Endometrial cytology in postmenopausal hormone replacement therapy

INTRODUCTION: The purpose was to examine whether health-promotion programs offered by California health plans are a serious attempt to improve health status or a marketing device used in an increasingly competitive marketplace. The research examined differences in the coverage, availability, utilization, and evaluation of health-promotion programs in California health plans. METHODS: A mail survey was done of the 35 HMOs (86% response) and 18 health insurance carriers (83% response) licensed to sell comprehensive health insurance in California in 1996 (some plans sell both HMO and PPO/indemnity products). The final sample included 30 commercial HMOs and 20 PPO and indemnity plans. The 1996 California Behavioral Risk Factor Survey (BRFS) of 4,000 adults was used to estimate population participation rates in health-promotion programs. RESULTS: California's HMOs in 1996 offered more comprehensive preventive benefits and health-promotion programs compared to PPO and indemnity plans. HMOs relied on a more comprehensive set of health-education methods to communicate health information to members and were more likely to open their programs to the public. HMOs are also more likely to have developed relationships with community-based and public health providers. Participation in health-promotion programs is low (2%-3%), regardless of plan type, and most health plans limit evaluations to assessment of member satisfaction and utilization. Only 35%-45% of HMOs, and no PPO/indemnity plans, assess the impact of health-promotion programs on health risks and behaviors, health status, or health care costs. CONCLUSION: For the majority of California's PPO and indemnity plans, health promotion is not an integral part of their business. For the majority of HMOs, health-promotion programs are offered primarily as a marketing vehicle. However, a substantial minority of HMOs offer health-promotion programs to achieve other organizational goals of health improvement and cost control.     

Rewards and adolescent health behavior: Promise or promise missed.

The paper, "Rewards and Adolescent Health Behavior," appearing on the following pages, is the second of two similar, large-scale field studies appearing in this journal on improving dental hygiene practices in junior high school students (see Lund & Kegeles, 1982). Both studies report well-designed and carefully evaluated experiments in the everyday setting of the school and raise two important issues for the reader: (1) Neither offers a great deal of encouragement in respect to the adequacy of our theoretical knowledge or technical competency in achieving substantial change in the health-promoting behaviors of school age children; and (2) Neither study encourages optimism in regard to the cost-effectiveness of health-promotion programs for adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smooth muscle cells isolated from the neointima after vascular injury exhibit altered responses to platelet-derived growth factor and other stimuli

Health promotion is gaining widespread recognition throughout the world as the most efficacious practice in achieving health for all. In Canada, the philosophy of health promotion is driving both federal and provincial health initiatives. Such a philosophy is derived from a human science paradigm and is in direct opposition to the natural science paradigm from which the biomedical approach to health care emerged. There now exists a tension between these contrasting paradigms as health care shifts to embrace a health-promotion perspective. The nursing process is based in the natural science paradigm and on a biomedical approach to health care. In order for nurses to embrace health promotion fully, they must move away from the philosophy of the natural sciences and adopt a human science perspective. Such a shift requires a radical transformation in nursing practice as nurses move away from the 'top-down' approach of the nursing process and adopt a 'bottom-up' approach to health-promoting nursing practice. The purpose of this paper is to compare and contrast the nursing process with the principles of health promotion, and to challenge our use of the nursing process in current nursing practice. In particular, a framework for health-promoting nursing practice will be provided.     

Health promotion in the workplace: A prescription for good health.

Encourages health promotion in the workplace, asserting that the growing awareness of the effectiveness of preventive activities in reducing health care costs presents a challenge to psychologists and other mental health professionals because changes in attitudes and behaviors are at the core of preventive efforts. The present author describes his introduction in 1983 of the Preventive Health Care Incentive Act to provide a tax credit for employers who provide preventive health programs to their employees. Examples of health-promotion programs for the workplace are offered, and advantages of such programs are considered. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Educating APNs for implementing the guidelines for adolescents in Bright futures: guidelines of health supervision of infants, children, and adolescents

As the scope of what constitutes health and the range of determinants of health-promoting and compromising behaviors among adolescents are expanded, APNs must be well prepared to be powerful influences in the lives of all adolescents. The guidelines offered by Bright Futures challenge nurse educators to prepare APNs who possess the core competencies to knowledgeably address the health issues and concerns of all adolescents in multiple settings. The American Academy of Nursing Expert Panel's recommendations contained herein, if implemented, will further enhance the capabilities of graduate programs to prepare APNs to provide developmentally and culturally relevant disease prevention and health promotion care to adolescents and their families.     

