HEALTH BEHAVIOR AND HEALTH EDUCATION: Theory, Research, and Practice pdf

PART ONE: HEALTH EDUCATION AND HEALTH BEHAVIOR: THE FOUNDATIONS 1ONE: THE SCOPE OF HEALTH BEHAVIOR The Editors Progress in Health Promotion and Health Behavior Research 16 TWO: THEORY, R

HEALTH BEHAVIOR

AND

HEALTH EDUCATION Theory, Research,

and Practice

4 TH E DITION

KAREN GLANZ BARBARA K RIMER

K VISWANATH

Editors

Foreword by C Tracy Orleans

HEALTH BEHAVIOR

AND

HEALTH EDUCATION

HEALTH BEHAVIOR

AND

HEALTH EDUCATION Theory, Research,

and Practice

4 TH E DITION

KAREN GLANZ BARBARA K RIMER

K VISWANATH

Editors

Foreword by C Tracy Orleans

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Library of Congress Cataloging-in-Publication Data

Health behavior and health education : theory, research, and practice / Karen Glanz, Barbara K Rimer, and K Viswanath, editors — 4th ed.

FOURTH EDITION

HB Printing 10 9 8 7 6 5 4 3 2 1

PART ONE: HEALTH EDUCATION AND HEALTH BEHAVIOR: THE FOUNDATIONS 1

ONE: THE SCOPE OF HEALTH BEHAVIOR

The Editors

Progress in Health Promotion and Health Behavior Research 16

TWO: THEORY, RESEARCH, AND PRACTICE

IN HEALTH BEHAVIOR AND HEALTH EDUCATION 23

Fitting a Theory or Theories to Research and Practice 35

PART TWO: MODELS OF INDIVIDUAL HEALTH BEHAVIOR 41

Barbara K Rimer

Victoria L Champion and Celette Sugg Skinner

Applications of the HBM to Mammography

BEHAVIOR, AND THE INTEGRATED BEHAVIORAL MODEL 67

Daniel E Montaño and Danuta Kasprzyk

Theory of Reasoned Action and Theory of Planned Behavior 70

Application of IBM to HIV Prevention in Zimbabwe 82

James O Prochaska, Colleen A Redding, and Kerry E Evers

SIX: THE PRECAUTION ADOPTION PROCESS MODEL 123

Neil D Weinstein, Peter M Sandman, and Susan J Blalock

How Stage Theories Address Explaining and Changing Behavior 124

Using the PAPM to Develop and Evaluate Behavior Change Interventions 131

An Example Using Matched and Mismatched Treatments 134

Criteria for Applying Stage-Based Interventions 143

THEORIES THAT FOCUS ON INDIVIDUALS 149

Noel T Brewer and Barbara K Rimer

Commonalities and Differences Across the Theories 157

PART THREE: MODELS OF INTERPERSONAL

BEHAVIORS INTERACT: SOCIAL COGNITIVE THEORY 169

Alfred L McAlister, Cheryl L Perry, and Guy S Parcel

NINE: SOCIAL NETWORKS AND SOCIAL SUPPORT 189

Catherine A Heaney and Barbara A Israel

Relationship of Social Networks and Social Support to Health 193Empirical Evidence on the Influence of Social Relationships 195

Social Network and Social Support Interventions 199Health Education and Health Behavior Applications 203

TEN:STRESS, COPING, AND HEALTH BEHAVIOR 211

Karen Glanz and Marc D Schwartz

Applications to Specific Health Behavior Research Areas 226

OUTCOMES: LESSONS FROM THEORY AND RESEARCH ON

Pathways Between Clinician-Patient Communication

Key Functions of Clinician-Patient Communication 245Moderators of Communication-Outcome Relationships 255Clinician-Patient Communication: Application in

Directions for Future Research

TWELVE: PERSPECTIVES ON MODELS OF

K Viswanath

Some Defining Characteristics of Interpersonal Interaction 272Theories and Models at the Interpersonal Level 273

PART FOUR: COMMUNITY AND GROUP MODELS

Karen Glanz

ORGANIZATION AND COMMUNITY BUILDING 287

Meredith Minkler, Nina Wallerstein, and Nance Wilson

Concepts in Community Organization and Community-Building Practice 293

Application of Community Organization and Community Building 300Community Organizing and Community Building with Youth:

The Challenge of Community Organization Approaches 308

Brian Oldenburg and Karen Glanz

Development of the Field and Related Research Traditions 314

The Role of Settings and Organizations in Diffusion

The Practice of Dissemination and Diffusion of Health

Applications 323Limitations of the Model and Challenges for the Future 328

PROMOTION: THEORIES OF ORGANIZATIONAL CHANGE 335

Frances Dunn Butterfoss, Michelle C Kegler, and Vincent T Francisco

Introduction to Theories of Organizational Change 336

Applications of Organizational Theory to Health Promotion 350Future Research to Inform Organizational Change Theories 355

