Susan J. Curry

How effective is tailored print communication

This article reviews the “frist generation” of tailored print communications studies in the published literature, describing the purpose, theoretical framework, sample, research design, message type and source, outcomes measured, and findings of each. Eight studies compared tailored versus similar nontailored print; one compared tailored print versus an alternate intervention, and three included tailored print as one of several intervention components. Although studies varied by behavioral topic, type of tailoring, and measurement of behavioral outcomes, several themes persist.Compared to their nontailored counterparts, tailored print communications have been consistently better remembered, read, and perceived as relevant and/or credible. There is also evidence that tailored print communications are more effective for influenceing health behaviors. Six of the eight tailored/nontailored comparisons found more behavior change among tailored than nontailored recipients. Tailored print communications have also demonstrated effectiveness as an adjunct to other intervention components such as self-help smoking cessation manuals. However, studies comparing tailored print communications with tailoring via other media such as telephone counseling have shown mixed results. Additional research is needed to assess whether the behavioral topic itself may make a difference in whether tailoring is appropriate and effective.

Community-level comparisons between the grocery store environment and individual dietary practices

BACKGROUND This article examines the relationship at the community level between individual dietary practice and the grocery store environment. METHODS Individual dietary practice was measured in 12 communities using a telephone survey to obtain self-reported diet. A protocol was developed to measure two aspects of the grocery store environment in these same 12 communities: the relative availability of healthful (low-fat and high-fiber) products, and the amount of health-education information provided. Comparisons were made between individual and store-level measures at two levels of geographic aggregation: community (typically a county) and zip code within community (n = 34). RESULTS We found positive and statistically significant correlations at both the community and the zip code level between the availability of healthful products in stores and the reported healthfulness of individual diets. Positive correlations were also found between measures of the amount of health-education material provided by stores and the healthfulness of individual diets, but these correlations did not reach statistical significance. CONCLUSIONS The results provide support for including measures of the grocery store environment as part of a community-level assessment of dietary behavior.

Reasons for quitting: Intrinsic and extrinsic motivation for smoking cessation in a population-based sample of smokers

An intrinsic-extrinsic model of motivation for smoking cessation is extended to a population-based sample of smokers (N = 1,137), using a previously validated Reasons for Quitting (RFQ) scale. Psychometric evaluation of the RFQ replicated the model that includes health concerns and self-control as intrinsic motivation dimensions and immediate reinforcement and social influence as extrinsic motivation dimensions. Compared to volunteers, the population-based sample of smokers reported equivalent health concerns, lower self-control, and higher social influence motivation for cessation. Within the population-based sample, women compared to men were less motivated to quit by health concerns and more motivated by immediate reinforcement; smokers above age 55 expressed lower health concerns and higher self-control motivation than smokers below age 55. Higher baseline levels of intrinsic relative to extrinsic motivation were associated with more advanced stages of readiness to quit smoking and successful smoking cessation at a 12-month follow-up. Among continuing smokers, improvement in stage of readiness to quit over time was associated with significant increases in health concerns and self-control motivation.

Prevention of relapse in women who quit smoking during pregnancy.

OBJECTIVES This study is an evaluation of relapse prevention interventions for smokers who quit during pregnancy. METHODS Pregnant smokers at 2 managed care organizations were randomized to receive a self-help booklet only, prepartum relapse prevention, or prepartum and postpartum relapse prevention. Follow-up surveys were conducted at 28 weeks of pregnancy and at 8 weeks, 6 months, and 12 months postpartum. RESULTS The pre/post intervention delayed but did not prevent postpartum relapse to smoking. Prevalent abstinence was significantly greater for the pre/post intervention group than for the other groups at 8 weeks (booklet group, 30%; prepartum group, 35%; pre/post group, 39%; P = .02 [different superscripts denote differences at P < .05]) and at 6 months (booklet group, 26%, prepartum group, 24%; pre/post group, 33%; P = .04) postpartum. A nonsignificant reduction in relapse among the pre/post group contributed to differences in prevalent abstinence. There was no difference between the groups in prevalent abstinence at 12 months postpartum. CONCLUSIONS Relapse prevention interventions may need to be increased in duration and potency to prevent post-partum relapse.

Differences in preconceptional and prenatal behaviors in women with intended and unintended pregnancies.

OBJECTIVES This study examined whether pregnancy intention was associated with cigarette smoking, alcohol drinking, use of vitamins, and consumption of caffeinated drinks prior to pregnancy and in early pregnancy. METHODS Data from a telephone survey of 7174 pregnant women were analyzed. RESULTS In comparison with women whose pregnancies were intended, women with unintended pregnancies were more likely to report cigarette smoking and less likely to report daily vitamin use. Women with unintended pregnancies were also less likely to decrease consumption of caffeinated beverages or increase daily vitamin use. CONCLUSIONS Pregnancy intention was associated with health behaviors, prior to pregnancy and in early pregnancy, that may influence pregnancy course and birth outcomes.

