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In this article, a description of how a comprehensive health promotion program for older adults was developed, tested with a quasi-experimental study design, and then revised to become a nationwide AARP and Red Cross program is presented. Teaching and learning methods used in the course are described with supporting education and behavioral theory. The course content for instructors, facilitators, and course partici pants is outlined. The key elements in the preparation of instructors and facilitators are identified. Results of the implementation of the program are given.

The Dartmouth Primary Care Cooperative Information (COOP) Project conducted a controlled trial on the impact of antismoking advice from office-based physicians. Eighteen primary care medical practices were randomly assigned to be intervention or customary care practices. Medical personnel assigned to the intervention practices were to systematically identify cigarette smokers (among patients aged 35 to 59 years making an office visit), advise them to quit smoking, and provide educational materials. A random sample of 258 smokers was identified and followed-up four months later. Intervention-group smokers were more likely to report being advised to quit smoking (77 percent versus 47 percent) and to attempt quitting (39 percent versus 31 percent), but had success rates similar to those of the other group (6 percent versus 7 percent). We conclude that the medical office is an excellent place to identify large numbers of smokers and initiate attempts at quitting, but find that simple antismoking information and advice are not enough to improve cessation rates.

This article describes how a successful health promotion program for older adults was adapted and disseminated through collaboration of the American Association of Retired Persons, the American Red Cross, and the Dartmouth Institute for Better Health. The details of this effort are presented in three sections: the conceptual frame work used to build the collaborative relationship, the outcomes, and an analysis of these experiences as they relate to the diffusion of innovations in organizations. The problems encountered are discussed as well as the need for more time to elapse before judging the ultimate success of the diffusion of the program.

We conducted a trial to evaluate the impact of medical self-care education on 330 elders whose average age was 71. The test group participated in a 13-session educational intervention with training in clinical medicine, life-style, and use of health services. The comparison group received a two-hour lecture-demonstration. Both groups were assessed pre-intervention, post-intervention, and one year after entry. The results indicate medical self-care instruction: produces substantial improvements, that were sustained for one year, in health knowledge, skills performance, and skills confidence; stimulates many attempts to improve life-style; and generates improvements in life quality. The program had little influence on utilization of medical care or health status.