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Schootman M, Perez M, Schootman JC, Fu Q, McVay A, Margenthaler J, Colditz GA, Kreuter MW, Jeffe DB. Influence of built environment on quality of life changes in African-American patients with non-metastatic breast cancer. Health Place 2020; 63:102333. [PMID: 32543424 PMCID: PMC7676919 DOI: 10.1016/j.healthplace.2020.102333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 12/15/2022]
Abstract
Research links the built environment to health outcomes, but little is known about how this affects quality of life (QOL) of African American breast cancer patients, especially those residing in disadvantaged neighborhoods. Using latent trajectory models, we examined whether the built environment using Google Street View was associated with changes in QOL over a 2-year follow-up in 228 newly diagnosed African American breast cancer patients. We measured QOL using the RAND 36-Item Health Survey subscales. After adjusting for covariates, improvement in emotional well-being and pain over time was greater for women living on streets with low-quality (vs. high-quality) sidewalks.
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Affiliation(s)
- M Schootman
- SSM Health, Department of Clinical Analytics and Insights, Center for Clinical Excellence, 10101 Woodfield Lane, St. Louis, MO, 63132, USA.
| | - M Perez
- Washington University in St Louis, School of Medicine, Department of Medicine, St. Louis, MO, 63110, USA
| | - J C Schootman
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology and Biostatistics, St. Louis, MO, 63103, USA
| | - Q Fu
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology and Biostatistics, St. Louis, MO, 63103, USA
| | - A McVay
- Saint Louis University, College for Public Health and Social Justice, Department of Epidemiology and Biostatistics, St. Louis, MO, 63103, USA
| | - J Margenthaler
- Washington University in St. Louis, School of Medicine, Department of Surgery, St. Louis, MO, 63110, USA
| | - G A Colditz
- Washington University in St. Louis, School of Medicine, Department of Surgery, St. Louis, MO, 63110, USA
| | - M W Kreuter
- Washington University in St. Louis, The Brown School, Health Communication Research Laboratory, St. Louis, MO, 63130, USA
| | - D B Jeffe
- Washington University in St Louis, School of Medicine, Department of Medicine, St. Louis, MO, 63110, USA
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Morshed AB, Ballew P, Elliott MB, Haire-Joshu D, Kreuter MW, Brownson RC. Evaluation of an online training for improving self-reported evidence-based decision-making skills in cancer control among public health professionals. Public Health 2017; 152:28-35. [PMID: 28732323 PMCID: PMC5966825 DOI: 10.1016/j.puhe.2017.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this evaluation was to assess the effect of the online evidence-based cancer control (EBCC) training on improving the self-reported evidence-based decision-making (EBDM) skills in cancer control among Nebraska public health professionals. STUDY DESIGN Cross-sectional group comparison. METHODS Previously developed EBDM measures were administered via online surveys to 201 public health professionals at baseline (comparison group) and 123 professionals who took part in the training. Respondents rated the importance of and their skill level in 18 EBCC skills. Differences were examined using analysis of variance models adjusted for gender, age, years at agency, and years in position, and stratified by respondent educational attainment. RESULTS Among professionals without an advanced degree, training participants reported higher overall skill scores (P = .016) than the baseline non-participant group, primarily driven by differences in the partnerships and collaboration and evaluation domains. No differences in importance ratings were observed. Among professionals with advanced degrees, there were no differences in skill scores and small differences in importance scores in the expected direction (P < .05). Respondents at baseline rated the following facilitators for EBDM as important: expectations from agency leaders and community partners, high priority placed on EBDM by leadership, trainings, and positive feedback. They also reported using a variety of materials for making decisions about programs and policies, though few used individual scientific studies. CONCLUSIONS EBCC led to improved self-reported EBDM skills among public health professionals without an advanced degree, though a gap remained between the self-reported skills and the perceived importance of the skills. Further research on training content and modalities for professionals with higher educational attainment and baseline skill scores is needed.
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Affiliation(s)
- A B Morshed
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - P Ballew
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - M B Elliott
- Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.
| | - D Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - M W Kreuter
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - R C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA; Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
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Strickland JR, Smock N, Casey C, Poor T, Kreuter MW, Evanoff BA. Development of targeted messages to promote smoking cessation among construction trade workers. Health Educ Res 2015; 30:107-20. [PMID: 25231165 PMCID: PMC4296889 DOI: 10.1093/her/cyu050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Blue-collar workers, particularly those in the construction trades, are more likely to smoke and have less success in quitting when compared with white-collar workers. Little is known about health communication strategies that might influence this priority population. This article describes our formative work to develop targeted messages to increase participation in an existing smoking cessation program among construction workers. Using an iterative and sequential mixed-methods approach, we explored the culture, health attitudes and smoking behaviors of unionized construction workers. We used focus group and survey data to inform message development, and applied audience segmentation methods to identify potential subgroups. Among 144 current smokers, 65% reported wanting to quit smoking in the next 6 months and only 15% had heard of a union-sponsored smoking cessation program, despite widespread advertising. We tested 12 message concepts and 26 images with the target audience to evaluate perceived relevance and effectiveness. Participants responded most favorably to messages and images that emphasized family and work, although responses varied by audience segments based on age and parental status. This study is an important step towards integrating the culture of a high-risk group into targeted messages to increase participation in smoking cessation activities.
