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This article examines the issue of maintaining participation in workplace health pro motion programs. The term "maintaining participation" is defined here as both continued program attendance and maintenance of recommended behaviors. The factors associated with participation and approaches to maintaining participation are reviewed. Evidence suggests that combinations of environmental and individual approaches are necessary to address the problem of maintenance. An approach to maintaining participation is sug gested that utilizes a preprogram diagnostic interview model to identify and address environmental and individual factors that may cause an employee to drop out of a program or relapse into prior behavioral patterns.

This study investigates the implementation of a restrictive smoking policy in decentralized worksites. A model which includes four elements--concept, context, process, and outcomes--is used as a framework for identifying characteristics that influence implementation. The organization studied was a state human services agency with approximately 400 worksites spread across 12 geographic regions. Quantitative data collection included three cross-sectional surveys of employees and supervisors administered before and after the date the policy became effective. Qualitative data were collected from three sources, including written comments on surveys, focus groups, and structured interviews with supervisors and top administrators. Tabular analyses and one-way analyses of variance were used to analyze quantitative data. Qualitative data were examined for key themes and have been used to elucidate findings. Those characteristics related to concept, context, and process which appeared to have the strongest influence on expected and unexpected outcomes of the restrictive smoking policy were degree of policy restrictiveness, job characteristics, perceived level of participation in formulation and implementation, and support of supervisors responsible for day to day enforcement. In particular, in this decentralized organization, lack of participation was found to underlie many of the problems experienced in implementation. The practical implications for developing and implementing a worksite restrictive smoking policy are discussed.

The School Health Curriculum Project(SHCP), initiated over a decade ago to provide a health education curriculum package for elemen tary students, has been widely and variously evaluated. In analyzing studies designed to assess the effectiveness of the SHCP, it was recognized that the measured impact of this project (or any health education intervention) would derive from the adequacy of the theory upon which the program is based, the adequacy of its implementation, and the adequacy of its measurement. Hence, an examination of the theoretical base of the SHCP and its variance in practice was conducted. In addition, a metaevaluation of 24 studies designed to access the effectiveness of the SHCP was completed. Results suggest that the project is effective in influencing health-related knowledge and attitudes. A rationale for future evaluation efforts in school health education is subsequently outlined.

Sustaining patient motivation for long-term adherence to drug therapies remains a substantial problem for physicians, other health care providers, the patients themselves, and their families. Other therapeutic requests such as dietary changes and weight control may be even more difficult to maintain than taking pills. As part of a controlled experimental design implemented in an outpatient teaching hospital, an educational program was implemented to improve family member support for medical compliance among hypertensive patients. Family members were interviewed, counseled, and provided with a booklet for the purpose of educating and involving them in the home management of high blood pressure. The booklet identified ways the family member could assist the patient with medication compliance, appointment keeping, as well as diet and weight control. These items were identified and recorded as behavioral objectives in the booklet. Patients were followed for three years to assess long-term outcomes. Results showed a strong statistically significant difference between the experimental and control groups, with the experimental group demonstrating higher levels of appointment-keeping behavior, weight control, and BP under control (all p values < .001). Analysis of the main effects of the educational program dem onstrated that the family member support intervention accounted for the greatest decrease in diastolic blood pressure variability, R2 = .20, p < .001.

In a recent issue of Health Education Quarterly, Chen( I ) reviewed the evaluations of worksite health promotion programs published in health education journals from 1980 through June 1983. He found few evaluations in the literature that used either quasi-experimental or experimental designs. This paper reviews the evaluations of stress reduction programs in the worksite, most of which were either published outside of health education journals or unpublished. Over one- half of the studies used either experimental or quasi-experimental designs in the evaluations. This suggests that reviews of worksite health promotion program evaluations must encompass journals from a variety of disciplines. Recommendations for improving the evaluations of stress reduction programs in the worksite are included.

Large-scale, integrated programs—as distinct from multiple and widespread replications of small-scale programs—require for their planning, implementation and evaluation a qualitatively different set of concepts, methods, and procedures. They are not merely the sum of the parts making up numerous applications of the same health education messages and objectives in various organizations or communities. This review of theory, research and the experience of national and community-based studies in mass media and community development for health, family planning and cardiovascular risk reduction identifies some distinctions between micro- and macrointerventions, as well as between the uses of mass media in commercial marketing and those in health promotion.

The relationships among social structure, stress, social support, life-style health behavior, and health status are explored in this multivariate analysis of data from the National Survey of Personal Health Practices and Consequences. Path analyses showed social structural factors to influence life-style practices both directly and indirectly through social network and negative life events. For women, social network and life events had direct relationships to health related life-style practices, while age and income acted both directly and indirectly through social network and, for income, through life events. Education was also directly related to life-style. For men, social network and education had the only direct effects on health practices, and age and income had indirect effects through social network. We then examined the relative contri butions of the social network index elements, life events, and demographic variables to each of the life-style practices. These analyses confirmed the importance of gender, education, age, and income to predicting life-style behaviors. Negative life events were associated with smoking for both men and women, sleep for women only, and physical activity and alcohol use for men, which suggests sex-specific norms for coping with stress. For both sexes, church attendance and marriage were associated with favorable smoking and alcohol use, implicating cognitive social support or social control as a mediator of health promotion. Finally, analyses for each gender using health status as the outcome variable indicated that age, income, education, and life events affected health directly, while the effects of church attendance and marriage were likely mediated through smoking and alcohol behaviors.

When I began worrying about this presentation several months ago, I coined a title that I was embarrassed seeing in print later, "The Paradox of Increasing Responsibility and Declining Influence: What is SOPHE Besides Small?" I was concerned then with the de cline in our membership, a 20% drop in 1978 and a 10% net loss each year after that. What happened in 1978 to cause that abrupt, precipitous change in our strength?