Cover Image

PAPERBACK
$40.00



View/Hide Left Panel

PAPER CONTRIBUTION F

Behavioral and Social Science Contributions to the Health of Adults in the United States

Karen M.Emmons, Ph.D.

The purpose of this paper is to briefly review the major causes of morbidity and mortality during adulthood and to provide a selected review of the literature that addresses efforts to reduce the prevalence of preventable disease among adults in the United States. Substantial progress has been made in reducing risk factor prevalence among adults. The premise of this paper is that the social and behav-

Dr. Emmons is associate professor, Department of Adult Oncology, Dana-Farber Cancer Institute, Dana-Farber/Harvard Cancer Center, and associate professor, Department of Health and Social Behavior, Harvard School of Public Health. This paper was prepared for the symposium, “Capitalizing on Social Science and Behavioral Research to Improve the Public's Health,” the Institute of Medicine and the Commission on Behavioral and Social Sciences and Education of the National Research Council, Atlanta, Georgia, February 2–3, 2000.

The author would like to thank Edwin Fisher, Russ Glasgow, Ellen Gritz, David Hemenway, Bernard Glassman, Sue Curry, Barbara Rimer, Tracy Orleans, and Judy Ockene for their thoughts on the topic of this paper and the future directions of the field. The author would also like to thank Glorian Sorensen for her contributions to the conceptualization of this manuscript and her ongoing contributions to the author's research. Jocelyn Pan contributed significantly to reviewing the literature discussed in this paper, and Mary Eileen Twomley provided editorial and manuscript preparation assistance. Portions of this paper are drawn from the author's previous writings (Sorensen et al., 1998, 1999; Emmons, in press).

This work was supported by grants from the Liberty Mutual Insurance Group, NYNEX, Aetna, the Boston Foundation, and NIH Grants 1RO1CA73242 and 1RO1HL50017 Best Beginnings: 5RO1 CA73242–04; PO1:1 PO1CA75308 –01A2; Polyp: 5RO1CA74000–02; CCSS: 1 R01 CA77780–02.



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research PAPER CONTRIBUTION F Behavioral and Social Science Contributions to the Health of Adults in the United States Karen M.Emmons, Ph.D. The purpose of this paper is to briefly review the major causes of morbidity and mortality during adulthood and to provide a selected review of the literature that addresses efforts to reduce the prevalence of preventable disease among adults in the United States. Substantial progress has been made in reducing risk factor prevalence among adults. The premise of this paper is that the social and behav- Dr. Emmons is associate professor, Department of Adult Oncology, Dana-Farber Cancer Institute, Dana-Farber/Harvard Cancer Center, and associate professor, Department of Health and Social Behavior, Harvard School of Public Health. This paper was prepared for the symposium, “Capitalizing on Social Science and Behavioral Research to Improve the Public's Health,” the Institute of Medicine and the Commission on Behavioral and Social Sciences and Education of the National Research Council, Atlanta, Georgia, February 2–3, 2000. The author would like to thank Edwin Fisher, Russ Glasgow, Ellen Gritz, David Hemenway, Bernard Glassman, Sue Curry, Barbara Rimer, Tracy Orleans, and Judy Ockene for their thoughts on the topic of this paper and the future directions of the field. The author would also like to thank Glorian Sorensen for her contributions to the conceptualization of this manuscript and her ongoing contributions to the author's research. Jocelyn Pan contributed significantly to reviewing the literature discussed in this paper, and Mary Eileen Twomley provided editorial and manuscript preparation assistance. Portions of this paper are drawn from the author's previous writings (Sorensen et al., 1998, 1999; Emmons, in press). This work was supported by grants from the Liberty Mutual Insurance Group, NYNEX, Aetna, the Boston Foundation, and NIH Grants 1RO1CA73242 and 1RO1HL50017 Best Beginnings: 5RO1 CA73242–04; PO1:1 PO1CA75308 –01A2; Polyp: 5RO1CA74000–02; CCSS: 1 R01 CA77780–02.

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research ioral sciences have made a significant contribution to these improvements. These contributions include providing a broader perspective on disease causation that goes beyond biomedical approaches, utilizing theory-based interventions, evaluating intervention strategies that vary in intensity and cost, and utilizing population-based approaches that extend intervention research beyond high-risk populations. A great deal of what we have learned has considerable potential for yielding greater intervention outcomes than have been achieved to date. A number of issues will be discussed that need to be considered in the design and evaluation of health behavior interventions in order to further advance our progress. These issues are presented briefly here and discussed in further detail later in the paper. First, research is needed that connects and bridges individual, community, environmental, and policy-level interventions. Second, more research is needed in how to effectively target multiple risk factors for chronic disease and to take advantage of naturally occurring relationships between health behaviors. Third, behavioral scientists need to anticipate the impact that advances in computer technology may have on intervention development and delivery, and to be prepared to take advantage of the resources that this technology has to offer. Fourth, it is argued that while there have been a number of innovations emanating from the behavioral and social sciences related to intervention design and delivery, such strategies are not typically implemented outside the research setting. Significant attention needs to be given to the issues of sustainability and dissemination because current efforts to disseminate effective interventions are poor. Finally, increased attention to social contextual factors that influence the development and maintenance of health behaviors is needed. Major Risks to Health During Adulthood Leading causes of morbidity and mortality among adults vary by age and gender, but are largely preventable. A brief review follows of the three leading causes of morbidity and mortality during early to middle and middle to older adulthood (see Table 1). Leading Causes of Mortality in Early to Middle Adulthood (Ages 20 –45) In early to middle adulthood, the leading cause of mortality is unintentional injuries. Among very young adults (≤24 years), injuries account for 77% of all deaths. The homicide rate among young males is almost 20 times higher than that found in most other industrialized nations (MMWR, 1993; Rachuba et al., 1995; Rosenburg, 1995). Across all age groups during adulthood, motor vehicle accidents account for the majority of deaths due to injury, although the death rate per miles driven has been reduced substantially in the past three decades (Bonnie, et al., 1999). Death rates for motor vehicle accidents are nearly equi-

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research TABLE 1. Leading Causes of Death and Numbers of Death, According to Age and Gender, United States, 1996   Age 25–44a Age 45–64b Malesc Femalesd Cause of Death Deaths Rank Deaths Rank Deaths Rank Deaths Rank Unintentional injuries 27,092 1 16,717 3 61,589 4 33,359 7 Malignant neoplasms 21,894 2 131,455 1 281,898 2 257,635 2 HIV 21,685 3 8,053 8 25,227 8   Heart disease 16,567 4 102,369 2 360,075 1 373,286 1 Suicide 12,602 5 7,762 9 24,998 9   Homicide and legal intervention 9,322 6   Chronic liver disease and cirrhoses 4,210 7 10,743 7 16,311 10   Cerebrovascular diseases 3,442 8 15,468 4 62,475 3 97467 3 Diabetes 2,526 9 12,687 6 27,646 7 34,121 6 Pneumonia and influenza 2,029 10 5,706 10 37,991 6 45,736 5 Chronic obstructive pulmonary disease   12,847 5 54,485 5 51,542 4 Alzheimer's disease   14,426 8 Nephritis   12,662 9 Septicemia   12,177 10 aAll cause mortality = 147,180. bAll cause mortality = 378,054. cAl1 cause mortality = 1,163,569. dAll cause mortality = 1,151,121.

