Laura C. Leviton

Knowledge, attitudes, and behaviors of Alabama's primary care physicians regarding cancer genetics.

Purpose To determine Alabamas primary care physicians knowledge, attitudes, and behaviors regarding cancer genetics. Method A questionnaire was mailed to a random sample of 1,148 physicians: family and general practitioners, internists, and obstetrician—gynecologists. Results Of the surveyed physicians, 22.1% responded. Of the respondents, 63% to 85% obtained family histories of cancer from 76% to 100% of their patients. Obstetrician—gynecologists referred more patients for cancer genetic testing (p =.008) and were more confident in their abilities to tailor preventive recommendations based on the results (p =.05) than were the other physicians. Primary care physicians were more likely than were obstetrician—gynecologists to identify lack of time during the patient visit as hindering efforts to do genetic counseling (p =.01). Physicians in practice for ten years or less were more confident in explaining genetic test results than were those in practice for more than 20 years (p =.01). Conclusion These data validate gaps in primary care practices in obtaining family history of cancer, as well as lack of confidence in explaining genetic test results and in tailoring recommendations based on the tests.

Model-Based Evaluation of Hiv Prevention Interventions

The ultimate goal of HIV prevention interventions is to reduce the spread of HIV; however, the effectiveness of these programs is seldom assessed directly. Although direct measurement of an interventions impact via HIV seroincidence monitoring is usually unfeasible, mathematical models can be used to estimate the number of infections averted by the intervention. This article describes three model-based summary measures of sexually transmitted HIV risk and discusses their relevance to HIV program evaluation m general and economic efficiency analyses in particular. The calculation of these measures is demonstrated with an illustrative application to previously published data from an HIV prevention intervention for gay men.

An exploration of opinion and practice patterns affecting low use of antenatal corticosteroids.

One of the major challenges in modern obstetrics is the prevention of preterm birth, especially the birth of a very preterm infant. Preterm birth is associated with most of all neonatal deaths and is a major cause of infant morbidity. To date little evidence exists that obstetric care is effective in reducing the preterm delivery rate.’ In fact recent data indicate that from 1981 to 1991 a small increase occurred in preterm births, especially among African-American women.’ Better management of preterm labor and delivery and advances in neonatal medicine have contributed to the increased survival of preterm infants. Although most survive, many of these very preterm babies end up with serious long-term complications as a result of prematurity-related conditions such as respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Therefore more attention is being given to secondary prevention strategies that may reduce these negative outcomes. One of the few interventions available to obstetricians that has been demonstrated to be effective in reducing the negative sequelae associated with preterm birth is

Teaching Evaluation Using Evaluability Assessment

A case is made for using the technique of evaluability assessment to introduce students to the field of evaluation. Procedures for directing, instructing, and supervising evaluability assessments in the classroom setting are described, along with techniques for adapting the method to the students level of training, mix of experiences, and duration of the class. Evaluability assessment is a useful exercise that assists students in applying their research skills to real program needs. Twenty local evaluability assessments, course evaluations, and subsequent contact indicate that this approach is beneficial for student professional development and is a useful service for program stakeholders.

Cumulative Probability of HIV Infection: A Summary Risk Measure for HIV Prevention Intervention Studies

Choosing outcome measures for HIV prevention intervention studies is difficult because of the multiplicity of behavioral and epidemiologic factors that affect HIV transmission. In attempts to address some of these factors, summary risk indices have been proposed as outcome measures for some intervention studies. These summary risk indices have suffered from a number of methodological difficulties (e.g., some indices are not expressed in meaningful units). We present six criteria that can be used to judge the soundness of summary risk indices. Further, we illustrate that the central equation from a (Bernoullian) mathematical model of HIV transmission can be used as a summary risk index, and that it meets these six criteria.

Integrating psychology and public health: Challenges and opportunities.

Psychology has made significant strides in developing applications relevant to public health. However, improvements are still needed to integrate psychology into the public health infrastructure. The challenge .(or public health is to recognize psychologys special contributions to poli~T and practice, especially to prevention of disease and injuo. The challenge.for psychology is to assure coherent integration of relevant theories, knowledge bases, and public health practice. Recommendations to address these challenges include (a) demonstrating how psychology incrementally improves public health service systems; (b) developing middle range and small theories of public health problems and practice (Lipsey, 1993, Merton, 1968); (c) developing intervention models in partnership with nonpsychologists so that the effects can become widespread, and (d) ongoing scrutiny of the intervention models to assure that theory has been operationalized well. Psychologys unique role in public health is to act as the steward of a correct application of behavioral knowledge and theory.

Preventing Halloween Arson in an Urban Setting: A Model for Multisectoral Planning and Community Participation

Arson is a violent crime and a public health problem that causes injuries and deaths, destroys homes, and destabilizes neighborhoods. During the late 1970s, pre-Halloween pranks in Detroit, Michigan, turned destructive when hundreds of fires were set deliberately throughout the city; in 1984, a record of 810 fires were set during the Halloween period. In 1985, a citywide anti-arson campaign that involved the mobilization and training of thousands of community volunteers was begun in Detroit. This report describes the multiple components of the anti-arson intervention from 1985 through 1996 and changes in the incidence of Halloween fires. Both the decrease in annual Halloween arson fires after the intervention began and the inverse relationship between the number of volunteers and the number of fires suggest a causal effect. This study illustrates the capacity of an urban community to mobilize its residents and stakeholders, the importance of community participation and multisectoral partnerships in program planning and implementation, and the challenges faced in retrospectively evaluating an apparently successful, complex, community-based intervention.

Health Care Providers’ Perspectives on Patient Delay for Seeking Care for Symptoms of Acute Myocardial Infarction

To inform intervention development in a multisite randomized community trial, the Rapid Early Action for Coronary Treatment (REACT) project formative research was undertaken for the purpose of investigating the knowledge, beliefs, perceptions, and usual practice of health care professionals. A total of 24 key informant interviews of cardiologists and emergency physicians and 15 focus groups (91 participants) were conducted in five major geographic regions: Northeast, Northwest, Southeast, Southwest, and Midwest. Transcript analyses revealed that clinicians are somewhat unaware of the empirical evidence related to the problem of patient delay, are concerned about the practice constraints they face, and would benefit from concrete suggestions about how to improve patient education and encourage fast action. Findings provide guidance for selection of educational strategies and messages for health providers as well as patients and the public.

A multi-project systems approach to developing community trust and building capacity.

Community characteristics are being recognized as important determinants for effective community-based programs. Community capacity to collaboratively identify issues, establish collective goals, and mobilize resources is built on experience with such interactions and trust among collaborators. Conceptual approaches and methods to develop community capacity rarely have been a focus of research programs, at least in part due to categorical funding, which often limits the scope and duration of interventions, thereby limiting capacity development. This approach uses multiple categorical funding sources to create sustained community programs involving multiple systems to increase capacity. Quasi-experimental evidence of increases in community capacity within two Alabama communities is presented.

Encouraging small businesses to adopt effective technologies to prevent exposure to health hazards

Small businesses are heterogeneous and the prospects are low for direct OSHA inspection and enforcement. Opportunities are explored to encourage voluntary adoption of new technology to reduce workplace exposures. The case of radiator repair shops is used in this paper to illustrate an approach to the dissemination of control technology to small businesses that will encourage these companies to adopt controls. Several behavioral theories are applied to the case.