Development of the Motivators of and Barriers to Health-Smart Behaviors Inventory.

The Motivators of and Barriers to Health-Smart Behaviors Inventory (MB-HSBI) was developed for use in identifying self-reported motivators of and barriers to the following health-promoting behaviors (called health-smart behaviors) that should occur daily to help promote health and overcome illnesses/diseases: eating a healthy breakfast, eating healthy foods and snacks, drinking healthy drinks, and engaging in physical activity. The MB-HSBI was developed through several phases as part of a multisite study on modifying and preventing obesity. A central aspect of the larger study was to identify motivators of and barriers to the targeted health-smart behaviors among African American, Asian, Hispanic, and White adults. After establishing content validity and preliminary pilot testing, the MB-HSBI was administered to a national sample of 926 culturally diverse adults. Factor analyses and most of the internal consistency results supported multiple scales and subscales measuring motivators of and barriers to each of the targeted health-smart behavior domains. Scores correlated in expected directions with health self-efficacy and with importance of health-related behavioral goals. Pending further psychometric support of the MB-HSBI, this inventory or selected scales from it may serve as flexible and novel tools for (a) assessing motivators of and barriers to health-smart behaviors in community and clinical health promotion research studies and (b) developing assessment-based, culturally sensitive intervention programs that are customized to address the motivators of and barriers to health-smart behaviors identified in target communities, particularly those communities whose members are mostly racial/ethnic minorities and/or have low family incomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sequences around the fragmentation sites of the large subunit ribosomal RNA in the family Rhizobiaceae. 23S-like rRNAs in Rhizobiaceae

The concept of self-efficacy has been used widely as a model for examining health-promoting education in such areas as cardiac rehabilitation, smoking cessation, dietary modifications, pulmonary rehabilitation, and compliance with prescribed regimens. Consequently, self-efficacy has emerged as an essential concept in developing and implementing health promotion programs in advanced practice. Self-efficacy refers to an individual's perceived ability to perform a specific behavior. It is the mediator between knowledge and action, and it influences the selection of behavior, the environment in which the behavior occurs, and the amount of effort and perseverance expended on performing the behavior. This paper analyzes the concept of self-efficacy and suggests applications of self-efficacy in advanced-practice nursing.     

Occupational health promotion programs to reduce cardiovascular risk.

This article surveys the literature on worksite health-promotion programs that target cardiovascular risk factors. We review findings in the areas of health-risk appraisal, hypertension control, smoking cessation, weight reduction, and exercise. Programs that address multiple risk factors are also discussed. In each area we discuss what is currently known, highlight exemplary studies, and identify both problems and priorities for future research. Increased attention needs to be paid to motivational and organizational issues that may influence participation in and outcomes of health promotion programs. The initial results in several areas (e.g., smoking cessation, hypertension control) are promising, but additional controlled research is needed to substantiate the optimistic claims that have been made about occupational health promotion. In particular, studies that evaluate impact on all employees in an organization are recommended. Clinicians and researchers also need to appreciate the unique political, logistical, and methodological issues posed by worksite programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identity-based motivation and health.

People do not always take action to promote health, engaging instead in unhealthy habits and reporting fatalism about health. One important mechanism underlying these patterns involves identity-based motivation (D. Oyserman, 2007), the process by which content of social identities influences beliefs about in-group goals and strategies. Seven studies show the effect of identity-based motivation on health. Racial-ethnic minority participants view health promotion behaviors as White middle class and unhealthy behaviors as in-group defining (Studies 1 and 2). Priming race-ethnicity (and low socioeconomic status) increases health fatalism and reduces access to health knowledge (Studies 3 and 4). Perceived efficacy of health-promoting activities is undermined when racial-ethnic minority participants who identify unhealthy behavior as in-group defining are asked to consider their similarities to (middle-class) Whites (Studies 5-7). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Worksite characteristics and changes in worksite tobacco-control initiatives. Results from the COMMIT study

