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With the onset and rapid spread of COVID-19 without a safe and effective vaccine, initial efforts to reduce community spread focused on basic public health measures such as mask wearing, social dis...

As this is being written, the Coronavirus (COVID-19) pandemic is spreading around the planet. To date, 210 countries have been affected.1 Billions of people are in lockdown as health services strug...

Health care reform tops the list of issues that voters consider important going into the 2020 elections. As health professionals, it is imperative that we not only become informed about this issue ...

The purpose of this paper is to update and enhance the 1989 Association for Health Education (AAHE) Scholar presentation, Reflections on Directions in Health Education: Implications for Pol...

Using Smoke-Free and Tobacco-Free policies on college and university campuses as an example this article discusses these initiatives in the context of the role of health educators and healt...

There is a growing concern among scientists and educators alike that we are failing in our mission to demonstrate the importance of science and of the scientific method and hypothesis testing. We discuss the alarming rise of misinformation, particularly on the Internet, and the inability of readers, particularly students, to decipher real, valid information from “fake” or alternative facts. We call for renewed educational efforts at all levels to address this new information age problem affecting science. Additionally, strategies for health promotion professionals and Certified Health Education Specialists are presented.

Health care has been an ongoing issue of public concern for decades, well before President Obama took office. Passage of the Affordable Care Act (ACA),1 also known as Obamacare, in March 2010 and u...

Termination of transcription of short non-coding RNAs is carried out in yeast by the Nab3-Nrd1-Sen1 complex. Nab3 and Nrd1 are hnRNP-like proteins that dimerize and bind RNA with sequence specificity. We show here that an essential region of Nab3 that is predicted to be prion-like based upon its sequence bias, formed amyloid-like filaments. A similar region from Nrd1 also assembled into filaments in vitro. The purified Nab3 domain formed a macroscopic gel whose lattice organization was observed by X-ray fiber diffraction. Filaments were resistant to dissociation in anionic detergent, bound the fluorescent dye thioflavin T, and showed a β-sheet rich structure by circular dichroism spectroscopy, similar to human amyloid β which served as a reference amyloid. A version of the Nab3 domain with a mutation that impairs its termination function, also formed fibers as observed by electron microscopy. Using a protein fragment interaction assay, the purified Nab3 domain was seen to interact with itself in living yeast. A similar observation was made for full length Nab3. These results suggest that the Nab3 and Nrd1 RNA-binding proteins can attain a complex polymeric form and raise the possibility that this property is important for organizing their functional state during termination. These findings are congruent with recent work showing that RNA binding proteins with low complexity domains form a dynamic subcellular matrix in which RNA metabolism takes place but can also aberrantly yield pathological aggregated particles.

Context This study examines a model of performance measurement in public health on the basis of logic model constructs focusing upon explanatory variables (inputs) within the realm of control of the local public health agency (LPHA), and their subsequent effect on LPHA functions (outputs). Methods Study protocol was reviewed and approved by an institutional review board, and informed consent was obtained from all participants. The investigation included measuring the human, informational, organizational and fiscal resources of the LPHAs (inputs) to determine the effect upon LPHA performance of the assessment, policy development, and assurance functions of public health (outputs), commonly referred to as the 3 core functions of public health. Results Study participants included the lead health officials (termed "administrators") representing the LPHAs within the state of Illinois. Forty-three of the 46 LPHAs selected participated in the study for a response rate of 93%. Analysis to identify the presence of any relationship between the explanatory variables (LPHA inputs or resources) and the dependent variables (LPHA outputs or core functions) was undertaken utilizing multiple regression analysis. Conclusions Results concluded that higher-level performance in areas noted as LPHA inputs or resources were associated with higher-level performance of the core functions of public health.