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Affiliation(s)
- J R Strickland
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA and George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112, USA
| | - N Smock
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA and George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112, USA
| | - C Casey
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA and George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112, USA
| | - T Poor
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA and George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112, USA
| | - M W Kreuter
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA and George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112, USA
| | - B A Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA and George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112, USA
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Sanders Thompson VL, Cavazos-Rehg PA, Jupka K, Caito N, Gratzke J, Tate KY, Deshpande A, Kreuter MW. Evidential preferences: cultural appropriateness strategies in health communications. Health Educ Res 2008; 23:549-59. [PMID: 17631608 DOI: 10.1093/her/cym029] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
While there is widespread agreement that communication programs and materials will be more effective when they are 'culturally appropriate' for the populations they serve, little is known about how best to achieve this cultural appropriateness. The specific strategies used to realize the potential of culturally appropriate communication take many forms. This paper discusses an approach to assessing and understanding the presentation of statistical information (an evidential strategy) to enhance the perceived relevance of communications targeted to older African American men and women. Formative research on African Americans' attitudes and knowledge of colorectal cancer explored preferences for presentation of statistical data. Focus group interviews elicited participants' (n = 49) thoughts and attitudes on and anticipated behavioral response to five strategies for presenting cancer data and evidence-general, race specific, disparity, social math and framing approximately 5-year probability of death or survival. A description is provided of the application of this approach to the development of a colorectal cancer campaign for African Americans. This strategy may prove useful in understanding and structuring the presentation of targeted cancer evidence that could result in more effective health communication.
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Affiliation(s)
- V L Sanders Thompson
- Health Communication Research Laboratory, Saint Louis University, School of Public Health, 3545 Lafayette Avenue, St Louis, MO 63104, USA.
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Vladutiu CJ, Nansel TR, Weaver NL, Jacobsen HA, Kreuter MW. Differential strength of association of child injury prevention attitudes and beliefs on practices: a case for audience segmentation. Inj Prev 2006; 12:35-40. [PMID: 16461418 PMCID: PMC2563488 DOI: 10.1136/ip.2004.007153] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Many injuries to children cannot be prevented without some degree of active behavior on the part of parents. A better understanding of social and cognitive determinants of parents' injury prevention behavior and the identification of potential subgroups for targeted message delivery could advance the effectiveness of educational and behavioral interventions. This study assessed the degree to which parents' injury prevention behavior is associated with theoretical determinants and examined whether this relation differs by age or birth order of child. DESIGN Cross sectional observational study. SETTING Three Midwestern pediatric clinics. SUBJECTS 594 parents of children ages 0-4 attending routine well child visits. MEASURES Injury prevention attitudes, beliefs, and practices. RESULTS Overall, only modest relations were observed between injury beliefs and attitudes and injury prevention behaviors. However, these relations differed substantially by child age and birth order, with stronger associations observed for parents of older first born children. Outcome expectations and social norms were more strongly related to injury prevention behavior among parents of preschool children than among parents of infants and toddlers, while attitudes were more predictive for parents of first born children than parents of later born children. CONCLUSIONS These findings highlight the complexity of relations between theorized determinants and behavior, and suggest the potential utility of using audience segmentation strategies in behavioral interventions addressing injury prevention.
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Affiliation(s)
- C J Vladutiu
- Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services, USA.
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Kreuter MW, Lezin NA, Young L, Koplan AN. Social capital: evaluation implications for community health promotion. WHO Reg Publ Eur Ser 2002:439-62. [PMID: 11729782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- M W Kreuter
- Cole Communications Santa Cruz, California, USA
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Lukwago SN, Kreuter MW, Bucholtz DC, Holt CL, Clark EM. Development and validation of brief scales to measure collectivism, religiosity, racial pride, and time orientation in urban African American women. Fam Community Health 2001; 24:63-71. [PMID: 11563945 DOI: 10.1097/00003727-200110000-00008] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This article describes the development and pilot-testing of brief scales to measure four cultural constructs prevalent in urban African American women. Internal consistency and temporal stability were assessed in two convenience samples (n=47 and n=25) of primarily lower-income African American women. All scales performed well: collectivism alpha=.93, r=.85, p<.001); religiosity (alpha=.88, r=.89, p<.001); racial pride (alpha=.84, r=.52, p<.001); present time orientation (alpha=.73, r=.52, p<.01) and future time orientation (alpha=.72, r=.54, p=.07).
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Affiliation(s)
- S N Lukwago
- Health Communication Research Laboratory, Division of Behavioral Science and Health Education, Department of Community Health School of Public Health, Saint Louis University, Missouri, USA
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Affiliation(s)
- H A Jacobsen
- Department of Community Health, School of Community Health, Saint Louis University, MO 63108, USA.
