Donald C Iverson

Health behavior models compared

This study compares the health belief, Fishbein/Ajzen, and PRECEDE models to predict changes in smoking, exercise, and consumption of sweet and fried foods over an eight-month interval. Data were collected from a panel of 326 adults in two large cities of the western United States. The PRECEDE model accounted for more variance in behavior than both the Fishbein/Ajzen and health belief models, but it required far more questions. Fishbein/Ajzen and PRECEDE provide a limited theoretical basis for selecting specific types of beliefs or predisposing factors without turning to the health belief model, making the health belief model complementary to either Fishbein/Ajzen or PRECEDE.

Implementing Comprehensive Health Education: Educational Innovations and Social Change

The effectiveness of health education is ultimately determined by whether it is implemented, and how it is implemented. Although a given health education innovation may be designed and experimentally assessed to promote well-being with some measure of effectiveness and efficiency, the actual impact of the innovation will depend upon the manner in which it is disseminated, initiated, and maintained. The implementation of health education programs in schools or elsewhere is a function of the types of innovations available, certain characteristics of those innovations that influence their use, and the manner in which the innovations are brought into practice. This paper has been prepared to review, synthesize, and apply current and relevant information about educational innovations and social change to provide a conceptual base for the design, execution, and analysis of efforts to implement health education in schools. The American system of public and private schools could be an agent vitally important to the realization of a second public health revolution. Indeed, in a democratic society, the implementation of health education in schools seems a condition necessary for such a revolution. By analyzing and learning from our own health education efforts, as well as the efforts of those experienced with implementing other types of educational innovations in schools, we might ensure that future populations are informed sufficiently about factors that influence their health and well-being.

Statistical design of the women's health trial

The National Cancer Institute has initiated a randomized trial to determine whether a low fat diet can reduce the incidence of breast cancer among women at increased risk for this disease. A feasibility trial involving 303 women has been conducted to examine recruitment strategies, study short-term compliance and, more generally, develop and refine trial procedures. The feasibility trial group also developed a detailed full-scale trial design plan, and randomization of participants to such a trial is currently underway. The purpose of this report is to describe the major design features of this Womens Health Trial, with particular emphasis on the statistical aspects of the design. The trial is planned to last 10 years and to include 32,000 participants. Of these 32,000 women, 12,800 will be assigned to a low fat diet intervention, and the other 19,200 will constitute a control group. The sample size of 32,000 arises from a range of estimates and assumptions pertaining to (a) the incidence of breast cancer at enrollment corresponding to selected eligibility criteria, (b) the relative risk of breast cancer as a function of a womans history of dietary fat intake, (c) compliance assumptions in terms of average percent fat in the intervention and control groups as a function of time from randomization, and (d) rates of competing causes of death. These estimates and assumptions will be discussed, as will the robustness of the intended sample sizes to departures from such design assumptions.

The School Health Curriculum Project: Its Theory, Practice, and Measurement Experience

The School Health Curriculum Project(SHCP), initiated over a decade ago to provide a health education curriculum package for elemen tary students, has been widely and variously evaluated. In analyzing studies designed to assess the effectiveness of the SHCP, it was recognized that the measured impact of this project (or any health education intervention) would derive from the adequacy of the theory upon which the program is based, the adequacy of its implementation, and the adequacy of its measurement. Hence, an examination of the theoretical base of the SHCP and its variance in practice was conducted. In addition, a metaevaluation of 24 studies designed to access the effectiveness of the SHCP was completed. Results suggest that the project is effective in influencing health-related knowledge and attitudes. A rationale for future evaluation efforts in school health education is subsequently outlined.

Analysis of the costs of a large prevention trial

Total direct costs of the Womens Health Trial (WHT), a large multicenter prevention trial, were reduced by more than 50% by means of research cost analysis conducted during the trial design phase. The unit costs of specific trial activities were estimated so that total direct costs of the trial could be predicted from design parameters. The relative costs of screening, treatment, and follow-up, and the fixed costs associated with each clinical center in a multicenter prevention trial were taken into account. Direct costs of the WHT were reduced from +195 million to +95 million by refinement of the trial protocol, selection of an efficient design, and consideration of trial logistics. The analyses suggest several ways to reduce costs in a prevention trial. Use of the case-cohort approach can reduce costs substantially when the protocol includes collection of specimens or data that are costly to process. When establishing and maintaining a clinical center represents a significant proportion of a clinical centers costs, use of a smaller number of larger clinical centers offers important cost savings. Because restrictive eligibility requirements reduce the recruitment potential of each clinical center, use of high-risk participants may not improve the efficiency of a prevention trial; its favorable impact on sample size may fail to compensate for its cost in terms of additional clinical centers and higher recruitment costs.

