A residents' training program for the development of smoking intervention skills.

This article describes the results of a three-hour training program that teaches residents a patient-centered counseling approach to smoking cessation, emphasizing questioning and exploring feelings, rather than providing information. Fifty internal medicine and family practice residents affiliated with a university medical center were assessed before and after training using questionnaires and videotape documenting changes in their knowledge about smoking, attitudes concerning intervention, and intervention skills. The residents showed a significant increase in knowledge and perceived themselves as having significantly more influence on their patients who smoke after completion of the training program. Counseling skills improved significantly in the use of questions and exploring feelings as judged by blind evaluation of videotapes. The results of this three-hour training program suggest that physicians in training are responsive to the teaching of specialized skills deemed important for promoting health behavior changes in their patients.

Prenatal child safety education.

In a prospective trial at two hospitals, 78 of 136 couples received a special 30-minute curriculum consisting of a lecture, a motion picture demonstrating the consequences of not using child car safety seats, and a question-and-answer session. Four to six months postpartum all parents were interviewed by telephone. When asked how their child rode during the most recent car trip, 96% of parents who received the special curriculum said they used a crash-tested child car safety seat, compared with 78% of those who had not received the curriculum. At hospital B, where parents reported demographic factors often associated with low compliance (eg, lower income, low use of seat belts, lower educational level), compliance rose from 60% before curriculum to 94% after curriculum (P less than .01). A car safety curriculum added to prenatal classes will increase parents' use of child car safety seats. Obstetricians and those managing prenatal care should assume a role in educating expectant parents about child passenger safety.

Promoting dietary change in adolescents: a school-based approach for modifying and maintaining healthful behavior.

We examined the immediate and long-term effects of a school-based, behaviorally focused dietary change program for tenth-graders. Our behavioral change objectives included increased consumption of complex carbohydrates and decreased intake of saturated fats, sugar, and salt, particularly in the form of snack foods. We randomly assigned tenth-grade classes in two northern California high schools to either a five-session dietary change program or an assessment-only control group. We collected pre- and postprogram self-report data on 218 students in areas of dietary knowledge, behavior, attitudes, food availability in the home, and intentions and self-efficacy concerning eating in specific ways. We also observed school snack choices both directly and indirectly. Our results indicated significant changes in reported behavior, knowledge, and food availability at home, as well as changes in snack choices at school. We found these changes to be durable at one-year follow-up. Our findings suggest ways in which school-based programs focused on behavioral and environmental changes may be effective in promoting dietary changes at school and at home.

A community study of a decade of in-hospital breast-feeding: implications for breast-feeding promotion.

Information concerning a subject of interest to the health community may be gathered through simple, low-cost minisurveys. Data were gathered on postpartum breast-feeding in one community in 1974, 1979, and 1984. This community mirrored national trends and offered additional information on areas of programmatic interest; findings also confirmed the hypothesis that education and national trends over time had statistically significant relationships with the choice to breast-feed. Of special note is the finding that the level of knowledge concerning infant feeding is closely linked to the choice to breast-feed, as is the relationship between the primary influence of another woman and the choice to breast-feed. With level of education controlled for, both associated variables remained significant for women with lower levels of education, the group least likely to select breast-feeding. This would suggest the probable advantage of breast-feeding promotion based on woman-to-woman contact during preconception and antepartum periods; such a program might be particularly effective with women of lower educational levels.

Impact of a comprehensive health promotion curriculum on physician behavior and attitudes.

Physician involvement with health promotion and disease prevention (HP/DP) is essential in the control of diseases in which behavioral risk factors are etiologically important. Yet physician involvement with health promotion is generally perceived as less than optimal. We report that an intensive, multifactorial curriculum introduced into a community hospital family medicine residency program increased physicians' use of preventive strategies with their patients and facilitated their use of specific, easy-to-follow protocols for the management of common problems amenable to health promotion.

Health promotion in medical education.

