Prevention and Treatment of Alcohol Problems Research Opportunities (1990) / Chapter Skim
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5 Community Approaches and Perspectives from Other Health Fields
5 Community Approaches and Perspectives from Other Health Fields
Pages 109-127
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From page 109... ...
These systematic efforts to reduce cigarette consumption, control high blood pressure, lower accident rates, and modify unhealthy eating habits have resulted in sustained, community-wide health risk reductions that can be linked to a lowered incidence of disease and early death. The use of controlled experimentation to test prevention theory in programs such as these provides research findings that can guide the design of alcohol prevention approaches and permit the evolution of sound program designs and methods.
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From page 110... ...
Another problem has been a tendency among policymakers to ignore complementary policy change strategies and legislative measures, such as local zoning ordinances. Surprisingly, these problems persist despite the well-accepted principle that successful health promotion and disease prevention programs maximize program effects through the integration of several components (Green and McAlister, 1984; Farquhar et al., 1985~.
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From page 111... ...
During a two-year period of community education, a statistically significant reduction was achieved in the composite risk score for cardiovascular disease as a result of significant declines in blood pressure, smoking, and cholesterol levels. , ~ This risk score decreased approximately 25 percent for the media-only community and 30 percent for the community in which media were supplemented by face-to-face instruction (Farquhar et al., 1977~.
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From page 112... ...
Theories and models that have been used in community CVD prevention include the communication-behavior change model, the social marketing framework, and the community organization model (Farquhar, Maccoby, and Wood, 1985~. The communication-behav~or change model draws on Bandura's social learning theory, McGuire's communication-persuasion model, and Rogers' diffusion theory (Farquhar et al., 1985)
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From page 113... ...
For example, a smoking cessation program may rely primarily on self-help booklets and classes, but it will also reinforce its message through a campaign at local work sites, publicize itself in the local media, and collaborate with other local agencies on such events as a ~quit-smokin~" contest or legislation to restrict smoking in _ , _ .
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From page 114... ...
Periodic independent and cohort surveys were conducted in these communities throughout the life span of the project, and epidemiological data on CVD morbidity and mortality were also collected. In addition to collecting outcome measures during the entire five years of the multicomponent intervention, specific risk reduction strategies (e.g., smoking cessation, dietary counseling)
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From page 115... ...
. The successes in cholesterol reduction, blood pressure control, and smoking cessation after two and three years of education in the Stanford TCS were comparable to those achieved after the first five years of education in the North Karelia Project.
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From page 116... ...
Although there are as yet no examples of comprehensive community-wide programs in fields other than cardiovascular disease, there are many successful illustrations of potential components of broad programs: studies in work sites, examples of the use of regulatory change, the use of the national mass media, or education and environmental change at the point of purchase of tobacco. From the extensive published literature on prevention, several successful programs that have particular relevance to alcohol problem prevention are highlighted below.
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From page 117... ...
For example, such incentives as free trips and cash prizes have been used successfully in community-wide smoking cessation programs and are an integral part of health promotion strategies based on social marketing (King et al., 1987~. Other studies show that incentives increase effectiveness when they are added to campaigns that include components to enhance awareness, knowledge, and behavior change skills (Brownell et al., 1984; Sallis et al., 1986~.
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From page 118... ...
Further research on consumer behavior is necessary before any conclusions can be drawn. Smoking Prevention and Cessation Smoking prevention and cessation programs are components of prevention programs in several fields of public health because smoking is a risk factor both for cardiovascular disease and for certain types of cancers.
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From page 119... ...
In Flay's (1987) review of 40 smoking cessation programs designed for adults, he finds that mass media-only or media with print material campaigns were somewhat successful in changing knowledge and attitudes about smoking but that mass media combined with support groups produced significant changes in behavior and actually affected the quit rate of participants (Filly, 1987~.
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From page 120... ...
SUMMARY OF LESSONS LEARNED FROM OTHER FIELDS From this examination of comprehensive, integrated, community-based programs in preventing cardiovascular disease and of certain more limited studies (potential components of comprehensive programs) , eight lessons may be derived: 1.
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From page 121... ...
· Is it possible to integrate a variety of seemingly unrelated prevention strategies into a single effective program to prevent alcohol-related problems? · How can such social marketing techniques as audience needs analysis be used in prevention efforts?
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From page 122... ...
of 3 .0 gU)
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From page 123... ...
are based on policy change. Results from studies of mandatory seat belt use suggest that legislation can have some effect on health behaviors, but more study is needed before conclusions can be drawn about the effects of the policy changes that have been proposed for alcohol problem prevention.
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From page 124... ...
Kline et al. The Minnesota Heart Health Program: A research and demonstration project in cardiovascular disease prevention.
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From page 125... ...
Flay, B Mass media and smoking cessation: A critical review.
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From page 126... ...
The North Karelia Project: Evaluation of a comprehensive community programme for control of cardiovascular diseases in 1972-77 in North Karelia, Finland. In Public Health in Europe.
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From page 127... ...
Health behavior change at the worksite: Cardiovascular risk reduction.
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