Health education quarterly最新文献

We examined whether perceptions of personal control over health and perceptions of personal responsibility for well-being were related, whether they had independent or interactive effects on health and health-related behaviors, and whether the effects of the perceptions varied by income. Young and middle-aged employees of a technology company (N = 186; aged 20-63) completed a questionnaire about perceived control and responsibility, health, health-related behaviors, and demographic information. Correlation analysis indicated that the perceived control and perceived responsibility variables were unrelated. Regression analysis indicated that a main effect of perceived control--but not responsibility--contributed significantly to the explanation of variance in health and several health-related behaviors (medical checkup, breast self-examination, exercise, and health promotion program membership). Perceived control and responsibility did not interact in their influences over health and behavior; however, the hypothesis that the variables would interact with income was partially confirmed. Overall, the results suggest that the sense of control rather than sense of responsibility should be targeted for health promotion efforts.

This article describes a two-factor schema for the development of culturally appropriate cancer risk reduction interventions for Mexican American women. Regarding this approach, risk factors for two major cancer areas are reviewed: cigarette smoking and obesity/diet. We first describe a schema that facilitates the planning of strategies associated with preferred health interventions and preventive approaches for cancer risk reduction with Mexican American and other Latino/Hispanic persons. This schema examines Acculturation and Education as key factors that should be considered in developing health education messages and interventions that are culturally and educationally appropriate to the identified subpopulations of Hispanics in terms of language and informational content of the message and in terms of psychological factors related to health behavior change. Empirical data from a community sample is presented for the purpose of illustrating the validity of this schema. Then we review studies that examine the effect of acculturation on the distribution of the risk factors, based on studies in the current literature. Here we note the target group of women with the highest risk, based on the available information on Acculturation and other sociodemographic factors. Additionally, an illustration is presented where information and the concepts offered by the two-factor schema facilitate the analysis of (a) health education message needs and (b) needed behavior change, thus pointing to (c) more appropriate health promotion strategies for targeted Hispanic/Latino individuals or groups. The information described in this article aims to help program planners, researchers, and health educators in the design of more effective programs of health intervention for Mexican American and other Hispanic/Latino women.

The Transtheoretical Model of Behavior Change was examined for its applicability to contraceptive and condom use adoption and maintenance using N = 248 heterosexually active college-age men and women. The model posits that individuals do not go directly from old behaviors to new behaviors to new behaviors, but progress through a sequence of stages: precontemplation, contemplation, preparation, action, and maintenance. The stages of change offer a temporal dimension that provides information regarding when a particular shift in attitudes, intentions, and behavior may occur. The model also postulates a set of or outcome variables--the pros and cons of change and self-efficacy. The results demonstrated that individuals were furthest along in the stages of change for general contraceptive use, followed closely by condom use with other (e.g., casual) partners, and then condom use with main partners. Although no sex differences were found for the stages for the three separate contraceptive behaviors, males and females differed on the pros and cons and levels of self-efficacy when engaging in intercourse with the two types of partners. MANOVA/ANOVA results indicated that the relationship between stages and other constructs follows predicted patterns suggesting that the transtheoretical model may provide a useful framework or paradigm for understanding contraceptive and condom use behavior.

A particularly interesting and consistent finding regarding the health of the Latino population is that Mexican American women, despite their relatively lower socioeconomic status, deliver significantly fewer low birth weight babies and lose fewer babies to all causes during infancy than do women of other ethnic groups. A central thesis of this discussion is that the religiosity and spirituality of many of these Latinas, a key factor in their culture, may protect them and their infants through the pre- and antenatal phases of life. We also suggest that lack of research, related to cultural similarities and differences in Hispanic/Latino subgroups, can lead to faulty or simplistic understanding regarding their health behavior and health status.