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Bull FC, Holt CL, Kreuter MW, Clark EM, Scharff D. Understanding the effects of printed health education materials: which features lead to which outcomes? J Health Commun 2001; 6:265-279. [PMID: 11550593 DOI: 10.1080/108107301752384442] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Printed health education materials (HEMs) are widely used to increase awareness and knowledge, change attitudes and beliefs, and help individuals adopt and maintain healthy lifestyle behaviors. While much of the contemporary research and development of persuasive communication is based on McGuire's input/output model, to date few studies have compared the impact of a large set of inputs across a comprehensive set of the 12 outputs. We examined the effects of printed HEMs on weight loss on the cognitive, affective, and behavioral responses of 198 overweight adults. Participants were recruited via a newspaper advertisement and were randomly assigned to review one of three HEMs. Participants were interviewed and asked to complete a series of questionnaires both before and after viewing the HEMs. Regression analyses were conducted to identify the input characteristics associated with success at each of the output steps. The results revealed attractiveness, encouragement, level of information, and application to one's life were significantly associated with early steps (attention, liking, and understanding) as well as some of the mediating steps (recalling, keeping, and rereading HEMs). Later steps, such as intention to change behavior and show others, were associated with readiness to change, self-efficacy, and perceived application to one's life. Behavior change was more likely for those who received tailored materials and those who had higher self-efficacy. These results provide useful direction for the use of computers in tailoring the content of HEMs and the development of effective communication of health information on weight loss.
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Affiliation(s)
- F C Bull
- Department of Public Health, University of Western Australia, Nedlands, Western Australia.
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10
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Abstract
Rotter's [Psychol. Monogr. 80 (1966)] construct of internal-external control of reinforcement led to the conceptualization of locus of control as a personality construct that can be used to predict behavior. More specific measures of locus of control in particular behavioral domains have followed. In the present study, the Weight Locus of Control Scale (WLOC) was used to predict weight-related attitudes and behaviors of overweight individuals, as well as their responses to health education materials (HEM) on weight loss. The WLOC scores predicted responses to baseline weight-related measures such as etiology of obesity, confidence in weight loss behaviors, and behavioral intention. In addition, WLOC scores predicted participants' reactions to the HEM, as well as the actual number of weight loss ideas from the HEM that the participants tried by the 1-month follow-up assessment. The results are discussed in terms of the validity of the WLOC and implications for future development of effective HEM.
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Affiliation(s)
- C L Holt
- Health Communication Research Laboratory, School of Public Health, Saint Louis University, MO 63108, USA.
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Abstract
Promising programs developed through health promotion and disease prevention research are not always disseminated to the agencies, organizations, and individuals that can benefit from them most. Systematic and practical approaches to dissemination are needed to ensure that effective programs more often reach end users in communities. This article describes six steps used in translation and dissemination of the ABC Immunization Calendar program to public health centers in St. Louis, Missouri. The authors discuss how one health center successfully adopted this program and provide recommendations for other researchers seeking to disseminate innovative, effective health promotion programs.
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Affiliation(s)
- C A Caburnay
- Health Communication Research Laboratory, Department of Community Health, School of Public Health, Saint Louis University, St. Louis, Missouri, USA
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Abstract
Applied research on cancer risk communication is sparse, and even less is known about effective communication under conditions of multiple risks. This paper briefly describes the need and rationale for cancer risk communication, then describes what is known and needs to be known about communication addressing multiple risks. Its focus is on two specific communication issues: 1) comparing different risks and 2) prioritizing between multiple risks. There is considerable unmet need in cancer risk communication for new knowledge and recommendations for best practices. Those professionals choosing to pursue this work can make a significant contribution to the field.
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Affiliation(s)
- M W Kreuter
- Health Communication Research Laboratory, School of Public Health, Saint Louis University, 321 North Spring Ave., St. Louis, MO 63108, USA.
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Abstract
Research in health communication has shown that individually tailored health education materials are more effective than traditional or generic materials in producing changes in health-related behaviors. However, tailored materials have not been equally effective for all individuals. Because locus of control affects behavioral outcomes in other self-change interventions, its effect on individuals' responses to tailored messages is of particular interest. The present study examined differences in cognitive responses to tailored and non-tailored weight loss materials among 198 overweight individuals. Weight locus of control significantly interacted with study group (who received either tailored or non-tailored materials), suggesting that externals may respond to tailored health education materials with counter-arguments. Implications for the development and application of tailored health communication materials are discussed.
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Affiliation(s)
- C L Holt
- Department of Psychology, St Louis University, MO 63108, USA
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Kreuter MW, Oswald DL, Bull FC, Clark EM. Are tailored health education materials always more effective than non-tailored materials? Health Educ Res 2000; 15:305-315. [PMID: 10977378 DOI: 10.1093/her/15.3.305] [Citation(s) in RCA: 138] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
While promising, the evidence in support of tailored health communication has not been overwhelming. One explanation is that tailored materials may be far superior to non-tailored materials in some cases, but only slightly better, no different or less effective in others. In this study, 198 overweight adults were randomly assigned to receive either tailored or non-tailored weight loss materials. Participants' cognitive, affective and behavioral responses to the materials were measured at an immediate and 1 month follow-up. Analyses compared those who received tailored materials to those who received non-tailored materials that were--by chance alone--either a good fit, moderate fit or poor fit, based on the match between behavioral characteristics of the participant and content of the non-tailored materials. Findings showed that good-fitting non-tailored materials performed as well or better than tailored materials for several cognitive, affective and behavioral outcomes. However, moderate- and poor-fitting non-tailored materials were consistently inferior to both approaches. The art and science of creating tailored health communication programs is still evolving. Data from this study suggest present approaches to tailoring are more effective than non-tailored materials in most, but not all cases. Specific recommendations are made describing ways to refine tailoring methods to maximize the effectiveness of this approach.