Few studies have prospectively examined the characteristics associated with worksite adoption of tobacco-control initiatives. Data were collected as part of the Community Intervention Trial (COMMIT) for Smoking Cessation, which conducted interventions in 11 communities. This smoking cessation intervention was based on community organization principles and delivered through multiple community channels, including worksites, health care providers, the media, and cessation resources. This article reports results from telephone interviews of intervention community worksites having 50 or more employees, conducted at baseline and the end of the intervention period. Among worksites that responded to both baseline and final surveys, 83% had not adopted a smoke-free policy at baseline, and 61% did not offer any cessation aid or quitting resources at baseline. By the final survey, 34% of those with no smoking ban at baseline had become smoke-free, and 36% of those offering no cessation assistance at baseline were offering cessation resources at the follow-up. The prevalence of policy adoption was higher among worksites employing more female employees and offering other health-promotion activities; manufacturing businesses were significantly less likely than businesses other than service and wholesale/retail businesses to adopt policies. Adoption of cessation programs was significantly more likely among worksites employing 100 to 249 workers, compared with those employing 50 to 99 workers; those predominantly employing men; those offering other types of health-promotion activities; and those with a higher rate of turnover. These results provide important information about the characteristics of worksites likely to engage in tobacco-control efforts. Health educators and others may choose to target those worksites most ready for adoption of tobacco control policies and programs, as indicated by these findings.     

Physical activity efficacy and effectiveness among older adults and minorities

The objective of this study was to consider efficacy and effectiveness of physical activity for the prevention and management of NIDDM among minorities and older adults of the U.S. Relevant population trends and projections are discussed, followed by a review of the efficacy of physical activity based on theoretical, prospective cohort, and intervention studies. With few empirical studies available, the assessment of effectiveness is largely theoretical and focuses on potentially important issues for future studies among older adults and minorities. Efficacy studies have shown that moderate-intensity physical activity is associated with a one- to two-thirds lower incidence of NIDDM over 4-14 years and 15-20% lower glycosylated hemoglobin over 3-4 months among people with NIDDM. With physical inactivity prevalence at 60-70%, much work remains to be done to improve physical activity effectiveness. In the most vulnerable populations, physician referral and community involvement structured around stage of change and self-efficacy theories are suggested as the most promising approaches to promoting physical activity adoption and maintenance. Effectiveness or demonstration studies that test and build on stage of change, self-efficacy, and other concepts of physical activity promotion and outcomes would likely prove to be highly valuable investments for public health.     

Mind-body fitness: encouraging prospects for primary and secondary prevention

In recent years health promotion programs have generated many worthwhile psychologic and physiologic benefits but frequently with less than optimal long-term adherence. Incorporating approaches such as mind-body exercise with existing health promotion and cardiac rehabilitation services can improve self-efficacy and long-term adherence to healthy behaviors as well as improve personal stress management skills. Mind-body exercise couples muscular activity with an internally directed focus so that the participant produces a temporary self-contemplative mental state. This internal focus is in contrast to conventional body-centered aerobic and muscular fitness exercise in which there is little or no mindful component. Research on mind-body exercise programs such as yoga and tai chi reveal they have significant mental and physical value. There also are numerous primary and secondary preventive indications for cardiovascular disease in which mind-body exercise can play a primary or complementary role. Mind-body exercise programs will be a welcome and necessary addition to evolving disease management models that focus on self-care and decreased health care use.     

Introduction to the Special Section on Dissemination: Dissemination Research and Research Dissemination: How Can We Close the Gap?

One of the greatest challenges facing health promotion and disease prevention is translating research findings into evidence-based public health and clinical practices that are actively disseminated and widely adopted. Despite the tremendous strides made in developing effective disease prevention and control programs, there has been little study of effective dissemination of evidence-based programs to and adoption by community, public health, and clinical practice settings. This special section provides a venue in which to highlight exemplary dissemination research efforts while also identifying limitations in research to date and framing important future research questions. This issue establishes a resource for investigators interested in dissemination research, with relevance to health psychology. In this sense, it can serve as a benchmark by which to examine subsequent progress. The 6 articles reflect the state of the science in dissemination research for the promotion and adoption of health behavior change interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Regional regulation of microtubule dynamics in polarized, motile cells

INTRODUCTION: Tobacco use, diet and physical activity patterns, and alcohol use are the leading causes of death in the United States. To make major improvements in the health status of the population, behavioral risk factors for disease must be addressed. METHODS: We propose a brief survey of behavioral risk factors for enrollees of health care organizations, employer groups, or other adult populations that can be used to profile the health risk behaviors of a population, assess performance of prevention and risk reduction programs, or make comparisons with other populations. The survey contains questions about tobacco, diet, physical activity, alcohol, firearms, motor vehicle safety, sexual behavior, and drugs. RESULTS: Recommendations for survey items, implementation, and calculation of performance measures are given. CONCLUSIONS: Widespread adoption of this type of survey would be a major step forward in acknowledging the impact that behavior has on health and in furthering individual and organizational accountability for improving health risk behaviors.     