Nab3 and Nrd1 are yeast heterogeneous nuclear ribonucleoprotein (hnRNP)-like proteins that heterodimerize and bind RNA. Genetic and biochemical evidence reveals that they are integral to the termination of transcription of short non-coding RNAs by RNA polymerase II. Here we define a Nab3 mutation (nab3Δ134) that removes an essential part of the protein's C terminus but nevertheless can rescue, in trans, the phenotype resulting from a mutation in the RNA recognition motif of Nab3. This low complexity region of Nab3 appears intrinsically unstructured and can form a hydrogel in vitro. These data support a model in which multiple Nrd1-Nab3 heterodimers polymerize onto substrate RNA to effect termination, allowing complementation of one mutant Nab3 molecule by another lacking a different function. The self-association property of Nab3 adds to the previously documented interactions between these hnRNP-like proteins, RNA polymerase II, and the nascent transcript, leading to a network of nucleoprotein interactions that define a higher order Nrd1-Nab3 complex. This was underscored from the synthetic phenotypes of yeast strains with pairwise combinations of Nrd1 and Nab3 mutations known to affect their distinct biochemical activities. The mutations included a Nab3 self-association defect, a Nab3-Nrd1 heterodimerization defect, a Nrd1-polymerase II binding defect, and an Nab3-RNA recognition motif mutation. Although no single mutation was lethal, cells with any two mutations were not viable for four such pairings, and a fifth displayed a synthetic growth defect. These data strengthen the idea that a multiplicity of interactions is needed to assemble a higher order Nrd1-Nab3 complex that coats specific nascent RNAs in preparation for termination.

Name changes of university departments that have professional preparation health education programs have been ongoing and significant. This study analyzes changes in the names of health education degree-offering departments between 1974 and 2009. It also discusses the implications for the health education discipline going forward with respect to personal and professional identification, as well as credentialing and employment opportunities for health educators. A large change was seen in many of the department names between 1974 and 2009. The greatest changes were seen in the increasing use of community health, kinds of health, public health, and health and something else. A large decrease was noted in the use of health education. Name changes present potential challenges for the professional and educational development of the field, employment opportunities, and personal and professional identification. This article does not purport to provide a prescription or solution but rather suggests that health ed...

Nab3 is an RNA-binding protein whose function is important for terminating transcription by RNA polymerase II. It co-assembles with Nrd1, and the resulting heterodimer of these heterogeneous nuclear ribonucleoprotein-C (hnRNP)-like proteins interacts with the nascent transcript and RNA polymerase II. Previous genetic analysis showed that a short carboxyl-terminal region of Nab3 is functionally important for termination and is located far from the Nab3 RNA recognition domain in the primary sequence. The domain is structurally homologous to hnRNP-C from higher organisms. Here we provide biochemical evidence that this short region is sufficient to enable self-assembly of Nab3 into a tetrameric form in a manner similar to the cognate region of human hnRNP-C. Within this region, there is a stretch of low complexity protein sequence (16 glutamines) adjacent to a putative α-helix that potentiates the ability of the conserved region to self-assemble. The glutamine stretch and the final 18 amino acids of Nab3 are both important for termination in living yeast cells. The findings herein describe an additional avenue by which these hnRNP-like proteins can polymerize on target transcripts. This process is independent of, but acts in concert with, the interactions of the proteins with RNA and RNA polymerase and extends the relationship of Nab3 as a functional orthologue of a higher eukaryotic hnRNP.

As health educators involved in our profession, as members of our professional organizations, and as authors, reviewers, and members of various professional journal editorial boards, and along with involvement with professional preparation programs, our interest was piqued by the journal article titled, "What About Health Educators? Nutrition Education for Allied Health Professionals: A Review of the Literature." (1) This study had three purposes: (1) to determine the definition of, and criteria for, nutrition education among allied health professionals; (2) to identify commonalities across health professions for nutrition education definitions and training requirements; and (3) to determine if there are criteria for nutrition education and training for health educators. Specifically, we do not take exception that, according to the authors, "Common across the studies of allied health professions included in this review was a sense of the importance of nutrition training and education of these professionals." The paper does document some shortcomings and obstacles in some other professional areas. Nor do we take exception with the general recommendations to improve such training, which included suggestions to "increase the number of clinical hours spent in nutrition, increase the number of nutrition-focused continuing education hours, or integrate nutrition into the current training curriculum." However, after reading the article, our initial enthusiasm quickly waned and then evaporated in terms of its major purpose to "determine if there are criteria for nutrition education and training for health educators." While the topic of nutrition education certainly is worthy of inquiry, our concerns are threefold. This article appears to be a classic example of reporting findings and conclusions based on: (1) inadequate and faulty methodology, (2) a demonstrated misunderstanding of the health education discipline and, (3) several practical limitations. INADEQUATE AND FAULTY METHODOLOGY Scope of the Search Once the methodology was described, we anticipated that the findings and the conclusions would be self-evident without further reading. Not surprisingly, they are consistent and perfectly fit the methodology. Unfortunately, the limitations inherent in their methodology render any valid conclusions inadequate. Specifically, the study is based on a reported comprehensive review of the literature. According to the authors, "This review involved rigorous search and assessment strategies to examine the body of literature advocating for the teaching of nutrition in the university curriculum for allied health professionals." To accomplish their review the authors searched two major heath science bibliography databases, MEDLINE and EBSCO. Reviews of literature, regardless of topic, require very detailed search strategies that have become more complicated over the years given the many new electronic databases that now exist. These search and data mining strategies were not described in enough detail to give us confidence that they accurately located all the existing articles in the professional literature. The small sample size of articles used in this review provides some evidence of this. For example, while the authors used the National Library of Medicine's MEDLINE bibliographic database that contains over 19 million references, these are primarily journal articles in the life sciences with a concentration in biomedicine. Further, while one of the key distinctive features of MEDLINE is its use of Medical Subject Headings known as MESH[R], the authors do not specifically mention their use of MeSH descriptors or terms used in their searches. Using different MeSH terms and even reordering these terms can elicit very differing results. While they do describe using words such as, "students, health, occupation and nutrition/dietetics" they seem to have omitted other search terms such as "curriculum and education" that may have provided different results. …

