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1 | INTRODUCTION New HIV infections in Kenya have fallen from 75,000 among adults in 2010 to 41,416 in 2019 [1]. To continue this trend, the provision of prevention services [...], Introduction: Key populations (KP) continue to account for high HIV incidence globally. Still, prioritization of KP in the national HIV prevention response remains insufficient, leading to their suboptimal access to HIV programmes. This commentary aims to share Kenya's challenges and successes in achieving 2020 global HIV targets and scaling up the KP programme in the last decade. Discussion: The KP programme in Kenya has scaled up in the last decade with the inclusion of female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), transgender people and people in prisons as priority populations in the national HIV response. KP coverage based on official size estimates for FSW is 73%, for MSM is 82%, for PWID through needle syringe programme (NSP) is 71%, and through opioid substitution therapy (OST) is 26% and for transgender people is 5%. The service outcomes for KP have been relatively strong in prevention with high condom use at last paid sex for FSW (92%) and use of sterile equipment among PWID (88%), though condom use at last sex with a non-regular partner among MSM (78%) is still low. The KP programme has not met care continuum targets for all subpopulations with low case findings. The national KP programme led by the Ministry of Health has scaled up the programme through (a) strategic partnerships with KP-led and competent organizations, researchers and donors; (b) development of policy guidance and programme standards; (c) continuous sensitization and advocacy to garner support; (d) development of national reporting systems, among others. However, the programme is still struggling with uncertain size estimates; lack of updated bio-behavioural survey data; inadequate scale-up of interventions among transgender people and people in prison settings; gaps in reaching adolescent and young KP, and effectively addressing structural barriers like violence and stigma. Conclusions: To reach the ambitious global HIV targets, sufficient coverage of KP with quality HIV programmes is critical. Despite scaling up the KP programme, Kenya has not yet achieved the 2020 global HIV targets and needs more efforts to scale-up quality programmes for KP who are underserved in the HIV response. Keywords: key populations; scale; 2020 global HIV targets; Kenya; HIV programmes

Author(s): Katharine D. Shelley [sup.1] , Rose Mpembeni [sup.2] , Gasto Frumence [sup.3] , Elizabeth A. Stuart [sup.4] , Japhet Killewo [sup.2] , Abdullah H. Baqui [sup.1] , David H. [...], Objectives Despite renewed interest in expansion of multi-tasked community health workers (CHWs) there is limited research on HIV and maternal health integration at the community-level. This study assessed the impact of integrating CHW roles for HIV and maternal health promotion on facility delivery utilization in rural Tanzania. Methods A 36-month time series data set (2014-2016) of reported facility deliveries from 68 health facilities in two districts of Tanzania was constructed. Interrupted time series analyses evaluated population-averaged longitudinal trends in facility delivery at intervention and comparison facilities. Analyses were stratified by district, controlling for secular trends, seasonality, and type of facility. Results There was no significant change from baseline in the average number of facility deliveries observed at intervention health centers/dispensaries relative to comparison sites. However, there was a significant 16% increase (p < 0.001) in average monthly deliveries in hospitals, from an average of 202-234 in Iringa Rural and from 167 to 194 in Kilolo. While total facility deliveries were relatively stable over time at the district-level, during intervention the relative change in the proportion of hospital deliveries out of total facility deliveries increased by 17.2% in Iringa Rural (p < 0.001) and 14.7% in Kilolo (p < 0.001). Conclusions for Practice Results suggest community-delivered outreach by dual role CHWs was successful at mobilizing pregnant women to deliver at facilities and may be effective at reaching previously under-served pregnant women. More research is necessary to understand the effect of dual role CHWs on patterns of service utilization, including decisions to use referral level facilities for obstetric care.

