David C. Pearson

Self-Help Quit Smoking Interventions: Effects of Self-Help Materials, Social Support Instructions, and Telephone Counseling.

Smokers requesting self-help materials for smoking cessation (N = 2,021) were randomized to receive (a) an experimental self-quitting guide emphasizing nicotine fading and other nonaversive behavioral strategies, (b) the same self-quitting guide with a support guide for the quitters family and friends, (c) self-quitting and support guides along with four brief counselor calls, or (d) a control guide providing motivational and quit tips and referral to locally available guides and programs. Subjects were predominantly moderate to heavy smokers with a history of multiple previous quit attempts and treatments. Control subjects achieved quit rates similar to those of smokers using the experimental quitting guide, with fewer behavioral prequitting strategies and more outside treatments. Social support guides had no effect on perceived support for quitting or on 8- and 16-month quit rates. Telephone counseling increased adherence to the quitting protocol and quit rates.

Smokers and drinkers in a health maintenance organization population: lifestyles and health status.

This study examines, among a large health maintenance organization population, the prevalence of two high-risk lifestyle practices (smoking and problem drinking), their interrelationships, and their relationships with other lifestyle practices, sociodemographic characteristics, and health status measures. Results, based on a random sample of 1,133 adults, showed that smoking and problem drinking are strongly correlated. Individuals with no drinking problems had an age-, sex-, and education-adjusted smoking prevalence of approximately 20%, while problem drinkers smoked at about twice that rate. In addition, reporting one type of problem drinking behavior (binge, chronic, or drinking and driving) at least doubled, and in one instance increased by sixfold, the likelihood of reporting another type of problem drinking behavior. Smokers and problem drinkers were more likely to be younger than age 65, to be irregular seat belt users (smokers and binge drinkers only), and not to belong to voluntary organizations. Results of the analysis suggest that detection, prevention, and treatment of drug use, in general, might prove more beneficial than only focusing on smoking and problem drinking. In addition, because binge drinking and drinking and driving were so widespread among younger age groups, it might prove more beneficial to consider preventive strategies that change the sale and distribution of alcohol and make the environment safer in which to drink, such as providing transportation to get drinkers back home.

Implementation of the Henry J. Kaiser Family Foundation's Community Health Promotion Grant Program: A Process Evaluation

The Community Health Promotion Grants Program, sponsored by the Henry J. Kaiser Family Foundation, represents a major health initiative that established 11 community health promotion projects. Successful implementation was characterized by several critical factors: (1) intervention activities; (2) community activation; (3) success in obtaining external funding; and (4) institutionalization. Analysis of the program was based on data from several sources: program reports, key informant surveys, and a community coalition survey. Results indicate that school-based programs focusing on adolescent health problems were the most successful in reaching the populations they were targeting. The majority of the programs were able to attract external funding, thereby adding to their initial resource base. The programs were less successful in generating health promotion activities and in achieving meaningful institutionalization in their communities.

The evaluation of the Henry J. Kaiser family foundation's community health promotion grant program: Design

The Kaiser Family Foundations Community Health Promotion Grant Program (CHPGP) provides funding and technical assistance in support of community-based efforts to prevent major health problems. The first phase of the program was implemented in 11 communities in the western United States. This paper describes the evaluation design of the CHPGP in the West, the methods of data collection, and the baseline comparability of intervention and control communities. Major features of the evaluation design include: (1) the randomization of qualified communities making application into funded and unfunded comparison groups; (2) a second set of matched control communities for some intervention sites; (3) data gathering through repeated surveys of community residents (probability samples of adults and adolescents) and institutions (health-related organizations and randomly sampled grocery stores and restaurants); and (4) the use of secondary data to monitor health events. Selected baseline data show that intervention and control communities differ in racial/ethnic composition, but relevant health behaviors and ratings of community activation for health promotion appear comparable.

Evaluating the California Wellness Foundation’s Health Improvement Initiative: A Logic Model Approach

The difficulties of conducting randomized trials to evaluate community-based initiatives have led some researchers to argue in favor of a case study “logic model” approach to evaluation. This article describes a case study logic approach adopted for the evaluation of one community initiative, the Health Improvement Initiative (HII) funded by the California Wellness Foundation (TCWF). The HII is a comprehensive, community-based initiative designed to improve population health by implementing and sustaining community-level systems changes. Nine communities received funding to create broad-based community coalitions (Health Partnerships) that were charged with developing and implementing action plans around systems change. The HII is being evaluated using a case-study logic-model approach that uses quantitative and qualitative data to construct indicators of coalition functioning, systems changes, and population health. By examining the relationship between these indicators over time, it should be possible to determine if any changes in intermediate or long-term outcomes are associated with Health Partnership activities.

Community activation and health promotion: identification of key organizations

Purpose. The purpose of this study is to identify the kinds of community organizations community leaders consider important for community health promotion efforts. Design. Key informants were identified by reputational sampling of organizations relevant to community health promotion. Key informants were asked to list organizations they considered important for community health promotion. Differences in identified organizations were compared across informants from seven urban, five suburban, seven rural, and three Native American communities, with significance evaluated by chi-square tests. Setting. This survey was conducted in 22 Western U.S. communities comprising the intervention and control communities of the Community Health Promotion Grants Program of the Henry J. Kaiser Family Foundation. Subjects. Key informants (N = 184) from community organizations, identified using a reputational sampling technique beginning with the health department, were interviewed by telephone. Measures. Key informants listed organizations considered important for community health promotion in five areas: adolescent pregnancy, substance abuse, tobacco use, cancer, and cardiovascular disease. Results. Informants frequently identified the health department (mentioned by 78% of informants overall), schools (72%), governmental agencies (55%), hospitals (47%), health clinics (42%), churches (33%), and newspapers (32%) as important. Organizations more prominent in urban and suburban areas than in rural and Native American areas included television stations, health-related private nonprofit organizations, substance abuse treatment centers, and colleges. Private physicians were frequently identified in rural areas (44% of informants). No more than one of the 25 informants in the Native American communities identified business organizations, private physicians, information/resource centers, senior citizen organizations, or community coalitions as important in their areas. Conclusions. Communities differ in the kinds of organizational resources available for community activation. These differences may need to be considered in planning community-based health promotion programs.

The California wellness foundation's Health Improvement Initiative: evaluation findings and lessons learned.

Purpose. To evaluate the effect of the Health Improvement Initiative (HII), a 5-year grantmaking initiative funded by The California Wellness Foundation designed to identify the critical factors needed to bring about population health improvements through community-level systems change. Design. The evaluation of the HII used a case-study, logic-model approach to make inferences about the effect of each community coalition (Health Partnership) on its target community. The primary outcome measure was the creation of significant and sustainable community-level systems change. Setting. The HII included nine communities in California that received funding to create broad-based Health Partnerships. Subjects. Primary data were collected from a variety of Initiative stakeholders by key informant interviews, closed-ended surveys, and participant observation. Intervention. The HII provided funding over 5 years to nine Health Partnerships that were intended to be a driving force in implementing community-level systems change. The ultimate objective of the systems change process was to improve “population health,” broadly defined to include social, economic, and cultural determinants of health, in addition to traditional health status indicators. Measures. Both qualitative and quantitative techniques were used to assess the effect of the HII on key community systems. The primary outcomes were qualitative descriptions of community-level changes. Results. At the end of the 5 years of HII funding, six of the nine Partnerships had played a critical role in implementing sustainable systems changes that would likely have a significant effect in their target communities. Conclusion. The HII was successful in promoting community-level systems change in the majority of funded communities, although the evidence was mixed regarding the role of the Partnerships in bringing about these changes.