Diane M. Grimley

The Evaluation of School‐Based Violence Prevention Programs: A Meta‐Analysis*

BACKGROUND Youth violence and related aggressive behaviors have become serious public health issues with physical, economic, social, and psychological impacts and consequences. This study identified and evaluated the characteristics of successful school-based violence prevention programs. METHODS Twenty-six randomized controlled trial (RCT), school-based studies that were designed to reduce externalizing, aggressive, and violent behavior between the 1st and 11th grades were analyzed for assessing the effects of 5 program characteristics by comparing results of intervention groups to control groups (no intervention) after intervention using a meta-analysis. Electronic databases and bibliographies were systematically searched, and a standardized mean difference was used for analysis. RESULTS There was no significant difference between interventions, although programs that used non-theory-based interventions, focused on at-risk and older children, and employed intervention specialists had slightly stronger effects in reducing aggression and violence. Interventions using a single approach had a mild positive effect on decreasing aggressive and violent behavior (effect size =-0.15, 95% CI =-0.29 to -0.02, p = .03). CONCLUSIONS Unlike previous individual study findings, this meta-analysis did not find any differential effects for 4 of the 5 program characteristics. In addition, the significant effect noted was contrary to expectation, exemplifying the complexity of identifying effective program strategies. This study adds to the current literature by assessing the program characteristics of RCT studies in an effort to determine what factors may affect school-based violence prevention program success.

The development and structural confirmation of the Rhode Island Stress and Coping Inventory.

A new measure, the Rhode Island Stress and Coping Inventory (RISCI), was developed to examine perceived stress and coping independent of specific stress situations. An adult sample (N = 466) was randomly divided into equal halves for developmental and confirmatory instrument development. Initial instrument development used principal components analysis, item analysis, and a measure of internal consistency (Coefficient alpha). Confirmatory factor analysis (CFA) was employed on the confirmatory sample to examine the structure of the refined item set. Several CFA fit indices indicated excellent fit for a model that represents perceived stress and coping as two moderately correlated dimensions. Validity analyses found strong relationships in the expected directions for both RISCI subscales with the 5-item Mental Health Inventory. Further validity analyses supported the utility of the RISCI in applied research with smokers and confirmed past research findings that successful quitters experience less perceived stress and cope better than relapsers.

Toward a Model of Prostate Cancer Information Seeking Identifying Salient Behavioral and Normative Beliefs Among African American Men

Public health actions to improve African American mens ability to make informed decisions about participation in prostate cancer control activities have a greater likelihood of success when they are theory driven and informed by members of the target population. This article reports on formative research to evaluate the usefulness of the theory of reasoned action as a model to explain and predict prostate cancer information-seeking behavior by African American men. Fifty-two men participated in eight focus group interviews. Positive behavioral beliefs for obtaining prostate cancer information from physicians included increasing awareness of and obtaining accurate information about the disease, early detection and screening, and treatment. Negative beliefs included fear, distrust, and inconvenience. Significant others, peers, siblings, and religious leaders were identified as individuals who could influence this behavior. These findings provide additional insight into ways to reach and intervene with African American men to influence this important cancer control activity.

Provider-delivered, Theory-based, Individualized Prevention Interventions for HIV Positive Adults Receiving HIV Comprehensive Care

HIV prevention efforts are often difficult to emphasize in settings delivering comprehensive HIV care due to factors such as time constraints and differing priorities about the use of clinical time. To assist clinicians within dedicated HIV clinics to offer prevention strategies, investigators at two universities in the United States (Johns Hopkins University and the University of Alabama at Birmingham) have developed and implemented similar, audio-computerized-assisted, self-interviewing systems that have been programmed to assess individual patient risk factors and identify based on the patient’s self-assessment, the patient’s behavioral stage or, readiness for changing, each identified target behavior. Following the assessment, the systems provide printouts of key elements of this information along with individualized, theory-based intervention strategies to the medical provider. This paper will describe our efforts in developing provider-delivered, individualized, stage-based interventions intended to reduce high-risk behaviors among HIV-infected persons.

Intention to use condoms among three low-income urban African American subgroups: cocaine users noncocaine drug users and non-drug users.

Cocaine use, marijuana use, alcohol use, and polysubstance use (e.g., alcohol and cocaine, alcohol and marifuana) are associated with high-risk sexual behavior and higher rates of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). The purpose of this study was to examine readiness for using condoms among three groups (cocaine users, noncocaine drug users, and non-drug users) of African Americans living in low-income urban settings. African Americans in this sample differed in sex risk behaviors according to their drug use status. Noncocaine drug users reported higher levels of sex risk behaviors than non-drug users, and cocaine users reported the highest levels of risk. Cocaine users also reported lower levels of condom use with their main and nonmain sexual partners than both other groups. Results of multivariate analyses indicate that, compared to the other two groups, cocaine users are at earlier stages of readiness for condom use with main partners. Cocaine users have accurate perceptions of their HIV risk, but are more likely to factor into their decisions for using condoms cost and the trouble that it takes to get condoms. Different approaches to sexually transmitted disease and human immunodeficiency virus prevention will be necessary to meet the needs of these three different subgroups.