Introduction Over 800 million people defecate in the open rather than use a toilet. (1) Though global mortality from diarrhoeal diseases has recently declined, (1) poor water and sanitation are [...], Objective To evaluate the long-term impact of a community-led total sanitation campaign in rural India. Methods Local organizations in Odisha state, India worked with researchers to evaluate a community-led total sanitation campaign, which aimed to increase the demand for household latrines by raising awareness of the social costs of poor sanitation. The intervention ran from February to March 2006 in 20 randomly-selected villages and 20 control villages. Within sampled villages, we surveyed a random subset of households (around 28 households per village) at baseline in 2005 and over the subsequent 10-year period. We analysed changes in latrine ownership, latrine functionality and open defecation among approximately 1000 households. We estimated linear probability models that examined differences between households in intervention and control villages in 2006, 2010 and 2016. Findings In 2010, 4 years after the intervention, ownership of latrines was significantly higher (29.3 percentage points; 95% confidence interval, CI: 17.5 to 41.2) and open defecation was significantly lower (-6.8 percentage points; 95% CI: -13.1 to -1.0) among households in intervention villages, relative to controls. In 2016, intervention households continued to have higher rates of ever owning a latrine (26.3 percentage points; 95% CI: 20.9 to 31.8). However, latrine functionality and open defecation were no longer different across groups, due to both acquisition of latrines by control households and abandonment and deterioration of latrines in intervention homes. Conclusion Future research should investigate how to maintain and rehabilitate latrines and how to sustain long-term behaviour change. Objectif Evaluer l&apos;impact a long terme d&apos;une campagne d&apos;assainissement total pilotee par la collectivite dans l&apos;Inde rurale. Methodes Des organisations locales de l&apos;Etat d&apos;Odisha, en Inde, ont travaille avec des chercheurs afin d&apos;evaluer une campagne d&apos;assainissement total pilotee par la collectivite, qui visait a accroitre la demande de latrines domestiques en sensibilisant aux couts sociaux d&apos;un mauvais assainissement. Lintervention s&apos;est deroulee de fevrier a mars 2006 dans 20 villages selectionnes aleatoirement et 20 villages temoins. Dans les villages en question, nous avons etudie un sousensemble aleatoire de foyers (environ 28 foyers par village) au point de reference en 2005 et sur les 10 annees suivantes. Nous avons analyse les changements en matiere de possession de latrines, de fonctionnalite des latrines et de defecation en plein air pour environ 1000 foyers. Nous avons estime des modeles de probabilite lineaire examinant les differences entre les foyers beneficiaires de l&apos;intervention et les villages temoins en 2006, 2010 et 2016. Resultats En 2010, 4 ans apres l&apos;intervention, la possession de latrines etait nettement plus elevee (29,3 points de pourcentage; intervalle de confiance de 95%, IC: 17,5 a 41,2) et la defecation en plein air nettement plus faible (-6,8 points de pourcentage; IC 95%: -13,1 a -1,0) dans les foyers des villages ayant beneficie de l&apos;intervention que dans les villages temoins. En 2016, les foyers beneficiaires de l&apos;intervention continuaient d&apos;avoir un taux de possession de latrines superieur (26,3 points de pourcentage; IC 95%: 20,9 a 31,8). Cependant, les groupes ne presentaient plus de differences quant a la fonctionnalite des latrines et a la defecation en plein air, en raison de l&apos;acquisition de latrines par les foyers temoins et de l&apos;abandon et de la deterioration des latrines dans les foyers qui avaient beneficie de l&apos;intervention. Conclusion Les recherches futures devraient s&apos;interesser aux moyens d&apos;entretenir et de renover les latrines et de faire changer durablement les comportements. Objetivo Evaluar el impacto a largo plazo de una campana de saneamiento total liderada por la comunidad en las zonas rurales de la India. Metodos Organizaciones locales en el estado de Odisha, India, trabajaron con investigadores para evaluar una campana de saneamiento total liderada por la comunidad, cuyo objetivo era aumentar la demanda de letrinas domesticas mediante la concienciacion sobre los costes sociales de un saneamiento deficiente. La intervencion se llevo a cabo entre febrero y marzo de 2006 en 20 aldeas seleccionadas al azar y 20 aldeas de control. Dentro de las aldeas muestreadas, se encuesto a un subconjunto aleatorio de hogares (alrededor de 28 hogares por aldea) al inicio del estudio en 2005 y durante el periodo de 10 anos subsiguiente. Se analizaron los cambios en la propiedad de las letrinas, la funcionalidad de estas y la defecacion al aire libre en aproximadamente 1 000 hogares. Se estimaron modelos de probabilidad lineal que examinaron las diferencias entre los hogares de las aldeas de intervencion y control en 2006, 2010 y 2016. Resultados En 2010, cuatro anos despues de la intervencion, la propiedad de las letrinas fue significativamente mayor (29,3 puntos porcentuales; intervalo de confianza del 95 %: 17,5 a 41,2) y la defecacion al aire libre fue significativamente menor (6,8 puntos porcentuales; IC del 95 %: 13,1 a 1,0) en los hogares de las aldeas de intervencion, en relacion con los controles. En 2016, los hogares de intervencion continuaron teniendo tasas mas altas de poseer una letrina (26,3 puntos porcentuales; IC del 95 %: 20,9 a 31,8). Sin embargo, la funcionalidad de las letrinas y la defecacion al aire libre ya no eran diferentes entre los grupos, debido tanto a la adquisicion de letrinas por los hogares de control como al abandono y deterioro de las letrinas en los hogares de intervencion. Conclusion Los estudios futuros deberian investigar como mantener y rehabilitar las letrinas y como mantener un cambio de comportamiento a largo plazo. [phrase omitted]

