




Home Endnotes:
Preface Chap 1
Chap 2
Chap 4 Chap 5
Chap 6 Chap 7
Chap 8 Chap 9
Health Program Planning, 4th edition
New Endnotes,
References, and Web Links
Chapter 3. The Epidemiological Diagnosis: Health,
Behavioral, and Environmental Assessments
In the 4th edition Chapter 3 combines what were
Chapters 3 & 4 in 3rd edition.
For an online glossary of statistical terms used in epidemiology,
click
here. For other terms, go to the glossary in our 4th edition. For online
biostatistics courses, click on "Descriptive Epidemiology" in the Table of
Contents below.
INTRODUCTION
Where's the Evidence?
Organization of the chapter
STARTING IN THE MIDDLE: A REALITY FOR PRACTITIONERS AND PLANNERS

THREE
REASONS WHY PLANNERS SHOULD KNOW THE WHOLE MODEL
MAINTAINING RECIPROCAL BALANCE
DESCRIPTIVE EPIDEMIOLOGY [Part 1]
EPIDEMIOLOGY: A DEFINITION
WHAT IS THE PROBLEM?
Rates
Specific and Adjusted Rates
Incidence and Prevalence Rates
Surveillance
Making Comparisons for Planning
Obtaining Data to Make
Comparisons
Comparisons in Evaluation
SETTING PRIORITIES and
OBJECTIVES FOR
HEALTH PROGRAMS
KEY QUESTIONS
DEVELOPING HEALTH OBJECTIVES
ETIOLOGY: WHY DO
THOSE WITH THE PROBLEM HAVE IT? [Part 2]
RISK
FACTORS: FINDING RELEVANCE FOR PLANNING
RISK FACTOR SURVEILLANCE
POPULATION-ATTRIBUTABLE RISK
COST-BENEFIT
ANALYSIS FROM POPULATION-ATTRIBUTABLE RISK
DATA: FOLLOW THE
SIGNS
ECOLOGICAL
CORRELATIONS
AN EXAMPLE: COAL
MINERS IN APPALACHIA
"PROTECTIVE"
FACTORS
BEHAVIORAL DIAGNOSIS
THREE
LEVELS OR CATEGORIES OF BEHAVIOR
GENETIC-BEHAVIOR INTERACTIONS
STEP
1: LISTING POTENTIAL BEHAVIORAL RISKS FOR THE HEALTH PROBLEM
STEP
2: RATING BEHAVIORS ON IMPORTANCE
STEP
3: RATING BEHAVIORS ON CHANGEABILITY
STEP 4: SETTING BEHAVIORAL
OBJECTIVES
STEP
5: STATING BEHAVIOR OBJECTIVES
ENVIRONMENTAL DIAGNOSIS
STEP 1: IDENTIFYING WHICH ENVIRONMENTAL
FACTORS
STEP 2: RATING ENVIRONMENTAL FACTORS ON
RELATIVE IMPORTANCE
STEP 3: RATING ENVIRONMENTAL FACTORS ON
CHANGEABILITY
STEP 4: CHOOSING THE ENVIRONMENTAL OBJECTS
OF CHANGE
STEP 5: STATING THE ENVIRONMENTAL
OBJECTIVES
EVALUATION SUMMARY
PUBLIC
HEALTH NEWS ON EPIDEMIOLOGY SINCE THIS BOOK WENT TO PRESS
ENDNOTES FOR CHAPTER 3: EPIDEMIOLOGICAL DIAGNOSIS
INTRODUCTION
1. The obesity epidemic trend maps. Details of this event based on
personal conversations with Dr. William Dietz, Director, Division of Nutrition
and Physical Activity, National Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control and Prevention (CDC); and Jeffrey P.
Koplan, Vice President for Health Sciences at Emory University and former
Director, CDC. Interviews conducted on (October 5 and 7, 2003). To review the
PowerPoint slides presenting obesity and diabetes trend data, see:
http://www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/index.htm
Where's the Evidence?
2. Role of public health professionals in surveillance, monitoring,
analyzing and presenting health data. Institute of Medicine, 2003.
Institute of Medicine (2003). Who will keep the public healthy?
Washington, DC: The National Academies Press.
Full-text online
Organization of the chapter
3. Starting in the middle. The algorithm on the title page of Chapters
2-5 shows how the planner can locate the most appropriate place in PRECEDE to
undertake data collection and planning. [A version of the algorithm for Chapter
3 is reproduced above in the table of contents.]
4. Evaluation as an integrated element of planning phases, rather than as
a separate phase. In previous editions of this book, and earlier renditions
of the Precede-Proceed model, we have devoted a separate chapter and a separate
phase to evaluation, following the diagnostic and implementation phases. We have
discovered that a separate, end-of-planning evaluation chapter has had
an unintended effect for some planners: putting off thinking about evaluation
until the program is launched. This leads to the neglect of evaluation
considerations in the earlier phases of planning where it is so essential not
only for making inevitable midcourse corrections but also for establishing the
baselines needed for measuring, monitoring, and documenting the important
outcomes. As Carol Weiss (1973) so famously said, "The sins of the program are
often visited on the evaluation." (p. 54).
For an updated perspective on these
observations in the context on theory-based planning and evaluation, see
Birckmayer
& Weiss, 2000.*
Birckmayer JD, Weiss CH.*
(2000). Theory-based evaluation in practice. What do we learn?
Eval Rev
2000 Aug;24(4):407-31.
Weiss, C. H. (1973). Between the cup and the lip. Evaluation, 1(2),
54.
*Material highlighted in yellow has
been added since the manuscript went to press for the 4th edition. Note that
authors names underlined are hyperlinked to the abstract of the article, or to
the publisher's catalog description of the book.
STARTING IN THE MIDDLE: A REALITY FOR PRACTITIONERS AND PLANNERS
See the algorithm on the title page of the chapter, and in the
table of contents above.
THREE
REASONS WHY PLANNERS SHOULD KNOW THE WHOLE MODEL
5. Web-based tools for linking social and epidemiological diagnosis.
MAPP is a refinement and extension of the CDC Planned Approach to Community
Health or PATCH (which was based on the principles and methods of the
Precede-Proceed model) and Assessment Protocol for Excellence in Public Health
(APEX/PH). For more details on the MAPP process, contact the National
Association of County and City Health Officials, 1100 17th Street,
NW, Second Floor, Washington, DC 20036. Phone: (202) 783-5550, Email:
mapp@naccho.org. See endnote 36 in Chapter
2 for web links. Related to the MAPP Web-based tools are other resources
designed to tie local planning efforts to national health objectives as part of
the Healthy People 2010 initiatives, e.g., U.S. Department of Health and Human
Services, 2001; 2002.