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research valent for black, white, and Hispanic men, although much lower for Asian men. Motor vehicle death rates among women are about one-third of those found in men. Fires also cause a substantial proportion of unintentional injuries; cigarettes are a major cause of residential fires (Baker et al., 1992). On average, one out of every 200 households experiences a fire each year; this rate is greater among poor households (National Center for Health Statistics, 1996b). Cancer is the second leading cause of death in early to middle adulthood. The death rate due to cancer among men and women is roughly equivalent for whites, Hispanics, and Asians; it is significantly higher among black men than black women, and is higher among Native American women than Native American men (USDHHS, 1998). In this age range, cancer morbidity is greater among women, especially those ages 35–44, and is most common among blacks, followed by whites. Similar patterns in morbidity rates by race or ethnicity are found among men. Cancer morbidity has also consistently been found to have an inverse relationship with socioeconomic status (SES) (Devesa and Diamond, 1980, 1983; McWhorter et al., 1989; Morton et al., 1983; Tomatis, 1992; Williams and Horm, 1977). The third leading cause of death in early to middle adulthood is HIV; incidence is clustered in large metropolitan areas. Gay and bisexual men still represent most prevalent HIV infections; although overall incidence is significantly lower now than in the 1980s; incidence among young and minority gay men remains high (Holmberg, 1996). Roughly half of all new infections occur among injection drug users (IDUs). Black and Hispanic IDUs are more likely to be HIV infected than are white IDUs (Friedman et al., 1999). In 1997, 22% of all new adult AIDS cases were in women. In the United States, AIDS cases among women have been concentrated in blacks and Hispanics (Kamb and Wortley, 2000). The primary routes of transmission among women are injection drug use and heterosexual contact with an HIV-infected male sex partner. Leading Causes of Mortality in Middle to Older Adulthood (ages 45 –64) The leading cause of death from ages 45 to 64 is cancer. Heart disease is the second leading cause of death in this age group; death rates are three times greater in men than women. Death rates due to heart disease are twice as high in black men as in white men, and slightly higher for Native American men than white men. Unintentional injury is the third leading cause of death in this age range (USDHHS, 1999). Leading Causes of Morbidity in Adulthood Morbidity related to a number of chronic conditions can cause substantial reductions in quality of life and contribute significantly to medical care costs. In the United States, 24% of adults have been diagnosed with hypertension (Burt et

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research al., 1995); prevalence increases with age and is slightly higher among men than women (He and Whelton, 1997); age-adjusted prevalence is higher in non-Hispanic blacks than non-Hispanic whites (Burt et al., 1995; Hall et al., 1997). Among both blacks and whites, hypertension is higher among men than women. The prevalence of hypertension in Mexican Americans is lower than in non-Hispanic whites. Asian Americans have lower prevalence of hypertension compared to other ethnic groups. The severity of hypertension is greater among those of low SES (Moorman et al., 1991). The prevalence of diabetes has increased over the past decade (USDHHS, 1996a). It is estimated that 15.7 million persons in the United States have diabetes (MMWR, 1997; National Diabetes Information Clearinghouse, 1999). The overall prevalence of diabetes increases with age. The prevalence rate among blacks is more than 80% higher than for the total population; rates among American Indians or Alaskan Natives and Mexican Americans are also quite elevated, compared to the total population (Harris, 1998; MMWR, 1997). Heart disease is the leading cause of diabetes-related deaths. Type 2 diabetes, which accounts for more than 90% of all diagnosed diabetes, is associated with modifiable risk factors (e.g., obesity, physical inactivity) and nonmodifiable risk factors (e.g., genetic factors or family history, age, and race or ethnicity). Mental health problems are a major concern in adulthood. Between 10 and 15% of adults in the United States have a diagnosable mental disorder, and up to 24% of adults have experienced a mental disorder during the preceding year (MMWR, 1998; Regier et al., 1993a; Robins et al., 1981). The impact of mental health problems on functional disability and quality of life is profound (Wells et al., 1989a). Marital status (being divorced or separated) and having low SES are powerful correlates of mental health problems (Bebbington et al., 1981; Henderson et al., 1979; Hodiamont et al., 1987; Mavreas et al., 1986; Regier et al., 1993a; Surtees et al., 1983; Vazquez-Barquero et al., 1987). After controlling for other factors, there are no racial or ethnic differences in mental health disorders (Regier et al., 1993a). Substance use disorders are most common among very young adults, while affective disorders are elevated in early to middle adulthood; all mental disorders are less common during older adulthood than in the younger age group. Men are more likely to have substance use disorders and personality disorders; women are more likely to have affective and anxiety disorders (Kessler et al., 1994). Unintentional injuries are also the cause of significant morbidity during adulthood, as well as mortality as noted above. In addition to the morbidity associated with motor vehicle and other types of accidents, occupational injuries and exposures cause 13.2 million nonfatal injuries and 862,200 illnesses occurring among the American workforce annually (Leigh et al., 1997).

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research Risk Factors for Primary Causes of Morbidity and Mortality During Adulthood Over the past three decades there has been extensive research into the causes of heart disease, cancer, and other chronic diseases. As noted above, age and gender are nonmodifiable risk factors for certain diseases, although the direction of this effect varies considerably across diseases. Genetic causes of chronic disease have become the focus of intense research attention in the past decade. Genetic factors have been implicated in certain forms of diabetes (Kahn et al., 1996), cancer (Easton and Peto, 1990), stroke (Rastenyte et al., 1998), and myocardial infarction (Marian, 1998). However, in most cases the overall contribution of genetics to disease incidence is likely to be relatively small compared to behavioral or environmental factors (Lerman, 1997). Social epidemiology has demonstrated the profound effect that social class has on health (Emmons, 2000). Although SES is typically thought of as a non-modifiable modifying condition in epidemiological and behavioral research, a growing body of work suggests that if we are ever to make a significant impact on economic disparities in health, we need to begin efforts in which we reconceptualize socioeconomic status as a modifiable variable, both in our research efforts and in political dialogue. Modifiable risk factors for chronic disease morbidity and mortality include individual and environmental-level exposures. Strong relationships exist between health behaviors and risk for all of the leading causes of morbidity and mortality during adulthood. For example, heart disease, stroke, and cancer have been linked to a number of modifiable risk factors, including physical inactivity, obesity, hypertension, cholesterol level, diet, smoking, and sun exposure (He and Whelton, 1997; Wilson and Culleton, 1998). For many diseases, screening and early detection strategies are available that can reduce the severity of disease and substantially increase survival time. Environmental or organizational-level risk factors include occupational exposure and work practices, motor vehicle and other product design, and environmental design (e.g., highway redesign). A number of recommendations have been put forth for the adoption of health-promoting behaviors in order to reduce the incidence of chronic disease morbidity and mortality (Greenwald et al., 1995; U.S. Preventive Services Task Force, 1996; USDHHS, 1996b, 1996c). The latest health promotion guidelines related to the primary causes of morbidity and mortality among adults are outlined in Box 1. WHERE DO WE STAND? There have been some significant improvements in morbidity and mortality rates over the past several decades; deaths from cardiovascular disease have declined dramatically (Cole and Rodu, 1996; USDHHS, 1996c), and cancer mortality has recently declined for the first time since such records have been kept (Heath et al., 1995). Recent data from the Framingham Heart Study suggest that