Author(s): Glen D. Johnson [sup.1] , Kristine Mesler [sup.2] , Marilyn A. Kacica [sup.3] [sup.4] Author Affiliations: (1) 0000 0001 2188 3760grid.262273.0City University of New York School of Public Health, [...], Objective The objective is to estimate community needs with respect to risky adolescent sexual behavior in a way that is risk-adjusted for multiple community factors. Methods Generalized linear mixed modeling was applied for estimating teen pregnancy and sexually transmitted disease (STD) incidence by postal ZIP code in New York State, in a way that adjusts for other community covariables and residual spatial autocorrelation. A community needs index was then obtained by summing the risk-adjusted estimates of pregnancy and STD cases. Results Poisson regression with a spatial random effect was chosen among competing modeling approaches. Both the risk-adjusted caseloads and rates were computed for ZIP codes, which allowed risk-based prioritization to help guide funding decisions for a comprehensive adolescent pregnancy prevention program. Conclusions This approach provides quantitative evidence of community needs with respect to risky adolescent sexual behavior, while adjusting for other community-level variables and stabilizing estimates in areas with small populations. Therefore, it was well accepted by the affected groups and proved valuable for program planning. This methodology may also prove valuable for follow up program evaluation. Current research is directed towards further improving the statistical modeling approach and applying to different health and behavioral outcomes, along with different predictor variables.

Author(s): Sunah S. Hwang[sup.1] [sup.2] , Denis V. Rybin[sup.3] , Timothy C. Heeren[sup.4] , Eve R. Colson[sup.5] , Michael J. Corwin[sup.6] Author Affiliations: (1) Section of Neonatology, Department of Pediatrics, [...], Objectives (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Methods Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2-6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination. Weighted frequencies of maternal trust in advice sources were calculated to obtain prevalence estimates. Multivariable logistic regression was used to assess the association of maternal and infant characteristics with maternal trust in advice sources. Results Mothers had the greatest trust in doctors for advice on all infant care practices (56-89 %), while trust was lowest for friends (13-22 %) and the media (10-14 %). In the adjusted analyses, there were significant associations of maternal race/ethnicity, education, and age with trust in advice sources. Conclusions for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices.

Author(s): Lisa N. Kransdorf[sup.1] , T. S. Raghu[sup.2] , Juliana M. Kling[sup.1] , Paru S. David[sup.1] , Suneela Vegunta[sup.1] , Jo Knatz[sup.3] , Allan Markus[sup.3] , Keith A. Frey[sup.4] , [...], Objectives The Centers for Disease Control and Prevention recommends a reproductive life plan (RLP) to promote individual responsibility for preconception health. The objectives of this study were to determine existing awareness of RLPs in a cohort of reproductive-age adults and to evaluate their knowledge level and beliefs about reproductive life planning. Methods We performed a cross-sectional survey study of adults ages 18-40 years old seeking care at the student health center of a large public university. Participation was voluntary. Survey responses were analyzed by age and gender. Results A total of 559 surveys were collected and analyzed. Only 24 % of participants had heard of an RLP although a majority (62.9 %) agreed that it is important to develop an RLP. Most respondents (85.4 %) preferred to receive information about reproductive life planning from a primary care provider or obstetrician-gynecologist, while only 4.2 % of patients surveyed reported ever being actually asked about an RLP by their healthcare provider. Among those who agreed that an RLP was important, knowledge of specific aspects of an RLP was lacking. Conclusions In our cohort of reproductive-age adults, general health literacy regarding RLPs was poor. Most of the young adults who responded to our survey did not know what an RLP was and even fewer had ever discussed one with their health provider.

