AIDS prevention in homosexual and bisexual men: results of a randomized trial evaluating two risk reduction interventions.

This study evaluates two AIDS risk-reduction interventions targeted at homosexual and bisexual men. Participants were randomized into two peer-led interventions: both involved a lecture on 'safer sex', and one provided a skills-training component during which men could discuss and rehearse the negotiation of safer sexual encounters. Follow-up data collection assessed self-reported changes in sexual behavior at 6 and 12 months. Skills training increased condom use for insertive anal intercourse. In sessions providing skills training, condom use increased, on average, by 44% between pre-test and second follow-up compared with only 11% on average in sessions which did not provide such training.

Can organizations benefit from worksite health promotion?

A decision-analytic model was developed to project the future effects of selected worksite health promotion activities on employees' likelihood of chronic disease and injury and on employer costs due to illness. The model employed a conservative set of assumptions and a limited five-year time frame. Under these assumptions, hypertension control and seat belt campaigns prevent a substantial amount of illness, injury, and death. Sensitivity analysis indicates that these two programs pay for themselves and under some conditions show a modest savings to the employer. Under some conditions, smoking cessation programs pay for themselves, preventing a modest amount of illness and death. Cholesterol reduction by behavioral means does not pay for itself under these assumptions. These findings imply priorities in prevention for employer and employee alike.

Preventing HIV infection in gay and bisexual men: experimental evaluation of attitude change from two risk reduction interventions.

In the course of learning their HIV serostatus, gay and bisexual men participated in small discussion groups aimed at increasing their practice of safer sex. Small discussion groups were randomly assigned to receive one of two interventions: a lecture/discussion by a gay health educator, or an intervention that included the lecture/discussion followed by a small group process aimed at increasing social skills for safer sex and at increasing peer support for safer sex. Men completed questionnaires relating to their knowledge about HIV and AIDS, attitudes toward sexual behavior change, and self-reported sexual behavior. At second follow-up, one year post-intervention, men who had received skills training and peer support endorsed significantly stronger attitudes in favor of safer sex than did men receiving lecture/discussion only. In particular, skills training and peer support caused greater reduction of the value placed on ejaculation inside the partner, stronger endorsement of plans to use condoms, and greater reduction of negative attitudes about condoms, than did lecture/discussion only. These results are helpful to design interventions for men who continue to engage in riskful behavior.

Feasibility of obtaining sexual risk and STD history in the context of a drinking drivers' program.

OBJECTIVES: This study was designed (a) to assess the feasibility of obtaining data about sexually transmitted diseases and sexual risk behavior in an alternative-to-incarceration program for convicted drinking drivers and (b) to determine whether asking health history and sexual risk questions using an anonymous questionnaire, anonymous interviews, or confidential interviews affected the willingness of people to participate. METHODS: The same survey instrument was used across three data collection modes to collect information on sexually transmitted diseases and sexual risk behavior. RESULTS: Overall, there were no differences across modes in self-reports of STDs and details of sexual history. Although the difference in refusal rates between the anonymous questionnaire and the anonymous interview was not significant, the refusal rate for the anonymous questionnaire was significantly higher than the rate for the confidential interview. Those answering the self-administered questionnaire were more likely than those receiving face-to-face interviews to refuse to answer questions about having sex while high and condom use. CONCLUSIONS: A drinking driver intervention program may be an appropriate site for health screenings and prevention activities for an at-risk population.

Preventing Halloween arson in an urban setting: a model for multisectoral planning and community participation.

Arson is a violent crime and a public health problem that causes injuries and deaths, destroys homes, and destabilizes neighborhoods. During the late 1970s, pre-Halloween pranks in Detroit, Michigan, turned destructive when hundreds of fires were set deliberately throughout the city; in 1984, a record of 810 fires were set during the Halloween period. In 1985, a city wide anti-arson campaign that involved the mobilization and training of thousands of community volunteers was begun in Detroit. This report describes the multiple components of the anti-arson intervention from 1985 through 1996 and changes in the incidence of Halloween fires. Both the decrease in annual Halloween arson fires after the intervention began and the inverse relationship between the number of volunteers and the number of fires suggest a causal effect. This study illustrates the capacity of an urban community to mobilize its residents and stakeholders, the importance of community participation and multisectoral partnerships in program planning and implementation, and the challenges faced in retrospectively evaluating an apparently successful, complex, community-based intervention.

Methods, results, and lessons learned from process evaluation of the high 5 school-based nutrition intervention.

This article describes the process evaluation of High 5, a school-based intervention targeting fruit and vegetable consumption among fourth graders and their families. The outcome evaluation involved 28 schools randomized to intervention or control conditions. The intervention included classroom, family, and cafeteria components. Process evaluation was completed on each of these components by using observations, self-report checklists, surveys, and other measures. Results indicated high implementation rates on the classroom activities. Moderate family involvement was attained, perhaps diminishing intervention effects on parent consumption. Cafeterias provided environmental cues, and fruit and vegetable offerings as directed by the program. A lower dose of the intervention was delivered to schools with larger African American enrollments and lower-income families. This article provides insights into the effective elements of a school-based dietary intervention and provides suggestions for process evaluation in similar studies.