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research there have been secular changes toward a less disabled and generally healthier population among adults aged 55 to 70 (Allaire et al., 1999). Of note, there have been improvements on 59% of the Healthy People 2000 target objectives (National Center for Health Statistics, 1996b). These successes should be celebrated, and social and behavioral scientists should be recognized for their contributions to these gains and to our understanding of the factors that influence health behaviors among diverse populations (Airhihenbuwa et al., 1996; Braithwaite et al., 1994; Kirsch et al., 1993; Kumanyika and Morssink, 1997; Kumanyika and Charleston, 1992; Pasick et al., 1996; Resnicow et al., 1999; Snow, 1974; Weiss et al., 1992). However, despite these gains, many diseases continue to have disproportionately high prevalence among minority groups. In addition, a number of studies highlight the importance of further improving behavioral risk factor prevalence on a population level, across all race, ethnicity, and gender groups. It has been estimated that community-based cholesterol interventions are cost-effective if cholesterol is reduced by as little as 2% (Tosteson et al., 1997). Other estimates suggest that implementation of currently available cancer prevention and early detection strategies at the population level could reduce U.S. cancer mortality by approximately 60% (Colditz et al., 1996; Willett et al., 1996). Given the encouraging estimates of the additional health gains that could be achieved from population-level adoption of recommended health behaviors, and the fact that many gains have been made, it is still disheartening that more than 50 years after the Framingham Heart Study demonstrated that behavioral risk factors greatly increase the risk of developing coronary heart disease, the prevalence of risk factors for this and many other diseases remains high. Only 24% of Americans engage in light to moderate physical activity at recommended levels (National Center for Health Statistics, 1996b). Racial and ethnic minority populations are less active than white Americans, with the largest differences found among women (Caspersen et al., 1986; Caspersen and Merritt, 1992; DiPietro and Caspersen, 1991). Physical activity patterns are also directly related to educational level and income (Caspersen et al., 1986; Centers for Disease Control and Prevention, 1990; Folsom et al., 1985; Siegal et al., 1993). Obesity is considered by some to be reaching epidemic proportions in the United States, with 18% of the U.S. adult population being obese and almost 60% being overweight (Must et al., 1999). Of particular concern is the recent finding that across most population groups, the prevalence of obesity and overweight is increasing rapidly (Mokdad et al., 1999). Significant improvements have been made in dietary habits over the past several years. Although the median intake of fruits and vegetables among adults is still less than five servings per day (Subar et al., 1995), intake has increased significantly since 1989 (National Cancer Institute, 1997). Consumption of red meat has also decreased substantially (U.S. Department of Agriculture, 1991). Fruit and vegetable consumption is higher among women than men at all ages, although the gender difference appears to increase with age. Lower-income households have significantly lower consumption of fruits and vegetables (Krebs-Smith et al., 1995), and have experienced less reduction in red meat con-

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research sumption compared to higher-income households (Interagency Board for Nutrition Monitoring and Related Research, 1993). Recent data indicate that 24.7% of adults smoke in the United States (MMWR, 1999), which represents a dramatic reduction in smoking prevalence over the past 30 years (Centers for Disease Control and Prevention, 1996). However, overall smoking prevalence has been virtually unchanged in the past 5 years. Educational status remains the strongest predictor of smoking status (Novotny et al., 1988; Pierce et al., 1989). Of particular concern is the recent finding that smoking prevalence among very young adults (ages 18–24) has increased substantially. Although there have been many increases in the prevalence of safety and injury prevention behaviors, only 61% of people in the United States wear seat belts (Bonnie et al., 1999). Although 49 states have seat belt laws, such regulations are rarely enforced. Other areas where injuries remain high, such as injuries involving firearms, have been the subject of little regulatory action (Freed et al., 1998). Unfortunately, the higher-than-ideal prevalence of modifiable risk factors is not limited to disease-free groups. There is an astonishingly low rate of action taken to control disease among those who have already been diagnosed with a chronic disease. For example, only 30% of white hypertensive men and 50% of black hypertensive men take action to control their blood pressure (USDHHS, 1999). Only 50% of people who have undergone angioplasty comply with postsurgical regimens for diet and exercise. Among diabetics, only 43% attend diabetes management classes, although significant progress has occurred among blacks in the past several years, with 50% of black diabetics now receiving this type of education (National Center for Health Statistics, 1996a). The data presented in this section illustrate that clear progress has been made on many risk factors for chronic disease as well as morbidity and mortality among adults. Effective strategies are available for reducing most risk factors. If applied effectively at the population level, such strategies could substantially reduce risk and improve disease outcomes. However, population-level interventions have been limited, and preventable risk factors remain the primary cause of morbidity and mortality. INTERVENTION OUTCOMES—EXAMPLES OF EFFECTIVE INTERVENTIONS The next section of this paper provides a brief discussion of outcomes for selected interventions targeting the causes of morbidity and mortality in adults. In particular, examples of intervention outcomes in key channels (e.g., communities, work sites, churches) that may exert influence on adults' health are provided. The social ecological model offers a framework for much of the discussion in this section (Stokols et al., 1996b). An ecological framework recognizes that behavior is affected by multiple levels of influence, including intrapersonal factors (e.g., motivation, skills, knowledge); interpersonal processes (e.g., social support, social network, social norms); institutional or organizational factors

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research (e.g., company management characteristics, workplace policies); community factors (e.g., social capital, neighborhood effects); and public policy (e.g., regulatory laws, tobacco taxes). A number of intervention studies have been conducted targeting health behaviors, occupational health, and injury prevention; the available literature for these targets varies by intervention level. For example, health behavior interventions often address intrapersonal and interpersonal levels, while occupational health and injury prevention interventions typically address policy and regulatory levels. Examples of interventions at each of the levels in the social ecological model are provided in Box 2. Examples of strategies for operationalizing the principles of the social ecological model at each level of influence are provided in Table 2. Reviews of behavior change interventions suggest that more intensive programs and those targeted at high-risk populations have the strongest outcome effects (Bowen and Tinker, 1995; Bowen et al., 1994; Sorensen et al., in press). These intervention strategies typically focus on intrapersonal factors and are studied in a reactive model, where participants who are ready to change are more likely to approach a specialty clinic or respond to advertisements for study programs. However, more recently many individual-level interventions have proactively recruited participants from a de- fined population. Common intervention modalities that have been utilized across a variety of intervention channels include individual counseling, group programs, telephone, computer-based interventions, and self-help or other mailed materials. These modalities vary in terms of their intensity, level of interpersonal interaction, and cost. Individual-level counseling interventions have come out of the medical model and psychological traditions, and generally have been found to be highly effective, while at the same time quite costly (Compas et al., 1998; Fisher et al., 1993). Individual counseling is limited in terms of its reach, and public health models are being developed that provide alternative strategies to intensive one-to-one counseling (Emmons and Rollnick, in press). Efforts to reach individuals who are at especially high risk have increasingly used home visitation models to deliver individualized counseling (Olds et al., 1986, 1997). One strategy is to combine a very limited number of counseling sessions with less costly intervention modalities (e.g., mailed materials, telephone counseling). Group sessions are also utilized as a way to deliver interpersonal counseling at a reduced cost. For some health behaviors, such as smoking and obesity, group programs have been found to outperform self-help materials, although their effectiveness relative to individual counseling has not been well evaluated (Hayaki and Brownell, 1996; Stead and Lancaster, 1999). Further, group approaches share the concerns about reach and generalizability that have been raised about individual counseling. Incorporating group sessions into community-based channels that attend to social contextual factors may be one way of improving generalizability. Telephone counseling has also become increasingly utilized as a modality for individual counseling (Ferguson, 1996; Glasgow et al., in press-b; Street et al., 1997). The impact of telephone-based interventions

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research TABLE 2. Health Recommendations Related to Primary Causes of Morbidity and Mortality Among Adults Health Promotion • accumulation of at least 30 minutes of moderate physical activity on most days of the week • consumption of a prudent diet ⇒ 30% or less of calories from fat ⇒ 20–30 grams or more of fiber per day ⇒ five or more servings of fruits and vegetables per day ⇒ daily multivitamin ⇒ limit alcohol intake • avoidance of unprotected sun exposure • avoidance of weight gain • practice of safe sex Health Protection • use seat belts and other safely equipment • minimize exposure to occupational hazards • use of smoke detectors Screening • comply with age-appropriate guidelines and health care provider's recommendations for the following screening tests: ⇒ cholesterol, blood pressure ⇒ pap tests ⇒ mammography ⇒ colon cancer screening ⇒ prostate cancer screening ⇒ depression SOURCE: Adapted from U.S. Preventive Services Task Force Guidelines,Healthy People 2000 Objectives, and Healthy People 2010 Objectives. on long-term behavior change is somewhat equivocal, although continued evaluations of its impact are needed (Bastani et al., 1999; Lichtenstein et al., 1996). Research is also needed on the effectiveness of telephone counseling with underserved and low-income populations, because this group is less likely to have telephones and thus may be more difficult to reach effectively with this strategy. It is also unclear whether removal of the face-to-face contact diminishes the impact of telephone intervention, especially among lower-income populations that may already be somewhat disenfranchised. Self-help materials are another strategy for reaching large numbers of people. With most health behaviors, self-help interventions are more effective than