Introduction The Global strategy for women's, children's and adolescents' health (2016-2030) calls for action towards three objectives for health: survive (end preventable deaths), thrive (ensure health and well-being) and transform [...], The Global strategy for women&apos;s, children&apos;s and adolescents&apos; health (2016-2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals. La Strategie mondiale pour la sante de la femme, de l&apos;enfant et de l&apos;adolescent (2016-2030) reconnait que les individus jouent un role central dans l&apos;amelioration de leur propre sante. Nous pensons que la participation communautaire, et notamment des communautes qui travaillent avec les services de sante (coproduction en matiere de soins de sante), sera essentielle pour atteindre les objectifs de la strategie mondiale. La participation communautaire repond plus particulierement au troisieme objectif cle: transformer les societes afin que les femmes, les enfants et les adolescents puissent exercer leur droit dejouirdu meilleur etat de sante et de bien-etre possible. Dans le present rapport, nous examinons ce que ceci suppose dans la pratique. Nous analysons trois domaines interdependants dans le cadre d&apos;une action visant une plus grande participation du public en matiere de sante: ameliorer la capacite de participation des individus et des groupes, developper et assurer la perennite des services de sante axes sur l&apos;etre humain, et favoriser la responsabilisation sociale. Nous donnons par ailleurs un apercu des difficultes liees a la mise en oeuvre et fournissons aux decideurs, aux administrateurs de programmes et aux professionnels de la sante des exemples illustrant les differents types d&apos;approches participatives necessaires dans chaque domaine pour atteindre les objectifs lies a la sante et au developpement. La Estrategia Mundial para la Salud de la Mujer, el Nino y el Adolescente (2016-2030) reconoce que las personas tienen un papel fundamental a la hora de mejorar su propia salud. Proponemos que la participacion comunitaria, concretamente las comunidades que trabajan junto con los servicios sanitarios (coproduccion de atencion sanitaria), sea fundamental para lograr los objetivos de la estrategia mundial. En particular, la participacion comunitaria aborda el tercer objetivo fundamental: transformar las sociedades de modo que las mujeres, los ninos y los adolescentes puedan ejercer sus derechos de salud y bienestar en la mayor medida posible. En este articulo se examina lo que esto implica en la practica. Se debaten tres ambitos de accion interdependientes que se encaminan hacia una mayor participacion del publico en la sanidad: mejorar las capacidades para la participacion individual y en grupo; desarrollar y mantener servicios sanitarios centrados en las personas; y contabilidad social. Se repasan los desafios para su implementacion,y se ofrece a los responsables politicos, gestores de programas y medicos ejemplos ilustrativos de los tipos de enfoques de participacion necesarios en cada ambito para contribuir a alcanzar los objetivos sanitarios y de desarrollo.