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Affiliation(s)
- M W Kreuter
- Department of Community Health, School of Public Health, St Louis University, MO 63108, USA
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Abstract
OBJECTIVE To explore a potential "priming effect" of physician advice on patient responses to behavioral change interventions. DESIGN Randomized controlled trial with a 3-month follow-up. SETTING Four community-based group family medicine clinics in southeastern Missouri. PARTICIPANTS Adult patients (N = 915). INTERVENTIONS Printed educational materials designed to encourage patients to quit smoking, eat less fat, and increase physical activity. MAIN OUTCOME MEASURES Recall, rating, and use of the educational materials; changes in smoking behavior, dietary fat consumption, and physical activity. RESULTS Patients who received physician advice to quit smoking, eat less fat, or get more exercise prior to receiving intervention materials on the same topic were more likely to remember the materials, show them to others, and perceive the materials as applying to them specifically. They were also more likely to report trying to quit smoking (odds ratio [OR] = 1.54, 95% confidence interval [CI] = 0.95-2.40), quitting for at least 24 hours (OR = 1.85, 95% CI = 1.02-3.34), and making some changes in diet (OR = 1.35, 95% CI = 1.00-1.84) and physical activity (OR = 1.51, 95% CI = 0.95-2.40). CONCLUSIONS Findings support an integrated model of disease prevention in which physician advice is a catalyst for change and is supported by a coordinated system of information and activities that can provide the depth of detail and individualization necessary for sustained behavioral change.
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Affiliation(s)
- M W Kreuter
- Department of Community Health, School of Public Health, Saint Louis University, MO 63108, USA.
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Abstract
Printed health education materials frequently consist of mass-produced brochures, booklets, or pamphlets designed for a general population audience. Although this one-size-fits-all approach might be appropriate under certain circumstances and even produce small changes at relatively modest costs, it cannot address the unique needs, interests, and concerns of different individuals. With the advent and dissemination of new communication technologies, our ability to collect information from individuals and provide feedback tailored to the specific information collected is not only possible, but practical. The purpose of this article is to: (a) distinguish between tailored print communication and other common communication-based approaches to health education and behavior change; (b) present a theoretical and public health rationale for tailoring health information; and (c) describe the steps involved in creating and delivering tailored print communication programs. Studies suggest computer tailoring is a promising strategy for health education and behavior change. Practitioners and researchers should understand the approach and consider the possibilities it presents for enhancing their work in disease prevention.
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Affiliation(s)
- M W Kreuter
- Department of Community Health, School of Public Health, Saint Louis University, MO 63108, USA
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Kreuter MW, Sabol BJ, O'Donovan A, Donovan J, Klein L, Green LW, Vliet M, Bradley T, Campuzano MK, Tarlov AR. Commentaries from grantmakers on Fawcett et al.'s proposed memorandum of collaboration. Public Health Rep 2000; 115:180-90. [PMID: 10968752 PMCID: PMC1308709 DOI: 10.1093/phr/115.2.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M W Kreuter
- Div. of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Affiliation(s)
- L W Green
- Office of Smoking and Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia 30341-3724, USA.
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Kreuter MW, Bull FC, Clark EM, Oswald DL. Understanding how people process health information: a comparison of tailored and nontailored weight-loss materials. Health Psychol 1999. [PMID: 10519465 DOI: 10.1037//0278-6133.18.5.487] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Health information tailored to meet individuals' unique needs has been shown to be more effective than generic information in promoting risk-reducing behavior changes. To explore mechanisms underlying tailoring's effectiveness, this study randomly assigned 198 overweight adults to receive weight-loss materials that were (a) tailored to the individual, (b) in an American Heart Association (AHA) brochure, or (c) AHA-content formatted to look like tailored materials. Participants who received tailored materials had more positive thoughts about the materials, positive personal connections to the materials, positive self-assessment thoughts, and positive thoughts indicating behavioral intention than those who received either of the untailored materials. The tailoring of health information can significantly improve the chances the information will be thoughtfully considered and can stimulate prebehavioral changes such as self-assessment and intention.
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Affiliation(s)
- M W Kreuter
- Department of Community Health, School of Public Health, Saint Louis University, 63108, USA.