BEHAVIOR CHANGE: THE MEDIA STUDIES FRAMEWORK 363

John R Finnegan Jr and K Viswanath

Major Models and Hypotheses at the Individual Level 367

Michelle C Kegler and Karen Glanz

New Concepts and Strategies for Macro-Level Change 390

Approaches to Defining Needs, Problems, and Aims 395The Influence of Technology on Macro-Level Theory and Practice 396

PART FIVE: USING THEORY IN RESEARCH AND PRACTICE 405

TO APPLY HEALTH BEHAVIOR THEORIES 407

Andrea Carson Gielen, Eileen M McDonald, Tiffany L Gary, and Lee R Bone

J Douglas Storey, Gary B Saffitz, and Jose G Rimón

The Role of Social Marketing Within a Strategic

The Role of Theory and Research in Social Marketing 448International and Domestic (U.S.) Social Marketing Experiences 452

James F Sallis, Neville Owen, and Edwin B Fisher

Background, History, and Principles of Ecological Models 466Application of Ecological Models to Health Behavior 470Critical Examination of Ecological Models of Health Behavior 479

Types of Validity 492Intervention Contexts and Intermediate Outcomes 493

Evaluation Methods and Analytical Strategies for

Karen Glanz and Barbara K Rimer

C Tracy Orleans, Ph.D.

Health behavior change is our greatest hope for reducing the burden of preventabledisease and death around the world Tobacco use, sedentary lifestyle, unhealthy diet,and alcohol use together account for almost one million deaths each year in the UnitedStates alone Smoking prevalence in the United States has dropped by half since the

first Surgeon General’s Report on Smoking and Health was published in 1964, but

to-bacco use still causes over 400,000 premature deaths each year The World Health ganization has warned that the worldwide spread of the tobacco epidemic could claimone billion lives by the end of this century The rising prevalence of childhood obe-sity could place the United States at risk of raising the first generation of children tolive sicker and die younger than their parents, and the spreading epidemic of obesityamong children and adults threatens staggering global health and economic tolls.The four leading behavioral risks factors and a great many others (for example,nonadherence to prescribed medical screening and prevention and disease manage-ment practices, risky sexual practices, drug use, family and gun violence, worksiteand motor vehicle injuries) take disproportionate tolls in low-income and disadvan-taged racial and ethnic populations, as well as in low-resource communities acrossthe world Addressing these behavioral risks and disparities, and the behaviors re-lated to global health threats, such as flu pandemics, water shortages, increasinglyharmful sun exposure, and the need to protect the health of the planet itself, will becritical to world health in the twenty-first century

Or-In the past two decades since the publication of the first edition of Health cation and Health Behavior: Theory, Research, and Practice in 1990, there has been

Edu-extraordinary growth in our knowledge about interventions needed to change healthbehaviors at both individual and population levels This progress can be measured inthe proliferation of science-based recommendations issued by authoritative evidencereview panels, including the U.S Clinical Preventive Services Task Force, the Cen-ters for Disease Prevention and Control Task Force on Community Preventive Ser-vices, and the international Cochrane Collaboration Today, there are evidence-based

clinical practice guidelines for most major behavioral health risks, including

to-bacco use, unhealthy diet, sedentary lifestyle, risky drinking, and diabetes ment And there are parallel research-based guidelines for the health care system

manage-changes and policies needed to assure their delivery and use New community tice guidelines offer additional evidence-based recommendations for a wide array of

prac-population-level school-, worksite-, and community-based programs and public cies to improve vaccination rates and physical activity levels for children and adults,improve diabetes self-management, reduce harmful sun exposure, reduce secondhand

poli-smoke exposure, prevent youth tobacco use and help adult poli-smokers quit, reduce place and motor vehicle injuries, and curb drunk driving and family and gun violence.Another success of the past two decades of theory-based research can be seen inthe evolution of theories and models themselves—a move away from a major focusonly on individual behavior change and toward broader multi-level behavior and so-cial change models By the late 1980s, the limited reach and staying power of evenour most effective individual health behavior interventions, based on theories empha-sizing intrapersonal and interpersonal determinants of health behaviors, made it clearthat an exclusive reliance on individually oriented interventions would be inadequate

work-to achieve our pressing population health and health care goals These failures led

to a fundamental “paradigm shift” in our understanding of what the targets of tive interventions needed to be, not just individuals but the broader contexts in whichthey live and work This shift fueled the rise of ecological models of health promo-tion that have guided the development of powerful interventions in public health andhealth care arenas

effec-Related shifts in the models and strategies of public health and clinical healthpromotion opened the way for even broader population models that link health plansand community public health organizations, communities, clinicians, and public healthpractitioners Examples are the Chronic Care Model promulgated by the Institute ofMedicine and the similar framework promoted by the World Health Organization.And these frameworks energized efforts to refine and apply models and theories totranslate effective clinical and public health interventions into practice and policy,including the diffusion of innovations model, community and organizational changetheories, and social marketing and communications theories

