Daniel L. Bibeau

An Ecological Perspective on Health Promotion Programs

During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health pro motion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses atten tion on both individual and social environmental factors as targets for health promo tion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individ uals in the population is essential for implementing environmental changes.

The Role of a Community Coalition in the Development of Health Services for the Poor and Uninsured

Access to primary health care for indigent citizens presents a dilemma for many communities in the United States. In response, communities have developed a variety of strategies to effectively deal with the problem. This article describes the evolution of a small free clinic into a comprehensive primary care clinic developed through the actions of a community-based coalition. The clinic originated within an umbrella organization for indigent residents as free medical service provided at a night shelter by a local physician once a week. Through a coalition of business, religious, medical, hospital, foundation, lay volunteer, county health department, and chamber of commerce representatives, the service was enlarged into a formal clinic operation with a small staff and volunteers providing services for about 3,500 patient visits each year. As the demand for services increased beyond resources, an expanded coalition created Health-Serve Medical Center, a comprehensive primary care clinic operating 40 hours per week. The Health-Serve Board is currently active in supporting service delivery at the clinic, with plans to serve 24,000 medical and dental visits annually by mid-1995. The evolution process was based upon the characteristics of effective community coalitions and the commitment of individuals from diverse community sectors.

Predictors of Uncontrolled Hypertension in the Stroke Belt

Inadequate control of high systolic blood pressure in older adults has been largely attributable to poor control of overall hypertension (HTN). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines emphasize the importance of controlling isolated systolic HTN in older adults. The study examined demographics, self‐reported health information, and clinical measures as predictors of uncontrolled HTN among individuals taking antihypertensive medications. The Community Initiative to Eliminate Stroke, a stroke risk factor screening and prevention project, collected data in two North Carolina counties. Statistical modeling of predictors included odds ratios (ORs) and logistic regression analyses. Of the 2663 participants, 43.5% and 22.8% had uncontrolled systolic and diastolic HTN, respectively. African Americans were more likely to have uncontrolled systolic (60%) or diastolic HTN (70.9%) compared with whites (40% and 29.1%, respectively). Participants 55 years and older were more likely to have uncontrolled systolic HTN compared with younger individuals. Regression analyses showed that race (OR, 1.239; P=.00), age (OR, 1.683; P=.00), and nonadherence with medications (OR, 2.593; P=.00) were significant predictors of uncontrolled systolic HTN. Future interventions should focus on improving management of isolated systolic HTN in older adults and African Americans to increase overall control of HTN.

Evaluation of worksite weight loss programs: A review of data and issues

Abstract This article reviews evaluations of weight loss programs at the worksite. Of the nine studies reviewed, five were behavior modification programs, three were hybrid programs, and one was a self-help program. The purpose of the report was to (a) identify evaluation studies of weight management programs conducted at the worksite; and (b) outline issues that should be addressed in subsequent evaluations. Issues which need to be considered in subsequent evaluations of worksite weight loss programs include: attrition, research design, sample size and selection, variable measurement and maintenance and follow-up.

Does providing nutrition information at vending machines reduce calories per item sold

In 2010, the United States (US) enacted a restaurant menu labeling law. The law also applied to vending machine companies selling food. Research suggested that providing nutrition information on menus in restaurants might reduce the number of calories purchased. We tested the effect of providing nutrition information and ‘healthy’ designations to consumers where vending machines were located in college residence halls. We conducted our study at one university in Southeast US (October–November 2012). We randomly assigned 18 vending machines locations (residence halls) to an intervention or control group. For the intervention we posted nutrition information, interpretive signage, and sent a promotional email to residents of the hall. For the control group we did nothing. We tracked sales over 4 weeks before and 4 weeks after we introduced the intervention. Our intervention did not change what the residents bought. We recommend additional research about providing nutrition information where vending machines are located, including testing formats used to present information.

