Knut Inge Klepp

Communitywide smoking prevention : Long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study

OBJECTIVES The Class of 1989 Study is part of the Minnesota Heart Health Program (MHHP), a populationwide research and demonstration project designed to reduce cardiovascular disease in three educated communities from 1980 to 1993. This paper describes an intensive, school-based behavioral intervention on cigarette smoking, comparing long-term outcomes in one of the intervention communities with those in a matched reference community. METHODS Beginning in sixth grade (1983), seven annual waves of cohort and cross-sectional behavioral measurements were taken from one MHHP intervention community and its matched pair. All students in each community were eligible to participate (baseline n = 2401). Self-reported data collected at each period described prevalence and intensity of cigarette smoking. RESULTS There were no differences at baseline for either weekly smoking prevalence or intensity of smoking. Throughout the follow-up period, however, smoking rates as determined by these measures were significantly lower in the intervention community: 14.6% of students were weekly smokers at the end of high school compared with 24.1% in the reference community. CONCLUSIONS These results suggest that multiple intervention components such as behavioral education in schools, booster programs to sustain training, and complementary communitywide strategies may all be needed for lasting reductions in adolescent tobacco use.

AIDS education for primary school children in Tanzania: an evaluation study.

Objective:To test the effects of an HIV/AIDS education program. Design:A quasi-experimental, nested cross-sectional design including baseline and 6-month follow-up surveys. Schools, stratified according to location, were randomly assigned to intervention (n = 6) or comparison conditions (n = 12). Setting:Public primary schools in Arusha and Kilimanjaro regions, Tanzania. Participants:A total of 2026 sixth and seventh grade pupils (average age, 14.0 years) participated at baseline (85%) and 1785 at follow-up. Intervention:The program was designed to reduce childrens risk of HIV infection and to improve their tolerance of and care for people with AIDS. Local teachers and health workers attended a 1-week training workshop before implementing the program over a 2–3-month period (averaging 20 school hours per class). Main outcome measures:Self-reported exposure to AIDS information, communication regarding AIDS; AIDS knowledge, attitudes towards people with AIDS, attitudes towards having sexual intercourse, subjective norms regarding sexual intercourse, and intention to engage in sexual intercourse. Results:Following this program, intervention pupils reported significantly higher scores for the following outcome measures than pupils attending the comparison schools: AIDS information (13.1 versus 10.5; P= 0.0001), AIDS communication (10.9 versus 7.8; P= 0.0001) AIDS knowledge (14.5 versus 11.5; P= 0.0001), attitudes towards people with AIDS (9.0 versus 6.7; P= 0.0008), subjective norms (45.5 versus 43.9; P= 0.011), and intention (1.3 versus 1.4; P= 0.020). No program effect was seen for attitudes towards sexual intercourse (47.0 versus 46.3, P=0.44). Conclusions:These results indicate that it is feasible and effective to provide AIDS education for Tanzanian primary school children.

Differences in smoking cessation strategies between men and women

This descriptive research was designed to identify differences in smoking cessation strategies between men and women in a cross-sectional population sample of current smokers in the upper Midwest. Data on the number of previous quit attempts, the success and persistence in quit attempts, future intentions to change smoking habits, and strategies planned for cessation were obtained from 1669 smokers. Log-linear analyses controlling for age and the number of cigarettes smoked revealed significant gender differences. Men and women appear to approach smoking cessation differently. Women were more tentative and less committed to quitting smoking entirely. Women were also less successful in sustaining smoking cessation attempts for longer than one week. Efficacy expectations and differential attributions for failure were suggested as possible explanations for the results, however further research will be necessary to confirm or disconfirm these hypotheses.

Sexual debut and predictors of condom use among secondary school students in Arusha, Tanzania

A cross-sectional survey was conducted using interviews among 852 students attending seven secondary schools in the Arusha region, Northern Tanzania, to predict determinants of sexual debut and recent condom use among students. Schools were sampled according to location, school size and ownership criteria. Subjects were randomly sampled within grade-level and gender through use of class registers. Altogether, 528 students were sexually active. Males were more likely than females to report their sexual debut status (82.0% versus 33.3%; OR = 8.78; 95% CI: 6.17-12.49). Among males, incidence of sexual debut increased with grade-level, but decreased according to religious affiliation. None of the socio-demographic predictor variables used in this study had a significant association with sexual debut among females when age was controlled for. Of the sexually active students, 26.8% reported having ever used a condom and 21.5% reported use of condoms during their most recent sexual encounter. Late sexual debut, prolonged duration of dating before intercourse and having only one sex partner were significantly associated with increased condom use during the most recent occasion. Condom use increased with levels of education, but gender was not significantly linked to increased condom use. Condom use was particularly infrequent among casual sex partners. We observed a marked gender difference among students with respect to their sexual debut status, but no such difference was found in relation to condom use.

Risk factors for HIV-1 infection among women in the Arusha region of Tanzania

Risk factors for HIV-1 infection among women were assessed through a population-based cross-sectional study in the Arusha region of northern Tanzania. The study participants were obtained by randomly selecting 10-household clusters from Unga limited, the town of Babati, and the roadside village of Matufa, which are urban, semi-urban, and rural communities, respectively. Informed verbal consent for participation in an interview and in HIV-1 testing was sought from each respondent. Blood samples were collected from each consenting individual for HIV-1 antibody testing using enzyme-linked immunosorbent assay (ELISA), and all positive sera were confirmed using repeated ELISA tests. Information of risk factors was obtained through the interview process using a structured questionnaire. Of the 567 women who gave blood samples, 48 (8.5%) were HIV-1 positive. The HIV-1 seroprevalence rates among women in the urban area, the semi-urban area, and the rural village were 14.4%, 6.9% and 2.3%, respectively. Factors associated with significantly higher HIV-1 seroprevalence were urban residence; history of having traveled out of the Arusha region within Tanzania, as well as having traveled abroad; having multiple sex partners; and having sexual intercourse under the influence of alcohol. Women who reported ever having used condoms had significantly higher probability of being infected with HIV-1 than those who had never used condoms, suggesting that condom use may be a marker of high-risk sexual behavior and that condom use is probably not adhered to in a way that consistently protects against HIV-1 infection. These results suggest the need for health education interventions aimed at increasing appropriate and consistent condom use and reduction of the number of sexual partners.

