A scope-of-practice survey leading to the development of standards of practice for health promotion in higher education

To review and analyze the scope of practice of health promotion services and draft standards of quality indicators for higher education communities, the American College Health Association (ACHA) initiated a Task Force on Health Promotion in Higher Education in May 1996. Members of the task force developed a National Survey on Health Promotion and Education in Institutions of Higher Education and mailed the survey to a stratified random sample of 600 ACHA member institutions, as well as to 97 key "best-practice health promotion leaders". The larger sample produced a 75.3% response rate, and 90.7% of the key informants returned usable surveys. The authors report selected findings from both groups that chronicle the state of health promotion practice in higher education at the close of the 20th century. The task force used the findings to establish a data-driven framework for the Year 2001 Standards of Practice for Health Promotion in Higher Education.     

Health promotion and disease prevention: a look at demand management programs

This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health care expenditures while improving overall health. This goal can be achieved through the use of health risk appraisals, organizational health risk appraisals, high risk programs, awareness programs, medical call centers, return to work programs, EAPs, and smoking cessation programs. Studies of a health program's cost effectiveness must disentangle the effects of many competing factors on cost effectiveness. For example, a health risk appraisal program may identify health problems of which the patient and the health care provider were unaware, resulting in the treatment of these health problems. At the same time, the employer may have switched from a nonmanaged pharmaceutical program to a managed program with incentives for participants to utilize generic and/or mail order drugs. As a result, when evaluating a health promotion program, the long-run impact on the program's cost effectiveness is most important.     

Parenting adolescents from ethno-cultural backgrounds: A scan of community-based programs in Canada for the promotion of adolescent mental health

ObjectivesTo i) describe current community-based programs across Canada to support parents for the promotion of adolescent mental health, with special attention to ethno-cultural populations; and ii) identify needs, gaps, and opportunities for the development of a framework to support parents for the promotion of adolescent mental health.MethodsWe conducted an internet-based cross Canada scan of community-based parenting programs that promote adolescent mental health in ethno-culturally diverse populations, followed by structured phone interviews with program staff. Findings were categorized according to audience (ethnicity/culture and age group), geographical distribution and coverage, and program type. Barriers to access and outreach mentioned by interviewees were documented.ResultsWe found a total of 47 programs that met our search criteria. The greatest numbers were found in the provinces of Ontario, British Columbia and Alberta, particularly in the Greater Toronto and Vancouver Areas. Most programs consisted of psycho-educational, information-based workshops, support groups, or used innovative approaches (e.g., arts, alternative medicine, mentorship, and skillsdevelopment courses). Five programs (11%) had parent and youth components. From the perspective of service providers, cultural distrust, stigma, financial constraints and language barriers pose challenges to outreach. Program evaluations are limited and often not publicly available.ConclusionThere are gaps in geographic coverage and types of programs available to parents for the promotion of adolescent mental health in ethno-cultural communities. Inconsistent and insufficient funding [and other forms of institutional support] detract from the capacity of community-based organizations to adequately support families and conduct, publicize, and evaluate their programs.     

Documenting effective coordination of medical education programs in response to medical underservice.

The Federal government has in the past initiated a variety of programs in an effort to address the issue of medical underservice throughout the United States. The results of two such programs sponsored by the University of Colorado Health Sciences Center are examined. Their federal and state support have been decreased at a time when encouraging progress was being made in reducing rural Coloradoans' inaccessibility to medical care, although much of the state remains designated a primary care health manpower shortage area. This paper challenges the Federal Government's policy of temporarily "seed" funding programs whose interventions require several years to complete, under the assumption that state legislatures will eagerly pick up financial support for all that document continuing need and effectiveness. It also describes the difficulties this policy and prevailing state legislative attitude pose for program evaluators in performing their professional function.     

Parental perceptions of the Children In Need Of Treatment dental program

This paper discusses the collaborative partnership involving the Middlesex-London Public Health Research, Education and Development site, the Ontario Ministry of Health Promotion and Sport, then Chronic Disease Prevention and Health Promotion Branch, and an academic institution in the first-ever research of parental perceptions of the Children In Need Of Treatment. This paper provides an overview of the Children In Need Of Treatment program, reviews the results of the research (a mailed, self-administered survey with a systematic random sample of parents from three health units whose children received dental treatment that was paid by Children In Need Of Treatment in 2006), and its subsequent recommendations. How these recommendations affected program planning and policy are examined. In conclusion, parents were very satisfied with the treating dentist and the Children In Need Of Treatment program, and found Children In Need Of Treatment to be vital in addressing the health of their children by attending to their urgent dental needs.     

