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PURPOSE: The purpose of this study was to evaluate the effectiveness of a 1-week didactic and clinical skin cancer prevention training module. The evaluation assessed both the immediate and the 3-month effects of the module on nurse participants. In addition, this study assessed whether the module had any secondary effects on skin cancer practices, including perceived support from colleagues, resources, time, and perceived responsibility to conduct skin cancer screening activities and education. METHODS: A quasi-experimental design with 32 intervention and 87 comparison subjects was employed. Instruments developed and validated specifically for this study were used to assess knowledge, self-efficacy, priority of skin cancer, and organizational level constructs. RESULTS: The findings indicate that the module significantly increased general and prevention knowledge as well as screening ability; the increase was stable over time. The module was also found to improve self-efficacy to screen and to educate. There was no effect on the organizational-level constructs. CONCLUSIONS: Baseline knowledge assessments validated other studies indicating that nurses need more education about skin cancer. Despite promising results from program participants, system-level barriers could impose substantial barriers to implementation in health care practice. Knowledgeable nurses must educate their colleagues, their supervisors, and the public about the priority of skin cancer screening and develop strategies for creating organizational change to increase the likelihood that screening and patient education will occur for people at risk for skin cancer.

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An increasing barrier to the development and implementation of effective youth smoking prevention and cessation programs involves recruiting adolescents into research studies. Even for non-intervention studies, issues of consent, confidentiality, and motivation to participate are important considerations. In 1996, 11 Prevention Research Center sites across the country conducted qualitative research using focus groups to explore ethnic differences in smoking among adolescents. The diversity in strategies used to interest, motivate, and retain potential focus group subjects provided a rich data set for information about effective strategies and challenges to recruitment. This article presents an overview of recruitment methods used in a multi-site qualitative study on adolescent tobacco use, reports on successful and less successful strategies, and provides recommendations for future recruitment.

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This article reviews recent literature on the physical and psychosocial correlates of head and neck cancer, with a focus on quality-of-life issues, rehabilitation outcomes, and changes in the literature from the previous decade. These studies have shown that head and neck cancer has an enormous impact on the quality of life of patients. The most important physical symptoms are speech problems, dry mouth and throat, and swallowing problems. Pain is also frequently reported. Disturbances in psychosocial functioning and psychological distress are reported by a considerable number of patients; worry, anxiety, mood disorder, fatigue, and depression are the main symptoms. Cancer of the head and neck has a negative effect on social, recreational, and sexual functioning. Despite a growing number of longitudinal studies, little is known about the rehabilitation outcomes over a longer period of time. Future research is necessary to form a consensus about the further development and use of specific instruments to study patients with cancer of the head and neck, to conduct more prospective studies, and to develop programs that are aimed at maximizing rehabilitation outcomes and evaluate these programs with randomized designs.

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OBJECTIVES: To study the social contexts and physiological consequences of an initial cigarette smoking experience among adolescents from four ethnic groups (African American, European American, Hispanic, Native American) who vary by gender and locale (e.g. urban vs rural). METHOD: A qualitative study using individual interviews and focus groups. RESULTS: Results both amplify and reinforce conclusions about peer and family influences on adolescent smoking initiation reported in quantitative studies of teen smoking. Within the broader themes of peers and family, several important sub-themes emerged. The study findings suggest that peer influence can be characterized as social conformity or social acceptance. Males were more likely than females to describe experiences involving peers exerting strong messages to conform to smoking behaviors. Roles played by family members in the initiation process were complex and included those of initiator, prompter, accomplice, and inadvertent source of cigarettes. European American and Hispanic girls provided descriptions of parents/family members as instigators of their first smoking experience. Hispanic adolescents descripted instances in which family members prompted cigarette use at a young age by encouraging the young person to light the adult's cigarette. Finally, ethnic differences in the physiological responses to initial smoking suggest the need to further explore the role of brand preference and variations in inhaling among ethnically diverse adolescents. CONCLUSION: In order to design effective cigarette smoking prevention programs for adolescents, it is important to understand the meaning of smoking behaviors for adolescents from different ethnic and social backgrounds.

