If we want more evidence-based practice, we need more practice-based evidence.*

If we want more evidence-based practice, we need more practice-based evidence.*



Table of Contents

Headlines, Timelines, & Milestones

Archived Headlines

Supplementary References

Books and Reviews

Other References

Web Resources

Power Point Slides:

Social Determinants of Health: Lessons from the Tobacco Control Experience

Headlines, Timelines, & Milestones

Zerhouni Says Brain Research Is Key To Future Health Behavior Success (Health Behavior News Service, March 3, 2003) - National Institutes of Health Director Elias Zerhouni predicts that brain and behavior studies, along with efforts to target disease at the molecular level, are the future of medical research that emphasizes prevention as much as cures.

Doctor Fights for Warnings On Viagra's Ads and Labels (Wall Street Journal, March 3, 2003) - Since last year, 43 new cases of syphilis and 14 new HIV infections have been diagnosed in Viagra users in San Francisco.  This occurrence has provides evidence that Viagra use may be associated with unsafe sexual behavior.

Archived Headlines


    Journal References

Abraham, C., Clift, S., & Grabowski, P. Cognitive predictors of adherence to malaria prophylaxis regimens on return from a malarious region: a prospective study. SOCIAL SCIENCE & MEDICINE 48 (11): 1641-1654.

Aaral, S.O., Hughes, J.P., Stoner, B., Whittington, W., Handsfield, H.H., Anderson, R.M., & Holmes, K.K. (1999). Sexual mixing patterns in the spread of gonococcal and chlamydial infections. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 825-833.
    ABSTRACT: Objectives. This study sought to define, among sexually transmitted disease (STD) clinic attendees, (1) patterns of sex partner selection, (2) relative risks for gonococcal or Chlamydial infection associated with each mixing pattern, and (3) selected links and potential and actual bridge populations. Methods. Mixing matrices were computed based on characteristics of the study participants and their partners. Risk of infection was determined in study participants with various types of partners, and odds ratios were used to estimate relative risk of infection for discordant vs concordant partnerships. Results. Partnerships discordant in terms of race/ethnicity, age, education, and number of partners were associated with significant risk for gonorrhea and Chlamydial infection. In low-prevalence subpopulations, within-subpopulation mixing was associated with Chlamydial infection, and direct links with high-prevalence subpopulations were associated with gonorrhea. Conclusions. Mixing patterns influence the risk of specific infections, and they should be included in risk assessments for individuals and in the design of screening, health education, and partner notification strategies for populations.

Bermudez, J.  (1999).  Personality and health-protective behavior. EUROPEAN JOURNAL OF PERSONALITY 13 (2), p.83-103.  
    ABSTRACT: Over the last decades much research has been devoted to the analysis of psychosocial factors associated with the development of health problems. However, less attention has been paid to mechanisms explaining why people keep engaging in risky behaviors and do not develop, instead, those habits that could increase their quality of life; To answer these questions, this review article follows two lines of research. The main hypothesis of the first line is that there are personality characteristics that predispose the development of certain patterns of behavior. The second line is focused on the analysis of the psychological processes that, together with situational factors, explain what behavior is initiated and how it is maintained or changed. The main purpose of this paper is to review these two lines of research: what their main contributions are and what the problems they face are.

Block, D. E., Hutton, S. J., & Braun, B. (1999). Health Concerns of Adults: Qualitative Data of the Bridge to Health Survey. AMERICAN JOURNAL OF HEALTH BEHAVIOR 23 (3):163-171 .

