Health education: historic windows of opportunity.
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Acquired Immunodeficiency Syndrome↗
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The core technology of work-site wellness.
Work-site wellness programming his evolved through four stages of development. This article proposes a core technology of work-site wellness programs comprised of 10 dimensions that organize and systematize the range of activities undertaken by such programs. These 10 dimensions address the following tasks: (1) establishing program policy, (2) assessing the health status of the work force, (3) linking the work site with service providers, (4) linking individual employees with services appropriate to their needs, (5) providing options for behavior change strategies and interventions, (6) engaging employees in these various interventions, (7) organizing work-sitewide activities to support health improvement, (8) reviewing and altering organizational policies to make the work environment more supportive of health, (9) routinely evaluating program process and changes in health risks, and (10) periodically assessing longer-term program results. Two future dimensions are described that require further evidence of impact. Arguments and evidence in support of each dimension are provided, including discussion on how activities within each dimension work together to produce maximum effectiveness, and how various dimensions relate to each other to make an effective overall program.
Comprehensive Health Care↗
Changes in sexual practices and some HIV related attitudes in New Zealand: 1987-9.
Two fully national samples of 1000 New Zealanders aged 16-60 were interviewed in 1987 and in 1989 about their sexual practices and related attitudes to HIV/AIDS matters. The data were gathered by means of a self completed questionnaire which was part of a larger interview undertaken in the respondents' own homes. Precautions were taken to ensure confidentiality, anonymity and privacy. There were significant differences in the reporting of sexual behaviour during the two year study period. The proportion of the sexually active reporting three or more sex partners in the previous year fell from 12% to 8%. The proportion reporting "always" or "often" using condoms rose from 13% to 18% and those reporting permanent changes to sexual behaviour because of AIDS rose from 16% to 26%. Changes towards safer sexual practices were more common amongst males, the young, the unmarried and those with multiple sex partners. Findings concerning attitudes to HIV/AIDS related matters showed an increase in the population's perceived risk of the virus to both themselves and others. For example the proportion who felt everyone was at risk rose from 71% in 1987 to 80% in 1989. There was also evidence of increased victim blaming of the person who caught HIV infection or other sexually transmitted diseases. Finally there was evidence of the need for more action on AIDS. In 1987 35% felt that enough was being done whereas this had dropped to 27% by 1989.
Acquired Immunodeficiency Syndrome↗
Cardiovascular risk factors and health behavior: some preliminary findings from the Cardiovascular Diseases and Alimentary Comparison Study.
This paper presents some preliminary findings from one particular Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study data collection center. The population and the environment of the Western Isles, Scotland, from where the subjects were drawn, are described. The methodology was as according to the CARDIAC Study protocol. The results show that in this population there is a high mean serum total cholesterol level, a high prevalence of smokers, and a high mean body mass index. However, knowledge, attitudes, and reported behavior change regarding diet were encouraging. Much further data processing work remains to be done.
Adult↗
Behaviour change in HIV infected subjects following health education.
A total of 85 HIV seropositive subjects among consecutive new registrants in the STD Department were given health education measures directed to avoiding high risk behaviours and also the events with a high potential for transmission of infection. The emphasis was on the use of condoms, discontinuing promiscuity, abstaining from homosexual acts and avoidance of pregnancy and advice against marriage for those contemplating it. The Health Education Programme was delivered individually to each subject over two or three sessions, each lasting for 30 to 45 min. At the time of follow up (one to 24 months) 42 per cent of subjects had become non-promiscuous. There was a good compliance on advice against marriage and pregnancy. Seven infants born during the follow up period were seronegative. The use of condom was not found to be acceptable. The prostitutes comprised the most resistant group to education. Among the factors that influenced the behaviour change favourably was the absence of earlier STD or a short duration of the current STD. Literacy, marital status, awareness of AIDS did not influence the outcome of education. The study demonstrated the feasibility of health education at individual level in the clinical setting of an STD Department. A longer follow-up may indicate the sustainability of behaviour change in the subjects.
Adult↗
[AIDS prevention: cognitive-emotional approach to the topic of AIDS and behavioral change].
This study investigates the cognitive-emotional arguments advanced by young adults on the subject of AIDS within the frame-work of a multivariate approach. The centre of all the deliberations is the question as to which factors exercise a major influence on emotional experience and on changes in sexual behaviour. The random sample study comprises 354 Göttingen students. Implications of the findings on AIDS prevention are discussed.
Acquired Immunodeficiency Syndrome↗
Weight reduction interventions for persons with a chronic illness: findings and factors for consideration.
