If we want more evidence-based practice, we need more practice-based evidence.*

If we want more evidence-based practice, we need more practice-based evidence.*


Chapter 4
- Archives of Headlines
Human Behavior and Community and
Population Health Education

Health Education Standards http://www.mcrel.org/standards-benchmarks/docs/chapter16.html
The US Dept of Education has compiled several standards relating to health education.

The following process was used to identify standards and benchmarks  for health:
Identification of National Reports

Six reports were identified as providing useful information on health  education standards in the schools: National Health Education  Standards: Achieving Health Literacy (1995) from the Joint Committee  on National Health Education Standards; Benchmarks for Science Literacy (1993) from Project 2061, American Association for the Advancement of Science; Health Framework for California Public Schools from the California Department of Education (1994); the Report of the 1990 Joint Committee on Health Education Terminology, from JCHET (1990); the Michigan Essential Goals/Objectives for Health Education (1988) from the Michigan State Board of Education; and the National Science Education Standards (1996) from the National Research Council.
Selection of the Reference Document National Health Education Standards: Achieving Health Literacy was
used as the reference document. However, some basic content information was also drawn from the Michigan and California documents identified above, and supporting material (as well as some primary material) came from the two science documents, National Science Education Standards and Project 2061's Benchmarks.
Identification of Standards and Benchmarks
At the benchmark level, information was derived from National Health Education Standards and from all other reports cited above. These reports, except for the California framework, which was more curricular in scope, provided relatively straightforward descriptions of knowledge and skills recommended for health education.
Consequently, most of the effort in the identification of benchmarks for health education centered on the synthesis and citation of information from multiple sources.
After the content review, those benchmark items that arose in all the reports were analyzed and grouped. Thus, the standards were developed  working up from the benchmark level. However, for the most part, it was found that the resulting standards were similar to the topic level recommendations found in the Report of the 1990 Joint Committee on Health Education Terminology. In addition to these topic areas, a standard on Growth and Development was added, derived largely from information in the two science documents, Science Standards and Project 2061's Benchmarks for Science Literacy.

Integration of Information from Other Documents
As mentioned above, material from the other documents was not only integrated with the reference material, but new material was added from them as well. This was done when information was found to be present in more than one of the selected reports. It should be noted, however, that all benchmark information from the reference document, the National Health Education Standards, will be found in this report.

Surgeon General Pushes Sex Education United Press International (12/06/98); Susman, Ed  Surgeon General David Satcher called for the use of sex education to teach responsible sexual behavior to children. Speaking at an interim meeting of the American Medical Association's House of Delegates in Honolulu on Sunday, Satcher said that Americans have to "get real" about sex education. He added that sex education can aid teenagers and children, helping them "feel good about themselves to be abstinent until they are involved in a committed relationship." Satcher noted that even though teenage pregnancy rates in the United States are higher than in other developed nations, sex education is not taught in many areas.

Our kids' lives worsen: Report Ottawa failing on health, poverty, author says Toronto Star.  The lives of Canadian children are getting worse, according to a new report. The annual Progress of Canada's Children report, to be released today, says children's well-being is declining on more than half of nine indicators from health to economic security.

Poor children are getting poorer and  they're suffering more. But even children in higher-income  families have been hit by a divorce rate that has tripled in the past 20 years and rising teen pregnancy and smoking rates, says the report by the Canadian Council of Social Development.

While there has been some improvement in school performance and physical safety in the '90s, ``Canada has failed to reverse negative trends in other important areas - most notably life prospects for poor children and health conditions for all children and youth,'' said the report's author, Louise Hanvey.
The federal government launched the national children's agenda several years ago to address these problems, but since then it has been tied up in a series of federal-provincial meetings that seem to be going nowhere, said David Ross, the council's executive director.
The report found child and youth poverty rates are rising, the gap between rich and poor children is widening, and poor children have fewer opportunities than in past years.

Part of the reason is the ``bloody stubborn unemployment rate'' which means single parents in particular can't find a place in the labour market, said Ross, an economist.
The council went searching for some good news in its third annual look at children's lives but ``it's pretty hard to find,'' he said, because of cuts to community services and resources.

The average family has slightly more disposable income than a year ago, but lower-income families still spend more each month than they earn. As well, criminal charges against youth are declining, math and science skills are improving compared to other countries and injury deaths among teens are falling.

But the report also found:
* The number of families using food banks has more than doubled in the last decade and almost half of those who depend on them are children and youth.

* About 57,000 Canadian children younger than 12 go hungry because of lack of food or money.

* Teen smoking rates have risen dramatically to nearly a third of all 15 to 19-year-olds.

* One out of every six children younger than 12 has parents who are separated or divorced and one-third of them live in families with no financial agreement in place.

* While more young women are earning post-secondary degrees, average university undergraduate tuition fees rose 7 per cent this year and the average debt load at graduation has gone up by nearly half since 1995.

* Affordable housing is a growing problem, particularly among young and single-parent families, and public housing construction has stopped in most provinces.

* Less than half of low-income families with children spend money on user fees for children's recreation activities while three-quarters of high-income families do.
To reverse the negative trends, the council called on the federal government to increase its contribution to the national child benefit to $2.5 billion annually by 2000.

It also called for delivery of the long-promised national child-care program, improved services for children and youth and ``a coherent, long-term and adequately financed approach to health care.''

To improve families' economic security, governments should increase funding for post-secondary education, increase employment insurance benefits and reform the tax system to make it more equitable for low- and moderate-income earners.

The Canadian telehealth landscape: a Canadian challenge (5 October 1998)  Alan Nymark, Associate Deputy Minister of Health spoke this morning in Fredericton, NB about Health Canada's interest in developing telehealth. "Better decision making through information will lead to improved health, greater access to health services, better quality health care and reduced costs for all Canadians. Most importantly, it will play a key role in creating a system that is accountable to the public and integrated around their needs."