Demographic and Organizational Variables That Affect Southeastern College and University Student Health Promotion

Abstract

This study examined the relationship between demographic and organizational variables and college student health promotion efforts. Two hundred and forty-one college administrators from 14 southern states were surveyed to determine factors that may affect college student health promotion programming. Enrollment, tuition, affiliation, and highest degree offered were the demographic variables that were examined. The organizational variables were goals, control, motivation, interaction, and decision making. The methods of gathering information regarding student health problems, the kinds of health promotion programs offered, the methods of publicizing the programs, and the extent of student participation in health promotion programs were the dependent variables.

The statistical tests for the effects of the demographic and organizational variables on student health promotion efforts indicate that a relationship does exist. Combined multiple regression analysis equations that include all of the organizational variables demonstrated graphically the effects of interaction among the independent organizational variables and the dependent variables. These combined equations were better predictors of student health promotion programs and services than any of the organizational variables taken separately. Future studies of the factors that affect student participation in health promotion programs, the extent of student participation, and the effects of a student participation should be conducted.     

Breastfeeding interventions in Kansas: A qualitative process evaluation of program goals and objectives

Across the state of Kansas, eighteen public health departments received funding through the 2011 Breastfeeding Grant Initiative to start a breastfeeding intervention. The main objective of this study was to evaluate the progress toward program goals and objectives. This study was a process evaluation. Qualitative data were collected from recipient health departments at two time-points during the program year. Structured, open-ended questions were asked through telephone interviews. This study examined: (1) progress toward program goals and objectives, (2) problems encountered during implementation, and (3) evaluation measures employed to assess program impact. All health departments reported making significant progress toward program goals and objectives and reported successful collaboration with other healthcare providers. The use of breast pumps, educational classes, and professional training of staff were reported as providing the best outcome in the promotion of breastfeeding. The majority of respondents did not measure program impact. From a public health perspective, it is important that infants receive breast milk for the first six months of life. It appears that goals and objectives set a priori guided health departments with the administration of their breastfeeding program. Results may be used to enhance and sustain delivery of breastfeeding support programs in Kansas communities.     

Mental Health on the Campus Revisited

Abstract

The author briefly reviews Mental Health on the Campus: A Field Study, published in 1973, noting areas of consensus and points of tension or disagreement that were reported in that study. He then assesses the extent to which the current state of mental health on the campus is an echo of that report. These comparisons form the basis for anticipating the probable direction of future developments in campus mental health. The areas and issues considered include the increased diversity of the student body, the stable incidence of psychotic disorders, the increased prevalence of gender-related diagnoses such as sexual abuse and eating disorders, the continuing financial pressures bearing on campus mental health programs, and the forms of care and treatment that fiscal and other circumstances are imposing. The author concludes that although the resources available and the particular challenges that are faced may have changed, the traditional goals of a campus mental health program, as articulated 75 years ago when the American College Health Association was founded, remain valid, even if they are difficult to attain.     

Proposing a model for promoting Children's Health in Early Childhood Education and Care Settings

This pilot study was conducted in one early childhood pre-school nursery setting in an area of high deprivation in England to explore the under-researched area of how practitioners promote the health of children. The research used an original tool, Child Health Promotion: A Toolkit for Early Childhood Education and Care Practitioners, containing a 5 Step Programme as a model to guide practitioners in identifying and implementing a health promotion activity. The findings will help to set the onward agenda for a larger scale study which will foreground the voices of practitioners and highlight the role that ECEC practitioners can play in promoting the health of children.     

