Thomas W. O'Rourke

Settings as an Important Dimension in Health Education/Promotion Policy, Programs, and Research

Settings—community, worksite, schools, and healthcare sites—constitute an important dimension of health education/health promotion policy and programs and for research about program needs, feasibility, efficacy, and effectiveness. These settings vary in the extent of coverage of and relationships with their respective constituencies, valued outcomes, and quantity and quality of evidence about the effectiveness of setting-specific and cross-setting programs. Main sources of evidence for program efficacy and effectiveness are summarized, leading to the conclusion that strides have been made toward building a strong evidentiary base for health education/health promotion in these settings. Gaps in research exist, especially for diffusion of effective programs, new technologies, the influence of policy, relations between settings, and approaches to marginal and special subgroups. Recommendations are offered for cross-setting and within-setting research related to intervention.

A Multivariate Analysis of Selected Psychosocial Variables on the Development of Subsequent Youth Smoking Behavior.

The purpose of this study was to determine if interaction effects of selected psychosocial variables could be utilized as indicators of subsequent smoking behavior among youth who had originally identified themselves on a survey as having never smoked. Interaction effects of several psychosocial variables selected for study were found to be indicative of subsequent smoking behavior.

The Utilization of Attitudes and Beliefs as Indicators of Future Smoking Behavior.

The purpose of this study was to assess if the initial attitudes and beliefs of a behaviorally homogeneous group can be utilized as indicators of future smoking behavior. The students included were those seventh graders who classified themselves as never smokers on the initial survey in 1966 and who participated in all three surveys over the two year period. A total of 1228 females and 868 males met these criteria. This represented a 68 per cent retention rate over the study period. Data were treated by sex. In 1968 subjects classified themselves according to their present smoking behavior as either a smoker, ex-smoker or never smoker. Using these three groups, an analysis of variance technique was employed to assess if initial attitude-belief differences existed between the three subsequent behavioral groupings. For the original never smoker seventh grade females, initial attitude-belief mean difference scores were found on the pleasure and exemplar factors. Never smokers who remained never smokers exhibited more unfavorable attitudes and beliefs toward smoking than those who became smokers or ex-smokers. Significant differences for male data were found on the pleasure, influence, and health and disease factors. Again, initial never smokers who maintained their behavior exhibited more unfavorable attitudes and beliefs with regard to smoking than those who became smokers or ex-smokers. These results suggest that attitudes and beliefs of initial never smokers may serve as indicators of future behavior. It appears that items of an affective rather than a cognitive domain were more useful indicators. However, the complexity of the influencing factors of a smoking or non-smoking behavior is manifested, with the exception of the pleasure factor, by the existence of different factors being significant for different sexes at the same grade level.

Assessment Of The Effectiveness Of The N.Y. State Drug Curriculum Guide With Respect To Drug Attitudes.

The major purpose of this investigation was to assess the effectiveness of the revised edition of the New York State Curriculum Guide with respect to the affective domain dealing with the drug topic. Drug attitude test score comparisons were made between high school students who received the Curriculum Guide program and comparable students receiving a traditional program. Results of the attitude scores between the two groups evidenced a significantly higher score for the experimental group. However, closer analysis revealed that the program seemed to be effective for males but not females.

Assessment of the Effectiveness of the New York State Drug Curriculum Guide With Respect to Drug Knowledge.

The major purposes of this investigation was to assess the effectiveness of the revised edition of the New York State Curriculum Guide with respect to the cognitive domain dealing with the drug topic. Knowledge achievement comparisons in the areas of alcohol, tobacco, and drugs were made between high school students who received the Curriculum Guide program and comparable students receiving a traditional program. Results of the knowledge test scores between the two groups evidenced a significantly higher score for the experimental group for each of the three subscores and for the entire test. Comparisons between the two educational approaches by the sex of the respondent indicated that the program appears more effective for males than females.

Methodological Considerations to Improve Anti-Smoking Research

One of the most extensively studied areas of health behavior is that related to smoking. However, significant methodological limitations often limit the usefulness of research efforts. The purpose of this paper is to identify several of the more significant limitations found in the present research and to present suggestions to improve further research in smoking behavior. Several significant limitations of smoking research include the lack of common definitions of various behaviors, honesty of subject response, the lack of prospective studies and the problems inherent in such a design, and the preponderance of univariate types of analyses. Also, evaluation of program effectiveness is often limited by lack of appropriate criteria of what is meant by “success.” Lastly, much of the current research appears to focus on cessation or modification of the smoking habit. Less emphasis is directed at the area of prevention, especially involving an educational approach. Suggestions for improving anti-smoking research efforts are presented.

Use and Impact of the Competencies for Entry-Level Health Educators on Professional Preparation Programs

Abstract The “Responsibilities and Competencies for Entry-Level Health Educators” (Competencies) document identifies the major responsibilities in which all entry-level health educators are expected to be proficient and serves as the basis of credentialing certified health education specialists (CHES). This study addresses several fundamental questions related to their use: (1) What are the characteristics of the units that have professional preparation programs that prepare entry-level health educators? (2) Are the faculty in those programs familiar with the Competencies? (3) Do the faculty use the Competencies when planning their curricula? (4) What has been the impact of the Competencies? (5) Would the administrators of undergraduate programs using the Competencies agree to inclusion in a voluntary registry of such programs? All departments (N = 214) listed in the most recently published American Association for Health Education Directory of Institutions Offering Undergraduate and Graduate Degree Progr...

Improving Anti-Smoking Education: Profiling the Ex-Smoker

Youth experimentation with smoking is commonplace. Most anti-smoking efforts have focused on studying smokers and/or nonsmokers. Less attention has been directed at a significantly large group-ex-smokers. The purpose of this study is to present a profile of the ex-smoker in comparison to his/her smoking or never smoking counterparts. Knowledge about the ex-smoker group could enhance anti-smoking efforts. Data were collected from 5,393 central Illinois school age youth in grades 7–12. Data were analyzed by grade and sex. A variety of attitudinal, behavioral intention, and behavior questions about smoking were developed. Results clearly indicated that the ex-smoker group has a significantly different profile than youths who reported being a smoker or never smoker. Variables where differences were noted included close friends smoke, mother smokes, father smokes, mother would be upset, father would be upset, no one would be upset, best male friend upset, best female friend upset, and that smoking is a health problem. Differences were also noted with respect to believing that smoking helps people relax, is socially o.k. and whether or not separate areas should be designated for smokers. In most cases the ex-smokers more closely resembled the never smokers than the smokers.

A Prospective Study of Trends in Youth Smoking

To assess smoking trends of junior and senior high school youth, a prospective study was conducted over a two year period. A total of 10,565 subjects comprised the study population. The resultant data were analyzed by smoking behavior classification, grade level, and sex. Comparisons of smoking rates by matched and unmatched samples were also included. The findings supported the contention that behavioral patterns with respect to smoking and nonsmoking behavior are well established by the junior high school years. The authors maintain that from an educational point of view, smoking education programs must begin before the junior high school years. Educators need to recognize the characteristics of the target population to maximize the effect and efficiency of their educational programs.

Public Health Governance and Population Health Outcomes

Research reviews have identified a gap in understanding the diversity of health department governance structures and in understanding how the variations in governing relates to health outcomes. This report details the categorization of local public health governance and reveals that certain governance types may be better suited to achieve better population health outcomes. State systems achieve the poorest health outcomes, but the best health outcomes are achieved when the political branches have a key role in local public health governance. Public health systems should consider greater local control and involvement in governance; but local governance should include the political branches -and even the state -to achieve more positive health outcomes.