Pilot study of strategies for effective weight management in type 2 diabetes: Pounds Off with Empowerment (POWER).

This pilot test effort focused on weight management strategies for individuals with type 2 diabetes living in rural, medically under-served communities. Randomly selected patients from the diabetes registry of a federally funded primary care practice in a rural community were randomized to one of two 8-week interventions: intensive lifestyle (reduced fat and calorie intake and increased activity) or intensive lifestyle plus ongoing formal evaluation for continuous quality improvement. Mean weight loss was 1.15 +/- 1.90 kg (96.4% African American, n = 23, p < 0.01) with no difference between groups. Among the 78% who lost weight, mean loss was 2.00 kg. Mean difference in pre- vs. postintervention fasting blood glucose was -24.23 mg/dL (n = 23, p < 0.05). In this rural, medically under-served community, the interventions were moderately successful in facilitating weight loss and improving fasting glucose concentration. For purposes of state-of-the-art weight management interventions with diabetics, the addition of formal evaluation did not result in improved outcomes.

Urban neighborhoods and mental health. Psychological contributions to understanding toxicity, resilience, and interventions.

The psychological consequences of living in urban neighborhoods are described by using examples related to 3 models of neighborhood characteristics. These models highlight the impact of physical, structural, and social characteristics on various types of mental health outcomes. In addition, the characteristics of individuals and neighborhoods that encourage resilience to negative outcomes are discussed. Finally, examples of how psychology can contribute to neighborhood interventions that ameliorate or prevent residents' distress and improve neighborhood conditions are described.

Conference report: community-based health promotion--state of the art and recommendations for the future.

The evaluators of the Henry J. Kaiser Family Foundation Community Health Promotion Grants Program in the West and the Foundation brought together 21 researchers, funders, and community organizers with a variety of perspectives on community-based health promotion to share what has been learned to date and how that knowledge should be applied in the future. The two-day conference was divided into three sessions, covering conceptual, implementation, and evaluation issues. Specific topics were selected by the organizers with input from participants. Two papers were presented in each session, followed by comments from discussants and a general discussion involving the entire group. The dominant theme of the conference was the relationship between communities and outside institutions, focusing on problems with the current state of relations and how they might be improved in the future. All viewed building partnerships between communities and institutions as a desirable goal; however, the challenges involved in building effective partnerships are considerable and require a substantial investment to make them work. Recommendations that emerged from the discussions included explicitly acknowledging the diverse interests of the parties in community-based programs at the earliest stages of program planning; making a concerted effort to bridge the cultural gaps that exist among the parties; structuring funding to allow enough lead time for partnerships to develop or using social reconnaissance to identify strong existing partnerships; and integrating the evaluation more closely into the process of program development.

Community coalitions for prevention and health promotion: factors predicting satisfaction, participation, and planning.

Coalitions currently are a popular tool for promoting community-based solutions to health problems, such as alcohol, tobacco, and other drug (ATOD) abuse. Private foundations, granting agencies, and other public health organizations assume that participation of community members in health promotion coalitions will increase the likelihood of program success. This article examines whether key characteristics of coalitions are related to effectiveness as measured by member satisfaction, commitment to the coalition, and the quality of planning efforts. Member survey data from the first year evaluation of an ATOD coalition were analyzed using factor analysis, chi-square, and multiple regression techniques at both the individual and group levels. The results suggest that community leadership, shared decision making, linkages with other organizations, and a positive organizational climate were key determinants of member satisfaction and participation. These same factors were not related to the quality of coalition plans. However, the significance of coalitions for community empowerment and health promotion is discussed.

Toward a social ecology of community coalitions.

This article is guided by several premises. First, community coalitions fit with a social ecology perspective of health promotion because they work with multiple domains and promote community change. Second, the community context affects the functioning of coalitions. Third, key leaders are an important part of the social fabric of a community and influence the social ecology of a community; therefore a coalition should include key leaders and influence them and their organizations. The purpose of this article is to advance an understanding of the social ecology of coalitions by describing concepts, variables and results from two national studies and by providing anecdotal evidence and a measure of key leaders from our own work. After briefly defining and describing community coalitions, we: (1) review literature on contextual variables and community coalitions, (2) provide examples of contextual variables influencing community coalition development, and (3) discuss the relationship of key leaders in multiple domains and community coalitions. The article concludes with a discussion of the need for a framework of contextual variables and a promising next step.

An ecological assessment of community-based interventions for prevention and health promotion: approaches to measuring community coalitions.

Presented an ecological assessment of a community coalition to prevent alcohol, tobacco, and other drug abuse, and related risks. Ecological assessment is defined as occurring at multiple social levels and along a continuum of stages of coalition readiness. The assessment is aided by the triangulation, or combining of assessment methods and strategies. Measures used to assess the coalition's formation, implementation of community initiatives, and production of community impacts are described, along with the triangulation strategies used to enhance the assessment findings.

Citizen participation and empowerment: the case of local environmental hazards.

Local environmental hazards place millions of citizens at risk of physical, emotional, and financial harm. While the discovery of such hazards can be fundamentally disempowering for individuals and communities, few scholars have examined the dynamics of empowerment in this context. We explore the relationships among forms of empowerment, citizen participation, and local environmental hazards, and offer a model of the processes of empowerment and disempowerment appropriate to a broad range of citizen issues. On the basis of this analysis we recommend a partnership approach to community decision making that is designed both to reduce the likelihood that local environmental hazards will develop and to minimize the disempowering impact of any threats that do occur.