Tremendous parallel gains in what we have learned about the paradigms, processes,methods, and limitations of public health promotion and health care quality improve-ment over the past two decades illustrate the fundamental premise of this and previ-

ous editions of Health Behavior and Health Education—that a dynamic exchange

between theory, research, and practice is critical to effective health education and

promotion Just as previous editions of Health Behavior and Health Education have

provided essential stewardship for many of the advances described here, this fourthedition will help us navigate the new frontiers and challenges that lie ahead

As this volume makes clear, using theory to craft and evaluate health behaviorchange interventions results in more powerful interventions and more robust theo-ries Like the previous editions, it presents in one place authoritative and highly read-able summaries and critiques of the major theories and models of health education atmultiple levels (individual, interpersonal, organizational, community, public policy)and in a wide variety of settings and populations Thorough analyses of their strengthsand weaknesses and helpful summaries of how their major constructs have been meas-ured and operationalized—illustrated with clear practical applications and case stud-ies—are features of the book designed to be helpful for researchers, practitioners,and program planners at all levels of experience, from those new to the field to itsmost seasoned leaders The rigor and accessibility of these reviews reflect the extraor-dinary knowledge and vision of the editors and authors, who include many of the most

respected and accomplished leaders in the field of health education and health ior; together, they bring exceptional skill and experience in planning, implement-ing, and evaluating theory-based interventions for a diverse range of problems, settings,and populations.

behav-In addition to describing important developments in theory and practice since theprevious edition, this volume gives special attention to cultural and health dispari-ties, global applications, and advances in health communications and e-health It alsoprepares us for the urgent need to identify, extract, and replicate the critical “active”ingredients of effective interventions through theory-driven reviews and syntheses ofpast trials and studies, as well as formative early assessments of promising innova-tions and rigorous theory-based studies of “natural experiments.” Theory is the es-sential “divining rod” in new efforts to learn rapidly about “what works” by evaluatinggrassroots efforts in schools and communities across the country and the world to im-plement programs, policies, and environmental changes to curb the rise in childhoodobesity For example, logic models that reflect lay conceptions of how programs canwork are helping the Robert Wood Johnson Foundation to identify early on the moreand less promising strategies being tried for obesity prevention The strategies thatalign best with theory are often the most promising This type of practical applica-tion of theory makes clear that, in the broadest sense, health education and health be-havior encompass the processes of policy development, which are so critical tounderstanding and overcoming policy resistance to dissemination of the growing num-ber of evidence-based interventions

In short, readers will find that the fourth edition of Health Education and Health Behavior retains and builds on all of the features that have established it as the pre-

eminent text and indispensable reference for our field—the first book we reach for tohelp us think about the foundations on which to design an intervention or researchplan, inform a systematic evidence review, write or review an article or grant appli-cation, plan a course or presentation, and consult with other practitioners or researchersboth within and outside our own disciplines

As the editors state in Chapter Two, “the gift of theory” is that it provides the sential conceptual underpinnings for well-crafted research, effective practice, andhealthy public policy The gift of this volume is that it provides essential guidancefor our efforts to realize the full potential of theory, as we build on our remarkablepast progress in navigating the new frontiers and challenges that lie ahead

Distinguished Fellow and Senior ScientistRobert Wood Johnson Foundation

Princeton, New Jersey

In memory of my brother, David Glanz, who contributed so much and so well to his family, in his scholarship and

to the lives of older adults.

—K G.

To my husband, Bernard Glassman, my parents, Joan and Irving, and my sisters, Liz and Sara, with gratitude for their unflagging support.

—B.K.R.

To my parents, whose life of hard work and sacrifice allowed their children to succeed in their endeavors.

—K V.

Table 2.2 Trends in the Most Commonly Used Health Behavior

Table 3.1 Key Concepts and Definitions of the Health Belief Model 48Table 3.2 Cronbach’s Alpha of Champion’s HBM Scales

Table 3.3 Learning Objectives Used to Change Mammography

Perceptions and Practices Among Urban Minority Women 55Table 4.1 TRA, TPB, and IBM Constructs and Definitions 74

Table 4.3 Strength of Association of Behavioral, Normative,

and Efficacy Beliefs with Intention to Use Condoms

Table 5.2 Processes of Change That Mediate Progression

Table 6.1 Examples of Factors Likely to Determine Progress

Table 6.2 Precaution Adoption Process Model: Stage Classification

Table 6.3 Progressed One or More Stage Toward Purchasing

Table 9.1 Characteristics and Functions of Social Networks 191Table 9.2 Typology of Social Network Interventions 200Table 10.1 Transactional Model of Stress and Coping 214Table 11.1 Representative Models of Patient-Centered

