The worksite environment as a cue to smoking reduction.

With a modified version of the Health Belief Model as the conceptual framework, the hypothesis that exposure to a worksite health-promoting environment acted as a cue to smoking reduction among 310 smokers was tested with a quasi-experimental design. Using path analysis (LISREL), the total effects on posttest smoking were decomposed. Results showed exposure to the health-promoting environment had statistically significant direct and indirect effects on posttest smoking. The indirect effect was through the posttest perceived barriers variable. The LISREL model explained 74% of the variance in smoking reduction and fit the data satisfactorily. The importance of developing the worksite as a health-promoting force is discussed.

A priority rating system for public health programs.

When resources are limited, decisions must be made regarding which public health activities to undertake. A priority rating system, which incorporates various data sources, can be used to quantify disease problems or risk factors, or both. The model described in this paper ranks public health issues according to size, urgency, severity of the problem, economic loss, impact on others, effectiveness, propriety, economics, acceptability, legality of solutions, and availability of resources. As examples of how one State can use the model, rankings have been applied to the following health issues: acquired immunodeficiency syndrome, coronary heart disease, injuries from motor vehicle accidents, and cigarette smoking as a risk factor. In this exercise, smoking is the issue with the highest overall priority rating. The model is sensitive to the precision of the data used to develop the rankings and works best for health issues that are not undergoing rapid change. Cost-benefit and cost-effectiveness analyses can be incorporated into the model or used independently in the priority-setting process. Ideally, the model is used in a group setting with six to eight decision makers who represent the primary agency as well as external organizations. Using this method, health agencies, program directors, or community groups can identify the most critical issues or problems requiring intervention programs.