The yeast IMD2 gene encodes an enzyme involved in GTP synthesis. Its expression is controlled by guanine nucleotides through a set of alternate start sites and an intervening transcriptional terminator. In the off state, transcription results in a short non-coding RNA that starts upstream of the gene. Transcription terminates via the Nrd1-Nab3-Sen1 complex and is degraded by the nuclear exosome. Using a sensitive terminator read-through assay, we identified trans-acting Terminator Override (TOV) genes that operate this terminator. Four genes were identified: the RNA polymerase II phosphatase SSU72, the RNA polymerase II binding protein PCF11, the TRAMP subunit TRF4 and the hnRNP-like, NAB3. The TOV phenotype can be explained by the loss of function of these gene products as described in models in which termination and RNA degradation are coupled to the phosphorylation state of RNA polymerase II's repeat domain. The most interesting mutations were those found in NAB3, which led to the finding that the removal of merely three carboxy-terminal amino acids compromised Nab3's function. This region of previously unknown function is distant from the protein's well-known RNA binding and Nrd1 binding domains. Structural homology modeling suggests this Nab3 'tail' forms an α-helical multimerization domain that helps assemble it onto an RNA substrate.

Transcriptional regulation of IMD2 in yeast (Saccharomyces cerevisiae) is governed by the concentration of intracellular guanine nucleotide pools. The mechanism by which pool size is measured and transduced to the transcriptional apparatus is unknown. Here we show that DNA sequences surrounding the IMD2 initiation site constitute a repressive element (RE) involved in guanine regulation that contains a novel transcription-blocking activity. When this regulatory region is placed downstream of a heterologous promoter, short poly(A)(+) transcripts are generated. The element is orientation dependent, and sequences within the normally transcribed and nontranscribed regions of the element are required for its activity. The promoter-proximal short RNAs are unstable and serve as substrates for the nuclear exosome. These findings support a model in which intergenic short transcripts emanating from upstream of the IMD2 promoter are terminated by a polyadenylation/terminator-like signal embedded within the IMD2 transcription start site.

(2006). The American Mirage of Equality—Is Social Justice Myth or Reality? American Journal of Health Education: Vol. 37, No. 1, pp. 58-62.

The purpose of this study was to replicate the Notaro, O'Rourke, and Eddy study to rank doctoral programs in health education, incorporating comments from professionals in health education to enhance the ranking study methods. This study used a multiple set of variables weighted by scholars and leaders in the field of health education. These variables included articles published; journal editorships; external funding of research; student activity; student/faculty ratio; mentoring and placement of doctoral students; and student support. Twenty-four of the 39 doctoral programs in health education participated in this study. Seventeen programs had at least 1 variable ranked in the top 10, and all but 1 program had at least 2 variables ranked in the top 20. Correlation analysis of the 7 variables provided additional insights. As in the Notaro, O'Rourke, and Eddy study, the faculty variables were not statistically significantly related to the student variables. Consistent with the literature, programs...