Obesity in persons with a concomitant chronic illness poses complex issues relating to the choice of appropriate interventions. More recent emphasis on modification of risk factors has resulted in the need to prescribe complex therapeutic regimens with multiple treatment goals. The traditional approach to weight reduction in such persons has been nutrition education. Studies have shown, however, that knowledge alone does not translate into self-care behaviors that in turn result in weight loss and weight maintenance. Although the latter outcomes continue to be primary goals of therapy in obese individuals with a chronic illness, improvement in the physiologic parameters associated with the illness is also a desired outcome. Behavior therapy and group support appear to be enabling factors that go beyond knowledge to facilitate behavior change and subsequent changes in health-related indexes. This article describes various approaches to the problem of combined interventions for patients education and weight reduction. Findings and factors are discussed about whether the primary goal of weight reduction interventions for persons with a chronic illness should focus on pounds lost or improvement in metabolic or physiologic status.
Behavior Therapy↗
Sexual self-defense versus the liaison dangereuse: a strategy for AIDS prevention in the '90s.
The present public health strategy to encourage the adoption of "safe sex" practices to contain the AIDS epidemic in America is incomplete. Current policy is responsive to and appropriate for control of homosexual, but not heterosexual transmission. Powerful societal forces restrict a woman's perception of risk. Consequently, the adoption of safe sex (condom use/insistence on use) by women at risk has not matched safe sex practice by homosexual men. Predictably, pattern two (heterosexual, maternal-fetal) HIV transmission is now rapidly increasing in the United States, particularly among minority women. In anticipation of an intensified pattern two subepidemic, AIDS containment policy should be reoriented to develop the role of women in AIDS prevention. An initiative, termed "sexual self-defense" (SSD), combines the technology of double-barrier (female irrespective of male) protection with a "universal precautions" approach to long-term sexual risk management. The initiative addresses both per-contact infectiousness and new partner acquisition, the principal determinants of HIV spread. As a female-targeted strategy, SSD is a timely supplement to existing programs, consistent with the direction of contemporary women's movements in the United States. A "street smart" approach, SSD bridges ethnic and socioeconomic individual differences. As a unifying philosophy of risk management in health promotion, SSD may avert the threatened fragmentation of AIDS control from existing programs of sexually transmitted disease control and teenage pregnancy prevention.
Acquired Immunodeficiency Syndrome↗
Heart healthy education. Effectiveness of teaching methods in the workplace.
One fourth to one third of employed workers in this country have at least one of three major risk factors for coronary heart disease. This pilot study examined differences between educational methods used in an occupational setting. The specific aims of the quasi-experimental study were: to determine differences between two groups of subjects who received either group support and instruction or only written instruction; and to determine the association between the practice of heart healthy behaviors and decreased blood cholesterol levels. No significant differences were found between the two groups in cholesterol and behavior changes. However, there was a significant difference between pre- and post-instruction for all subjects. The study documented significant changes in cholesterol levels, cholesterol and fat intake, and weight reduction.
Adult↗
Six school-based clinics: their reproductive health services and impact on sexual behavior.
An evaluation of the reproductive health programs of six diverse school-based clinics measured the impact of the clinics on sexual behavior and contraceptive use. All six clinics served low-income populations; at five of them, the great majority of the students served were black. An analysis of student visits by type of care given found that these clinics were not primarily family planning facilities; rather, they provided reproductive health care as one component of a comprehensive health program. Student survey data collected in the clinic schools and nearby comparison schools (four sites) or collected both before the clinic opened and two years later (two sites) indicated that the clinics neither hastened the onset of sexual activity nor increased its frequency. The clinics had varying effects on contraceptive use. Providing contraceptives on site was not enough to significantly increase their use; in only one of the three sites that did so were students in the clinic school significantly more likely than students in the comparison school to have used birth control during last intercourse. However, condom use rose sharply at one clinic school that had a strong AIDS education program and was located in a community where AIDS was a salient issue. At another clinic school, where pregnancy prevention was a high priority and staff issued vouchers for contraceptives, the use of condoms and pills was significantly higher than in the comparison school. A third clinic school--which focused on high-risk youth, emphasized pregnancy prevention and dispensed birth control pills--recorded a significantly higher use of pills than its comparison school. Although the data suggest that the clinics probably prevented small numbers of pregnancies at some schools, none of the clinics had a statistically significant effect on school-wide pregnancy rates.
Acquired Immunodeficiency Syndrome↗
Clinical issues in cholesterol testing.
Lipid investigators have begun to examine the biological sources of variation in serum cholesterol levels and to seek ways to accurately measure the total cholesterol (TC) level in the serum of a patient. A person's TC level varies primarily because of the effects from seasonal changes, behavioral changes, and illness. Results of studies of the effect of seasonal changes indicate that serum TC and obesity increase during winter and decrease during summer. Behavioral sources of variation include diet, alcohol intake, smoking, and exercise. Clinical sources of TC level variation include all illnesses. The physician can help control sources of variation by recognizing their causes, by advising of the effect that behavioral risk factors have on cholesterol levels, and by using the average of results for multiple specimens to estimate the true value of serum cholesterol in a patient.
Behavior↗
Patient reactions to nutrition education for cholesterol reduction.