U.S. Department of Health and Human Services, 2001. Healthy people in
healthy communities. Washington, DC: U.S. Government Printing Office.
U.S. Department of Health and Human Services (2002).
Healthy people 2010 toolkit: A field guide to health planning. Washington,
DC: The Public Health Foundation. http://www.health.gov/healthypeople/state/toolkit.
6. International example of linking health with social
functioning. First published by the World Health Organization in 1980, the
WHO International Classification of Functioning, Disability and Health,
2001, is now available on line at
http://www.who.int/classification/icf/intros/ICF-Eng-Intro.pdf, and bundled
with the companion International Classification of Diseases (ICD-10) in
book and CD-ROM.
World Health Organization. (2001). International
Classification of Functioning, Disability and Health. Geneva: World Health
Organization.
http://www.who.int/classification/icf/oderform/orderform.pdf. Accessed Dec
2, 2003.
7. Potential social consequences of health objectives.
E.g., on youth violence, Rigby, 2003. On parental alcohol abuse,
Christoffersen, & Soothill, 2003.
Rigby, K. (2003). Consequences of bullying in schools. Canadian Journal
of Psychiatry, 48, 583-90.
Christoffersen, M. N., & Soothill, K. (2003). The long-term consequences
of parental alcohol abuse: a cohort study of children in Denmark. Journal
of Substance Abuse Treatment, 25, 107-16.
8. Working knowledge of trends, technologies, and recent
evaluations of programs on similar health problems helps set up evaluation
baseline measures. E.g., CDC, 2003,
http://www.cdc.gov/cancer/ncccp/guidelines/index.htm
Centers for Disease Control and Prevention. (2003).
Guidance for comprehensive cancer control planning: Guidelines. Vol
1 CDC, 2003:
http://www.cdc.gov/cancer/ncccp/guidelines/index.htm.
MAINTAINING RECIPROCAL BALANCE
9. Growing evidence of the social gradient in morbidity and mortality.
E.g., Evans, Barer, & Stoddard, 1994; Smedley, & Syme, 2000; Wilkinson, 1996;
Yen & Syme, 1999.
See also endnote 2, Chapter 2.
Evans, R. G., Barer, M. L.,& Marmor, T. L. (Eds.). (1994). Why are some
people healthy and others not? Hawthorne, New York: Aldine De Guyter.
Smedley, B. D., & Syme, L. S. (2000). Promoting health: Intervention
strategies from social and behavioral research. Washington, DC: National
Academy Press.
Wilkinson, R.(1996). Unhealthy societies: The afflictions of inequality.
London: Routledge, 1996.
Yen, I., Syme, S.L. (1999). The social environment and health: A discussion
of the epidemiologic literature. Annual Review of Public Health 20:
287-308.
10. Poverty, racial, and ethnic factors in health disparities. E.g.,
Stewart & Napoles-Springer, 2003; Whaley, & Geller, 2003; Zuvekas, & Taliaferro,
2003.
Stewart, A. L., & Napoles-Springer, A. M. (2003). Advancing health
disparities research: can we afford to ignore measurement issues? Med Care,
41, 1207-20.
Whaley, A. L., & Geller, P. A. (2003). Ethnic/racial differences in
psychiatric disorders: a test of four hypotheses. Ethnicity & Disease, 13,
499-512.
Zuvekas, S. H., & Taliaferro, G. S. (2003). Pathways to access: health
insurance, the health care delivery system, and racial/ethnic disparities,
1996-1999. Health Affairs (Millwood), 22, 139-53.
11. Participatory research engaging intersectoral collaboration on social
determinants of health. E.g., Krieger, Cheadle, et al., 2002.
Krieger, J. W., Cheadle, A. C, Higgins D, Schier,
J., Senturia, K., & Sullivan, M. (2002). Using community-based participatory
research to address social determinants of health: Lessons learned from
Seattle Partners for Healthy Communities. Health Education and Behavior,
29, 361-82.
DESCRIPTIVE EPIDEMIOLOGY
EPIDEMIOLOGY: A DEFINITION
10>12. Definition of epidemiology. Last, 2000, pp. 62ff.
The definition and
explanation of epidemiology has been paraphrased from several pages of
Last, which he assures us was a committee product and never considered to be
cast in stone (personal correspondence, Dec. 3, 2003). For variations on this
definition, see Green & Ottoson, 1999, p. 70; Timmerick, 1997, pp. 221–2.
Last, J. (2000). Dictionary of epidemiology, 4th edition.
New York: Oxford University Press.
Timmerick, T. C. (1997). Health services cyclopedic dictionary. 3rd
ed. Sudbury, MA: Jones and Bartlett Publishers.
Because
epidemiology relies on biostatistical methods, readers of this book who have
not had a course either in biostatistics or epidemiology might want to
consider http://statistics.com for
current announcements of online courses, or one of the following online courses:
http://www.eric.seattle.med.va.gov/education/seattle_eric_cyber.htm
This is a web-TV course. Various lectures are on video, along with other
assignments via the web.
http://garnet.indstate.edu/bell/hs340/coursesyll.htm.
This Indiana State University course is undergraduate level.
http://www.uic.edu/depts/spha/
Only those who have been admitted to an MPH degree program can take this.
http://www.sph.emory.edu/CMPH/ Emory's course has students meet in person at the beginning and the end
of the course, with assignments in the interim period.
http://www.sph.unc.edu/nciph/certificate/curriculum.htm
http://hsc.usf.edu/publichealth/dlp/epbphc6050.html
This University of South Florida School of Public Health course is a satellite course. Not just on-line.
http://distance.jhsph.edu/statr1/
Bloomberg School of Public Health, Johns Hopkins University. Distance
education. Note that this source of credit courses from Johns Hopkins differs
from the Free "Open Access" courses described and linked
below.
Johns
Hopkins Bloomberg School of Public Health Offers Free Courses Online
The Johns Hopkins Bloomberg School of Public Health has launched the
initial phase of its OpenCourseWare project, which provides free and open
access to some of the School's most popular courses. The courses are available
through the Internet to students, self-learners and educators anywhere in the
world.
Demystifying
Data: Accessing, Interpreting, and Using Health Data -- May 9 - June 27,
2005
The University of Michigan School of Public Health is offering an online
mentored course that highlights an evidence-based approach to decision-making.
Participants will learn how to identify, interpret, and present appropriate
data to describe an issue quantitatively and develop data-based program or
policy options.
