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OBJECTIVES: To identify the best methods of reaching individuals at high risk with HIV-prevention messages. METHODS: Data were collected from 827 men who have sex with men, injection drug users, sex workers, HIV+ individuals, heterosexuals, migrant workers, and perinatal women. RESULTS: Over 70% of participants were exposed to HIV-prevention messages, but sources of exposure varied by risk group. CONCLUSIONS: Most methods examined were effective means of communicating prevention messages. As multifaceted approaches to intervention allow for more comprehensive dissemination, interventions can be tailored to the targeted risk group by using sources shown most effective for each group.

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This study determined age of first use of cigarettes among rural and small town elementary school students. Data were collected from 1,950 elementary school students, grades kindergarten through sixth, attending seven different schools in southern Illinois. Bivariate odds ratios and multivariate logistic regression procedures identified risk factors of cigarette use among this elementary school population. A Duncan multiple-range test revealed no significant difference in cigarette use between grades kindergarten through fifth (average percentage of use for those grades was 4.7%), but use increased significantly to 17.4% in the sixth grade. Predictor variables with the greatest odds ratios were having tried alcohol (OR = 8), having tried chewing tobacco or snuff (OR = 4.4), and being in the sixth grade (OR = 2.2). Healthy People 2010 draft objectives emphasize prevention and reduction of tobacco use among youth. To be effective, tobacco prevention programs must begin in the elementary school years.

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Intimate violence has been recognized as a major problem in the United States. The financial and social hardships of declining rural economies, the social isolation of distance and poor transportation, inadequate social services for families in crisis, and limited options for women who might otherwise leave abusive partners are risk factors for intimate violence in rural areas. Church-based prevention programs are considered particularly useful in rural communities. If preventive health programs engage them properly, rural church members' overlapping social structures and their especially interconnected social circles can spread and support new ideas and practices. This study was conducted in four rural, predominately white, southern Illinois counties. The survey instrument used consisted of four subscales, measuring knowledge about, attitudes toward, and practices to prevent intimate violence as well as religious ideology. Overall, clergy knowledge and attitudes about intimate violence in this study did not necessarily translate into actual prevention practices against intimate violence. However, liberal clergy tend to employ prevention practices more often when compared with conservative clergy. Nevertheless, rural churches and their clergy seem to be promising sources for diffusion of intimate violence prevention information, attitudes and acceptable standards of behavior to rural communities.

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OBJECTIVES: This study compared prevalence of substance use among high school seniors in rural and urban areas from 1976 through 1992. METHODS: We used data collected for these years from urban (n = 75,916) and rural (n = 51,182) high school seniors. Thirty-day prevalence for alcohol, cigarettes, marijuana, cocaine, LSD, and inhalant use, binge drinking, smoking a pack or more of cigarettes a day, and daily alcohol and marijuana use were evaluated. RESULTS: Substance use declined from 1976 through 1992. In 1976, urban students had greater prevalence for most substances, but by 1992, rural and urban students were similar, with rural students having higher prevalence for alcohol and cigarette use (particularly excessive use). Trends were similar for both sexes, though rural girls showed a later catch-up to use levels of urban girls. CONCLUSIONS: Rural students are currently at risk approximately equal to that of urban students. Other studies have demonstrated the association of substance use with increased morbidity and mortality. Policy alterations and health education programs should address this pattern in the nation's rural areas.

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This paper compares rural and urban youth cigarette-smoking behavior using the Monitoring the Future data set, a national, probability-based, multi-stage sample design. Cigarette smoking was examined by region, race, and gender over time. Results indicated that rural White males smoked more often (30-day prevalence of 34%) than any other group. Urban Black males smoked the least (10%). Urban White females smoked more (30-day prevalence of 33%) than urban Black females (7%). In general, rural and urban Whites reported smoking at significantly higher rates than rural and urban Blacks. Smoking rates declined steadily for both rural and urban Black females and urban Black males over the study period. These data document distinctive patterns of tobacco use among the nation's youth, which can be used by program planners for specific targeted interventions.

