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Background: Many institutions offer introductory personal health courses to fulfill a general requirement; however, gaps may exist regarding health education and information students receive and what they find relevant to their lives. Purpose: Identification of topics of salience/relevance to college students in introductory personal health courses, including delivery improvement recommendations. Methods: We interviewed students (ages 18-25) who completed an introductory personal health course. MAXQDA© was used for organizing codes and themes responsive to research questions. Results: Emergent themes related to mental health, exercise, nutrition, stress, sexual health, and alcohol substance use were uncovered. Students preferred interactive learning and harm reduction approaches to passive learning. Discussion: A disconnect exists between students' interests and what is taught. Formats for presenting topics alienated students, making them feel judged if pursuing questions. The gap between the product desired and that delivered occurred across delivery platforms, syllabi, and textbooks. Translation to Health Education Practice: We heard praise for examples of active, skills-based learning. Students were eager to improve content and delivery and enumerated examples of how to make courses more relevant and applicable. Instructors may need to be better prepared in content, pedagogy, and health-based philosophy to accommodate the diverse student population at collegiate institutions. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http:// portal.shapeamerica.org/trn-Webinars.

Background: Unhealthy eating contributes to morbidity in adolescents and college students and is an antecedent of premature mortality in adulthood. It has been suggested that the increase in independence (i.e., living away from parents) of adolescents contributes to their poor eating behaviors. Some literature reports that specific parenting styles may reduce the probability of engaging in poor eating practices. Purpose: We investigated the association between college freshmen's eating practices and their perceptions of parenting style. Methods: An Internet-based survey was used to sample 264 college freshmen between the ages of 18 and 20 years from a large southeastern university. Data analysis used univariate and bivariate statistics along with multiple regression analysis. Results: Student eating practices fell short of optimal dietary recommendations. Whereas the literature suggests that parenting style predicts healthy eating during early adolescence, it did not predict healthy eating in this sample of college freshmen, accounting for less than 1% of the variance in eating practices. Nevertheless, responses to an open-ended question suggested that some students believed that parents had influenced their current eating behaviors. Discussion: We found little evidence of any latent effects of parenting style on eating behaviors among college freshmen. Translation to Health Education Practice: Despite positive parental influences, as it relates to health eating, continued reinforcement at the individual (e.g., skill enhancement with regard to meal preparation), interpersonal (e.g., role modeling healthy eating practices among peers), community (e.g., establishing farmers' markets) and organizational (e.g., increased access to healthy food options in cafeterias) levels is needed. (Contains 5 tables.)

