Biomedical subjects

N H Gottlieb

Publications and source records attributed to N H Gottlieb.

At least 19 recordsLinked to original sources

PubMed1999

Put prevention into practice. Evaluation of program initiation in nine Texas clinical sites.

INTRODUCTION: Put Prevention Into Practice (PPIP) is a program designed to improve the delivery of clinical preventive services by primary care providers, through the use of specific office materials for providers and clinic staff, as well as an educational booklet for patients. The purpose of this study was to identify potential predictors of successful initiation of PPIP among 9 Texas public health clinics participating in a demonstration project funded by the Texas Department of Health (TDH). METHODS: The PRECEDE model was utilized as a theoretical framework for the study. A qualitative, case study methodology was employed, with structured interviews and open-ended questions asked of each site's PPIP personnel. Information from the sites' report to the TDH on the number of charts containing PPIP forms was also used for purposes of data triangulation. RESULTS: Sites that initiated PPIP successfully were characterized by a medium patient load, the ability to serve low-resource populations, prior attempts to implement categorical programs, existence of a philosophy of prevention, and pre-implementation planning. Barriers to successful initiation were identified as systems-related, patient-related, and staff-related. CONCLUSIONS: We identified factors that might predict the successful initiation of PPIP in public health primary care settings. Implications of present findings for implementation of similar health promotion programs in clinical settings are discussed.

Attitude of Health Personnel↗

PubMed1999

Partnerships for comprehensive school health: collaboration among colleges/universities, state-level organizations, and local school districts.

A qualitative survey on the collaborative experiences of colleges and universities, state-level organizations, and school districts related to comprehensive school health programs in 12 states found four primary collaborative outcomes: training, consultation, research, and networking. Five common dimensions of collaboration also were identified: interpersonal and organizational interactions, level of awareness and understanding of comprehensive school health programs, organizational priorities and reward systems, political forces, and availability and sharing of resources. The potential for such linkages to advance comprehensive school health programs remains largely untapped. Recommendations for developing such collaborations are presented.

Data Collection↗

PubMed1999

Chart documentation of clinical preventive services at 9 Texas clinics.

Documentation of clinical preventive services at 9 Texas family practice residency programs, community health centers, and public health regional clinics was examined. Assessment of 11 risks, counseling on those risks, and timeliness of 8 screening tests and immunizations were abstracted. Documentation of clinicians' risk assessment focused on tobacco use (56.4%), alcohol/drug abuse (45.8%), and excess weight (21.6%). Counseling was documented most often for nutrition (20.5%), family planning (11.6%), and physical activity (10.3%). Of the sites studied, public health regional clinics had the highest documentation of assessment and counseling. Community health centers were most up-to-date for diabetes and cholesterol screening. Family practice residencies documented the highest rate of counseling for obesity risk. Clinicians do not document risk assessment, counseling, or up-to-date screening tests and immunizations for most of their adult patients. Texas practitioners may need support or assistance to provide universal access to clinical preventive services.

Adult↗

PubMed1997

State legislators' intentions to vote and subsequent votes on tobacco control legislation.

The predictive validity of state legislators' behavioral intentions in relation to their votes on tobacco control legislation was assessed by using the theory of planned behavior (I. Ajzen, 1991). Intentions to vote for cigarette tax increases were measured through interviews in the summer of 1994. A bill containing cigarette tax increases was considered about 8 months later. Votes were compared with intentions and were found to be consistent for 78% of these legislators (N = 120). Multiple logistic regression analyses showed a strong independent relationship between intentions and voting and a similar effect of political party; results suggested but did not confirm that votes were predicted by interactions between intentions and perceived control. Legislator surveys that use this conceptual model can provide results relevant to understanding tobacco policy development.

Adult↗

PubMed1997

State legislators' perceptions of lobbyists and lobbying on tobacco control issues.

OBJECTIVE: To determine state legislators' perceptions about health and tobacco lobbyists, their frequency of contact with these lobbyists, and the amount of campaign contributions from health professional organisations and the tobacco industry. DESIGN: Cross-sectional study. SUBJECTS: State legislators from North Carolina, Texas, and Vermont (USA), serving in 1994. MAIN OUTCOME MEASURES: Perceptions about lobbyists representing the tobacco industry, non-profit health organisations, and state medical societies with respect to their credibility, importance as sources of information, and persuasiveness; extent of lobbying activities; campaign contributions from health professional organisations and the tobacco industry. RESULTS: Almost all legislators reported that medical society and non-profit health organisation lobbyists are credible on tobacco issues and just over half believed that these lobbyists are important sources of information. More legislators said they could be persuaded by medical and health lobbyists than by tobacco lobbyists. Although health professional Political Action Committees (PACs) gave campaign contributions to more state legislators, and gave higher amounts on average, than tobacco PACs, legislators reported less contact with medical society lobbyists than tobacco lobbyists about tobacco issues. CONCLUSIONS: State legislators have positive attitudes toward lobbyists for non-profit health organisations and state medical societies regarding tobacco issues. These groups may be an underused resource for educating legislators about tobacco control measures.