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One persistent problem that faces state and federal health policy-makers is determining the level of primary care needs of the citizens they serve. To refine the decision making process in Illinois, a model was developed to compare the 84 rural counties of Illinois and their potential need for additional primary care interventions. Using expert panel methods, a group of public health professionals selected a set of 31 health status indicators that were available at the county level throughout the state. Next, the panel developed a weighting system for those indicators. These weighted values were then applied to the demographic and epidemiologic data from each of the counties to rank the counties on the basis of need. Indicators having the highest correlation with the weighted sum were the percent of the population enrolled in Medicaid, lung cancer mortality rate, general population mortality rate, proportion of population at poverty level, and percent of births to teens. Data also showed that the rural counties with the greatest needs clustered in five geographic regions. The identification of these five geographic clusters may facilitate collaborative efforts in meeting the primary care needs of these populations.

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PURPOSE: The purpose of this study was to determine how injury prevention awareness of children ages 3, 4, and 5, based on recognition of hazards in pictures differs in the United States, Belgium, East Germany and West Germany. METHODS: Children from these four countries were presented with 10 different pictures. Each picture represented a common injury producing situation to which children are exposed in traffic, home, and recreation. RESULTS: Results indicate that for pictures relating to home hazards, less than 22% of children from Belgium (21.5%), West Germany (4.7%), and the United States (20.3%) clearly recognized the essential hazards in the pictures, whereas over 40% of the East German children clearly recognized these dangers. A higher proportion of the children from all countries recognized the traffic hazards. Only 23.9% of all children had a clear recognition of the playground situations. The child's age had a bearing on ability to recognize hazards overall. CONCLUSIONS: Children need to be provided with better injury prevention education at an early age, especially those from West Germany.

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Survey data concerning the first sexual intercourse (FSI) experiences of 272 undergraduate students revealed that 6% had experienced FSI against their personal wills (victims); 1% had experienced FSI against the will of the other person (offenders); 81% had experienced FSI at the will of both participants (consenting); and 11% were virgins (does not add up to 100% because of rounding). Examination of the students' perceptions of the various factors contributing to nonconsensual sexual intercourse (NSI) showed that fewer than 50% of the students agreed that situational and psychological factors contribute to NSI. Results also indicated that being a woman and perceptions about the factors that reduce victims' resistance were significant predictors of who would be the victim of FSI. Religious background, the reasons for having a date, and perceptions regarding the factors that enhance motivation to have NSI were significant predictors of FSI offenders. Personal risk behaviors were the strongest predictors of students who experienced FSI at the will of both participants, and risk factors were inversely related to being a virgin.

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A non-equivalent control group design was used to examine effectiveness of a drug and alcohol abuse prenatal care health education program for pregnant teens (N = 212) in the Mississippi delta region of southern Illinois. Experimental group posttest knowledge scores were significantly higher than control group scores; however, no significant differences occurred in attitudes between the two groups at posttest. Frequency of drug use decreased substantially for both experimental and control groups at posttest; however, significantly more experimentals than controls indicated they reduced or quit using drugs. The experimental group had a significantly lower rate of diabetes, anemia, and sexually transmitted diseases, and possibly a lower rate of spontaneous abortion depending on the statistical test used. Data suggest prenatal care health education programs may be effective methods for increasing patient awareness about the dangers of drug and alcohol abuse and may have an effect on infant and maternal outcomes.

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A randomized, posttest-only experimental design was used to compare the date-rape attitudes of university students who were exposed to a mixed-gender date-rape workshop (n = 163) with those of students who were not exposed (n = 168). A previously validated instrument, the 25-item Date Rape Attitudes Survey (DRAS), was used as the criterion measure. Three hypotheses were tested, with the following results: (1) Men reported attitudes that were more tolerant of date rape than those reported by women (ie, the men were more likely to condone date rape); (2) students in the control group reported attitudes that were more tolerant of date rape than those reported by students in the treatment group; and (3) men exhibited a greater effect from the program than did women. Finally, the authors discuss implications of the study and offer recommendations for future research evaluating date-rape prevention programs.

