Health education quarterly最新文献

This article argues that there has been a tendency to empower the "conventional" positivist paradigm in health promotion research, often at the expense of confounding or ignoring much of health promotion practice. This article argues further that a "constructivist" research paradigm not only has the potential to resolve some of the tensions between research and practice in health promotion but also is inclusive of knowledge generated by the conventional paradigm. The usefulness of a constructivist paradigm is demonstrated through the use of four practice-based case examples drawn from actual community-based health promotion efforts. The congruence of a constructivist paradigm with the health promotion principles of empowerment and community participation are discussed. Finally, this article argues for the acceptance of the legitimacy of knowledge generated from the constructivist paradigm and concludes that this paradigm is more suited to the goals of current health promotion.

This article describes the development of a mass media smoking prevention intervention targeted primarily toward adolescent girls at increased risk for smoking and assesses its outcomes. A cohort of 5,458 students was surveyed at baseline in Grades 4-6 and annually for 4 years. Through diagnostic and formative research, media messages were created to appeal especially to girls. Students beginning in Grades 5-7 received the 4-year media intervention and a school program in two communities, while students in two matched communities received the school program alone. Media targeting techniques resulted in high levels of message appeal and exposure consistent with effects on mediating variables and 40% lower weekly smoking at Grades 8-10 for girls receiving the media and school interventions compared to school alone. Smoking behavior effects were maintained at Grades 10-12. These results indicate that mass media interventions targeting specific audience segments can reduce substance use behavior for those segments.

The authors investigated the effects of a media advocacy program to build support for cardiovascular disease (CVD)-related policy changes and to encourage adoption of heart-healthy behaviors in the Stanford Five-City Project, a long-term trial of community-wide CVD risk reduction. The authors content analyzed 4,824 health articles in two treatment city newspapers and two reference city newspapers between 1977 and 1990. One treatment city newspaper responded well to the program; the other did not. In the Salinas Californian, the number of CVD-related articles increased during the campaign; these articles became more prominent and conspicuous, the focus on prevention increased, and more of these articles were written by local staff. Maintenance of these effects after the campaign was mixed. Results suggest that frequent, regular, systematic contact with media professionals and provision of materials influence newspaper coverage of health-related topics, which has important implications for shaping public opinion and policy change.

This article describes one effort to help prevent violence against women by addressing some of the larger societal factors involved. The Dangerous Promises campaign is based on the premise that sexist advertising images contribute to an environment conducive to violence against women. The goal of the campaign is to convince alcohol companies to eliminate sexist alcohol advertising and promotions. Using the tools of community organizing and media advocacy, the campaign pressures the alcohol industry to change the ways in which they portray women in much of their advertising. Media advocacy has been instrumental in the successes of the campaign. This article examines the strategies and outcomes of the Dangerous Promises efforts to date and makes a case for application of media advocacy as a tool for increasing community voice in policy-making processes.

Acquired immunodeficiency syndrome (AIDS) continues to be a significant concern for adolescents, especially in minority populations. There is a scarcity of knowledge of the cultural context of sexual behavior in this age group and the influences that lead to early initiation of sex and unsafe sex. Few efforts targeting young adolescents have been community based, although there has been an increased awareness of the need for such research and intervention programs. Four key processes have been defined in gaining community participation in health education programs: (a) defining the community and reaching the community; (b) recognizing tensions among service, research, and community participation; (c) involving community residents; and (d) considering cultural differences in a community. These processes are used to describe the "Focus on Kids" project, a human immunodeficiency virus (HIV) risk reduction intervention that resulted in significant increases in condom use demonstrated by a randomized controlled trial.

The purpose of media advocacy is to promote public health goals by using the media to strategically apply pressure for policy change. It provides a framework for moving the public health discussion from a primary focus on the health behavior of individuals to the behavior of the policymakers whose decisions structure the environment in which people act. It addresses the power gap rather than just the information gap. Media advocacy focuses on public policy rather than personal behavior. This article uses two case studies to illustrate key aspects of media advocacy. The first is a 5-year statewide violence prevention initiative for young people in California. The second focuses on the activities of a mothers' group working to improve public housing. The "new public health," with its focus on participation, policy development, and political processes, could benefit from incorporating media advocacy.

Empowerment education is a social action process that promotes participation of communities in gaining control over their lives and their community. The Resource Sisters/Compañeras Program represents a case study in implementing an empowerment education effort. The program developed skills of women from the community to facilitate peer support groups that brought other women together. The program attempted to foster community development while also providing individual case management services. The program, its challenges, and its successes are described. The difficulties of possibly conflicting goals and objectives are discussed.

In 1991, the Massachusetts legislature considered a bill that would have allowed a drunk driving defendant's refusal to take a breathalyzer test to be admitted as evidence in a criminal trial. After the measure passed in both houses, a state senator used a parliamentary maneuver to prevent it from being prepared for the governor's signature. Mothers Against Drunk Driving (MADD) employed media advocacy techniques to alert the public, but the senator was unyielding and the legislative calendar ran out with the bill unsigned. Because of MADD's efforts, however, the senate president put the bill on a "fast track" the following year. The news media's focussed attention on MADD's protests exposed deep schisms among its volunteer leadership regarding the nature and purpose of the organization and the appropriateness of using confrontational media strategies advance its agenda. Paralyzed by the lack of consensus, MADD Massachusetts was rendered a far less effective advocate for policy change.