Background: Launched 50 years ago, the School Health Education Study (SHES) examined the health education offerings in 135 public school systems, in 38 states, and over 1100 elementary schools and 350 secondary schools. In its second year, knowledge surveys were administered to students in grades 6, 9 and 12 at many of these schools. Analysis of the results in year three led to a one-word description of the state of health education in public schools--"appalling." Subsequent years saw the SHES writing team engage in development of a conceptual approach to health education (through physical, mental and social dimensions) applied at four levels (K-3, 4-6, 7-9, 10-12) and in three learner domains (cognitive, affective and psychomotor). The SHES has been identified time and again for its pioneering effort to bring prominence to school health education. Purpose: We attempted to identify ways that the SHES has influenced health education practice in schools as told by school health education scholars. Methods: Between April and June 2011, we used a snowball sampling approach with saturation to identify individuals believed to have historiographic knowledge of the SHES; we asked them to respond to eight questions (developed by the primary authors and modified though the individual judgments of four school health scholars) about the SHES' influence and legacy, its relevance after 50 years and issues pertinent to today's practice of school health education. Twenty-eight individuals were contacted (based on having been named by at least two people as authorities) through their active email addresses; 22 agreed to participate, and ultimately, 16 responded to the questions (The School Health Education Study Fifty-Year Reflection Group). Three people did not respond to the original invitation and three others indicated they did not believe they had insights to offer. All participants did not respond to each item. Some responses have been edited for length or clarity, or because they intersected with comments already presented by other participants. However, a full transcript of all responses received can be obtained by writing to the primary authors. Results: We found a wide array of thoughts about the SHES. Whereas we see much consensus about the SHES' impact and legacy, we also acknowledge that some disparate opinions emerged. The details of these perspectives are contained herein, mostly in the participants' own words. Discussion: The importance of the SHES continues to be recognized. Participants concur that the SHES: (1) Demonstrated application of an exemplary process and set of principles for curriculum development, including a conceptual approach that minimized the potential impact of content or factual changes over time; and (2) Was the forerunner of the development of the National Health Education Standards, the School Health Policy and Practices Study, and countless other initiatives. Whereas no conclusions can be drawn, participants raised points about the SHES that we see worthy of further note, discussion and debate: (1) The SHES conceptual approach may have been too complex for some school systems to interpret or adopt; (2) It may have lacked thorough description of an implementation strategy; and (3) It may have failed to gain sufficient involvement of administrators and policymakers during development and implementation to achieve more widespread buy-in. With respect to school health education in general, some participants argue that: (1) A more sustained foothold for school health education may have failed due to reliance on K-6 teachers in a vanguard role when so many teacher preparation institutions lack requirements for school health for elementary teachers; and (2) Some academicians have abandoned their advocacy role, contributing to the demise of school health in some communities. At least some participants see gains being accomplished in the future if school health education proponents consider: (1) Marketing health education as education for health literacy, thereby bringing health into better philosophical alignment with core subjects such as reading and mathematics and integrating it more fully into the curriculum, or in a similar vein, focusing more on educational and productivity outcome metrics, rather than on health outcomes alone, whose long-term effects are both difficult to trace and to measure; and (2) Viewing school health education as a component of a broader community or public health construct, thereby drawing the full breadth of health resources and health education venues into a supportive matrix. Whereas these respondents' comments likely represent mainstream historiographic reflections about the SHES and school health education, the collection of remarks is obviously limited to ones made by these 16 participants. Additional invitees may have wanted to participate, but could not because of the timing of the request, their personal obligations, and other constraints. Moreover, other scholars whose names did not surface in the sampling procedure might have different but equally valid remarks to make about the SHES. Because all responses were created independently, alternative interpretations might have emerged had these individuals been part of a face-to-face panel where a discussion ensued. Translation to Health Education Practice: Concerns abound that the legacy of the SHES is already being lost in the rising generation of health education practitioners, and that, therefore, the heritage brought to health education by the SHES and its key personnel needs to be transmitted via identified stewards of the profession. We leave further interpretation and the translation experience of "lessons-to-be-learned" up to readers as a dialogue building exercise related to the SHES and contemporary school health education issues. We recommend that some of these participants or other school health scholars be invited as panelists at forthcoming health education conferences over the next few years and react to questions like ones presented here. Further, we recommend that a similar project be pursued on a recurring basis so that future generations of health educators can glean insights from their historic heritage.

Numerous reports and studies have touted the benefits of school health education for over five decades and extensive public health data support an association between education levels and health outcomes. This paper recounts the "tacit" approval given to school health education historically by reviewing reports issued by various governmental and nongovernmental organizations from the 1960s to the present. Whereas these reports and studies demonstrate an influence on the status of modern school health education programs, many of the barriers to effective school-based programs described 50 or more years ago continue to be challenges for school health education advocates. Additional elements that may further impact the delivery and of quality of school health education negatively in the next decade include legislation that places pressure on schools to improve students' performance on subject areas that do not include health; a declining tax base for funding education programs in general; the deterioration or complete disappearance of school health education professional preparations programs; and evolving technology that alter the ways in which students learn.

Background: Preordinate attitudes and beliefs about contraception may influence acceptance or rejection of a particular method. Purpose: We examined the attitudes about contraception methods held by undergraduate students (N=792) at two large southeastern universities in the United States. Methods: Twelve methods were rated on 40 semantic differential scales. Means of the scale sum scores for men and women were compared using t-tests. Results: Among women the most favorably rated methods were: abstinence, oral contraceptive, male condom, Nuva ring, contraceptive patch, emergency contraception, male sterilization, female sterilization, diaphragm and female condom, each yielding a mean above the scale midpoint. The most negatively rated methods were withdrawal and douche. For men, the ratings in descending order were: oral contraceptive, male condom, abstinence, contraceptive patch, emergency contraception, female sterilization, Nuva ring, female condom, diaphragm, withdrawal, male sterilization and douche. There were four statistically significant (P less than 0.05) gender differences, with abstinence, male condom, male sterilization and Nuva ring all rated more favorably by women. Discussion: These evaluative indices suggest that contraceptive methods elicit varied responses among potential users that theoretically could manifest themselves in acceptance or rejection of a particular method. Improved understanding of the traits by which potential users judge contraception may be beneficial in fostering communication between potential users and practitioners who provide relevant advice. Translation to Health Education Practice: Health educators and other practitioners engaged in contraception counseling must consider that persons may already hold strong feelings about some methods before they enter the clinical setting. (Contains 3 tables.)

