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Direct support professionals (DSPs) play a large social role in the lives of people with developmental disabilities (DD) and have the potential to influence their health behaviors. Six qualitative focus groups ( n = 48) were conducted with DD community agency administrators, DSPs, family members and adults with DD to better understand the perceived role of DSPs in the health promotion efforts of those with DD. Findings from this study suggest that DSPs experience several barriers when trying to promote the health of those with DD, one of which is fear of violating the rights of people with DD. Future work should identify ways to overcome the barriers experienced by DSPs, so that they can better assist people with DD with health promotion efforts.

Theory-driven, mass media interventions prevent smoking among youth. This study examined effects of a media campaign on adolescent smoking cessation. Four matched pairs of media markets in four states were randomized to receive or not receive a 3-year television/radio campaign aimed at adolescent smoking cessation based on social cognitive theory. The authors enrolled 2,030 adolescent smokers into the cohort (n = 987 experimental; n = 1,043 comparison) and assessed them via annual telephone surveys for 3 years. Although the condition by time interaction was not significant, the proportion of adolescents smoking in the past month was significantly lower in the experimental than comparison condition at 3-year follow-up when adjusted for baseline smoking status. The media campaign did not impact targeted mediating variables. A media campaign based on social cognitive constructs produced a modest overall effect on smoking prevalence among adolescents, but the role of theory-based constructs is unclear.

Purpose: To investigate common youth group activities and how they relate to young people's attitudes of empowerment around tobacco control., Design: A mailed survey was administered to 940 Minnesota youth involved in locally organized tobacco prevention groups. By multivariate linear regression, participation in eight tobacco-related activities and selected personal characteristics were examined in relation to youths'perceived influence on youth smoking., Results: Two activities--developing materials with antismoking messages and taking action to change school smoking policies--were associated with significantly higher perceived influence scores for the youth involved (p < .05). Youth in groups who had worked to raise awareness of how the tobacco industry targets teens also had significantly higher influence scores (p < .001). Associated personal factors included high involvement in extracurricular activities (p < .001), having never experimented with smoking (p < .01), leadership experience (p < .001), and being white (p < .01)., Discussion: Some youth group activities and strategies may be particularly effective at instilling attitudes of empowerment for tobacco control among youth.

We present a program evaluation of the Phillips Lead Project, a 5-year study of the effectiveness of culture-specific, peer education in maintaining low blood lead levels of children in an inner-city neighborhood. We conducted focus groups to understand how project participants felt about the various strategies employed by the Lead Project. The purpose of this article is to describe their reactions to the project and make recommendations concerning appropriate educational strategies for lead poisoning prevention projects being undertaken in similar communities. Although this project was a research study, many of its methods, and participants' reactions to those methods, are relevant to non-research prevention programs and may be generalizable to other health issues besides lead poisoning.

Purpose: To outline the design and present select findings from an evaluation of a statewide anti-tobacco industry youth organizing movement., Design: A telephone survey was administered to teenagers to assess associations between exposure to anti-industry youth organizing activities and tobacco-related attitudes and behaviors. A group-level comparison between areas high and low in youth organizing activities was planned. Methodological obstacles necessitated a subject-level analytic approach, with comparisons being made between youth at higher and lower levels of exposure., Setting: Six rural areas (comprising 13 counties) and two urban regions of Minnesota were selected for survey., Subjects: The study comprised 852 youth, aged 15 to 17 years old, randomly selected from county-specific sampling frames constructed from a marketing research database., Measures: Exposure index scores were developed for two types of activities designed to involve youth in the anti-industry program: branding (creating awareness of the movement in general) and messaging (informing about the movement's main messages). Attitudinal outcomes measured attitudes about the tobacco industry and the effectiveness of youth action. Behavioral outcomes included taking action to get involved in the organization, spreading an anti-industry message, and smoking susceptibility., Results: Branding index scores were significantly correlated with taking action to get involved (p < or = .001) and spreading an anti-industry message (p < or = .001). Messaging index scores were significantly correlated with all five attitudinal constructs (all associations, p < or = .001), taking action to get involved (p < or = .001), and spreading an anti-industry message (p < or = . 01). The hypothesized association between messaging scores and susceptibility was not significant., Conclusion: A youth organizing effort, in combination with an intensive countermarketing media campaign, can be an effective strategy for involving youth in tobacco prevention and generating negative attitudes about the industry.