Rising rates of obesity are driving the increasing burden of diseases such as type 2 diabetes, cardiovascular disease (1) and cancer. (2) Obesity and overweight during childhood are especially concerning [...], OBJECTIVES: We describe the processes used in SCOPE, a community-based participatory research (CBPR) initiative, to achieve multisectoral engagement and collective action to prevent childhood obesity. PARTICIPANTS: SCOPE engages representatives from various sectors (local government, health, schools, recreation, local media, early childhood, community services) who influence the environments in which children live, learn and play. SETTING: SCOPE has been implemented in three communities in British Columbia (BC). INTERVENTION: SCOPE (www.live5210.ca) is a multi-setting, multi-component initiative designed to enhance a community&apos;s capacity to create and deliver localized solutions to promote healthy weights among children. SCOPE, in partnership with a local organization, engages multiple stakeholders who plan and implement actions framed by a common evidence-based health message (&apos;Live 5-2-1-0&apos;). SCOPE&apos;s central team in Vancouver, BC facilitates alignment with provincial initiatives, knowledge translation and exchange (KTE) within and across communities, and the collection, analysis and reporting of shared data. OUTCOMES: Best practice processes that have emerged from SCOPE&apos;s experience align with the principles of CBPR and the five conditions of Collective Impact--a common agenda, mutually reinforcing action, continuous communication, a backbone organization and shared measurement. SCOPE has achieved sustainable practice change framed by a common agenda (&apos;Live 5-2-1-0&apos;) leading to mutually reinforcing cross-sectoral action. CONCLUSION: A multi-pronged community-led childhood obesity prevention initiative can be achieved using CBPR principles and attending to the conditions for achieving collective impact. KEY WORDS: Pediatric obesity; prevention & control; health promotion; community-based participatory research Can J Public Health 2015;106(6):e426-e433 doi: 10.17269/CJPH.106.5114 OBJECTIFS: Nous decrivons les processus utilises par SCOPE, une initiative de recherche participative communautaire (RPC), pour obtenir une mobilisation multisectorielle et une action collective afin de prevenir l&apos;obesite juvenile. PARTICIPANTS: SCOPE recrute des representants de divers secteurs (administration municipale, sante, ecoles, loisirs, medias locaux, petite enfance, services communautaires) qui influencent les milieux de vie, d&apos;apprentissage et de jeu des enfants. LIEU: SCOPE est mise en oeuvre dans trois communautes de la ColombieBritannique (C.-B.). INTERVENTION: SCOPE (www.live5210.ca) est une initiative concertee, appliquee dans plusieurs milieux, qui vise a ameliorer la capacite d&apos;une communaute a creer et a offrir des solutions locales pour promouvoir les poids-sante chez les enfants. En partenariat avec un organisme local, SCOPE recrute plusieurs acteurs qui planifient et mettent en oeuvre des actions encadrees par un message de sante commun (<>) fonde sur des donnees probantes. L&apos;equipe centrale de SCOPE a Vancouver (C.-B.) facilite l&apos;harmonisation des actions avec les initiatives provinciales, l&apos;application et l&apos;echange des connaissances (AEC) dans et entre les communautes, ainsi que la cueillette, l&apos;analyse et la diffusion des donnees partagees. RESULTATS: Les pratiques exemplaires issues de l&apos;experience de SCOPE sont conformes aux principes de la RPC et aux <>, a savoir: un plan d&apos;action commun; des actions se soutenant mutuellement; la communication permanente; une structure de soutien; et un systeme d&apos;evaluation commun. SCOPE a obtenu des changements durables dans les pratiques, encadres par un plan d&apos;action commun (<>) qui a mene a des actions intersectorielles se soutenant mutuellement. CONCLUSION: Une initiative communautaire concertee de prevention de l&apos;obesite juvenile est possible si l&apos;on utilise les principes de la RPC et que l&apos;on porte attention aux conditions necessaires pour obtenir un impact collectif. MOTS CLES: obesite pediatrique; prevention et controle; promotion de la sante; recherche participative communautaire

Introduction Persistently elevated rates of adverse pregnancy outcomes including low birthweight births among low-income and African-American women are a high-priority public health problem [1], contributing to the US ranking of [...], Care coordination services that link pregnant women to health-promoting resources, avoid duplication of effort, and improve communication between families and providers have been endorsed as a strategy for reducing disparities in adverse pregnancy outcomes, however empirical evidence regarding the effects of these services is contradictory and incomplete. This study investigates the effects of maternity care coordination (MCC) on pregnancy outcomes in North Carolina. Birth certificate and Medicaid claims data were analyzed for 7,124 women delivering live infants in North Carolina from October 2008 through September 2010, of whom 2,255 received MCC services. Propensity-weighted analyses were conducted to reduce the influence of selection bias in evaluating program participation. Sensitivity analyses compared these results to conventional ordinary least squares analyses. The unadjusted preterm birth rate was lower among women who received MCC services (7.0 % compared to 8.3 % among controls). Propensity-weighted analyses demonstrated that women receiving services had a 1.8 % point reduction in preterm birth risk; p < 0.05). MCC services were also associated with lower pregnancy weight gain (p = 0.10). No effects of MCC were seen for birthweight. These findings suggest that coordination of care in pregnancy can significantly reduce the risk of preterm delivery among Medicaid-enrolled women. Further research evaluating specific components of care coordination services and their effects on preterm birth risk among racial/ethnic and geographic subgroups of Medicaid enrolled mothers could inform efforts to reduce disparities in pregnancy outcome. Keywords Care coordination * Preterm birth * Birth outcomes * Pregnancy * Propensity weighted analysis

Do characteristics such as race, ethnicity, age, sex, gender, occupation, or even geographical location influence how likely people are to drink alcohol or to experience problems related to alcohol use? [...]