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research no-intervention controls, although the overall intervention effects seen with self-help materials are generally small (Curry, 1993; Fiore et al., 1996; Glanz, 1997; Lancaster and Stead, 1999). However, the cost of self-help materials is low and the potential reach is high, which makes self-help an important component of many intervention programs. There is evidence for the contribution made by individual approaches to health behavior change. For example, Orleans and colleagues (Orleans et al., in press) evaluated interventions for six health-damaging behaviors, including tobacco use, alcohol abuse, drug abuse, unhealthy diet, sedentary life-style, and risky sexual practices. They conclude that at the individual level, there are reasonably effective interventions for these six risk factors. Minimal intervention strategies for several risk factors have produced clinically meaningful changes when extrapolated to the population level (Abrams et al., 1996; Calfas et al., 1996; Jeffrey, 1989; McLeroy et al., 1988; O'Malley et al., 1992; Velicer et al., 1999; Warner et al., 1997). However, there is also increasing recognition of the limitations of the individual perspective. Such approaches have contributed enormously to our understanding of health behavior, and they play an important role in a comprehensive approach to public health. However, individual-level approaches are limited in their potential for health behavior change if they are conducted in isolation without the benefit of interventions and policies that also address interpersonal and societal factors that influence health behaviors. McKinlay (1995) argued for the adoption of a population perspective to health promotion. He has proposed that effective behavior change at the population level requires concerted effort across the full spectrum of intervention levels posited by the social ecological model, which would include downstream interventions (e.g., individual-level interventions for those at risk or already affected); mainstream interventions (e.g., population-level or channel-based interventions that target defined populations for prevention); and upstream interventions (e.g., macro-level public policy and environmental interventions to create and strengthen social norms for healthy behaviors to reduce access to unhealthy products, and provide incentives for engaging in healthy behaviors). Population-based approaches to health promotion have arisen out of an interest in broadening the reach of prevention interventions. The work of Rose (1992) provided a particularly good illustration of the paradox of health promotion and prevention efforts. Individually based interventions may be more effective for the individual participants, particularly those at high risk, but have limited population coverage. In contrast, population-based efforts target a large percentage of the population, but typically have lower levels of effectiveness compared to individually based intervention approaches. However, as noted earlier, small changes at the population level can lead to large effects on disease risk. In evaluating health promotion interventions, the level of intervention impact must be judged as a function of the intervention's efficacy in terms of producing individual change, as well as its reach or penetration within the population (Abrams et al., 1996; Glasgow et al., 1999; Sorensen et al., in press). Focusing on impact and reach is a more useful dialogue than the increasingly

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research Luepker, R.V., Murray, D.M., Jacobs, D.R. J., Mittlemark, M., and Bracht, N. ( 1994). Community education for cardiovascular disease prevention: Risk factor changes in the Minnesota Heart Health Program. American Journal of Public Health, 84, 1383–1389. Lundberg, G. ( 1991). National health care reform: An aura of inevitability is upon us. Journal of the American Medical Association, 265, 2566–2567. Lutz, S.F., Ammerman, A.S., Atwood, J.R., Campbell, M.K., DeVellis, R.F., and Rosamond, W.D. ( 1999). Innovative newsletter interventions improve fruit and vegetable consumption in healthy adults. Journal of the American Dietetic Association, 99(6), 705–709. Mallonee, S., Istre, G.R., Rosenberg, M., Reddish-Douglas, M., Jordan, F., Silverstein, P., and Tunell, W. ( 1996). Surveillance and prevention of residential-fire injuries. New England Journal of Medicine, 335(1), 27–31. Manley, M.W., Epps, R.P., and Glynn, T.J. ( 1992). The clinician's role in promoting smoking cessation among clinic patients. Medical Clinics of North America, 76(2), 477–494. Marcus, B., Albrecht, A., Niaura, R., Taylor, E., Simkin, L., Feder, S., Abrams, D., and Thompson, P. ( 1995). Exercise enhances the maintenance of smoking cessation in women. Addictive Behavior, 20(1), 87–92. Marcus, B.H., Albrecht, A.E., King, T.K., Parisi, A.F., Pinto, B.M., Roberts, M., Niaura, R.S., and Abrams, D.B. ( 1999). The efficacy of exercise as an aid for smoking cessation in women: A randomized controlled trial. Archives of Internal Medicine, 159(11), 1229–1234. Marcus, B.H., Albrecht, A.E., Niaura, R.S., Abrams, D.B., and Thompson, P.D. ( 1991). Usefulness of physical exercise for maintaining smoking cessation in women. American Journal of Cardiology, 68(4), 406–407. Marcus, B.H., Goldstein, M.G., Jette, A., Simkin-Silverman, L., Pinto, B.M., Milan, F., Washburn, R., Smith, K., Rakowski, W., and Dube, C.E. ( 1997). Training physicians to conduct physical activity counseling. Preventive Medicine, 26, 382–388. Marian, A. ( 1998). Genetic risk factors for myocardial infarction. Current Opinion in Cardiology, 13, 171–178. Marmot, M., Adelstein, A., Robinson, N., and Rose, G. ( 1978). The changing social class distribution of heart disease. British Medical Journal, 2, 1109–1112. Marmot, M., Bobak, M., and Davey Smith, G. ( 1996). Explanations for social inequalities and health. In B.Amick, S.Levine, A.Tarlov, and D.Walsh (Eds.), Society and Health. London: Oxford University Press. Marmot, M., and Davey Smith, G. ( 1997). Socioeconomic differentials in health: The contribution of the Whitehall studies. Journal of Health Psychology, 2(3), 283–296. Marrero, D. ( 1993). Computers in the assessment of diabetes control: In C.Mogensen and E.Staid (Eds.), Diabetes Forum Series, Volume IV: Concepts of the Ideal Diabetes Clinic. Berlin/New York: Walter de Gruyter. Mavreas, V., Beis, A., Mouyias, A., Rigoni, F., and Lyketsos, G. ( 1986). Prevalence of psychiatric disorders in Athens. Social Psychiatry, 21, 172–181. McBeath, W. ( 1991). Health for all: A public health vision. American Journal of Public Health, 81, 1560–1565. McConnaughy, J., Lader, W., Chin, R., and Everette, D. ( 1997). Falling Through the Net II: New Data on the Digital Divide; National Telecommunications and Information

