Exposure to a Community-Level HIV Prevention Intervention: Who Gets the Message

As part of the evaluation of a community-level HIV prevention program for women, this study examined predictors of exposure to print media and community outreach and assessed the relationship between exposure to the intervention and condom use behavior. Data from interviews with 479 women randomly selected from the intervention community in 1995 and 1996 were examined. Analysis of demographic and risk characteristics were conducted to identify predictors of exposure to the project's HIV prevention messages. Additionally, logistic regression analyses were conducted to examine the effects of intervention exposure on condom use, controlling for factors related to exposure. The results revealed that the print media campaign reached the largest number of women. However, women at highest risk did not have high rates of exposure to print media, but had greater exposure to outreach. Exposure to print media had an effect on increased communication with a main partner about condom use, but was not significantly related to condom use last time had sex. There were no significant main effects for exposure to outreach on condom use behavior. An important finding of this analysis was that each intervention strategy was successful in reaching a different portion of the target population and that exposure had differential effects on the condom use behavior of particular segments of the target population.     

Needs and Preferences for the Prevention of Intimate Partner Violence Among Hispanics: A Community’s Perspective

Research suggest that Hispanics in the U.S. are disproportionately affected by the consequences of intimate partner violence. Nevertheless, few intimate partner violence prevention interventions have been developed to address the unique needs and preferences of this population. The Partnership for Domestic Violence Prevention is a community-based participatory research project that assessed the needs and preferences for prevention programs for Hispanics in Miami-Dade County. Nine focus groups with domestic violence service providers, victims and general community members were conducted (N = 76). Four major themes emerged from the focus groups. These included immigrants and teens as the highest priority groups to target in prevention efforts, culture as a double-edged sword, the system that helps and hurts the victim, and the need for wide-scale prevention programs that would reach Hispanics systematically. The results from this study have important implications for the development of intimate violence prevention interventions targeting Hispanics in the U.S.     

Efficacy of a Randomized Trial of a Community and School-based Anti-violence Media Intervention Among Small-town Middle School Youth

In a community randomized controlled trial, intervention middle school students from small towns were exposed to a community and school-based anti-violence intervention ("Resolve It, Solve It"). The primary intervention was a media campaign in which local high school students served as models in print, radio, and television PSAs and spearheaded local school and community activities. The media campaign was supported with school and community events that reinforced campaign messages. Tests of recognition and recall indicated widespread exposure to the media intervention. Multiple group latent growth models indicated that relative to control students, intervention students reported significant differences in rates of growth for intent for violence, physical assault against people, verbal victimization, and perceived safety at school. No differences were found for verbal assault, physical assault against objects, physical victimization, or self-efficacy for avoiding violence. When examined by sex, it was determined that results for physical assault against people were obtained only among female students, and changes in verbal victimization and perceived school safety were observed only among male students. These results suggest that a media and reinforcing community intervention led by older peers can alter rates of growth for some measures of violence and associated factors among small-town youth. Further research is indicated to determine how different campaign messages influence students by sex.     

Development of a smoking prevention mass media program using diagnostic and formative research

The process of developing a mass media campaign to prevent smoking among adolescents is described in detail. This campaign supplements a school smoking prevention program and shares educational objectives with the school program but is otherwise independent. It comprises various television and radio 30- and 60-sec "spot" messages. The campaign development process includes identifying educational objectives and strategies for appealing to young people; conducting diagnostic surveys and focus groups to determine target audience interests and perceptions about smoking and media content; suggesting approaches to producers to create preliminary television and radio messages for testing; conducting formative pretests with target groups to select optimal messages and suggest improvements to those messages; producing final messages for media presentation; and developing a media exposure plan to place messages in local media at optimal times for reception by target audiences. The media campaign is being evaluated in a 5-year project with 5,500 adolescents in four communities to determine the additional effect of mass media over a school program alone in preventing smoking.     