Online
course: Fundamentals of Epidemiology -- June 10 - July 15,
2005
Professors David Kleinbaum
and Nancy Barker of the Emory University Rollins School of Public Health will
be teaching the online course “Fundamentals of Epidemiology” at
statistics.com from Friday, June 10 through Friday, July 15. Based on
their electronic textbook “ActiveEpi,” this is an introductory course that
emphasizes the underlying concepts and methods of epidemiology. Topics covered
include: study designs (clinical trials, cohort studies, case-control studies,
and cross-sectional studies), measures of disease frequency and effect.
15>13.
Measures of quality of life. E.g., Centers for Disease Control and
Prevention, 2000; see also Chapter 2, endnotes 5 and 16-22.
Centers for Disease Control and Prevention (2000). Measuring healthy days:
Population assessment of health-related quality of life. Atlanta, GA,
Health Care and Aging Studies Branch, Division of Adult and Community Health,
National Center for Chronic Disease Prevention and Health Promotion, CDC.
WHAT IS THE PROBLEM?
16>14. Years of potential life lost (YPLL) measure the impact of
diseases and injuries that kill people before the customary age of retirement.
It is computed as the sum of products over all age groups up to age 65,
sometimes 75, each product being the annual number of deaths in an age group
multiplied by the average number of years remaining before the age of 65 for
that age group. See, e.g., Fellows, Tosclair, et al., 2002;
O'Shea, 2003.
Fellows, J.
L., Trosclair, A., Adams, E. K., & Rivera, C. C. (2002). Annual
smoking-attributable mortality, years of potential life lost, and economic
costs--United States, 1995-1999. MMWR Morbidity & Mortality Weekly Report,
51, 300-3. [full text]
O'Shea E. (2003). Social gradients in years of potential life lost in
Ireland. European Journal of Public Health, 13, 327-33.
Rates
Specific and Adjusted Rates
Incidence and Prevalence Rates
Surveillance
17>15. Definition of surveillance. Hockin, 2002, p. 1171. Earlier
definitions from the communicable disease era of public health had emphasized
"continuous" rather than "ongoing" collection of data, but because surveillance
of chronic diseases calls upon public health to have earlier warnings of
emerging diseases than the symptoms that are detected in continuous reporting by
doctors, surveys of population health practices and lifestyles have been
required to detect risk factors like smoking or obesity that would predict
oncoming epidemics like cancer and diabetes. Surveys usually cannot be done
continuously, hence the shift in definition of surveillance. The Behavioral Risk
Factor Surveillance System (BRFSS), however, has a rolling sampling method
within states that makes it virtually continuous (e.g., CDC, 2004).
Centers for Disease Control and Prevention (CDC). (2004). Declining
prevalence of no known major risk factors for heart disease and stroke among
adults--United States, 1991-2001. MMWR Morbidity & Mortality Weekly Reports,
53, 4-7. [Full text]
Hockin, J. (2002). Suveillance. In L. Breslow, B. Goldstein, L. W. Green, C.
W. Keck, J. M. Last, & M. McGinnis (Eds.). Encyclopedia of public health,
vol. 4, S-Z (pp. 1171-72). New York: Macmillan Reference USA.
16.
Canadian federal compilation of surveillance data. Go to:
http://www.hc-sc.gc.ca/pphb-dgspsp/, accessed Dec. 3, 2003.
Making Comparisons for Planning
Obtaining Data to Make
Comparisons
17. New York
City Community Health Profiles,
New York City Department of Health and Mental Hygiene. Website:
http://www.ci.nyc.ny.us/html/doh/html/data/data.html, accessed Dec. 3, 2003.
Comparisons in Evaluation
SETTING PRIORITIES FOR
HEALTH PROGRAMS
KEY QUESTIONS
DEVELOPING HEALTH OBJECTIVES
24>18. Some applications of PRECEDE illustrating epidemiological
assessments and setting of health objectives include Antoniades & Lubker,
1997; Cadman, 1996; Cain, Schyulze, & Preston, 2001; Castilla y Leon, 1993;
Clarke, Frankish, & Green, 1997; Farthing, 1994; Gielen, 1992; Green, Mullen, &
Friedman, 1991; Green, Wilson, & Bauer, 1983; Howatt, Jones, et al., 1997;
Livingston, 1985; Simons-Morton, Parcel, Brink, Harvey, & Tiernan, 1991;
Stevenson, Jones, Cross, Howatt, & Hall, 1996;
Stevenson, Jones, et al., 1996;
Timmerick, 1998, pp. 338–340; Walter, Hoffman, Connelly, et al., 1985;
1986. See also Chapter 1, endnote 26.
Antoniadis, A., & Lubker, B. B. (1997). Epidemiology as an essential
tool for establishing prevention programs and evaluating their impact and
outcome. Journal of Communication Disorders 30, 269-83;
quiz 283-4. Review.
Cadman, R.
(1996).
Ski injury prevention - An epidemiological investigation of the social, behavioural, and environmental determinants of injury. Vancouver, BC:
Institute of Health Promotion Research, Faculty of Graduate Studies, University
of British Columbia, Unpublished doctoral dissertation.
Cain, R. E., Schyulze, R. W., &
Preston, D. B. (2001). Developing a partnership for HIV primary prevention for
men at high risk for HIV infection in rural communities. Promotion and
Education: International Journal of Health Promotion and Education, 8,
75-8.
Castilla y Leon, Junta de (1993). Plan
sectorial
de educacion
para
la
salud.
Madrid: Graficas Don Bosco, Arganda del Rey.
[Consejeria
de Sanidad y Bienestar Social, Direccion General de Salud Publica y Asistencia,
Avenida de Burgos, 5-47071 Valladolid, Spain]
Clarke, V.,
Frankish, C. J., & Green, L. W. (1997). Understanding suicide among indigenous
adolescents: A review using the Precede model. Injury Prevention 3:
126-34.
Farthing, M.
(1994). Health education needs of a Hutterite colony. The Canadian
Nurse/L'Infirmiere Canadienne, 90, 20-6.
Gielen, A. C. (1992). Health education and injury control: Integrating
approaches. Health Education Quarterly, 19, 203-18.
Green, L. W., Mullen, P. D., & Friedman, R. (1986). An epidemiological
approach to targeting drug information. Patient Education & Counseling,
8, 255-68.
Green,
L. W., Wilson,
R. W.,
&
Bauer, K.
G.(1983).
Data required to measure progress on the objectives for the nation in disease
prevention and health promotion. American Journal of Public Health, 73,
18-24.
Howat, P.,
Jones, S., Hall, M., Cross, D., & Stevenson, M. (1997). The PRECEDE-PROCEED
model: Application to planning a child pedestrian injury prevention program.
