Knowledge and attitudes of adults towards smoking in pregnancy: results from the HealthStyles© 2008 survey.

Smoking during pregnancy is causally associated with many adverse health outcomes. Quitting smoking, even late in pregnancy, improves some outcomes. Among adults in general and reproductive-aged women, we sought to understand knowledge and attitudes towards prenatal smoking and its effects on pregnancy outcomes. Using data from the 2008 HealthStyles© survey, we assessed knowledge and attitudes about prenatal smoking and smoking cessation. We classified respondents as having high knowledge if they gave ≥ 5 correct responses to six knowledge questions regarding the health effects of prenatal smoking. We calculated frequencies of correct responses to assess knowledge about prenatal smoking and estimated relative risk to examine knowledge by demographic and lifestyle factors. Only 15 % of all respondents and 23 % of reproductive-aged women had high knowledge of the adverse effects of prenatal smoking on pregnancy outcomes. Preterm birth and low birth weight were most often recognized as adverse outcomes associated with prenatal smoking. Nearly 70 % of reproductive-aged women smokers reported they would quit smoking if they became pregnant without any specific reasons from their doctor. Few respondents recognized the benefits of quitting smoking after the first trimester of pregnancy. Our results suggest that many women lack knowledge regarding the increased risks for adverse outcomes associated with prenatal smoking. Healthcare providers should follow the recommendations provided by the American Congress of Obstetricians and Gynecologists, which include educating women about the health risks of prenatal smoking and the benefits of quitting. Healthcare providers should emphasize quitting smoking even after the first trimester of pregnancy.

Applying the interactive systems framework to the dissemination and adoption of national and state recommendations for hypertension.

The Centers for Disease Control and Prevention (CDC), Division for Heart Disease and Stroke Prevention (DHDSP), commissioned an Institute of Medicine (IOM) report to identify the highest priority action areas for CDC, state health departments, and other public health partners in their efforts to reduce and control hypertension. To assess the dissemination and adoption of the IOM report recommendations, DHDSP developed an evaluation based on the Interactive Systems Framework for Dissemination and Implementation (ISF). The evaluation incorporates data collection at critical points across 3 years. In this article, we focus on the ISF systems to describe the role of funded state partners and their relationship with CDC in implementing public health recommendations. We describe baseline results for three data collection activities: (1) key informant interviews, (2) a Web-based survey, and (3) content analysis of state workplans to determine the degree of alignment with IOM recommendations. For example, currently 30 % of surveyed programs are implementing most (or all) of the recommendations in the IOM report, however 76 % intend to change hypertension program priorities based on the recommendations of the IOM report. Qualitative data suggest that there are several facilitators and barriers in implementing public health policy recommendations. DHDSP will use these baseline results to provide additional technical assistance and support to state health departments in their efforts to implement the IOM report's recommendations.

It's what you do! Reflections on the VERB campaign.

This article shares the first-hand experiences of the CDC's VERB team in planning, executing, and evaluating a campaign that used social marketing principles, which involved paid media advertising, promotions, and national and community partnerships to increase physical activity among children aged 9-13 years (tweens). VERB staff gained valuable experience in applying commercial marketing techniques to a public health issue. This article describes how marketing, partnership, and evaluation activities were implemented to reach a tween audience. In doing so, fundamental differences in marketing between public health and the private sector were revealed.

Did augmenting the VERB campaign advertising in select communities have an effect on awareness, attitudes, and physical activity?

BACKGROUND: Although VERB was designed as a national media campaign, funding and donated media time enabled more-intensive advertising and marketing in certain communities. To investigate the effect of increased advertising on physical activity outcomes, six "high-dose" communities were selected to receive more hours of advertising and additional promotional activities. DESIGN: Longitudinal quasi-experimental design comparing outcomes in six communities that received additional VERB marketing activities with outcomes in a comparison group that received only the national dose of advertising. SETTING/PARTICIPANTS: Two cohorts of dyads of youth aged 9-13 years (tweens) and one parent at baseline (2002), followed for 2 years. INTERVENTION: During the first year of the VERB campaign, each of the six high-dose communities received 50% more advertising and conducted special campaign activities. During the second year, only four of the six communities received the larger dose of advertising and additional promotional activities because of reduced funding. MAIN OUTCOME MEASURES: Awareness and understanding of VERB messages; attitudes about physical activity (self-efficacy, social influences, and outcome expectations); and physical activity behaviors. RESULTS: After 1 year, tweens in the high-dose communities reported higher levels of awareness and understanding of VERB and scored higher on the social influences scale than did tweens in a comparison group in areas that received only the national dose of advertising. After 2 years, tweens in the high-dose communities reported higher awareness and understanding of VERB, greater self-efficacy, more sessions of free-time physical activity per week, and were more active on the day before being surveyed than tweens in the comparison group who received the average national dose. CONCLUSIONS: Providing communities with a higher dose of marketing activities and sustaining those activities over time yields more positive outcomes.

The VERB campaign's strategy for reaching African-American, Hispanic, Asian, and American Indian children and parents.

