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The design of a large-scale research project (The Health and Religion Project) in which church volunteers deliver behavior change programming on major cardiovascular risk factors (smoking, elevated blood pressure, elevated serum cholesterol, excess weight, and physical inactivity) is described. A total of 20 churches (Roman Catholic, Baptist, and Episcopal) were recruited throughout Rhode Island and randomly assigned to five experimental conditions. These conditions were designed to test the necessity of training special task forces to coordinate efforts within each church and to test the relative efficacy of high or low levels of professional (paid staff) involvement. Churches have many characteristics that are compatible with behavior change programming for primary prevention of chronic diseases. However, there have been very few research studies of churches engaging in primary prevention activities. Thus, the first step was to test the churches' receptivity to participation in this type of project. To do this, all churches in Rhode Island were surveyed by mail and phone. Those that met several eligibility criteria were randomly selected for recruitment into the study. The high receptivity of the churches was demonstrated by a response rate of 65 percent (20 of 31). This readiness is bolstered by the fact that all of the 20 churches that originally began the study have remained involved for at least 2 1/2 years.

The use of modern epidemiological and biostatistical methods has been lacking in the research literature on anorexia nervosa. The present study utilized a retrospective case control design in which 40 cases of anorexia nervosa were matched to two separate control series, one being population based and one being clinic based. Odds ratio of 4.00 (p less than 0.006) and 7.67 (p less than 0.001) were obtained for family history of alcoholism and family history of psychological disorders, respectively, among the families of anorexia nervosa cases. The implications of this result for treatment planning and implementation are discussed.

Tuberculosis, a major cause of death in the nineteenth century, has consistently and steadily declined in industrialized countries. Such decline antedates the introduction of specific treatment or immunization programs. In the United States of America, the tuberculosis problem is almost exclusively confined to ethnic minorities, socially marginal groups, and migratory workers. All the countries of Latin America have adopted the programs for tuberculosis control recommended by the World Health Organization and the Pan American Health Association. The degree to which these programs are followed in Mexico is critically discussed. A number of suggestions are offered to improve a program that appears to be insufficient in terms of controlling this disease.

A telephone survey of randomly-sampled churches, labor unions, supermarkets and restaurants was conducted in San Diego, California to determine the level of health promotion activities offered for members and customers. Nearly two-thirds of the churches offered health promotion programs, the bulk of which were single educational sessions. A similar proportion of labor unions reported programs, and most of them consisted of the distribution of materials and single-session group meetings. About one-third of the supermarkets reported activities, with most of these being the distribution of brochures. Similarly, about one-third of restaurants reported programs, which primarily consisted of the enforcement of no-smoking regulations. Very few organizations evaluated programs or desired assistance from health professionals. It was concluded that while secular health promotion programs are common and are available to many people, their quality and effectiveness are unknown. These findings present a challenge for public health professionals and agencies.

Relapse remains a major problem in successful smoking cessation. This study evaluated selected responses and coping skills in male and female quitters and relapsers in four situational contexts: general social competence, smoking-specific "high-risk-for-relapse" situations, social anxiety, and relaxation. Results showed that quitters coped better than relapsers with intrapersonal (e.g., negative mood) smoking-specific situations. Quitters had lower heart rates than relapsers during relaxation and intrapersonal situations and had lower anxiety scores at the end of the procedures. Women showed more stress and less confidence in their ability to cope than did men. Groups did not differ in responses to the general social competence and social anxiety procedures. Results are discussed in the context of the importance of considering individual differences in responses and in coping skills for treatment and relapse prevention for smokers.

This paper reviews the fundamental concepts and technology of behavior modification. Behavioral strategies are categorized as employing either 'pleasant' or 'unpleasant' consequences for accelerating or decelerating target behaviors. Subsequently, a review of the applications of this technology to wasteful fertility is provided. Given the additional importance of malnutrition and communicable diseases to the health in the developing world, behavioral approaches to their control are also reviewed or proposed. The article concludes with a discussion of the limitations and recommendations for use of behavior modification in health promotion in a developing country context.

The association between maternal tobacco smoke exposure and hazards to reproduction has been investigated since the turn of the century. Numerous studies have demonstrated an increased risk to the developing fetus as a result of maternal smoking. This risk continues to manifest itself postnatally into childhood. The present study examined both risk factors for and consequences of smoking behavior among a sample of 50 pregnant women consecutively admitted to the obstetrics ward of the Tijuana General Hospital, Tijuana, Mexico. A questionnaire completed postpartum examined social, cultural, and economic variables for the mother, and physical variables of the newborn. Twenty-one subjects were smokers and 29 were nonsmokers. The number of previous pregnancies per subject was significantly higher in the group of smoking mothers. Overall, 86.2% of the nonsmoking mothers had three or fewer pregnancies versus 52.4% of the smoking mothers (p less than or equal to 0.005). It was also noted that the smoking subjects tended to be light smokers (90% reported smoking ten or fewer cigarettes a day, with an average of 4.27 years of smoking history). No difference in knowledge of the harmful effects of smoking during pregnancy was observed between the two groups; however, the proportion of subjects whose mothers and siblings also smoked was significantly higher (p less than or equal to 0.005 and p less than or equal to 0.01, respectively) in the smoking groups. The results are discussed in terms of antismoking prevention and health promotion programs for the developing world.