A dietary intervention in primary care practice: the Eating Patterns Study.

OBJECTIVES This study evaluated the effectiveness of a low-intensity dietary intervention in primary care practice in lowering dietary fat intake and raising dietary fiber intake. METHODS A randomized controlled trial of 28 physician practices in six primary care clinics enrolled, by telephone, adult patients who had appointments for nonurgent nonacute visits. Of 3490 eligible patients contacted, 2111 completed baseline interview; 86.1% also completed a 12-month follow-up. Physicians gave intervention participants a self-help booklet and a brief motivational message. Changes in fat and fiber from baseline to 12-month follow-up were evaluated. RESULTS Intervention and control groups both reported a decrease in fat intake and an increase in fiber intake. The differential change and 95% confidence interval (CI) for the percentage of energy obtained from fat was -1.2 (CI = -0.71, -1.7) (P = .0015), for grams fiber/1000 kcal 0.32 (CI = -0.066, 0.71) (P = .086), for fat score -0.044 (CI = -0.016, -0.072) (P = .010), and for fiber score 0.036 (CI = 0.011, 0.061) (P = .014), with greater reductions in fat and greater increase in fiber in the intervention group. CONCLUSIONS This low-intensity intervention was effective in dietary behavior change.

PARTNER SMOKING STATUS AND PREGNANT SMOKER'S PERCEPTIONS OF SUPPORT FOR AND LIKELIHOOD OF SMOKING CESSATION

Perceptions of support for cessation of smoking during pregnancy, likelihood of quitting, and partner smoking status were explored in a sample of 688 pregnant smokers (372 baseline smokers and 316 baseline quitters). Women with nonsmoking partners were significantly more likely to be baseline quitters than women with partners who smoked. Baseline quitters reported significantly more positive support from their partners than did continuing smokers (p = .02). Neither partner smoking status nor partner support at baseline was associated with cessation or relapse later in pregnancy. Women reported greater support, both positive and negative, from nonsmoking partners than from partners who smoked (p = .001). Among partner smokers, those who were trying to quit were perceived to be particularly supportive. Cessation interventions for expectant fathers may increase pregnant womens success at quitting.

Intrinsic and Extrinsic Motivation for Smoking Cessation.

An intrinsic-extrinsic model of motivation for smoking cessation was evaluated with 2 samples (ns = 1.217 and 151) of smokers who requested self-help materials for smoking cessation. Exploratory and confirmatory principal components analysis on a 36-item Reasons for Quitting (RFQ) scale supported the intrinsic-extrinsic motivation distinction. A 4-factor model, with 2 intrinsic dimensions (concerns about health and desire for self-control) and 2 extrinsic dimensions (immediate reinforcement and social influence), was defined by 20 of the 36 RFQ items. The 20-item measure demonstrated moderate to high levels of internal consistency and convergent and discriminant validity. Logistic regression analyses indicated that smokers with higher levels of intrinsic relative to extrinsic motivation were more likely to achieve abstinence from smoking.

Stages of Change for Increasing Fruit and Vegetable Consumption among Adults and Young Adults Participating in the National 5-a-Day for Better Health Community Studies:

Higher fruit and vegetable consumption is associated with a reduced risk of certain cancers and chronic diseases. The 5-a-Day for Better Health community studies are evaluating population-based strategies to achieving dietary behavior change using the stages-of-change model and associated theories. The authors present baseline comparisons of stages of change for fruit and vegetable consumption among adults and young adults in eight study sites representing diverse regions of the United States and diverse populations and settings. Three dominant stages, precontemplation, preparation, and maintenance, were found across sites. Women and those with college degrees were more likely to be in action/maintenance. Fruit and vegetable consumption, self-efficacy, and knowledge of the 5-a-Day recommendation were positively associated with more advanced stages of change in all study sites. The authors discuss the findings in relation to possible limitations of this and other dietary stages-of-change measures and suggest directions for future research.

Using physician correspondence and postcard reminders to promote mammography use.

OBJECTIVES In a health maintenance organization that mails letters to women recommending that they schedule mammograms, we conducted a randomized trial to evaluate simple methods of increasing the use of screening mammography. METHODS Using a 2 x 2 factorial design, we tested the effects of (1) mailing the recommendation letter from each womans primary care physician rather than from the program director and (2) sending a subsequent reminder postcard. RESULTS Sending a reminder postcard nearly doubled the odds that women would get mammograms within 1 year (participate). The letter from the womans personal physician had no effect. Attending a clinic more than 45 minutes from the screening center, being a current smoker, or being in fair or poor health were negatively associated with subsequently obtaining a mammogram. The odds of participation doubled if women had had previous mammograms. CONCLUSIONS When preceded by written recommendations to schedule mammograms, reminder postcards effectively increased participation. Future randomized trials to promote use of screening mammography should compare interventions with a reminder condition.