonstrated that the characteristics of respondents who favored blood donation and long-term storage for genetic research were attitudinal; specifically, those believing that genetic research will prevent disease [odds ratio (OR) 2.9; p<0.001]; those believing in genetic determinism (OR 1.5; p=0.004) and those agreeing they would participate in government research (OR 2.9; p<0.001). The model also demonstrated that characteristics indirectly associated with attitudes toward blood donation/storage for genetic research were demographic and included higher education, white race, living in the Mountain/Pacific or mid-Atlantic regions of the United States and positive family history of a genetic disorder (p<0.05). CONCLUSION: Understanding the various factors contributing to knowledge, attitudes and behavior regarding the donation and storage of blood specimens for genetic research will contribute to future actions in communication genetic research goals to the public and recruitment for population-based genetic studies.

The Centers for Disease Control and Prevention Director's Physical Activity Challenge: an evaluation of a worksite health promotion intervention.

In 1996, the Centers for Disease Control and Prevention launched a 50-day exercise campaign called the "Director's Physical Activity Challenge" to stimulate its employees to exercise. Of the 5822 eligible employees, 3740 (64%) joined, but pre- and post-data was available on only 1192 (20.5%) people. Of this group, 86% of those in contemplation and 64% of those in preparation, and 34% of those in action advanced to a higher stage.

Physical activity interventions using mass media, print media, and information technology.

INTRODUCTION: Media-based physical activity interventions include a variety of print, graphic, audiovisual, and broadcast media programs intended to influence behavior change. New information technology allows print to be delivered in personalized, interactive formats that may enhance efficacy. Media-based interventions have been shaped by conceptual models from health education, Social Cognitive Theory, the Transtheoretical Model, and Social Marketing frameworks. METHODS: We reviewed 28 studies of media-based interventions of which seven were mass media campaigns at the state or national level and the remaining 21 were delivered through health care, the workplace, or in the community. RESULTS: Recall of mass-media messages generally was high, but mass-media campaigns had very little impact on physical activity behavior. Interventions using print and/or telephone were effective in changing behavior in the short term. Studies in which there were more contacts and interventions tailored to the target audience were most effective. CONCLUSION: A key issue for research on media-based physical activity interventions is reaching socially disadvantaged groups for whom access, particularly to new forms of communication technology, may be limited. There is a clear need for controlled trials comparing different forms and intensities of media-based physical activity interventions. Controlled studies of personalized print, interactive computer-mediated programs, and web-based formats for program delivery also are needed. The integration of media-based methods into public and private sector service delivery has much potential for innovation.

Using "stages of behavioral change" constructs to measure the short-term effects of a worksite-based intervention to increase moderate physical activity.

We evaluated a three-level incentive program to promote regular, moderate physical activity among employees working in a federal agency. The objective was to assess the short-term effects of the intervention by examining the stages people go through as they attempt to make permanent changes in physical activity. Indicators of the process by which changes in physical activity take place were based on a modified version of the Transtheoretical Model of Behavior. A one-group pretest/posttest design was used to ascertain which of the stages the 1,192 participants were in both before and after the intervention. Analysis indicated that, of the 1,192 participants, 6.5% regressed one or more stages, 30.3% did not regress or progress from one stage to another, 27.7% remained in the maintenance stage, and 35.4% progressed one (21.1%) or more (14.3%) stages during the 50-day intervention. Among those who progressed, the most common change was from preparation to late preparation (20.8%) and from late preparation to action (19.4%). Findings reinforce the notion that the stages of change concept can serve as indicators of the change process which in turn, can be used as evidence of the short-term effectiveness of interventions. Findings also indicate this type of intervention holds promise for increasing physical activity among willing participants of a worksite population.

Environmental and policy approaches to cardiovascular disease prevention through physical activity: issues and opportunities.

The majority of Americans remain inactive despite evidence of significant health benefits from even moderately intense activity. Previous intervention efforts have generally focused on changing individual behavior. This article discusses the use of policy, legislative and regulatory, and environmental interventions in promoting physical activity to prevent cardiovascular disease (CVD) and other chronic diseases. The authors present evidence on the need, formulation, description, and effectiveness of policy and environmental intervention approaches. Types of approaches addressed to promote physical activity include federal, state, and local legislation and regulation, policy development and implementation, and environmental support. They also describe opportunities for state and local health departments to initiate and participate in environmental and policy approaches.

