Health attitude scale construction: importance of psychometric evidence.

OBJECTIVE: To identify 18 steps to 3-component attitude scale construction. METHODS: Examples are provided to illustrate each step. RESULTS: The presentation primarily focused on specific steps in constructing meaningful health attitude scales. Further, the importance and concept of various forms of realibilty and validity are provided. Special attention is given to factors affectiving psychometric evidence. CONCLUSIONS: In order to meaningfully measure health related attitudes, researchers and evaluators should consider following the steps outline in the presentation.

Health promotion beliefs and practices among pharmacists.

OBJECTIVE: To examine the health promotion beliefs and practices of pharmacists. DESIGN: Cross-sectional mail survey. SETTING: Indiana. PARTICIPANTS: Staff pharmacists. METHODS: Of the 1,440 registered Indiana pharmacies, one-half were selected using a systematic random process. Questionnaires were mailed to the 720 selected pharmacies asking one staff pharmacist to complete a 73-item questionnaire. RESULTS: A total of 552 pharmacists responded to the questionnaire, providing a 76.7% response rate. The majority of pharmacists believed that 10 of the 20 behaviors encouraged by national health objectives were very important for the average person. There was, however, considerably less agreement among pharmacists about the importance of the other 10 behaviors and practices. Pharmacists' involvement, preparation, and confidence in specific health promotion areas and activities were limited. A number of barriers were cited by respondents that could have hindered pharmacists' involvement in public health education activities. Despite these hindrances, pharmacists appear to be making strides toward providing health promotion education and activities. CONCLUSION: Pharmacists are readily accessible sources of information concerning the importance of needed lifestyle factors on health. They can provide valuable education to patients about improvement of lifestyles as a routine component of pharmaceutical care.

Evaluation of HIV/AIDS education in Russia using a video approach.

HIV/AIDS has intruded upon the geographic, political, ethnic, gender, and sexual orientation of communities all over the world. As of April 1999, Russia has recorded approximately 13,532 cases of HIV infection. Since the costs of treatment are expensive for many countries, and especially for Russia, educational intervention appears to offer the most effective and affordable solution. A quasi-experimental design, with pre/post tests and intervention (through video education)/control groups, was used to study 20 public schools in St. Petersburg, Russia. Results confirmed the lack of HIV/AIDS education in schools and insufficient information sources from parents, friends, and public health education. ANCOVA statistics demonstrated that use of video education significantly improved students' scores on knowledge and attitudes related to HIV/AIDS prevention. Thus, health educators should consider video education as an effective and efficient tool to present facts to a young audience when they face constraints of shortage of funds, lack of trained teachers, and scarcity of related information.

Pharmacists' concerns and suggestions related to the sale of tobacco and alcohol in pharmacies.

A random sample of Pharmacists in Indiana was selected and surveyed regarding their thoughts and comments on the sale of tobacco and alcoholic products by pharmacies. A total of 212 pharmacists provided written responses to an open-ended question. The replies were then synthesized into major themes. The majority of comments categorized revealed strong opposition to pharmacies selling tobacco and alcohol products. The most frequently occurring message regarding the sale of these products by pharmacies was that it goes against the pharmacist's role as a professional health care provider and may harm their image. For some pharmacists, this issue posed a moral dilemma between caring for patient safety and the economic incentives provided by the sale of tobacco and alcohol. Based on these findings, a follow-up phone survey was conducted to solicit suggestions from pharmacists on how to advocate against the sale of tobacco and alcohol by pharmacies. The majority of pharmacists strongly recommended that they need to do more among themselves and within their store environment, rather than have regulations imposed on pharmacies when it comes to limiting the sale of these products.

Pharmacists' opinions and practices related to the sale of cigarettes and alcohol--a follow-up study.

Opinions that pharmacists hold and their practices concerning sale of cigarettes and alcohol are of interest to health experts. As a follow-up to a 1990 statewide survey of pharmacists opinions and practices related to the sale of cigarettes and alcohol, this study was designed (1) to determine current opinions and practices of pharmacists' related to the sale of cigarettes and alcohol; (2) compare these findings with results from the 1990 study; and (3) to gather new information on pharmacists' practice of health promotion activities. A structured survey questionnaire was designed and reviewed by a jury of experts and subsequently administered to half of the 1340 pharmacies in Indiana. Collected data were analyzed by using descriptive and inferential statistical methods. Findings reveal that 64 percent of responding pharmacists sell cigarettes in their stores even though 82 percent think that their stores should not sell cigarettes. Approximately 42 percent of the pharmacies sell alcoholic beverages while more than two-thirds of the pharmacists (68%) think pharmacies should not sell alcoholic beverages. These findings represent a decline of 7.2 percent in pharmacies that sell cigarettes and a 6.8 percent increase in pharmacies selling alcoholic beverages compared to the 1990 study. Study results also revealed that most pharmacists agree the use of cigarettes and alcohol were important causes of morbidity and mortality and that pharmacists should play a role in health promotion and disease prevention to the public. However, the majority do not ask their patients about their smoking and alcohol habits and do not participate in health education/promotion programs for the general community.