Model-based evaluation of HIV prevention interventions.

The ultimate goal of HIV prevention interventions is to reduce the spread of HIV; however, the effectiveness of these programs is seldom assessed directly. Although direct measurement of an intervention's impact via HIV seroincidence monitoring is usually unfeasible, mathematical models can be used to estimate the number of infections averted by the intervention. This article describes three model-based summary measures of sexually transmitted HIV risk and discusses their relevance to HIV program evaluation in general economic efficiency analyses in particular. The calculation of these measures is demonstrated with an illustrative application to previously published data from an HIV prevention intervention for gay men.

The yield from work site cardiovascular risk reduction.

Health decision makers in business need to know what to expect from efforts at cardiovascular risk reduction offered through the workplace. In terms of health, the yield from such efforts is the extent to which risk in the entire work force is lowered. Yield is assessed from available reports of interventions, and is defined as the joint probability of (1) participation of the at-risk work force, (2) retention of participants in an intervention, and (3) improvement on an indicator of risk. The median and range of outcomes are presented so that decision makers can better know what to expect and can have a basis of comparison for the performance of their own risk reduction programs.

Decision points for hospital-based health promotion.

Hospitals that are developing health promotion programs to market to business and the community need to develop a high quality product. Hospitals frequently gain needed experience in health promotion by providing the service to their own employees. Cases are presented that illustrate several crucial choices hospitals must make in developing health promotion programs. These choices include selection of markets; activities to be included; linkages to other health services; purchase of an existing program or development in-house; extent of employee involvement; and information to be collected for assessing outcomes.

Encouraging small businesses to adopt effective technologies to prevent exposure to health hazards.

Small businesses are heterogeneous and the prospects are low for direct OSHA inspection and enforcement. Opportunities are explored to encourage voluntary adoption of new technology to reduce workplace exposures. The case of radiator repair shops is used in this paper to illustrate an approach to the dissemination of control technology to small businesses that will encourage these companies to adopt controls. Several behavioral theories are applied to the case.

Urban issues in health promotion strategies.

The powerful influence of behavioral choices on health status is well established. The implications and challenges for urban populations are formidable. Understanding urban environments will better prepare health promotion professionals to deal effectively with the forces affecting health-related behaviors. In thinking about urban health promotion in the United States, researchers often distinguish between 2 frameworks; one contending with urbanization, which affects most of us, and another contending with inner-city environments, where many of the deepest needs are. Urbanization confers both benefits and liabilities, but the single greatest challenge for health promotion may lie in reestablishing positive social connections. In contrast, 2 key features of the inner-city environment may be the negative ecological forces within neighborhoods and the lack of control over one's fate. Too often, prescriptions for the inner city stereotype its problems and ignore its strengths. For the inner city, important foundation stones for the future include ways to build on these strengths through positive connections and increased community control through coalition building.

Drake Chemical Workers' Health Registry: coping with community tension over toxic exposures.

BACKGROUND: Programs to communicate health risk information and to protect the health of groups exposed to toxic substances need to tailor interventions to the political, economic, and cultural situation of the at-risk group. In particular, such programs must often cope with exceptional community tension and conflict over these exposures. METHODS: This article uses interviews and written materials to document and describe the state of affairs that led up to community tension over an occupational exposure to a bladder carcinogen. The article describes the planning and design of a program to provide medical surveillance to workers, which also alleviated community concern. RESULTS: The Drake Chemical Workers' Health Registry coped successfully with community conflict and obtained a high participation rate. CONCLUSIONS: General recommendations include the following: avoid identification with extraneous agendas; know the community and maintain communication; and match the intervention to the evolution of the community conflict.

Evaluation issues in the Drake Chemical Workers Notification and Health Registry Study.

The Drake Chemical Workers' Health Registry combined notification of workers about bladder cancer risk with access to a free program for screening and diagnosis. Evaluation of the project has given rise to several findings and new research questions. Findings in this article illustrate the following evaluation issues: 1) studying the combination of strategies that are most effective and cost effective to notify workers of their disease risks, 2) determining the realistic yield from strategies to gain participation in health screening and other protective services for notified workers, 3) identifying the notification strategies that were most effective for different kinds of participants, 4) using process evaluation to identify key activities for ensuring continued participation of cohort members in screening, and 5) examining the extent to which participants are willing to quit smoking to protect their health.

Applying the criteria for the development of health promotion and education programs to AIDS risk reduction programs for gay men.