Health Promotion: Can Scare Tactics Work?
Health promotion campaigns that play on fear may be promoting counter-productive effects if they aren't designed correctly, warns a team of researchers who field tested one such campaign.   Researchers at Michigan State University found that the key to ensuring successful scare tactic campaigns is to give individuals specific information about the effectiveness of a recommended action as well as clear information on how to actually do what is recommended. If no such information is given about a desired health behavior change, then scare tactic campaigns may cause people to deny they're at risk for experiencing health hazards, says Kim Witte, PhD, and her colleagues in the October Health Education & Behavior.   "Fear appeal campaigns can produce multiple outcomes, some of which interfere with desired behavior changes," they write, and while some such campaigns do persuade people that they face a significant threat, if not done correctly they also promote denial or avoidance of the issue, which prevents people from taking action to reduce their risk.
Witte and her colleagues tested the effectiveness of a fear campaign designed to reduce the risk of genital warts caused by human papilloma virus (HPV) - the number one sexually transmitted disease on many college campuses.  About half of their sample of 219 college women received a brochure on HPV with vivid, personalized language describing the consequences of infection. They also completed questionnaires designed to assess their fear of HPV, if they believed condoms could reduce their risk, and the extent to which they discounted the HPV threat. Overall, Witte and her colleagues found that only women who felt threatened by HPV were motivated to protect themselves against the disease. Those who did not feel threatened failed to respond "in either positive or negative ways to the campaign - they simply ignored it" and made no changes in attitudes or behavior.   The research team also found that the fear-based campaign "appeared" to fail because there was no difference in attitudes toward HPV risk or change in behavior between the women who received the fear literature and those who did not. But, when they looked more closely, they found that women who strongly believed they could lower their risk of HPV were more likely to change their behavior than those who did not believe they could modify their risk.   The findings, they say, suggest that scare tactics can be effective because fear motivates individuals into action, but they only work when people believe they are able to do something that really averts a threat . The researchers caution that if it is impossible to address negative beliefs about the recommended remedies, such as condom usage, then designers of public health campaigns should avoid the use of fear appeals. Annals of Behavioral Medicine is the official peer-reviewed publication of The Society of Behavioral Medicine. For information about the journal, contact editor Arthur Stone, PhD, 516-632-8833.  It's available online at: http://psychweb.syr.edu/sbm/abm.html.


Advisory Council on Health Info-Structure Asks Canadians for Comments on Interim Report (30 September 1998) The Advisory Council on Health Info-structure is calling on Canadians to comment on its interim report which outlines how the use of information and communications technologies could support and promote more informed decision making about health, and the health sector, by individual Canadians, health professionals, and policy makers. Until recently, extensive health information has been available mainly to a limited number of decision makers within the health sector. The new information and communications technologies used in a health infostructure, offer the promise of significant change. Highlights of the report are available. The deadline for comments is November 6, 1998. For more information, visit http://www.mposhawa.ca/co981005.htm

Health impacts of literacy profiled
(8 September 1998)  September 8 is International Literacy Day. A profile paper prepared for Health Canada confirms that Canadians with low literacy rates generally have more health problems. According to the authors of the paper, literacy affects and interacts with almost all other determinants of health. For more information, visit  http://www.hc-sc.gc.ca/hppb/healthpromotiondevelopment/pube/literacy-health/literacy.htm

Release of final report of National Conference on Health Info-Structure
(3 September 1998) 
The final report was made public today by the conference co-hosts Health Minister Allan Rock and Alberta Health Minister Halvar Jonson.The purpose of the conference was to advance the development of a national strategy on using information and communication technologies to modernize the health system. Minister Rock took the opportunity to announce the National Telehealth Research Project for First Nations communities. The $2 million project, which is being funded under the Health Transition Fund, will pilot test the use of telehealth technology to improve and expand the range of health services available to First Nations communities.   
For more information, visit http://www.hc-sc.gc.ca/english/media/releases/1998/98_51e.htm

AIDS Educator Charged for Showing Video
Washington Times (08/28/98) P. A5 Keith Carson, an AIDS prevention educator in New Jersey, has was charged with distributing obscenity to minors after he showed a
videotape of homosexual sex acts to teens. The tape, produced by Gay Men's Health Crisis in New York City, was shown to seven teens aged 15 to 17 at a county youth shelter. The program advocates the use of condoms as an AIDS prevention effort. Carson, who is employed by the South Jersey AIDS Alliance, could face up to 18 months in prison.


The Institute of Medicine's new document, "Scientific Opportunities and Public Health Needs: Improving Priority Setting and Public Input at the National Institutes of Health," (Washington, DC: National Academy Press, 1998) offers welcome encouragement to community and population health and the social and behavioral sciences. While it does not directly encourage a funding increase, the document's recommendations could result in an increased emphasis on behavioral science research.

Most importantly, the report suggests that the NIH improve its analysis and use of public health data on burden of disease, costs, and potential health impact. As documented by McGinnis and Foege (1993), behaviors are linked with half of all deaths in the US each year. (Less than 7% of the NIH budget is believed to be devoted to behavioral research).   The report also suggests that the definition of "public health need" be expanded to include not only prevention/treatment of illness, but also maintenance of positive health and functioning. A true commitment to broadening the definition of health would also mean a commitment to increasing funds for health and behavior research.

In addition to recommendations about criteria for priority setting, the report provides advice to the NIH on creating mechanisms for public input, and to Congress on its role in relationship to NIH. View the report at http://www.nap.edu/readingroom/books/nih/.

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