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The National Institutes of Health convened a workshop to engage researchers and practitioners in dialogue on research issues viewed as either unique or of particular relevance to rural areas, key content areas needed to inform policy and practice in rural settings, and ways rural contexts may influence study design, implementation, assessment of outcomes, and dissemination. Our purpose was to develop a research agenda to address the disproportionate burden of cardiovascular disease (CVD) and related risk factors among populations living in rural areas. Complementary presentations used theoretical and methodological principles to describe research and practice examples from rural settings. Participants created a comprehensive CVD research agenda that identified themes and challenges, and provided 21 recommendations to guide research, practice, and programs in rural areas. INSETS: Workshop Presentations;Guiding Principles for Cardiovascular Disease Research in Rural..;Opportunities for Cardiovascular Disease Research in Rural.... [ABSTRACT FROM AUTHOR]

The Reagan Administration has adopted the policy guidelines developed over the previous few years in the disease prevention and health promotion initiative of the Carter Administration. Broad national consensus had been sought in the formulation of 226 measurable objectives for the decade. We classify the prevention objectives according to their position in an implied causal chain: 1) improved programs, 2) increased public and professional awareness, 3) reduced risk factors, and 4) improved health status. Prior to 1980, the data systems and periodic surveys sponsored by federal agencies and national organizations covered only four of the 42 objectives in the public and professional awareness category, whereas at least half of the objectives in each of the other three categories were covered by available national data sources, mostly federal. Sample surveys are needed to measure the majority of the currently unmeasured objectives in all four categories. Private and state health interview surveys are needed to supplement the federal capacity, especially in the face of federal cutbacks in survey capacity. [ABSTRACT FROM AUTHOR]

Abstract: Graduate Turkish midwives were trained in triage rules for determining family planning home visit frequency based on risk of couples. In a sample of 542 couples followed for six months, modern contraceptive use increased 22 per cent among high-risk and about 15 per cent among moderate- and low-risk couples. After making assumptions about the fecundity, contraceptive success, and pregnancy complications, the estimated average cost per complication averted was $61 for high-risk, $177 for moderate-risk, and $526 for low-risk couples. (Am J Public Health 69:950-953, 1979.) [ABSTRACT FROM AUTHOR]

Seven dilemmas of evaluation and measurement posed by the nature of health education are presented, together with suggestions for their resolution. These include the dilemmas of: 1) rigor of experimental design vs significance or program adaptability; 2) internal validity or "true" effectiveness vs external validity or feasibility; 3) experimental vs placebo effects; 4) effectiveness vs economy of scale; 5) risk vs payoff; 6) measurement of long-term vs short-term out- comes; and 7) threshold vs diminishing-return levels of expenditure on health education. Emphasis is placed on the need to develop a more cumulative data base through standardization of measures, replication of experiments in different settings, and better documentation, reporting, and diffusion of experiences in practice. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the editorial on record linkage systems published in the December 1980 issue of the "American Journal of Public Health."

Abstract: Three health education interventions for urban poor hypertensive patients were introduced sequentially in a randomized factorial design: 1) an exit interview to increase understanding of and compliance with the prescribed regimen: 2) a home visit to encourage a family member to provide support for the patient's regimen: and 3) invitations to small group sessions to increase the patient's confidence and ability to manage his/her problem. Previous evaluation of the initial two-year experience demonstrated a positive effect of the educational program on compliance with the medical treatment and brood pressure control, Data accumulated over an additional three years, including mortality analysis, are now presented. The study group consisted of the same cohort of 400 ambulatory hypertensive outpatients in the eight experimental and control groups. The five-year analysis shows a continuing positive effect on appointment keeping, weight control, and blood pressure control. All-cause life table mortality rate was 57.3 per ¢ less for the experimental group compared to the control group (12.9/100 vs 30.2/100, p < .05), while the hypertension-related mortality rate was 53.2 per ¢ less (8.9/100 vs 19.0/100, p < .01). The results from this longitudinal study provide evidence to encourage health practitioners to utilize such educational programs in the long-term management and control of high blood pressure. [ABSTRACT FROM AUTHOR]

The author reflects on the rationale and implications of setting objectives for tobacco control in the U.S. The author specifically focused on the target-setting process in the Healthy People 2010 objectives. The goal of reaching the 13 percent prevalence by 2010 depends partly on improved effectiveness for each attempt to quit, partly on increased numbers of smokers who attempt to quit and partly on increased frequency of smokers' attempts to quit.

Several letters to the editor are presented in response to articles in previous issues including "Beyond the Statistics of Adolescent Smoking," by P. Eckert that was published in an issue, "In Support of Jogging," by Dr. M. A. Ibrahim, and the "Editor's Report: LPU, The Nation's Health and Other Matters," by A. Yankauer that was published in an issue.

The article cites a study which seeks to evaluate the impact of nutritional aides among poor homemakers in the Extended Food and Nutrition Education Program in the U.S. The objective of the study is to support earlier evaluations regarding the subject and to reexamine neglected issues including appropriate criteria and standards of comparison, the point of diminishing returns among homemakers, and the broader impact of the said program. The study revealed that, the effects of nutritional aides on the improvement of homemakers diminishes after one year of contact. Continuing home visits to the same homemaker has its minimal impact and value as compared to its first year.

The reflects on health, safety and driver education. He cites and comments on the general position of Robertson's report as part of a larger school of research and theory on injury control. He states that the real question at issue is how to supplement the classroom experiences with the appropriate services and safeguards in the community to reinforce the positive effects of education. He suggests that the community must strengthen the school driver education and its supplementary testing and procedures.

The article focuses on the move to oversimplify the subject of prevention in health policy in the U.S. It stresses that new oversimplifications have shifted recently from pessimism to optimism. There are unrealistic expectations which caused disillusion that greatly affect medicine and surgery. In this regard, enthusiasm for legislative actions in prevention, health education, and health promotion needs proper moderation to avoid any disillusionment in public health programs.

A letter to the editor is presented in response to the editorial "The nutrition connection: Why doesn't the public know," by Patricia Crawford in the September 1988 issue.

An introduction to the articles published in the "American Journal of Public Health", September 1988 issue is presented.