Brug, J., Steenhuis, I., van Assema, P., Glanz, K., De Vries, H.  (1999). Computer-tailored nutrition education: differences between two interventions. HEALTH EDUCATION RESEARCH 14 (2): 249-256. 
    ABSTRACT: The impact of two computer-tailored nutrition education interventions was assessed and compared in a randomized trial among 315 subjects with a pre-test-post-test comparison group design. Respondents in both the experimental and the comparison group received feedback tailored to their consumption of fat, fruit and vegetables. Respondents in the experimental group received additional psychosocial feedback tailored to their attitudes, perceived social support and self-efficacy expectations towards reducing their fat consumption and increasing their consumption of fruit and vegetables. A significant reduction in fat consumption and increase in the consumption of fruit and vegetables were found in both the experimental and the comparison group between pre-test and post-test. Respondents in the experimental group more often indicated that the feedback they received was interesting and easy to understand.   Respondents in the comparison group more often reported having reduced their fat consumption because of the feedback they received. No significant differences in consumption of fat, fruit and vegetables were found at post-test between the experimental group and the comparison group. These results do not support the hypothesis that additional psychosocial information is an essential component of effective tailored feedback. The results indicate that tailored feedback might be effective in inducing dietary changes.

Cohen, D., Scribner, R., Bedimo, R., & Farley, T. A. (1999). Cost as a barrier to condom use: The evidence for condom subsidies in the United States. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (4): 567-568.
    ABSTRACT: Objectives. This study sought to determine the impact of price on condom use.  Methods. A program based on distribution of condoms at no charge was replaced with one providing low-cost condoms (25 cents). Pretest and posttest surveys asked about condom use among persons reporting 2 or more sex partners. Results. At pretest, 57% of respondents had obtained free condoms, and 77% had used a condom during their most recent sexual encounter. When the price was raised to 25 cents, the respective percentages decreased to 30% and 64%. Conclusions. Cost is a barrier to condom use. Free condoms should be distributed to encourage their use by persons at risk for HIV and other sexually transmitted diseases.

Cunningham, P.J., Kemper, P.  (1998). Ability to Obtain Medical Care for the Uninsured: How Much Does It Vary Across Communities. JAMA - JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 280(10): 921-927.

Gascoigne, P., Mason, M.D., & Roberts, E. (1999). Factors affecting presentation and delay in patients with testicular cancer: Results of a qualitative study. PSYCHO-ONCOLOGY 8 (2): 144-154.
    ABSTRACT: A qualitative study was undertaken with men treated for testicular tumors, to ascertain how they interpreted their symptoms and the factors which influenced a decision to consult a physician. The research was undertaken with six men who had been diagnosed as having testicular tumors. Interviews were also conducted with four wives and one mother. The findings showed that giving men information on testicular cancer may not guarantee early presentation. Symptoms were not generally attributed to cancer and the one patient who practiced self-examination had delayed seeking help for 6 months. The extent to which symptoms affected the patient's lifestyle was also a factor in the decision-making process, as was the checking of symptoms with other family members. Wives were often pivotal in persuading men to seek help. The discovery of testicular symptoms produced emotional responses which included embarrassment and fear of both cancer and castration. There was evidence of strong feelings of masculine identity bound up with the appearance of 'normal' genitals. Provider-delay was identified in four cases and was associated with misattribution of symptoms by physicians and the failure to initiate specialist referral. Delay was under-recorded in the hospital notes in all cases where presentation was not immediate.