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research Administration : Office of Policy Analysis and Development. Internet report: www. ntia.doc.gov. McKinlay, J. ( 1995). The new public health approach to improving physical activity and autonomy in older populations. In E.Heikkinon (Ed.), Preparation for Aging. New York: Plenum Press. McLeroy, K.R., Bibeau, D., Steckler, A., and Glanz, K. ( 1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. McWhorter, W., Schtzhin, A., Horm, J. et al. ( 1989). Contribution of socioeconomic status to black/white differences in cancer incidence. Cancer, 63, 982–987. Meister, J.S., Warrick, L.H., Zapien, J.G., and Wood, A.H. ( 1992). Using lay health workers: Case study of a community-based prenatal intervention. Journal of Community Health, 17(1), 37–51. Minkler, M., and Wallerstein, N. ( 1997). Improving Health Through Community Organization and Community Building, 2nd ed. San Francisco: Jossey-Bass. MMWR. ( 1991). Child passenger restraint use and motor vehicle related fatalities among children—United States, 1982–90. Morbidity and Mortality Weekly Review, 40, 600–602. MMWR. ( 1993). Mortality trends and leading causes of death among adolescents and young adults. Morbidity and Mortality Weekly Review, 42, 459–462. MMWR. ( 1997). Trends in the prevalence and incidence of self-reported diabetes mellitus—United States, 1980–1994. Morbidity and Mortality Weekly Review, 46, 1014–1018. MMWR. ( 1998). Self-reported frequent distress among adults—United States, 1993– 1996. Morbidity and Mortality Weekly Review, 279, 1772–1773. MMWR. ( 1999). State-specific prevalence of current cigarette and cigar smoking among adults—United States, 1998. Morbidity and Mortality Weekly Review, 48(45), 1034–1039. Mokdad, A.H., Serdula, M.K., Dietz, W.H., Bowman, B.A., Marks, J.S., and Koplan, J.P. ( 1999). The spread of the obesity epidemic in the United States, 1991–1998. Journal of the American Medical Association, 282(16), 1519–1522. Moorman, P., Hames, C., and Tyroler, H. ( 1991). Socioeconomic status and morbidity and mortality in hypertensive blacks. In E.Saunders (Ed.), Cardiovascular Diseases in Blacks, pp. 179–194. Philadelphia: FA Davis Co. Morrow, G.R., and Bellg, A.J. ( 1994). Behavioral science in translational research and cancer control. Cancer, 74(4 Suppl), 1409–1417. Morton, W., Baker, H., and Fletcher, W. ( 1983). Geographic pathology of uterine cancers in Oregon: Risks of double primaries and effects of socioeconomic status. Gynecologic Oncology, 16, 63–77. Must, A., Spadano, J., Coakley, E.H., Field, A.E., Colditz, G., and Dietz, W.H. ( 1999). The disease burden associated with overweight and obesity. Journal of the American Medical Association, 282(16), 1523–1529. National Cancer Institute. ( 1987). Working guidelines for early cancer detection: Rationale and supporting evidence to decrease mortality. Internet report: National Cancer Institute. www.NCI.gov. National Cancer Institute. ( 1997). Americans Closer to Eating “5-a-Day,” Food Survey Finds. Bethesda, MD: National Cancer Institute.

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research National Center for Health Statistics. ( 1996a). Healthy People 2000 Progress Review: Diabetes and Chronic Disabling Conditions. Hyattsville, MD: Department of Health and Human Services. National Center for Health Statistics. ( 1996b). Healthy People 2000 Review: 1995–1996 (DHHS Pub No. 96–1256). Hyattsville, MD: Public Health Service. National Diabetes Information Clearinghouse. ( 1999). Diabetes Statistics (NIH Publication No. 99–3892). Bethesda, MD: National Institute of Health. National Highway Traffic Safety Administration. ( 1996a). Effectiveness of Occupant Protection Systems and Their Use: Third Report to Congress. Washington, DC: NHTSA. National Highway Traffic Safety Administration. ( 1996b). Traffic Safety Facts 1995: A Compliance of Motor Vehicle Crash Data from the Fatal Accident Reporting System and the General Estimates System. Washington, DC: NHTSA. National Research Council. ( 1989). A Common Destiny: Blacks and American Society. Washington DC: National Academy of Sciences. Neuhouser, M., Kristal, A., and Patterson, R. ( 1999). Use of food nutrition labels is associated with lower fat intake. Journal of the American Dietetic Association, 99, 45–50,53. Neumark Sztainer, D., Story, M., French, S., Cassuto, N., Jacobs, D.R.J., and Resnick, M.D. ( 1996). Patterns of health-compromising behaviors among Minnesota adolescents: Sociodemographic variations. American Journal of Public Health, 86(11), 1599–1606. NIOSH. ( 1996). National Occupational Research Agenda (Public Law 91–596, Section 5 (al). Bethesda, MD: US Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health. Novotny, T., Warner, K., Kendrick, J., and Remington, P. ( 1988). Smoking by blacks and whites: Socioeconomic and demographic differences . American Journal of Psychiatry, 78, 1187–1189. Novotny, T.E., and Healton, C.G. ( 1995). Research linkages between academia and public health practice. American Journal of Preventative Medicine, 11(supp), 1–61. Ockene, I.S., Hebert, J.R., Ockene, J.K., Merriam, P.A., Hurley, T.G., and Saperia, G. M. ( 1996). Effect of training and a structured office practice on physician-delivered nutrition counseling: The Worcester-Area Trial for Counseling in Hyperlipidemia (WATCH). American Journal of Preventative Medicine, 12(4), 252–258. Ockene, I.S., Hebert, J.R., Ockene, J.K., Saperia, G.M., Stanek, E., Nicolosi, R., Merriam, P.A., and Hurley, T.G. ( 1999). Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population: Worcester Area Trial for Counseling in Hyperlipidemia (WATCH). Archives of Internal Medicine, 159(7), 725–731. Ockene, J.K., Kristeller, J., and Goldberg, R. ( 1991). Increasing the efficacy of physician delivered smoking interventions: A randomized clinical trial. Journal of General Internal Medicine, 6(1), 1–8. Ockene, J.K., Ockene, I.S., Quirk, M.E., Hebert, J.R., Saperia, G.M., Luippold, R.S., Merriam, P.A., and Ellis, S. ( 1995). Physician training for patient-centered nutrition counseling in a lipid intervention trial. Preventative Medicine, 24, 563–570.

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research Olds, D.L., Eckenrode, J., Henderson, C.R.J., Kitzman, H., Powers, J., Cole, R., Sidora, K., Morris, P., Pettott, L. M, and Luckey, D. ( 1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Journal of the American Medical Association, 278(8), 637–643. Olds, D.L., Henderson, C.R. J., Tatelbaum, R., and Chamberlin, R. ( 1986). Improving the delivery of prenatal care and outcomes of pregnancy: A randomized trial of nurse home visitation. Pediatrics, 77(1), 16–28. O'Malley, S.S., Jaffe, A.J., Chang, G., Schottenfeld, R.S., Meyer, R.E., and Rounsaville, B. ( 1992). Naltrexone and coping skills therapy for alcohol dependence. A controlled study. Archives of General Psychiatry, 49(11), 881–887. Orleans, C., Gruman, J., Ulmer, C., Emont, S., and Hollendonner, J. (in press). Rating our progress in population health promotion: Report card on six behaviors. American Journal of Health Promotion. Orleans, C.T., George, L.K., Houpt, J.L. et al. ( 1985). Health promotion in primary care: A survey of U.S. family practitioners . Preventative Medicine, 14, 636–647. Panzarino, P., Jr. ( 1998). The costs of depression: Direct and indirect; treatment versus nontreatment . Journal of Clinical Psychiatry, 59, 11–14. Parker, E.A., Schulz, A.J., Israel, B.A., and Hollis, R. ( 1998). Detroit's East Side Village health worker partnership: Community-based health advisor intervention in an urban area. Health Education and Behavior, 25(1), 24–45. Pasick, R., D'Onofrio, C., and Otero Sabogal, R. ( 1996). Similarities and differences across cultures: Questions to inform a third generation for health promotion research. Health Education Quarterly, 23(Supplement), S142–S161. Pate, R.R., Heath, G.W., Dowda, M., and Trost, S.G. ( 1996). Associations between physical activity and other health behaviors in a representative sample of U.S. adolescents. American Journal of Public Health, 86(11), 1577–1581. Patterson, R.E., Kristal, A.R., Glanz, K., McLerran, D.F., Hebert, J.R., Heimendinger, J., Linnan, L., Probart, C., and Chamberlain, R.M. ( 1997). Components of the working well trial intervention associated with adoption of healthful diets. American Journal of Preventative Medicine, 13(4), 271–276. Peterson, T.R., and Aldana, S.G. ( 1999). Improving exercise behavior: An application of the stages of change model in a worksite setting. American Journal of Health Promotion, 13(4), 229–232, iii. Pierce, J.P., Fiore, M.C., Novotny, T.E., Hatziandreu, E.J., and Davis, R.M. ( 1989). Trends in cigarette smoking in the United States: Projections to the year 2000. Journal of the American Medical Association, 26(1), 61–65. Pietinen, P., Vartianinen, E., Seppanen, R., Aro, A., and Puska, P. ( 1996). Changes in diet in Finland from 1972 to 1992: Impact on coronary heart disease risk. Preventative Medicine, 25, 243–250. Puska, P., Salonen, J.T., Nissinen, A., Tuomilehto, J., Vartianinen, E., Korhonen, H., Tanskanen, A., Ronnqvist, P., Koskela, K., and Huttunen, J. ( 1983). Change in risk factors for coronary heart disease during 10 years of a community intervention programme (North Karelia project). British Medical Journal, 287, 1840–1844. Rachuba, L., Stanton, B., and Howard, D. ( 1995). Violent crime in the United States. An epidemiologic profile. Archives of Pediatric and Adolescent Medicine, 149, 953–960.

