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Biomedical subjects

E J Stone

Publications and source records attributed to E J Stone.

At least 37 records · Page 2Linked to original sources
PubMed1994

Program evaluation strategies for community-based health promotion programs: perspectives from the cardiovascular disease community research and demonstration studies.

Community-based programs are being widely adopted in the struggle to prevent chronic disease. Program evaluation of community-based programs involves a particular set of problems stemming from the variety of activities being undertaken simultaneously, the multiple intermediate goals of the programs and the rapidity with which the programs evolve. An analysis of the experience of four large community-based cardiovascular disease research and demonstration studies (Stanford Five-City Project, Minnesota Heart Health Program, Pawtucket Heart Health Program and the German Cardiovascular Prevention Project) provides valuable models, methodologies and strategies for planning and conducting evaluations of public health programs or community studies. By comparing and combining their experiences, the four programs have identified eight categories of evaluation for community studies, including formative evaluation, quality assurance, assessment of delivered dose, assessment of received dose, component program impact, intermediate outcomes, community impact and cost analysis. This paper presents information on the strategies by which each of the four programs addressed these evaluation categories.

Cardiovascular Diseases↗
PubMed1994

Successful recruitment strategies for school-based health promotion: experiences from CATCH.

School-based research designs in the 1990s often require that a large number of schools be recruited to participate in studies. Therefore, effective recruitment and maintenance of schools becomes an important activity for ensuring the integrity of the study design. The Child and Adolescent Trial for Cardiovascular Health (CATCH) is the largest school-based health promotion research project yet undertaken; 96 schools (24 per field site) were successfully recruited and retained for this cardiovascular disease risk reduction project. This article describes general recruitment strategies used at the four CATCH sites, a description of how Social Learning Theory guided these activities, a discussion of logistical considerations, and recommended recruitment strategies for future school-based research.

Community Participation↗
PubMed1994

Design of process evaluation within the Child and Adolescent Trial for Cardiovascular Health (CATCH).

Process evaluation complements outcome evaluation by providing data to describe how a program was implemented, how well the activities delivered fit the original design, to whom services were delivered, the extent to which the target population was reached, and factors external to the program that may compete with the program effects. The process evaluation system used in the Child and Adolescent Trial for Cardiovascular Health (CATCH) is presented in this paper. The conceptual model underlying the CATCH process evaluation system is described, and process measures and data collection protocols are reviewed. Functions of process evaluation data in the trial include: (1) describing the implementation of the program, (2) quality control and monitoring, and (3) explaining program effects. The importance of incorporating process evaluation into final outcome analyses and assessments of program impact is emphasized.

Adolescent↗
PubMed1994

CATCH: classroom process evaluation in a multicenter trial.

The purpose of this paper is to describe the process evaluation model for the classroom curricula of the Child and Adolescent Trial for Cardiovascular Health (CATCH) Project. The process evaluation plan specifically targets how much each curriculum was implemented, to what degree it was implemented as designed, and the barriers to implementation. Additionally, the rationale for each of the process evaluation measures and the instrument development process are presented. Data resulting from these measures will be essential in order to answer questions regarding the internal validity of the main outcomes of the project. Specific examples and sample results are provided from the CATCH third-grade classroom curriculum, which was implemented the first year of CATCH. A discussion also is presented of how the findings from a sample of these measures were used to gain additional insight on the salient features of the curriculum, and how those features may be related to student outcomes.

Adolescent↗
PubMed1994

CATCH: physical activity process evaluation in a multicenter trial.

This paper presents the process evaluation model for the physical activity intervention component of the Child and Adolescent Trial for Cardiovascular Health (CATCH) and describes the major procedures used to monitor CATCH PE, the physical education intervention. The paper focuses on CATCH PE teacher training and in-service support as well as on the curriculum implementation. Monitoring training and support included assessing the in-service training workshops and the follow-up on-site assistance provided by staff. Monitoring the implementation included assessing the quantity and quality of CATCH PE instruction in terms of student physical activity engagement and lesson context, the fidelity of the curricular implementation, and the opportunities for other physical activity by children throughout the school day.

Adolescent↗
PubMed1994

CATCH: process evaluation of environmental factors and programs.