Assessment of Public Health Educator Practice: Health Educator Responsibilities

This study presents a method for better understanding how practicing health educators in local health departments spend their time. The purpose of this study was to document the daily practice of health educators in the 10 areas of responsibility as defined by a competency-based framework for graduate-level health educators. The results of the current study present the average percentage of time health educators spent carrying out each area of responsibility and the percentage of health educators that did not carry out activities related to a specific area of responsibility. For example, the greatest percentage of time was spent implementing programs (21.2%), and approximately 60% of the health educators in the sample did not conduct research nor did they participate in activities to advance the profession. These findings have implications for the professional preparation of health educators and for their continuing education. The current study contains several suggestions for future research in this area.

Ethical Issues in Health Education and Health Promotion: Challenges for the Profession

Abstract This paper highlights some of the ethical issues that have begun to receive attention in health education. We suggest that a greater awareness of the ethical dimensions of public health policies is needed, and that health educators should play a prominent role in leading public discussions of these issues. We invoke several basic moral principles — including the principles of utility, autonomy, and justice — particularly pertinent to ethical issues in health promotion. These principles are used to examine the issues of individual responsibility and victim blaming, biases in interventions, societal obsessions with health, and the role of the health educator in specific settings.

Factors Related to the Number of Fast Food Meals Obtained by College Meal Plan Students

Abstract Objectives: This study tested whether days on campus, financial access through a meal plan, and health consciousness were associated with number of meals that college students obtained from fast food restaurants. Participants and Methods: In April 2013, all students currently enrolled in a meal plan were invited to participate in an online survey (N = 1,246). Students were asked to report the total number of meals eaten in the past week and where they obtained them. Results: Negative binomial regression was used, and it was found that the number of meals obtained from fast food restaurants was positively associated with financial access and negatively associated with health consciousness. An association between days on campus and the number of meals obtained from fast food restaurants was not found. Conclusions: Increasing levels of health consciousness and reducing access to fast food restaurants through flex plans may reduce college students’ consumption of fast food.

Coping strategies used in residential hospice settings: Findings from a national study

The purpose of this study was to explore professional caregivers’ coping strategies for dealing with the deaths of patients in residential hospices in the United States. Using the Guide to the Nation’s Hospices, 1996-97, purely residential hospices were identified and invited to participate in the study. Employees at each residential hospice were asked to complete the Ways of Coping Questionnaire. Results indicated that positive reappraisal coping was the most frequently used coping strategy. Employees dissatisfied with the coping experience reported greater use of confrontive coping, escape-avoidance coping, and accepting responsibility strategies. The findings suggest that in-service training related to coping strategies and environmental interventions may help in strengthening the coping responses of residential hospice staff.

Untapped resources: Refugee employment experiences in Central North Carolina

OBJECTIVE The objective of this study was to elucidate a comprehensive understanding of the pre-migration expectations and current realities of refugees resettled in the United States (U.S). Employment expectations and the current work situations experienced by African refugee populations recently resettled in Greensboro, NC are examined. PARTICIPANTS Ten French-speaking refugees of African descent who had resided in Central North Carolina for less than three years were selected to participate. METHODS A phenomenological approach was used; semi-structured interviews were conducted with participants in spring 2010. Interviews needing interpretation were translated throughout the course of the interview in real time. All interviews were transcribed verbatim or word for word. RESULTS All participants expected to find work in their fields with relative ease, but were either unemployed or under-employed compared to their professional training and/or previous occupation in their country of origin at the time of their interview. Emergent themes from the interviews included financial stability, ease of finding work, identity concerns, English language comprehension, the economy, and navigating a new system. CONCLUSIONS Refugees in this sample were not prepared for the challenges they encountered when searching for gainful employment. Their experiences appear to be common with available anecdotal evidence. Adjustments to the cultural orientation programs received prior to migration, and enhancements to social networks in addition to an increased focus on English language comprehension post-migration have the potential to positively impact employment outcomes for newly arrived refugees.