Biomedical subjects

V J Strecher

Publications and source records attributed to V J Strecher.

At least 37 records · Page 2Linked to original sources

PubMed1993

The role of outcome and efficacy expectations in an intervention designed to reduce infants' exposure to environmental tobacco smoke.

The purpose of this paper is to examine the role of a theoretical framework in an intervention program designed to reduce infants' exposure to environmental tobacco smoke (ETS). The content of a nurse-based intervention focused on two psychosocial constructs: expectations of outcomes which may result from behaviors associated with ETS exposure and expectations of self-efficacy associated with the mother's ability to engage in these behaviors. This study found both constructs predictive of change in, and maintenance of, ETS exposure control. In particular, mothers reporting both low outcome and low efficacy expectations tended to have infants with the highest levels of ETS exposure. We also found that our intervention was effective in changing outcome and efficacy expectations in the desired direction. These findings suggest that outcome and efficacy expectations are changeable, and, therefore, represent important targets in future programs aimed at controlling ETS exposure.

Adolescent↗

PubMed1991

Passive smoking during the first year of life.

BACKGROUND AND PURPOSE: A description of passive smoking during the first year of life might assist planning preventive efforts. METHODS: Changes in the ecology of passive smoking were investigated in a sample of infants in central North Carolina followed from birth to one year of age. RESULTS: The prevalence of tobacco smoke absorption, indicated by excretion of cotinine, increased from 53 percent to 77 percent (95% CI of difference: 14, 35) during the first year of life. Most infants (92 percent) excreting cotinine at three weeks of age were also excreting it at one year. Moreover, 61 percent of infants not excreting cotinine at age three weeks were excreting it at one year. This increase reflected an increased exposure to household and, particularly, nonhousehold sources of smoke; the proportion of infants exposed to nonhousehold smokers increased from 14 percent to 36 percent. CONCLUSIONS: These findings suggest that prevention of the onset of passive smoking should begin very early.

Adult↗

PubMed1991

Prevention and early detection activities in primary care: new directions for implementation.

Physicians in primary care generally do not perform recommended prevention and early detection services. Many factors influence the utilization of these services; however, often not considered and/or well understood is the very process whereby these services are adopted within the primary care setting. Understanding the process, and factors affecting the process, suggest new directions for designing and implementing effective intervention strategies which increase the use of such services. New directions include the importance of identifying a discrepancy between what the practice is doing vis-à-vis what it should be doing as the first stage in the adoption process; the identification of the particular stage within the overall adoption process which best characterizes the practice and tailoring specific interventions to the requirements of that stage; emphasizing the reshaping of work actually performed within the practice beyond simply changing knowledge and attitudes of physicians and support personnel; recognition that there is a changing set of expectations to which the practice is at risk to be held accountable in any litigation; and finally that the interventions have realistic time expectations.

Health Services Administration↗

PubMed1991

Psychosocial predictors of participation in a work site health-promotion program.

An understanding of psychosocial factors associated with participation in health promotion programs could lead to targetted interventions to increase enrollment. This study used questionnaires to measure employees' perception of program efficacy, health attitudes, beliefs, social support, and stress prior to the introduction of a comprehensive health promotion program at a research and development work site. The association of these factors with enrollment in the program was then prospectively determined. In addition, open-ended questionnaires were used retrospectively to determine additional factors associated with participation. Of the above factors, only program efficacy was significantly associated with participation in the entire sample. Perceived social support was associated with participation among non-white employees. In open-ended questionnaires, a desire for health information, a desire for help with behavior change, and concern about health status were the most commonly given reasons for participating. The study findings imply that environmental factors operating during the enrollment period at the work site may be more powerful than preexisting attitudes and beliefs in determining participation.

Community Participation↗

PubMed1990

Attributions for previous failures and subsequent outcomes in a weight reduction program.

This prospective study examines the effects of causal attributions given to previous weight control failures on subsequent success in controlling weight. Adult participants enrolled in a weight control program were screened to identify those who had made previous weight reduction attempts through a formal program. Once identified, subjects (n = 158) were asked to make causal attributions for their previous failures. Subjects were then followed through the 15-week program to determine their degree of success. Subjects who attributed the cause of previous failures to stable, immutable conditions were more likely to have low expectations of success. Low success expectancies, in turn, were associated with lack of goal attainment through the program. The number of previous failures in formal weight control programs was associated with a perception of the respondents that previous failures had stable causes. Neither the number of former failures nor the attributions of their causes were directly related to goal attainment. Practice implications of the results are discussed.

