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This article presents a study where extinction responding of children with severe retardation was compared when one component of a multiple schedule was interpolated with one session of additional reinforcement. The process of extinction has an important role in the learning theory. A variety of competing accounts of extinction have been developed in terms of inferred processes such as inhibition, frustration, interference and fatigue. These accounts argued that responding did not merely decline passively in extinction but were actively suppressed. An operant account assumes that extinction is not a special process and that the return of responding lo baseline levels merely demonstrate that the effects of reinforcement are temporary.

Rigorous evaluation of community-based programs can be costly, particularly when a representative sample of all members of the community are surveyed in order to assess the impact of a program on individual health behavior. Community-level indicators (CLIs), which are based on observations of aspects of the community other than those associated with individuals, may serve to supplement individual-level measures in the evaluation of community-based programs or in some cases provide a lower-cost alternative to individual-level measures. Because they are often based on observations of the community environment, CLIs also provide a way of measuring environmental changes--often an intermediate goal of community-based programs. The Centers for Disease Control and Prevention convened a panel of experts knowledgeable about community-based program evaluation and cardiovascular disease (CVD) prevention to develop a list of CLIs, and rate their feasibility, reliability and validity. The indicators developed by the panel covered tobacco use, physical activity, diet and a fourth group that were considered 'cross-cutting' because they related to all three behaviors. The indicators were subdivided into policy and regulation, information, environmental change, and behavioral outcome. For example, policy and regulation indicators included laws and ordinances on tobacco use, policies on physical education, and guidelines for menu and food preparation. These indicators provide a good starting point for communities interested in tracking CVD-related outcomes at the community level.

Large, well-funded, community heart health programs (CHHPs) have successfully focused on improving the cardiovascular health status of entire communities. CHHPs attempt to reduce the prevalence of risk factors associated with high rates of coronary heart disease mortality: high blood pressure, elevated serum cholesterol, smoking, overweight, and sedentary lifestyle. Program components include community organization, needs assessment, priority and evaluation, and program maintenance. Organizing the community, assessing needs and resources, and setting priorities generally occur concurrently, followed by implementing interventions. CHHP activities include social marketing, direct behavior-change efforts (including skills training, health education, and contingency management), screening (including counseling and referral), and policy and environmental change. Because State-sponsored efforts will seldom have the resources of federally-funded demonstration projects, they must pay particular attention to the "3 As" of community interventions: affordability, acceptability, and adequacy. Attention to these principles and the critical program components outlined in this paper facilitate the planning, development, implementation and evaluation of the next generation of CHHPs.

State Health Agencies play a critical role in the Nation's efforts for health promotion and disease prevention. This role is especially critical in efforts to reduce the burden of CVD through community-based programs. Resources SHAs need to facilitate implementation of community-based CVD prevention programs fall into three general categories: (a) Adequate time to plan, carry out and evaluate, (b) Financial resources to support staff, community organization and demonstration programs, and (c) Personnel with requisite technical expertise, skills and technological resources. Six critical activities for building state-level CVD program capacity include: (1) Forming a statewide CVD oversight committee, (2) Developing a state CVD plan, (3) Developing quality assurance standards and guidelines, (4) Developing new paradigms of community assessment and evaluation, (5) Planning for institutionalization, and (6) Translation of research to application. SHA roles vary from direct service delivery to serving as a linking agent, transferring information and resources and coordinating efforts between agencies.

Public health departments nation-wide are implementing community-based cardiovascular disease (CVD) prevention programs. Many such programs are turning for guidance to three research and demonstration projects: the Stanford Five City Project, the Pawtucket Heart Health Program, and the Minnesota Heart Health Program. This article summarizes some of the lessons learned in these projects and recommends strategies for the new generation of CVD prevention programs. The core of a successful program is the community organization process. This involves identification and activation of key community leaders, stimulation of citizens and organizations to volunteer time and offer resources to CVD prevention, and the promotion of prevention as a community theme. A wide range of intervention settings are available for health promotion. As is true for the workplace, places of worship are receptive to health promotion programs and have access to large numbers of people. Mass media are effective when used in conjunction with complementary messages delivered through other channels, such as school programs, adult education programs, and self-help programs. Community health professionals play a vital role in providing program endorsement and stimulating the participation of other community leaders. School-based programs promote long-term behavior change and reach beyond the school to actively involve parents. Innovative health promotion contests have widespread appeal and promote participation in other community interventions. In the area of evaluation, health program participation rates are appropriate primary outcome measures in most community-oriented prevention programs. Other program evaluation priorities include community analysis and formative evaluation, providing data to fine-tune interventions and define the needs and preferences of the community. It is premature to comment conclusively on the effectiveness of community-based CVD prevention programs in reducing population risk factor levels. However, it has been demonstrated that a broad range of intervention strategies can favorably modify the health behaviors of specific groups in communities such as employees and school children.