Conducting evaluations that are both valid and ethical is imperative for the support and sustainability of programs that address underserved and vulnerable populations. A key component is to have evaluators who are knowledgeable about relevant cultural issues and sensitive to population needs. Hispanics in rural settings are vulnerable for many reasons but especially because of language issues, differences in cultural beliefs and socioeconomic barriers. Additional factors, such as cultural proclivity to be deferential to authority figures and the possibility of having an undocumented alien status also are important issues for Hispanics living and working in rural communities. Because migrant farm workers comprise a large part of Hispanics living in rural areas, attention to the sensitive issues surrounding this population is paramount during program evaluations. This paper highlights ethical issues pertinent to program evaluations involving Hispanics residing in rural settings.

Background: Participation in free-time play, including individual and group activities, is important during youth as patterns of physical activity established then persist into adulthood. The VERB Summer Scorecard (VSS) intervention is an innovative physical activity promotion initiative that offers tweens (8-13 year-olds) opportunities to be active during the summer months when increased sedentariness can occur, leading to weight gain and a predisposition for further inactivity. Purpose: This study identified factors associated with intentions to participate in VSS among tweens previously exposed to the intervention. Methods: We conducted a cross-sectional study of 1,063 middle school youth using a 39-item survey and performed a multi-level analysis. Results: Being female (OR=1.43), having tried a new physical activity (OR=1.59), not currently participating in out-of-school activities but wanting to (OR=2.60), and self-monitoring of physical activity (OR=4.42 to 7.50) were associated with future intention to participate in VSS. Discussion: Adoption of the VSS seemed to inspire some tweens to initiate and sustain activity. VSS appealed to tween girls, an especially important priority audience because of the observed tendency of girls' physical activity to decline during the teen years. Moreover, VSS offered youth the opportunity for trying a variety of games, sports, and other activities. Additionally, the tangible practice of monitoring physical activity (via the scorecard) appeared to have a favorable impact on intention to participate again in VSS. Translation to Health Education Practice: Implications for school and community based physical activity interventions include structures that incorporate trialabilty and observability as mechanisms for increasing likelihood of intervention adoption. (Contains 3 tables and 1 figure.)

Background: Following the occurrence of natural or man-made disaster, relief worker priorities include providing water, food, shelter, and immunizations for displaced persons. Like these essential initiatives, reproductive health education and services must also be incorporated into recovery efforts. Purpose: This study examined reproductive health care indicators, including the key areas of HIV/AIDS and other sexually transmitted infection (STI) transmission, family planning and pregnancy-related health services, and selected reproductive health education knowledge among refugees and internally displaced persons residing in southern Belize following Hurricane Mitch's assault on the region in 1998. In addition, the occurrence of gender-based violence was measured. Methods: Internally displaced persons and refugee men and women were interviewed about prenatal care and delivery services, family planning knowledge and utilization, HIV/AIDS and other STI transmission knowledge, and sexual violence. Results: Numerous misconceptions about HIV/AIDS and other STIs existed. Most persons had never used any family planning method. Oral contraceptive use declined as length of stay at refugee camps increased. Most women were able to access prenatal services. Violence against women, including sexual violence, was reported. Discussion: Better access to medical services and education about reproductive health issues are needed following disasters. Translation to Health Education Practice: Health educators can contribute to relief efforts. Moreover, other relief workers should be equipped with skills and knowledge to help meet the reproductive health needs of disaster victims. (Contains 3 tables.)

Stem cells are being touted as the greatest discovery for the potential treatment of a myriad of diseases in the new millennium, but there is still much research to be done before it will be known whether they can live up to this description. There is also an ethical debate over the production of one of the most valuable types of stem cell: the embryonic form. Consequently, there is public confusion over the benefits currently being derived from the use of stem cells and what can potentially be expected from their use in the future. The health educator's role is to give an unbiased account of the current state of stem cell research. This paper provides the groundwork by discussing the types of cells currently identified, their potential use, and some of the political and ethical pitfalls resulting from such use. (Contains 2 tables.)

Background: Publication is the primary means of contributing to and establishing credibility within the scientific community. Some researchers have reported an increase in the average number of authors per manuscript for some scholarly journals in the past two decades. Whereas author proliferation may be warranted in some cases, other reasons for increasing the overall number of authors per manuscript may have more dubious motives, including gratuitous authorship for embellishing curriculum vitae. Purpose: The purpose of this study was to determine whether there was evidence of authorship proliferation in the "American Journal of Health Education" during 1996-2006. In addition, other selected authorship information was identified. Methods: A content analysis of original articles published from January 1996 through December 2006 (N = 755) was performed. Results: There has not been a statistically significant change in the number of authors per manuscript for the time period studied. Discussion: Although no significant change in number of authors was found, other investigative methods may be necessary to estimate the practice of gratuitous authorship. Translation to Health Education Practice: Health educators should be cognizant of the International Committee of Medical Journal Editors (ICMJE) criteria for authorship and endeavor to ensure that all authors meet these criteria. (Contains 2 tables and 2 figures.)

