Loss-framed minimal intervention increases mammography use

INTRODUCTION: Although mammography is the most effective early detection breast cancer screening technology available, it is underutilized. This study was conducted to test the effectiveness of a loss-framed minimal intervention to increase mammography use. Loss-frame refers to a communication strategy in which messages are framed from the perspective of what a person has to lose by not taking a particular behavioral action. METHODS: Participants were medically un- and underinsured women 50-64 years old who called one of two urban clinics randomly selected based on demographic statistical equivalency. The women who participated telephoned to inquire about a mammogram during the 6-month study period. The group randomly designated as the experimental group received a loss-framed message conveyed by trained staff telephonically. Members of the comparison group received the "usual" communication, also conveyed telephonically. In the experimental group, 31 of 112 (27%) women who inquired received mammograms, whereas 157 of the 992 (16%) comparison group women who inquired received mammograms. RESULTS: The odds of a mammogram, adjusted for race and breast cancer symptoms, significantly increased for the experimental (odds ratio [OR] = 1.914, chi2 = 7.48, p = .0063, 95% confidence interval [CI] 1.20-3.05) versus comparison group. CONCLUSIONS: A loss-framed, in-reach, minimal intervention approach holds promise as a mammography promotion strategy.     

Working with Licensed Cosmetologists to Promote Health: Results from the North Carolina BEAUTY and Health Pilot Study

BACKGROUND: Beauty salons are located in all communities and represent a promising channel for delivering health promotion programs. No previous salon-based health promotion program has assessed the needs, interests, and preferences of licensed cosmetologists about sharing health information with their clients. METHODS: Licensed cosmetologists in one town completed a mailed survey assessing (1) health topics typically discussed with clients, (2) interest in delivering messages about beauty and health, and (3) preferred methods for learning about and sharing health information with their clients. RESULTS: The average cosmetologist sees 47 clients per week and spends 30-60 min per appointment. Eighty-two percent report that they are interested in talking about health with their clients. Most cosmetologists already discuss a wide range of health topics with their clients and are most comfortable discussing healthy eating (65.3%), physical activity (63.3%), and dieting (63.3%). Cosmetologists preferred reading pamphlets (55.1%) and watching educational videos (46.9%) to learn about beauty and health. Distributing pamphlets (69.4%), talking with clients (61.2%), and placing posters/mirror stickers in the salons (59.2%) were the methods cosmetologists most preferred for sharing health information with their clients. CONCLUSIONS: Licensed cosmetologists are in a unique position to serve as "natural helpers" by delivering health messages to their clients and reinforcing those messages over time. Partnerships with licensed cosmetologists should be developed to deliver salon-based health promotion programs.     

P.L. 99-252 and the Roles of State and Local Governments in Decreasing Smokeless Tobacco Use

Evaluation of the impact of the Comprehensive Smokeless Tobacco Health Education Act of 1986 (P.L. 99-252) will help determine the level of progress being made to reduce smokeless tobacco use and will help determine changes or new strategies needed to prevent or reduce smokeless tobacco use. Indicators of progress made toward implicit goals and explicit provisions of P.L. 99-252 are proposed as appropriate for local, state, and federal government health agencies to address. Examples of roles that can be played by health agencies relative to implicit goals of the law are drawn from experiences of public health professionals in Ohio and other states. These roles relate to work with the media, research and evaluation, surveillance activity, support for development of materials and implementation of programs, and funding for community educational programs. Indicators to measure impact of explicit provisions of the law focus on provisions specified in the public education section of the law. Proposed indicators involve monitoring the development and availability of programs, materials and media, monitoring research and dissemination of findings, and monitoring technical assistance and grants available. Possible measurement and evaluation strategies are discussed. Survey methodology seems most suitable for monitoring level and type of anti-smokeless tobacco activity in which health agencies engage and for determining awareness of resources available through the law.     

A Complementary Ecological Model of the Coordinated School Health Program

BACKGROUND: A complementary ecological model of the coordinated school health program (CSHP) reflecting 20 years of evolved changes is proposed. Ecology refers to the complex interrelationship between intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy. METHODS: Public health and child development theories that incorporate the influence of personal and social environments on health behavior, along with models that incorporate the influence of ecology, were consulted. RESULTS: Concepts from several models were combined with the 8 components of CSHP to formulate an ecological model involving 6 program and services components in an inner circle surrounded by 4 concentric rings representing the healthy school environment, essential structures of CSHP, local school district governance, and family and community involvement. CONCLUSION: This complementary ecological model is intended to serve as an additional conceptual approach to CSHP practice, evaluation, and research, and should prove especially useful to practitioners and researchers who already have a fundamental understanding of CSHP.     

A Replication Study of Reducing the Risk, a Theory-Based Sexuality Curriculum for Adolescents

ABSTRACT: Reducing the Risk is a theory-based, sexuality education curriculum shown to influence the knowledge and behaviors of secondary students. This study determined whether the behavioral effects of the curriculum could be duplicated in a southern, rural state. In a quasiexperimental design, pretest and posttest inventories were administered to students in treatment and comparison groups to determine the influence of Reducing the Risk on sexual behaviors. Results of the 18-month study indicated students receiving the curriculum significantly delayed initiating sexual intercourse. Sexually active students in the treatment group were significantly more likely to protect themselves from STD/HIV and pregnancy than sexually active students in the comparison group. In addition, students receiving Reducing the Risk showed a significant increase in parent-child communication about sexual issues. These results reinforce previous research that found positive behavioral effects for students receiving the Reducing the Risk curriculum