Effectiveness of a school-based backpack health promotion program: Backpack Intelligence

A prominent school health issue in the United States is the use of backpacks, however, there is a paucity of literature on the effectiveness of backpack safety programs. The purpose of this paper is to describe a school-based backpack health promotion program: Backpack Intelligence, report on its effectiveness, and suggest avenues for future research. Three-hundred-seventy-two 6th and 7th grade students participated in the program which was integrated into their physical education curriculum. Of those students, 242 completed post-education surveys to assess its effectiveness. Pre-education, 44% reported that their backpack was uncomfortable to carry, and 61% reported two or more warning signs that their backpack was too heavy. Only 57% wore their backpack properly and less than half organized the contents in their backpack correctly. Post-education, 63% reported the program worthwhile. Forty-two percent changed the way they used their backpack, and 93% felt knowledgeable about backpack safety, a 24% increase. Both grade and gender differences were found. Areas identified in the literature as fruitful for future research were suggested. Until we have definitive research on the link between backpack use and injury, interventions may be imperfect, but as a society we are compelled to safeguard the health of our children.     

Chapter 3: Health and Productivity Management

SUMMARY

This article focuses on the emergence of Health and Productivity Management (HPM) as a context for understanding the integration of health and wellness into employee assistance and work-life programs. Major factors influencing the growth of HPM are raising medical costs as well as the rising incidence of obesity. The Wake-up Call to Corporate America underscores the need to manage these costs and improve health through the proactive alignment of health-related benefits and programs. HPM is described as an integrated approach to capture direct medical costs as well as the indirect costs associated with poor health and lost productivity. Critical design and implementation features that are likely to contribute to a successful integrated approach are described and highlighted. An HPM case example of a large pharmaceutical company examines a unique cross referral program including considerations for continuous improvement. Finally, the article concludes with key challenges related to marketplace competition, pricing pressures, concerns regarding the sub-optimization of programs and the influence of current health care system changes.     

How local health departments work towards health equity

BackgroundHealth inequities are exacerbated when health promotion programs and resources do not reach selected populations. Local health departments (LHDs)¹ have the potential to address health equity via engaging priority populations in their work. However, we do not have an understanding of what local agencies are doing on this front.MethodsIn the summer of 2016, we collaborated with informants from thirteen LHDs across North Carolina. Via semi-structured interviews, the research team asked informants about their LHD’s understanding of health equity and engaging priority populations in program planning, implementation, and evaluation.FindingsAll informants discussed that a key function of their LHD was to improve the health of all residents. LHDs with a more comprehensive understanding of health equity engaged members of priority populations in their organizations’ efforts to a greater extent than LHDs with a more limited understanding. Additionally, while all LHDs identified similar barriers to engaging priority populations, LHDs that identified facilitators more comprehensively engaged members of the priority population in program planning, implementation, and evaluation.ConclusionsLHDs are ideally situated between the research and practice worlds to address health equity locally. To promote this work, we should ensure LHDs hold an understanding of health equity, have the means to realize facilitators of health equity work, and recognize the complex context in which health equity work exists.     

A Pseudofolliculitis Barbae Clinic for the Black Male who Has to Shave

Abstract

We conducted focus group interviews with students who were current peer health educators at a mid-sized university to determine what factors motivate individuals to volunteer for a peer health education program. Specifically, we asked the participants questions designed to explore their life experiences, their expectations of the peer education program, and their motivations. Constructs from social learning theory were used to categorize and contribute to our understanding of the responses. Many participants specified experiences with family members or friends, such as alcoholism or other illnesses, that had influenced their decisions. Participants' expectation of the program varied greatly and did not indicate a strong link to the decision to volunteer. The peer health educators' motivations for volunteering were altruistic, such as wanting to help others; egoistic, such as wanting job training; or related to self-efficacy beliefs, such as satisfying a personal need for health education. This study indicated that life experiences, a belief in the effectiveness of peer health education programs, and positive reinforcement to join influence the decision to volunteer. Implications for coordinating peer education programs are discussed.     