TABLES AND FIGURES

Table 11.2 Representative Measures and Coding Systems of

Patient-Centered Communication Functions 246Table 13.1 Key Concepts in Community Organization and

Table 13.2 Examples of YES! Group Social Action Projects 306

Table 14.2 Characteristics of Innovations That Affect Diffusion 319

Table 15.2 Summary of Organizational Change Concepts 342Table 15.3 Constructs of the Community Coalition Action Theory 349Table 16.1 Selected Communication Theories and Levels of Analysis 368Table 16.2 Knowledge Gap Concepts, Definitions, Applications 372Table 16.3 Agenda-Setting Concepts, Definitions, Applications 376Table 18.1 PRECEDE-PROCEED Model as an Organizing

Framework for Application of Theory and Principles 413Table 18.2 Main Results of Project Sugar 1 Interventions 428Table 19.1 Comparisons Between Social Marketing, Commercial

Table 19.2 Applications of Major Theories and Research

Table 20.1 Historical and Contemporary Ecological Models 468Table 21.1 Model of Phases of Research (Greenwald and Cullen, 1985) 491Table 21.2 RE-AIM Dimensions and Questions in Evaluating

Health Education and Health Behavior Programs 496Table 21.3 Common Challenges Encountered in Evaluating

FIGURES

Figure 3.1 Key Concepts and Definitions of the Health Belief Model 49Figure 4.1 Theory of Reasoned Action and Theory of Planned Behavior 70

Figure 5.1 Point Prevalence Abstinence Rates Over Time

for Smokers Recruited by Reactive Versus Proactive Strategies and Treated with TTM-Tailored

Figure 6.1 Stages of the Precaution Adoption Process Model 127Figure 6.2 Two Examples of the Stages of the Precaution

Adoption Process Model: Home Radon Testing and

Figure 8.1 AIDS Community Demonstration Projects: Exposure

and Behavior Change in Carrying Condoms 182Figure 9.1 Conceptual Model for the Relationship of Social

Figure 10.1 Transactional Model of Stress and Coping 216Figure 11.1 Direct and Indirect Pathways from Communication

Figure 15.1 Community Coalition Action Theory (CCAT) 348

Figure 18.2 Application of PRECEDE-PROCEED to Injury Prevention 419Figure 18.3 Safe Home Case Study Design and Results 423Figure 18.4 Application of PRECEDE-PROCEED to Diabetes Care

Figure 19.2 Communication for Healthy Living (Egypt) 455Figure 19.3 Red Ribbon Question Mark Campaign (Baltimore, Md.) 460Figure 20.1 Ecological Model of Four Domains of Active Living 472Figure 20.2 Illustrative Model of Relationships among Organizational

Factors and Supports for Diabetes Self-Management 477

Figure 21.2 Hypothetical Worksite Intervention Participation

The Editors

Programs to influence health behavior, including health promotion and education grams and interventions, are most likely to benefit participants and communities whenthe program or intervention is guided by a theory of health behavior Theories ofhealth behavior identify the targets for change and the methods for accomplishingthese changes Theories also inform the evaluation of change efforts by helping toidentify the outcomes to be measured, as well as the timing and methods of study to

pro-be used Such theory-driven health promotion and education efforts stand in contrast

to programs based primarily on precedent, tradition, intuition, or general principles.Theory-driven health behavior change interventions and programs require an un-derstanding of the components of health behavior theory, as well as the operational

or practical forms of the theory The first edition of Health Behavior and Health Education: Theory, Research, and Practice, published in 1990, was the first text to

provide an in-depth analysis of a variety of theories of health behavior relevant tohealth education in a single volume It brought together dominant health behaviortheories, research based on those theories, and examples of health education practicederived from theory that had been tested through evaluation and research The sec-

ond (1996) and third (2002) editions of Health Behavior and Health Education

up-dated and improved on the earlier volume People around the world are using thisbook, and it has been translated into multiple languages, including recent Japaneseand Korean editions

It has been over five years since the release of the third edition; the fourth

edi-tion of Health Behavior and Health Educaedi-tion once again updates and improves on

the preceding edition Its main purpose is the same: to advance the science andpractice of health behavior and health education through the informed application oftheories of health behavior Likewise, this book serves as the definitive text for stu-dents, practitioners, and scientists in these areas and education in three ways: by (1)analyzing the key components of theories of health behavior that are relevant to healtheducation, (2) evaluating current applications of these theories in selected health pro-motion programs and interventions, and (3) identifying important future directionsfor research and practice in health promotion and health education

The fourth edition responds to new developments in health behavior theory andthe application of theory in new settings, to new populations, and in new ways Thisedition includes (1) an enhanced focus on the application of theories in diverse pop-ulations and settings, (2) an expanded section on using theory, including its transla-tion for program planning, and (3) chapters on additional theories of health behavior

More global applications from both developing and developed countries are included.

