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This article describes the development and evaluation of an online workplace stress reduction toolkit for use by managers of 9-1-1 emergency communication centers (ECCs). A three-step process for development and testing of digital learning resources was used: (1) establishing need and focus through ECC manager stakeholder engagement, (2) pretesting of the toolkit with the target ECC manager audience, and (3) toolkit utilization and evaluation. The toolkit was developed in close partnership with stakeholders throughout the entire process. Toolkit usage was documented via registration data. The evaluation utilized an online survey that included closed and open-ended questions, which were analyzed using descriptive statistics and qualitative thematic analysis. Over a 20-month period, 274 people registered for the toolkit and, of those, 184 (67%) accessed the content. Respondents to the evaluation survey ( N = 156) scored the toolkit highly on satisfaction, self-efficacy, and perceived utility measures. Survey respondents reported intent to apply toolkit content through the following: providing organizational resources to help workers take better care of themselves (41%); creating a lower stress worksite environment (35%) and sharing resources with staff to (1) reduce stress (19%), (2) support conflict resolution (21%), and (3) prevent and/or stop bullying (17%). In delivering actionable content to ECC managers, the toolkit shows promise in addressing and mitigating occupational stress in ECCs. Further research needs to determine the relationship of this strategy for reducing ECC stress.

As a "thought experiment," the authors used a modified stages of change model for smoking to define homogeneous segments within various hypothetical populations. The authors then estimated the population effect of public health interventions that targeted the different segments. Under most assumptions, interventions that emphasized primary and secondary prevention, by targeting the Never Smoker, Maintenance, or Action segments, resulted in the highest nonsmoking life expectancy. This result is consistent with both social marketing and public health principles. Although the best thing for an individual smoker is to stop smoking, the greatest public health benefit is achieved by interventions that target nonsmokers.

Farmworkers carry pesticide residue home on their clothing, boots, and skin, placing other household members at risk, particularly children. Specific precautions are recommended to reduce this take-home pathway, yet few studies have examined the perspectives of farmworkers and other household members regarding these behaviors and the reasons for or against adoption. The authors conducted semistructured interviews with 37 Mexican/Mexican-American women in farmworker households to explore the family and cultural context in which pesticide safety practices are performed and to identify factors that facilitate or hinder their adoption. Whereas women could describe the take-home pathway, they were less able to connect it with their family's susceptibility to pesticide exposure. Women experienced difficulty integrating the prevention behaviors into their everyday lives because of competing responsibilities, conflicts with their husbands' intentions and with cultural health beliefs, perceived lack of control, and community barriers that interfered with women's motivations. Implications for practice are discussed.

The Heart Attack Survival Kit (HASK) project is a prospective, randomized trial, testing the effectiveness of an intervention delivered door-to-door by firefighters to increase use of 911 and ingestion of aspirin for symptoms of acute myocardial infarction (AMI) among seniors in King County, Washington. Firefighters visited 24,582 seniors in King County, Washington and delivered a Heart Attack Survival Kit. Another 24,191 senior households served as the control group. Outcomes of the program were measured by tracking 911 calls as well as survey data. This study reports on the results of the telephone survey with a random sample of seniors (N = 323) to assess their knowledge of and intentions to act during a heart emergency. Results of a logistic regression analysis showed that being female, being younger, and remembering the kit was significantly related to intentions to act appropriately to AMI symptoms. The results are discussed in terms of public education around AMI.

The Internet might transform the way in which health information is communicated to patient and general populations. Understanding differences in usage patterns will be critically important to ensuring the successful distribution of health information. The present study presents early data on the use patterns and predictors of use of a Web-based intervention in a population-based subsample of women aged 18-74 in King County, WA. By three months over half (51%) of users had logged into the website, using multiple components. Predictors of use by three months included employment, perceptions of health and mental health scores. These data have implications for how to conduct Web-based intervention research and for individuals that may not benefit from such interventions.

To inform intervention development in a multisite randomized community trial, the Rapid Early Action for Coronary Treatment (REACT) project formative research was undertaken for the purpose of investigating the knowledge, beliefs, perceptions, and usual practice of health care professionals. A total of 24 key informant interviews of cardiologists and emergency physicians and 15 focus groups (91 participants) were conducted in five major geographic regions: Northeast, Northwest, Southeast, Southwest, and Midwest. Transcript analyses revealed that clinicians are somewhat unaware of the empirical evidence related to the problem of patient delay, are concerned about the practice constraints they face, and would benefit from concrete suggestions about how to improve patient education and encourage fast action. Findings provide guidance for selection of educational strategies and messages for health providers as well as patients and the public.

This study evaluated an 8-month media campaign, implemented in western Washington, to educate people on the basic steps of cardiopulmonary resuscitation (CPR) for cardiac arrest. A telephone survey was conducted with a total of 384 adults randomly selected from two towns, one that had been exposed to the campaign (intervention town) and one that had not been exposed to the campaign (comparison town). Results showed that respondents in the intervention town were more likely than respondents in the comparison town to report (a) having heard messages on CPR in the past month, (b) having seen the CPR media campaign, and (c) knowing the three basic steps of CPR. Respondents who had seen the campaign evaluated it very favorably. There were no differences between respondent groups in self-reported CPR training or intentions to perform CPR, suggesting that the campaign had a greater impact on knowledge and awareness than on intentions and behavior.

This study describes and empirically tests a health priorities model. This model predicts underuse of regular mammography screening among adult women within the larger health context in which such decisions are made. The model incorporates women's comparative illness threats, comparative importance of health behaviors, and demographic variables. A telephone survey was conducted with a sample of women (N = 887) older than 50, in 40 rural communities in the state of Washington. Logistic regression analyses showed that women who perceived themselves at low risk for getting breast cancer and/or who perceived another disease (i.e. heart attack) as an equal or greater threat than breast cancer were less likely to be regular screeners of mammography. In addition, women who perceived other health behaviors as more important than regular mammography screening were less likely to be regular screeners than those women who perceived regular mammography screening as more important. Current or anticipated health problems were not related to screening behavior. The results are discussed in light of the practical, theoretical, and empirical implications.

This study evaluated a direct mail intervention called the "Call Fast, Call 911" campaign designed to increase use of emergency medical services for symptoms of acute myocardial infarction. The campaign was targeted at individuals over the age of 50. Persons over 50 years of age (N = 130,000) in King County, Washington, were randomly assigned to intervention or control groups. Individuals in the intervention groups received six direct mail pieces over a 1-year period encouraging them to call 911 quickly in response to chest pain. A postintervention telephone survey of a random sample of households (N = 434) assessed the impact of the campaign on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction. The results showed no significant differences between intervention and control groups in terms of knowledge of AMI. However, there were significant differences in beliefs and behavioral intentions to call 911 in a cardiac emergency.