Perceived continuing education needs and job relevance of health education competencies among health education and promotion practitioners in college health settings

Objective and Participants: The author conducted this study to determine college health education and promotion practitioners' perceived continuing education needs and perceived job relevance in relation to national health education responsibilities and competencies. Methods: In Spring 2006, the author invited college health education and promotion professionals to participate in an online survey, using 3 listservs. Of 276 individuals visiting the Web site, 141 participants completed the survey (51%). Participants rated their perceived training needs and job relevance for the 35 National Commission for Health Education Credentialing (NCHEC) competencies as well as preferred training formats. Results: Participants identified the following competencies as those in which they needed additional training: designing data-collection instruments, securing fiscal resources, interpreting evaluation and research results, carrying out evaluation and research plans, and developing plans for evaluation and research. They identified the following competencies as being the most relevant to their jobs: demonstrating a variety of skills in delivering strategies, interventions, and programs; using a variety of methods to implement strategies, interventions, and programs; initiating a plan of action; and using health-related information resources. The most preferred methods of obtaining additional continuing education were attending the American College Health Association annual meeting (67%) and completing home self-study print materials (67%). Conclusions: Collegiate professional organizations should offer a variety of continuing education opportunities centering on NCHEC competencies, specifically those perceived as needed by study participants.     

A liberal arts health promotion course.

With a grant from the W. K. Kellogg Foundation, the University of North Carolina at Asheville and the Mountain Area Health Education Center established a campus health promotion program that also trained family practice residents in health promotion skills. The heart of the program was a 3-credit course that emphasized stress management, aerobic conditioning, interpersonal relationship skills, and nutrition. Follow-ups after 2 years revealed that 90% of the students who responded said the course had had some lasting effect on their lives.     

Perceived Continuing Education Needs and Job Relevance of Health Education Competencies Among Health Education and Promotion Practitioners in College Health Settings

Objective and Participants: The author conducted this study to determine college health education and promotion practitioners' perceived continuing education needs and perceived job relevance in relation to national health education responsibilities and competencies. Methods: In Spring 2006, the author invited college health education and promotion professionals to participate in an online survey, using 3 listservs. Of 276 individuals visiting the Web site, 141 participants completed the survey (51%). Participants rated their perceived training needs and job relevance for the 35 National Commission for Health Education Credentialing (NCHEC) competencies as well as preferred training formats. Results: Participants identified the following competencies as those in which they needed additional training: designing data-collection instruments, securing fiscal resources, interpreting evaluation and research results, carrying out evaluation and research plans, and developing plans for evaluation and research. They identified the following competencies as being the most relevant to their jobs: demonstrating a variety of skills in delivering strategies, interventions, and programs; using a variety of methods to implement strategies, interventions, and programs; initiating a plan of action; and using health-related information resources. The most preferred methods of obtaining additional continuing education were attending the American College Health Association annual meeting (67%) and completing home self-study print materials (67%). Conclusions: Collegiate professional organizations should offer a variety of continuing education opportunities centering on NCHEC competencies, specifically those perceived as needed by study participants.     

Harmonizing databases? Developing a quasi-experimental design to evaluate a public mental health re-entry program

Our study is the first-ever initiative to merge administrative databases in Massachusetts to evaluate an important public mental health program. It examines post-incarceration outcomes of adults with serious mental illness (SMI) enrolled in the Massachusetts Department of Mental Health (DMH) Forensic Transition Team (FTT) program. The program began in 1998 with the goal of transitioning offenders with SMI released from state and local correctional facilities utilizing a core set of transition activities. In this study we evaluate the program's effectiveness using merged administrative data from various state agencies for the years 2007-2011, comparing FTT clients to released prisoners who, despite having serious mental health disorders, did not meet the criterion for DMH services. By systematically describing our original study design and the barriers we encountered, this report will inform future efforts to evaluate public programs using merged administrative databases and electronic health records.     

Harmonizing databases? Developing a quasi-experimental design to evaluate a public mental health re-entry program

Our study is the first-ever initiative to merge administrative databases in Massachusetts to evaluate an important public mental health program. It examines post-incarceration outcomes of adults with serious mental illness (SMI) enrolled in the Massachusetts Department of Mental Health (DMH) Forensic Transition Team (FTT) program. The program began in 1998 with the goal of transitioning offenders with SMI released from state and local correctional facilities utilizing a core set of transition activities. In this study we evaluate the program's effectiveness using merged administrative data from various state agencies for the years 2007–2011, comparing FTT clients to released prisoners who, despite having serious mental health disorders, did not meet the criterion for DMH services. By systematically describing our original study design and the barriers we encountered, this report will inform future efforts to evaluate public programs using merged administrative databases and electronic health records.