As new communication and information technologies have opened up an dented range of strategies for health behavior change, this edition integrates coverage

unprece-of e-health into health communications examples throughout the book Issues unprece-of ture and health disparities are also integrated into many chapters, rather than covered

cul-as a separate chapter These issues are of broad and growing importance across manytheories and models

AUDIENCE

Health Behavior and Health Education speaks to graduate students, practitioners,

and scientists who spend part or all of their time in the broad arenas of health ior change, health promotion, and health education; the text will help them both un-derstand the theories and apply them in practical settings Practitioners, as well asstudents, will find this text a major reference for the development and evaluation oftheory-driven health promotion and education programs and interventions Researchersshould emerge with a recognition of areas in which empirical support is deficient andtheory testing is required, thus helping to set the research agenda for health behav-ior and health education

behav-This book is intended to assist all professionals who value the need to influencehealth behavior positively Their fields include health promotion and education, med-icine, nursing, health psychology, behavioral medicine, health communications, nu-trition and dietetics, dentistry, pharmacy, social work, exercise science, clinicalpsychology, and occupational and physical therapy

OVERVIEW OF THE BOOK

The authors of this text bring to their chapters an understanding of both theory andits application in a variety of settings that characterize the diverse practice of publichealth education—for example, worksites, hospitals, ambulatory care settings, schools,and communities The chapters, written expressly for the fourth edition of this book,address theories and models of health behavior at the level of the individual, dyad,group, organization, and community

This book is organized into five parts Part One defines key terms and concepts.The next three parts reflect important units of health behavior and education prac-tice: the individual, the interpersonal or group level, and the community or aggregatelevel Each of these parts has several chapters, and ends with a perspectives chapterthat synthesizes the preceding chapters

Part Two focuses on theories of individual health behavior, and its chapters focus

on variables within individuals that influence their health behavior and response to

health promotion and education interventions Four bodies of theory are reviewed inseparate chapters: the Health Belief Model, the Transtheoretical Model, the Theory

of Reasoned Action/Theory of Planned Behavior/Integrated Behavioral Model, andthe Precaution Adoption Process Model

Part Three examines interpersonal theories, which emphasize elements in the terpersonal environment that affect individuals’ health behavior Three chapters focus

in-on Social Cognitive Theory: social support and social networks, clinical-patient andinterpersonal communication, and stress and coping

Part Four covers models for the community or aggregate level of change and

in-cludes chapters on community organization, diffusion of innovations, organizationalchange, and media communications

Part Five explores “Using Theory,” which presents the key components and plications of overarching planning and process models, and a discussion of the ap-plication of theory in culturally unique and other unique populations It includeschapters on the PRECEDE-PROCEED Model of health promotion planning, socialmarketing, ecological models, and evaluation of theory-based interventions

ap-The major emphasis of Health Behavior and Health Education is on the

analy-sis and application of health behavior theories to health promotion and educationpractice Each core chapter in Parts Two, Three, and Four begins with a discussion

of the background of the theory or model and a presentation of the theory, reviewsempirical support for it, and concludes with one or two applications Synthesis chap-ters review related theories and summarize their potential application to the develop-ment of health education interventions Strengths, weaknesses, areas for futuredevelopment and research, and promising strategies are highlighted

Chapter authors are established researchers and practitioners who draw on theirexperience in state-of-the-art research to critically analyze and apply the theories tohealth education This text makes otherwise lofty theories accessible and practical,and advances health education in the process

No single book can be truly comprehensive and still be concise and readable cisions about which theories to include were made with both an appreciation of theevolution of the study of health behavior and a vision of its future (see Chapter Two)

De-We purposely chose to emphasize theories and conceptual frameworks that pass a range from the individual to the societal level We acknowledge that there issubstantial variability in the extent to which various theories and models have beencodified, tested, and supported by empirical evidence Of necessity, some promisingemerging theories were not included

encom-The first three editions of Health Behavior and Health Education grew out of the

editors’ own experiences, frustrations, and needs, as well as their desire to size the diverse literatures and to draw clearly the linkages between theory, research,and practice in health behavior and education We have sought to show how theory,research, and practice interrelate and to make each accessible and practical In thisedition we have attempted to respond to changes in the science and practice of pub-lic health and health promotion, and to update the coverage of these areas in a rap-idly evolving field Substantial efforts have been taken to present findings from healthbehavior change interventions, based on the theories that are described, and to illus-trate the adaptations needed to successfully reach diverse and unique populations

synthe-Health Behavior and synthe-Health Education has now been established as a widely used

text and reference book We hope the fourth edition will continue to be relevant and

useful, and to stimulate readers’ interest in theory-based health behavior and healtheducation We aspire to provide readers with the information and skills to ask criti-cal questions, think conceptually, and stretch their thinking beyond using formulaicstrategies to improve health.