Purpose: This study was undertaken to gain a better understanding of health promotion practices among college students and the relationship of stress and the practice of various health behaviors. Method: [...]

For numerous reasons, children of Mexican descent experience many health disparities. One strategy for addressing these disparities is to increase health promotion and protection behaviors that mothers use with their preschool children. Limited literature is available on such practices used by mothers of Mexican descent with their healthy preschool children. This study explored child health promotion and protection practices used by mothers of Mexican descent. A naturalistic design, guided by Spradley's ethnographic interview techniques, was selected for this study. The sample included 9 Mexican-descent mothers from an urban U.S. community with healthy preschool children. Despite significant challenges, participants promoted and protected the health of their preschool children by al cuidado (taking care) and by being al pendiente (being mindful) of balancing the health of their children's bodies, minds, and souls. Understanding these mothers' approaches allows the creation of culturally sensitive health programs that can build on existing maternal strengths. Keywords: health promotion; child health; cultural values; Mexican

Mass media are very influential in shaping discourses about health but few studies have examined the extent to which newspaper coverage of such stories reflect issues embedded in health policy documents. We estimate the relative distribution of health stories using content analysis. Nine meta-topics are used to sort stories across a range of major influences shaping the health status of populations adapted from the document Toward a Healthy Future (Second Report on the Health of Canadians (1999)) (TAHF). A total of 4732 stories were analyzed from 13 Canadian daily newspapers (10 English, 3 French language) using a constructed week per quarter method. Stories were sampled from each chosen newspaper for the years 1993, 1995, 1997 and 2001.72% (n = 3405) of stories in this analysis were from English-language papers, 28% (n = 1327) were from French-language papers. Topics related to health care (dealing either with issues of service provision and delivery or management and regulation) dominated newspaper stories, accounting for 65% of all stories. Physical environment topics accounted for about 13% of all stories, the socio-economic environment about 6% of stories, personal health practices about 5% of stories, and scientific advances in health research about 4% of stories. Other influences upon health identified in TAHF were rarely mentioned. The overall prominence of topics in newspapers is not consistent with the relative importance assigned to health influences in TAHF. Canadian newspapers rarely report on socio-economic influences frequently cited in the research literature (and reflected in TAHF) as being most influential in shaping population health outcomes. Keywords: Canada; Population health; Public policy; News media; Socio-economic environment; Determinants of health; Discourse; Content analysis

Objectives: Health promotion is a core function of public health services and improving the effectiveness of health promotion services is an essential part of public health service development. This report describes the rationale, the process and the outcomes of a realignment designed to improve the effectiveness of health promotion activities in a public health unit (PHU) in New Zealand. Methods: A practice environment analysis revealed several factors that were hindering the effectiveness of the health promotion unit's (HPU) activities. Two primary change mechanisms were implemented. The first was an outcomes-focused model of planning and service delivery (to support evidenced-based practice), the second was the reorganisation of the HPU from a topics-based structure to an integrated one based on a multi-risk factor paradigm of population health. Results: During the realignment barriers were encountered on multiple levels. At the individual level, unfavourable attitudes to changes occurred because of a lack of information and knowledge about the benefits of evidence and research. At higher levels, barriers included resourcing concerns, a lack of organisational commitment and understanding, and tensions between the political need for expedient change and research and development need for timely consideration of the impact of different models of practice. Conclusions and Implications: This realignment took place within the context of a changing public health environment, which is significantly altering the delivery of public health and health promotion. Realignments designed to facilitate more effective health promotion and public health practice will continue, but need to do so in the light of others' experience and debate.

This paper reports on findings from an ethnographic study of female sex workers who work in the indoor sex markets in a British city. An unexpected finding was the collective narratives that sex workers construct to rationalise their involvement in the sex industry. Fifty-five respondents who took part in in-depth interviews maintained that prostitution is a useful occupation and function in society. Narratives included providing emotional support to male clients; a service for men who are socially or physically disabled; preventing men having adulterous affairs; and health education, disease prevention and as therapists for sexual dysfunction. This paper evaluates how the latter narrative of sexual health promotion is an example of how sex workers are ideally placed to work as health educators with men who buy sex. Arguing against gender specific sexual health policies, men who buy sex are described as a 'high risk' group who are also a hidden population. Limitations posed by ideological, ethical and practical concerns relating to the specific conditions of the sex industry suggest that this proposal could be partially successful. In conclusion, I suggest the sexual health of the nation and the place of sex workers in society must be considered with regard to recent policy debates on the management of prostitution and the cultural construction of the sex worker. Keywords: Sex workers; Prostitution: Male clients: Health promotion: Sexual health; Health education: UK