(2002). Health Care Reform—Insights for Health Educators. American Journal of Health Education: Vol. 33, No. 5, pp. 297-300.

Healthcare reform in any nation is an evolving process. Brought about by demographic, technological, social, cultural, economic and political factors, all healthcare systems are continually confronting issues related to cost, access and quality. This paper examines other countries' approaches to healthcare in the ongoing efforts at healthcare reform in the USA. While recognizing the uniqueness of the healthcare system in each nation, it appears there are valuable lessons from other nations to be considered by policy makers in the USA as healthcare reform continues to evolve. This paper synthesizes several lessons for the USA that may be applicable by looking beyond its borders. In so doing, it reveals differences that may be insightful in considering future healthcare paradigms influencing healthcare reform efforts in the USA.

The mitochondrial genome is a significant target of exogenous and endogenous genotoxic agents; however, the determinants that govern this susceptibility and the pathways available to resist mitochondrial DNA (mtDNA) damage are not well characterized. Here we report that oxidative mtDNA damage is elevated in strains lacking Ntg1p, providing the first direct functional evidence that this mitochondrion-localized, base excision repair enzyme functions to protect mtDNA. However, ntg1 null strains did not exhibit a mitochondrial respiration-deficient (petite) phenotype, suggesting that mtDNA damage is negotiated by the cooperative actions of multiple damage resistance pathways. Null mutations in ABF2 or PIF1, two genes implicated in mtDNA maintenance and recombination, exhibit a synthetic-petite phenotype in combination with ntg1 null mutations that is accompanied by enhanced mtDNA point mutagenesis in the corresponding double-mutant strains. This phenotype was partially rescued by malonic acid, indicating that reactive oxygen species generated by the electron transport chain contribute to mitochondrial dysfunction in abf2 Delta strains. In contrast, when two other genes involved in mtDNA recombination, CCE1 and NUC1, were inactivated a strong synthetic-petite phenotype was not observed, suggesting that the effects mediated by Abf2p and Pif1p are due to novel activities of these proteins other than recombination. These results document the existence of recombination-independent mechanisms in addition to base excision repair to cope with oxidative mtDNA damage in Saccharomyces cerevisiae. Such systems are likely relevant to those operating in human cells where mtDNA recombination is less prevalent, validating yeast as a model system in which to study these important issues.

The hyperthermophilic bacterium, Thermotoga maritima , grows up to 90°C by fermenting carbohydrates and it disposes of excess reductant by H 2 production. The H 2 -evolving cytoplasmic hydrogenase of this organism was shown to consist of three different subunits of masses 73 (α), 68 (β) and 19 (γ) kDa and to contain iron as the only metal. The genes encoding the subunits were clustered in a single operon in the order hydC (γ), hydB (β), and hydA (α). Sequence analyses indicated that: (a) the enzyme is an Fe-S-cluster-containing flavoprotein which uses NADH as an electron donor; and (b) the catalytic Fe-S cluster resides within the α-subunit, which is equivalent to the single subunit that constitutes most mesophilic Fe-hydrogenases. The α- and β-subunits of the purified enzyme were separated by chromatography in the presence of 4 M urea. As predicted, the H 2 -dependent methyl viologen reduction activity of the holoenzyme (45–70 U mg −1 ) was retained in the α-subunit (130–160 U mg −1 ) after subunit separation. However, the holoenzyme did not contain flavin and neither it nor the α-subunit used NAD(P)(H) or T. maritima ferredoxin as an electron carrier. The holoenzyme, but not the α-subunit, reduced anthraquinone-2,6-disulfonate (apparent K m , 690 μM) with H 2 . The EPR properties of the reduced holoenzyme, when compared with those of the separated and reduced subunits, indicate the presence of a catalytic ‘H-cluster’ and three [4Fe-4S] and one [2Fe-2S] cluster in the α-subunit, together with one [4Fe-4S] and two [2Fe-2S] clusters in the β-subunit. Sequence analyses predict that the α-subunit should contain an additional [2Fe-2S] cluster, while the β-subunit should contain one [2Fe-2S] and three [4Fe-4S] clusters. The latter cluster contents are consistent with the measured Fe contents of about 32, 20 and 14 Fe mol −1 for the holoenzyme and the α- and β-subunits, respectively. The T. maritima enzyme is the first ‘complex’ Fe-hydrogenase to be purified and characterized, although the reason for its complexity remains unclear.

