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This article summarizes critical evaluation needs, challenges, and lessons learned in translational research. Evaluation can play a key role in enhancing successful application of research-based programs and tools as well as informing program refinement and future research. Discussion centers on what is unique about evaluating programs and policies for implementation impact (or potential for dissemination). Central issues reviewed include the importance of context and local issues, robustness and external validity issues, multiple levels of evaluation, implementation fidelity versus customization, choosing evaluation designs to fit questions, and who participates and characteristics of success at each stage of program recruitment, delivery, and outcome. The use of mixed quantitative and qualitative methods is especially important, and the primary redirection that is needed is to focus on questions of decision makers and potential adoptees rather than the research colleagues.

Purpose. This study examines whether social support for behavior change at work is associated with changes in employee heart disease risk factors. Design. A prospective correlational design was used with data sets collected 12 months apart. Setting. Twenty-five small to medium worksites in Oregon. Subjects. Participants were 689 men and 421 women volunteers who participated in two health assessments at the worksite on company time. Measures. Demographic characteristics, gender, social support, smoking behavior, dietary fat intake, and total blood cholesterol. Results. Employees reporting strong social support at work for not smoking and for limiting dietary fat were less likely to smoke (r = -.11, odds ratio [OR] = .86) and to consume fat in their diets (r = −.10) at baseline. Employees who reported the most change in social support over a 12-month period were most likely to have stopped smoking (r = .15, OR = 1.31). Social support at baseline, however, was unrelated to change in smoking, dietary fat, or total blood cholesterol in a prospective design. Although women reported more social support at work than did men, no differential gender effects of social support were reported on heart disease risk status or change in risk status. Conclusion. Baseline social support at work did not predict future behavior change. The observed association between social support and lifestyle may be better explained as cognitive rationalization than by the impact of social support on behavior.

Purpose. Little is known about compliance with worksite nonsmoking policies. This study provides an examination of the relationship of policy compliance to characteristics of the organization and the manner in which the policy was implemented Design. Data came from two separate surveys of 1) representatives of worksites that reported having a nonsmoking policy and 2) employed residents from the same communities whose worksites had nonsmoking policies. Setting. This study was conducted as part of the Community Intervention Trial for Smoking Cessation (COMMIT), being conducted in 11 diverse intervention communities. Subjects. Data are presented from surveys of 710 worksites (response rate =90%) and 3,143 employed residents (response rate = 80%) of the same communities. Measures. Compliance with nonsmoking policies was measured by self-report in both surveys and is compared with worksite and respondent characteristics, type of policy, and methods of policy implementation. Results. Compliance with nonsmoking policies was high; 55% of worksites with a policy restricting smoking reported that employees always adhered to the policy. Compliance was highest in worksites with more restrictive policies and where labor-management relations were reported to be good. Compliance also was high where the policy was effectively communicated to workers, as through worksite distribution channels, the absence of cigarette vending machines, and the availability cessation assistance. Conclusions. These findings indicate that compliance with worksite nonsmoking policies is generally high, especially in the presence of more stringent policies.

Evidence-based program repositories (EBPR) report intervention characteristics and how to implement the intervention. These EBPR are a dissemination strategy to address questions such as, "I have cancer, what programs can I join?" or "What evidence-based programs for weight loss are a good fit for my community?" However, these EBPR fall short of realizing their potential and are not seen as particularly interactive, robust, or relevant to stakeholders who may benefit from their content. We propose 2 solutions for existing EBPR to enhance dissemination of evidence-based information. Addressing this critical dissemination need is one strategy for health promotion.

Purpose.This study tested the efficacy of a computer-assisted counseling intervention to reduce diet-related cancer risk.Design.Randomized controlled trial.Subjects.Healthy women HMO members (n = 616) aged 40 to 70.Intervention.Participants were randomly assigned to nutrition intervention or an attention-control intervention unrelated to diet. Intervention consisted of two 45-minute counseling sessions plus two 5- to 10-minute follow-up telephone contacts. Counseling sessions included a 20-minute, interactive, computer-based intervention using a touchscreen format. Intervention goals were reducing dietary fat and increasing consumption of fruit, vegetables, and whole grains.Measures.Twenty-four hour diet recalls and the Fat and Fiber Behavior Questionnaire (FFB).Results.Four-month follow-up data were collected from 94% of the intervention participants and 91% of the controls. Testing with a multivariate general linear models analysis showed improvements on all dietary outcome variables. Compared to the control, intervention participants reported significantly less fat consumption (2.35 percentage points less for percentage of energy from fat), significantly greater consumption of fruit and vegetables combined (1.04 servings per day), and a significant reduction in a behavioral measure of fat consumption (.24 point change in the FFB).Conclusions.These 4-month results are comparable to several other moderate-intensity studies showing that, in the appropriate circumstances, moderate-intensity dietary interventions can be efficacious. Study limitations include the short follow-up period and the use of self-reported outcome measures.