Violence and drug use in rural teens: national prevalence estimates from the 2003 Youth Risk Behavior Survey

Objectives: The purpose of this study was to compare national estimates of drug use and exposure to violence between rural and urban teens. Methods: Twenty‐eight dependent variables from the 2003 Youth Risk Behavior Survey were used to compare violent activities, victimization, suicidal behavior, tobacco use, alcohol use, and illegal drug use across rural, urban, and suburban teens across the country. Results: Overall, rural teens were equally or more likely than both suburban and urban teens to report experiencing many measures of violent behavior, victimization, suicide behaviors, and drug use. Among all teens, nonwhites reported equal or higher rates of violent behavior and victimization than whites, but these associations disappeared within the rural‐only population. Conclusions: Rural areas do not appear to provide a strongly protective effect against risk behaviors in teens and may be a risk factor in itself. Community prevention efforts should focus on reaching rural areas and segmenting program content based on need. Where white teens might benefit from an emphasis on preventing tobacco and alcohol use, nonwhite teens would benefit from an emphasis on preventing violence and victimization.     

Media and community campaign effects on adult tobacco use in Texas

The present study reports on the effects on adult tobacco cessation of a comprehensive tobacco-use prevention and cessation program in the state of Texas. Differences in cessation rates across treatment conditions were measured by following a panel of 622 daily smokers, recruited from the original cross-sectional sample, from baseline to follow-up. The adult media campaign combined television, radio, newspaper and billboard advertisements featuring messages and outreach programs to help adults avoid or quit using tobacco products. The ads also promoted quitting assistance programs from the American Cancer Society Smokers' Quitline, a telephone counseling service. The cessation component of the intervention focused on increasing availability of and access to cessation counseling services and pharmacological therapy to reduce nicotine dependence. Both clinical and community-based cessation programs were offered. Treatment areas which combined cessation activities with high level media campaigns had a rate of smoking reduction that almost tripled rates in areas which received no services, and almost doubled rates in areas with media campaigns alone. Analyses of the dose of exposure to media messages about smoking cessation show greater exposure to television and radio messages in the areas where high level media was combined with community cessation activities than in the other areas. Results also show that exposure to media messages was related to processes of change in smoking cessation and that those processes were related to the quitting that was observed in the group receiving the most intensive campaigns.     

A comparison of different approaches to promote community-wide dietary change

BACKGROUND: Because public health education funds are limited, it is important to determine which methods are most effective for promoting healthy lifestyles to communities. We conducted interventions in two communities to further examine the effectiveness of various educational approaches for communicating the "1% Or Less" message to switch from high-fat (whole or 2%) to low-fat (1% or fat-free) milk. METHODS: One intervention used public relations and community-based educational activities in supermarkets, schools, worksites, and other community settings. The other used paid advertising in the absence of other programming. We used telephone surveys and supermarket milk sales data, collected before and after each campaign and in a comparison community, to determine changes in milk-usage patterns. RESULTS: After the campaign of community-based educational programs and public relations activities, the proportion of high-fat milk drinkers who reported drinking low-fat milk was 19.6% compared with 6.8% for the comparison city (p<0.0001). After the advertising-only campaign, 12.8% of high-fat milk drinkers reported drinking low-fat milk (p<0.01). Although supermarkets experienced increases in low-fat milk sales after both campaigns, the results were not statistically significant. CONCLUSIONS: The results show how well-designed public relations activities can attract news coverage and provide further evidence that such coverage can be an important component of health-promotion campaigns. Although the use of paid advertising in the absence of other media or programming appeared to change milk-drinking habits, the results were not sustained after the ads stopped airing.     

The Effects of the <Emphasis Type="Italic">Moms and Teens for Safe Dates</Emphasis> Program on Dating Abuse: a Conditional Process Analysis

Moms and Teens for Safe Dates (MTSD) is a dating abuse (DA) prevention program for teens exposed to domestic violence. In a randomized controlled trial (RCT), MTSD prevented certain types of DA victimization (psychological and physical) and perpetration (psychological and cyber) among teens with higher, but not lower, exposure to domestic violence. We built on these findings by using moderated mediation analysis to examine whether level of teen exposure to domestic violence conditioned the indirect effects of MTSD on these types of DA through targeted mediators. MTSD consisted of six mailed activity booklets. Mothers who had been former victims of domestic violence delivered the program to their teens. Mother and teen pairs were recruited into the RCT through community advertising and completed baseline and 6-month follow-up interviews (N?=?277 pairs). As expected, MTSD had significant favorable effects for teens with higher but not lower exposure to domestic violence on several mediators that guided program content, including teen conflict management skills and mother-perceived severity of DA, self-efficacy for enacting DA prevention efforts, and comfort in communicating with her teen. MTSD had significant main effects on other mediators including teen feeling of family closeness and cohesion and mother-perceived susceptibility of her teen to DA. As expected, all significant indirect effects of MTSD on DA outcomes through mediators were for teens with higher exposure to domestic violence. Findings have implications for developing DA victimization and perpetration prevention programs for teens with high exposure to domestic violence.     