Achievement↗

PubMed1989

Ecology of passive smoking by young infants.

This study provides a detailed description of passive smoking by 433 infants (mean age 18 days) enrolled from a representative population of healthy neonates in central North Carolina during 1986 and 1987. Sixty-four percent (276) lived in households with smokers or had contact with nonhousehold smokers. During the week before data collection, two thirds (184) of these 276 infants reportedly had tobacco smoke produced in their presence. Seventy-five percent of smoking mothers smoked near their infants. The amount smoked by the mother near the infant correlated with the amount smoked near the infant by nonmaternal smokers. Cotinine, an indicator of smoke absorption, was found in the urine of 60% (258) of all study infants. The amount smoked in the infant's presence, as well as the amount smoked farther away from the infant, especially by the mother, were the most significant correlates of the urine cotinine concentration. The results of this study suggest that efforts to reduce passive smoking in young infants should emphasize the importance of the mother's smoking behavior, smoke produced anywhere in the home, and household social influences on smoking behavior near the infant.

Cotinine↗

PubMed1989

Development of a new self-help guide--Freedom From Smoking for you and your family.

This article describes the development of a new smoking cessation and maintenance guide aimed at a broad spectrum of cigarette smokers. To accomplish this task the authors reviewed the research literature and conducted a series of iterative pretests with representatives of the target populations using qualitative and quantitative methods. A process is described for developing health education materials which includes the selection of the target audience, organization and presentation of content, and pretesting of the material. The utility of this user-oriented strategy and step-by-step pretesting is discussed.

Adult↗

PubMed1989

A survey of smoking and quitting patterns among black Americans.

A sample of adult Black policyholders of the nation's largest Black-owned life insurance company was surveyed in 1986 to add to limited data on smoking and quitting patterns among Black Americans, and to provide direction for cessation initiatives targeted to Black smokers. Forty per cent of 2,958 age-eligible policyholders for whom current addresses were available returned a completed questionnaire. Population estimates for smoking status agree closely with national estimates for Blacks age 21-60 years: 50 per cent never-smokers; 36 per cent current smokers; 14 per cent ex-smokers. Current and ex-smokers reported a modal low-rate/high nicotine menthol smoking pattern. Current smokers reported a mean of 3.8 serious quit attempts, a strong desire and intention to quit smoking, and limited past use of effective quit smoking treatments and self-help resources. Correlates of motivation to quit smoking were similar to those found among smokers in the general population, including smoking-related illnesses and medical advice to quit smoking, previous quit attempts, beliefs in smoking-related health harms/quitting benefits, and expected social support for quitting. Methodological limitations and implications for the design of needed Black-focused quit smoking initiatives are discussed.

Adolescent↗

PubMed1988

Social learning theory and the Health Belief Model.

The Health Belief Model, social learning theory (recently relabelled social cognitive theory), self-efficacy, and locus of control have all been applied with varying success to problems of explaining, predicting, and influencing behavior. Yet, there is conceptual confusion among researchers and practitioners about the interrelationships of these theories and variables. This article attempts to show how these explanatory factors may be related, and in so doing, posits a revised explanatory model which incorporates self-efficacy into the Health Belief Model. Specifically, self-efficacy is proposed as a separate independent variable along with the traditional health belief variables of perceived susceptibility, severity, benefits, and barriers. Incentive to behave (health motivation) is also a component of the model. Locus of control is not included explicitly because it is believed to be incorporated within other elements of the model. It is predicted that the new formulation will more fully account for health-related behavior than did earlier formulations, and will suggest more effective behavioral interventions than have hitherto been available to health educators.

Attitude to Health↗

PubMed1987

Responses of patients to nutrition counseling by family physicians.

