Multilevel community health promotion: How can we make it work?

The need for multilevel, comprehensive health promotion programmeshas become widely accepted, as has the importance of communityapproaches. However, many health promotion programmes focuson change at the individual level, no doubt partly due to thedifficulty of implementing all-inclusive health promotion. Thispaper discusses two strategies for guiding multilevel projects:multiple methods for community assessment and charting projectactivities by level of change (a possibility framework). Thesestrategies help ensure a multilevel focus and provide valuableinformation that can assist with the implementation of multilevelhealth promotion research projects in specific community contexts.Our primary purpose, therefore, is not to focus on theory orresearch findings. Rather, our goal is to make visible two strategiesthat have been helpful in one health promotion research projectin Victoria, British Columbia, Canada.     

Family transitions in Young Adulthood

Using the first (1995) and third (2001-2002) waves of the Add Health survey, we examine women 's family transitions up to age 24. Only a third of all women marry, and a fifth of those marriages dissolve before age 24. Three out of eight women have afirst birth, with a substantial majority of those births outside of marriage: 66% for whites, 96% for blacks, and 72% for Mexican Americans. Cohabitation is the predominant union form; 59% of women cohabit at least once by age 24. Most cohabitations are short lived, with approximately one in five resulting in a marriage. We summarize the family and relationship experience of women up to age 24 in terms offour categories, each accounting for roughly a quarter of all women. Category 1 has the women who remain single nonparents. Category 2 has the early marriers, women whose marriage is not preceded by a first birth. Category 3 has those who become single parents. Category 4 has the women who cohabit at least once, but who do not marry or have a birth by age 24. The strictly ordered transitions of the 1950s are long gone and have been replaced by a variety of paths to adulthood.     

Social Background Differences in Early Family Behavior

Social background has historically been recognized as a major factor influencing family behavior, though recent work has largely emphasized racial/ethnic influences. Here we use 1994 – 1995 and 2001 – 2002 Add Health data to examine the cohabitation, first marriage, and first birth experience of young women. In a multistate life table context, hypothetical cohorts specified in terms of race and mother’s education are followed, from age 11 to age 24, as they move through 6 family‐related statuses. The results indicate that, for both Black and White women, a higher level of maternal education is generally associated with less cohabitation, less marriage, fewer first births, and a higher percentage of women who experience none of those transitions before age 24. Racial and social background differences are conceptually and empirically distinct. Because mother’s education is associated with substantially different trajectories of early family behavior for both Blacks and Whites, we argue that social background merits increased attention in research on contemporary American family patterns.     

Generalized Youden designs: construction and tables

Generalized Youden Designs are generalizations of the class of two-way balanced block designs which include Latin squares and Youden squares. They are used for the same purposes and in the same way that these classical designs are used, and satisfy most of the common criteria of design optimality.We explicitly display or give detailed instructions for constructing all these designs within a practical range: when υ, the number of treatments, is ?25; and b₁ and b₂, the dimensions of the design array, are each ?50.     

Artificial neural networks and center-of-pressure modeling: a practical method for sensorimotor-degradation assessment

Numerous methods for studying the prevention of falls and age-related sensorimotor degradation have been proposed and tested. Some approaches are too impractical to use with seniors or too expensive for practitioners. Practitioners desire a simple, reliable technique. The goals of this research were to develop such an approach and to apply it in exploring the effect of Tai Chi on age-related sensorimotor degradation. The method employed artificial-neural-network (ANN) models trained by using individuals' center-of-pressure (COP) measurements and age. Ninety-six White and Chinese adults without Tai Chi training were tested. In contrast, a third group, Chinese seniors with Tai Chi training, was tested to ascertain any influence from Tai Chi on sensorimotor aging. This study supported ANN technology with COP data as a feasible tool in the exploration of sensorimotor degradation and demonstrated that Tai Chi slowed down the effects of sensorimotor aging.     

Contextual assessment of couples therapy: the Clinical Discourse Q-Sets

This article describes a method for creating highly contextual assessments of couples therapy interaction using concepts from Systemic Functional Linguistics (SFL). According to SFL, talk in interaction serves three primary functions: to mediate social relations, to negotiate representations of reality, and to organize and structure the event as coherent. These concepts are operationalized using observational q-methodology. The Clinical Discourse Q-Sets (CDQS) include three separate q-sets for use by trained observers in rating 12-min segments of couples therapy conversation. Each q-set captures one aspect of the communication process as defined by Systemic Functional theory. Good-to-high reliabilities for the q-set profiles over various (n = 16) couples therapy episodes were found. Preliminary evidence for the conceptual structure and clinical validity of the system was found.     

A Taxometric Analysis of Problem Gambling Data from a South African National Urban Sample

We investigate the question whether problem gambling (PG) in a recent South African sample, as measured by the Problem Gambling Severity Index (PGSI), is dimensional or categorical. We use two taxometric procedures, Mean Above Minus Below A Cut (MAMBAC) and Maxim Covariance (MAXCOV), to investigate the taxonic structure of PG as constructed by the PGSI. Data are from the 2010 South African National Urban Prevalence Study of Gambling Behavior. A representative sample of the urban adult population in South Africa (N = 3,000). Responses are to the 9 item PGSI. MAMBAC provided positive but modest evidence that PG as measured by the PGSI was taxonic. MAXCOV pointed more strongly to the same conclusion. These analyses also provide evidence that a PGSI cutoff score of 10 rather than the standard 8 may be called for. PG as constructed by the PGSI may best be thought of as categorical, but further studies with more theory based measurements are needed to determine whether this holds in a wider range of samples and for other screens. A higher cutoff score may be called for on the PGSI when it is used for research purposes to avoid false positives.     

Validation of a Multi‐Dimensional Measure of Strategy Development Processes

In this paper, we present evidence on the measurement properties of an instrument that assesses six dimensions of organizational strategy development. These dimensions are labelled planning, incrementalism, cultural, political, command and enforced choice. Using data from 5332 managers, results indicate the instrument has acceptable reliability and validity. Exploratory factor analysis confirms its underlying structure. Generally, the sub‐scales have acceptable internal reliability and inter‐rater reliability at the organizational level (n = 770 organizations). Further, using data aggregated at the organizational level, the sub‐scales are judged to have acceptable validity from the pattern of correlations amongst the six dimensions and with other variables.