Cross-Sectional Studies↗

PubMed1997

State legislators' attitudes and voting intentions toward tobacco control legislation.

OBJECTIVES: This study describes state legislators' knowledge, attitudes, and voting intentions with regard to tobacco-related issues. METHODS: A cross-sectional survey of state legislators was conducted in North Carolina, Texas, and Vermont in 1994. RESULTS: Most legislators agreed that secondhand smoke can cause lung cancer in nonsmokers, and a majority believed that smokers are addicted to nicotine. More than 75% stated that they would support a measure to enforce laws preventing tobacco sales to youth. A majority of Texas and Vermont legislators supported an increase in the state cigarette excise tax; 43% of North Carolina legislators would support an increase if revenues were directed toward tobacco farmer diversification. CONCLUSIONS: State legislators believe tobacco to be addictive, and they support policies to protect youth from tobacco. Support for other legislative measures differs significantly across states.

Cross-Sectional Studies↗

PubMed1995

Diffusion of an effective tobacco prevention program. Part I: Evaluation of the dissemination phase.

As health promotion methods are proven effective, the diffusion and widespread implementation of successful programs can significantly reduce behaviors that pose risks to health within a targeted population. The Smart Choices Diffusion Project developed and evaluated a dissemination intervention program that targeted 128 school districts in east Texas. The project employed a theory-based model to disseminate information about a proven tobacco prevention program to opinion leaders in each district. These opinion leaders were asked to personally communicate the program information within their district using a videotape and printed materials, and advocate for program adoption. In addition to personal communication, a newsletter linked school districts. Opinion leaders in 52% of the districts showed the videotape, which modeled program adoption. A quasi-experimental design was used to evaluate the impact of the dissemination phase on teachers' and administrators' readiness to adopt a tobacco prevention program. Evaluation of the dissemination phase revealed no differences between the intervention and comparison districts in a district's readiness to adopt a tobacco prevention program. However, in intervention districts where school administrators viewed the videotape, the administrators were more likely to perceive the innovative program as having a relative advantage and to perceive their district's organizational and social environment as supportive of adopting the program.

Administrative Personnel↗

PubMed1995

Diffusion of an effective tobacco prevention program. Part II: Evaluation of the adoption phase.

This paper presents the results of theory-based intervention strategies to increase the adoption of a tobacco prevention program. The adoption intervention followed a series of dissemination intervention strategies targeted at 128 school districts in Texas. Informed by Social Cognitive Theory, the intervention provided opportunities for districts to learn about and model themselves after 'successful' school districts that had adopted the program, and to see the potential for social reinforcement through the knowledge that the program had the potential to have an important influence on students' lives. The proportion of districts in the Intervention condition that adopted the program was significantly greater than in the Comparison condition (P < 0.001). Stepwise logistic regression indicated that the variables most closely related to adoption among intervention districts were teacher attitudes toward the innovation and organizational considerations of administrators. Recommendations for the development of effective strategies for the diffusion of innovations are presented.

Administrative Personnel↗

PubMed1995

Settings as an important dimension in health education/promotion policy, programs, and research.

Settings--community, worksite, schools, and healthcare sites--constitute an important dimension of health education/health promotion policy and programs and for research about program needs, feasibility, efficacy, and effectiveness. These settings vary in the extent of coverage of and relationships with their respective constituencies, valued outcomes, and quantity and quality of evidence about the effectiveness of setting-specific and cross-setting programs. Main sources of evidence for program efficacy and effectiveness are summarized, leading to the conclusion that strides have been made toward building a strong evidentiary base for health education/health promotion in these settings. Gaps in research exist, especially for diffusion of effective programs, new technologies, the influence of policy, relations between settings, and approaches to marginal and special subgroups. Recommendations are offered for cross-setting and within-setting research related to intervention.

Community Health Services↗

PubMed1994

Increasing teacher receptivity toward use of tobacco prevention education programs.