As a result of the AIDS (Acquired Immune Deficiency Syndrome) epidemic, many community health agencies are faced with the task of planning and implementing programs to prevent or reduce the risks of HIV (Human Immunodeficiency Virus) infection. Furthermore, the urgency of AIDS will force community groups to develop prevention programs prior to an analysis of substantial data relating to intervention efficacy. By using the five criteria for the development of health promotion and education programs enumerated by the American Public Health Association, planners can benefit from the experience of past health promotion initiatives, and insure a comprehensive approach to planning. The authors describe, using specific examples, how these criteria were used to develop and implement an AIDS risk reduction program for gay and bisexual men.

A protocol for bladder cancer screening and medical surveillance among high-risk groups: the Drake Health Registry experience.

In 1986, the Drake Health Registry Study initiated bladder cancer screening for 366 persons at high risk because of occupational exposure to beta-naphthylamine. The Drake Health Registry Study screening protocol consists of urinalysis, Papanicolaou cytology, and quantitative fluorescence image analysis. A positive screening test qualifies participants for a full diagnostic evaluation. The screening protocol has been modified during the first 3 years of the program's existence to address unexpected patterns of test results and to incorporate advances in screening technology. The current protocol, which has a two-tiered screening schedule, has been utilized successfully for 15 months. Of the 26 positive results to date most have been based on abnormal Papanicolaou cytology and/or quantitative fluorescence image analysis. Bladder abnormalities were cited among most of the 18 study members who underwent diagnostic evaluation, including chronic cystitis, inflammation, hyperplasia, and dysplasia. We conclude that the screening program is detecting very early changes in a relatively young cohort and that these persons must be monitored over a number of years to ensure adequate medical surveillance.

Variables influencing condom use in a cohort of gay and bisexual men.

Nine hundred fifty-five of 1,384 (69 per cent) gay and bisexual men enrolled in a prospective study of the natural history of human immunodeficiency virus (HIV) infection who reported engaging in anal intercourse in the past six months were surveyed about condom use practices for both insertive (IAI) and receptive anal intercourse (RAI). The following results were obtained: 23 per cent of the men reported that they always used condoms for IAI and 21 per cent for RAI; 32 per cent sometimes used condoms for IAI; 28 per cent sometimes used condoms for RAI; 45 per cent never used condoms for IAI; and 50 per cent never used condoms for RAI. Multiple logistic regression analysis revealed that the following variables were associated with both insertive and receptive condom use: condom acceptability; a history of multiple and/or anonymous partners in the past six months, and the number of partners with whom one is "high" (drugs/alcohol) during sex. Knowledge of positive HIV serostatus was more strongly associated with receptive than with insertive use. Condom use is a relatively complex health-related behavior, and condom promotion programs should not limit themselves to stressing the dangers of unprotected intercourse.

Direct methods of obtaining information on cigarette smoking in occupational studies.

Many occupational epidemiology studies require complete and accurate information on tobacco use to control for confounding by smoking and to assess interactions of smoking with workplace exposures. This paper reviews and evaluates the availability, reliability, validity, and efficiency of the various data sources and techniques for obtaining individual smoking data, including existing records, biological markers, and surveys. Emphasis is placed on the highly problematic issue of obtaining retrospective smoking histories. In general, the survey technique is currently deemed the most feasible approach for obtaining lifetime smoking histories. Both theoretical and practical aspects of smoking surveys are discussed in detail and are illustrated with a review of the recent literature and with data from two recent retrospective cohort studies conducted at the University of Pittsburgh. Several recommendations involving both the use of smoking data and areas for future methodologic research are presented. These include (1) justification for collecting smoking data in occupational studies based primarily on the potential for smoking to act as an effect modifier rather than solely as a confounder, (2) checks for reliability and validity in all studies which involve the collection of smoking data, (3) more methodologic research to better understand the impact that missing, unreliable, and invalid smoking data may have on the ability to detect and quantify important smoking-exposure interactions, and (4) an assessment of the correlation between biological markers and cigarette carcinogen exposure.

Risk and prevalence of treatable sexually transmitted diseases at a Birmingham substance abuse treatment facility.

OBJECTIVES: We evaluated the prevalence of gonorrhea, chlamydia, trichomoniasis, and syphilis in patients entering residential drug treatment. METHODS: Data on sexual and substance abuse histories were collected. Participants provided specimens for chlamydia and gonorrhea ligase chain reaction testing. Trichomonas vaginalis culture, and syphilis serologic testing. RESULTS: Of 311 patients, crack cocaine use was reported by 67% and multisubstance use was reported by 71%. Sexually transmitted disease (STD) risk behaviors were common. The prevalence of infection was as follows: Chlamydia trachomatis, 2.3%; Neisseria gonorrhoeae, 1.6%; trichomoniasis, 43%; and syphilis, 6%. CONCLUSIONS: STD counseling and screening may be a useful adjunct to inpatient drug treatment.