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multicenter trial designed to test the effectiveness of school and family-based cardiovascular health promotion for preadolescents. CATCH interventions target multiple cardiovascular health behaviors such as dietary intake of fat and sodium, physical activity, and tobacco use. Evaluation includes physiological, psychosocial, behavioral, and process measures. An important aspect of the process evaluation is the assessment of environmental factors and "secular events" in both intervention and control schools that may affect outcomes independently of the CATCH interventions. With such information, CATCH investigators are able to isolate the impact of the CATCH intervention from competing (non-CATCH) factors as well as "track" proximal (i.e., immediate and short term) changes related to the intervention that may in turn lead to "distal" (long-term) behavior change. The School Health Questionnaire, the major process evaluation tool for monitoring secular and environmental changes in the schools, is described in detail, and data describing tobacco-related environmental factors and secular events are presented.

Adolescent↗
PubMed1993

A community education monitoring system: methods from the Stanford Five-City Project, the Minnesota Heart Health Program and the Pawtucket Heart Health Program.

Understanding the process of behavior change interventions is critical to achieving campaign effectiveness and successful program replication. The present article presents a community education monitoring system (CEMS) using data from the Stanford Five-City Project (FCP), the Minnesota Heart Health Program (MHHP) and the Pawtucket Heart Health Program (PHHP). CEMS records the number and type of intervention activities, outcome objectives, targets of change (individual, organizational or environmental), channel(s) of dissemination and proportion of programs funded by the community. These data illustrate (1) the application of theory for each project, (2) data-based program administration, (3) feedback for revising programs and (4) type of reach or 'dose' information obtained from intervention monitoring. Process evaluations such as CEMS provide critical links between field realities and evaluation outcomes. This type of evaluation develops standards for measuring program reach and allows comparisons with other programs. CEMS also illustrates how programs enact theory. Validation studies are critical to the continued successful use of CEMS. The first step, however, is to develop a uniform way of describing complex multichannel behavior change programs. CEMS in a refined form should prove invaluable to health promotion program planners whether in research or service settings.

Behavior Therapy↗
PubMed1990

ACCESS: keystones for school health promotion.

This article provides a perspective on the three elements that traditionally constitute school health programs in the U.S. and describes a new model called ACCESS. Consisting of five major keystones, ACCESS provides an organizational structure for planning, implementing, and evaluating school health promotion programs. In addition, the model provides a reference point for international comparisons of school health.

Health Promotion↗
PubMed1990

United States: perspectives in school health.

An overview is presented of school health programs being conducted in the U.S. as well as the U.S. education system. Major health problems of youth are identified and initiatives to improve the health of school-aged youth are reviewed. With the start of the new decade, it will be important to use and disseminate the findings from ongoing school health programs and research projects, to address the growing social issues for children and adolescents that directly affect their physical health, and to broaden the scope of school health to include issues of psychological or mental health, issues related to social competencies, dysfunctional family lives, or major life events.

Adolescent↗
PubMed1990

School-based cardiovascular health promotion: the child and adolescent trial for cardiovascular health (CATCH).

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multisite intervention research study that builds on significant progress made in school health education research in the 1980s. The study has three phases: Phase I deals with study design, intervention, and measurement development, Phase II involves the main trial in 96 schools in four states, and Phase III focuses on analysis. The intervention program targets third-fifth grade students and focuses on multiple cardiovascular health behaviors, including eating habits, physical activity, and cigarette smoking. Classroom curricula, school environmental change, and family involvement programs are developed for each grade level and behavioral focus. This paper describes Phase II of CATCH with a rationale for cardiovascular health promotion with youth. The process of change that appears to be necessary for school-based health promotion and that will be tested in CATCH are presented as a framework to guide these efforts.

Adolescent↗
PubMed1990

Risk factors for cardiovascular disease in U.S. medical students: the Preventive Cardiology Academic Award Collaborative Data Project.

Risk factors for cardiovascular disease are commonly obtained in freshman medical students for the purpose of increasing interest and awareness in preventive cardiology. What would be a normal range of values for this select group? This paper describes the major cardiovascular risk factors for 3,811 male and female freshman medical students from eight U.S. medical schools that were obtained in a standardized fashion as part of the Preventive Cardiology Academic Award (PCAA) programs at these institutions. The distributions of height, weight, Quetelet index, systolic and diastolic blood pressures, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and calculated low-density lipoprotein cholesterol are presented for male and female medical students stratified by race into white, black, Asian, and Hispanic groups. The sex and race distributions of cardiovascular risk factors such as previously diagnosed hypertension, diabetes mellitus, smoking, lack of regular exercise (three times a week or more), oral contraceptive use in women, and family history of coronary heart disease are presented. The cardiovascular risk of freshman medical students is compared to other epidemiologic studies of young adults. The use and limitations of these race- and sex-specific data on cardiovascular risk, including physiologic measurements, are discussed in the context of educational programs for medical students and house staff in preventive cardiology.

