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SPECIAL SERIES: ADOLESCENT HEALTH

Introduction Health Promotion Interventions in Adolescents :

Different Populations, Different Approaches

T. David Elkin, The University of Oklahoma Health Sciences Center

p REVENTIVW medicine techniques have become an at- tractive avenue for instilling long-term healthy behav-

iors. Interventions that focus on heal th-promotion and better lifestyle choices can benefit individuals through- out the lifespan. Many of the diseases that are currently the costliest to treat can be linked to behavioral choices and patterns. Thus, early interventions aimed at creating heal th-promoting cognitions and behaviors may be med- ically, psychologically, and economically beneficial. One populat ion that seems to be particularly suited for early intervention is adolescents and youths. Since this is an age when many adult patterns of healthy behaviors are established, researchers have focused on health promo- tion in this age group. While many different theories ex- ist for the implementat ion of health promot ion interven- tions in adolescents and youths, the questions of when, where, and to whom to apply these interventions still re- main. Many of these interventions tend to be applied in a general manner to all adolescents and may not be as ef- fective as more specific techniques targeted at certain groups, including minorities and chronically ill patients.

The three different projects included in this featured section currently are using cognitive-behavioral interven- tions aimed at promoting healthy behaviors in adolescents and based on different conceptual models (i.e., the Trans- theoretical Model, social skills training, and the Health Belief Model). As each project is involved with unique groups of adolescents in different settings, unique and specified interventions are presented for each of these pop_ ulations. These three articles begin to address some of the questions that arise when well-researched psychological theories and interventions are applied to discreet popula- tions. All of these articles discuss tobacco use specifically, al- though each does so with a view of promoting different overall healthy behaviors in these different populations.

Recently, McFadden and Evans (1998) argued that be- havior therapists should consider the implications of en- v i ronment in general and social networks and policy con- straints in particular in achieving behavior health-care

Cognitive and Behavioral Practice 6, 127 -128 , 1999 1077-7229/99/127-12851.00/0 Copyright © 1999 by Association for Advancement of Behavior Therapy. All rights of reproduction in any form reserved.

change. They suggested that behavior therapists should focus both on "specific aspects o f direct interventions" (p. 71) and on identifying "social and environmental fac- tors" (p. 72). Redding et al. (1999) address these con- cerns in their article by using expert systems and the Transtheoretical Model in an at tempt to modify health risk behaviors among urban adolescents. By using these methods, they are able both to increase their impact among the targeted population, and to increase public health impact in general. A noteworthy feature of this ar- ticle is that the authors adjusted their methodology in or- der to have a greater impact on the study population, without compromising the theoretical underpinnings that give support to their approach.

The belief that ethnic differences impact health-care beliefs and behaviors has been a relatively recent devel- opment. Sadly, it has long been assumed that what works for a sample of Euro-Americans probably works for sam- ples of different ethnicity. Robinson, Klesges, and Levy (1999) examine this unders tanding of health behaviors by describing the effects of a smoking prevention pro- gram that has been adapted for an ethnically diverse pop- ulation. A notable aspect o f this article is its impressive scope: seventh graders in 12 public schools were used as the study sample. The authors, who have been involved in the field of smoking cessation for some time, found that ethnicity does play a role in the initiation and main- tenance of healthy behaviors, and conclude that inter- ventions aimed at reducing unheal thy behaviors would do well to consider this. Again, the implications for pub- lic policy are intriguing.

Finally, research has shown that pediatric cancer pa- tients remain at high risk for a variety o f medical late ef- fects (Green, 1993; Mulhern, Fairclough, & Ochs, 1991). The choices they make regarding maladaptive health be- haviors may be magnified given their t reatment history. Tyc, Hudson, Hinds, and Srivastava (1999) seek to edu- cate pediatric cancer patients about these risks and ulti- mately change their unheal thy choices by utilizing as- pects from the Health Belief Model, specifically perceived vulnerability. By focusing on an aspect that is of great importance to pediatric cancer patients, the au- thors have been able to change unheal thy behaviors by changing an intermediary var iable--percept ions o f vul-

128 Tyc et al.

nerability. Again , the benef i t s o f f ine - tun ing theore t i ca l

p ro toco l s a p p e a r to be impressive.

