Lorraine O. Walker, EdD, RN, FAAN, Director Luci B. Johnson Centennial Professor of Nursing Assistant Dean for Graduate Programs, School of Nursing

"Pitfalls in Randomized Clinical Trials"

Randomized clinical trials are the gold-standard in biomedical research, but may have pitfalls when translated to clinical research with humans, such as health promotion/disease prevention. These pitfalls, updated in an article by Fogg and Goss (2000), include issues of differential drop out, unraveling of random assignment, problems in defining the control condition, inconsistent adherence to intervention protocols, and problems related to when and how to measure change in a meaningful way. Solutions offered to these pitfalls include: use of dose-response models, adding qualitative measures of change, and tailoring interventions to groups through user-centered design.

Fogg, L. & Gross, D. (2000). Threats to validity in randomized clinical trials. Research in Nursing & Health, 23, 79-87.

(Copy also available in the CHPR office).

"Unraveling Socioeconomic Influence on Mortality"

It is widely known that people of lower socioeconomic status face greater threats to their health. Based on a national study of socioeconomic status, risk behaviors, and mortality, Lantz et al. (1998) proposed three potential models by which socioeconomic status may adversely affect health and contribute to mortality. Besides risk behaviors, which accounted for only a "modest proportion" (p. 1707) of the adverse impact of socioeconomic factors, the authors identified the following three explanatory models:

differential exposures to health hazards at work or in the environment that are interwoven with socioeconomic status differences;
differences in access to preventive and related health services, including actual use of such services; and
psychosocial burdens, such as chronic stress, lack of social support, less perceived control, associated with lower socioeconomic resources.
For more information about this study, see:

Lantz, P. M., House, J. S., Lepkowski, J. M., Williams, D. R., Mero, R.P., & Chen, J (1998). Socioeconomic factors, health behaviors, and mortality. Journal of the American Medical Association, 279, 1703-1708.

(Copy also available in CHPR resource room).

"Tailoring" of Health Communications to Target Populations

"Tailoring" is a user-centered approach to developing health communications that move beyond "one-size-fits-all" approaches. The fall issue of the Annals of Behavior Medicine devotes several articles to bring readers up to date on the effectiveness of tailored health communications. See, in particular, informative review articles by Kreuter, Strecher, and Glassman (1999) and Rakowski (1999).

Kreuter, M. W., Strecher, V. J., & Glassman, B. (1999). One size does not fit all: The case for tailoring print materials. Annals of Behavioral Medicine, 21, 276-283.

Rakowski, W. (1999). The potential variances of tailoring in health behavior interventions. Annals of Behavioral Medicine, 21, 284-289.

(Copy available in the CHPR office)

"Third Millennium Visions of Theory to Improve the Nation's Health"

First challenging existing public health paradigms, such as "risk factorology," McKinlay and Marceau (2000) then point to new approaches for public health theory and methods in the new millennium. As a foundation for innovative directions, they propose critically reconceptualizing social philosophies and concepts of health among other things. For more about this vision, you may read it online:

McKinlay, J. B., & Marceau, L. D. (2000). To boldly go...American Journal of Public Health, 90, 25-33.

(Copy also available in CHPR resource room).

Funded by the National Institute of Nursing Research of the National Institutes of Health