The VERB campaign promoted physical activity to U.S. children aged 9-13 years (tweens) by surrounding them with appealing messages that were associated with the VERB brand and tag line It's what you do! To maximize the impact of the campaign, VERB had a two-level strategy for its marketing. One level was designed to reach a general audience of tweens (i.e., most tweens who use mainstream media). The second level was designed specifically to reach four racial or ethnic audiences: African Americans, Hispanics, Asian Americans, and American Indians as an augmentation to the first level. This article focuses on VERB's market segmentation strategy and reports how messages for the general audience were adapted to reach specific racial or ethnic segments of the U.S. population. Findings are reported from qualitative studies conducted with tweens and the parents of tweens from these ethnic groups, and the marketing strategies used to reach each ethnic group and the results of evaluations of those strategies are also described.

Overview of formative, process, and outcome evaluation methods used in the VERB campaign.

Evaluation was an integral part of the VERB campaign. This paper describes the array of evaluation methods used to support the development, implementation, and assessment of campaign activities. The evaluation of VERB consisted of formative, process, and outcome evaluations and involved both qualitative and quantitative methods. Formative evaluation allowed staff to test ideas for messages and to gauge their appropriateness for the intended audiences. Process evaluation allowed staff to test and monitor the fidelity of the campaign's implementation to objectives and to make changes while the campaign was under way. Outcome evaluation allowed staff to determine the campaign's effects on the target audience. Because a comprehensive approach was used, which included formative and process evaluation, the VERB team's ability to interpret the results of the outcome evaluation was enhanced.

Catalyzing community action within a national campaign: VERB community and national partnerships.

The VERB campaign used a social marketing approach to deliver its message through the mass media, school and community promotions, and partnerships to encourage children aged 9-13 years (tweens) to be physically active every day. This paper presents the VERB campaign's community and national partnership strategy, highlights three successful partnerships, and discusses challenges associated with the efforts. The national advertising generated awareness of and affinity for the product's brand and motivated the primary audience to seek out the product. The campaign's national and community partners were engaged to facilitate a product-distribution channel. The campaign developed a three-pronged partnership strategy to integrate the promotion with the placement of the campaign's product (physical activity): (1) reframe the way physical activity is positioned and delivered; (2) connect the brand to the point-of-purchase; and (3) refer (or drive) the audience to the action outlets, opportunities, places, spaces and programs to purchase the product. The VERB campaign provided partners with marketing training and resources to assist them as they leveraged tweens' brand awareness and supported regular physical activity among tweens. The method of technical assistance and the types of marketing tools were provided in relationship to four characteristics of the partner: (1) partner's network, (2) leaders and champions in the network, (3) partner's financial resources for community campaigns; and (4) partner's understanding of the marketing mindset. Coordinated, collaborative, and strong mass-media and community-based interventions within a national social marketing campaign can sustain the immediate effects of such campaigns.

Trials of decision aids for prostate cancer screening: a systematic review.

BACKGROUND: Patient decision aids are used to promote informed decision making. This review examines the methods and findings of studies that have evaluated the impact of prostate cancer screening decision aids on patient outcomes. METHODS: MEDLINE, the Cochrane Registry, reference lists, and abstracts from professional meetings were searched through December 2006. Search terms included prostate cancer screening and decision making. Studies were included if a patient education intervention for prostate cancer screening had been evaluated against a control condition. RESULTS: Eighteen eligible trials, involving 6221 participants, were identified. Sixteen studies enrolled primary care patients, while the remaining two studies were community-based. All the prostate cancer screening decision aids were in English, with varied reading levels. Consistent with previous reviews, the patient decision aids improved patient knowledge and made patients more confident about their decisions. The aids appeared to decrease interest in prostate-specific antigen testing and screening behavior among patients seeking routine care (relative risk [RR]=0.88, 95% confidence interval [CI]=0.81-0.97, p=0.008); the aids had no impact on the screening behavior of patients seeking screening services. Additionally, patients who received patient decision aids were more likely to prefer watchful waiting as a treatment option if they were found to have prostate cancer than were controls (RR=1.53, 95% CI=1.31-1.77, p<0.001). CONCLUSIONS: Prostate cancer screening decision aids enhance patient knowledge, decrease decisional conflict, and promote greater involvement in decision making. The absence of outcome measures that reflect all elements of informed decision making continues to limit the field.

Communicating cardiovascular disease risk due to elevated homocysteine levels: using the EPPM to develop print materials.

Improving the effectiveness of written information to promote compliance with therapeutic regimens is essential, particularly among older adults. Guiding their development and evaluating their effectiveness with an accepted communication theory or model may help. A preliminary test of written materials developed within the context of the Extended Parallel Process Model (EPPM) to motivate compliant behaviors among older adults at risk for cardiovascular disease is described. Participants who were not previously following the recommendations felt more confident in their ability to do so after reading a high-threat/high-efficacy message. Advanced age, lower education level, an existing chronic illness, and a higher initial homocysteine level were factors associated with lower levels of perceived threat and/or fear and may have attenuated the effectiveness of the message. This study's results contribute to our understanding of the usefulness of theory-guided written materials in motivating compliant health behaviors. Recommendations for using this model are provided.