PURPOSE OF THE REVIEW. This review of the literature examines the relationship between abdominal fat distribution and specific health outcome measures, modifiable risk factors, the impact of intervention efforts, and the significance of measurement methods. SEARCH METHODS USED. The research material that was received was found through several on-line data bases, including MEDLINE and CINAHL, an examination of references from selected articles, a manual review of recent relevant journals, and interviews with several physicians and epidemiologists who are experts in this field of inquiry. Forty-three research articles were reviewed for the section on health risk outcomes and abdominal fat distribution. Twenty studies were reviewed in the section on modifiable variables associated with fat distribution. Finally, 10 studies which examined the effect of behavior change on fat distribution were included in this review. SUMMARY OF IMPORTANT FINDINGS. Recent research indicates that people whose body fat is deposited more in the central or abdominal area, especially the intra-abdominal area, than it is in the gluteofemoral area are at increased risk for cardiovascular disease. This risk is independent of, but exacerbated by, the degree of obesity. Several nonmodifiable factors such as age, gender, and menopause as well as some modifiable factors such as obesity, smoking, physical inactivity, and alcohol intake are positively associated with abdominal fat deposition. MAJOR CONCLUSIONS. Intervention results indicate that it is possible to decrease abdominal fat with total weight loss or smoking cessation.

This study evaluated a methodology for obtaining information on the prevalence of risk behaviors for human immunodeficiency virus infection (HIV) in the general population. From two census tracts in an upper midwestern urban community, 334 households were identified at random. One adult between the ages of 18 and 55 years in each household was asked to complete a confidential questionnaire about knowledge and attitudes toward acquired immunodeficiency syndrome (AIDS) and risk behaviors for HIV infection. Half the responders were also asked to provide a blood sample for HIV serotesting. Response rates to the behavior questionnaire were high (85 to 90 percent). However, only 72 percent of those asked to provide a blood sample agreed to do so. Survey results showed low rates of HIV risk behavior in this population sample. The median number of lifetime sexual partners was five for men and three for women, and most reported contacts exclusively with persons of the opposite sex. Eleven percent of the men and 5 percent of the women reported having had sexual partners of the same sex during their lifetime. Seven percent of men and 3 percent of women reported same sex partners in the last 12 months. Very few reported extremely high-risk behaviors (that is, only one man reported multiple sexual partners with anal intercourse in the previous year). About one in five survey respondents reported having changed his or her behavior because of the AIDS epidemic, usually by being more selective about and reducing the number of sexual partners. Success of the methodology employed in this survey gives reason for optimism that population-based surveys of behavioral risks for HIV infection are feasible.

Background: Tobacco related diseases remain the most important public health problem. Public policy approaches to tobacco control have been used historically, and remain a viable, though largely untested, tobacco control strategy. The purpose of this article is to report assessment of support for tobacco control policies among the general public., Methods: A random sample of 821 residents from seven Minnesota communities was surveyed by telephone to assess their support for 12 measures designed to restrict smoking behavior and curb demand for tobacco. Some of these policies were similar to those already in place, while others had not yet been adopted., Results: Over 50% of the respondents indicated that they strongly favored or somewhat favored each of the measures, suggesting that a constituency exists for further regulation of tobacco. Measures that restrict tobacco advertising, prohibit smoking in public places, increase the penalties for selling tobacco to minors, and reduce access of young people to tobacco are especially popular. Women, nonsmokers, and older people form the basis of support for these measures., Conclusions: These results suggest that Minnesota citizens are more supportive of restrictive tobacco control policies than policy makers might believe, and that more aggressive lobbying on behalf of such measures at the state and local level is warranted.

The Hypertension Prevention Trial (HPT) was a multicenter, randomized trial testing calorie control, sodium restriction, and potassium increases in the prevention of hypertension in 841 men and women. Thirty four variables that were potentially related to changes in urine sodium, urine potassium, and weight were examined individually and together across 3 years of treatment and maintenance sessions. Univariate and multivariate analysis did not reveal a consistent pattern of variables associated with successful attainment of treatment goals or failure to do so. Baseline levels of urine sodium, urine potassium, and weight were the variables most consistently associated with compliance. Household composition, such as number of people living in the house or marital status and control over selection and preparation of foods, was associated with compliance in sodium reduction treatments. Number of complaints about the diets were positively associated with noncompliance. Attendance at treatment sessions was generally associated with compliance especially for weight loss. Practical implications of these results are discussed.