The “Responsibilities and Competencies for Entry-Level Health Educators” (Competencies) document identifies the major responsibilities in which all entry-level health educators are expected to be proficient and serves as the basis of credentialing certified health education specialists (CHES). This study addresses several fundamental questions related to their use: (1) What are the characteristics of the units that have professional preparation programs that prepare entry-level health educators? (2) Are the faculty in those programs familiar with the Competencies? (3) Do the faculty use the Competencies when planning their curricula? (4) What has been the impact of the Competencies? (5) Would the administrators of undergraduate programs using the Competencies agree to inclusion in a voluntary registry of such programs? All departments (N = 214) listed in the most recently published American Association for Health Education Directory of Institutions Offering Undergraduate and Graduate Degree Progr...

The ever-increasing ease of travel coupled with the importance, if not necessity, of improving our international outlook both personally and professionally, has stimulated a new interest in study abroad programs for both students and professionals alike. This article first presents a review of travel/study options and provides a rationale for integrating an international professional experience into the curriculum for health professionals and students. Second, the authors describe the necessary phases in the development, marketing, implementation, and evaluation of an international travel/study learning experience. The article addresses important issues such as feasibility of offering an international course, mechanisms for approval, marketing, arranging site visitations, safety/legal liability, budgeting, and balancing the educational and cultural experience.

These are only a few of the possible examples of challenging our thinking and approaches which guide our actions. As previously mentioned, challenges inevitably are accompanied by opportunities which are essential not only to survive but thrive. In the year ahead, I challenge each of you on a personal level, and ASHA at an organizational level, to meet both imposed and self-initiated challenges. The results will be positive, both for you and ASHA, and especially for our chief concern, the children who bind all of us together and our future.

The American Cancer Society (ACS) has developed the curriculum “Right Choices” for secondary students in order to give them the information they need to make good health decisions. The goals were to increase students' understanding of cancer and their ability to reduce their personal risk of cancer. The article in the January/February 1993 issue of the Journal of Health Education entitled “‘Right Choices’- Development and Implementation of an American Cancer Society Cancer Prevention Curriculum for Secondary Students” described the framework, theory base, and implementation of that curriculum. This article focuses on the evaluation of that implementation. The curriculum evaluation was comprehensive, utilizing both process and outcome measures, and included cognitive, affective, and behavioral intention factors. Data were collected from 957 students and 20 teachers in grades 8–12 in 16 schools in three states. Student evaluation in terms of knowledge, attitudes, and behavioral intentions was favor...

We assess how cost sharing for medical services affects restricted activity days (RADs) and work loss disability days (WLDs), using data from a controlled experiment. We grouped the experimental insurance plans into four categories, one providing free care and the other three requiring varying amounts of cost sharing. RADs per person per year decreased by one to two days with greater cost sharing, with the strongest effects among those of average or poor health status, especially the non-poor. Unlike RADs, WLDs showed no systematic differences by plan.

The IMD2 gene in Saccharomyces cerevisiae is regulated by intracellular guanine nucleotides. Regulation is exerted through the choice of alternative transcription start sites that results in synthesis of either an unstable short transcript terminating upstream of the start codon or a full-length productive IMD2 mRNA. Start site selection is dictated by the intracellular guanine nucleotide levels. Here we have mapped the polyadenylation sites of the upstream, unstable short transcripts that form a heterogeneous family of RNAs of approximately 200 nucleotides. The switch from the upstream to downstream start sites required the Rpb9 subunit of RNA polymerase II. The enzyme's ability to locate the downstream initiation site decreased exponentially as the start was moved downstream from the TATA box. This suggests that RNA polymerase II's pincer grip is important as it slides on DNA in search of a start site. Exosome degradation of the upstream transcripts was highly dependent upon the distance between the terminator and promoter. Similarly, termination was dependent upon the Sen1 helicase when close to the promoter. These findings extend the emerging concept that distinct modes of termination by RNA polymerase II exist and that the distance of the terminator from the promoter, as well as its sequence, is important for the pathway chosen.