ACKNOWLEDGMENTS

We owe deep gratitude to all the authors whose work is represented in this book Theyworked diligently with us to produce an integrated volume, and we greatly appreci-ate their willingness to tailor their contributions to realize the vision of the book.Their collective depth of knowledge and experience across the broad range of theo-ries and topics far exceeds the expertise that the editors can claim

We pay special tribute to Dr Everett Rogers, a luminary in our broad field, whosework in the area of diffusion of innovations has taught and inspired us, and whosebody of work cuts across several chapters in this book Along with many colleagues,

we were saddened by Ev’s death in the fall of 2005 and know his work will continue

to be influential in using theory to improve research and practice

We also wish to acknowledge authors who contributed to the first three editions

of this text Although some of them did not write chapters for this edition, their tellectual contributions form an important foundation for the present volume We es-pecially appreciate the contributions of Frances Marcus Lewis, an editor for thefirst three editions And we welcome K “Vish” Viswanath, an internationally recog-nized health communication scholar, to the editorial team

in-The staff at Jossey-Bass Publishers provided valuable support to us for ment, production, and marketing from the time that the first edition was releasedthrough completion of this edition Our editors at Jossey-Bass—Andy Pasternack andSeth Schwartz—provided encouragement and assistance throughout Kate Harris pro-vided exceptional technical editing support for this edition

develop-The editors are indebted to their colleagues and students who, over the years,have taught them the importance of both health behavior theories and their cogentand precise representation They have challenged us to stretch, adapt, and continue

to learn through our years of work at the University of Michigan, University of NorthCarolina at Chapel Hill, Emory University, Harvard University, the University of Min-nesota, Ohio State University, The Johns Hopkins University, Temple University, FoxChase Cancer Center, Duke University, the University of Hawai’i, and the NationalCancer Institute (NCI) The updated review of theory use for this edition was com-pleted by doctoral students at Emory University—Julia Painter, Michelle Hynes,Christina Borba, and Darren Mays

We particularly want to acknowledge Kelly Blake and Jenny Lewis for their itorial and substantive contributions Completion of this manuscript would not havebeen possible without the dedicated assistance of Kristen Burgess, Johanna Hinman,Jenifer Brents, Kat Peters, Terri Whitehead, Mae Beale, Suzanne Bodeen, Dave Poten-ziani, Elizabeth Eichel, Lisa Lowery, Shoba Ramanadhan, and Josephine Crisistomo

ed-Karen Glanz would like to acknowledge partial funding support from the gia Cancer Coalition for technical editing and production of this volume.

Geor-We also wish to express our thanks to our colleagues, staffs, friends, and lies, whose patience, good humor, and encouragement sustained us through our work

THE EDITORS

Karen Glanz is a professor and a Georgia Cancer Coalition Distinguished Research

Scholar in the Rollins School of Public Health at Emory University, where she holdsappointments in the Departments of Behavioral Sciences and Health Education andEpidemiology She is also the founding director of the Emory Prevention ResearchCenter Prior to coming to Emory, Karen Glanz was professor and director of the So-cial and Behavioral Sciences Program at the Cancer Research Center of Hawai’i atthe University of Hawai’i from 1993 to 2004 From 1979 to 1993, she was a profes-sor in the Department of Health Education at Temple University in Philadelphia Shereceived her M.P.H (1977) and Ph.D (1979) degrees in health behavior and healtheducation from the University of Michigan

Glanz’s research and academic interests have been in the area of health ior change program development and evaluation, community nutrition environments,cancer prevention and control, ethnic differences in health behavior, and risk com-munication She is currently principal investigator on five federally funded researchgrants that test health behavior change interventions for skin cancer prevention, col-orectal cancer risk counseling, and chronic disease prevention; and on several grantsthat focus on translation and dissemination of effective interventions and measure-ment tools Glanz’s scholarly contributions consist of more than 270 journal articlesand book chapters, and she serves on the editorial boards of several journals She wasrecognized in 2006 as a Highly Cited Author by ISIHighlyCited.com, in the top 0.5percent of authors in her field over a twenty-year period