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Kreuter MW, Bull FC, Clark EM, Oswald DL. Understanding how people process health information: a comparison of tailored and nontailored weight-loss materials. Health Psychol 1999; 18:487-94. [PMID: 10519465 DOI: 10.1037/0278-6133.18.5.487] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Health information tailored to meet individuals' unique needs has been shown to be more effective than generic information in promoting risk-reducing behavior changes. To explore mechanisms underlying tailoring's effectiveness, this study randomly assigned 198 overweight adults to receive weight-loss materials that were (a) tailored to the individual, (b) in an American Heart Association (AHA) brochure, or (c) AHA-content formatted to look like tailored materials. Participants who received tailored materials had more positive thoughts about the materials, positive personal connections to the materials, positive self-assessment thoughts, and positive thoughts indicating behavioral intention than those who received either of the untailored materials. The tailoring of health information can significantly improve the chances the information will be thoughtfully considered and can stimulate prebehavioral changes such as self-assessment and intention.
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Affiliation(s)
- M W Kreuter
- Department of Community Health, School of Public Health, Saint Louis University, 63108, USA.
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Abstract
Physical inactivity is a major public health problem. Patient education programs and materials that are customized to address the unique needs and concerns of specific patients have shown promise in changing a range of health related behavior, although findings to date for physical activity have been equivocal. In this study a randomized controlled trial was conducted among 272 adult primary care patients to compare the effectiveness of tailored, personalized and general health messages, and usual medical care in promoting leisure time physical activity (LTA) and physical activities of daily living (PADLs). Patients in the tailored group were more likely to increase PADLs than were patients in the personalized, general and control groups (65% vs. 46% vs. 56% vs. 54%) and less likely to being doing fewer PADLs at follow-up (18% vs. 38% vs. 38% vs. 38%; chi 2 = 12.2, df = 6, p = 0.056). There were no significant differences for LTAs. To help maximize the effectiveness of future tailored interventions on physical activity, studies should seek to identify the social, psychological and environmental variables that are most important to include in tailored materials.
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Affiliation(s)
- F C Bull
- Department of Public Health, University of Western Australia, Perth, Western Australia, Australia
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Abstract
BACKGROUND National objectives and guidelines call upon physicians to help reduce the population burden of chronic diseases by advising patients to eat less fat and get more physical activity. However, studies show physicians are most likely to provide behavioral recommendations to patients who are already sick. Understanding factors that influence physicians' advising decisions can help broaden the reach of these activities. METHODS Subjects were 915 adult patients and 27 physicians from four community-based family medicine clinics in southeastern Missouri. To participate, patients completed a self-administered behavioral and health questionnaire while waiting to see their doctor. RESULTS Having a high body mass index was the strongest predictor of receiving advice to increase physical activity (OR = 1.6; 95% CI 1.3, 2.0), and having a high cholesterol level was the strongest predictor of receiving advice to eat less fat (OR = 1.9; 95% CI 1.5, 2.4). Neither the actual content of patients' diets nor their levels of physical activity were associated with receiving advice. CONCLUSIONS Physicians' advising may be guided by quick but fallible heuristics that systematically exclude patients whose needs are not easily visible. This pattern misses the opportunity to reduce future needs for therapeutic counseling by taking preventive action now.
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Affiliation(s)
- M W Kreuter
- Department of Community Health, School of Public Health, Saint Louis University, Missouri 63108, USA.
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Kreuter MW, Brennan LK, Scharff DP, Lukwago SN. Do nutrition label readers eat healthier diets? Behavioral correlates of adults' use of food labels. Am J Prev Med 1997; 13:277-83. [PMID: 9236964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Reading and understanding nutrition labels on foods may be an important precursor to dietary change. However, little is known about how nutrition labels are used by consumers and what effect reading labels has on dietary behaviors. METHODS This article identifies behavioral and health status correlates of nutrition label reading and describes patterns of label use among 885 adult patients from four family medicine clinics in southeastern Missouri. To participate, patients completed a self-administered survey while waiting to see their physicians. RESULTS Analyses revealed patients eating diets lower in fat were much more likely (51% versus 26%) than patients whose diets were higher in fat to report labels influencing their food purchase decisions, as were patients eating diets higher in fruits, vegetables, and fiber. Patients with high blood pressure were 63% more likely than those with normal or low blood pressure to look for sodium on the nutrition label (odds ratio [OR] = 1.63, 95% confidence interval [CI] = 1.35, 1.97), but no more likely to look for other nutrition label information. Similarly, patients with high cholesterol were more likely than those with normal or low cholesterol to look for saturated fat (OR = 1.39, 95% CI = 1.13, 1.72) and cholesterol (OR = 1.60, 95% CI = 1.29, 1.98) on the label, but no more likely to look for other nutrition label information. CONCLUSIONS Findings consistently supported a relationship between patients' label reading and their dietary practices.
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Affiliation(s)
- M W Kreuter
- Department of Community Health, School of Public Health, Saint Louis University, MO 63108, USA.
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Abstract
Many accomplishments of public health can be cited, yet public health professionals face unprecedented challenges and opportunities in the coming decades. To assist public health practitioners, researchers, and educators in preparing for current and future changes affecting the population's health, the authors describe several important "macrolevel" trends. These trends include: the aging of the population, changing patterns in the U.S. racial/ethnic composition, changes in health care delivery systems, the explosion of information technologies, changing needs in the public health work force, the growth in health-related partnerships, and anti-government sentiment and polarization. A series of implications for each of the major trends is provided. It may be important for public health leaders and policy makers to take these trends and implications into account as they plan and prioritize future approaches to disease prevention and health promotion.
