Wayne W. Westhoff

Restricting smoking at the University of Köln, Germany: a case study.

The effects of a new policy limiting smoking to separate, designated areas in School of Education buildings at the University of Köln, Germany, were analyzed. Although the majority (77%) of the 1,223 students surveyed did not expect the changed policy to affect their smoking habits, approximately 28% of the men and 30% of the women said they were smoking less at the university after the change went into effect. Ninety-one percent of the nonsmoking students and 68% of the smokers supported the new policy. Smoking rates among Köln students are not significantly different from those of the adult German population, where 34% of the women and 41% of the men are smokers. The findings in this study indicate that such a policy change may result in a net decrease in amount smoked and could be a successful intervention in countries where smoking rates are traditionally higher than they are in the United States.

Health Risk Behavior of Rural Secondary School Students in Zimbabwe

A socioculturally appropriate health risk behavior instrument, modeled after the U.S. Centers for Disease Control and Prevention’s Youth Risk Behavior Survey (YRBS), was administered to 717 secondary school students in a rural area of Zimbabwe. Comparisons of risk behaviors by gender and school grade were made using univariate procedures and multiple logistic regression. Males were significantly more likely than females to have had sexual intercourse (odds ratio = 5.02, p < .0001) and to report drug use behaviors. Males also were significantly more likely to report early initiation (by age 13 years) of alcohol use, cigarette smoking, and marijuana use. School site violence and drug use behaviors also were prevalent in this sample. An interaction between gender and grade was evident for some behaviors. Additional research may further the understanding of these risk behaviors and facilitate development of effective, culturally relevant risk reduction programs.

ACQUISITION OF HIGH-RISK BEHAVIOR BY AFRICAN-AMERICAN, LATINO, AND CAUCASIAN MIDDLE-SCHOOL STUDENTS '

The purpose of this study was to measure the stages of acquisition of selected high-risk health behaviors in 768 randomly selected 7th- and 8th-graders in a Florida school district. Specific high-risk health behaviors included use of alcohol, tobacco, and drugs, fighting and weapon carrying, and suicide ideation. Analysis indicated few behaviors that were significantly different when African-American and Lad-no students were compared with Caucasian students. The most weapon carrying was reported by Latinos. Fewer Caucasian students than their minority peers used inhalants. Knowledge of stages of acquisition among small diverse samples may assist school personnel to intervene during tine inculcation process with appropriate responsive programs.

Reproductive Health Education and Services Needs of Internally Displaced Persons and Refugees following Disaster.

Abstract Background: Following the occurrence of natural or manmade disaster, relief worker priorities include providing water, food, shelter, and immunizations for displaced persons. Like these essential initiatives, reproductive health education and services must also be incorporated into recovery efforts. Purpose: This study examined reproductive health care indicators, including the key areas of HIV/AIDS and other sexually transmitted infection (STI) transmission, family planning and pregnancy-related health services, and selected reproductive health education knowledge among refugees and internally displaced persons residing in southern Belize following Hurricane Mitch’s assault on the region in 1998. In addition, the occurrence of gender-based violence was measured. Methods: Internally displaced persons and refugee men and women were interviewed about prenatal care and delivery services, family planning knowledge and utilization, HIV/AIDS and other STI transmission knowledge, and sexual violence. Results: Numerous misconceptions about HIV/AIDS and other STIs existed. Most persons had never used any family planning method. Oral contraceptive use declined as length of stay at refugee camps increased. Most women were able to access prenatal services. Violence against women, including sexual violence, was reported. Discussion: Better access to medical services and education about reproductive health issues are needed following disasters. Translation to Health Education Practice: Health educators can contribute to relief efforts. Moreover, other relief workers should be equipped with skills and knowledge to help meet the reproductive health needs of disaster victims.

Establishing Health Status Indicators by Surveying Youth Risk Behaviors of High School Students in the Dominican Republic

The purpose of this survey was to determine the health-risk behaviors among high school students in the Dominican Republic. Samples were taken from communities with an industrial base and an increasing population (n = 1175). The communities under study had dissimilar population sizes (i.e., 5,000, 30,000, 50,000) and were located in various geographical locations. Frequency data are compared by gender and population differences for high-risk health behavior indicators associated with urban migration. We found significant differences in tobacco, alcohol, and crack use among the different population sites, with higher rates reported by the more populous communities. Boys reported more fighting and sexual activity. Girls reported higher rates of suicide ideation and attempts. These results can be used to 1) help focus on those behaviors rooted during the school years that most influence health, 2) monitor those behaviors by establishing baseline data, and 3) supply data that are comparable with recognized categories of high-risk behaviors.