The purpose of this study was to assess the perceptions of patients with elevated cholesterol who participated in a physicians' office-based cholesterol management program and to compare patient reports with clinic counseling records. We conducted telephone interviews with 94 patients from five family practice clinics participating in the Physician-Based Nutrition Program (PBNP) between January and March 1988. Within two weeks after a cholesterol counseling visit, interviewers asked patients what happened during the cholesterol management process, queried their understanding of their health risk and recommended dietary changes, and assessed their attitudes toward the educational process and recommended nutrition behavior changes. Results indicate that a large majority of patients understood the problem of high cholesterol and the needed behavior changes and were highly satisfied with the cholesterol management process. However, patients' memory of specific facts, such as their cholesterol levels and behavioral goals, was often incorrect. We discuss the implications of these findings for developing and providing patient cholesterol education.
Adult↗
The Health Belief Model in the research of AIDS-related preventive behavior.
Studies of AIDS-related behavior change which used a systematic psychosocial conceptual model--The Health Belief Model (HBM)--are reviewed. Based on this, it is suggested for further studies: (1) to differentiate among different patterns of potential behavioral change--acceptance of new behaviors, change of existing behaviors, and maintenance of current behaviors; (2) to widen the conceptual model, (3) to use a similar model systematically in studies of different populations. A proposed application of an extended version of the HBM for the study of condom use among adolescents is presented.
Acquired Immunodeficiency Syndrome↗
Education for health. A role for physicians and the efficacy of health education efforts. Council on Scientific Affairs.
Health education efforts have grown dramatically over the past decade and seek to improve the health of individuals by providing them with information that will lead to behavioral changes and thereby result in improved health. There is now substantial evidence to support the idea that health education activities can alter health behaviors, even though the mechanisms by which health education efforts succeed are largely unknown. Physicians could add to the success of health education efforts by incorporating preventive services into their patient encounters, particularly patients in high-risk situations. There are many examples of successful physician-based interventions, and a new emphasis on preventive services in primary care is emerging.
American Medical Association↗
Promoting AIDS risk reduction via behavioral training.
The present study employed behavioral techniques to teach assertive strategies designed to reduce the risk of contracting AIDS and to promote "safer-sex" behaviors. A total of 79 university students (38 male and 41 female) were included in the final data analysis. Subjects participated in three one-hour training sessions which included live modeling of assertive interactions, role-playing, behavior shaping, corrective feedback, verbal reinforcement, assertiveness training, and an AIDS educational lecture. Dependent measures included ratings of the key components of assertive behavior from videotaped role-plays at pre- and posttests. Behavioral training had a positive effect on participants' assertive behavior. On the role-play ratings, experimental subjects were rated higher on overall assertiveness than the controls. Even brief behaviorally based educational interventions can produce increases in assertive behaviors known to be related to AIDS prevention, for example, insisting on condom use and requesting information about a prospective partner's sexual and drug use histories. Behavior changes extended to in vivo situations, of course, remain less assured.
Acquired Immunodeficiency Syndrome↗
Efficacy of health education programme on awareness of AIDS among transsexuals.
A study of the awareness of Acquired Immunodeficiency Syndrome (AIDS) among Transsexual prostitutes attending the Middle Road Hospital was made. The present study involved 71 subjects of a cohort of 100 who were interviewed a year earlier and had subsequently been given intensive health education. The results show that there was now an increased awareness of AIDS in virtually all the subjects studied. In contrast, there has been no significant change in the use of safe sex practices as a direct consequence of this knowledge. The reasons for this are discussed. There may be a need for more intensive behaviour modification programme in this group of individuals.
Acquired Immunodeficiency Syndrome↗
The AIDS dilemma: worry and concern over AIDS.
Information was collected from 148 homosexual men to examine their current sexual practices, knowledge of acquired immunodeficiency syndrome (AIDS), perception of risk for this disease and change in sexual behaviour. The data were analyzed to investigate the relationship of these variables to the degree of worry and concern about AIDS expressed by most respondents. Overall, a decline in high-risk sexual behaviour was reported. Measures of worry and concern were significantly related to the subjects' perception of risk for AIDS and reduction in risk behaviours. However, the measures of Health Locus of Control, knowledge about AIDS and sociodemographic characteristics did not significantly predict the degree of worry and concern. The data are discussed in light of the current AIDS epidemic.
Acquired Immunodeficiency Syndrome↗
The social impact of AIDS in Sub-Saharan Africa.
The potential expansion of the HIV epidemic and its cultural impact in sub-Saharan Africa are vast. Projections under conservative assumptions suggest that the toll of AIDS will reach five million annual deaths by 2010, although the net African population will continue to increase significantly. Cultural practices, including large differences in age between men and women at marriage and a long period of postpartum abstinence, have contributed to the frequency of extramarital relations and eased the spread of sexually transmitted diseases. In response to the spread of AIDS, social adaptations will include profound changes in sexual behavior, marriage customs, and childbearing.
Acquired Immunodeficiency Syndrome↗