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Affiliation(s)
- R C Brownson
- Department of Community Health, Saint Louis University School of Public Health, Missouri, USA
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Kreuter MW, Strecher VJ. Do tailored behavior change messages enhance the effectiveness of health risk appraisal? Results from a randomized trial. Health Educ Res 1996; 11:97-105. [PMID: 10160231 DOI: 10.1093/her/11.1.97] [Citation(s) in RCA: 162] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Health risk appraisal (HRA) remains one of the most widely used health promotion tools despite only equivocal evidence for its effectiveness. Theories of behavior change predict conventional HRA's ineffectiveness because risk information alone is seldom sufficient to change complex behaviors. In this study, a randomized trial compared the effects of feedback from an enhanced HRA with a typical HRA and a control group among adult patients from eight family medicine practices. The enhanced HRA assessed behavior-specific psychosocial factors and provided patients with computer-generated, individually-tailored behavior change information in addition to typical HRA risk feedback. Changes in seven behaviors were assessed at a 6 month follow-up. Overall, patients receiving enhanced HRA feedback were 18% more likely to change at least one risk behavior than were patients receiving typical HRA feedback or no feedback (OR = 1.18, 95% CI = 1.00, 1.39). The enhanced HRA feedback appeared to promote changes in cholesterol screening, dietary fat consumption and physical activity, but not in smoking, seat belt use, mammography and Pap smears. We conclude that the addition of theory-based, individually-tailored behavior change information may improve the effectiveness of HRA.
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Affiliation(s)
- M W Kreuter
- Department of Community Health, School of Public Health, St Louis University, MO 63108, USA
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Kreuter MW, Vehige E, McGuire AG. Using computer-tailored calendars to promote childhood immunization. Public Health Rep 1996; 111:176-8. [PMID: 8606919 PMCID: PMC1381728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- M W Kreuter
- Department of Community Health, Division of Behavioral Science and Health Education, School of Public Health, Saint Louis University, MO, USA
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Abstract
We sought to identify and correct inaccurate perceptions of risk among 1,317 adult patients in a primary care setting. Patients' perceived risks of heart attack, stroke, cancer, and motor vehicle crash were assessed and compared with a measure of risk derived from a health risk appraisal. Patients were then randomly assigned to receive computer-generated individualized risk feedback, risk feedback plus behavioral change feedback, or no feedback. Changes in perceived risk from baseline to a 6-month follow-up were compared across study groups. Results showed that individualized risk feedback was effective in increasing perceived stroke risk among patients who had underestimated their stroke risk at baseline and in reducing perceived risk of cancer among patients who had overestimated their cancer risk at baseline. Individualized risk feedback did not alter patients' perception of their heart attack and motor vehicle crash risks.
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Affiliation(s)
- M W Kreuter
- Department of Community Health, School of Public Health, Saint Louis University, Missouri 63108-3342, USA
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Kreuter MW, Strecher VJ, Harris R, Kobrin SC, Skinner CS. Are patients of women physicians screened more aggressively? A prospective study of physician gender and screening. J Gen Intern Med 1995; 10:119-25. [PMID: 7769467 DOI: 10.1007/bf02599664] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the effects of physician gender on rates of Pap testing, mammography, and cholesterol testing when identifying and adjusting for demographic, psychosocial, and other patient variables known to influence screening rates. DESIGN A prospective design with baseline and six-month follow-up assessments of patients' screening status. SETTING Twelve community-based group family practice medicine offices in North Carolina. PARTICIPANTS 1,850 adult patients, aged 18-75 years (six-month response rate, 83%), each of whom identified one of 37 physicians as being his or her regular care provider. MAIN RESULTS Where screening was indicated at baseline, the patients of the women physicians were 47% more likely to get a Pap test [odds ratio (OR) = 1.47, 95% confidence interval (CI) = 1.05, 2.04] and 56% more likely to get a cholesterol test (OR = 1.56, 95% CI = 1.08, 2.24) during the study period than were the patients of the men physicians. For mammography, the younger patients (aged 35-39 years) of the women physicians were screened at a much higher rate than were the younger patients of the men physicians (OR = 2.69, 95% CI = 0.98, 7.34); however, at older ages, the patients of the women and the men physicians had similar rates of screening. CONCLUSIONS In general, the patients of the women physicians were screened at a higher rate than were the patients of the men physicians, even after adjusting for important patient variables. These findings were not limited to gender-specific screening activities (e.g., Pap testing), as in some previous studies. However, the patients of the women physicians were aggressively screened for breast cancer at the youngest ages, where there is little evidence of benefit from mammography. Larger studies are needed to determine whether this pattern of effects reflects a broader phenomenon in primary care.