Adult↗
PubMed1990

The Preventive Cardiology Academic Award program: a focus on physician education.

The National Heart, Lung, and Blood Institute (NHLBI) has funded the Preventive Cardiology Academic Award (PCAA) for more than a decade. The background for focusing on physicians in training and prevention is reviewed, as well as the status of the 49 medical schools that have received the award. This report presents a synthesis of the objectives for the award, curricular approaches, and teaching strategies employed by awardees and also the framework for program evaluation. The degree of institutionalization of the programs and the diffusion nationally as well as trends in the program over the past decade are examined.

Awards and Prizes↗
PubMed1989

Synthesis of cardiovascular behavioral research for youth health promotion.

The National Heart, Lung, and Blood Institute (NHLBI) has funded school and family-based research studies for more than a decade. The scientific background for focusing on the major cardiovascular health behaviors with youth is reviewed, as well as the importance of the components in the school health program as a framework for the multiple considerations in school health research. A synthesis of 10 NHLBI funded studies is presented including the sociodemographic characteristics of study populations, study designs, interventions, measures, and results. The studies address single or multiple behaviors, elementary and high school age groups, and multiple ethnic/racial groups, and test various combinations of curriculum, parental involvement, and environmental changes (including school food service).

Adolescent↗
PubMed1989

Research design and analysis issues.

The overall perspective of this article is the need for researchers of school-based health promotion to make more progressive use of existing statistical methods to improve both the rigor and the efficiency of school-based experiments. Investigative teams working in the school setting have an advantage over health education researchers working in communities or worksites in that they have greater choice of the experimental unit and usually easier access to large clusters of units. They are, therefore, in a position to make optimal use of a wide variety of experimental designs and observation strategies. In order to make full use of this advantage, however, researchers in this field need to assemble multidisciplinary teams, including researchers from other fields who are not restricted by the traditional approaches evident in many of the current school studies. Such teams should include statisticians and epidemiologists who have broadly-based experimental design and survey experience to work with the health educators and other behavioral and biomedical scientists.

Data Interpretation, Statistical↗
PubMed1988

Attitudes toward prevention of cardiovascular diseases among first-year students at eight American medical schools, 1983-1985.

First-year medical students at eight U.S. medical schools were surveyed by written questionnaire in 1983-1985 to determine their attitudes toward cardiovascular diseases prevention at medical school entry. An overall response rate of 92% was achieved (2,654 questionnaires), and 97% of responders provided complete and analyzable survey data. Response rates at five of eight medical schools were 98-100%, and one school each had rates of 67, 84, or 90%. Differences in mean attitude responses from school to school were small, as were differences between men and women or between blacks and whites. This survey found that entering medical students have generally positive attitudes toward the effectiveness of preventive cardiology practice as well as toward the importance of research efforts in cardiovascular disease prevention. Students frequently indicated, however, that it is "extremely difficult" to change patients' unhealthful habits and that "physician encouragement" may not be sufficient to help patients achieve more healthful behaviors. These findings could be helpful in directing educational efforts for medical students. The data suggest that major emphasis should be placed on conveying facts regarding the physicians' efficacy in clinical preventive cardiology and on teaching the skills of preventive cardiology practice. Less emphasis appears to be necessary on encouraging positive attitudes about the importance of prevention since current students' attitudes appear to be already positive in this dimension.

Attitude of Health Personnel↗
PubMed1985

School-based health research funded by the National Heart, Lung, and Blood Institute.

This paper presents a brief overview of the trends in the National Institutes of Health (NIH) funding for school-based research and describes the school-based research initiatives for cardiovascular health promotion and disease prevention at the National Heart, Lung, and Blood Institute (NHLBI). Currently, 15 cardiovascular school-based research studies are funded at the NHLBI. A summary table and a brief description are provided for each study including the name of the investigator, the name of the institute awarded the grant, the funding period, grade levels and racial/ethnic groups in each study, intervention components, research design, outcome measures, and a capsule of reported results.

Cardiovascular Diseases↗
PubMed1983

School health: a national policy issue in the Soviet Union.

In the Soviet Union school health services are provided as an integral part of the health care delivery system, which is under the Ministry of Health. This paper presents an overview of the Soviet health care delivery system, the model for the delivery of school health services, the role and training of school personnel involved in school health services and implications the Soviet model may have for other countries.

Health Policy↗