Estimating Maternal Mortality in Monseñor Nouel Province, Dominican Republic

Objectives Maternal deaths are estimated by the World Health Organization at over 500,000 annually. Various methods of calculating mortality ratios have been utilized throughout the world, but many are inaccurate. The purpose of this study was to measure maternal mortality by using a sibling survivorship survey and by recording and tracking death certificates. Methods The data for the survey were collected within a specific province in the Dominican Republic that represents predominately rural communities. Interviews with 2,180 women and data from their 17,807 siblings were recorded, 9,723 of which were sisters. The Death Certificate data were obtained by tracking 3,430 records at the local government office in the same province. Results The results from the rural sibling survey show a maternal mortality ratio significantly higher than other national estimates (348/100,000 live births versus 72–250/100,000). Data collection methods are discussed, including government record keeping and potential sources of inaccuracy. Conclusion Reported maternal mortality ratios may not portray the true magnitude of the poor health status of women in developing countries.

Cooperation or Competition: Does Game Theory Have Relevance for Public Health?.

Abstract In this paper, we use game theory to understand decisions to cooperate or to compete in the delivery of public health services. Health care is a quasi-public good that is often associated with altruistic behavior, yet it operates in an increasingly competitive environment. With mounting health care regulation and changes in privatization, altruistic arguments give way to more competitive rationales for market decisions. Profit and not-for-profit institutions must address widespread health care needs while balancing the needs of more lucrative markets against the needs of lesser ones. Recognizing the roles of cooperation and competition as motivators in the delivery of health care to the public is imperative. We explore two game theory models (Nashs Equilibrium and the Prisoners Dilemma) and their related concepts of simultaneous interdependence and rationality to examine decision-making. Four hypothetical public health case studies are presented. We conclude that understanding game theory and the factors influencing decision making allows potential competitors to make more efficient decisions, including decisions to cooperate or compete. As public health agencies move toward more collaborative models of service delivery, such understanding may help enhance efficient and effective service delivery.

A Cardiovascular Health Program for Latinos Supplemented with Pedometers.

Abstract Background: Physical inactivity is an important modifiable risk factor for many chronic diseases which disproportionately affect Latinos in the U.S. Targeting at-risk Latinos for prevention and intervention programs to increase physical activity can help decrease their risk for developing these diseases. Purpose: The purpose of this study was to promote physical activity, while measuring and monitoring behavior change associated with pedometer use among Latinos. The studys objectives were to: (1) promote physical activity and increase awareness of the importance of walking and exercise through the use of pedometers, (2) calculate the amount of pedometer steps each participant takes over a period of time, and (3) determine whether the use of pedometers along with education about exercise in a cardiovascular disease program would increase participants physical activity. Methods: Prior to starting the program, participants were given a pedometer and a journal to track their steps. Results: The average number of steps participants took from the first to the last week of data collection increased significantly [F (188)= 6.20, P=0.014]. Discussion: A pedometer may be a useful tool for health educators when combined with an evidence-based physical education program. Translation to Health Education Practice: This study is a demonstration of how health education responsibilities can be put into practice.

Neighbors United for Health

Abstract Modeled upon the ecclesiastic community group concept of Latin America to unite and strengthen the bond between the Church and neighborhoods, a community-based organization created Vecinos Unidos por la Salud (Neighbors United for Health) to bring health messages into urban Latino neighborhoods. The model is based on five tenants, and incorporates Latino subjective norms to strengthen the bonds of group members with similar interest, lifestyles, language and acculturation.

Assessing the self-reported health risks of urban street children working in the dominican republic.

Children throughout the world work on street corners selling newspapers, washing car windows, shining shoes, or hustling anything that will earn cash for the day. Many of them start early in the morning, work all day without attending school, and then return home late in the evening. A 26-item questionnaire was given to a sample of forty children working the streets of Santo Domingo. Examination of the responses revealed that the mean age was 14.5 years. Over 92 percent of the children had contact with a relative in the past thirty days. Fifty percent responded that they were victims of physical abuse at home, while 97 percent said they believe they are healthy. Qualitative data on family, friends, and future goals are discussed.