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research Rakowski, W., Ehrich, B., Goldstein, M.G., Rimer, B.K., Pearlman, D.N., Clark, M.A., Velicer, W.F., and Woolverton, H., 3rd. ( 1998). Increasing mammography among women aged 40–74 by use of a stage-matched, tailored intervention. Preventative Medicine, 27(5 Pt 1), 748–756. Ramelson, H.Z., Friedman, R.H., and Ockene, J.K. ( 1999). An automated telephone-based smoking cessation education and counseling system. Patient Education Counseling, 36(2), 131–144..li Rastenyte, D., Tuomilehto, J., and Sarti, C. ( 1998). Genetics of stroke—A review. Journal of Neurologic Science, 153, 132–145. Regier, D.A., Farmer, M.E., Rae, D.S., Myers, J.K., Kramer, M., Robins, L.N., George, L.K., Karno, M., and Locke, B.Z. ( 1993a). One-month prevalence of mental disorders in the United States and sociodemographic characteristics: The Epidemiologic Catchment Area Study. Acta Psychiatrica Scandinavica, 88(1), 35–47. Regier, D.A., Narrow, W.E., Rae, D.S., Manderscheid, R.W., Locke, B.Z., and Goodwin, F.K. ( 1993b). The de facto U.S. mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 50(2), 85–94. Resnicow, K., Baranowski, T., Ahluwalia, J.S., and Braithwaite, R.L. ( 1999). Cultural sensitivity in public health: Defined and demystified. Ethnicity and Disease, 9(1), 10–21. Resnicow, K., Futterman, R., Weston, R., Royce, J., Parms, C., Freeman, H., and Orlandi, M. ( 1996). Harlem Hospital smoking prevalence. Smoking Prevalence in Harlem, New York, 10(5), 343–346. Rimer, B., Conaway, M., Lyna, P., Glassman, B., Yarnell, K., Lipkus, I., and Barber, L. ( 1999). The impact of tailored interventions on a community health center population. Patient Education Counseling, 37(2), 125–140. Rimer, B., and Glassman, B. ( 1997). Tailored communications for cancer prevention in managed care settings . Outlook, 4–5. Rimer, B., and Glassman, B. ( 1999). Is there a use for tailored print communications (TPC's) in cancer risk communication (CRC)? 25, 140–148. Rimer, B.K., Orleans, C.T., Fleisher, L., Cristinzio, S., Resch, N., Telepchak, J., and Keintz, M.K. ( 1994). Does tailoring matter? The impact of a tailored guide on ratings and short-term smoking-related outcomes for older smokers. Health Education and Research, 9(1), 69–84. Rivara, F., Grossman, D., and Cummings, P. ( 1997). Injury Prevention (2 part review article). New England Journal of Medicine, 337(8), 543–618; 613–618. Robins, L., Helzer, J., Croughan, J., Williams, J., and Spitzer, R. ( 1981). Diagnostic Interview schedule: Version III. Rockville, MD: NIMH. Rogers, E.M. ( 1983). Diffusion of Innovations, 3rd ed. New York: The Free Press. Roman, P., and Blum, T. ( 1996). Alcohol: A review of the impact of worksite interventions on health and behavioral outcomes. American Journal of Health Promotion, 11(2), 136–149. Rose, G. ( 1982). Strategy of prevention: Lessons from cardiovascular disease. British Medical Journal, 282, 1847–1851. Rose, G. ( 1985). Sick individuals and sick populations. International Journal of Epidemiology, 14(1), 32–38.

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research Rose, G. ( 1992). The Strategy of Preventive Medicine. New York, NY: Oxford University Press. Rosenburg, M. ( 1995). An integrated approach to understanding and prevention. Journal of Health Care for the Poor and Underserved, 6, 102–110. Rothman, J. ( 1970). Three models of community organization practice. In E.J.Cox, Rothman J., Tropman J.E. (Ed.), Strategies of Community Organization, pp. 86–162. Itasca, NJ: Peacock. Salina, D., Jason, L.A., Hedeker, D., Kaufman, J., Lesondak, L., McMahon, S.D., Taylor, S., and Kimball, P. ( 1994). A follow-up of a media-based worksite smoking cessation program. American Journal of Community Psychology, 22(2), 257–271. Sanders-Phillips, K. ( 1996). The ecology of urban violence: Its relationship to health promotion behaviors in low-income black and latino communities. American Journal of Health Promotion, 10(4), 308–317. Schafer, R. ( 1978). Factors affecting food behavior and the quality of husbands' and wives' diets. Journal of the American Dietetic Association, 72, 138–143. Schafer, R., and Keith, P. ( 1982). Social psychological factors in the dietary quality of married and single elderly. Journal of the American Dietetic Association, 81, 30–34. Schensul, S. ( 1985). Science, theory and application in anthropology. American Behavioral Scientist, 29, 164–185. Schulberg, H., Saul, M., McLelland, M., Ganguli, M., Christy, W., and Frank, R. ( 1985). Assessing depression in primary medical and psychiatric practices . Archives of General Psychiatry, 44, 152–156. Schultz, A., Israel, B., Becker, A., and Hollis, R. ( 1997). “It's a 24-hour thing A living for each other concept”: Identity, networks, and community in an urban village health worker project. Health Education and Behavior, 24(4), 465–480. Sebastian, J.L., McKinney, W.P., and Young, M.J. ( 1989). Epidemiology and interaction of risk factors in cardiovascular disease . Primary Care, 16(1), 31–47. Seetharam, S. ( 1999). Selecting a Process for Identifying Tobacco Reduction Best Practices: A preview of the issues. Ottawa, Canada: Office of Tobacco Reduction Programs. Shepard, R. ( 1996). Worksite fitness and exercise programs: A review of methodology and health impact. American Journal of Health Promotion, 10(6), 436–452. Shiffman, S. ( 1993). Smoking cessation treatment. Journal of Consulting and Community Psychology, 61(5), 718–722. Siegal, P., Fraizer, E., and Mariolis, P. ( 1993). Behavioral Risk Factor Surveillance, 1991: Monitoring Progress Toward the Nation's Year 2000 Health Objectives. Morbidity and Mortality Weekly Report, 42(SS-4), 1–30. Skinner, C., Campbell, M., Rimer, B., Curry, S., and Prochaska, J. ( 1999). How effective is tailored print communication? Annals of Behavioral Medicine, 21(4), 290–298. Skinner, C.S., Siegfried, J.C., Kegler, M.C., and Strecher, V.J. ( 1993). The potential of computers in patient education. Patient Education and Counseling, 22(1), 27–34. Snow, L.F. ( 1974). Folk medical beliefs and their implications for care of patients. A review bases on studies among black Americans. Annals of Internal Medicine, 81(1), 82–96. Sobell, L.C., Sobell, M.B., Kozlowski, L.T., and Toneatto, T. ( 1990). Alcohol or tobacco research versus alcohol and tobacco research. British Journal of Addiction, 85(2), 263–269.