Burdens and gratifications of caregiving: appraisal of parental care of adults with schizophrenia.

The caregiving experiences of 60 parents of adults with schizophrenia were investigated for the presence of gratification; the role of the interpersonal caregiver-child relationship; and the effects of burden, gratification, conflict, and intimacy. Results indicate that relationships, as measured by intimacy and conflict, were more highly associated with burden and gratification than were severity of schizophrenic symptoms or degree of caregiving involvement. Implications for therapeutic interventions are discussed.

Perceived costs and benefits of membership in a self-help group: comparisons of members and nonmembers of the Alliance for the Mentally Ill.

We assess the utility of looking at the costs/barriers and benefits/incentives of belonging to an Alliance for the Mentally Ill (AMI) self-help group. Support for bimotivational factors of costs and benefits was found. Comparisons were made between members vs. nonmembers and between more active vs. less active members. Implications for theory and application are discussed.

Living near a hazardous waste facility: coping with individual and family distress.

Residents near a hazardous waste facility were interviewed about their level of distress and their involvement in a community organization concerned about toxic exposure. Specific beliefs about living near such a facility were related to individual and family distress and to participation in the organization. Implications for research and for clinical practice are discussed.

Measuring knowledge of cancer.

At best, most individuals are able to recount two to three of the seven warning signs of cancer [1]. However, this finding is primarily based on free recall of symptoms personally experienced by the respondent. In the present study, a new approach is introduced as an alternative to traditional assessment of knowledge of cancer warning signs. The Knowledge of Cancer Warning Signs Inventory (KCWSI) is a 25 item self-report questionnaire which yields three scores concerning probability judgments about symptoms: basic recognition of the seven warning signs (BRCWS), the extent to which nonwarning signs are perceived to be warning signs (NSPWS), and the extent to which one can accurately discriminate between real and false positive warning signs (accurate knowledge of cancer: AKC). The KCWSI was given to a population who live in a community facing a perceived toxic waste hazard, based on the hypothesis that such a group should be cognizant of the warning signs of cancer because of the serious health threats posed by toxic exposure and the presumed need to engage in greater health preventative activities when living with such an environmental threat. Results show that basic knowledge of the seven cancer warning signs is predicted by AKC, fear of cancer, and a family history of cancer. Misperception of common distress symptoms (of anxiety, somatization, and depression) as symptoms of cancer (nonwarning signs perceived as warning signs: NSPWS) is predicted by fear of cancer, a composite scale of perceived susceptibility to cancer and other health-related problems, Global Symptom Distress, and higher order interactions among the demographic variables of race, gender, income and education. Accurate Knowledge of Cancer (AKC) is associated with lower fear of cancer and lower psychological distress than the other two knowledge measures. The Knowledge of Cancer Warning Signs Inventory yields complex information about how symptoms are perceived and may prove superior to other methods in understanding what people believe about the warning signs of cancer and how this understanding relates to health care behaviors. This study also illustrates the need to pay attention to how health information is measured.

Fear of cancer and knowledge of cancer: a review and proposed relevance to hazardous waste sites.

Cancer is a disease that is widely feared because of its prevalence and incidence, its widespread causes (heredity, environment, lifestyle) and the belief that 'everything causes cancer'. We review evidence on knowledge of cancer and find that knowledge is very limited. Then we examine factors that are related to knowledge of cancer and the pursuit of additional knowledge about cancer and factors that are related to health care behavior such as low rates of participation in cancer screening tests. This review leads us to conceptualize the essential, and perhaps central, role that fear of cancer has in the psychology of cancer. We then explore why cancer and fear of cancer have gained much attention in communities located near hazardous waste sites.

How residents cope with living near a hazardous waste landfill: an example of substantive theorizing.

It is hard to be a community or environmental psychologist and not be interested in newspaper stories on global warming, oil spills, or toxic wastes in your own backyard. To the general public, these issues tend to be viewed as environmental, technological, toxicological, or governmental, but not psychological. As psychologists, we see many ways in which psychology does play a role in understanding these events. We have been engaged in a study of residents living near a hazardous waste landfill in which many subdisciplines of psychology have played an illuminating role. Wicker's (this issue) article on substantive theorizing outlines an approach to theory and research that helps communicate the structure and process of doing research on a complex area. We use his article to help us describe key aspects of our research that are not usually discussed in research articles. We believe that the type of research Wicker describes occurs more often than people realize. Unfortunately, however, journal conventions cause investigators to omit discussions of substantive theorizing aspects of their work. We hope that reading this article increases your understanding of substantive theorizing and our research as much as writing it increased our own.

Neighboring in an urban environment.

Neighbors are an informal resource who may act individually to provide socioemotional support to each other as well as collectively to ameliorate problems in their residential environment. To explore when neighbors are likely to interact and provide aid and emotional support for each other, 702 residents living in a neighborhood in Nashville, Tennessee, were interviewed during 1978. Factor analysis was used to cluster several variables of individual characteristics of residents related to neighboring. Other indices assessed the block environment. Neighboring activities were found to be associated with an individual's psychological investment in his neighborhood as well as his rootedness and integration on his block, a positive sense of well-being, sex, and life stage. At the neighborhood block level, homogeneity of socioeconomic status (SES) contributed to neighbor relations along with indices of an individual's similarity to block residents. Implications are discussed for the development of neighboring activities and neighborhood organizations.