behav-Glanz has been recognized with several national awards and was the 2007 cipient of the Elizabeth Fries Health Education Award from the James and Sarah FriesFoundation She was honored by the Public Health Education and Health PromotionSection of the American Public Health Association (APHA) with the Early CareerAward (1984), the Mayhew Derryberry Award for outstanding contributions to the-ory and research in health education (1992; with Barbara Rimer and Frances Lewis),and the Mohan Singh Award for contributions to humor in health education (1996).Her recent health education programs in skin cancer and underage drinking preven-tion have received national awards for innovation and program excellence Glanzserves on numerous advisory boards and committees for scientific and health organ-izations in the United States and abroad, including the Task Force on Community Pre-ventive Services at the Centers for Disease Control and Prevention

re-䊏 re-䊏 re-䊏

Barbara K Rimer is dean and Alumni Distinguished Professor of Health

Behav-ior and Health Education in the School of Public Health at the University of NorthCarolina at Chapel Hill Rimer received an M.P.H (1973) from the University ofMichigan, with joint majors in health education and medical care organization, and

a Dr.P.H (1981) in health education from The Johns Hopkins School of Hygiene andPublic Health Previously, she served as deputy director for Population Sciences atUNC Lineberger Comprehensive Cancer Center at UNC-Chapel Hill (2003–2005),

as director of the Division of Cancer Control and Population Sciences at the NationalCancer Institute (part of the National Institutes of Health), from 1997–2002, as Pro-fessor of Community and Family Medicine at Duke University (1991–1997), and asdirector of behavioral research and a full member at the Fox Chase Cancer Center inPhiladelphia (1987–1991)

Rimer has conducted research in a number of areas, including informed decisionmaking, long-term maintenance of behavior changes (such as diet, cancer screen-ing, and tobacco use), interventions to increase adherence to cancer prevention andearly detection, dissemination of evidence-based interventions, and use of new tech-nologies for information, support, and behavior change

Rimer is the author of over 280 publications and serves on several journal rial boards She is the recipient of numerous awards and honors, including the Health-trac Foundation Award for Health Education (2004), the Secretary’s Award forDistinguished Service from the U.S Department of Health and Human Services (2000),the Director’s Award from the National Institutes of Health (2000), and the AmericanCancer Society Distinguished Service Award (2000) Rimer was the first woman andbehavioral scientist to lead the National Cancer Institute’s National Cancer AdvisoryBoard—a presidential appointment She currently is vice chair for the Task Force onCommunity Preventive Services at the Centers for Disease Control and Prevention

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K “Vish” Viswanath is an associate professor in the Department of Society, Human

Development and Health at the Harvard School of Public Health (HSPH) and ciate professor of population sciences at Harvard’s Dana-Farber Cancer Institute(DFCI) He is also the director of the Dana-Farber Harvard Cancer Center’s HealthCommunication Core and chair of the steering committee of the Health Communica-tion Concentration of HSPH Before coming to Harvard, Viswanath was the acting as-sociate director of the Behavioral Research Program, Division of Cancer Control andPopulation Sciences, at the National Cancer Institute He was also a senior scientist

asso-in the Health Communication and Informatics Research Branch He came to the tional Cancer Institute from Ohio State University where he was a tenured facultymember in the School of Journalism and Communication He also held an adjunct ap-pointment in the School of Public Health and was a Center Scholar with Ohio State’sCenter for Health Outcomes, Policy, and Evaluation Studies Viswanath received hisdoctoral degree in mass communication from the University of Minnesota (1990).Viswanath’s research interest is studying how macro-social factors influencehealth communication, particularly strategic communication campaigns His schol-arly work focuses on health communication and social change in both national andinternational contexts, with a particular focus on communication inequities and healthdisparities and sociology of health journalism He has been involved with plannedsocial change projects in India and the United States His current research examines

Na-the use of new communication technologies for health among urban poor, medicaland health reporters and the conditions of their work, and social capital and healthcommunications Viswanath has published more than sixty-three journal articles and

book chapters and coedited three books and monographs, including Mass Media, cial Control and Social Change with David Demers (Iowa State University Press, 1999) and The Role of the Media in Promoting and Discouraging Tobacco Use, a mono-

So-graph to be published by the National Cancer Institute He was also the editor of the

Social Behavioral Research section of the International Encyclopedia of cation, a ten-volume series to be published by the Blackwell Press.