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OBJECTIVE: To describe and understand variations in cigarette brand preferences between adolescents from varying ethnic and gender groups around the US. DESIGN: A qualitative study where adolescents, both smokers and nonsmokers, were interviewed individually in depth. SETTING: Schools and recreation centers in four sites: urban Maryland (Baltimore), urban Texas (Houston), rural Alabama and rural New Mexico. PARTICIPANTS: 121 adolescent volunteers 13-19 years of age, representing African American, white, American Indian and Hispanic ethnic groups, from both genders. RESULTS: Considerable geographic and ethnic variation exists in terminology used by youth to refer to cigarettes and to their use. Clear patterns in brand preference by ethnic group were found that follow patterns of targeted marketing by ethnicity. White teens preferred Marlboro brand cigarettes, while African-American teens who smoke preferred Newports. Hispanic and American Indian teens were more likely to smoke Marlboro or Camel cigarettes. Hispanic teens were most likely to mention low price as a reason for choosing a particular brand or to state that the brand does not matter. Tobacco advertisements targeting ethnic groups and the use of promotional items to encourage teen smoking were also recognized as factors influencing brand preferences. CONCLUSIONS: These findings have implications for the design of intervention programs aimed at curbing teen smoking. When working with teens who already smoke, using youth language to target messages at perceived characteristics of commonly used brands may be more effective and meaningful than talking about cigarette use in general. Another implication of this work is to shed light on what impact an advertising ban would have on teen brand preferences, brand loyalty, and prevalence of smoking.

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The current US immunization rates for 2 year olds are approximately half of the goal set for the year 2000. Research studies have focused primarily on the perception of health care providers in the identification of barriers and benefits to childhood immunization. While health care providers are an important part of the immunization delivery process, the perceptions of parents are also important. In this study, qualitative methods were used to explore perceived parental barriers to childhood immunization delivery. Twelve focus groups comprising White, African-American, Hispanic, urban and non-urban people were conducted at a variety of sites, including clinics, churches, schools and work sites. The results indicated that time off from work, access to well-child care and difficulty understanding the complexity of the immunization schedule were seen as barriers to adhering to an immunization schedule. Participants emphasized problems in taking time off from work to get immunizations, sometimes without pay, and expressed fears that doing so would jeopardize promotions and raises. While some of the parental perceptions were similar to those identified in studies of health care providers in the literature, many were not. This study emphasizes the importance of gathering information from parents as well as from health care providers.

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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.

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PURPOSE: The purpose of this study was to determine the extent of implementation of school health education curricula, to identify factors which enhanced or impeded implementation, and to examine the link between the adoption and implementation phases of the diffusion process. DESIGN: The study used an experimental design; 22 school districts were randomly assigned to intervention and control conditions. SETTING: The study was conducted in North Carolina. SUBJECTS: All teachers in the study districts identified by their schools as "eligible to teach health" were included in the sample. INTERVENTION: An in-depth training was conducted on the use of the middle school tobacco prevention curriculum that had been adopted. MEASURES: Three measures were used to assess implementation of the curricula. Independent variables of interest included organizational size and climate, teacher training, how long it took to make the adoption decision, and attitudes toward tobacco use prevention curricula. Response rates for these measures ranged from 44% to 78%. RESULTS: Nonparametric correlations and regression modeling indicated that larger organizational size and teacher training were the strongest predictors of curricula implementation. A favorable organizational climate within school districts also improved implementation. CONCLUSIONS: While interventions to increase adoption of school health education curricula should focus on larger school districts, the majority of efforts to improve implementation should focus on smaller districts.

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Legal and educational interventions have not had a significant impact in reducing alcohol use among college students. The purpose of this study was to determine the frequency at which students placed themselves "at-risk" for alcohol-related traffic fatalities, either by driving while alcohol impaired or riding with an alcohol-impaired driver. On a given weekend night, 18% (n = 60) of students surveyed placed themselves at risk of being involved in an alcohol-related traffic fatality. Two-thirds of the "at-risk" subjects reported returning home with an alcohol-impaired driver. Recommendations are made for strengthening prevention efforts.

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This quasi-experimental study assessed impact of factors associated with classroom implementation of health curricula by North Carolina teachers. School representatives selected and implemented one of three tobacco prevention curricula--Project SMART, Growing Healthy, or the Teenage Health Teaching Modules--in either sixth or seventh grades. Prior to implementation, experimental teachers and administrators received extensive curricula training. Implementation data were collected through teacher completed checksheets and classroom observations for two time periods--initial implementation (n = 69) and maintained implementation (n = 136). While training was associated significantly with whether teachers implemented a curriculum (p < .05), other factors also were important. Variables outside of teachers' direct control, such as supportive administrators, context in which health instruction is taught, and turbulence, affected quantity and quality of curricular implementation.

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Sixth and seventh graders (N = 2,020) were surveyed to determine the prevalence of smokeless tobacco (SLT) use and peer and parental influences on SLT use. Nearly 34% of boys and 12% of girls had used SLT at some time, and 8% of boys and 1% of girls were current users. While most associations were significant, the strongest relationships were between subjects' and peers' use of SLT. Logistic regression showed that the odds ratios for predicting adolescent's current use of SLT were 13.6 for peer use, 6.0 for male gender, 2.8 for white race, 2.8 for fathers' and 8.0 for mothers' ever use of SLT, and 2.6 if the mother was not a high school graduate. Results support the need for a multidisciplinary approach to research, education, treatment, and prevention to combat this growing health risk.

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