Community Organization and School Liaisons: How to Get Programs Started

This paper briefly reviews four intervention models, Rothman's community organization, Green's system-centered education, Rogers' innovation-decision process, and Watzlawick's planned change, for their applicability to help initiate community-based programs for drug abuse prevention and health promotion in youth. An expanded model is described, including preprogram assessment of the target population, community, and drug use problem, and continuous evaluation of program process and product. School liaisons are emphasized as a key factor in early adoption and demonstration of a community-based program for youth. The expanded model, including school liaisons, is applied to a comprehensive community drug abuse prevention project being implemented in the Greater Kansas City area. The model--and the project--suggest methods for organizing communities for long-term drug prevention, initially at the level of school and school district, and later to the family, mass media, and community organizations in a proximal-to-distal sequence of programming.     

The Anatomy of a Community Health Center System-Level Intervention for Intimate Partner Violence

The US Preventive Services Task Force (USPSTF) now recommends screening for intimate partner violence (IPV) as part of routine preventive services for women. However, there is a lack of clarity as to the most effective methods of screening and referral. We conducted a 3-year community-based mixed-method participatory research project involving four community health centers that serve as safety net medical providers for a predominately indigent urban population. The project involved preparatory work, a multifaceted systems-level demonstration project, and a sustainability period with provider/staff debriefing. The goal was to determine if a low-tech system-level intervention would result in an increase in IPV detection and response in an urban community health center. Results highlight the challenges, but also the opportunities, for implementing the new USPSTF guidelines to screen all women of childbearing years for intimate partner violence in resource-limited primary care settings.     

An evaluation of Arizona's youth tobacco access prevention media campaign

OBJECTIVES: The goal of this research effort is to evaluate changes in public opinion associated with the youth tobacco access (YTA) prevention media campaign in Arizona. METHODS: This evaluation effort utilized a pre-post test quasi-experimental design with a control group. The sampling pool consists of Arizona adult residents from Maricopa (intervention) and Pima (control) counties. Pre-test data were collected via phone survey in November of 2002 (n = 823). Post-test data were collected in late summer 2003 (n = 872). Data were analyzed in January 2004. RESULTS: Exposure to the campaign was limited. Nonetheless, exposure was associated with increased satisfaction with community efforts, perceptions that one's community is strongly opposed to minors purchasing tobacco, and a reduction in the perceived ease in which a minor can purchase tobacco. At post-intervention, community respondents also assigned increased responsibility for YTA prevention to stores that sell tobacco. CONCLUSIONS: While exposure to the campaign was limited, important changes were observed. For example, at post-campaign, the respondents in the intervention community reported greater satisfaction with current YTA prevention efforts. However, future research must investigate if increased satisfaction leads to more or less community involvement. Further, research must also investigate whether a campaign influencing community members to assign greater responsibility for YTA prevention on the retailers selling tobacco serves community interests. Data from this evaluation suggest that researchers and practitioners must be aware of potential negative, as well as potential positive, outcomes of YTA prevention efforts.     

Effects of "10,000 steps Ghent": a whole-community intervention

BACKGROUND: Currently there is a great deal of interest in multistrategy community-based approaches to changing physical activity or health behaviors. The aim of this article is to describe the effectiveness of the physical activity promotion project "10,000 Steps Ghent" after 1 year of intervention. METHODS: A multistrategy community-based intervention was implemented in 2005 with follow-up measurements in 2006 to promote physical activity to adults. A local media campaign, environmental approaches, the sale and loan of pedometers, and several local physical activity projects were concurrently implemented. In 2005, 872 randomly selected subjects (aged 25 to 75), from the intervention community Ghent and 810 from a comparison community, participated in the baseline measurements. Of these, 660 intervention subjects and 634 comparison subjects completed the follow-up measurements in 2006. Statistical analyses were performed in 2006. RESULTS: After one year there was an increase of 8% in the number of people reaching the "10,000 steps" standard in Ghent, compared with no increase in the comparison community. Average daily steps increased by 896 (95% CI=599-1192) in the intervention community, but there was no increase in the comparison community (mean change -135 [95% CI= -432 to 162]) (F time x community=22.8, p<0.001). Results are supported by self-reported International Physical Activity Questionnaire (IPAQ) data. CONCLUSIONS: The "10,000 steps/day" message reached the Ghent population and the project succeeded in increasing pedometer-determined physical activity levels in Ghent, after 1 year of intervention.     