Communi-An internationally recognized health communications expert, Viswanath holdsleadership roles in professional organizations He was chair of the Mass Communi-cation Division of the International Communication Association, head of the The-ory and Methodology Division of the Association for Education in Journalism andMass Communication, and secretary and president of the Midwest Association forPublic Opinion Research (MAPOR) He was recently elected a Fellow of MAPOR

Susan J Blalock is associate professor of Pharmaceutical Outcomes and Policy in

the School of Pharmacy at the University of North Carolina in Chapel Hill

Lee R Bone is associate professor at The Johns Hopkins University Bloomberg School

of Public Health

Noel T Brewer is assistant professor in the Department of Health Behavior and Health

Education at the University of North Carolina School of Public Health in Chapel Hill

Frances Dunn Butterfoss is professor and director of the Division of Behavioral

Re-search and Community Health in the Department of Pediatrics at Eastern VirginiaMedical School, Norfolk, Virginia

Victoria L Champion is the Mary Margaret Walther Distinguished Professor and

associate dean for research at the Indiana University School of Nursing

Ronald M Epstein is professor of Family Medicine, Psychiatry and Oncology and

director of the Rochester Center to Improve Communication in Health Care at theUniversity of Rochester School of Medicine and Dentistry

Kerry E Evers is director of health behavior change projects Pro-Change Behavior

Systems, Inc., in Rhode Island

John R Finnegan Jr is professor and dean of the School of Public Health at the

University of Minnesota

Edwin B Fisher is professor and chair of the Department of Health Behavior and

Health Education at the School of Public Health, University of North Carolina atChapel Hill

Vincent T Francisco is associate professor in the Department of Public Health

Ed-ucation at the University of North Carolina in Greensboro

Tiffany L Gary is assistant professor of epidemiology at The Johns Hopkins

Bloomberg School of Public Health in Baltimore

Andrea Carson Gielen is professor and director of the Center for Injury Research

and Policy at The Johns Hopkins Bloomberg School of Public Health in Baltimore

Russell E Glasgow is senior scientist at the Center for Health Dissemination &

Im-plementation at the Institute for Health Research, Kaiser Permanente, Colorado.THE CONTRIBUTORS

Catherine A Heaney is with the Stanford Prevention Research Center at Stanford

University

Barbara A Israel is professor in the Department of Health Behavior and Health

Ed-ucation in the School of Public Health at the University of Michigan

Danuta Kasprzyk is research leader at the Centers for Public Health Research and

Evaluation, Battelle Memorial Institute, in Seattle

Michelle C Kegler is associate professor in the Department of Behavioral Sciences

and Health Education in the Rollins School of Public Health at Emory University inAtlanta

Laura A Linnan is associate professor in the Department of Health Behavior

and Health Education at the University of North Carolina, Chapel Hill, School of lic Health

Pub-Alfred L McAlister is professor of behavioral sciences at the University of Texas

School of Public Health regional campus in Austin

Eileen M McDonald is associate scientist and MHS program codirector at The Johns

Hopkins Bloomberg School of Public Health in Baltimore

Meredith Minkler is professor of Health and Social Behavior in the School of

Pub-lic Health at the University of California, Berkeley

Daniel E Montaño is research leader at the Centers for Public Health Research

and Evaluation, Battelle Memorial Institute, in Seattle

Brian Oldenburg is professor and chair of International Public Health at Monash

University in Melbourne, Australia

Neville Owen is professor and director of the Cancer Prevention Research Centre at

the University of Queensland in Brisbane, Australia

Guy S Parcel is the John P McGovern Professor in Health Promotion in the School

of Public Health at the University of Texas Health Science Center, Houston

Cheryl L Perry is professor and regional dean at the University of Texas School of

Public Health regional campus in Austin

James O Prochaska is professor and director of the Cancer Prevention Research

Center at the University of Rhode Island

Colleen A Redding is a research professor in the Cancer Prevention Research

Cen-ter at the University of Rhode Island

Jose G Rimón is at the Center for Communication Programs at The Johns Hopkins

Bloomberg School of Public Health in Baltimore

Gary B Saffitz is deputy director of the Center for Communication Programs and

senior associate faculty at The Johns Hopkins University Bloomberg School of lic Health

Pub-James F Sallis is professor of psychology at San Diego State University and

direc-tor of the Active Living Research program in San Diego

Peter M Sandman is a risk communication consultant in Princeton, New Jersey Marc D Schwartz is associate professor of oncology at the Lombardi Cancer Cen-

ter at Georgetown University in Washington, D.C

Celette Sugg Skinner is professor and chief of the Division of Behavioral and

Com-munication Sciences at UT Southwestern Medical Center in Dallas

J Douglas Storey is associate director of the Center for Communication Programs

at the Johns Hopkins Bloomberg School of Public Health in Baltimore

Richard L Street Jr is professor and head of the Department of Communication

at Texas A&M University and Baylor College of Medicine

Nina Wallerstein is professor in the Masters in Public Health Program at the

Uni-versity of New Mexico in Albuquerque

Neil D Weinstein is research professor in the Department of Family and

Commu-nity Medicine at the University of Arizona College of Medicine in Tucson

Nance Wilson is a principal investigator with the Public Health Institute in Oakland,

California

HEALTH BEHAVIOR

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HEALTH EDUCATION

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HEALTH EDUCATION

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HEALTH BEHAVIOR The Foundations