UK health policy is concerned with emphasising nutritional status as a factor in the relationship of social inequalities to health outcomes. This paper examines pupil and parent responses to an after-school 'Food Club' designed to promote food preparation skills and healthier food choices amongst 12-13 year olds in low-income areas in North East England. The rationale for the intervention was a series of distinct but connected premises: food preparation skills are essential to inexpensive healthier eating; practical cooking skills are given limited emphasis in the secondary school curriculum; children have some choice over what they eat and may serve as a conduit of influence within the family. The qualitative investigation used group discussions and individual interviews with participating pupils and their parents. Most participating pupils enjoyed the practical emphasis upon food preparation, believed their skills developed, and were aware of the underlying message about healthier eating, but only made limited changes to their diet. Interviews with parents showed most to be positive about their child's involvement in such a club, though they varied in their attitude to its underlying message. There was some evidence of children being more involved in cooking at home and making some specific requests about food, but little to suggest they were influencing family food consumption. The findings suggest that an extra-curricular Food Club is an appropriate and feasible approach to developing food preparation skills with pupils in this age group. These findings raise questions about children's opportunities to exercise food preparation skills and make food choices within families, and the extent to which barriers to dietary change may be lowered through educational initiatives directed at pupils. Keywords: Children; School; Food preparation skills; Health promotion; Food choices; UK

Health information is everywhere, but can it be presented to better promote behavior? Past research finds that framing messages can effectively motivate health behaviors. This article briefly summarizes the role of message framing in health promotion in the general population, investigates findings for medically underserved populations, and discusses the influence of targeting to group characteristics on increasing the persuasiveness of framed messages. The conclusion is that theory-driven approaches lead to more persuasive messages across socioeconomic status. Keywords: message framing; persuasion; health disparities; ethnicity: health promotion

The authors present a program of research that focuses on reducing health disparities among African American populations through innovative health communication and health promotion interventions. Research on tailored communications ranges from investigating efficacy, manipulating communication variables, and comparing tailored print versus other state-of-the-art intervention modalities to integrating tailored materials into public health interventions based on a socioecological model. Examples from other research, as well as advantages and disadvantages of these approaches, are discussed. The purpose of the overall research program is to develop effective and cost-effective health communications for promoting health behavior change that also are culturally relevant and potentially sustainable in communities. Keywords: tailoring; community interventions; health communication; health disparities; minority health

Objective: To compare the health of Queensland women prisoners with that of community women using the target areas of public health promotion identified by Health Determinants Queensland as a framework. Methods: Data from the Queensland Women Prisoners' Health Survey was compared with published community data in each of the target areas. Results: Queensland women prisoners had poorer nutrition, did less exercise, had higher rates of smoking and had a greater prevalence of asthma and diabetes than women in the community. They seemed to have a greater prevalence of mental health disorders. Conclusions: Within the framework, women prisoners had significantly poorer measured outcomes than community women in all areas except cervical screening, breast cancer screening and overweight and obesity. Implications: The Health Determinants Queensland target areas for Queensland women are of even greater priority in the subgroup of women prisoners. Benefits for the health of prisoners, and therefore the community, could be gained by expanding existing community health promotion activities to prisons through collaboration and partnerships. (Aust N Z J Public Health 2005; 29: 324-7)

In his comment on Victor Fuch's essay, the late Alvan Feinstein raised the question of whether government-sponsored programs of 'health promotion' are always good for well-being.