Gilbert, L. K. (1999). The female condom (TM) (FC) in the US: Lessons learned. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): A1-A28.
    ABSTRACT: Prior to the introduction of the female condom (TM) (FC) no effective, safe, reversible, female-controlled contraceptive methods that prevented both unintended pregnancy and STDs, including HIV existed. FC was invented in the mid-1980's and approved by the FDA in 1993. FC is a polyurethane sheath with rings on each end, one to insert into the vagina and the other to provide coverage for the external genitalia. FC is durable, odorless, long-lasting, and impermeable to temperature, humidity, and oil-and water-based lubricants. While many people are allergic to latex acid/or nonoxynol-9, FC causes few, if any allergic reactions or other vaginal irritation, cytotoxicity, or mutagenicity. Contraceptive efficacy studies in the US found that FC compared favorably with other female barrier options, the ranges varying widely dependent upon correct and consistent usage. FC tested in vitro and in vivo was found to be impenetrable to trichomoniasis, cytomegalovirus, herpes virus, hepatitis B virus, Phi X174 and HIV. Participants in FC acceptability studies reported the following benefits: caused no side effects (not systemic), required no health care services to fit, prescribe, refill, insert or remove, required no partner consent; and provided a feeling of safety It could be inserted in advance of sexual activity; allowed more sexual spontaneity and intercourse before full erection of the penis; covered internal and external genitalia; and, warmed to body temperature. Further, it was reported to feel natural and clean, had no odor or taste, was soft, non-drying, and nonconstricting, enhanced sexual stimulation ,and reduced painful intercourse. Finally, it increased women's bargaining power, provided incremental gains from expanded contraceptive choices, and was easily reversible. Acceptability of FC increased with increased use of the method. Reported obstacles to FC use included: aesthetics, insertion difficulties, discomfort, dislodgment, reduced sensation, and partner objections. Among higher risk populations, such as teens, substance abusers, and commercial sex workers (CSW), FC has additional benefits and obstacles. Recommendations for the future include education programs for health care/FC providers, potential FC users and their partners. Ongoing research is needed regarding STD prevention, reuse (one approach to reduce cost), operations research (effective ways to integrate FC into prevention programs), other uses (such as anal intercourse) and special population use (such as postmenopausal women).

Glik, D. C., Kronenfeld, J. J., Jackson, K., & Zhang, W. (1999). Comparison of Traffic Accident and Chronic Disease Risk Perception. AMERICAN JOURNAL OF HEALTH BEHAVIOR 23 (3): 198-209.

 Miller, D.R., Geller, A.C., Wood, M.C., Lew, R.A., & Koh, H.K. (1999). The Falmouth safe skin project: Evaluation of a community program to promote sun protection in youth.    HEALTH EDUCATION & BEHAVIOR 26 (3): 369-384.
    ABSTRACT: A multidimensional community-based skin cancer prevention program was conducted in Falmouth, Massachusetts, combining community activism with publicity campaigns and behavioral interventions to improve sun protection knowledge; attitudes; and practices in parents, caregivers, and children. The program was associated with improvements in target outcomes, based on two telephone surveys of random samples of parents (n = 401, 404). After program implementation, fewer parents reported sunburning of their children, particularly among children 6 years old or younger(18.6% in 1994 vs. 3.2% in 1997), and more parents reported children using sunscreen, particularly continuous use at the beach (from 47.4% to 69.9% in younger children). Hat and shirt use did not increase. Improvements also were seen in parent role modeling of sun protection practices, parents' self-efficacy in protecting children from the sun, and sun protection knowledge. While these findings must be interpreted cautiously, they do suggest that this project was effective in promoting sun protection.

Mitchell, S. A. & Olds, R. S. (1999). Psychological and perceived situational predictors of physical activity: a cross-sectional analysis. HEALTH EDUCATION RESEARCH 14(3): 305-313.

Poppius, E., Tenkanen, L., Kalimo, R., & Heinsalmi, P. (1999). The sense of coherence, occupation and the risk of coronary heart disease in the Helsinki Heart Study. SOCIAL SCIENCE & MEDICINE 49 (1): 109-120, July.

Reisen, C. A., & Poppen, P. J. Partner-specific risk perception: A new conceptualization of perceived vulnerability to STDs. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 29 (4): 667-684.
    ABSTRACT: Two studies were conducted to test a new conceptualization of risk perception, focusing on the risk posed by a specific sexual partner at a specific time rather than a generalized perception of vulnerability to HIV or sexually transmitted diseases. Study 1 used a cross-sectional design and found support for a model with the following domains as antecedents of partner-specific risk perception (PSRP): generalized perception of HIV risk, partner's sexual history, and characteristics of relationship with the partner. However, PSRP was not associated with condom use in Study 1. Study 2, which used a longitudinal design, replicated the domains predictive of PSRP and also demonstrated the influence of PSRP on condom use 4 weeks later while controlling for past condom use. The findings support the utility of this conceptualization of risk perception in lieu of the Health Belief Model and other models in sexually-transmitted disease control.