A model for the inclusion of a physical fitness and health promotion component in a chemical abuse treatment program.

Alcohol and other substance abuse treatment programs are focusing more on the wellbeing of the total patient rather than just targeting functional sobriety. Various explanations are offered in this article for the inclusion of a fitness and health promotion component in a chemical abuse treatment program. The treatment program at Charter Hospital of Fort Worth, Texas, is discussed in detail, including a comprehensive medical examination, fitness and nutritional screenings, and appropriate exercise activities. Educational sessions are offered on health fitness, risk reduction, stress management, smoking cessation, proper nutrition and the positive psychological aspects of exercise. The implications of a health/fitness component in the recovery process are emphasized.

A comparison of results of a national cholesterol and blood pressure screening with the NHANES II Study: implications for further emphasis on reducing cardiovascular risk among Americans.

A comparison was made of serum total cholesterol and blood pressure levels taken from participants in a voluntary national health screening (N = 257,665) in 1988 with estimates for the general U.S. population from the NHANES II Study (1976-80). Although total serum cholesterol and blood pressure levels in the national health screening may be biased due to a higher proportion of females and whites, curvilinear age-related increases in mean total serum cholesterol (peak years 60-69) of approximately the same proportions among "desirable" to "high" classifications, and similar proportional increases in elevated blood pressure readings across age groups, were found in both the voluntary screening and NHANES II population estimates. Within and between gender-comparisons of total cholesterol and blood pressure measures showed greater risk among participants in the present study. The findings suggest that both blood cholesterol and blood pressure levels in the U.S. may not have decreased appreciably in the past decade, and that continued national, state and local public health efforts to modify behaviors related to hypercholesteremia and hypertension are warranted.

Physician and consumer attitudes and behaviors regarding self-help health support groups as an adjunct to traditional medical care.

This study assessed the creditability of self-help health support groups as an adjunct to traditional medical care among a sampling of physicians (N = 120) and group members (N = 73) located in the Dallas/Ft. Worth Metropolitan area. Findings suggest a general lack of awareness of local groups among physicians, referral to only a few select groups, as well as little communication between health care professionals and their patients. Physicians in group practice, surgical specialties, and having never referred patients to support groups responded less favorably. Several benefits were reported by the group members, although for a majority their patient-physician relationship remained relatively unchanged.

Reliability of long-term recall of participation in physical activity by middle-aged men and women.

The reliability of long-term recall of physical activity participation was examined in 322 women and 129 men in a worksite health study conducted at the Liberty Corporation, Greenville, South Carolina during 1976-1987. Leisure time physical activity was assessed at baseline; and energy expenditure in total, light, moderate, and vigorous activities was calculated. The long-term recall of baseline activities was determined 1-10 years after the examination. The relation between actual baseline and recalled activity was positive and in most cases the coefficients were statistically significant at p less than 0.05. The correlations were modest, most in the range of 0.20 to 0.50. Percent agreement between baseline and recalled activity generally ranged from 60 to 75%. Multiple regression analyses suggested that recalled activity was a significant predictor of baseline activity, but recall interval and age were not important contributors to the regression model. R2 values for the model were 0.10 for light activity and 0.26 for vigorous activity. Questionnaire assessment of long-term physical activity recall appeared to be reliable, length of recall interval up to 10 years was not an important factor, and recall of vigorous activity was more accurate than for less intensive activities.

HIV antibody testing: who benefits and who loses?

From a public health perspective, a significant milestone in the AIDS crisis so far has been the development of serologic tests to detect exposure to the HIV. With AIDS now reported in more than 124 countries and in every state of the Union, with the possibility that in excess of two million Americans have been infected and in the absence of a cure or vaccine, the issue of testing cannot be ignored anymore. Unfortunately, the testing debate has generated more heat than light. This paper examines the proposed "benefit" to public health in testing certain target groups deemed "at risk", and also discusses socio-ethical implications of such testing. The whole question of HIV antibody testing essentially raises the need for a balance between voluntary and mandatory testing; and society's commitment to protect public health as well as safeguard individual civil rights.