How mitochondrial DNA (mtDNA) copy number is determined and modulated according to cellular demands is largely unknown. Our previous investigations of the related DNA helicases Pif1p and Rrm3p uncovered a role for these factors and the conserved Mec1/Rad53 nuclear checkpoint pathway in mtDNA mutagenesis and stability in Saccharomyces cerevisiae. Here, we demonstrate another novel function of this pathway in the regulation of mtDNA copy number. Deletion of RRM3 or SML1, or overexpression of RNR1, which recapitulates Mec1/Rad53 pathway activation, resulted in an approximately twofold increase in mtDNA content relative to the corresponding wild-type yeast strains. In addition, deletion of RRM3 or SML1 fully rescued the ∼50% depletion of mtDNA observed in a pif1 null strain. Furthermore, deletion of SML1 was shown to be epistatic to both a rad53 and an rrm3 null mutation, placing these three genes in the same genetic pathway of mtDNA copy number regulation. Finally, increased mtDNA copy number via the Mec1/Rad53 pathway could occur independently of Abf2p, an mtDNA-binding protein that, like its metazoan homologues, is implicated in mtDNA copy number control. Together, these results indicate that signaling through the Mec1/Rad53 pathway increases mtDNA copy number by altering deoxyribonucleoside triphosphate pools through the activity of ribonucleotide reductase. This comprises the first linkage of a conserved signaling pathway to the regulation of mitochondrial genome copy number and suggests that homologous pathways in humans may likewise regulate mtDNA content under physiological conditions.

With the exception of base excision repair, conserved pathways and mechanisms that maintain mitochondrial genome stability have remained largely undelineated. In the budding yeast, Saccharomyces cerevisiae, Pif1p is a unique DNA helicase that is localized both to the nucleus and mitochondria, where it is involved in maintaining DNA integrity. We previously elucidated a role for Pif1p in oxidative mtDNA damage resistance that appears to be distinct from its postulated function in mtDNA recombination. Strains lacking Pif1p (pif1Delta) exhibit an increased rate of formation of petite mutants (an indicator of mtDNA instability) and elevated mtDNA point mutagenesis. Here we show that deletion of the RRM3 gene, which encodes a DNA helicase closely related to Pif1p, significantly rescues the petite-induction phenotype of a pif1Delta strain. However, suppression of this phenotype was not accompanied by a corresponding decrease in mtDNA point mutagenesis. Instead, deletion of RRM3 alone resulted in an increase in mtDNA point mutagenesis that was synergistic with that caused by a pif1Delta mutation. In addition, we found that over-expression of RNR1, encoding a large subunit of ribonucleotide reductase (RNR), rescued the petite-induction phenotype of a pif1Delta mutation to a similar extent as deletion of RRM3. This, coupled to our finding that the Rad53p protein kinase is phosphorylated in the rrm3Delta pif1Delta double-mutant strain, leads us to conclude that one mechanism whereby deletion of RRM3 influences mtDNA stability is by modulating mitochondrial deoxynucleoside triphosphate pools. We propose that this is accomplished by signaling through the conserved Mec1/Rad53, S-phase checkpoint pathway to induce the expression and activity of RNR. Altogether, our results define a novel role for Rrm3p in mitochondrial function and indicate that Pif1p and Rrm3p influence a common process (or processes) involved in mtDNA replication, repair, or stability.

The American Cancer Society (ACS) has developed the curriculum “Right Choices” for secondary students in order to give them the information they need to make good health decisions. This article describes the framework for the curriculum, the theory base, and the curricula implementation. A second article to be published in the next issue of the Journal of Health Education focuses upon the evaluation of curriculum implementation. The formulation of goals and objectives served as a framework to guide in “Right Choices” development. The goals were to increase students' understanding of cancer and their ability to reduce their personal risk of cancer. A range of theories was incorporated into “Right Choices” with particular attention given to social learning, self-concept, communication, fear arousal, and decision making. Processes utilized to ensure quality control in “Right Choices” curriculum development are described. The inclusion of many checks and balances is an integral part of the ACS materi...

Settings—community, worksite, schools, and healthcare sites—constitute an important dimension of health education/health promotion policy and programs and for research about program needs, feasibility, efficacy, and effectiveness. These settings vary in the extent of coverage of and relationships with their respective constituencies, valued outcomes, and quantity and quality of evidence about the effectiveness of setting-specific and cross-setting programs. Main sources of evidence for program efficacy and effectiveness are summarized, leading to the conclusion that strides have been made toward building a strong evidentiary base for health education/health promotion in these settings. Gaps in research exist, especially for diffusion of effective programs, new technologies, the influence of policy, relations between settings, and approaches to marginal and special subgroups. Recommendations are offered for cross-setting and within-setting research related to intervention.

