A large-scale intervention, designed to increase healthier fast-food consumption, was evaluated at a national fast-food chain. Participants included fast-food consumers at three separate restaurant locations in southwestern Virginia. Each restaurant received three phases, consisting of fourteen days each. Two of the restaurants were exposed to two conditions, A (Baseline) and B (Intervention), while the other restaurant served as a control. Restaurant 1 received the following phases, with each phase lasting two weeks: A--B--A. Restaurant 2 received A--A--B, and Restaurant 3 received A--A--A. Research assistants distributed discount coupons on a new healthy sandwich to consumers during Condition B in Restaurants 2 & 3. This sandwich was available in a healthy combo including salad and water, and a regular combo including soda and fries. At all 3 locations, research assistants collected receipts showing all total menu item sales every day during the six-week intervention. Analyses of variance revealed consumers purchased the healthy sandwich significantly more during the incentive conditions, and also purchased the regular combo more frequently than the healthier combo during the intervention condition. Implications for the social validity of using incentives to motivate nutrition-related behaviors are discussed. / Master of Science

Introduction: According to the CDC (2008), tobacco-related deaths out number deaths from alcohol use, motor vehicle injuries, suicides, murders, human immunodeficiency virus (HIV), and illegal drug use. One out of every five deaths in the United States can be attributed to tobacco, culminating in a staggering 443,000 deaths in the US every year. Smoking is also the leading preventable cause of death in America (CDC, 2008). In 2006, the Surgeon General’s Report speaks to not only the detrimental effects of smoking, but also the harmful effects second hand smoke can have on an individual’s health. Furthermore, the Centers for Disease Control’s Office of Smoking and Health reported that 49,400 deaths every year in the US are the result of second hand smoke exposure, of which 46,000 will have died from heart disease attributable to second hand smoke in the environment in which they live, work, play, and learn (CDC, 2008). While the negative health outcomes with tobacco use have inundated mainstream media and literature, tobacco use has another large and devastating effect on communities around the world. That effect is the result of Tobacco Product Litter (TPL). Beyond the unsightliness of TPL, several other unwanted complications to society result from the disregarded refuse, such as harm to the environment and damages incurred by other businesses not associated at all with tobacco products. Rationale for Intervention: First and foremost the Tobacco-Free GSU Initiative was intended to promote the health of the Georgia State University community consisting of students, faculty, and staff. The American College Health Association (2009) recommends 100% tobacco-free campuses, indoors and outdoors. Studies have shown that non-smokers and smokers attending college are in favor of campus policies that control the use of tobacco on campus (Rigotti, Regan, Moran, et al., 2003; Thompson B, Coronado GD, Chen L, et al., 2006). Sawdey et al. (2011) cites the need for the implementation of smoke-free policies by campuses in order to utilize the opportunity to create an atmosphere conducive to tobacco cessation. Considering that one third of young Americans attend a college or university (Rigotti et al., 2003), exposing one third of the youth population of the United States to a tobacco-free environment could potentially change the socially acceptable norms of using tobacco, whist simultaneously creating an environment free of TPL. Intervention Strategy Analysis: Tobacco-Free GSU utilized a methodology similar to the strategies Glassman, Reindel and Whewell outlined in their 2011 study Strategies for Implementing a Tobacco-Free Campus. The Glassman et al. (2011) strategy included: Creating a Committee, Utilizing a Student Debate, Publicity, Drafting of a Potential Policy, Targeting the College or University Board of Trustees, Addressing Barriers to Becoming Tobacco-Free, Student Involvement, Administrative and Staff Support, Resources, and Enforcement Conclusion: In order to facilitate the best possible outcome, we recommend those seeking to create a tobacco-free campus utilize the strategies outlined throughout this document, whilst creating strategies specific to their location, population, and situation.

