Carol N. D'Onofrio

Diffusion of School-Based Substance Abuse Prevention Programs

Despite promising evidence of the effectiveness of psychosocial-based approaches to drug abuse prevention, these programs have not been widely adopted by schools. This article considers the feasibility of widespread diffusion of empirically based prevention programs in school settings. The literature on determinants of diffusion is reviewed, results of recent research on strategies to increase diffusion are discussed, and barriers to successful diffusion in school settings are identified. The article concludes by presenting implications of these research findings for policy, practice, and future research.

Theory and the Empowerment of Health Education Practitioners

Both the nature of theory and the way it is taught can overpower health education practitioners. As a consequence, myths which maintain theory and practice in separate realms may develop. This paper argues that to remedy this situation, practitioners must be helped to gain greater control of theory. Specific suggestions for accomplishing this goal are offered in a three-part prescription. First, concepts and teaching methods are introduced to dismantle myths about theory and to help practitioners understand its origins, nature, and functions. Second, health educators are encouraged to acknowledge limitations in theories currently guiding their practice. Third, they are shown ways they can exert leadership in developing theory to fill these gaps and build a more adequate knowledge base for confronting contemporary practice problems. Through this exercise of power, health educators will gain control over theory and expand the boundaries of practice, while also enhancing their professional status. The boundaries of professional practice are made and changed by the relation ship between the discourse of scientific knowledge and the exercise of profes sional power. 1 Turner

Curtailing Tobacco Use Among Youth: Evaluation of Project 4-Health

This article reports the development and evaluation of Project 4-Health, a theory-driven, research-based program to prevent tobacco use among youth enrolled in 4-H clubs throughout California. Additional goals were to involve youth in discouraging others’tobacco use and to develop youth leadership for tobacco control. To assess program effectiveness, 72 clubs were matched and randomly assigned to the program or control condition. Of 1,853 eligible club members, 88.6% completed the pretest. Of these, 79.5% completed a posttest 4 months after conclusion of program delivery, and 77.6% completed a second posttest 2 years later. Short-term effects were found on 7 of 24 outcome measures, indicating changes in knowledge, attitudes, and behavioral intention, but not in social influence variables or behaviors. No long-term effects were observed. Discussion considers how the challenges of designing, delivering, and evaluating the intervention influenced results and implications for preventing tobacco use through community-based youth groups.

HIV Risk Behaviors Among Three Classes of Female Sex Workers in Vietnam

Increases in the rate of HIV infection in Vietnam among female sex workers and their clients require more effective preventive interventions based on a better understanding of this population and important subgroups within it. Because little was known about women in the hospitality sex industry, this study compared demographic and work characteristics, history of sexually transmitted infections (STIs), and condom use among a sample of 310 female sex workers in low-, middle-, and high-class hospitality businesses in Ho Chi Minh City (mean age = 26.77 years, SD = 6.17). Data were collected through individual, face-to-face, semistructured interviews. Logistic regression models were used to identify demographic predictors of the incidence of STIs and reported condom use. Low occupational status was most strongly associated with a history of STIs, and use of condoms with new and regular clients also differed by occupational class. Implications are discussed.

Public Health Administration and Health Education Training Need More Integration

Nicholas Parlette is Associate Dean, School of Public Health, University of California at Berkeley. Eli Glogow is Associate Professor, School of Public Administration, University of Southern California, Los Angeles. Carol D’Onofrio is Associate Professor, School of Public Health, University of California at Berkeley. Address reprint requests to N. Parlette, 36 Sereno Circle, Oakland, CA 94619. There is a fundamental reason why the fields of public health education and health administration should integrate their curricula much more closely. It is simply a recognition of reality. In

Institutions as agents and objects of health-promoting change: Considerations in selecting research priorities

The study of institutional effects upon health is an important, but neglected area of inquiry in the behavioral sciences. Drs. Silversin and Coombs therefore have made a valuable contribution through their systematic review of the literature on institutional factors associated with oral health behavior and accompanying suggestions for needed investigations. The purpose of this paper is to complement their discussion by considering relationships between institutions and health from the broader perspectives of medicine and the behavioral sciences, with particular attention to issues in selecting priorities for behavioral science research.