An empirical examination of teacher receptivity to and practice of tobacco prevention education provides the foundation for comprehensive staff development to increase diffusion of drug prevention education curricula. Randomly-selected first grade Texas teachers (n = 313) were asked to complete a questionnaire during the first and second years of the Smoke-Free Class of 2000 (SFC2000) project. Initially 64 percent of recipients used materials. However, two of every five first-year users did not maintain use one year later, and many who intended use never implemented. Principal components analysis of fourteen items pertaining to receptivity resulted in four scales with acceptable reliability scores: general receptivity to tobacco prevention education, personal support for teaching tobacco prevention education, personal involvement, and school involvement in tobacco prevention. Scales were predictive of initial and continued use and provide a teacher receptivity measure to guide staff development.

Adult↗

PubMed1993

Correlates of coalition effectiveness: the Smoke Free Class of 2000 Program.

Fifty state and local coalitions that carry out the Smoke Free Class of 2000 program of the American Cancer Society, American Heart Association and American Lung Association were surveyed in 1990. Almost all (95%) rated themselves moderately or very active and a total of 88 900 second grade teachers were estimated to have received the materials. The availability of funds, competing priorities, lack of coordination, differences in agency service areas and personnel availability were most frequently cited as areas of concern to the coalitions. Personnel barriers and formality of coalition structure were independently related to perceived coalition effectiveness and, with the number of elementary schools, to perceived coalition activity. General recommendations, that were accepted upon completion of the assessment, included (1) formalization of agreements, mission statements, and goals and objectives, (2) attention to group formation and identification, and (3) clarification of national coalition expectations.

Data Collection↗

PubMed1992

The implementation of a restrictive worksite smoking policy in a large decentralized organization.

This study investigates the implementation of a restrictive smoking policy in decentralized worksites. A model which includes four elements--concept, context, process, and outcomes--is used as a framework for identifying characteristics that influence implementation. The organization studied was a state human services agency with approximately 400 worksites spread across 12 geographic regions. Quantitative data collection included three cross-sectional surveys of employees and supervisors administered before and after the date the policy became effective. Qualitative data were collected from three sources, including written comments on surveys, focus groups, and structured interviews with supervisors and top administrators. Tabular analyses and one-way analyses of variance were used to analyze quantitative data. Qualitative data were examined for key themes and have been used to elucidate findings. Those characteristics related to concept, context, and process which appeared to have the strongest influence on expected and unexpected outcomes of the restrictive smoking policy were degree of policy restrictiveness, job characteristics, perceived level of participation in formulation and implementation, and support of supervisors responsible for day to day enforcement. In particular, in this decentralized organization, lack of participation was found to underlie many of the problems experienced in implementation. The practical implications for developing and implementing a worksite restrictive smoking policy are discussed.

Cross-Sectional Studies↗

PubMed1992

A profile of health risks among blue-collar workers.

Despite national objectives for extending health promotion programs to blue-collar workers and to small work sites, baseline behavior information for planning such programs is lacking. This study seeks to describe the health risks and norms specific to a population of male, blue-collar gas pipeline workers in remote sites. These workers (n = 395) completed a health risk appraisal and a "health gauge" survey designed to measure nutrition, physical activity, tobacco use, participatory patterns in health-enhancing activities, group norms, and change efforts. Selected behaviors were similar to those of other Texas men (eg, smoking 27% versus 26%) although others were not (eg, smokeless tobacco 18% versus 8%). Multivariate analysis confirmed the relationship of friends' behavior patterns, risk-taking, and interpersonal experience to four lifestyle health behaviors. With 75% or more of workers expressing an interest in various programs, the findings suggest that programming for this population can be successful if tailored to current behaviors and the worksite culture.

Adult↗

PubMed1991

A comparison of smokeless tobacco and smoking practices of university varsity and intramural baseball players.

To examine the smokeless tobacco (ST) and smoking practices of collegiate varsity and intramural baseball players, 284 undergraduate athletes at two major Southwestern universities were surveyed using a questionnaire previously developed to measure use among this population. About one-fourth of all athletes were current ST users and 4% smokers. Over half of varsity players (53%) compared to 25.9% of intramural players used one or both forms of ST. Varsity players were about 20 times more likely to use ST as to smoke, while intramural players were about five times as likely to use ST than to smoke. On both teams, use of chewing tobacco was associated with use of snuff. Smoking was not associated with ST use in either group. Mean ages for initiation for all products was 15, and for quitting, 18. There was no evidence that one form of tobacco served as a gateway for the other among these young adult athletes. Over a fourth of all users started after age 17, suggesting that college is an appropriate locus for both ST prevention and cessation programming. Such programs for this population must address the unique characteristics of the social environment in collegiate baseball.