Attempts by behavior scientists to test interventions designed to promote environmentally-responsible behavior (ERB) have been documented for decades. Numerous behavioral scientists have looked to community-based interventions to decrease environment-destructive behaviors, as well as to increase environmental-protective behaviors (Geller, 1995). Litter is one of the most obvious examples of environmental degradation. Litter, defined here as misplaced waste material (Geller, Winett, & Everett, 1982), is a form of environmental pollution that not only degrades the quality of the environment but also proves costly to taxpayers. A wide variety of ecological and monetary benefits result from a decrease in litter. The current research examined the effectiveness of positive vs. negative antecedent messages to reduce littering behavior. A methodology similar to that used by Geller, Witmer, and Orebaugh (1976), in which handbills containing weekly supermarket specials and special anti-litter message prompts were distributed at local community shopping centers, was used in the current research. In the first study, handbills with no anti-litter messages were distributed for a one-week period to determine percentage of handbills that were littered, and to serve as a baseline. The total percentage of handbills littered was 38.5. A second, web-based, study was conducted to determine the six specific (three positive or gain-framed, and three negative or loss-framed) anti-litter antecedent messages to be added to the handbills. In the third study, handbills with anti-litter messages were distributed for a two-week period. Upon addition of anti-litter prompts, results revealed 36.09% of distributed handbills were littered. Although no significant interactions were found, several significant main effects were found for store location, distribution period, and gender. The gender effect, indicating women littered at significantly higher rates than males, is notable. Survey research in the area of gender differences related to environmental concerns often has often shown modest differences between men and women, with women frequently displaying greater levels of environmental concern as compared to men. Based on behavioral observations (instead of self-report measures frequently used in previous research), the present research demonstrated significantly more women littering than men. Although slightly more handbills, in terms of total handbill numbers, containing positive antecedents were littered as compared to those containing negative antecedents (which might be interpreted as stronger impact of loss-framed messages), this difference was not statistically significant. Similarly, there were no statistically significant differences found among each of the six anti-litter messages. Comparisons of Study 1 (baseline) and Study 2 (prompting intervention) revealed significantly more littered handbills in the baseline condition as compared to the anti-litter message condition. These results indicate a beneficial anti-litter effect of the prompts added to handbills. Conclusions based on the findings of the three studies within the present research are discussed. Implications for policies, public campaigns, and follow-up research designs are noted. Suggestions for future research involving message prompts and ERBs are offered. / Ph. D.

Background: Non communicable diseases (NCD) are recognized as a major burden of human health globally, especially in low and middle-income countries including Indonesia. This thesis addresses a community intervention program utilizing a community empowerment approach to study whether this is a reasonable strategy to control NCD. Objective: To explore possible opportunities, common pitfalls, and barriers in the process of developing a pilot community intervention program to prevent NCD in an urban area of a middle-income country. Methods: The study was conducted in Yogyakarta Municipality. The baseline risk factor survey in 2004 (n=3205) describes the pattern of NCD risk factors (smoking, physical inactivity and low fruit and vegetable intake) and demographic characteristics using STEPwise instrument. A qualitative study was conducted in order to illustrate peoples’ perceptions about NCD risk factors and how NCD might be prevented. A pilot intervention was developed based on the baseline survey and the qualitative data. The pilot intervention was conducted in four intervention communities while one community served as the referent area. The intervention was evaluated using quantitative and qualitative approaches. Finally, a second cross-sectional survey conducted in 2009 (n= 2467) to measure NCD risk factor changes during the five year period. Results: Baseline qualitative data showed that people in the high SES (Socio Economic Status) group preferred individual activities, whereas people in the low SES group preferred collective activities. Baseline survey data showed that the prevalence of all NCD risk factors were high. The community intervention was designed to promote passive smoking protection, promote healthy diet and physical activity, improve people’s knowledge of NCD, and provide a supporting environment. A mutual understanding between the Proriva team and community leadership was bargained. Several interactive group discussions were performed to increase NCD awareness. A working team was assigned to set goals and develop programs, and the programs were delivered to the community. There were more frequent activities and higher participation rates in the low SES group than in high SES group. The repeated cross-sectional surveys showed that the percentage of men predicted to be at high risk of getting an NCD event had significantly increased in 2009 compared to 2004. Conclusion: The community empowerment model was a feasible choice as a “moderate”strategy to accommodate with people’s need when implementing a community intervention that also interacts with the service provided by the existing health system. A community empowerment approach may improve program acceptance among the people.