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Health concerns of adolescents are important factors to consider when developing and implementing school health education programs. In addition, an understanding of adolescent concerns compared to their teachers' and parents' beliefs about adolescents' concerns may enhance communication between adolescents and adults. Despite the need to identify the health concerns of adolescents and beliefs about them among parents and teachers, few instruments exist. The inventory described in this article is one approach to assessing adolescent health concerns. Three forms of the Adolescent Health Concerns Inventory (AHCI) were developed to assess: (1) the health concerns of adolescents, (2) teachers' beliefs about adolescent health concerns, and (3) parents' beliefs about adolescent health concerns. The final version of the instrument contained 150 health-related items grouped into 12 topical subscales. Reliability estimates for the 12 subscales as measured by Cronbach's alpha ranged from .76 to .92. A panel of experts was used to assess content validity. Construct validity was assessed using principal components factor analysis. All items were positively loaded on factor 1. Readability was estimated at the eighth grade as measured by the SMOG readability formula. Psychometric characteristics of the instrument and recommendations for the use of the ACHI are presented.

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Healthy People 2000: National Health Promotion and Disease Prevention Objectives states that the reduction of unintended pregnancies is one of the primary health objectives for college-aged people. In addition, the reduction in rates of sexually transmitted diseases, with special emphasis on reducing the incidence of HIV infection, is an important objective for this population. One way of addressing these objectives is through promoting use of effective contraception methods. Attitudes toward a particular contraceptive option may play an important role in acceptance of, and predisposition toward, using a given method. The authors used semantic differential scaling to study the connotative meanings college students assigned to 13 contraceptive methods. They asked 751 students (mean age = 19.6 years) to rate each method of contraception, using 7-point scales composed of 15 bipolar adjective pairs. Scale internal consistency was estimated using Cronbach's alpha, and ranges were from .68 for douching to .92 for oral contraceptives. Respondents' rank-ordered approval ratings of the 13 options were as follows: oral contraceptives; abstinence; the condom; the diaphragm; the contraceptive sponge; female sterilization; rhythm; male sterilization; douching, the IUD, and vaginal suppositories (tied); spermicidal foam; and withdrawal. These results indicated general approval for methods that are effective in preventing conception. Semantic interpretation of selected contraceptive options differed by gender and race, but not by age. Implications for contraception education and future research issues are discussed.

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Data were collected from 293 pregnant adolescents living in the southern Illinois section of the Mississippi Delta region concerning their substance use behaviors in 1989 and 1990. Subjects used a variety of drugs in the past and present. For example, 24.4% of the sample reported they presently smoked cigarettes. Alcohol was used by 20.4% in the previous five months, while 5.2% reported marijuana use during the same period. Regression models designed to predict substance use produced adjusted r2 values of .30 (SE = 1.06) for cigarette use, .38 (SE = .49) for marijuana use, and .43 (SE = .59) for alcohol use. Significant indicators included peer and personal substance use behavior, parental substance use, and having previously received mental health treatment.

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A cross-sectional survey research design measured factors related to cigarette use among 2,212 senior high school students. Results showed 14.3% of the sample smoked cigarettes at least occasionally, with 5.3% reporting they were daily smokers. About 12.8% indicated they were ex-smokers. Males and females smoked at almost equal rates, and the percentage of 10th grade student smokers was slightly higher (16.4%) than the percentage of juniors and seniors who smoked. Approximately 22% of Hispanic students, 15% of Caucasian students, and 4.5% of African-American students reported smoking cigarettes at least occasionally. An initial regression analysis used 21 variables to predict cigarette smoking. A more parsimonious regression model (R2 = .28), using variables from the initial regression analysis with significance levels of .01 or less, indicated the most important predictors of cigarette use were ethnic group, attitude toward females who smoke, close friends' use of cigarettes, personal use of marijuana, best friend's use of cigarettes, personal use of alcohol, and school self-esteem. Implications for school health programs are addressed.