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Affiliation(s)
- M W Kreuter
- Department of Community Health, School of Public Health, Saint Louis University, MO 63108, USA
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Abstract
This study examined whether perceived risks of heart attack, cancer, and stroke were higher among smokers than nonsmokers; whether smokers were more likely to underestimate these risks; and the demographic correlates of unrealistic risk estimation among smokers. Two thousand seven hundred eight-five patients from 12 North Carolina family practices completed a questionnaire including a health risk appraisal and questions concerning smoking behavior and perceived risks of heart attack, cancer, and stroke. While most smokers accurately perceived their health risks to be greater than nonsmokers', smokers were also more likely to underestimate their risks. This optimistic distortion of risk was associated with age, gender, and education levels. Smokers may not yet understand the magnitude of health risks posed by smoking. These data suggest the need for renewed attention to perceptions of the health risks of smoking. As long as smokers underestimate their risks, they underestimate the imperative to quit.
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Affiliation(s)
- V J Strecher
- Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill 27599-7400, USA
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Abstract
We sought to identify and correct inaccurate perceptions of risk among 1,317 adult patients in a primary care setting. Patients' perceived risks of heart attack, stroke, cancer, and motor vehicle crash were assessed and compared with a measure of risk derived from a health risk appraisal. Patients were then randomly assigned to receive computer-generated individualized risk feedback, risk feedback plus behavioral change feedback, or no feedback. Changes in perceived risk from baseline to a 6-month follow-up were compared across study groups. Results showed that individualized risk feedback was effective in increasing perceived stroke risk among patients who had underestimated their stroke risk at baseline and in reducing perceived risk of cancer among patients who had overestimated their cancer risk at baseline. Individualized risk feedback did not alter patients' perception of their heart attack and motor vehicle crash risks.
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Affiliation(s)
- M W Kreuter
- Department of Community Health, School of Public Health, Saint Louis University, Missouri 63108-3342, USA
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Green LW, Glanz K, Hochbaum GM, Kok G, Kreuter MW, Lewis FM, Lorig K, Morisky D, Rimer BK, Rosenstock IM. Can we build on, or must we replace, the theories and models in health education? Health Educ Res 1994; 9:397-404. [PMID: 10150456 DOI: 10.1093/her/9.3.397] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- L W Green
- Institute of Health Promotion Research, Faculty of Graduate Studies, University of British Columbia, Vancouver, Canada
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Strecher VJ, Kobrin SC, Kreuter MW, Roodhouse K, Farrell D. Opportunities for alcohol screening and counseling in primary care. J Fam Pract 1994; 39:26-32. [PMID: 8027729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND The physician can be an important part of a comprehensive strategy to assist persons with alcohol problems. This study was designed to contribute to the development of physician-initiated brief interventions for patients with alcohol problems by incorporating into an existing screening instrument questions that solicit information relevant to behavior change strategies. METHODS Adult patients from 12 family practices in North Carolina (N = 2716) completed a self-administered questionnaire assessing alcohol consumption and other health-related behaviors. Alcohol problems were assessed using the four-item CAGE (Have you ever felt you should cut down on your drinking? Have people annoyed you by criticizing your drinking? Have you ever felt bad or guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves, or to get rid of a hangover?). For this study, CAGE was adapted to address only the past 12 months. Patient interest in reducing the amount of alcohol consumed was measured using the Transtheoretical Model developed by Prochaska and colleagues. Patients were also asked about their motives for and barriers to reducing consumption. RESULTS Five percent of all patients and 9% of patients who reported drinking alcohol gave positive responses on at least two CAGE items. Patients with three or four positive CAGE responses were 74% more likely to report an interest in reducing alcohol consumption than were those with one or two. Intrinsic reasons were the most important motives for reducing consumption. No pattern was found in barriers. CONCLUSIONS We found that in the management of patients with alcohol-related problems, there are many clinical opportunities for patient counseling and referral in the family practice setting. Individually tailored brief interventions that take into consideration the patient's interest in, motives for, and barriers to reducing alcohol consumption are likely to be successful for the family practice physician.
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Affiliation(s)
- V J Strecher
- Health Communications Research Laboratory, School of Public Health, University of North Carolina at Chapel Hill 27599-7400
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Abstract
A large portion of the death, disease, and disability caused by cancers are preventable. A substantial amount of what is preventable is linked directly to our conditions of living and the way we act within that context. This paper addresses the following three questions: (1) To what extent are behavioral and social "interventions" effective in the prevention, early detection, and control of various health problems, including cancers and their selected risk factors? (2) What are the common elements of those strategies considered to be effective? (3) What actions need to be taken to enhance the benefits of social and behavioral strategies in the future? Behavioral and social strategies will not come in the form of pre-packaged, easily exported "magic bullets," complete with efficacy estimates, for the prevention and control of selected cancers. Effective behavioral and social interventions are dependent ultimately on two phenomena: (1) the competent application of basic principles that have been demonstrated to be effective and are tailored to the unique needs and circumstances of target populations, and (2) an infrastructure that is supportive of behavioral and social research, programs, and training. This article offers specific recommendations for instituting these measures.