Background. Hospitalization can provide one of the most opportune times to prompt smoking cessation. This study determined the frequency of various smoking cessation related behaviors occurring during and following hospitalization and identified variables associated with these outcomes. Methods. A sample of 526 HMO members who smoked prior to hospitalization and were hospitalized for nonpregnancy related, nonterminal conditions were surveyed to assess the natural history of smoking cessation associated with hospitalization. Results. Three events were studied: not smoking while hospitalized (51 % of subjects), attempting to quit following hospitalization (37%), and smoking status one year after hospitalization (16% abstinent). Similar factors were associated with not smoking in the hospital and quit attempts: older persons and patients with circulatory/respiratory diagnoses were only half as likely to smoke in the hospital as other patients and twice as likely to try to quit. Different variables predicted smoking status at follow-up: heavier smokers were significantly more likely to stop (26% cessation) than light or moderate smokers (10 % and 11 % cessation, respectively). Discussion. The hospital may be an effective setting for smoking cessation programs, especially those aimed at heavy smokers. Research is needed to determine whether smokefree hospital policies alter smoking rates following hospitalization. (Am J Health Promot, 1991; 6(1): 24-29).

Purpose. To assess the efficacy of an intervention designed to increase appropriate use of breast self-examination (BSE). Methods. Two-armed randomized clinical trial of cancer-control interventions in women that compared a BSE intervention program to a dietary intervention, which served as the control group. The study was conducted at a large health maintenance organization in Portland, Oregon. Participants were 616 female members of the health maintenance organization who were aged 40 to 70 years. The intervention consisted of a 30- to 45-minute individual counseling session that featured BSE instruction, training and practice with silicone models, identification of barriers to BSE, and problem-solving. This intervention was followed by two brief follow-up telephone calls. The study outcome measure was self-reported BSE practice, which included duration, frequency, and specific elements of exam. Results. The study had a 90% response rate. At the 1-year follow-up, χ2 analyses showed that significantly more individuals in the BSE intervention (59%) reported adequate BSE performance compared with those in the control group (12.2%; p < .001). Conclusions. This brief intervention was successful in encouraging women to perform adequate BSEs. Although the role of the BSE in patient care remains controversial, these results show that even brief intervention programs can be effective at encouraging self-screening for cancer. This intervention could easily be modified to target other screening practices (e.g., skin or testicular cancer screening) that are associated with reduced cancer morbidity and mortality.

Background. There have been few reports of the process of implementing ongoing worksite health promotion programs. This article describes the implementation of a year-long smoking cessation program in nine worksites employing a total of approximately 700 smokers. Methods. Issues discussed include: forming a partnership with organizations, design of the multicomponent incentive intervention, program promotion, maintaining participation, and the need to modify program components over time. Results. The program produced high participation rates (29 % of smokers joined the program) and moderate cessation rates among participants (during the last half of the program, monthly cessation rates averaged 20%). There was marked variability across worksites on both participation and cessation, and qualitative features of organizations associated with outcome are discussed. Discussion. The importance of working with employee steering committees to tailor health promotion programs to fit the organization is discussed. The article concludes with recommendations for implementation of similar programs.

The combination of radon and smoking produces a synergistic risk of lung cancer. Lay understanding of this risk was examined from the perspectives of mental models theory, the psychometric approach to risk perception, and optimistic bias. As assessed by interview, participants (N= 50) had more extensive mental models for the risks of smoking than for the risks of radon or the combination of radon and smoking; 32% knew little or nothing about radon. Despite reading an informational brochure, their risk‐perception ratings of the three hazards showed no perception of the synergy between smoking and radon risk, although the combined hazard was rated as less familiar but more controllable than the average of the single hazards (p < .01). No evidence of optimistic bias for the health consequences of radon, or the combination of radon and smoking was observed. Participants appeared to be combining the single‐hazard risks subadditively to arrive at their combined‐hazard risk perceptions. Further research on the integration of perceived risks would be beneficial for designing optimal communications about synergistic risk.

Purpose: To examine if employee health literacy (HL) status moderated reach, retention, and weight outcomes in a worksite weight loss program. Design: The study was a two-group cluster randomized controlled weight loss trial. Setting: The study was conducted in 28 worksites. Subjects: Subjects comprised 1460 employees with a body mass index >25 kg/m2. Interventions: Two 12-month weight loss interventions targeted diet and physical activity behaviors: incentaHEALTH (INCENT; incentivized individually targeted Internet-based intervention) and Livin' My Weigh (LMW; less-intense quarterly newsletters). Measures: A validated three-item HL screening measure was self-completed at baseline. Weight was objectively assessed with the Health Spot scale at baseline and 12-month follow-up. Analysis: The impact of HL on program effectiveness was assessed through fixed-effect parametric models that controlled for individual (i.e., age, gender, race, ethnicity, income, education) and worksite random effects. Results: Enrolled employees had significantly higher HL status [13.54 (1.68)] as compared to unenrolled [13.04 (2.17)] ( p < .001). This finding was consistent in both interventions. Also, HL moderated weight loss effects ( beta = .66; SE = 027; p = .014) and losing >5% weight ( beta = −1.53; SE = .77; p < .047). For those with lower baseline HL, the INCENT intervention produced greater weight loss outcomes compared to LMW. The HL level of employees retained was not significantly different from those lost to follow-up. Conclusion: HL influences reach and moderates weight effects. These findings underscore the need to integrate recruitment strategies and further evaluate programmatic approaches that attend to the needs of low-HL audiences.