Injury Prevention, 3, 282-7.
Livingston, I.
L. (1985). Hypertension and health education intervention in the Caribbean: A
public health appraisal. Journal of the National Medical Association, 77,
273-80.
Stevenson, M., Iredell, H., Howat, P., Cross, D., Hall, M. (1999).
Measuring community/environmental interventions: The Child Pedestrian Injury
Prevention Project. Injury Prevention, 5, 26-30.
Stevenson, M.,
Jones, S., Cross D., Howat, P., & Hall, M. (1996). The child pedestrian
injury prevention project. Health Promotion Journal of Australia,
6, 32-6. [Department of Epidemiology and Biostatistics, School of
Public Health, Curtin University of Technology, Perth, Australia.]
Timmerick, T. C. (1998). An introduction to
epidemiology (2nd ed.). Boston: Jones & Bartlett.
Walter,
H. J., Hofman, A., Connelly, P. A., Barrett, L. T., & Kost, K. L.
(1985).
Primary prevention of chronic disease in childhood: changes in risk factors
after one year of intervention. American Journal of Epidemiology, 122,
772-81.
Walter, H. J., Hofman, A., Connelly, P. A., Barrett, L. T., & Kost, K. L.
(1986). Coronary heart disease prevention in childhood: one-year results of a
randomized intervention study. American Journal of Preventive Medicine, 2,
239-45.
ETIOLOGY: WHY
DO THOSE WITH THE PROBLEM HAVE IT?
19. Social
determinants of health. E.g., Karpati, Galea, et al., 2002; Marmot, 2000;
Marmott, & Wilkinson, 1999; Wallerstein, Duran, et al., 2003; Wilkinson, &
Marmot, 1998.
Karpati, A., Galea, S., Awerbuch, T., & Levins, R. (2002). Variability and
vulnerability at the ecological level: Implications for understanding the
social determinants of health. American Journal of Public Health, 92,
1768-72.
Marmot, M. (2000). Social determinants of health: From observation to policy.
Medical Journal of
Australia, 17,:
541-44.
Marmot M. & Wilkenson, R.G. (Eds.). (1999). Social determinants of health.
New York: Oxford University Press.
Wallerstein. N., Duran, B. M., Aguilar, J., Joe, L., Loretto,
F., Toya, A., Yepa-Waquie, H., Padilla, R., & Shendo, K. (2003). Jemez Pueblo: built and
social-cultural environments and health within a rural American Indian
community in the Southwest. American Journal of Public Health, 93,
1517-8.
Wilkinson, R.
G., & Marmot, M. (Eds.) (1998). Social determinants of health: The solid
facts. Geneva: World Health Organization.
The Influence of
Community Factors on Health: An Annotated Bibliography provides insight
into the findings of researchers who have investigated community effects on
health, and the program and policy implications that can be drawn from their
work. Developed by PolicyLink, and funded by The California Endowment, this
annotated bibliography contains summaries of over 150 articles, reports, and
books on how environmental, social, and economic conditions of community life
affect health. The document is available in PDF form and in searchable
web-based version at http://www.policylink.org/CHB/
20. Economic
determinants of health. E.g., Green & Potvin, 2002; Hart, 2002; Wilkinson,
1996.
Green, L. W. & Potvin, L. (2002). Education, health promotion, and social and
lifestyle determinants of health and disease. In R. Detels, J. McEwen, R.
Beaglehole, & H. Tanaka (Eds.). Oxford Textbook of public health: Vol 1:
The scope of public health, 4th edition (pp. 113-130). New
York: Oxford University Press.
Hart, N. (2002). Social, economic, and cultural environment and human health.
In R. Detels, J. McEwen, R. Beaglehole, & H. Tanaka (Eds.). Oxford Textbook
of public health: Vol 1: The scope of public health, 4th
edition (pp. 89). New York: Oxford University Press.
Wilkinson, R. G.
(1996). Unhealthy societies: The afflictions of inequality. London:
Routledge.
21.
Environmental risks. E.g., Dannenberg, Jackson, et al., 2003; Wallerstein,
Duran, et al., 2003; Wright, & Fischer, 2003. See also Chapter 4, endnote 71.
Dannenberg, A. L., Jackson, R. J., Frumkin, H., Schieber,
R. A.., Pratt, M., Kochtitzky, C., & Tilson, H. H. (2003). The impact of
community design and land-use choices on public health: A scientific research
agenda. American Journal of Public Health, 93, 1500-8.
Wallerstein. N., Duran, B. M., Aguilar, J., Joe, L., Loretto,
F., Toya, A., Yepa-Waquie, H., Padilla, R., & Shendo, K. (2003). Jemez Pueblo: built and
social-cultural environments and health within a rural American Indian
community in the Southwest. American Journal of Public Health, 93,
1517-8.
Wright, R. J., & Fischer, E. B. (2003). Putting
asthma into context: Community influences on risk, behavior and interventions.
In I. Kawachi, & L. F. Berkman (Eds.) Neighborhoods and health, pp.
222-262. New York: Oxford University Press Inc.
22. Cultural determinants of health. E.g.,
House, & Williams, 2000; Wright & Fisher, 2003.
House, J. S., & Williams, D. R. E. (2000).
Understanding and reducing socioeconomic and racial/ethnic disparities in
health. In Committee on Capitalizing on Social Science and Behavioral Health
to Improve the Public’s Health, Institute of Medicine. Promoting health:
Intervention strategies from social and behavioral research. Washington:
National Academy Press, 2000.
Full
text online at:
http://books.nap.edu/catalog/9939.html
Wright, R. J., & Fischer, E. B. (2003). Putting asthma
into context: Community influences on risk, behavior and interventions. In I.
Kawachi, & L. F. Berkman (Eds.) Neighborhoods and health, pp. 222-262.
New York: Oxford University Press Inc.
23. "Determinants" might overstate the causal
certainty of the connection, but not the consistent, cumulative weight of associational evidence.
Daniels, Kennedy, & Kawachi, 2000.
Daniels, N., Kennedy, B., & Kawachi, I. (2000).
Justice is good for our health. Boston Review, February/March 2000.
24. Risk, risk perception, risk assessment. For
a detailed review of these concepts and data related to them, see WHO, 2002,
chapters 3, 4, & 5.
World Health Organization. (2002). The World
Health Report 2002: Reducing risks, promoting healthy life. Geneva: World
Health Organization.
http://www.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=24&codcch=2002
In the March 10, 2004
Journal of the American Medical Association (291(10):1238-45), CDC
researchers
updated the "actual causes of death" (see McGinnis and Foege's seminal piece on
"actual causes of death," JAMA, 1990) to the year 2000. The purpose of
the new study was to determine whether lifestyle pattern changes over the past
decade had influenced leading causes of mortality. They concluded that smoking
remained the "real" cause of the most current deaths, but that with the declines
in smoking and the increasing rates of obesity, diet and physical activity could
soon overtake tobacco as the leading actual cause of death.