Objectives. This article assesses pastor-level factors that affect the successful recruitment and implementation of community-based health promotion programs in Black churches. Methods. Semistructured interviews with 16 pastors of Black churches were analyzed for content. Results. We found that although the involvement of Black pastors in an array of secular activities makes them open to participate in health programs, their overcommitment to other issues can negatively influence their ability to participate. Second, although Black pastors appreciate being included in and benefiting from health research, minorities' history of being underserved and exploited can lead to suspiciousness and reluctance to participate. Conclusions. Our findings suggest that those interested in developing church-based health programs in the Black community must be attuned to how the same factors can both facilitate and hinder a program's development. 805-810)

This paper considers the discursive properties of public health literature produced around AIDS in the 1980s and early 1990s. Attention is focused upon the role of health promotion in the UK government's response to the epidemic and on the language used in the educational campaigns conducted by the Health Education Council and its replacement the Health Education Authority. Using an analytical approach influenced by the work of Michel Foucault, the paper argues that the knowledges of AIDS produced by these various public health institutions constructed discursive boundaries between the idea of 'normal' and 'abnormal' behavioural practices. The notion of risk, produced as it is from epidemiological knowledge, is a central mechanism in this process. It is through the production, articulation and normalisation of 'at risk' groups that society is fragmented and hence subject to the governance strategies of late-modern liberal economies.

Health promotion and disease prevention programs are becoming important components of contemporary health care. There are at least 2 pathways to the enhancement of population health status through disease prevention. The first pathway requires the early diagnosis and treatment of disease. The second pathway promotes healthy lifestyles and disregards the requirement that a condition must be diagnosed before intervention is recommended. Data from several evaluations suggest that prevention efforts that rely on diagnosis have produced somewhat limited benefits, whereas primary prevention efforts may have substantial benefits. Current health policy places greater emphasis on secondary prevention. The objectives of improved population health might be better achieved by devoting relatively more resources to primary prevention through the promotion of healthy behaviors.

A report of a case study concerning the effect of the probability and severity of health problems on health protection is given. Analyses indicated that the perceived probability and severity of health hazards have no independent effect on the motivation to engage in health protection. Results also indicated a surprising insensitivity to variations in moderate to high hazard probability.

Teleonics is an approach to the study of living systems. The latter can be regarded as synergistic collections of processes through which the systems interact with their internal and external environments. Teleonics can serve as a framework for positioning issues of health into the wider context of the fabric of life. There are essentially three webs of processes that are of relevance for a discussion of healthcare, viz, the normal web of the living fabric (Biomatrix), the 'web of disease' (Pathomatrix) and the web of Healthcare. The latter interacts with the first two through the processes of Health Promotion, Disease Prevention and Disease Management. The end result of these interactions is an entirely new web of great complexity that incorporates the processes of all three webs intertwined with each other. This complexity presents a considerable challenge to all those involved in healthcare and can only be untangled with the aid of a process-based methodology, such as teleonics. KEYWORDS: Biomatrix, teleonics, health, disease, healthcare, health promotion

Policymakers in many countries seek to contain health care costs over the long range by promoting health and more effective health behavior. Such efforts can be directed at entire populations, at members of a health plan, at defined risk groups or single individuals at risk. Many health risks are associated with socio-economic status and social inequalities but these are often difficult to address because of social and political conflicts. Health, also, is often a product of culture and other social circumstances. Health may be promoted through non-health interventions or through more targeted health efforts seeking to effect behavior change. Preventive screening is of growing importance but such efforts often out-pace evidence of efficacy or cost-effectiveness. Many opportunities exist to build on new clinician - patient partnerships to make patients better informed and to effect positive health behavior. New technologies, and particularly the internet, offer new ways to promote health and more constructive illness behaviors. Keywords: Health promotion; Prevention: Social inequalities; Behavior change: Screening; Health status

The Global Advisory Committee on Vaccine Safety (GACVS), an independent expert clinical and scientific advisory body, provides WHO with scientifically rigorous advice on vaccine safety issues of potential global importance. [...]

The authors examined comparative effects of five health campaign channels used in the Stanford Five-City Multifactor Risk Reduction Project. Three distinct criterion variables were evaluated: (a) reach, measured as the number of messages intervention community residents remembered, (b) specificity, assessed by examining whether the campaign differentially reached those who were already knowledgeable and practicing cardiovascular disease risk reduction, and (c) impact, defined as the amount of knowledge gained during the 5-year campaign. Path analyses revealed that reach was highest for tip sheets. Specificity was highest for booklets and then television programs. Newspaper messages appeared to have the most impact, followed by booklets and television public service announcements, tip sheets, and finally, television programs. Channels varied according to reach, specificity, and impact, and each of these criteria were distinct. No channel was optimal for all three of the outcome measures, suggesting that channel selection involves tradeoffs among different types of effects.