A significant portion of the deaths in the United States could have been prevented or postponed using known interventions. One reason this did not occur is because medical science and medical education are disease, not health, oriented. Since physicians are at the center of the health care delivery system, their disease orientation pervades the industry. Historically, there have been calls for physicians to focus more on disease prevention; however, medical education does not teach disease prevention/health promotion. There are several reasons for this: 1) medical school faculty conceptual discordance between "certainty" of curative disease vs. the "probability" of risk factor reduction; 2) gaps in the knowledge of effective interventions; 3) the concept that health promotion/disease prevention are outside the province of physicians; 4) the significant role of biomedical research grants on medical school funding; 5) the close association of medical education and the acute care hospital; and 6) the use of rote memory/lecture based teaching methods of traditional medicine vs. the problem-based learning necessary to teach disease prevention/health promotion. Some medical schools have begun to use problem based learning and to introduce health promotion concepts. Widespread and long-lasting change requires support of the leadership in medical schools and the preventive medicine/public health community, and grant funding from state and federal sources to support research on medical education research and change.

A survey of health promotion programs in U.S. and Canadian medical schools.

A health promotion and wellness survey questionnaire was sent to all 143 accredited medical schools in the United States, Canada, and Puerto Rico. Of the 120 responding schools, 29 (24.2%) offer health promotion programs and 91 (75.8%) do not; most programs began only recently (average 5.42 years). Nineteen schools plan to begin programs soon. Most emphasized in the programs is physical well-being and least emphasized is spiritual well-being. Over 50% of the schools offer these components: study skills (62.1%), support groups (62.1%), time management (58.6%), aerobics (55.2%), intramural sports (55.2%), and financial planning (51.7%). Most programs are administered by the Dean of Student Affairs, 48.3% have a budget, and 51.7% have an evaluation component. All schools with programs expressed an interest in developing a network to share information. Emphasizing health promotion and disease prevention throughout medical education is important, particularly as an approach to enhancing the doctor-patient relationship.

[Data on the community health education of social workers at the Ecole d'études sociales et pédagogiques]. / Quelques données sur la formation en santé communautaire des travailleurs sociaux à l'Ecole d'études sociales et pédagogiques.

Social workers may be an essential link between health professionals and patients. Their possibilities of action in health education and prevention could be used more systematically. From this viewpoint, the various functions they carry out are an absolute advantage. They are confronted with countless relevant matters of social and preventive medicine and often resort to "original" intervention models. This article presents a programme of training in social and preventive health developed in the Social and Educational School of Lausanne for future social workers and health promoters. The critical analysis of this programme shows the numerous difficulties which are linked to this training, but also the necessity of such a training for the social workers who are more and more involved in interventions where health problems are in the front rank.

Smoking recognition by family physicians.

Family physicians have an essential, unique, and vital role to play in preventive health care. However, the actual practice of and emphasis upon preventive medicine varies widely. Cigarette smoking is the leading preventable cause of illness and high medical costs in the United States today. This study examined the recognition of smoking patients by family physicians. The results show that physicians fail to recognize large numbers of their patients who smoke and that physician behavior is disease oriented rather than preventive. A modest educational program was very successful in improving physician awareness and recognition of smoking patients. This study suggests that family physicians can and need to become better prevention specialists and they must document the smoking habits of all their patients before attempting to counsel or intervene with smoking cessation programs.

Information services and health promotion. What libraries can do.

Effective health promotion depends on a broad information base and with the help of new technology, librarians are responding to the challenge. Robert Gann introduces a new series of articles by health information specialists which describe some of the information services available in the field of health promotion, and suggest ways in which they may best be used.

Effecting change in multicultural health promotion: a systems approach.

Given the context of a rapidly changing demography and an evolving health care system, the project described in this article was designed to address the system-wide need for changes in allied health service delivery to minority populations. A multidisciplinary, multicultural, and participative model was adopted to initiate attitudinal and behavioral changes among three groups: faculty from three allied health departments, students preparing for careers in these three professions, and community health care practitioners. This paper briefly describes the major objectives, activities, and outcomes of the project as well as insight into the factors and dynamics that affected its immediate and long-range success. The idea that significant and lasting change requires strategies that incorporate the interactive dynamics of individuals and groups of the inclusive health care system was supported in the outcomes of the project.

Curricular implications of health promotion and disease prevention in allied health education.

Several recent articles have addressed the role of allied health professionals in health promotion and disease prevention (HP/DP). The consensus is that allied health professionals are on the threshold of making major contributions to the HP/DP initiative. The focus of these contributions usually centers on the role of allied health professionals in clinical settings and the traditional medical-model emphasis on direct patient contact. In addition, there is discussion of the programmatic changes that will be required to meet the challenge of integrating health promotion concepts, knowledge, and skills into current professional curricula. The purpose of this paper is to examine critically the rationale behind providing HP/DP education for allied health professionals and to discuss the implications of such education for professional preparation programs.