Direct support professionals (DSPs) play a large social role in the lives of people with developmental disabilities (DD) and have the potential to influence their health behaviors. Six qualitative focus groups (n = 48) were conducted with DD community agency administrators, DSPs, family members and adults with DD to better understand the perceived role of DSPs in the health promotion efforts of those with DD. Findings from this study suggest that DSPs experience several barriers when trying to promote the health of those with DD, one of which is fear of violating the rights of people with DD. Future work should identify ways to overcome the barriers experienced by DSPs, so that they can better assist people with DD with health promotion efforts.

Theory-driven, mass media interventions prevent smoking among youth. This study examined effects of a media campaign on adolescent smoking cessation. Four matched pairs of media markets in four states were randomized to receive or not receive a 3-year television/radio campaign aimed at adolescent smoking cessation based on social cognitive theory. The authors enrolled 2,030 adolescent smokers into the cohort (n = 987 experimental; n = 1,043 comparison) and assessed them via annual telephone surveys for 3 years. Although the condition by time interaction was not significant, the proportion of adolescents smoking in the past month was significantly lower in the experimental than comparison condition at 3-year follow-up when adjusted for baseline smoking status. The media campaign did not impact targeted mediating variables. A media campaign based on social cognitive constructs produced a modest overall effect on smoking prevalence among adolescents, but the role of theory-based constructs is unclear. (Contains 4 tables.)

Introduction. Despite increasing interest in structural (policy, systems, and environmental) changes to improve health, little attention has focused on the adoption, implementation, sustainability, and potential for dissemination of these changes among local community-based organizations. Method. A mixed methods approach was used for this process evaluation. Representatives of nine community-based organizations were surveyed using closed-ended questions and in-depth qualitative interviews to describe 32 policy changes. Diffusion of Innovation theory was used to inform the development of survey questions and the interview guide. Results. Policies adopted by local community-based organizations concerned types of food/beverages provided to staff/clients, methods to encourage physical activity, breastfeeding support, and tobacco control. The majority of the policies were either fully (66%) or partially (31%) implemented 1 year after their initial adoption. In general, participants somewhat/strongly agreed that policies had characteristics that predict sustainability/diffusion (relative advantage, compatibility, complexity, trialability, observability). In-depth interview responses described a generally smooth process for policy adoption and high levels of optimism for continued sustainability but revealed few efforts to disseminate the policies beyond the original organization. Conclusions. Structural changes in community-based organizations are a valuable tool for encouraging healthy changes in communities and have great potential to be adopted, sustained, and diffused. [ABSTRACT FROM AUTHOR]

The article discusses the specific issues and approaches which were the focus of community-based health promotion program evaluation efforts in the cardiovascular disease community research and demonstration studies. The studies that were conducted included Stanford Five-City Project, Minnesota Heart Health Program, Pawtucket Heart Health Program, and the German Cardiovascular Prevention Project. A few lessons were learned from the studies. The first lesson is the importance of monitoring the dose of intervention, both in the intervention and in the comparison communities. A second major lesson is that these community-based programs are not occurring in a vacuum. Thirdly, there was the need to simultaneously monitor changes at various levels of the community.

The Minnesota Heart Health Program was a community trial of cardiovascular disease prevention methods that was conducted from 1980 to 1990 in three Upper Midwestern communities with three matched comparison communities. A 5- to 6-year intervention program used community-wide and individual health education in an attempt to decrease population risk. A major hypothesis was that the incidence of validated fatal and nonfatal coronary heart disease and stroke in 30- to 74-year-old men and women would decline differentially in the education communities after the health promotion program was introduced. This hypothesis was investigated using mixed-model regression. The intervention effect was modeled as a series of annual departures from a linear secular trend after a 2-year lag from the start of the intervention program. In the education communities, 2, 394 cases of coronary heart disease and 818 cases of stroke occurred, with 2, 526 and 739 cases, respectively, being seen in the comparison communities. The overall decline in coronary heart disease incidence was 1.8 percent per year in men (p = 0.03) and 3.6 percent per year in women (p = 0.007). For stroke, there were no significant secular trends. The authors recently published findings showing minimal effects of sustained intervention on risk factor levels. In the current report, there was no evidence of a significant intervention effect on morbidity or mortality, either for coronary heart disease or for stroke. Am J Epidemiol 1996; 144: 351–62. [ABSTRACT FROM AUTHOR]

This article offers background on the Bloomington Heart and Health Program, one of the three education communities that are included in the Minnesota Heart Health program. The Bloomington Heart and Health program is aligned with the Bloomington Public Health Division to continue the activities and objectives of the Minnesota Heart Health program. A major component of the Minnesota Heart Health program is the community contest aimed at promoting smoking cessation. For its part, the Blooming Public Health Division had successfully conducted the 1990 and 1991 contests.