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research Sorensen, G., Emmons, K., Hunt, M., Eisenberg, M., and Johnston, D. (in press). Public Health Interventions Targeting Health Behaviors: Building on Research to Date. Washington, DC: Institute of Medicine. Sorensen, G., Emmons, K., Hunt, M., and Johnston, D. ( 1998a). Implications of the results of community intervention trials. Annual Review of Public Health, 19, 379–416. Sorensen, G., Himmelstein, J., Hunt, M., Youngstrom, R., Hebert, J., Hammond, S. et al. ( 1995). A model for worksite cancer prevention: Integration of health protection and health promotion in the Wellworks Project. American Journal of Health Promotion, 10(1), 55–62. Sorensen, G., Hunt, M., Cohen, N., Stoddard, A., Stein, E., Phillips, J., Baker, F., Combe, C., Hebert, J., and Palombo, R. ( 1998b). Worksite and family education for dietary change: The Treatwell 5-a-Day Program. Health Education and Research, 13(4), 577–591. Sorensen, G., Lando, H., and Pechacek, T.F. ( 1993). Promoting smoking cessation at the workplace: Results of a randomized controlled intervention study. Journal of Medicine, 35(2), 121–126. Sorensen, G., Morris, D., Hunt, M., Hebert, J., Harris, D., Stoddard, A., and Ockene, J. ( 1992). Work-site nutrition intervention and employees' dietary habits: The Treatwell program. American Journal of Public Health, 82(6), 877–880. Sorensen, G., Stoddard, A., and Hunt, M. ( 1998c). Behavior change in a worksite cancer prevention intervention: The WellWorks Study. American Journal of Public Health, 88, 1685–1690. Sorensen, G., Stoddard, A., Peterson, K., Cohen, N., Hunt, M., Stein, E., Palumbo, R., and Lederman, R. ( 1999). Increasing fruit and vegetable consumption through worksites and families in the Treatwell 5-a-Day Study. American Journal of Public Health, 89(1), 54–60. Sorensen, G., Thompson, B., Basen-Enquist, K., Abrams, D., Kuniyuki, A., DiClemente, C., and Biener, L. ( 1998d). Durability, dissemination, and institutionalization of worksite tobacco control programs: Results from the Working Well Trial. International Journal of Behavioral Medicine, 5(4), 335–351. Sorensen, G., Thompson, B., Glanz, K., Feng, Z., Kinne, S., DiClemente, C., Emmons, K., Heimendinger, J., Probart, C., and Lichtenstein, E. ( 1996a). Work site-based cancer prevention: Primary results from the Working Well Trials. American Journal of Public Health, 86(7), 939–947. Sorensen, G., Thompson, B., Glanz, K., Feng, Z., Kinne, S., DiClemente, C., Emmons, K., Heinmendinger, J., Probart, C., and Lichtenstein, E. ( 1996b). Work site-basedcancer prevention: Primary results from the Working Well Trial. American Journal of Public Health, 86(7), 939–947. Sorensen, G., Thompson, B., Glanz, K., Feng, Z., Kinne, S., DiClemente, C., Emmons, K.M., Heimendinger, J., Probart, C., and Lichtenstein, E. ( 1996c). Working Well: Results from a worksite based cancer prevention trial . American Journal of Public Health, 86, 939–947. Stead, L., and Lancaster, T. ( 1999). Group behaviour therapy programmes for smoking cessation. The Cochrane Library(4), Oxford: Updated software.

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research Stokols, P., Allen, J., and Bellingham, R.L. ( 1996b). The social ecology of health promotion: Implications for research and practice. American Journal of Health Promotion, 10, 247–251. Stokols, D., Pelletier, K.R., and Fielding, J.E. ( 1996a). The ecology of work and health: Research and policy directions for the promotion of employee health. Health Education Quarterly, 23(2), 137–158. Strecher, V.J., Kreuter, M., Den Boer, D.J., Kobrin, S., Hospers, H.J., and Skinner, C. S. ( 1994). The effects of computer-tailored smoking cessation messages in family practice settings. Journal of Family Practice, 39(3), 262–270. Street, R., Jr., Gold, W., and Manning, T. ( 1997). Health Promotion and Interactive Technology: Theoretical Applications and Future Directions. London: Lawrence Erlbaum Associates. Subar, A.S., Heimdinger, J., Krebs-Smith, S.M., Patterson, B.H., Kessler, R., and Pivonka, E. ( 1995). Fruit and vegetable intake in the United States: The baseline survey of the Five a Day for Better Health Program. American Journal of Health Promotion, 9(5), 352–360. Sundstrom, E. ( 1986). Workplaces: The Psychology of the Physical Environment in Offices and Factories. New York: Cambridge University Press. Surtees, P., Dean, C., Ingham, J., Kreitman, N., Miller, P., and Sashidharan, S. ( 1983). Psychiatric disorder in women from an Edinburgh community: Associations with demographic factors. British Journal of Psychiatry, 142, 238–246. Susser, M. ( 1985). Editorial: The tribulations of trials-Intervention in communities . American Journal of Public Health, 85(2), 156–158. Syme, S. ( 1997). Individual vs. community interventions in public health practice: Some thoughts about a new approach. Vic Health(2). Tarr, K., Highstein, G., Sykes, R., Musick, J., Strunk, R., and Fisher, E. ( 2000). Asthma Coaches Reach Underserved Medicaid Enrolled Through Nondirective Support and Proactive Strategies. Paper presented at the SBM Annual Meeting. Nashville, TN. Taylor, V., Robson, J., and Evans, S. ( 1992). Risk factors for coronary heart disease: A study in inner London. British Journal of General Practice, 42(362), 377–380. Thomas, S.B., Quinn, S.C., Billingsley, A., and Caldwell, C. ( 1994). The characteristics of northern black churches with community health outreach programs. American Journal of Public Health, 84(4), 575–579. Thorndike, A., Rigotti, N., Stafford, R., and Singer, D. ( 1998). National patterns in the treatment of smokers by physicians. Journal of the American Medical Association, 279(8), 604–608. Tilley, B.C., Glanz, K., Kristal, A.R., Hirst, K., Li, S., Vernon, S.W., and Myers, R. ( 1999a). Nutrition intervention for high-risk auto workers: Results of the next step trial. Preventative Medicine, 28, 276–283. Tilley, B.C., Vernon, S.W., Myers, R., Glanz, K., Lu, M., Hirst, K., and Kristal, A.R. ( 1999b). The Next Step Trial: Impact of a worksite colorectal cancer screening promotion program. Preventative Medicine, 28(3), 276–283. Tomatis, L. ( 1992). Poverty and cancer. Cancer Epidemiology, Biomarkers, and Prevention, 1, 167–175. Tosteson, A.N., Weinstein, M.C., Hunink, M.G., Mittleman, M.A., Williams, L.W., Goldman, P.A., and Goldman, L. ( 1997). Cost-effectiveness of populationwide