<p>Härtill 6 uppsatser</p> / digitalisering@umu

AbstractJuvenile delinquency is a problematic social phenomenon that could lead to major future social problems. These social problems are very likely to affect the juveniles as well as the society overall. Because of this, it is extremely important, but also interesting, to investigate and highlight this particular problem. An effort made to counteract this problem is a community intervention team (Sociala insatsgrupper), which through collaboration with various authorities aim to help juveniles from a criminal life. The purpose of the study was to investigate how community intervention teams in the city of Malmö work with juveniles who are living a criminal lifestyle. We also intended to investigate how the information that emerged about the effort harmonized with selected theory and previous research. In order to achieve this, we chose to conduct a document analysis based on selected documents, all of which explain and describe the work with community intervention teams. The results from the study shows that the work done by the community intervention teams, are highly well functioning, due to the collaborations between different authorities. Further on, the result shows that the information from the chosen documents do harmonize with theory and previous research, about juvenile delinquency.

This dissertation contributes to research on social isolation in older adults aged 65 years and above through three essays that expand our understanding of the social determinants of health and identify the social and interpersonal factors that contribute to elderly wellbeing. This dissertation examines the significant factors contributing to the problem of social isolation, and how the availability of interest-based, low-cost engagement resources in the community can alleviate social isolation and foster healthy aging. Essay 1 is a systematic literature review with implications for future research that explores how technological skills and training based on user intention and availability of resources can alleviate social isolation. Essay 2 is a qualitative study that evaluates the effectiveness of a unique community-based senior exercise program in fostering social integration and in reducing social isolation. Essay 3 is a quantitative study that examines the magnitude and direction of the correlated relationships among the determinants of social inclusion and the impact of social and interpersonal processes on senior wellbeing. These three essays provide insight into the social isolation phenomenon that negatively impacts senior wellbeing and recommends solutions derived from a data driven examination of the problem that is especially applicable to economically disadvantaged senior communities. Moreover, this research provides community partners and gatekeepers a foundation for future research on the social isolation phenomenon and strategies for developing digital confidence and mobility program strategies that foster social inclusion and reduce social isolation for older adults.

The "Actively Caring for KIDS Process," a multi-component program that taught retail store sales associates to act as behavior-change agents for child passenger safety, was implemented at a nationwide-chain discount store and evaluated with an interrupted time series design and a similar control site for comparison. Key components of the KIDS Process included a) training of sales associates to act as behavior-change agents at the point-of-purchase, b) the use of in-store awareness and supportive materials such as posters and sales associate buttons, and c) incentives for participation in checkpoints. Safety-seat checks (n = 31) were held in store parking lots, where caregivers' safety-seat installations (n = 241) were recorded as safe or at-risk for a variety of criteria and then the seats were reinstalled correctly. Research assistants posing as child caregivers visited the retail stores (n = 156) with the purported objective of obtaining information about selecting and installing a safety seat. Information given by sales associates was systematically recorded as safe or at-risk on a checklist. A 2 (Store) x 2 (Phase) ANOVA on sales associates' percent safe information scores revealed a significant interaction and no main effects. The Control store did not differ across the two phases, but scores at the intervention store were significantly higher after the intervention than during pre-intervention and when compared to the Control store during post-intervention. The training of sales associates resulted in an average 65% increase in percent safe scores. At the parking lot checks, 93 percent of seats checked were misused in one or more ways, with an average of four errors per seat. ANOVA and Chi-square analyses indicated that the intervention failed to have an impact on child safety-seat misuse observed or on the number of participants attending the checkpoints. This is likely a result of few parents attending the checkpoints who had talked to our trained associates. To target more parents, this intervention might be better placed at well-baby checkups. / Ph. D.

