Randy Schwartz

A critique of contemporary community health promotion approaches: based on a qualitative review of six programs in Maine

Purpose. This article reports on a process evaluation of three Planned Approach to Community Health (PATCH) projects and three Community Chronic Disease Prevention Programs (CCDPP) that operated in the State of Maine. PATCH and CCDPP are similar approaches to community health promotion developed and disseminated by the Centers for Disease Control. The evaluators studied how the Planned Approach to Community Health and the Community Chronic Disease Prevention Program models worked as community health strategies across the six field sites. Research Methods Used. Qualitative methods were used in a cross-case comparison of the six field sites. In studying each site, the evaluators focused on six stages common to both the Planned Approach to Community Health and the Community Chronic Disease Prevention Program models: Stage 1: conducting a community needs assessment; Stage 2: analyzing needs assessment data; Stage 3: setting priorities for the project based on the data; Stage 4: implementing activities; Stage 5: producing process outcomes; and Stage 6: institutionalizing the project. The analysis focused on how each of the six communities traversed these stages. Summary of Findings. Eight recommendations for refining Planned Approach to Community Health and Community Chronic Disease Prevention strategies resulted from the study: 1) do a community capacity assessment prior to initiating a community needs assessment; 2) do not overly rely on Behavioral Risk Factor Surveys; 3) analyze needs assessment data rapidly for community consumption; 4) allow flexibility and community input in determining priority health objectives; 5) provide technical assistance throughout a project, not just in the beginning; 6) fund at least one full-time local coordinator and extensive capacity building; 7) emphasize multiple interventions around one chronic condition at a time; and 8) emphasize program institutionalization. Conclusions. Community development approaches like Planned Approach to Community Health and Community Chronic Disease Prevention are promising health promotion strategies. To be optimally effective, however, these strategies need refinement based on systematic study in field settings. Because this study was limited to six sites in Maine, some of these findings may have limited generalizability.

Policy Advocacy Interventions for Health Promotion and Education: Advancing the State of Practice

Health promotion specialists increasingly recognize that to be effective in improving the health and quality of life of citizens, they must incorporate policy advocacy interventions as integral, if not priority, strategies. Policy advocacy, as currently viewed and practiced, has roots in the concepts of democracy and citizen participation. In modern political thought, democracy is embodied in the concepts of freedom, equality, and participation.’ Participation is frequently equated with democracy, the implication being that the greater the participation in political decision making, the greater the democracy.2 2

The use of fenbendazole in the treatment of commercial turkeys infected with Ascaridia dissimilis

Birds on a commercial turkey Farm were treated with fenbendazole on two separate occasions. For each treatment, fenbendazole was administered in the feed for 3 days at 30 mg/kg. Mean Ascaridia dissimilis total counts in randomly selected birds were 14.4 and 33.0 prior to the first and second treatments, respectively, whilst post-treatment counts averaged only 0.1 and 0.3, respectively. Anthelmintic effectiveness as demonstrated by both treatments was >99.0%. No untoward effects were noted with either fenbendazole treatment. After fenbendazole withdrawal, routine treatments with piperazine dihydrochloride were commenced with no apparent anthelmintic effectiveness. Mean total nematode burdens rose to 153.9 with a high individual count of 451. The potential for severe ascaridiasis when effective anthelmintic intervention is precluded was demonstrated.

Using public health and community partnerships to reduce density of alcohol outlets.

Excessive alcohol use causes approximately 80,000 deaths in the United States each year. The Guide to Community Preventive Services recommends reducing the density of alcohol outlets — the number of physical locations in which alcoholic beverages are available for purchase either per area or per population — through the use of regulatory authority as an effective strategy for reducing excessive alcohol consumption and related harms. We briefly review the research on density of alcohol outlets and public health and describe the powers localities have to influence alcohol outlet density. We summarize Regulating Alcohol Outlet Density: An Action Guide, which describes steps that local communities can take to reduce outlet density and the key competencies and resources of state and local health departments. These include expertise in public health surveillance and evaluation methods, identification and tracking of outcome measures, geographic information systems (GIS) mapping, community planning and development of multisector efforts, and education of community leaders and policy makers. We illustrate the potential for partnerships between public health agencies and local communities by presenting a contemporary case study from Omaha, Nebraska. Public health agencies have a vital and necessary role to play in efforts to reduce alcohol outlet density. They are often unaware of the potential of this strategy and have strong potential partners in the thousands of community coalitions nationwide that are focused on reducing alcohol-related problems.

Health Promotion Practice: Advancing the State of Health Promotion and Education Practice

W ith this inaugural issue ofHealth Promotion Practice, SOPHE brings the practice of health promotion and education forward into the 21st century. We are pleased to add this new practice-based journal to complement Health Education & Behavior , SOPHE’s flagship journal that is one of the most highly cited journals in the social sciences literature. Health Promotion Practiceseeks to advance the application of health promotion and education through the stimulation and publication of articles detailing the applied work of health promotion practice and policy. The journal’s mission statement speaks to the heart of this endeavor.

An Interview with Jeffrey Koplan, MD, MPH, Director, Centers for Disease Control and Prevention

H ealth Promotion Practice editor Randy Schwartz and associate editor David Altman were pleased to have the opportunity to interview the Centers for Disease Control and Prevention (CDC) director, Dr. Jeffrey Koplan, for this issue of HPP. Dr. Koplan is widely known to many in the health education and health promotion community for his long-term support of health promotion and education at the CDC. Dr. Koplan was the first director of the National Center for Chronic Disease Prevention and Health Promotion at the CDC. SOPHE was honored to have Dr. Koplan serve as the keynote speaker at its recent 50th Anniversary Annual Meeting held in Chicago, November 1999.