Trends of public opinion on tobacco use and public policy.

This study examined the trends and stability of public opinion related to tobacco use and raising tobacco taxes in Indiana. Using a structured questionnaire, a sample of 800 households was randomly selected, and the adults were interviewed by telephone in 1989, 1990 and 1992 by the Indiana University Center for Survey Research. The data were subjected to descriptive and chi-square statistical procedures. The results of the study indicate that more than 80% agreed that secondhand smoke is a health threat, and the opinions remained practically stable for the duration of the study. Most respondents agreed that public places should be required to have nonsmoking areas. Further, most people favored a tax increase on cigarettes, and there was an upward trend toward more people favoring a tax increase in recent years. It was concluded that the tax on tobacco should be increased for public health reasons.

Prevalence of adolescent health risk behaviors: school health implications.

This state survey randomly selected 2,037 ninth- and twelfth-grade students to determine the onset and prevalence of health risk behaviors. A higher pattern of risk-taking behavior was found among younger in comparison with older students. Gender differences were also noted. Implications for school health intervention are discussed.

Cross-cultural study of samples of adolescents' attitudes, knowledge, and behaviors related to smoking.

This study examined the smoking behavior, knowledge, and attitudes of 413 students in Grades 7 and 8 in the United States and 393 such students in the People's Republic of China. A survey questionnaire developed by Pederson and Lefcoe was adapted and then translated into Mandarin. There were statistically significant differences between the students of the two countries in knowledge, attitude, and behavior related to smoking. Families played an important role in relation to smoking among this age group.

Public opinion on tobacco use, its taxes and public policy.

Public opinion is an important vehicle in shaping legislative efforts and public policy related to tobacco use and related taxes. This study examined public opinion about policy related to tobacco use and raising tobacco taxes in a Midwestern state. The American Lung Association of Indiana provided a grant to sponsor this project. A structured questionnaire was developed, field tested and revised for the final data collection procedure. A sample of 800 adult subjects was randomly selected and telephone interviewed by the Indiana University Center for Survey Research. The collected data were subjected to descriptive and inferential statistics. The data revealed a good representative sample of adult males and females for various age groups and socioeconomic backgrounds. Among other findings, 29% were currently smokers, 23% were former smokers, and 47.5% never smoked. More than 90% support a requirement that public places have nonsmoking areas. About 85% favor an increase in cigarette taxes to pay for health education and tobacco-related research. The relationship of the subjects' gender, education and income to their opinion about the various aspects of tobacco, taxes and related policies were examined.

The 1993 ASHA membership survey: members speak up.

Professional organizations, to better serve their members, must strive to communicate regularly with the membership at large and to learn about members' needs, interests, and personal and professional status. The membership survey of the American School Health Association was sent to a stratified random sample of 500 members. A 68% response rate was achieved after a presurvey announcement and two follow-up mailings. Collected data was subjected to descriptive analysis and the chi-square test of significance. Survey findings indicated most ASHA members are satisfied with the overall operation and services of the Association. Data revealed satisfaction with overall quality, format, content, and appearance of the Journal of School Health. The ASHA national school health conference, The PULSE, and other ASHA publications also received strong approval. One-half the respondents reported they are required to earn continuing education credit. More than two-thirds of respondents had never attended a national conference. Overall ratings of various ASHA functions were statistically related to age, gender, income level, educational background, and primary discipline.

Cigarette smoking as a predictor of alcohol and other drug use by children and adolescents: evidence of the "gateway drug effect".

Data from a statewide survey, conducted by the Indiana Prevention Resource Center, of 20,629 Indiana students in grades 5-12 were analyzed to determine the extent to which cigarette smoking predicted use of alcohol and other drugs and acted as a so-called "gateway drug." A three-stage purposive/quota cluster sampling strategy yielded a representative sample of Indiana students, stratified by grade. Cross-tabulated data revealed a strong, dose-dependent relationship between smoking behavior and binge drinking, as well as use of alcohol and illicit drugs. Daily pack-a-day smokers were three times more likely to drink alcohol, seven times more likely to use smokeless tobacco, and 10-30 times more likely to use illicit drugs than nonsmokers. A stepwise multiple regression analyzed the role that the student's perceptions of the risk of using drugs and of peer approval/disapproval of the student's drug use, gender, grade in school, and ethnic background played in predicting alcohol and other drug use.

HIV/AIDS education in Indiana public schools, grades 7-12.

Indiana secondary school principals were surveyed regarding HIV/AIDS education status in their schools. A questionnaire from the Centers for Disease Control was evaluated then modified for the survey. More than 520 school principals responded to the questionnaire mailed to all 680 school principals, grades 7-12, in Indiana. Most schools offer some form of HIV/AIDS education in grades 7-12. HIV education was taught by teachers with different educational backgrounds and school roles. Almost 60% of school principals believe students are at risk for HIV infection. Tests of statistical significance were conducted with regard to principals' opinions and actual practice of HIV/AIDS education in schools. Most schools have responded to the need for HIV/AIDS education, but with a variety of formats, teaching personnel, and teacher training.