Secker-Walker, R. H., Vacek, P. M., Hooper, G. J., Plante, D. A., & Detsky, A. S. (1999). Screening for Breast Cancer: Time, Travel, and Out-of-Pocket Expenses. JOURNAL OF NATIONAL CANCER INSTITUTE 91: 702-708.

Smith, B., Sullivan, E., Bauman, A., Powell-Davies, G., & Mitchell, J. (1999). Lay beliefs about the preventability of major health conditions. HEALTH EDUCATION RESEARCH 14(3): 315-325.

Turner, G. & Shepherd, J.  (1999). A method in search of a theory: peer education and health promotion.   HEALTH EDUCATION RESEARCH 14 (2): 235-247.
    ABSTRACT: Peer education has grown in popularity and practice in recent years in the field of health promotion. However, advocates of peer education rarely make reference to theories in their rationale for particular projects. In this paper the authors review a selection of commonly cited theories, and examine to what extent they have value and relevance to peer education in health promotion. Beginning from an identification of 10 claims made for peer education, each theory is examined in terms of the scope of the theory and evidence to support it in practice. The authors conclude that, whilst most theories have something to offer towards an explanation of why peer education might be effective, most theories are limited in scope and there is little empirical evidence in health promotion practice to support them. Peer education would seem to be a method in search of a theory rather than the application of theory to practice.

Uetrecht, C. L., Greenberg, M., Dwyer, J. J. M., Sutherland, S., & Tobin, S. (1999). Factors Influencing Vegetable and Fruit Use: Implications for Promotion. AMERICAN JOURNAL OF HEALTH BEHAVIOR 23 (3): 172-181.

Ziglio, E. and Harrison, D. (Eds). The Social determinants of health: Implications for the health professions. FORUM: TRENDS IN EXPERIMENTAL AND CLINICAL MEDICINE 8.3 (Suppl. 4).  National Academy of Medicine, Rome, Italy. 
    Available in full text on-line at http://www.accmed.net/hpi under the title 'Social determinants of health : implications for the health professions : Genoa 18-21 April 1998'. See esp. the paper by Martin Bobak, Social determinants of health across Europe, and one by P. Gilles, Social capital and its contribution to public health.

    Books and Reviews

Huff, Robert, & Kline, Michael (Eds.).  Promoting Health in Multicultural Populations: A Handbook for Practitioners.   Sage Publishing Co., 1999. 
    For description and table of contents, go to: http://www.sagepub.co.uk/

Salovey, P, Rothman A and Rodin J. (1998). "Health behavior" In D Gilbert, S Fisk and G Lindzey (Eds.), Handbook of Social Psychology. The McGraw Hill Companies, Inc.: Boston. 
    This chapter is a review of theories of health behavior. First, review of formal social psychological theories about general behavior, which link attitudes to behavior, which have been used to explain health behavior, then review of theories specifically developed for health behavior.

    Other References

Denison, J. (1996). Behavior change: a summary of four major theories.  An AIDSCAP Behavioral Research Report. 
    In this article, the four major behavioral change theories used in HIV and AIDS research are summarized with key references in the Family Health International web site:


For more information on how to talk with your kids about drugs, ask for a free copy of "Growing Up Drug-Free – A Parent’s Guide to Prevention." Call the Office of National Drug Control Policy at 1-800-788-2800, or visit www.projectknow.com or www.drugfreeamerica.org

Some websites with search capacity for social marketing analyses of audience characteristics ("psychographics") relevant to message development.


More health and health-behavioral determinants + psychographics at Healthstyles developed by Porter Novelli http://www.porternovelli.com/pnwesite/pnwebsite.nsf/index?openpage


More demographic + media + consumer habits using PRIZM clustering. See NDS website at http://www.accessgear.com/partners/ipartners_program.html