This study identified youth and adult perceptions of factors that influence initiation of youth drinking, access to alcohol, strategies for deterring youth drinking, and parents' role in prevention. A combination of qualitative (focus group and individual interview) and quantitative (written survey) community-based participatory research methods was used. Results showed that parents and other adults influence youth decisions about alcohol use both positively and negatively. Parental strategies identified by both youths and adults as important for the prevention of youth alcohol use includes communication, modeling positive behavior, monitoring youths, and controlling youths' access to alcohol. Communication was considered the most effective strategy, especially if parents do not lecture or nag their children. Both parents and students viewed monitoring as important but in need of improvement. Most youths and adults believed it is easy for minors to obtain alcohol, usually from their own or friends' parents. However, few parents had talked with other parents about youth drinking. Youths' perceptions of alcohol use norms were assimilated from adults, but many parents reported difficulty in modeling positive drinking behavior. Parent education and support are needed to encourage parents to confront the extent of youth drinking and to improve their own prevention skills. (Contains 1 table.)

In this paper, we use game theory to understand decisions to cooperate or to compete in the delivery of public health services. Health care is a quasi-public good that is often associated with altruistic behavior, yet it operates in an increasingly competitive environment. With mounting health care regulation and changes in privatization, altruistic arguments give way to more competitive rationales for market decisions. Profit and not-for-profit institutions must address widespread health care needs while balancing the needs of more lucrative markets against the needs of lesser ones. Recognizing the roles of cooperation and competition as motivators in the delivery of health care to the public is imperative. We explore two game theory models (Nash's Equilibrium and the Prisoner's Dilemma) and their related concepts of simultaneous interdependence and rationality to examine decision-making. Four hypothetical public health case studies are presented. We conclude that understanding game theory and the factors influencing decision-making allows potential competitors to make more efficient decisions, including decisions to cooperate or compete. As public health agencies move toward more collaborative models of service delivery, such understanding may help enhance efficient and effective service delivery. (Contains 6 tables.)

Background: Understanding how "health issues" are socially constructed may be useful for creating culturally relevant programs for Hispanic/Latino populations. Purpose: We explored the constructed meanings of cervical cancer and cervical cancer screening among Panamanian women, as well as socio-cultural factors that deter or encourage screening services. Women in this age group have the highest rate of HPV in Panama, placing them at elevated risk for cervical cancer. Methods: Using a social construction approach, four qualitative research techniques were employed to assess the meaning of cervical cancer in the lives of 132 Panamanian women between 20 and 40 years of age. Results: Emergent themes included the importance of religion and family, the relationship between sexuality and health, influence of media, and the influence of husbands and of other women in helping to construct screening knowledge. Also, the generalized belief that cancer signifies death was clear. Discussion: Cervical cancer and cancer screening arouse fears, embarrassment, and shame that serve as barriers to screening and impede better screening rates and earlier diagnosis of disease. Cervical cancer screening guidelines are not promoted causing lack of awareness. Translation to Health Education Practice: Culturally relevant health education interventions and programs delivered in a participatory group format at the community level may be effective in reaching Panamanian women. Women themselves may be good resources for identifying appropriate health education messages, interventions and delivery modes. (Contains 5 tables.)

In this article, the author discusses what life will be like in 2035, and what its implications will be for the way in which health education is practiced. He states that in the next 25 years health educators will have to leave their comfort zones and take a calculated risk with some radical and more creative approaches to health behavior change. More programs, more education and more of what has failed to move the needle in the past 25 years also is unlikely to move it much in the next 25. Health educators should be less enamored with their past "healthedcentrism". Instead, they must: (1) unite with persons from other social and behavioral science professions to perform collaborative research that focuses on the needs of vulnerable populations; (2) focus an interdisciplinary research effort on the graying of America and the world, and the challenges that this phenomenon presents; (3) celebrate the increasing diversity in this country and worldwide at school, at work, in places of worship, and in communities; and (4) note the reality that the world will improve best from policies that support and incentivize cooperation, and that come about as a result of partnerships with the consumers that they wish to reach in health behavior or just about any other task. Long before 2035, however, the health education profession is going to need to come to terms with a series of other issues. The author shares what he thinks his professional colleagues ought to be pondering.