This paper examines patient responses to nutrition counseling activities of their family physicians. Two hundred-six patients (seen by one of nine family physicians) were asked whether the physician inquired about their dietary practices and whether they were asked to change any of these practices. Patients were also asked whether they understood, agreed with, and changed any of their dietary practices as a result of the consultation. Responses are examined in light of the self-reported physical condition of the patient. Patients without nutrition-related conditions were just as likely to be asked about their eating habits as patients with nutrition-related conditions. Patients with nutrition-related conditions were far more likely to report being asked to change their practices than patients with no nutrition-related conditions (p less than .001). However, self-reported change in dietary practices as a result of physician counseling did not vary by nutrition related condition.

Adolescent↗

PubMed1986

A survey of physicians' views and practices on patient education for smoking cessation.

A two-wave panel survey of physicians in southeastern Pennsylvania assessed the smoking intervention strategies physicians use with their patients, their intention to prescribe nicotine chewing gum (Nicorette), and their subsequent prescribing of Nicorette. The most frequently employed health education strategies were counseling, counseling in combination with written materials or referral, and recommendation to stop smoking, with significant differences among specialty groups. Most of the responding physicians (87%) were aware of nicotine chewing gum; of those aware, 71% reported an intention to prescribe it for their patients who smoke. Physicians' prescription patterns differed by specialty: family practitioners were most inclined to prescribe Nicorette. Forty-seven percent of physicians had no follow-up data on the patients for whom they had prescribed Nicorette. The survey data reported here demonstrate that physicians are willing to adopt a new smoking cessation practice. The challenge is to incorporate this practice into a cost-effective smoking cessation intervention which can be integrated into the routine of patient care.

Chewing Gum↗

PubMed1986

Patient medication instruction and provider interactions: effects on knowledge and attitudes.

This prospective study examines whether a patient medication instruction sheet (PMI) given to clinic patients by their health care provider affects knowledge and/or attitudes with thiazide diuretic use as part of an antihypertensive regimen. Adult male patients (N = 285) in a general medicine clinic were assigned to groups receiving the American Medical Association PMI describing their diuretic. Patients getting the PMI obtained it either directly from their provider or at the pharmacy dispensing window. All patients were surveyed by phone 1 week following the clinic visit with regard to the PMI, knowledge of medication use, and attitudes toward drug use. Results indicate that a provider-dispensed PMI results in higher levels of drug knowledge and greater patient satisfaction with their knowledge than a pharmacy-dispensed PMI. In addition, the PMIs educational value may be lessened by an incomplete verbal consult. This study demonstrates that the AMA PMI is an effective educational tool when distributed by a provider and can promote better understanding and use of prescribed medications.

Adult↗

PubMed1986

The role of self-efficacy in achieving health behavior change.

The concept of self-efficacy is receiving increasing recognition as a predictor of health behavior change and maintenance. The purpose of this article is to facilitate a clearer understanding of both the concept and its relevance for health education research and practice. Self-efficacy is first defined and distinguished from other related concepts. Next, studies of the self-efficacy concept as it relates to health practices are examined. This review focuses on cigarette smoking, weight control, contraception, alcohol abuse and exercise behaviors. The studies reviewed suggest strong relationships between self-efficacy and health behavior change and maintenance. Experimental manipulations of self-efficacy suggest that efficacy can be enhanced and that this enhancement is related to subsequent health behavior change. The findings from these studies also suggest methods for modifying health practices. These methods diverge from many of the current, traditional methods for changing health practices. Recommendations for incorporating the enhancement of self-efficacy into health behavior change programs are made in light of the reviewed findings.

Alcohol Drinking↗

PubMed1985

Smoking behavior, cessation techniques, and the health decision model.

The magnitude of the problem of smoking challenges health providers to persuade patients of the importance of trying to quit. Smoking behavior and cessation techniques are discussed in terms of the health decision model, a third-generation model combining health beliefs, decision analysis, and behavioral decision theory. This review suggests the need for physicians to emphasize factors such as health beliefs, self-efficacy, social support, and reduction of stress in smoking cessation efforts. Patients experiencing symptoms, particularly relating to the lungs or heart, may have stronger health beliefs and are clearly more likely to quit smoking. In the absence of a clear-cut advantage for any particular smoking cessation technique, physicians should provide advice about smoking as a regular part of every patient visit.

Adult↗

PubMed1985

Psychosocial aspects of changes in cigarette-smoking behavior.