Alternate forms of HIV prevention attitude scales for teenagers.

The purpose of this study was to develop valid, alternate-form scales to measure teenagers' attitudes toward prevention of the transmission of human immunodeficiency virus (HIV). Using a three-component attitude model, a two-way table of specifications was constructed as a theoretical framework for generating attitudinal items relevant to HIV and HIV prevention. Thus, a large pool of Likert-type items was generated, reviewed for clarity and content validity, and prepared for the preliminary scale with 50 items. The scale was administered to 210 high school students. As a result of extensive analyses, two alternate forms with 15 items each were developed. The two forms were simultaneously administered to a sample of 600 high school students. The collected data were subjected to item analyses, factor analysis, and reliability estimation. The results of the analyses provided strong evidence of internal consistency, content validity, and comparability of both forms. The alternate reliability across the form was .82. The alpha reliability coefficients for forms A and B was .78 and .77 and the split-half .76 and .69, respectively. It is concluded that these alternate forms produce valid, reliable, and comparable results for measuring teenagers' attitudes toward HIV prevention. These forms are ideal for pretest/posttest designs used for evaluating educational approaches to HIV control.

An alcohol attitude scale for teen-agers: a short form.

Lack of valid measurement remains a major obstacle in research and evaluation of health education programs. An alcohol attitude scale for teen-agers developed by the author was found to be a valid tool for researchers. However, because of the length of the scale, it was not a feasible device for practitioners in health education. In this study, a shorter form of the scale was developed. An alcohol attitude scale for teen-agers, composed of 54 Likert-type items, was reduced to produce a short form. Stepwise discriminant function analysis of the data identified 19 items that were the greatest discriminators between heavy drinking and nondrinking teen-agers. For the purpose of cross-validation, the short form of 19 items was administered to a representative sample of more than 1,250 teen-agers in several midwest school districts. The collected data were analyzed using univariate and multivariate statistical methods for providing evidence of validity and reliability of the short form. Results demonstrated highly significant levels of internal consistency and discriminating power of items and the total scale. The short form of the attitude scale for teen-agers was found to be a valid and reliable instrument for use as an alternative to the longer alcohol attitude scale from which it was derived.

Evaluation of the effects of cancer education on knowledge, attitude, and behavior of university undergraduate students.

Reviews indicate that multiple predisposing factors such as knowledge, attitudes, and values significantly influence health-related practices and lifestyle. Some predispositions, such as basic knowledge about and attitudes toward cancer, are conducive to change through education. This study has investigated the effects of cancer education on the knowledge, attitude, and behavior scores of students concerning cancer prevention. A quasiexperimental design using pretests and posttests was the design of choice. The undergraduate students served as the experimental group and enrolled in an elective course entitled "The Nature of Cancer." Another group of students enrolled in the elective course "Sex Education" and served as a control group for one semester. A battery of instruments consisting of cancer prevention attitudes, knowledge, and behavior was used to measure the dependent variables. The findings, using a split-plot model for repeated measure data, revealed significant improvements in attitude, knowledge, and behavior scores for the experimental group over the control group.

Tobacco use by samples of american and Turkish students: a cross-cultural study.

Tobacco use is a world-wide problem with a significant impact on the health and well-being of many people. To design an effective smoking education program, it is important to understand smoking patterns and factors associated with this additive habit from a cross-cultural perspective. The purpose of this study was to investigate some of the patterns of and certain factors associated with smoking and chewing tobacco behavior among the students of the United States and Turkey. A questionnaire, designed, reviewed, and revised by experts, was administered to a representative sample of 450 college students in a major public university in the United States. It was then translated and reviewed by bilingual authorities. The investigator administered the questionnaire to a sample of 450 representative college students in a counterpart public university in Turkey. The results indicate that a significant number of college students in both countries use tobacco. The patterns of smoking and various factors associated with tobacco use, however, are different in the two cultures. It was concluded that international health education programs which are sensitive to cultural differences are the key to ultimately eliminating this major health crisis.

Factors affecting reliability coefficients of health attitude scales.

This study determined the minimum number of health attitude items and minimum sample size required to achieve maximum scale reliability coefficients, using different methods of estimating reliability. A 54-item alcohol attitude scale was administered to 700 participants. The scale produced .96 and .91 reliability coefficients, using the Cronbach Alpha (CA) and the Split-half (S-B) methods, respectively. A computer program randomly selected groups of participants and items from the pool of participants and items using different increments. A matrix of coefficients of reliability for both methods was calculated for different groups of items and sample size. To replicate the study, a 30-item cancer attitude scale was administered to more than 1,000 representative participants and produced reliability coefficients of .94 (using CA) and .82 (using S-B). The same computer and statistical procedures were repeated for the second data set. Results from both analyses consistently demonstrated that sample size has an insignificant effect on the coefficient values of reliability. Reliability increased as the number of items reached 18. Adding more items only negligibly increased the coefficients. Overall, the CA method consistently produced higher coefficient values of reliability compared to the S-B method.