Community-based prevention marketing: organizing a community for health behavior intervention.

This article describes the application and refinement of community-based prevention marketing (CBPM), an example of community-based participatory research that blends social marketing theories and techniques and community organization principles to guide voluntary health behavior change. The Florida Prevention Research Center has worked with a community coalition in Sarasota County, Florida to define locally important health problems and issues and to develop responsive health-promotion interventions. The CBPM framework has evolved as academic and community-based researchers have gained experience applying it. Community boards can use marketing principles to design evidence-based strategies for addressing local public health concerns. Based on 6 years of experience with the "Believe in All Your Possibilities" program, lessons learned that have led to revision and improvement of the CBPM framework are described.

Persistence of Parent-Reported ADHD Symptoms From Childhood Through Adolescence in a Community Sample.

OBJECTIVE: To examine ADHD symptom persistence and factors associated with elevated symptom counts in a diverse, longitudinal community-based sample. METHOD: Parents reported demographics and completed a diagnostic interview repeatedly over a 6-year period. At Time 1, 481 interviews were completed about children (5-13 years); all participants were invited to four annual follow-up interviews, and 379 (79%) completed at least one. Inattentive (IA) and hyperactive-impulsive (HI) symptom counts were modeled with logistic quantile regression, while accounting for study design complexities. RESULTS: The prevalence of seven IA symptoms remained stable from early childhood through late adolescence. The prevalence of eight HI symptoms decreased by more than half over time. After demographic adjustment, the upper quartile of HI symptom counts decreased with age (p < .01). High HI symptom counts persisted more among those with high IA symptom counts (p = .05). CONCLUSION: This study further characterizes and provides insights into ADHD symptom trajectory through adolescence.

An event history analysis of recurrent child maltreatment reports in Florida.

OBJECTIVE: The purpose of this study was to (a) describe the timing of maltreatment recurrence and (b) measure associations between child demographics and characteristics of initial reports with recurrent maltreatment. METHOD: Using administrative data from the Florida Department of Children and Families, case histories of 189,375 children with an initial maltreatment report in 1998 or 1999 were examined using event history techniques, also known as survival analysis, to assess the relationship between predictor variables and the likelihood and timing of recurrence. Specifically, data were analyzed using descriptive and multivariate analytic methods, including life-table analysis and logistic regression analysis. RESULTS: Over 26% of the sample had a maltreatment recurrence during the 2-year follow-up period, and the risk of recurrence was greatest in the first 4 months after the initial incident. Results also suggest the presence of unique associations between recurrence and a child's race/ethnicity and age, as well as indication level, maltreatment type, and service disposition as specified in the initial report. CONCLUSIONS: Results indicate that recurrent reports are more likely for young and White children whose first report resulted in a substantiation of neglect and the provision of in-home preventive services. This research highlights the importance of further investigating the relationship between chronic maltreatment and other influential variables.

Cigarette use in 6th through 10th grade: the Sarasota County Demonstration Project.

OBJECTIVES: To identify factors associated with cigarette smoking in the 6th-grade through 10th-grade youth population of Sarasota County, Florida. METHODS: A closed-ended, quantitative survey was completed by 2004 youth and used to extract population-specific data on the correlates of cigarette use. RESULTS: A range of factors influence cigarette use including self-efficacy to refuse offers of cigarettes, perceived emotional benefits, and perceived maternal disapproval of smoking. CONCLUSIONS: Results underscore the need for multiple-component interventions. This study is unique in that it represents population-specific research in which community partners are using the findings to develop community-specific prevention marketing interventions.

Factors related to alcohol use among 6th through 10th graders: the Sarasota County Demonstration Project.

Alcohol consumption by youth can produce negative health outcomes. This study identified correlates of lifetime alcohol use, recent alcohol use, and binge drinking among youth in sixth through 10th grade (n = 2,004) in Sarasota County, Fla. Results from a closed-ended, quantitative survey acknowledged a range of personal, social, and environmental influences. Breadth of these influences supports a need for multifaceted, community-based interventions for effective prevention of youth alcohol use. This study was unique because it represents population-specific research in which community partners are using the findings to develop community-specific social marketing interventions to prevent underage drinking and promote alternative behaviors.

Social disparities in the receipt of contraceptive services among sexually experienced adolescent females.

Social disparities in the receipt of contraceptive services were assessed among a sample of 2,031 sexually experienced adolescent females 15 to 18 years of age using secondary data from the National Longitudinal Study of Adolescent Health (Add Health). Findings revealed no social disparities in receipt of contraceptive services; rather, adolescent females who had a parent with less than a high school degree were more likely to receive contraceptive services. Adolescents' individual characteristics, including perceptions of maternal disapproval of sexual activity and use of contraceptives, barriers in access to and use of birth control, health needs, and enabling resources were significantly associated with their receipt of contraceptive services. Neighborhood characteristics were not significantly associated with adolescents' receipt of services in this study.

Associations between parental limits, school vending machine purchases, and soft drink consumption among Kentucky middle school students.

OBJECTIVE: To examine associations between parental limits on soft drinks and purchasing soft drinks from school vending machines and consuming soft drinks among middle school students. DESIGN: Secondary analysis of cross-sectional data from the middle school Youth Risk Behavior Survey. SETTING: Eight public middle schools in central Kentucky. PARTICIPANTS: All sixth- through eighth-grade students in 7 schools and all eighth-grade students in 1 school (n = 4,049). VARIABLES MEASURED: Self-reported parental limits on soft drink intake, school vending machine soft drink purchases, soft drink consumption, and control variables. ANALYSIS: Chi-square and binary logistic regression analyses. RESULTS: Compared to students with no parental limits on soft drink consumption, students with the strictest limits were less likely to purchase soft drinks from school vending machines and consume soft drinks; conversely, students with minor parental limitations were more likely to consume soft drinks. The odds of consuming soft drinks were nearly 4 times greater when students purchased soft drinks from school vending machines than when they did not. CONCLUSIONS AND IMPLICATIONS: Further research may enhance understanding of the influence of varying degrees of parental limitations. Efforts to reduce children's soft drink consumption may be augmented by policies limiting soft drink purchases in schools.

Factors contributing to intervention fidelity in a multi-site chronic disease self-management program.

BACKGROUND AND OBJECTIVES: Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. METHODS: The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. RESULTS: This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. CONCLUSION: Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.

Associations of psychosocial factors with the stress of infertility treatment.

This study investigated psychosocial factors thought to be associated with perceived stress over the course of infertility treatment. The research was based on secondary analysis of data from the Study of Marriage, Family, and Life Quality with a sample of 128 people who completed an infertility-related stress instrument at all three measurement intervals (1988, 1999, and 1990). Self-esteem and perceived health were associated with stress at the study baseline, importance of a biological family and extent of spousal support associated with stress at the 12-month follow-up, and factors pertaining to infertility treatment (number of treatments, relationship with physicians) associated with stress at the 24-month follow-up. Self-esteem was the only psychosocial factor associated with change in stress over the course of treatment. Social workers and health care professionals should be sensitive to the emotional experiences of couples during infertility treatment. Identifying factors explaining stress, or that may be targets for intervention, has significance for social workers in health care and other settings.