Smart patient, smart community: improving client participation in family planning consultations through a community education and mass-media program in Indonesia

In health care consultations, patients often receive insufficient information from providers and communicate little with providers about their needs or concerns. This study evaluated a combined community education and mass media intervention to improve clients' participation in family planning consultations. A household survey was conducted with 1,200 women in three sub-districts (two intervention and one control) of West Java province in Indonesia. A comparison of post-campaign findings among family planning clients suggests that the intervention as a whole had a positive effect on client participation, specifically the number of clients who prepared questions to ask the service provider prior to a family planning visit in the past year. Multivariate analyses showed that the "Smart Card" intervention and elements of the "Sahabat" (Friend) mass media campaign were positively associated with clients' preparation of questions and question asking behavior during family planning consultations, indicating that a combined community education and mass-media approach can improve client communication with providers and improve the quality of family planning counseling.     

Community interdisciplinary education to promote partnerships in family violence prevention

Family violence is a major social and health problem in the United States. Educational approaches are needed that help professionals and communities develop more effective skills to work with families and communities. This article describes a statewide, interdisciplinary, community-based educational program for professionals and paraprofessionals and a 6-month post-evaluation. Participants reported knowledge and skill development in assessment and interventions, improved use of violence prevention data for planning and interventions, and increased community partnerships and collaborations. Recommendations address violence prevention leadership, funding, infrastructure, interdisciplinary professional education, greater community awareness, and policy development.     

Engaging Families in Voluntary Prevention Services to Reduce Future Child Abuse and Neglect: a Randomized Controlled Trial

Research on secondary prevention is mixed as to whether referrals to evidence-based practices and other community interventions reduce maltreatment recidivism. This evaluation sought to rigorously assess whether a community service–linkage model to evidence-based programs decreased subsequent reports of abuse and neglect among families reported to the child protection system (CPS). Between 2016 and 2018, administrative CPS records were used to identify families with at least one child under 5 years of age recently reported for maltreatment in Orange County, California, but where no follow-up services were mandated. Families were randomized to one of two community outreach and engagement conditions (i.e., targeted provider outreach vs. treatment-as-usual). Re-reporting outcomes were tracked in administrative records for a period of 12 months. A total of 4873 families met eligibility criteria, with 2231 (45.0%) randomized to the intervention arm and 2642 (54.0%) families to the control group. Among families in the intervention group, 811 (36.4%) were successfully contacted by a community provider. Of those families contacted, 145 (18.0%) agreed to participate in voluntary services. Overall, we did not detect any significant difference in re-reporting between our treatment and control groups (P?=?.433). Likewise, no significant differences in re-reporting were observed when we stratified the treatment group by levels of outreach and service engagement. Findings indicate low levels of successful engagement of families in voluntary services. Notwithstanding the absence of significant findings, this study demonstrates the potential for using community-based RCTs and administrative records to rigorously evaluate secondary prevention programs in the child protection system.

     

An Intervention to Address Interpersonal Violence Among Low-Income Midwestern Hispanic-American Teens

This paper reports pilot testing of “Familias En Nuestra Escuela”, an in-school interpersonal violence prevention intervention targeting Hispanic-American teens. The intervention, based on the hypothesis that the preservation and reinforcement of Hispanic cultural values can serve as a protective factor against violence, focused on the enhancement of ethnic pride. Researchers formed a partnership with a midwestern Hispanic community to test the feasibility, receptivity and preliminary impact of the intervention in a pre/post test, no control group design. Participants were low-income, predominantly first-generation Hispanic-American freshmen and sophomore students from one Hispanic-serving high school. Findings revealed a statistically significant increase in the intervention’s mediator, ethic pride. Changes in the desired direction occurred on measures of perceptions of self-efficacy for self-control, couple violence, and gender attitudes. The incidence of physical fighting and dating violence behaviors decreased over the course of an academic school year. Results provide preliminary evidence for the use of interventions based on ethnic and cultural pride as a violence prevention strategy among Hispanic-American teens, especially those who are first generation Americans.     