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research educational approaches to reduce serum cholesterol levels . Circulation, 95(1), 24–30. Troutt, D. ( 1993). The Thin Red Line: How the Poor Still Pay More. San Francisco: Consumers Union of the United States. Unger, J. ( 1996). Stages of change of smoking cessation: Relationships with other health behaviors. American Journal of Preventative Medicine, 12, 134–138. U.S. Department of Agriculture. ( 1991). USDA Continuing Survey of Food Intakes by Individuals, 1989–1991. Washington, DC: ARS, Beltsville Hum. Nutr. Res. Cent. Food Surv. Res Group. U.S. Preventative Services Task Force. ( 1996). Guide to Clinical Preventative Services. Baltimore: Williams & Wilkins. USDHHS. ( 1991). Healthy People 2000: National Health Promotion and Disease Prevention. Bethesda, MD: Public Health Service. USDHHS. ( 1994). A Report on Research, Training, Career Development, Education, and Other Activities Related to Nutrition, Fiscal Year 1994. Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute Programs in Nutrition . USDHHS. ( 1996a). Healthy People 2000 Progress Review: Diabetes and Chronic Disabling conditions. Hyattsville, MD: National Institute of Health. USDHHS. ( 1996b). Physical Activity and Health: A Report of the Surgeon General. Atlanta: Center for Disease Control and Prevention; National Center for Chronic Disease Prevention and Health Promotion . USDHHS. ( 1996c). Vital Statistics of the U.S., 1992, vol. 2, Mortality Part A (Pub No. 96–1101). Hyattsville, MD: National Center for Health Statistics. USDHHS. ( 1998). Socioeconomic Status and Health Chartbook. Washington, DC: Department of Health and Human Services. USDHHS. ( 1999). Healthy People 2000, Progress Review: Heart Disease and Stroke. Bethesda, MD: Department of Health and Human Services. Vazquez-Barquero, J., Diez-Manrique, J., Pena, C. et al. ( 1987). A community mental health survey in Cantabria: A general description of morbidity. Psychological Medicine, 17, 227–241. Velasquez, M., Hecht, J., Quinn, V., Emmons, K., DiClemente, C., and Mullen, P. (in press). The application of motivational interviewing to prenatal smoking cessation: Training and implementation issues. Tobacco Control. Velicer, W.F., Prochaska, J.O., Bellis, J.M., DiClemente, C.C., Rossi, J.S., Fava, J.L., and Steiger, J.H. ( 1993). An expert system intervention for smoking cessation. Addictive Behavior, 18, 269–290. Velicer, W.F., Prochaska, J.O., Fava, J.L., Laforge, R.G., and Rossi, J.S. ( 1999). Interactive versus noninteractive interventions and dose-response relationships for stage-matched smoking cessation programs in a managed care setting. Health Psychology, 18(1), 21–28. Vogt, T., Hollis, J., Lichtenstein, E., Stevens, V., Glasgow, R., and Whitlock, E. ( 1998). The medical care system and prevention: The need for a new paradigm . HMO Practice, 12, 6–14. Voorhees, C.C., Stillman, F.A., Swank, R.T., Heagerty, P.J., Levine, D.M., and Becker, D.M. ( 1996). Heart, body, and soul: Impact of church-based smoking cessation interventions on readiness to quit. Preventative Medicine, 25, 277–285.

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research Wallack, L., and Winkleby, M. ( 1986). Primary prevention: A new look at basic concepts. Social Science and Medicine, 25, 923–930. Wang, J., Carson, E., Lapane, K., Eaton, C., Gans, K., and Lasater, T. ( 1999). The effect of physician office visits on CHD risk factor modification as part of a worksite cholesterol screening program. Preventative Medicine, 28, 221–228. Warner, K.E., Slade, J., and Sweanor, D.T. ( 1997). The emerging market for long-term nicotine maintenance. Journal of the American Medical Association, 278(13), 1087–1092. Webber, D., Balsam, A., and Oehlke, B. ( 1995). The Massachusett's farmer's market coupon program for low-income elders. American Journal of Health Promotion, 9(4), 251–253. Wegman, D., and Levy, B. ( 1995). Preventing occupational disease. In D.Wegman and B.Levy (Eds.), Occupational Health: Recognizing and Preventing Work-Related Disease, pp. 83–101. Boston: Little, Brown, and Company. Weinstein, N. ( 1988). The precaution adoption process. Health Psychology, 7, 355–386. Weiss, B.D., Hart, G., McGee, D.L., and D'Estelle, S. ( 1992). Health status of illiterate adults: Relation between literacy and health status among persons with low literacy skills. Journal of the American Board of Family Practice, 5, 257–264. Wells, K., Lewis, C., Leake, B., Schleiter, M., and Brook, R. ( 1986). The practice of general and subspecialty internists in counseling about smoking and exercise. American Journal of Public Health, 76, 1009–1013. Wells, K., Stewart, A., Hays, R. et al. ( 1989a). The functioning and well-being of depressed patients. Journal of the American Medical Association, 262, 914–919. Wells, K.B., Hays, R.D., Burnam, M.A., Rogers, W., Greenfield, S., and Ware, J.E., Jr. ( 1989b). Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study. Journal of the American Medical Association, 262(23), 3298–3302. Wells, K.B., and Lewis, B. ( 1984). Do physicians practice what they preach? Journal of the American Medical Association, 252, 2846–2848. Wiist, W.H., and Flack, J.M. ( 1990). A church-based cholesterol education program. Public Health Reports, 105(4), 381–388. Wilkinson, R.G. ( 1992). Income distribution and life expectancy. British Medical Journal, 304(6820), 165–168. Willemsen, M.C., de Vries, H., van Breukelen, G., and Genders, R. ( 1998). Long-term effectiveness of two Dutch work site smoking cessation programs. Health Education and Behavior, 25(4), 418–435. Willett, W., Colditz, G., and Mueller, N. ( 1996). Strategies for minimizing cancer risk. Scientific American, 275(3), 58. Williams, A. ( 1982). Passive and active measures for controlling disease and injury: The role of health psychologists. Health Psychology, 1, 399–409. Williams, M.V., Parker, R.M., Baker, D.W., Parikh, N.S., Pitkin, K., Coates, W.C., and Nurss, J.R. ( 1995). Inadequate functional health literacy among patients at two public hospitals. Journal of the American Medical Association, 274(21), 1677–1682. Williams, R., and Horm, J. ( 1977). Association of cancer sites with tobacco and alcohol consumption and socioeconomic status of patients: Interview study from the Third National Cancer Study. Journal of the National Cancer Institute, 58, 525–547.

OCR for page 254
Promoting Health: Intervention Strategies from Social and Behavioral Research Wilson, D. M, Taylor, D.W., Gilbert, J.R., Best, J.A., Lindsay, E.A., Willms, D.G., and Singer, J. ( 1988). A randomized trial of a family physician intervention for smoking cessation. Journal of the American Medical Association, 260(11), 1570–1574. Wilson, M.G., Holman, P.B., and Hammock, A. ( 1996a). A comprehensive review of the effects of worksite health promotion on health-related outcomes. American Journal of Health Promotion, 10(6), 429–435. Wilson, M.G., Jorgensen, C., and Cole, G. ( 1996b). The health effects of worksite HIV/AIDS interventions: A review of the research literature. American Journal of Health Promotion, 11(2), 150–157. Wilson, P.W., and Culleton, B.F. ( 1998). Epidemiology of cardiovascular disease in the United States. American Journal of Kidney Disease, 32(5 Suppl 3), S56–65. Winett, R., King, A., and Altman, D. ( 1989). Health Psychology and Public Health: An integrative approach. New York: Pergamon Press. Winkleby, M. ( 1994). The future of community-based cardiovascular disease intervention studies. American Journal of Public Health, 84(9), 1369–1371. Winkleby, M.A., Feldman, H.A., and Murray, D.M. ( 1997). Joint analysis of three U.S. community intervention trials for reduction of cardiovascular disease risk. American Journal of Public Health, 87. Winkleby, M.A., Taylor, B., Jatulis, D., and Fortmann, S.P. ( 1996). The long-term effects of a cardiovascular disease prevention trial: The Stanford five-city project. American Journal of Public Health, 86(12), 1773–1779. Womble, K. ( 1988). The Impact of Minimum Drinking Age Laws on Fatal Crash Involvements: An Update of the NHTSA Analysis. Washington, DC: National Highway Traffic Safety Administration.