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Abstract
BACKGROUND With 1.9 million US children cared for in organized group child care, the safety of these children is a public health concern. In the absence of federal policy, each state has developed its own day care safety regulations. METHODS After creating a set of 36 criteria from three sets of national guidelines, we assessed the safety regulations of 45 states. With a mailed survey of state day care regulatory personnel, we examined the processes of formulating and implementing safety policy in 47 states. RESULTS For 24 of the 36 items, more than half the states' regulations were below the criteria or failed to mention the topic. Most notable is the inattention to playground safety, choking hazards, and firearms. CONCLUSION The uneven quality of regulations may be a reflection of a regulatory process that is fragmented, with many different groups sharing authority and with limited involvement of injury prevention specialists.
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Affiliation(s)
- C W Runyan
- University of North Carolina School of Public Health, Department of Health Behavior and Health Education, Chapel Hill
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Affiliation(s)
- L W Green
- Henry J. Kaiser Family Foundation, Menlo Park, CA 94025
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Kreuter MW, Powell KE. Psychosocial predictors of smoking among adolescents. Introduction. MMWR Suppl 1987; 36:1S-2S. [PMID: 3116390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Marks JS, Kreuter MW. Youth pregnancy: a community solution. JAMA 1987; 257:3410. [PMID: 3586276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Lammers JW, Kreuter MW, Smith BC. The effects of the SHCP on selected aspects of decision-making among fifth graders. Health Educ 1984; 15:14-7. [PMID: 6444001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Kreuter MW, Christenson GM, Davis R. School health education research: future issues and challenges. J Sch Health 1984; 54:27-32. [PMID: 6565117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This paper presents the view that the dissemination of effective school health education constitutes a significant problem that deserves high priority on a national research agenda for school health education. Justification of dissemination is grounded in two presuppositions: (1) that there is a positive correlation between health education and the practice of health-enhancing behaviors and (2) that health education is an appropriate and fundamental task for schools. Two complex sub-problems are discussed. The first is related to the fact that there are no data to help us determine how many children in this country actually receive health information in schools. In addition, there is insufficient evidence to ascertain either the quality or quantity of health information children receive or where in the curriculum the presentation of that information occurs. The second problem pertains to the myriad of complex factors that impede the implementation of health education in schools. These two problems are re-cast into a series of researchable questions.
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Kreuter MW. Marshall W. Kreuter, U.S. Health Education Director, praises Pittsburgh health education center as 'classic example of good community networking'. Health Educ Rep 1983; 5:2-6. [PMID: 10263868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Christenson GM, Nelson GD, Christenson PD, Kreuter MW. A heuristic technique to assess resistance to persuasion skills in sixth-grade students. J Sch Health 1983; 53:241-249. [PMID: 6552339 DOI: 10.1111/j.1746-1561.1983.tb01138.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Kreuter MW, Christensen GM, Divincenzo A. The multiplier effect of the health education-risk reduction program in 28 states and 1 territory. Public Health Rep 1982; 97:510-5. [PMID: 7146300 PMCID: PMC1424374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The multiplier effect of the Health Education-Risk Reduction (HE-RR) Grants Program funded by the Public Health Service is examined to identify outcomes for the period 1978-81. Responses to a questionnaire from the directors of health education of 28 States and 1 Territory supplied the information concerning new health promotion activities generated by the program. The directors were asked to identify and give cost estimates of new activities that resulted from State-level and local intervention projects. A method for calculating the extent to which the HE-RR program influenced new health promotion activities that were funded by alternate sources was devised. The calculation, termed the new activity rate, was applied to the survey data. Rates calculated for the HE-RR program revealed that it generated nearly $4 million in new health promotion activities, most of them funded by the private and voluntary segments of society.
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Duryea PE, Kreuter MW, Braza GF. Cognitive perceptions of importance in students' decisions about smoking. Health Educ 1981; 12:4-8. [PMID: 6792156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Kreuter MW. The behavioral sciences and health education. Health Educ 1981; 12:2-3. [PMID: 6792126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Kolbe LJ, Iverson DC, Kreuter MW, Hochbaum G, Christensen G. Propositions for an alternate and complementary health education paradigm. Health Educ 1981; 12:24-30. [PMID: 6792127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
We have tried to raise several issues in this paper. First, schools are very complex systems. It is as difficult to generalize about schools as it is to generalize about the children in them. Second, because of this complexity, any serious discussion of outcomes resulting from any educational program requires a commitment to specificity in problem identification and planning. Third, the current national interest in health promotion, disease prevention and risk reduction has given rise to a greater emphasis on the principles of epidemiologic analysis. This kind of analysis facilitates a focus on outcomes which are, to varying degrees, contributing factors to specific health problems. Fourth, while there are those who fear that this emphasis may compromise the traditional goals of schools, there is clear evidence that the addition of an epidemiologic cause/effect dimension to school health education is consistent both with the tenets of major educational philosophers as well as the goals of health education as stated by scholars in the field. Fifth, the process of decision-making (the assessment of which is admittedly primitive at this point) represents the bridge across which the science of epidemiology can cooperatively join hands with the art of education toward the goal of enhancing the competence of children and youth.
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Kreuter MW. School health evaluation: it's now or never. Health Educ 1977; 8:2-3. [PMID: 402337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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