1. Planning, Implementing, and Evaluating Your Health Promotion Programs A 6-Week Public Health Course Week 2: Assessing Our Population, Part 1

2. Today: Discuss behavior change theory application homework PRECEDE-PROCEED introduction Assessing our Population Part 1: epidemiological assessment and behavioral and environmental assessment Applying Social Cognitive Theory

3. Homework What did you learn? Which theory did you think was best for STI prevention? Share components of the best fit theory

4. Health Belief Model ConstructApplication Perceived susceptibility Use guest speakers who are close to students’ age Famous people with HIV (posters/videos) When students think they have an STI/nervous about test results, make it real that they could have an STI Perceived severity Graphic pics of STIs (health fair, posters in wellness) Reality of HIV (side effects and cost of meds) Infertility (may not be salient for many adolescents) STIs make more susceptible to HIV (newsletter article, educate students during wellness class, in wellness center) How do you deal with students who have had an STI many times and don’t seem to care? Perceived benefits Avoid stigma of STI (individual or group counseling) Preserve fertility (might not be salient to adolescents) Pregnancy prevention/better future (groups of females)

5. Health Belief Model ConstructApplication Perceived barriers Educate students in groups/couples (make using a condom less awkward and stigmatized) Make sure students have access to free condoms when they need them, including the weekend (expensive) Female empowerment/Male responsibility (females apprehensive to confront males about condom use/feminine/masculine roles) Have condoms available in dorms/bathrooms, etc. (privacy and access) Have a number for students to call or an anonymous question box (embarrassment) Talk about effects of drinking/drugs on decision making/troubleshoot (bad decisions when under the influence) Discuss myths about STIs (break down any imagined barriers)

6. Health Belief Model ConstructApplication Cues to action Reinforce condom availability Encourage all students to make an appointment for STI testing if they have symptoms Peer mentors Brochures/handouts Social networking Self efficacy Teach students proper condom usage (banana) Trouble shoot difficult situations Help a student talk with her partner before they are in the heat of the moment Ask question and don’t be judgmental Mentor students in developing self respect and increased self esteem Review student understanding of information Encourage students to ask questions

7. In Sexuality Education Works with: ▫Primary prevention—prevent pregnancy, STIs, etc. by increasing condom use ▫Secondary prevention—increase early detection of STIs or HIV to reduce spread/early treatment Does not work well with: ▫Comprehensive sexuality education programs that are not action oriented ▫Not a good fit for abstinence only (threat logic) Source: Resource Center for Adolescent Pregnancy Prevention. http://www.etr.org/recapp/index.cfm?fuseaction=pages.TopicsInBriefDetail&PageID=51

9. JC’s No Sex Policy What is the effect on STI rates? When would it be helpful and when harmful? What is the effect of abstinence-only education? ▫Lowest STI rate in 15-24 y/o from states with no mandates for abstinence education ▫States with mandates emphasizing abstinence had the highest rates ▫States with mandates to cover (not emphasize) abstinence fell in the middle Source: Hogben, M. et al. (2010). Sexuality education policies and sexually transmitted disease rates in the USA. International Journal of STD and AIDS. 21; 293-297.

10. In Sexuality Education Works with: ▫Programs designed for long term behavior change ▫Overall effective ▫Couples and individuals Does not work well without: ▫Integration with the other theories El-Bassel, N, et al. (2003). The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. 93(6), 963-969. DiClemente, R.J., et al. (2007). A review of STD/HIV prevention interventions for adolescents: sustaining effects using an ecological approach. Journal of Pediatric Psychology. 32(3), 888-906.

12. In Sexuality Education Works with: ▫Working 1:1 with teens ▫Troubleshooting risky behaviors ▫Interventions that take place in the HW center Does not work well with: ▫Comprehensive sexuality education programs that are not action oriented/cognitive learning-based programs ▫Groups Source: Resource Center for Adolescent Pregnancy Prevention. http://www.etr.org/recapp/index.cfm?fuseaction=pages.TopicsInBriefDetail&PageID=51

14. In Sexuality Education Works with: ▫Prevention-based programs (prevent sexual involvement or increase condom use) ▫Particularly good for pregnancy prevention, STI prevention and HIV prevention  Influenced by knowledge/skills/attitudes/relationships/environment, few positive role models for teens, behavioral skills practice Does not work well with: ▫Comprehensive sexuality education programs that are not action oriented/cognitive learning-based programs Source: Resource Center for Adolescent Pregnancy Prevention. http://www.etr.org/recapp/index.cfm?fuseaction=pages.TopicsInBriefDetail&PageID=51

17. Cool Things That Came Up Age-specific interventions A lot of partnerships Myths: “One male student told me that if he put his finger in his partner’s vagina then touched his finger behind his ear and it did not burn, then she didn’t have an STI.” Strategic placement of condoms Role play situations Peer education/groups Cultural/gender-specific interventions Know the policy to advocate for change

19. Social Assessment What health issues affect students’ quality of life? Involving the student in planning Key informant interviews Focus groups Observation Surveys

20. Epidemiological Assessment Documents which health problems are most important Data collection Data analysis Do you want to focus on a specific group? How about a specific disease?

21. Behavioral and Environmental Assessment “The Behavioral and Environmental Assessment identifies factors, both internal and external to the individual, that affect the health problem.”

22. Questions to Ask Behavioral factors ▫What are the behaviors linked to this issue? ▫Which of these behaviors are most important? ▫Which of these behaviors are most changeable? Environmental factors ▫What parts of the environment (social and built) hinder healthy choices? ▫Which of these factors are most important? ▫Which of these factors are most changeable?

23. Finding Information Interviews, survey, focus group Literature ▫PubMed (http://www.ncbi.nlm.nih.gov/pubmed)http://www.ncbi.nlm.nih.gov/pubmed ▫Google scholar (http://scholar.google.com)http://scholar.google.com ▫Hint: American Academy of Pediatrics: Condom Use by Adolescents: http://aappolicy.aappublications.org/cgi/content/ full/pediatrics;107/6/1463 (check out the PubMed and Google Scholar links on the side too) http://aappolicy.aappublications.org/cgi/content/ full/pediatrics;107/6/1463

24. Organize Your Thoughts More important/more changeable (focus on these) Less important/more changeable (only if you need to demonstrate for political purposes) More important/less changeable (do these second/good for innovation) Less important/less changeable (don’t worry about these)

25. Example More important/more changeable -Access to healthy food -Access to recreation -Portion sizes Less important/more changeable -Calorie counts are not posted in the cafeteria More important/less changeable -Preference for unhealthy foods -Unhealthy eating part of students’ culture -Genetic predisposition to gaining weight Less important/less changeable -Delivery restaurants don’t offer calorie counts -Students go home on weekends and do not eat in the cafeteria

26. Social Cognitive Theory

27. Closing Homework #2 due by COB on Friday Questions?