Youth experimentation with smoking is commonplace. Most anti-smoking efforts have focused on studying smokers and/or nonsmokers. Less attention has been directed at a significantly large group-ex-smokers. The purpose of this study is to present a profile of the ex-smoker in comparison to his/her smoking or never smoking counterparts. Knowledge about the ex-smoker group could enhance anti-smoking efforts. Data were collected from 5,393 central Illinois school age youth in grades 7–12. Data were analyzed by grade and sex. A variety of attitudinal, behavioral intention, and behavior questions about smoking were developed. Results clearly indicated that the ex-smoker group has a significantly different profile than youths who reported being a smoker or never smoker. Variables where differences were noted included close friends smoke, mother smokes, father smokes, mother would be upset, father would be upset, no one would be upset, best male friend upset, best female friend upset, and that smoking is a health problem. Differences were also noted with respect to believing that smoking helps people relax, is socially o.k. and whether or not separate areas should be designated for smokers. In most cases the ex-smokers more closely resembled the never smokers than the smokers.

The purpose of this study was to determine if interaction effects of selected psychosocial variables could be utilized as indicators of subsequent smoking behavior among youth who had originally identified themselves on a survey as having never smoked. Interaction effects of several psychosocial variables selected for study were found to be indicative of subsequent smoking behavior.

One of the most extensively studied areas of health behavior is that related to smoking. However, significant methodological limitations often limit the usefulness of research efforts. The purpose of this paper is to identify several of the more significant limitations found in the present research and to present suggestions to improve further research in smoking behavior. Several significant limitations of smoking research include the lack of common definitions of various behaviors, honesty of subject response, the lack of prospective studies and the problems inherent in such a design, and the preponderance of univariate types of analyses. Also, evaluation of program effectiveness is often limited by lack of appropriate criteria of what is meant by “success.” Lastly, much of the current research appears to focus on cessation or modification of the smoking habit. Less emphasis is directed at the area of prevention, especially involving an educational approach. Suggestions for improving anti-smoking research efforts are presented.

The purpose of this study was to assess if the initial attitudes and beliefs of a behaviorally homogeneous group can be utilized as indicators of future smoking behavior. The students included were those seventh graders who classified themselves as never smokers on the initial survey in 1966 and who participated in all three surveys over the two year period. A total of 1228 females and 868 males met these criteria. This represented a 68 per cent retention rate over the study period. Data were treated by sex. In 1968 subjects classified themselves according to their present smoking behavior as either a smoker, ex-smoker or never smoker. Using these three groups, an analysis of variance technique was employed to assess if initial attitude-belief differences existed between the three subsequent behavioral groupings. For the original never smoker seventh grade females, initial attitude-belief mean difference scores were found on the pleasure and exemplar factors. Never smokers who remained never smokers exhibited more unfavorable attitudes and beliefs toward smoking than those who became smokers or ex-smokers. Significant differences for male data were found on the pleasure, influence, and health and disease factors. Again, initial never smokers who maintained their behavior exhibited more unfavorable attitudes and beliefs with regard to smoking than those who became smokers or ex-smokers. These results suggest that attitudes and beliefs of initial never smokers may serve as indicators of future behavior. It appears that items of an affective rather than a cognitive domain were more useful indicators. However, the complexity of the influencing factors of a smoking or non-smoking behavior is manifested, with the exception of the pleasure factor, by the existence of different factors being significant for different sexes at the same grade level.

The role of citizen involvement in the health planning process in Great Britain and the United States makes for interesting comparisons. Within both systems, the record of citizen participation in health planning has been mixed. Both the philosophical goals and political and economic realities of the two countries have contributed to the development of markedly different systems of health care delivery and for the perceived role of the citizens within this delivery system. While previous comparisons have primarily centered on the nature of the delivery systems and potential effectiveness and cost, this study focuses upon the citizen's role in effecting meaningful health planning in both societies. Furthermore, the study relates findings to implications for developing effective health education strategies based upon these understandings.