The marketing of preventive health behaviors is typically accomplished through various broadcast, print, and other mass media channels. By making randomly-dialed telephone calls to 4,000 residents of Pawtucket, RI, volunteers of the Pawtucket Heart Health Program succeeded in registering nearly 400 individuals for risk factor reduction groups or self-help behavior change kits. Additionally, community awareness of the program was an indirect benefit of this "telemarketing." Telemarketing is an interactive and inexpensive approach to marketing preventive health behaviors.

We describe an attempt to influence the selection of menu items in a family-style restaurant. Three different messages, varying in content and emphasis, were used to promote one food special each intervention day. One message emphasized that the specials were particularly healthful, being relatively low in fat, sodium, and cholesterol. A second message stressed flavor and added that the choice was healthful. A third, nonspecific message made no mention of taste or health factors, but simply noted that there was a daily special. Results indicated that restaurant patrons selected healthful specials when the message noted that the choice was healthful but emphasized flavor. Patrons were apparently more open to information about the palatability of the food than its healthfulness per se. These results have implications for point-of-purchase health promotion efforts in general, especially those involving food-labeling programs in restaurants and grocery stores.

The use of cigarettes and other forms of tobacco poses a major and growing health threat to populations of developing countries. The present study examined the onset of cigarette use among public school students in Tijuana, Mexico. Fifty-four percent of the males and 34 percent of the females had experimented with smoking. Maternal smoking was more strongly associated with smoking among girls, while peer smoking had a relatively stronger association with future intentions to smoke among boys. Rates of smoking behavior among Mexican-American school children in nearby San Diego more closely resembled the higher rates of their Tijuana than those of their Anglo-American counterparts.

A random telephone survey was conducted to measure the public's willingness to participate in a boycott of popular consumer products manufactured by corporations owned by tobacco companies. Results suggest a strong interest in such a boycott. Previous boycott experiences, attitudes, and smoking statuses significantly predicted subjects' willingness to participate. Age was inversely related to willingness to participate, while sex, income, ethnicity, and education were not related to this variable.

The modification of dietary behaviors on a community-wide basis requires broad-based, multilevel approaches. Dietary interventions at the point of choice have the potential, as one approach, of reaching a large number of individuals at minimal cost. This article presents the potential advantages and limitations of point-of-choice interventions, and describes the controlled evaluations of their efficacy in restaurants/cafeterias and supermarkets. Discussion addresses the refinement and extension of successful restaurant-based strategies and the challenge of developing more powerful strategies for influencing supermarket purchases.

Many self-reported measures of health status, attitudes, and knowledge used by clinicians and researchers suffer from a variety of shortcomings, including limited empirical justification, excessive complexity, assessments of nonmodifiable historic or hereditary factors, and limited utility for public health program planning. The Health Attitudes and Behavior Scale is an instrument designed to overcome many of these shortcomings and direct public health professionals toward more efficacious interventions. One hundred sixty-four subjects responded to true-false and Likert scale items related to health beliefs, attitudes, and behavioral practices. A principal component analysis of the Likert items yielded six components, tentatively labeled (a) Lack of Social Support, (b) Hurdles to Health, (c) Health Attitudes/Weight Concerns, (d) Positive Environment, (e) Disease Concerns, and (f) Time and Work Pressure. Analyses of these scales using coefficient alpha indicated adequate internal consistency for each of them. These scales were then related to demographic variables of age, educational level, sex, and marital status. Next, these scales were correlated with individual true-false items reflecting self-reported behavioral practices or health histories. A component analysis of the true-false items yielded four principal components labeled (a) Organizational Health Concerns, (b) Smoking and Exercise Concerns, (c) Coronary and Weight Concerns, and (d) Blood Pressure and Risk Factor Programs. Finally, a cluster analysis yielded six typical profiles reflecting different levels of the original six components. Of interest is the fact that the Lack of Social Support and Time and Work Pressure scales had a very limited integration into the overall patterns. The assumption that organizational and environmental factors can have an important impact on health was supported. The need for further research in this area is also discussed.

The prevalence of overall or "generic" tobacco use among Hispanic, white, Black and Asian youths in grades four, seven, ten and twelve was compared in San Diego, California (n = 4980). Significant differences in generic tobacco use between ethnic groups were found in the 4th, 10th and 12th grades, but were greatest in the 10th grade. Only white youths demonstrated a sharp increase in regular tobacco use (once a month or more) between 7th and 10th grade. Overall, the prevalence of regular use was highest among whites (25.8%), followed by Hispanics (19.7%), Blacks (17.6%) and Asians (12.6%). Marijuana, alcohol, and other drug use explained approximately 40 percent of the variance in tobacco use in each ethnic group. Other predictors varied by ethnicity and included socioeconomic status, happiness of student, strictness of parent, adult tobacco use at home, accessibility to marijuana, and gender.