Föreliggande uppsats undersöker hur deltagande i en social insatsgrupp (SIG) kan bistå upphörandeprocessen. Uppsatsens empiri bestod av elva semistrukturerade intervjuer som har utförts med totalt sex individer vilka har deltagit i en social insatsgrupp (SIG) och som uppgav att de har upphört begå brott. Intervjuerna bearbetades med en tematisk analys där resultatet analyserades utifrån Giordanos et al.s (2002) teori om kognitiva transformationer. Resultatet visade att SIG kan ses som en ”hook for change” (dvs. en krok för förändring). SIG-deltagarna behövde emellertid vara mottagliga för att förändras för att kunna dra nytta av insatsen och de behövde aktivt använda sitt aktörskap för att framgångsrikt upphöra med brott. Den del av insatsen som förefaller ha haft störst betydelse för upphörandet är relationen till samordnaren. Andra viktiga delar i insatsen som underlättat upphörandet av brott är materiellt och ekonomiskt stöd. / The aim of this paper was to investigate how participants in a community intervention team (SIG) perceived support from the intervention and how it helped them desist from crime. Data was collected through semi-structured interviews with six participants in SIG who claimed to have desisted. The data was analysed with a qualitative thematic analysis and linked to Giordano's et al.s (2002) theory of cognitive transformations. The results showed that the participant need to have an openness to change in order to desist with help from SIG. We also concluded that the participants needed to use agency in order to desist with support from SIG. The most important part of the intervention for assisting desistance was the relationship to the social worker employed in SIG. Structural support also played an important role in SIG assisting desistance, particularly housing opportunities.

There is still a debate concerning the evidence base for community interventions. The randomised clinical trial design (RCT) is increasingly challenged as a gold standard for their evaluation. This thesis takes the Norsjö health programme in Västerbotten as the starting point for a discussion about the ethical platform of community interventions and for exploring the role of self-rated health. The specific objectives are: 1) to better understand barriers to community participation and to assess the role of ethical premises among decision-makers, 2) to explore how health related norms and attitudes interact with self-rated health and the risk factor outcome of an intervention and 3) to analyse the gender and socio-cultural interplay of self-rated health with biomedical risk factors for cardiovascular disease. The participation and views of different actors in the planning and implementation phases of the intervention were studied by contrasting information between official documents, interviews with decision makers and professionals and questionnaires to community members. The role of basic values in setting priorities and choosing intervention strategies utilised a questionnaire design with hypothetical scenarios sent to a representative sample of Swedish health care politicians. Qualitative research interviews were used to explore health related norms and attitudes. Health examination measurements and questionnaire data formed the basis for analysis of the development of self-rated health and risk factor load during a 10-year follow-up of the intervention. Access to a stroke registry enabled a case-referent approach for studying the interaction between bio-medical risk factors, socio-demographic factors and self-rated health. Data from the Västerbotten Intervention Programme (VIP) could be utilised for a cross-country comparison with a “sister project” in Otsego, U.S.A. The results point to both strengths and limitations of the efforts made to involve people in the intervention. The problem definition mainly remained with the professionals and participation as a goal in itself, strengthening local democracy was felt to be an exaggerated ambition. However, there was an overall agreement about the seriousness of the health problem, the need to intervene and about the implementation mode. Self-rated health and reported behavioural change were important indicators of participation and young men with bad health seemed to have been least involved. Among Swedish health care politicians there was an overall agreement to allocate resources for prevention directed towards communities when there are serious health problems. The majority preferred an intervention strategy that involved primary health care. The risk of harm by creating some degree of anxiety or stigma was for many considered an acceptable drawback of a successful intervention. The follow-up study revealed a positive risk factor reduction accompanied by a positive development of self-rated health, especially for men. Additional support for an intervention effect was given through a comparison with a reference area. The interaction pattern between risk reduction and self-rated health was more polarised for men than for women, with a corresponding pattern for the lower compared to the higher educated. These results could be linked to a transition in the health related norm system and to “ideal types” representing attitudinal sets towards the intervention. The case-referent analysis suggested an interaction effect between self-rated health and bio-medical risk factor load in predicting stroke that was greater for men than for women. The cross-country comparison revealed a stronger influence of education in the U.S.A. The lower educated, with a high risk load, had a greater risk of self-rated poor health than their Swedish counterparts. The thesis suggests that self-rated health is an unexplored indicator, potentially important for understanding the complexity of community interventions. Self-rated health may predict disease development as well as modify the impact of established risk factors.