Assigned participants in the Hypertension Prevention Trial to one of four diets for a period of 3 years: (a) weight loss, (b) reduced sodium, (c) weight loss plus reduced sodium, and (d) reduced sodium plus increased potassium. At 6-month intervals, they reported problems they were having adhering to their diets. Problem attributions were coded along the dimensions of internality, stability, and controllability and were categorized as intrapersonal or extrapersonal. Attributions were found to differ by type of diet and sex of participant. Participants assigned to weight-loss groups were significantly more likely than those assigned to non-weight-loss groups to blame themselves for their problems with adherence, making characterological as opposed to external or situational attributions. Men perceived problems to be more controllable than women. Attributions did not predict weight loss, change in urinary sodium, or change in potassium excretion.

We report the results of a survey conducted in upper-midwestern communities to assess public attitudes toward policy level interventions to moderate the use of alcohol, tobacco, and high-fat food. Four hundred thirty-eight women and 383 men were asked to indicate how much they favored or did not favor 29 policy proposals. Results showed that regulatory controls in all three areas were favored by the general public. Support was strongest for alcohol and tobacco controls, less so for high-fat food. Interventions designed to protect children and youths were most strongly endorsed, followed by restrictions on advertising and direct control over conditions of sale. Women favored all interventions more than men. There was a strong positive association between age and support for measures to moderate alcohol use. Individuals reporting least personal use of alcohol, tobacco, and high-fat foods were most in favor of control policies. The results of this survey indicate specific measures that might be most readily enacted and what segments of the population are likely to be most and least receptive.

Mailed invitations to participate in weight loss and/or smoking cessation correspondence programs to 31,400 households in a suburban community. Two programs were offered to randomized subsets of households, a 6-month correspondence program costing +5 and the same program for free but requiring a +60 deposit to be refunded based on success in weight loss or smoking cessation. Overall, sign-up included 1,304 people for weight loss and 142 for smoking cessation. The +5 program was about 5 times as popular as the incentive program. Validated weight change after 6 months averaged about 4 lb for the +5 program and 8 lb for the incentive program. Corresponding rates of smoking cessation were about 9% and 20%, respectively. We conclude that correspondence programs for the promotion of weight control and smoking cessation are potentially cost-effective methods for reaching individuals in the community at large, many of whom would not be interested in clinic-based programs. Issues meriting further research include recruitment, especially of smokers, and evaluation of the relative trade-offs in recruitment success versus efficacy of differing treatment approaches.

Trustful behavior was defined in terms of the consecutive numbers of matching-to-sample problems worth money that each subject worked during sessions that ended in an equitable distribution. Two stages of acquisition are inherent in this definition; the first stage requires acquisition of an equitable method of distributing reinforcers (cooperation) to show that the within-session deviations (trust) from equity that develop during the second stage are temporary and are not part of an inequitable method of distributing reinforcers. Previous research has indicated that a contingency to trust is necessary to override the aversiveness of the inequity inherent in trusting and to produce consistent and maximal trust (half of the problems worked consecutively by each subject). The present experiment examined such a contingency. The trust contingency was an increased requirement for changing the direction of problem allocation. Only the subject who had been allocated a problem could change that allocation, by pulling a lever 45 or more times. On the other hand, no separate responses were required to allow the person who worked the last problem to also work the next one (passive trust). Hence, giving a problem was the only way to increase the distribution of problems to the other person and hence prevent oneself from receiving all of the reinforcers. All eight pairs of subjects cooperated from the outset. Trusting behavior developed for all four pairs exposed to the contingency to trust and expanded to maximal levels by the second session for three of the four pairs.

Abstract This paper describes a study examining the feasibility of a worksite health promotion program that was repealed twice in one year. Weight control and smoking cessation classes, which included a supporting incentive component, were made available at a worksite of 485 white-collar employees continuously throughout one year. Identical education programs were offered twice at six-month intervals. Results suggest that this model of program implementation is attractive to employees. Total participation over 12 months included an estimated 53% of overweight employees in the weight program and 23% of smokers in the smoking cessation program. The two series of classes, run back to back, generated similar participation. Thirty-nine percent of weight control participants and six percent of smoking cessation participants who enrolled in the first program also enrolled in the second. Weight losses and smoking cessation rates were comparable for the two cycles, with a mean weight loss of about seven pounds and a smoking cessation rate at six months of about 33%. Surveys of a random sample of employees at baseline and again at 12 months showed a 28% reduction in the prevalence of cigarette smoking, but no change in average weight or the prevalence of overweight. This study suggests that health promotion programs at worksites which offer repeated opportunities for employee participation are promising and deserve further study.

This study evaluated the feasibility and effectiveness of a program for weight gain prevention in normal-weight adults. Two hundred nineteen participants were randomized to either weight gain prevention treatment or no treatment for a period of 12 months. Those in the treatment group received monthly newsletters relating to weight management, participated in a financial incentive system, and were offered an optional four-session education course in the sixth month of the program. Results demonstrated high interest in weight gain prevention among individuals who were not objectively overweight. Participation, as measured by return of postcards sent with each newsletter, was approximately 75%. Results after 1 year showed a net weight loss in the group receiving the program of 1.8 lb compared to those in the control group. Eighty-two percent of program participants maintained or lost weight, compared to 56% of the control group. It is concluded that programs for weight gain prevention are feasible in adults and may be more effective than weight loss treatment programs in addressing the problem of community-wide obesity.

