Soldier and family wellness across the life course: a developmental model of successful aging, spirituality, and health promotion, Part II.

As an alternative to the current Department of Defense approach to health promotion and related research, which is critiqued in Part I of this article, the authors present a new, integrative health promotion and wellness model. This age-graded model incorporates successful aging, targeted health promotion, and spirituality in the context of the developmental perspective provided by life course constructs. By using an age-graded, multidisciplinary system of assessment, intervention, and follow-up in the context of preparing military personnel and families for the next season of life, this model advocates the prevention of disease and disability, active engagement with life, the maximization of high cognitive and physical functioning, and positive spirituality. Preliminary, selected illustrations from a variation of this model at the U.S. Army War College are provided. Progressive extrapolation of the model to other military leadership schools is proposed as a more efficacious health promotion strategy for the Department of Defense.

Soldier and family wellness across the life course: a developmental model of successful aging, spirituality, and health promotion. Part I.

The primary purposes of this article are to (1) highlight current challenges facing health promotion advocates within the military and civilian culture; (2) present the strengths and weaknesses of the current Army approach to health promotion and preventive medicine; and (3) present several unifying themes that contribute to enhanced progress within the field of health promotion. A conceptual model that links common goals across the fields of successful aging, health promotion, spirituality and health, and life course is advocated to maximize efficacious interventions and to transform the current Army approach to health promotion. A companion article will describe an integrative model of health promotion and wellness that responds to the challenges and incorporates the unifying themes described in this article.

Smoking cessation counseling practices: a survey of Alabama obstetrician-gynecologists.

BACKGROUND: Minimal interventions delivered by obstetrician-gynecologists (OB-GYNs) to their pregnant patients who smoke could result in a substantial decrease in smoking during pregnancy. We examined performance and motivation levels of Alabama OB-GYNs for engaging in clinical practices based on National Cancer Institute (NCI) guidelines. METHODS: Questionnaires assessing attitudes, intentions, and behaviors specified by the NCI's "4-A" model (ask, advise, assist, and arrange follow-up) were mailed to all OB-GYNs licensed in Alabama. RESULTS: A total of 130 physicians completed the questionnaire. Nearly all reported that they ask (93%) and advise (90%) their patients who smoke to quit; however, significantly fewer reported that they assist (28%) or arrange follow-up (24%) with their pregnant patients. CONCLUSIONS: Interventions are needed to motivate, support, and guide OB-GYN physicians to assist and follow-up with their pregnant patients who smoke.

Computer-based smoking cessation interventions in adolescents: description, feasibility, and six-month follow-up findings.

The impact of adolescent smoking cessation clinics has been disappointing due to low participation rates, high attrition, and low quit rates. This paper describes two computerized self-help adolescent smoking cessation intervention programs: 1) a program utilizing the expert system which is based on the transtheoretical model of change and 2) a popular action-oriented smoking cessation clinic program for teens which was modified for computer presentation. High participation rates in the program among 132 smokers demonstrate the high feasibility and acceptability of the programs. Quit rates of up to 20% were observed during the intervention, and an additional 30% made unsuccessful quit attempt(s). The 6-month follow-up findings indicated that adolescents were poorly prepared to maintain abstinence.

Smoking status and mammography in a statewide survey.

The association between smoking status and mammography was examined for women aged 40 to 75 (n = 2902), who were recruited through a statewide random digit dial survey. Controlling for income, education, age, marital status, ethnicity, and self-rated health, logistic regression showed that current smokers were less likely to be screened on each of three indicators of mammography status. Less than a high school education, income less than $20,000, martial status, and age also showed associations with screening. Having a recent medical visit was important for screening specifically among the women who smoked (n = 851). Smoking may pose a challenge to achieving national mammography goals.

An expert system intervention for smoking cessation.

Intervention efficacy can be increased when the treatment is maximally matched to the needs of the client. One means of achieving such matching is through use of an expert system, a computer-based decision-making system designed to utilize client information to produce unique, matched information and interventions. An expert system can combine the individual matching possible in a clinic-based intervention and the low cost associated with a public health approach. This paper begins by discussing several alternative implementations of the expert system approach within the general context of communication theory. Second, the theoretical model and related empirical evidence which form the basis of the expert system is described briefly. Third, the details of a computer-driven, expert system intervention specifically developed for smoking cessation is described. Finally, empirical results from a study comparing the expert system intervention to three alternative interventions for smoking cessation are presented. In general, the expert system approach can provide a cost effective, viable, and efficacious means of intervening in a specific problem behavior area. Implications and potential areas of development are discussed.

Assessing the stages of change and decision-making for contraceptive use for the prevention of pregnancy, sexually transmitted diseases, and acquired immunodeficiency syndrome.

A synergistic approach was taken to examine contraceptive use adoption for two related behaviors: pregnancy prevention and the prevention of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). One hundred twenty-three young adults responded to questionnaire items based on two constructs from the Trans-theoretical Model of Change, the Stages of Change and Decisional Balance, as well as other pertinent variables. In Phase 1, two Decisional Balance measures were developed: One for the prevention of pregnancy and one for disease prevention. Final versions of both measures consisted of two 10-item scales: one representing the positive aspects (PROS) and one representing the negative aspects (CONS) of contraceptive and condom use. In Phase 2, the same individuals were staged for both pregnancy and disease prevention according to their readiness to change for contraceptive and condom use. MANOVAs and ANOVAs indicated that the PROS and CONS for both measures were related to stage of change for both contraceptive and condom use. Results from this pilot study were consistent with prior applications of the Trans-theoretical Model to the cessation of such problem behaviors as smoking and to the adoption of positive health behaviors such as exercise acquisition.

PIP: The authors adopted a synergistic approach to explore the adoption of contraceptive use for the prevention of pregnancy and the transmission and contraction of sexually transmitted diseases (STD). 123 students from a freshman level psychology course at a northeastern university were sampled via questionnaire in 1992. Questionnaire items were based upon 2 constructs from the Transtheoretical Model of Change, Stages of Change and Decisional Balance, and other pertinent variables. Subjects were of average age 19.87 years in a range of 18-25; 62% were female; 95% were Whites; and 99% reported being heterosexual. 87% had engaged in oral and vaginal intercourse, and 14% had experienced anal intercourse. 39% reported having 5 or more sex partners since becoming sexually active. 17% reported to be currently having vaginal intercourse with someone in addition to their main or steady sex partner; 10% had been diagnosed with an STD at one time; and 14% stated that a pregnancy had occurred in one of their relationships. 2 Decisional Balance measures were developed in phase 1. In phase 2, the subjects were staged for pregnancy and disease prevention according to their readiness to change for contraceptive and condom use. It was found that the pros and cons for both measures were related to stage of change for both contraceptive and condom use.