Older women: social cognitive theory correlates of health behavior

Most research about health promoting behaviors has focused on pre-old adults and men, despite clear evidence that the leading cause of death among postmenopausal women is related to health behaviors. This study applied social cognitive theory constructs to exercise, dietary, and stress management health behavior. The purpose of this study was to examine the ability of self-efficacy expectation and outcome expectancy to predict health behavior among older women. Community-dwelling women aged 65 to 92 years were interviewed with previously developed instruments and instruments designed specifically for this study (N = 225). Self-efficacy was the strongest predictor of each of the health behaviors (beta weights: dietary behavior .50; exercise, .39; stress management, .32). Outcome expectancy was not a significant predictor of exercise or dietary behavior. Outcome expectancy was a significant predictor of stress management behavior. The findings of this study, combined with the importance of health promotion behaviors among older women, justify the need for continued research about self-efficacy and health behavior among this vulnerable population.     

The stages and processes of exercise adoption and maintenance in a worksite sample.

Applied the model of the stages and processes (SPs) of change to exercise adoption and maintenance. Questionnaires dealing with the SPs of exercise change were developed and administered to 1,172 employees in a worksite health promotion project. Ss were split randomly into halves for (1) initial model development and testing and (2) confirmatory measurement model testing. Additional model confirmation was obtained by examining the hierarchical structure of the processes of change and by conducting stage and process analyses. Results suggest that the underlying constructs derived from smoking cessation and other addictive behaviors can be generalized to exercise behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between self-efficacy and reductions in smoking in a contingency management procedure.

Social–cognitive and behavioral theories of change disagree on what the relevant controlling variables for initiating behavior change are. Correlations between baseline smoking cessation self-efficacy and the changes in breath carbon monoxide (CO) and the reduction in breath CO and increases in smoking cessation self-efficacy from baseline were obtained from a contingency management smoking cessation procedure. A test of the difference between the cross-lag correlations suggested a nonspurious causal relationship between smoking cessation self-efficacy and changes in breath CO. Path analyses showed that decreases in breath CO (reductions in smoking) predicted later increases in smoking cessation self-efficacy. Baseline self-reports of smoking cessation self-efficacy were not significantly correlated with subsequent changes in breath CO. Rather, significant correlations were found between reductions in breath CO and later increases in smoking cessation self-efficacy. These results suggest that self-efficacy may be a cognitive response to one’s own behavior, and are inconsistent with a social–cognitive view of self-efficacy’s role in behavior change. Implications for the development of smoking cessation programs and health-promoting behavior changes in general are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community dentistry: rationale

The present curricula in dentistry are biased in favor of cure and technical capability ... individualism rather than promotive, preventive and community orientation. The team "approach" and "total patient care" concepts must be given emphasis in these curricula. Dentistry, being a profession, should accentuate service, rather than materialism and profit. The Philippine situation demands than adoption of a "New Horizon in Health" which emphasized positive health as part of human development. The educational system, organized dentistry, the licensing board, the legislators, policy makers, oral health providers and research formulators will have important roles to perform in the successful implementation of this "new horizon in health" concept. "Primary Health Care" is another strategy adopted to realize the global goal of "Health for all by Year 2000". This is a positive approach for both individual and community oral health intervention programs.     

Recovery: Leaps of faith for addicts and psychologists.

Reviews research supporting a biologic role for addiction and argues that psychologists must become more accepting of 12-step programs for alcoholism and addiction, such as the programs offered by AA. The research indicates that craving for alcohol or drugs involves abnormalities in the reward system in the mesolimbic area of the brain. Research from adoption studies and twin studies also supports a genetic link for alcoholism. Some psychologists have opposed the AA model of recovery for reasons ranging from its "incompatibility" with psychotherapy to its emphasis on the disease concept. This opposition has alienated psychology from a position of influence in addiction treatment. More psychologists should accept these types of recovery programs and integrate them into practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)