Prevention of Partner Violence by Focusing on Behaviors of Both Young Males and Females

Historically, the political context of partner physical aggression policy and research has focused on protection of physically victimized women and mandated interventions for male batterers. This emphasis is understandable when one considers the injuries and deaths of women by men. However, physical aggression against partners among teens is a very different phenomenon than battering. Intimate partner violence (IPV) in the form of physical aggression, the focus of this review, often starts in junior high school, and approximately 35% of male and female senior high school students report engaging in IPV. The specific trajectory of IPV varies by sample, but IPV appears to decrease in the late teens or early 20s. IPV is generally reported by both males and females, and not attributable to self-defense. IPV is significantly stable in couples who remain together, but stability appears lower if partners change. Given the importance of physical aggression by both males and females, prevention and early intervention programs need to address relationship factors, and targeted prevention and early intervention would be prudent with young high-risk couples. Decades of intervention programs for batterers have not proven very successful, and IPV appears easier to prevent than treat. Thus, emphasis on prevention of IPV seems both timely and promising. This review is intended for diverse audiences including educational administrators, policy makers, and researchers. It reviews issues such as who and when to target for IPV prevention programs, and it summarizes data relevant to these issues.     

Impact of a Rural Domestic Violence Prevention Campaign

Domestic violence is a prevalent health problem that in rural areas is further complicated by limited services, social isolation and the lack of privacy. Little is known about the impact of public health education on awareness, attitudes and behavior of the general public regarding domestic violence. This study sought to measure change in societal attitudes and behavioral intention in response to a seven-month public health education campaign targeting domestic violence in a rural county. From October 1998 to April 1999, the campaign used radio advertisements, posters, mailings to libraries and clergy, printed media articles, printed advertisements and health facility modifications. A random-digit-dialing telephone survey was used to evaluate attitudinal and behavioral changes in the intervention and comparison counties before and after the campaign. The response rates for the pre- (n =378) and postcampaign (n=633) surveys were 73 percent and 65 percent, respectively. Statistically significant increases in slogan and advertising recognition occurred in the intervention county (P=0.03), particularly among men recalling the campaign slogan (P=0.006). In a vignette regarding actions to be taken if the neighbor next door was abusing a partner, significant increases occurred in the intervention county in the percentage of respondents who thought that most people would talk to the victim (P=0.04), consult with friends (P=0.002) or talk to a doctor (P=0.004). Domestic violence agency hotline calls in the intervention county doubled following the campaign. Local public health education campaigns in a rural setting may be a valuable adjunct to national efforts, especially in reaching men.     

Recruiting participants for community-based research: the Diabetic Retinopathy Awareness Program

PURPOSE: Recruiting participants is a major challenge for population studies. We present the recruitment methods followed by the Diabetic Retinopathy Awareness Program (DRAP), a community-based, randomized, masked, controlled trial to meet and exceed its sample size goals. METHODS: A county-wide multi-media promotional campaign to recruit and enroll participants in the trial was planned and executed from October 1993 through April 1994, with the assistance of the local news media and community and professional groups. A toll-free 800 number recruitment line was established, and postage-paid recruitment postcards distributed. The trial was designed to examine whether a mailed educational intervention could increase compliance with vision care guidelines among persons with diabetes in the community. RESULTS: A total of 2308 persons with diabetes were interviewed for eligibility and 813 enrolled in the intervention trial, exceeding the original recruitment goals of 1800 and 600, respectively. Those who completed the enrollment interview reflected county demographics. During recruitment, newspaper, television and radio stories featured the study; pharmacies and physician offices displayed study materials; public service announcements appeared in local print and broadcast media. The largest single recruitment response was a local television news report, followed by a newspaper story. CONCLUSIONS: These experiences substantiate the need for a comprehensive coordinated approach, using planned multiple sources, to achieve recruitment success. By engaging the lay and professional communities along with the media, recruitment costs can be kept to a minimum. Participant costs can be minimized by employing a toll-free number and eliminating study participant travel, thus allowing for inclusion of traditionally underserved populations. This approach is applicable to other studies, where community-based participation is desired.