This paper examines the relationships between patients' perceptions of susceptibility to illness, self-efficacy, anxiety, social support and subsequent changes in cigarette-smoking behavior through a prospective study involving 213 patients using a Veterans Administration Medical Center (VAMC). During an inpatient or outpatient visit to the VAMC, veterans received a questionnaire and were then enrolled in a smoking cessation intervention trial wherein some patients received a practitioner-initiated minimal-contact intervention and other patients received usual care. Smoking status was assessed 3 months following hospital discharge. Analyses revealed that patients most likely to have reduced their smoking, whether in the intervention or control group, were those reporting both high perceived susceptibility and high expectations of efficacy. Those least likely to have reduced their smoking were those reporting high susceptibility but low efficacy--what has been characterized as a 'learned helplessness' mode. Expectations of efficacy were inversely associated with general level of anxiety; that is, those reporting high levels of anxiety tended to report lower levels of self-efficacy. This relationship was powerfully buffered by a measure of social support. The results of this study suggest a number of potentially effective counseling strategies for practitioners who are trying to get their patients to quit smoking.

Disease Susceptibility↗

PubMed1985

Evaluation of a minimal-contact smoking cessation program in a health care setting.

A controlled evaluation of a minimal-contact smoking cessation intervention was conducted with 213 inpatients and outpatients at a Veterans Administration Medical Center (VAMC). The intervention had three components: Brief consultation from a health practitioner; administration of a self-help smoking cessation manual; and provision of an incentive to adhere to recommendations in the manual. Enrollment procedures differed from those of many other smoking-intervention trials in that, instead of enrolling only smokers who were motivated to quit, all patients who smoked and who would normally be considered eligible for a smoking-cessation intervention were included. The evaluation examined acceptability of the program to patients who smoked, overall effectiveness of the intervention, and efficacy of the intervention for specific patient demographic, social status, and health status groups. The program had a high degree of acceptance by patients who smoked, with over 60% agreeing to participate and take home the self-help smoking-cessation manual. The program was effective in getting patients to reduce their daily smoking, and marginally effective in influencing smoking cessation, with some patient groups exhibiting higher cessation rates than others. Special problems to be considered when attempting to influence groups of smokers at high levels of psychological stress and with low levels of education and income--factors normally associated with high rates of smoking and failure in traditional smoking-cessation programs--are discussed in light of the results obtained.

Hospitals, Veterans↗

PubMed1983

Improving physician-patient interactions: a review.

The interaction between physician and patient comprises aspects of communication common to any two human beings and other aspects peculiar to the roles exclusively adopted by physicians and patients. In this review, nonverbal and verbal elements of general communication are discussed, detailing important aspects of vocal tone, body postures, appearance, and verbal cues that may influence attributions made of physicians by patients. Role-related elements of physician-patient interactions are discussed in light of findings from research on interactions between physicians and patients. Developmental elements of general communication are discussed, relating stages tht evolve in interactions to physician-patient interactions. Finally, an examination is made of how interpersonal skills are taught to physicians and medical students. Discussion of what skills are specified for teaching, whether they are effectively taught, and whether the learning of these skills produces desired patient health-related outcomes is presented.

Communication↗

PubMedDate not supplied

Cost-effectiveness of smoking cessation modalities: comparing apples with oranges?

BACKGROUND: Although the results of self-help and group treatments for smoking cessation are known, the cost effectiveness and participants' characteristics of these treatments remain mostly undetermined. METHODS: Consecutive samples of 84 self-help manual requesters and 83 group participants in a Dutch community-based smoking cessation program were subjected to telephone interviews before treatment and after a 6-month follow-up. Participants' baseline characteristics were compared and contrasted with a random sample of nonparticipating smokers (N = 924). Cost effectiveness rates were computed from the perspectives of the society, the steering group, and the participants. RESULTS: Participants appeared to be more "hardcore smokers" than nonparticipants. Self-help manual requesters seemed easier quitters than group participants. Self-help was at least three times as cost effective as group treatment from the perspective of the program provider and over four times as cost effective from the viewpoint of the participants. When taking savings through not smoking into account, return on the social investment was positive. CONCLUSIONS: From a social perspective, the project seemed cost effective, compared with medical interventions. Since both modalities attracted different groups of smokers, cost effectiveness comparisons may incorporate the comparison of apples with oranges, and referral to either modality should be based on smokers' characteristics and the societal value placed on health as well.

Adult↗