RISK FACTORS: FINDING
RELEVANCE FOR PLANNING
RISK FACTOR SURVEILLANCE
25. Limited surveillance capacity in most local jurisdictions. E.g.,
Ounpuu, Kreuger, et al., 2000; Remington, & Goodman, 1998; Teutsch, & Churchill,
2000.
Ounpuu, S., Kreuger, P., Vermeulen, M., Chambers, L. (2000). Using the U.S. Behavior[al] Risk Factor Surveillance System’s health related quality of life
survey tool in a Canadian city. Canadian Journal of Public Health, 91,
67-72.
Remington, P. L., & Goodman, R. A. (1998). Chronic
disease surveillance. In R. C. Brownson, P. L. Remington, & J. R. Davis
(Eds.). Chronic Disease Epidemiology and Control, 2nd ed.
(pp. 55-76). Washington, DC, American Public Health Association.
Teutsch, S. M., & Churchill, R. E. (2000). Principles
and practice of public health surveillance, 2nd ed. Oxford, New
York, Oxford University Press.
26. Making surveillance systems relevant to regional or
local program planning. McQueen et al., 2003. See especially the analysis
and interpretation of data from the BRFSS, Holtzman, 2003; and the bottom line,
"Will they use it?" Ottoson & Wilson, 2003.
Holtzman, D. (2003). Analysis and interpretation of data
from the U.S. Behavioral Risk Factor Surveillance System (BRFSS). In D. V.
McQueen, & P. Puska (Eds.). (2003). Global behavioral risk factor
surveillance, pp. 35-46. New York: Kluwer Academic/Plenum
Publishers.
McQueen, D. V., Puska, P. (Eds.). (2003). Global
behavioral risk factor surveillance. New York: Kluwer Academic/Plenum
Publishers.
Ottoson, J. M., & Wilson, D. H. (2003). Did they use it?
Beyond the collection of surveillance information. In D. V. McQueen, & P.
Puska (Eds.). (2003). Global behavioral risk factor surveillance,
pp.119-132. New York: Kluwer Academic/Plenum Publishers.
27. Accessing state risk factor survey data. The easiest way to access
state specific data for the BRFSS is to go to the website for the Association of
State and Territorial Health Officers at:
www.astho.com. Once in that site, go to the map of the United States and
click on the state or territory for which you are seeking data. Most state health departments
now have some of their state data on health indicators available on their
respective websites. One of the most thoroughly developed databases of health
indicators is the IBIS-PH (Indicator-Based Information System for Public Health)
of the Utah Department of Health. The following website will link you to
categorized and alphabetical listings of all indicators, with links from there
to each to the corresponding databases: http://health.utah.gov/ibis-ph/.
For an extensive guide to compiling such data in the context of a PRECEDE
approach to planning, see the guides for the CDC PATCH planning process
online and downloadable:
http://www.cdc.gov/nccdphp/patch/.
POPULATION-ATTRIBUTABLE RISK
COST-BENEFIT ANALYSIS FROM POPULATION-ATTRIBUTABLE RISK
28. Smoking-attributable risk. The recent population-attributable
risks and social costs for smoking are calculated for the U.S. in Fellows,
Trosclair, et al., 2002; for full text of the article, click on the authors. For
a review of health-related costs, see Max, 2001. Software for calculating
smoking-attributable mortality and economic costs for adults and for maternal
and child health are available from the Office on Smoking and Health, CDC, 2002,
and at
http://www.cdc.gov/tobacco/sammec.
Centers for Disease Control and Prevention. (2002). Smoking-attributable
mortality, morbidity, and economic costs (SAMMEC): adult SAMMEC and maternal and
child health (MCH) SAMMEC software. Atlanta: Office on Smoking and Health,
National Center from Chronic Disease Prevention and Health Promotion, Centers
for Disease Control and Prevention.
Fellows, J.
L., Trosclair, A., Adams, E. K., & Rivera, C. C. (2002). Annual
smoking-attributable mortality, years of potential life lost, and economic
costs--United States, 1995-1999. MMWR Morbidity & Mortality Weekly Report,
51, 300-3. [full text]
Max,W. (2001). The financial impact of smoking on health-related costs: a
review of the literature. American Journal of Health Promotion, 15,
321-31.
DATA: FOLLOW THE SIGNS
29. The Missouri data were taken from: Section IV, Chronic Disease,
Risk Factor, and Preventive Services, Missouri, The Burden of Chronic Diseases
and Their Risk Factors: National and State Perspectives 2002, at
http://www.cdc.gov/nccdphp/statbook/statbook.htm, accessed Dec. 3, 2003. Any
other state's data can be accessed from this site.
30. The report to the Missouri Board of Health. Missouri Foundation
for Health, 2001, p. 20.
Missouri
Foundation for Health. (2001). A report to the Board. Missouri State
Department of Health. Missouri Foundation.
ECOLOGICAL CORRELATIONS
31. Two studies on social capital and health.
Kawachi, Kennedy,
et al., 1997.
Kawachi, I., Kennedy, B. P., Lochner, K.& Prothro-Stith, D. (1997). Social
capital, income inequality, and mortality. American Journal of Public
Health, 87, 1491-98.
AN EXAMPLE: COAL MINERS IN
APPALACHIA
32. The
Appalachian mineworkers’ lung disease project.
Terry, Wang, et
al, 1981; Wang, Terry, et al 1979.
*Terry, P. B., Wang, V. L. Flynn, B. S., et al. (1981). A continuing medical
education program in chronic obstructive pulmonary diseases: Design and
outcome, American Review of Respiratory Diseases
123, 42-6.
*Wang
VL, Terry P, Flynn BS, Williamson JW, Green LW, Faden R.
(1979). Multiple indicators of
continuing medical education priorities for chronic lung diseases in Appalachia,
Journal of Medical Education, 54, 803-11.
"PROTECTIVE" FACTORS
33. The Alameda County studies of protective health
factors. Belloc, 1973; Belloc & Breslow, 1972; Berkman & Breslow, 1983; see
also the retrospective reflections on this series of studies in an interview
with Lester Breslow at age 89: Breslow, [Stallworth & Lennon], 2003.
Belloc, N. B. (1973). Relationship of health practices and mortality.
Preventive Medicine, 3, 125-35.