Theoretical Approaches Guiding the Development and Implementation of Health Promotion Programs

This chapter describes several theories and models that have been used to explain behavior and to design health promotion and disease prevention programs. Behavioral theories are explanations of what influences people to do the things they do. Behavioral theories generally identify the determinants of behavior, that is, those factors that are thought to be causally related to the behavior. Theories may also identify the mechanisms by which the determinants influence the behavior. Theories are used in several ways to guide the researcher in deciding what research questions are important to ask and to guide the development, implementation, and evaluation of health promotion programs. Theories guide health promotion research by providing propositions about what behavioral factors are related to a health problem and what factors are important to address in working on the problem. For example, smoking is a behavior causally related to many types of cancer. To address smoking and cancer as a public health problem, health researchers and practitioners may ask such questions as: Why do people smoke? What influences people to start smoking? What makes it hard to stop smoking? Why don’t people quit in the face of so much information that it is dangerous? A theory can provide a starting place to look for answers to these questions.

Fear of physical response to exercise among overweight and obese adults

Regular physical activity has been shown to have significant impact on both physical and mental health; however, over half of adults in the US do not meet current recommendations for physical activity. Pain is one of the most commonly cited barriers to physical activity among adults. Fear of pain has been shown to have a significant correlation with pain-related disorders including back pain and arthritis, but no studies have examined the role that weight plays on these fears. We conducted three focus groups (n = 21) to explore the role of fear-avoidance beliefs related to exercise among a group of overweight and obese adults. Focus group members discussed their beliefs that overweight and obese adults have more exaggerated physical responses to exercises than normal weight adults. They also endorsed a belief that overweight and obese individuals interpret similar physical responses differently than normal weight individuals, and that these interpretations lead to fear that may result in exercise avoidance. Further exploration of the role of fear in exercise avoidance will be useful in designing tailored exercise prescriptions and physical activity interventions that may increase adherence among overweight and obese adults.

DEPRESSIVE SYMPTOMS AND INTERPERSONAL VICTIMIZATION AMONG AFRICAN AMERICAN WOMEN ATTENDING AN URBAN STD CLINIC

OBJECTIVES This study evaluated the association of depressive symptom levels and interpersonal victimization. The sample was comprised of 455 African American women attending an urban sexually transmitted disease clinic. Interpersonal victimization was defined as whether a woman was forced to have sexual intercourse and whether a woman was ever hit, slap or physically hurt by a boyfriend, girlfriend, or spouse in the past 12 months. METHODS Using audio computer-assisted self-interviewing (ACASI), women responded to questions regarding interpersonal victimization and depressive symptom levels (e.g., depression, sadness, loneliness and crying in the past week). RESULTS Results indicated that women with a history of interpersonal victimization were more likely to experience higher levels of depressive symptoms when compared with women who did not. Statistically significant differences were found for being forced to have sexual intercourse (all ps <0.0001) and ever being hit, slap or physically hurt by a boyfriend, girlfriend, or spouse in the past 12 months (ps range from 0.012 to 0.0003) with regard to each depressive symptom item. CONCLUSION Behavioral women-focused interventions need to address mental health issues associated with risky sexual behaviors in order to be more efficacious.

Tobacco Use Prevention and Cessation

Cigarette smoking is one of the country’s most important public health problems (US DHHS, 1990). Approximately 400, 000 US citizens die yearly from tobacco-related diseases, including cardiovascular disease, cancer, and obstructive lung disease (CDC, 1993). Tobacco is also responsible for increased disability from a variety of causes including chronic obstructive lung disease (Renwick & Connelly, 1996; Higgens {tiet al.}, 1993), cerebrovascular accidents (Shinton & Beevers, 1989), myocardial infarction (Seeman, Mendes de Leon, Berkman, & Ostfeld, 1993; Chun, Dobson, & Heller, 1993), amputations secondary to peripheral vascular disease (Eneroth & Persson, 1993), and blindness due to macular degeneration (Seddon, Willett, Speizer, & Hankinson, 1996). Collectively, Americans spend approximately

The Transtheoretical Model of Change Applied to Developing Suicidal Behavior

50 billion annually in medical costs related to the negative health consequences of tobacco addiction (CDC, 1994c). Moreover, the cost of lost productivity and earnings due to disability is estimated at