This study determined whether a two-person exchange situation contained natural contingencies for trusting behavior or whether external contingencies were necessary. Pairs of college students worked matching-to-sample problems for money. On each trial there was one problem and the subjects determined which of them would solve it. Trusting behavior was defined as an increase in the number of consecutive problems each subject allowed his partner to work during sessions that also ended with an equitable distribution. Simply, trust was a temporary deviation from equity. A subject could give the problem to the other person (cooperate), or not respond and let the other person take the problem (share). Other possibilities were for both subjects to try to take the problem (complete), or for neither subject to respond and thereby let the person who worked the last problem also work the next one (passive trust). When only four lever pulls were required to distribute a problem (no external contingencies to reach either equity or trust) subjects reached equity, but only minimal trust (strict alternation of single problems) developed in 18 sessions. When 30 or 60 lever pulls were required to distribute a problem (smaller response requirement for passive trust and therefore a contingency for trust), trusting behavior developed after a few sessions (fixed ratio 30) or after several trials of the first session (fixed ratio 60) and it ordinarily expanded gradually to 10 to 15 consecutive problems through passive trust. The aversiveness of the inequity involved in trusting appears to necessitate a contingency for acquisition. Once trust develops, however, this aversiveness is reduced as subjects learn the inequity is only temporary (e.g., once trust was acquired at fixed ratio 60 it was maintained at fixed ratio 4, which would not initially produce it), and the direction of the inequity appears to become of questionable importance (e.g., being behind was alternated over rather than within sessions and usually not in a systematic manner).

Public support of eight policies to regulate the sale and consumption of high-fat food was evaluated in a survey of 438 women and 383 men in seven Minnesota communities. The survey was part of the ongoing activities of the Minnesota Heart Health Program (MHHP). Respondents, when asked to indicate their level of support or opposition to each of eight policies, expressed general support for all but two. Women were consistently more supportive than men. Other sociodemographic characteristics and reported use of food and other substances were generally not predictive of support. Policies that would control conditions of sale or information about the product were the most strongly supported. Taxation as an incentive to food producers to provide alternatives to high-fat food or as a disincentive to consumers to purchase these foods was moderately supported. A proposal to limit sale of high-fat food to children was the most strongly opposed. The majority of respondents indicated that they felt the individual consumer, as opposed to the producer or retailer, is most responsible for problems associated with high-fat food use. The three communities which had received MHHP health promotion activities were significantly more supportive than the comparison communities on two of the eight proposals. There is a moderate level of support in the general public for additional policies to regulate the sale and consumption of high-fat foods. These policy level interventions, similar to policies common in the regulation of alcohol and tobacco use, may be a feasible strategy to help moderate use of potentially health-compromising food products.

Obesity and smoking remain major public health problems. Because of their widespread prevalence, large scale community-wide programs are needed to have an impact on public health. The purpose of this study was to determine the magnitude of response to four variations in recruitment and demographic characteristics of people enrolling in self-help programs for weight control and smoking cessation. A total of 76,900 households from three communities were offered correspondence-based programs in weight control and smoking cessation. Rates of enrollment ranged from 0.1 to 5% for smoking and from 0.3 to 12% for weight after adjusting for estimated prevalence of smoking and obesity. Recruitment rates were positively related to amount of money spent on recruitment per household. Sending sign-up packages only to those returning interest cards was less costly than sending sign-up packages to everyone. Those who received announcements of the program prior to receiving sign-up packages enrolled at a higher rate than those not receiving announcements. Mass media campaigns did not clearly increase enrollment. A flat fee/materials only option was about 10 times more popular than an incentive option which required a deposit and was refunded proportional to success. Enrollees were somewhat older, better educated and less overweight than those enrolling in traditional programs. Average recruitment costs per enrollee ranged from +14 to +27 in the three communities. Total enrollment was 1990 for weight and 298 for smoking across the three communities in what may be the largest direct mail recruitment effort and intervention program of its kind yet attempted.

Effects of interpolating additional reinforcement into an existing "natural" schedule of reinforcement were examined on subsequent responding when experimenter-controlled reinforcement was withdrawn. Six mildly to moderately mentally retarded children were given from 10 to 45 minutes of interpolated reinforcement for target behavior that interfered with habilitation. When the interpolated reinforcement was discontinued, the forms of responding returned to those of initial baseline, and the rates were lower. The significantly lower rate of responding in the return-to-baseline condition suggests that such a procedure may be effectively incorporated into behavior-reduction programs.