Belloc, N. B., & Breslow, L. (1972). Relationship of physical health status
and health practices. Preventive Medicine, 1, 409-21.
Berkman, L. F., & Breslow, L. (1983). Health and ways of living: The
Alameda County study. New York: Oxford University Press.
Breslow, L. (2003). An interview with Dr. Lester Breslow [interview by JoAna
Stallworth and Jeffery L. Lennon]. American Journal of Public Health, 93,
1803-5.
34. The
longer-term follow up of Alameda County cohort.
Breslow & Egstrom,
1980.
Breslow, L., & Engstrom, J. D. (1980). Persistence of health habits and their
relationship to mortality. Preventive Medicine, 9, 469-83.
35. Even bedridden, post-surgical patients can make a difference through
participation in their care. Devine & Cook, 1983; Hughes, Hodgson, et al.,
2000..
Devine, E. C., & Cook, T. D. (1983). A meta-analytic analysis of effects of
psycho-educational interventions on length of postsurgical hospital stay.
Nursing Research, 32, 267-74.
Hughes, L. C, Hodgson, N. A., Muller, P., Robinson, L. A., & McCorkle, R.
(2000). Information needs of elderly postsurgical cancer patients during the
transition from hospital to home. Journal of Nursing Scholarship, 32,
25-30.
BEHAVIORAL DIAGNOSIS
THREE LEVELS OR CATEGORIES
OF BEHAVIOR
36. The declines in smoking, lung cancer incidence, and heart mortality
rates in California following passage of Proposition 99. Fichtenberg, &
Glantz, 2000; MMWR, 2000.
Fichtenberg, C. M., & Glantz S. A. (2000). Association of the California
Tobacco Control Program with declines in cigarette consumption and mortality
from heart disease. New England Journal of Medicine, 343, 1772-7.
Cowling, D.
W., Kwong, S. L., Schlag, R., Lloyd, J. C., & Bal, D. G.
(2000). Decline in lung cancer rates –
California, 1988-1997. Morbidity and Mortality Weekly Reports, 49: 1066-9.
[Full text]
GENETIC-BEHAVIOR INTERACTIONS
37. Genetic-behavioral-environmental interactions. Ridley, 1999, pp.
153-4. Our placement of behavior
between "environment" and "genetics" in the generic Precede-Proceed logic model
is consistent with the inclusion of behavior within the use of the term
"environment" in most of the genetics literature.
Ridley, M. (1999). Genome: The autobiography of a species in 23 chapters.
New York: Harper Collins.
38. Genetic
variations, food, and susceptibility or resilience.
The Pyramid
Paradigm, Center of Excellence for Nutritional Genomics, University of
California, Davis,
http://nutigenomics.ucdavis.edu, accessed Dec 3, 2003.
39. Global
obesity epidemic.
WHO (2002).
World Health Organization. (2002).
The World Health
Report 2002: Reducing risks, promoting healthy life. Geneva: World Health
Organization.
40.
Gene-gene, gene-environment interactions in obesity.
Froguel, P., &
Boutin, P. (2001). Genetics of pathways regulating bogy weight in the
development of obesity in humans. Experimental Biology and Medicine, 226,
991-96. [Full text online]
STEP 1: LISTING POTENTIAL BEHAVIORAL RISKS FOR THE HEALTH PROBLEM
41. For examples of the application of PRECEDE in behavioral risk factor
assessment in cardiovascular disease, see Arbeit et al., 1992; P. H. Bailey,
Rukholm, Vanderlee, & Hyland, 1994; Berenson, Harsha, et al., 1998; Bruce, &
Grove, 1994; Bush, Zuckerman, et al., 1987; 1989; Carlaw, Mittlemark, et al.,
1984; Downey, Butcher, et al., 1987; Green, Lewis, & Levine, 1980; Kok, Matroos,
et al., 1982; Mantell, DiVittis, & Auerbach, 1997, pp. 199–203; Morisky et al.,
1981; Morrison, 1996; Nguyen, Grignon, Tremblay, & Delisle, 1995; Nguyen et al.,
1995; O’Loughlin et al., 1995; Paradis et al., 1995; Zuckerman,
Olevsky-Peleg, et al., 1989.
Arbeit, M. L., Johnson, C. C., Mott, D. S., Harsha, D. W., Nicklas, T. A.,
Webber, L. S., & Berenson, G. S. (1992). The Heart Smart Cardiovascular School
Health Promotion: Behavior correlates of risk factor change. Preventive
Medicine, 21, 18-21.
Bailey, P. H., Rukholm, E. E., Vanderlee, R., & Hyland, J. (1994). A heart
health survey at the worksite: The first step to effective programming,
AAOHN Journal, 42, 9-14.
Berenson, G.
S., Harsha, D. W., Hunter, S. M., Johnson, C. C., Levy, M., Little, S. D.,
Nicklas, T. A., Srinivasan, S. R., Virgilio, S. J., & Webber, L. S. (1998).
Introduction of comprehensive health promotion for elementary schools: The
Health Ahead/Heart Smart Program. New York: Vantage Press, esp. Chapters
3 & 6.
Bruce, S., & Grove, S. K. (1994). The effect of a coronary artery risk
evaluation program on serum lipid values and cardiovascular risk levels.
Applied Nursing Research, 7, 67-74.
Bush, P. J.,
Downey, A. M., Frank, L. S., & Webber, L. S. (1987). Implementation of "Heart
Smart": Cardiovascular school health promotion program. Journal of School
Health, 57, 98-104.
Bush, P. J., Zuckerman, A. E., Theiss, P. K.,
Peleg, E. O., & Smith, S.A.
(1989). Cardiovascular
risk factor prevention in black school children--2-year results of the Know
Your Body Program. American Journal of Epidemiology, 129, 466-82.
Carlaw, R. W., Mittlemark, M., Bracht, N., & Luepker, R. (1984). Organization
for a community cardiovascular health program: Experiences from the
Minnesota
Heart Health Program. Health Education Quarterly, 11, 243-52.
Downey, A. M., Butcher, A. H., Frank, G. C., Webber, L. S., Miner, M. H. &
Berenson, G. S. (1987). Development and implementation of a school health
promotion program for reduction of cardiovascular risk factors in children and
prevention of adult coronary heart disease: 'Heart Smart'. In B. Hetzel and
G. S. Berenson, (Eds.), Cardiovascular risk factors in childhood:
Epidemiology and prevention. Amsterdam, NY & Oxford: Elsevier Science
Publishers B.V., pp. 103-121.
Kok, F. J., Matroos, A. W., van den Ban, A. W., & Hautvast, J. G. A. J. (1982).