The present research was designed to contribute to the empirical literature on the scope and determinants of parents' injury prevention practices among families living in disadvantaged, urban areas. One hundred fifty mothers were interviewed about their living environment when they brought their children (ages 6-36 months) to a hospital-based, pediatric primary care clinic. Only 37% of respondents reported that they knew their hot water temperature was 125 degrees or less. A majority (59%) of families reported that they did not use stair gates. More than one fourth (27%) of respondents said they did not have smoke detectors. Mothers uniformly reported very favorable attitudes and beliefs and strong support from others for in-home injury prevention practices. Factors significantly associated with the number of injury prevention practices implemented were family income, housing quality, and environmental barriers. Instead of attempting solely to persuade parents about the value of injury prevention practices, skill-based interventions are needed to help parents overcome specific barriers that result from living in substandard housing and having very limited financial resources.

We used outcome data from a randomized work site intervention trial to examine the cost-effectiveness of four cardiovascular disease (CVD) risk reduction programs: health risk assessment (HRA), risk factor education (RFE), behavioral counseling (BC), and behavioral counseling plus incentives (BCI). Composite CVD risk scores were derived from measures of serum total cholesterol, blood pressure, number of cigarettes smoked, body mass index, and aerobic capacity. The economic evaluation of the programs focused on the subset of costs most sensitive to the differences between the interventions, and a sensitivity analysis examined some of the relevant cost variations. At the 6-month follow-up (i.e., the "action" or initiation stage of lifestyle change), the RFE, BC, and BCI interventions produced a significant reduction in cardiovascular risk. Incremental analyses demonstrated RFE to be more cost-effective, but not as clinically effective as BC; BC was more cost-effective than RFE when assessment costs were included, and BCI was judged to be the least cost-effective. At the 12-month follow-up (i.e., the "maintenance" stage of lifestyle of change), BC was the only program found to produce a significant reduction in CVD risk. Individualized behavioral counseling was found to be a cost-effective strategy for the initiation and maintenance of CVD risk factor reduction.

Using the social marketing principle of audience segmentation, a Hispanic audience was disaggregated to examine heterogeneous behaviors and lifestyles that could guide planning for public information campaigns designed to reduce cardiovascular disease (CVD) risk. Signal detection analysis resulted in six mutually exclusive subgroups, based on self-reported behavioral changes to improve health. Subgroups differed significantly in communication, behavioral, psychological, and demographic dimensions, indicating they may require unique campaign planning strategies. To determine whether subgroups were meaningful relative to external health-related criteria, they were compared as to health knowledge and status on cardiovascular disease risk factors. The results showed significant differences among audience subgroups in plasma high-density lipoprotein levels and hypertensive status. Results are discussed in terms of their implications for campaign planning and the need for public health campaigns to diversify strategies when targeting Hispanic audiences.

The purpose of this study was to identify factors that contribute to a group of working women's decision related to mammography. The study was guided by a decision model called the Multiattribute Utility Model. Exploratory interviews were conducted among 36 women to identify positive and negative factors associated with the mammography decision. Eighteen factors emerged and were categorized into three broad areas: Knowledge and Attitudes (Confidence in Efficacy, Personal Risk, Other Means of Knowing, Fear of Cancer/Treatment, Belief in Fate, Embarrassment), Issues Related to Participation (Accessibility and Convenience, Difficulty Arranging, Time, Cost, Pain, Radiation), and Social Concerns (Role Model, Responsibility to Self, Responsibility to Others, Family/Friends' Influence, Societal Influences, Health Care Providers' Influence). This information served as the basis of a survey among 87 women to determine the importance of these factors. Seven factors emerged as significantly different between compliers and noncompliers. In order of significance, they were Difficulty Arranging, Fear of Cancer/Treatment, Cost, Accessibility and Convenience, Time, Other Means of Knowing, and Influence of Health Care Provider. The predictive validity of this analysis was 85%. Implications of findings are discussed.

Casa en Casa is a popular education project of the community health education section of La Clínica de la Raza, a community-based health clinic in Oakland, California. The author examines the Casa en Casa model for its contributions to furthering health education practitioners' understanding of critical pedagogy and community organizing and their relationship to health education. A description of the project's achievements and the obstacles faced in reaching its goals of community empowerment is followed by an analysis of the weaknesses in the project that may undermine its effectiveness. Recommendations are made as to the importance of linking theory to practice and practice to a long-term vision of social change.