Health Education & Behavior

A quasi-experimental research design is used to evaluate Carolina Healthstyle, a health promotion project for South Carolina state employees. A 10% stratified ran dom sample of employees was surveyed in the Spring of 1983 and again in 1984. Eighteen agencies were intervention agencies and the rest comparison that year. This article reports changes with simple before-after comparisons in the intervention agencies and matched pair analysis and randomized block designs to compare inter vention and comparison agencies. Results are reported for smoking, exercise, safety, nutrition, stress, and alcohol. Significant increases in exercise were found in both intervention and comparison agencies. The number of smokers decreased in interven tion from 30% - 26% with no change in comparison agencies. Safety practices changed at similar rates in both intervention and comparison groups. Consumption of chicken increased significantly only in the intervention agencies. Few other diet or stress changes were found. There were changes in alcohol consumption in intervention agen cies only. The presence of the comparison group helps to separate the program effects from secular trends.

This study evaluated whether interventions involving competition and rewards would enhance a school-based educational curriculum on tobacco use. Written pre- and post-tests were used to assess the relevant knowledge of 1068 seventh grade students in three comparable communities. The students' smoking beliefs, intentions, and behavior were assessed by questionnaires before and after the educational unit. Students in two communities participated in interventions designed to enhance knowl edge acquisition, social activism, and non-use of tobacco; students in one community served as controls.

Students in competitive and control communities did not differ prior to interven tion. The interventions influenced respondents' concern about their health and the health of their family and friends and increased the likelihood that they would asso ciate smoking with maturity and short-term bad effects, regardless of their pre-inter vention smoking behavior. Experimenters' and regular smokers' knowledge about smoking and its consequences, and concern about the amount of substance use in their town were increased by the competitions. The competitions were also more like ly to reduce their intentions to smoke. The interventions did not affect smoking be havior. Fortunately, competition losers and winners were not differentially affected by the interventions.

This article presents the gatekeeping funnel as a model of the process that a public service announcement (PSA) goes through from distribution until it reaches its target audience. Process measures such as bounceback postcards, the Broadcast Advertisers Report (BAR), and analysis of audience response are suggested as ways of monitoring this funneling process.

The model is then applied to the National Cancer Institute's PSA campaign de signed to promote cancer prevention awareness. Three waves of PSAs were distributed between March 1984 and May 1985. Two of these waves of PSAs were targeted to the general public and the third wave was targeted to black audiences.

Bounceback postcards, BAR data, and the Cancer Information Service (CIS) call data exemplify the gatekeeping funnel model described in the article. When the mes sages were distributed, they had the potential of reaching 170 million adults with tele visions. BAR data show that the gatekeeping function narrowed the number of people potentially exposed to the messages to 24 million, or 14% of the total. Yet only 144,000 people, or less than one-tenth of 1% responded to the messages by calling the CIS number and asking about cancer prevention. This analysis may help PSA campaign planners to develop more realistic expectations for message effects.

The Safety Belt Connection Project was a worksite health promotion project con ducted at a medical school and hospital complex to test the effectiveness and cost effectiveness of four treatment conditions (TCs): TCl, Persuasive Communications (PCs) alone; TC2, PCs plus overt monitoring; TC3, PCs plus incentives; and TC4, PCs plus incentives and prompts. Parking lots were randomized to treatment condition. A community traffic intersection served as a comparison group. Trained observers re corded safety belt use rates (SBURs) of subjects (front seat occupants) over a two- week period at baseline and after a four-week period of intervention. Results were analyzed by chi-square comparisons of pre-treatment and post-treatment SBURs. At baseline, significant differences in SBURs between treatment groups were observed. Significant pre-to-post differences were found for TC3 and TC4: the SBUR in TC3 went from 18.3% - 38.4% (p < 0.001) and the SBUR in TC4 went from 16.9%- 44.8% (p < 0.001). Both TC3 and TC4 were effective, but TC4 cost 2.6 times more per person influenced to wear their safety belt.

Reports of workplace health promotion programs are reviewed in light of Kuhn's views on paradigmatic advances in science. Such reports fall into two categories: (1) those which describe single health-habit interventions (e.g., smoking cessation, weight control, or stress management) and (2) those which describe comprehensive efforts to incorporate many single health-habit interventions into integrated programs. Com mon to virtually all of these programs in their focus on the modification of the health behavior of individuals. Consideration of such organizational-level factors as work design or climate which are beyond the control of the individual, yet may contribute heavily to illness and absenteeism of employees, is typically omitted. It is concluded that workplace health promotion in the United States has achieved the status of a paradigm and that this paradigm is associated with several limitations and ethical prob lems in light of the programs' objectives: to reduce organizations' medical-care costs and improve productivity.

A model of risk factors and psychosocial variables that should enhance the predic tion of participation in worksite health promotion programs was evaluated in a sample of 357 States employees in South Carolina. Degree of satisfaction with one's current health status, intent to change it, and participation in a relevant program were assessed in four health areas: weight, exercise, alcohol consumption, and the handling of stress and tension. In each area, a known risk factor was used to predict intent to change and participation during a one-year interval. Variables from the psychosocial model were added in a step-wise regression procedure. The key variables in the psychosocial model were personal efficacy, job stress, and trait anxiety. Neither intent to change a health relevant behavior nor degree of satisfaction with the health area were consistently asso ciated with subsequent participation in a relevant health promotion program. The re gression model was a statistically significant predictor of actual participation in two cases: exercise and weight control. For exercise, participators tended to be persons whose job stress was high (r = 0.15) and whose anxiety was high (r = 0.16). In the case of weight control, those who were high in the body mass index (r = 0.22) and in job stress (r = 0.15) were more likely to participate. Participants in stress management also had higher levels of job stress.

As part of a school-based alcohol misuse prevention study, questionnaires were ad ministered to 2,589 fifth and sixth grade students to determine levels of use of alcohol, marijuana, and cigarettes, intentions to use these substances, and problems resulting from alcohol misuse. The questionnaire also included 45 items concerning susceptibil ity to peer pressure, self-esteem, and health locus of control. These 45 items were factor analyzed separately for two groups formed by random assignment. Six factors were identified which were both internally consistent and replicable, and indices were constructed. The indices measuring susceptibility to peer pressure, self-esteem, and internal health locus of control were significantly and negatively correlated with most of the substance use, misuse, and intention items, and an external health locus of con trol index was not significantly related to most of the substance use, misuse, and inten tion items. The "Susceptibility to Peer Pressure" index correlated more highly with the adolescent substance use, misuse, and intention items than the self-esteem or the health locus of control indices, and it had the highest alpha coefficient. Implications for the design of school-based substance abuse prevention programs are discussed.