Characteristics of individuals with multiple behavioral risk factors for
coronary heart disease: the Netherlands, American Journal of Public Health,
72, 986-91.
Zuckerman, A.
E., Olevsky-Peleg, E., Bush, P. J., Horowitz, C., Davidson, F. R., Brown, D.
G., & Walter, H. (1989). Cardiovascular risk factors among Black
schoolchildren: comparisons among four Know Your Body Studies.
Preventive Medicine, 18, 113-32.
STEP 2: RATING BEHAVIORS ON
IMPORTANCE
42.
Teen smoking predicts adult smoking. Jacobsen, Lantz, et al., 2001.
Jacobsen, P.
D., Lantz, P. M., Warner, K. E., Wasserman, J., Pollack, H. A., & Ahlstrom, A.
A. (2001). Combating teen smoking: Research and policy strategies. Ann
Arbor: The University of Michigan Press.
STEP 3: RATING BEHAVIORS
ON CHANGEABILITY
43. North Karelia project. Pietinen, Nissinen, et al., 1992; Puska,
1992; Puska & Uutela, 2000; Puska, Vartiainen, et al., 1998; Vartiainen,
Jousilahti, et al., 2000.
Pietinen, P. Nissinen, A., Vartiainen, E., Tuomilehto,
J., Uusitalo, U., Ketola, A., Moisio, S., & Puska, P. (1992). Dietary
changes in the North Karelia Project (1972-1982). Preventive Medicine,
17,183-93;
Puska, P. (1992). The
North Karelia Project: Nearly 20 years of successful prevention of CVD in
Finland. Hygie: International Journal of Health Education, 11, 33-5.
Puska, P., Uutela, A. (2000). Community intervention in
cardiovascular health promotion: North Karelia, 1972-1999. In: Schneiderman N,
Speers MA, Silva JM, Tomes H, Gentry JH (Eds.), Integrating Behavioral and
Social Sciences with Public Health. (pp. 73-96). United Book Press, Inc.,
Baltimore: American Psychological Association.
Puska, P., Vartiainen, E., Tuomilehto, J., Salomaa, V., &
Nissinen, A. (1998). Changes in premature deaths in Finland: successful
long-term prevention of cardiovascular diseases. WHO Bulletin, 76,
416-425.
Vartiainen, E., Jousilahti, P., Alfthan, G., Sundvall, J., Pietinen, P., Puska,
P.. (2000). Cardiovascular risk factor changes in Finland, 1972-1997.
International Journal of Epidemiology 29, 49-56.
44. Limitations of the evidence for best practices
in dietary behavior change. Agency for Healthcare Research and Quality,
2000. http://www.ahrq.gov/clinic/epcsums/dietsumm.htm.
Agency for Healthcare Research and
Quality, 2000. Efficacy of interventions to modify
dietary behavior related to cancer risk. Summary,
Evidence Report/Technology Assessment: Number 25. Rockville, MD: Agency for
Healthcare Research and Quality, AHRQ Publication No. 01-E028.
http://www.ahrq.gov/clinic/epcsums/dietsumm.htm
STEP 4: CHOOSING BEHAVIORAL
TARGETS
STEP 5: STATING BEHAVIOR
OBJECTIVES
ENVIRONMENTAL DIAGNOSIS
46. Evidence of social-environmental factors in health. Cannuscio,
Block, & Kawachi, 2003; Kreuter & Lezin, 2003; Lochner, Kawachi, et al., 2003.
Cannuscio, C., Block, J., Kawachi, I. (2003). Social capital and successful
aging: the role of senior housing. Annals of Internal Medicine, 139,
(5 Pt 2), 395-9.
Kreuter, M. W., & Lezin, N. S. (2002). Social capital theory: Implications for
community-based health promotion. In DiClementi, R.J., Crosby, R.A., Kegler,
M.C. (Eds.). Emerging theories in health promotion practice and research:
Strategies for improving public health (pp. 228-254). San
Francisco, Jossey-Bass.
Lochner, K. A., Kawachi, I., Brennan, R. T., & Buka, S. L. (2003). Social
capital and neighborhood mortality rates in Chicago. Social Science &
Medicine, 56, 1797-805.
47. Ecological vision of influences on the population’s health.
National Committee on Vital and Health Statistics. (2002).
National Committee on Vital and Health Statistics. (2002). Shaping a
vision of health statistics for the 21st century. Washington:
National Center for Health Statistics, Centers for Disease Control and
Prevention, U.S. Department of Health and Human Services.
48. The built environment. E.g., Dannenberg, Jackson, et al., 2003;
Killingsworth, Earp, & Moore, 2003.
Dannenberg, A. L., Jackson, R. J., Frumkin, H., Schieber,
R. A.., Pratt, M., Kochtitzky, C., & Tilson, H. H. (2003). The impact of
community design and land-use choices on public health: A scientific research
agenda. American Journal of Public Health, 93, 1500-8.
Killingsworth, R., Earp, J., & Moore, R. (2003).
Supporting health through design: Challenges and opportunities. American
Journal of Health Promotion, 18, 1-2.
49. Epidemiology of promoting safe walking and biking to school.
Howatt, Jones, et al., 1997; Staunton, Hubsmith, &
Kallins, 2003; Stevenson, Iredell, et al., 1999; Stevenson, Jones, et al., 1996.
Preceed-Proceed applications marked with asterisk.
*Cross
D, Stevenson M, Hall M, Burns S, Laughlin D, Officer J, Howat P. (2000).
Child pedestrian injury prevention project: student results. Preventive
Medicine, 30, 179-87.
*Howat,
P., Cross, D., Hall, M., Iredell, H., Stevenson, M., Gibbs, S., Officer, J.,
Dillon, J., et al. (2001). Community participation in road safety:
barriers and enablers. Journal of Community Health. 26: 257-269.
*Howat, P.,
Jones, S., Hall, M., Cross, D., & Stevenson, M. (1997). The PRECEDE-PROCEED
model: Application to planning a child pedestrian injury prevention program.
Injury Prevention, 3, 282-7.
Staunton, C. E., Hubsmith, D., & Kallins, W. (2003).
Promoting safe walking and biking to school: The Marin County success story.
American Journal of Public Health, 93, 1431-4.
*Stevenson,
M., Iredell, H., Howat, P., Cross, D., & Hall, M. (1999). Measuring
community/environmental interventions: The Child Pedestrian Injury Prevention
Project. Injury Prevention, 5, 26-30.
*Stevenson,
M., Jones, S., Cross D., Howat, P., & Hall, M. (1996). The child pedestrian
injury prevention project. Health Promotion Journal of Australia, 6,
32-6.