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Although accidents are the leading cause of death among college students, literature about developing student health safety programs is limited. In this article, we present preliminary recommendations based on literature review, epidemiologic data, and Nominal Group Process (NGP) activities, for developing university student safety programs. Our recommendations include appointing a coordinator to oversee all on-campus safety activities, providing for university-wide education programs dealing with alcohol and drug use, promoting personal safety efforts in areas such as family violence and rape prevention, and encouraging students to use safe transportation alternatives.

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The acute shortage of human organs and tissues for transplantation has been attributed in part to health professionals, including nurses, for their reluctance to recognize and refer suitable candidates for donation. In 1988, nurses' knowledge, attitudes, and beliefs regarding organ and tissue donation and transplantation were assessed using a 70-item questionnaire. Respondents included 1,683 nurses employed in 62 rural and urban hospitals in the Midwest. Only 365 respondents (21.7 percent) reported having requested tissue donations and 243 (14.4 percent) reported having requested organ donations. However, of those who requested tissue or organ donations, 270 (74 percent) obtained consents for tissues and 150 (61.7 percent) obtained consent for organ donations. Respondents were knowledgeable about organ and tissue donation (mean score of 7.5 on a 0 to 10 knowledge scale with 10 as highest) and reported attitudes and beliefs were moderately positive. Factors that were significantly correlated with the number of requests made for organs and tissues and the number of consents obtained included nurses' knowledge, attitudes, and beliefs about donation; nurses' perception of their own confidence in their ability to request tissues and organs; being a supervisor; and working in an emergency department.

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We collected data from 548 rural home health care workers in Southern Illinois in 1990 to replicate a study conducted in 1988 designed to identify and assess the attitudes of those workers toward the elderly and their elderly clients. Subjects were asked to respond to a fifteen item, self-report questionnaire. Reliability of the scale was estimated at .79, using Cronbach's alpha. Readability was estimated at the sixth-grade reading level as measured by the SMOG Readability Formula. Chi-square statistics were used to determine whether there were any differences between the 1988 and 1990 data sets, with a significance level of .003, using the Bonferroni correction procedures. Results were similar for both the 1988 and 1990 data sets. For example, whereas 31.8% of the 1988 respondents agreed with the statement: "most of my clients are pretty much the same," 30.5% of the 1990 respondents agreed. The findings from this study indicate that attitudes toward the elderly among this population of home health care workers have remained relatively consistent over this two year period.

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The recent call for comprehensive drug education programs has provided a multitude of opportunities for health education specialists. Unfortunately, not all drug education programs are effective. Because of their lack of effectiveness, there is a need for comprehensive evaluation of existing programs. In order to conduct high quality evaluations, valid data collection procedures must be used. Probably the most common method of collecting data in drug use studies is the self-report questionnaire. One method of establishing the validity of these questionnaires is through urinalysis-based concurrent validity studies. Despite results similar to laboratory tests, investigators may have increased confidence in the results obtained from their questionnaires.

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Data concerning self-reported driving after drinking or using other drugs were collected from 3,382 junior and senior high school students in rural central and southern Illinois. Drinking, drug use, and driving increased steadily with age, with 42% of the 12th grade class indicating they had driven a car at least one time in the past six months after drinking or using other drugs. Riding with a driver who had been drinking also increased with age; 20% of the seventh grade sample had ridden in a car with a drinking driver, while 58% of the 12th grade sample reported having done so. Slightly more females had ridden in a car with a driver who had been drinking than males, while males reported higher rates of driving after drinking or using other drugs than females. Correlation analyses indicated 22 variables related significantly to drinking, drug use, and driving. Forward stepwise multiple regression analysis showed that 11 variables related significantly to riding as a passenger with a drinking driver. Thirteen variables were related significantly to driving after drinking or using other drugs. Frequency of alcohol use variables were the most powerful indicators of self-reported driving after drinking or using other drugs in this sample.

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