Adult↗

PubMed1991

An evaluation of the effectiveness of a planned diffusion process: the Smoke-Free Class of 2000 project in Texas.

The first year of the Texas Triagency Coalition Smoke-Free Class of 2000 project (SFC2000) in Texas was evaluated using a descriptive model developed from diffusion theory. Tobacco-prevention education (TPE) materials were to be made available to all first grade teachers within the state. A random sample survey of 213 teachers indicated that 96 (44.7%) had received the materials. Adoption and implementation were high. By May of 1989, 64.2% of those teachers receiving materials had adopted and already implemented the program, and 25.3% had adopted and intended to use the materials. Almost all (96.8%) of those teachers who received the kit indicated that they would maintain the first grade program in the coming school year. Of respondents to a 1 year follow-up survey, 41.1% used it the first year only, 27.3% used it both years, 12.5% used it only in year 2 and 18.2% did not use it either year. Of those receiving the kits, 48% indicated that they had not previously taught TPE and thus were introduced to the concept of TPE through the SFC2000 kits. Receptivity was highest (over 90% agreement) for including TPE in elementary school curricula, with fewer teachers strongly agreeing with items tapping personal involvement with TPE. This evaluation of a statewide component of a national initiative reinforces the need to consider the dissemination and implementation of materials when planning large-scale interventions and evaluating their impact.

Adult↗

PubMed1990

Impact of a restrictive work site smoking policy on smoking behavior, attitudes, and norms.

Three successive cross-sectional surveys were used to measure the impact of a restrictive smoking policy on employee smoking patterns, perceived exposure to environmental tobacco smoke, attitudes about the policy, and smoking-related norms in a large decentralized state agency. No significant change was detected in smoking prevalence, the proportion of smokers attempting to quit, or the total daily consumption of cigarettes by smokers. The daily consumption of cigarettes at work decreased significantly, from 16.9% to 4.9% smoking 15 or more cigarettes per day. The proportion of respondents bothered every day by coworkers' smoke dropped from 21.8% to 3.8%. Following policy implementation, the interaction between smokers and nonsmokers about smoking decreased. The findings suggest that restrictive work site smoking policies are effective at decreasing exposure to environmental tobacco smoke, but not, at least in the short run, at lowering smoking prevalence. Also, the decreased interaction regarding smoking may have the unintended consequence of reducing the perceived pressure on smokers to quit.

Black or African American↗

PubMed1990

A systematic effort to reduce smoking at the worksite.

Smoking control is a key element of worksite health promotion. This three-stage study in a large state human services agency included a baseline survey, an assessment of the effects of competition on recruitment to a self-help cessation program, and examination of the outcome of the cessation program. In stage 1, scales for measuring smoking-related attitudes and the social environment were developed and used to study norms for smoking. Regression analysis was used to ascertain correlates of smokers' intentions to quit and to join a self-help program and non-smoker assertiveness. In stage 2, an evaluation using a quasi-experimental design indicated that competition was moderately effective in increasing the recruitment of all employees to the Great American Smoke-Out (70 vs. 17%) and of smokers to a self-help cessation program (28 vs. 6%). In stage 3, the self-reported quit rate at the end of the program was 28% and the biochemically-verified six months' cessation rate was 7%. Efforts are needed to strengthen, using ethical means, the norms for not smoking at the worksite and to increase both the recruitment to and the effectiveness of smoking cessation programs.

Adult↗

PubMed1989

Smoking policies among private employers and public agencies in Texas: a statewide analysis.

The present study examined the prevalence, correlates, and perceived impact of smoking policies among private employers and public agencies in Texas. An identical survey instrument was administered to two groups of Texas employers: a random sample of private industries and all state agencies (excluding universities). Response rates were 62% (n = 420) for private industries and 73% (n = 130) for public agencies. Fifty-two percent of state agencies and 53% of private employers reported having a smoking policy, with the majority of policies having been implemented since 1986. Concern about employees' health or comfort was the most important reason for implementing a policy for both state agencies and private employers. Both groups believed that implementation of a policy resulted in fewer complaints from employees and less smoking in the workplace but had less impact on productivity or morale. This study on the prevalence of smoking policies in the workplace is the first to document that the majority of surveyed employers have a restrictive smoking policy in place. In addition, this study found minimal differences in the prevalence, rationale, and perceived benefits of smoking policies between private employers and state agencies.

Humans↗