50. Indoor air example of emerging environmental
threat. Lee, T. G. (2003)., Health and the Built Environment: Indoor Air
Quality, Health and Well Being, Vital Signs Curriculum Project.
http://arch.ced.berkeley.edu/vitalsigns/.
STEP 1:
IDENTIFYING WHICH ENVIRONMENTAL FACTORS
STEP
2: RATING ENVIRONMENTAL FACTORS ON RELATIVE IMPORTANCE
STEP 3:
RATING ENVIRONMENTAL FACTORS ON CHANGEABILITY
51.
Consulting with the community on environmental risk assessments.
Commission on Risk
Assessment and Risk Management, 1996. A debate in the community-based
participatory research literature, which has been stimulated by such
environmental assessment issues, is whether community participants in the
research effort need to be involved in every aspect of the research, or whether,
as the Commission suggests, they can be involved primarily at these two points
in the formulation of the risk assessment research questions and the
interpretation of the results. See, e.g., Green & Mercer, 2001.
Commission on Risk Assessment and Risk Management. (1996). Risk assessment
and risk management in regulatory decision-making. Washington, DC: Author.
Green, L. W., & Mercer, S. L. (2001). Participatory research: Can public
health researchers and agencies reconcile the push from funding bodies and the
pull from communities? American Journal of Public Health, 91, 1926-9.
[Full text online]
52.
Risk assessment Vs
risk perception, subjective and objective considerations.
Amaro, Frazao,
Pereira, & da Cunha Teles, 2004; Horey, Weaver, & Russell, 2004; Huang, Palta,
et al., 2004; Pickles, 2004; Robb, Miles, & Wardle, 2004; Slovic, 1999;
2001.
Amaro F, Frazao C, Pereira ME, da Cunha Teles L. (2004). HIV/AIDS risk
perception, attitudes and sexual behaviour in Portugal. International Journal
of STD and AIDS, 15, 56-60.
Horey D, Weaver J, Russell H. (2004). Information for pregnant women about
caesarean birth.
Cochrane Database Syst Rev. (1):CD003858.
Huang GH, Palta M, Allen C, LeCaire T, D'Alessio D. (2004). Self-rated
Health among Young People with Type 1 Diabetes in Relation to Risk Factors in a
Longitudinal Study. American Journal of Epidemiology, 159, 364-72.
Pickles T. (2004). What's a man to do? Treatment options for localized
prostate cancer. Canadian Family Physician, 50, 65-72.
Robb KA, Miles A, Wardle J. (2004). Subjective and objective risk of
colorectal cancer (UK).
Cancer Causes Control, 15, 21-5.
Slovic, P. (1999). Trust, emotion, sex, politics, and science: surveying the
risk-assessment battlefield. Risk Analysis, 19, 689-701.
Slovic, P. (2001). The risk game. Journal of Hazardous Material, 86,
17-24.
53. Three
ingredients for success in addressing “wicked” environmental problems.
Goldsmith, 1969;
Kreuter, DeRosa, et al., 2004.
Goldsmith JR. (1969). Air pollution epidemiology. A wicked problem, an
informational maze, and a professional responsibility. Archives of
Environmental Health, 18, 516-22.
Kreuter
MW., DeRosa CR, Howze E, & Baldwin G. (2004). Understanding wicked problems: A
key to environmental health promotion. Health Education and Behavior,
31, 441-54.
STEP 4:
CHOOSING THE ENVIRONMENTAL OBJECTS OF CHANGE
STEP 5: STATING THE
ENVIRONMENTAL OBJECTIVES
EVALUATION SUMMARY
SUPPLEMENTAL MATERIAL
In its 27th annual report on the overall health of Americans, the National
Center for Health Statistics devoted an entire section to troubling gains in the
incidence of diabetes, noting that 6.5 percent of adults were diagnosed with
diabetes in 2002, compared with 5.1 percent in 1997, possibly bringing the total
number of adults with diabetes to 12 million.
National Center for Health Statistics,
CDC. (2003). The Health of Americans, 2003. Hyattsville, MD: National
Center for Health Statistics, Centers for Disease Control and Prevention, U.S.
Department of Health and Human Services.
http://www.healthinschools.org/2003/oct03_alert.asp
Physical activity: An example of reducing a
complex behavior to multiple discrete behaviors or categories of behavior and
the implications for health in terms of the amount of metabolic expenditure and
type of health effect (aerobic vs anaerobic and musculoskeletal).
Physical Activity and Health Branch, Division of Nutrition and Physical
Activity, and Cardiovascular Health Branch, Division of Adult and Community
Health, National Center for Chronic Disease Prevention and Health Promotion; and
an EIS Officer, CDC. (2001). Physical activity trends, United States--1990-1998.
Morbidity and Mortality Weekly Report, 50,
166-9.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5009a3.htm

Standardized measurement of physical activity, and shifts in the
measurement at points in the trend lines of national surveys, illustrated by the
change in questions between the Behavioral Risk-Factor Surveillance System
surveys in 2000 and 2001.

Source: Macera, C. A., Jones, D. A., Yore, M. M., Ham, S. A., Kohl, H. W.,
Kimsey, Jr, C. D., & Buchner, D. (2003).
Prevalence of Physical Activity, Including Lifestyle Activities Among Adults ---
United States, 2000--2001. Morbidity and Mortality Weekly Reports, 52,
764-769.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5232a2.htm
How the prevalence of a complex behavior can
change from one year to the next as a result of a change in the definition
and/or survey questions used to measure the behavior, as illustrated by the
Behavioral Risk-Factor Surveillance System changes from the previous table.

Source: Macera, C. A., Jones, D. A., Yore, M. M., Ham, S. A., Kohl, H. W.,
Kimsey, Jr, C. D., & Buchner, D. (2003).
Prevalence of Physical Activity, Including Lifestyle Activities Among Adults ---
United States, 2000--2001. Morbidity and Mortality Weekly Reports, 52,
764-769.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5232a2.htm
Strath, S. J., Bassett, Jr., D. R., &
Swartz, A. M. (2004). Comparison of the college alumnus questionnaire
physical activity index with objective monitoring
Annals of Epidemiology,
14,
409-415.
PUBLIC
HEALTH NEWS ON EPIDEMIOLOGY SINCE THIS BOOK WENT TO PRESS
US leads
developed countries in sexually transmitted disease rates.
Newsday, Jan 26, 2005, from British Journal Sexually
Transmitted Infections. Jan 27, 2005.
Return
to Home Page
Go to Endnotes:
Preface Chap 1
Chap 2
Chap 4 Chap 5
Chap 6 Chap 7
Chap 8 Chap 9