Gender Differences in the Class of 1989 Study: The School Component of the Minnesota Heart Health Program

Abstract The Class of 1989 Study is part of the Minnesota Heart Health Program (MHHP). Beginning in sixth grade (1983), seven annual waves of measurements were taken from students in one of the MHHP intervention communities and its matched pair (baseline n = 2,376). Self-reported data were collected at each time period describing a variety of health-related behaviors, including smoking, physical activity, and food preferences. With regard to the intervention hypotheses, significant positive differences between genders were observed on the physical activity and food preference variables. Significant gender by treatment interactions were observed on five of six follow-up periods for food preferences. The effects of the intervention on smoking by gender were less apparent. The results from the tracking analysis indicate there is evidence of early consolidation and tracking of physical activity, food preference, and smoking behaviors, but these results did not differ greatly by gender. These data suggest that...

Etiology of Drinking and Driving among Adolescents: Implications for Primary Prevention

A prospective study was conducted to investigate what factors are predictive of self-reported drinking and driving (DD) among adolescents. The study employs a theoretical framework taken from Problem Behavior Theory; environmental, personality, and behavioral factors are explored for their predictability of DD. A cohort of 1482 high school students completed a written survey in spring of 1986 and again in fall of 1986. The findings confirm that Problem Behavior Theory provides a useful theoretical framework with which to identify etiological factors predictive of DD among adolescents. Identified personality, perceived environmental, behavioral, and demographic factors accounted for approximately 50% of the reported variance in DD at baseline. The same factors accounted for approximately 40% percent of the variance in follow-up DD and were predictive both among the students who did not drink and drive at baseline (incidence cases), and among those students who did drink and drive at baseline (continuation versus discontinuation of the behavior). Based on these etiological data, we recommend that school-based, peer-led educational prevention programs be designed to reach young adolescents prior to the age at which a drivers license is obtained. We further recommend that the programs be broad-based and consider DD within the larger context of drinking and driving related behaviors and traffic safety in general.

Effects of the Increased Minimum Drinking Age Law on Drinking and Driving Behavior Among Adolescents

In Minnesota, the minimum drinking age law was raised from 19 to 21, effective September 1, 1986. As anyone born prior to September I, 1967 could legally continue to purchase alcohol, we hypothesized that adolescents born on or after September 1, 1967 would report less drinking and driving than their peers born prior to this date. Participants originally comprised the entire seventh-grade enrollment of four suburban school districts in Minnesota in 1979 and 1980 (N = 7124). Drinking and driving data were collected in 1987 and 1988. Comparing the Younger cohort (born on or after September 1, 1967) in 1988 to the Older cohort in 1987, we observed lower overall drinking and driving prevalence in the Younger cohort. The Younger cohort reported a significantly lower rate of driving after drinking at least two drinks than did the Older cohort, though there was a minimal difference in rates of heavy drinking and driving. The increased drinking age seemed effective in reducing the overall drinking and driving pre...

Exposure to HIV / AIDS information AIDS knowledge perceived risk and attitudes toward people with AIDS among primary school-children in northern Tanzania.

An AIDS survey based on WHOs KABP survey instrument for adolescents was implemented with sixth and seventh grade students attending one of 18 randomly selected primary schools in the Arusha and Kilimanjaro regions of Northern Tanzania (n = 2,026). While students reported having been exposed to several sources of AIDS information, overall knowledge level was low, particularly with respect to risk associated with causal contact, and the fact that a person can be infected and show no signs of the disease. Students who reported frequent exposure to AIDS information or who frequently talked to others about AIDS, were more knowledgeable regarding AIDS than students who reported less frequent exposure to AIDS information or communication. Furthermore, students with high scores on AIDS knowledge were more likely to report AIDS as a very severe disease. Also, they perceived themselves as less susceptible to AIDS, and were more likely to have a positive attitude toward spending time with and taking care of people with AIDS than did less knowledgeable students. It is recommended that primary schools be utilized as an arena for AIDS education in Tanzania.

Alcohol and marijuana use among adolescents: Long-term outcomes of the class of 1989 study

The Minnesota Heart Health Program (MHHP) is a population-wide research and demonstration project designed to reduce cardiovascular disease in three educated communities (1980–1993) compared to three matched reference communities. The Class of 1989 Study, a substudy of the MHHP, collected self-reported data in one educated and one matched reference community. All sixth graders enrolled in both communities were invited to participate in a baseline survey in 1983, and that grade cohort was surveyed annually throughout junior high and high school until 1989. Students received interventions designed to favorably influence their smoking, physical activity levels, and eating behavior each year from 1983 to 1987. As part of this five-year intervention, a program addressing smoking, alcohol use, drinking and driving behavior, and marijuana use was implemented during the school year of 1985–1986, when students were in ninth grade.Using the school as the unit of analysis, we found that students in the intervention community in 1986 reported fewer occasions on which they had been drinking alcohol in the past 30 days than did students in the reference community. Furthermore, students in the intervention community reported less problem drinking in the previous two weeks and less driving after drinking than did students in the reference community. These positive intervention effects were not maintained through twelfth grade.