The Effects of an Education Intervention Program for Juvenile Drug Abusers and Their Parents

The Juvenile Intervention Program represents an attempt to intervene in the development of juvenile drug dependence. The program involves the early identification of juvenile drug abusers followed by the recruitment of the juveniles and their parents into the program. The program utilizes the principles of family involvement and peer pressure throughout the program, while the basis of the program involves the education of the participants in such areas as family architecture, family communication patterns and drug knowledge. The results indicate that the program had a positive effect on the parents with no significant changes among the juveniles. It is hypothesized that the changes that have been initiated within the parents will have a positive effect on the juveniles at the six month follow-up.

Carpal tunnel syndrome in primary care: a report from ASPN. Ambulatory Sentinel Practice Network.

BACKGROUND Carpal tunnel syndrome (CTS) is a common condition in primary care, yet little is known about its presentation and management. This study was designed to provide a better understanding of the frequency of CTS in a primary care population, and its presentation, diagnosis, and management. METHODS Clinicians in 74 Ambulatory Sentinel Practice Network (ASPN) practices from 30 states and three Canadian provinces collected data on all patients presenting with symptoms of CTS during a 30-month period. RESULTS The adjusted frequencies of all visits and of first visits for symptoms of CTS were 1.01 and 0.68 per 1000 patient visits, respectively. Women visited more frequently than men with new onset symptoms of CTS (0.81 vs 0.55 per 1000 visits), and homemakers accounted for 15.9% of all new cases. Clinicians judged 43.1% of all CTS incident visits to be job-related. The diagnostic evaluation of patients seldom included nerve conduction studies (12.9%) or electromyography (11.8%). The most frequent treatments were splints (56.3%) and nonsteroidal anti-inflammatory agents (50.8%). Four-month follow-up data were obtained for 68.5% of the patients, and symptom relief was reported by 55.2% of patients. Ninety percent of patients were able to continue working at the same job, and 96% were able to continue their usual activities. CONCLUSIONS Carpal tunnel syndrome symptoms are common in primary care, and most cases occur among women, many of whom are homemakers. Most patients with CTS symptoms are treated conservatively by their primary care clinicians with minimal testing or referral, and most patients report improvement or resolution of symptoms at 4 months.

The Juvenile Intervention Program: Results of the Process, Impact and Outcome Evaluations.

Data were analyzed for a random sample of sixty-four juvenile participants who completed the program between January 1, 1977 and April, 1978 and a random sample of forty-seven juvenile participants who completed the program between May, 1978 and August, 1979. In order to assess program impact, all the juvenile participants are administered a pretest during the first JIP session and a posttest after the last session. Follow-up data on impact measures are collected six months after program completion. In addition, participants are asked to complete a one-page questionnaire assessing their participation at the completion of each of the seven JIP sessions. Analysis of the data indicates that the program positively affected family communication patterns, self-esteem levels and drug knowledge levels at follow-up. The follow-up data indicated that drug-related school system and drug-related criminal justice system contacts were significantly reduced. The data also indicated that there was a reduction in drug usage by regular users for selected drugs.

An Overview and Analysis of the Health Style Campaign

In 1981, the Office of Health Information and Health Promotion of the U.S. Department of Health and Human Services launched a national health promotion media campaign titled Health Style. The purposes of the Health Style campaign were: (1) to increase public awareness of the effects of life-style on health; (2) to enable persons to assess which life-style changes would be most conducive to their health; (3) to stimulate information-seeking behavior and; (4) to foster the development of local health promotion activities and referral networks. The campaign was implemented in nine test communities across the United States. This article: (1) provides an overview of the campaign; (2) examines strategies used to implement the campaign in three local communities and; (3) presents the findings of evaluations conducted at both the national and local levels. A summary of lessons learned from the Health Style campaign experience is included in the article.

A cost-benefit analysis of a smoking cessation program

Smoking cessation programs are usually evaluated in terms of the percentage of participants who have stopped smoking at least 6 months after the programs completion. This paper shows how a relatively low rate of behavior change may actually result in a high ratio of benefits to costs. Cost-benefit analysis is done for a specific program but the procedures and cost estimates are generalizable to other smoking cessation programs. Benefits to the firm included reduced costs of insurance and the savings due to employee absenteeism and disability. Costs included the program costs as well as the opportunity costs of the participants. Data from the literature and from the specific program are combined to form conclusions about the effectiveness of the program.