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PURPOSE: Most research on preventive health behaviors has focused on individual rather than groups of behaviors. This study examined interrelationships among multiple preventive health behaviors in different age and gender groups. METHODS: From 1990 to 1992, Maryland residents were surveyed by telephone through the Behavioral Risk Factor Surveillance System. The study sample of 4455 was divided into 8 groups based on age (18-24, 25-39, 40-54, and 55+) and gender. Correlation and oblique rotated factor analyses were used to examine patterns of 8 to 11 preventive health behaviors in each age-gender group. RESULTS: Medical checkup and cholesterol test formed one behavioral cluster in the four male age groups. Breast and cervical cancer screening (mammogram, clinical breast examination [CBE], and Pap Smear) did not form one cluster until age 55 or older; Pap smear, CBE formed one cluster for women of all ages. Risk-taking behaviors were only prominent in the youngest age group: Seatbelt non-use, smoking, and drinking formed one cluster in younger males, and drinking and driving after drinking clustered in younger females. CONCLUSION: Screening and risk-taking behaviors form distinct groups, and behavioral patterns differ by age and gender. Public health programs should consider multi-behavioral approaches, and be sensitive to the gender and age of the target population.

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Attention to the sustainability of health intervention programs both in the US and abroad is increasing, but little consensus exists on the conceptual and operational definitions of sustainability. Moreover, an empirical knowledge base about the determinants of sustainability is still at an early stage. Planning for sustainability requires, first, a clear understanding of the concept of sustainability and operational indicators that may be used in monitoring sustainability over time. Important categories of indicators include: (1) maintenance of health benefits achieved through an initial program, (2) level of institutionalization of a program within an organization and (3) measures of capacity building in the recipient community. Second, planning for sustainability requires the use of programmatic approaches and strategies that favor long-term program maintenance. We suggest that the potential influences on sustainability may derive from three major groups of factors: (1) project design and implementation factors, (2) factors within the organizational setting, and (3) factors in the broader community environment. Future efforts to develop sustainable health intervention programs in communities can build on the concepts and strategies proposed here.

PIP: Many community-based health programs implemented in developing countries around the world are discontinued soon after initial funding ends. Attention to the sustainability of health intervention programs in the US and abroad has increased in recent years as policymakers and funders become ever more concerned with allocating scarce resources effectively and efficiently. There is, however, little consensus upon the conceptual and operational definitions of sustainability. Planning for program sustainability requires a clear understanding of the concept of sustainability and operational indicators which can be used to monitor sustainability over time, as well as the use of programmatic approaches and strategies which favor long-term program maintenance. Potential influences upon sustainability may derive from the following factors: project design and implementation factors, factors in the organizational setting, and factors in the broader community environment.

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UNLABELLED: An implementation analysis of the first eighteen months of the Maryland Breast and Cervical Cancer Program examined the variability among participating local agencies in the extent of screening services delivered; local program implementation processes; and the relationships between extent of screening and the local level processes. The study used: 1) a mail and telephone survey of local health departments (LHD, N = 24) and 2) state program surveillance data, with correlational methods. OUTCOMES MEASURED: 1) "Penetration," the proportion of the target population screened; and 2) "Efficiency," the number of women screened per program staff member. Categories of implementation variables were: 1) Environment, 2) Staffing, 3) Collaboration with community organizations, 4) Outreach, 5) Provider variables, 6) Relationships with State and LHDs, 7) Organizational variables, and 8) Service delivery. Results showed wide local variability in screening levels. Availability of local resources; provider involvement; success of community linkages; and local health department readiness showed relationships with the extent of local screening. Studying implementation is needed to improve the effectiveness and efficiency of community-based programs.