T h e use o f a p p r o p r i a t e i n t e rven t ions for specific pop-

u la t ions is o f vital i m p o r t a n c e in e n h a n c i n g hea l thy be-

haviors. All o f these articles have ta i lo red the i r in te rven-

t ions to m e e t the d i sc ree t needs o f d i f f e ren t ado l e scen t

popula t ions . They assume a n e e d to stress self-control and

self- ini t iated change . But these art icles also address the

o t h e r side o f behav io ra l a n d cogni t ive-behaviora l hea l t h

in tervent ions : the role o f e n v i r o n m e n t a l and social forces.

As behav io ra l a n d cogni t ive-behaviora l researchers , we

s h o u l d c o n t i n u e to emphas i ze se l f -change and self-

beliefs; bu t these n e e d to be u n d e r s t o o d in the c o n t e x t o f

the e n v i r o n m e n t w h e r e individuals exist. Obviously; these

social a n d e n v i r o n m e n t a l con tex t s vary t remendous ly ,

a n d as such the in t e rven t ions d e s i g n e d to ta rge t individu-

als in these p o p u l a t i o n s shou ld vary. This does n o t m e a n

tha t t heo ry is d i scarded . O n the contrary, t heo ry cont in-

ues to gu ide in te rven t ions ; bu t e n v i r o n m e n t in f luences

h o w t h e o r y s h o u l d be de l ive red practically.

R e f e r e n c e s

Green, D. M. (1993). Effects of treatment for childhood cancer on vital organ systems. Cancer, 71, 3299-3306.

McFadden, A. S., & Evans, I. M. (1998). Behavioral health care: Have Winkler's admonitions regarding rights and duties been heeded? the Behavior Therapist, 21, 69-72.

Mulhern, R. K., Fairclough, D., & Ochs, J. (1991). A prospective com- parison of neuro-psychologic performance of children surviving leukemia who receive 18 Gy, 24 Gy, or no cranialirradiation.Jour- nat of Clinical Oncology, 9, 1348-1356.

Redding, C. A., Prochaska, J. o., Pallonen, U. E., Rossi, J. S., Velicer, W. E, Rossi, S. R., Greene, G. W. Meier, K. S., Evers, K. E., Plum- met, B. A., & Maddoek, J. E. (1999). Transtheoretical individual- ized multimedia expert systems targeting adolescents' health behaviors. Cognitive and Behavioral Practiee, 6, 144-153.

Robinson, L. A., Klesges, R. C., Levy, M. C., & Zbikowski, S. M. (1999). Preventing cigarette use in a hi-ethnic population: Results of the Memphis smoking prevention program. Cognitive and Behavioral Practice, 6, 136-143.

Tyc, V. L., Hudson, M. M., & Hinds, E (1999). Health promotion inter- ventions for adolescent cancer survivors. Cognitive and Behavioral Practice, 6, 128-136.

I wish to thank Andrew W. Meyers for his continual support and in- spiration, and Heather C. Huszfi for her patient editorial work and overall help.

Address correspondence to T. David Elkin, The University of Oklahoma Health Sciences Center, Department of Psychiatry" and Behavioral Sciences, EO. Box 26901, Oklahoma City, OK 73190-3048; e-mail: tdelkin@theshop.net

Received: June 11, 1998 Accepted: October 22, 1998

Health Promot ion Interventions for A d o l e s c e n t Cancer Survivors

V i d a L. Tyc, M e l i s s a M. H u d s o n , a n d P a m e l a H i n d s , S t . Jude Children's Research Hospi ta l

There is clearly a need to develop effective health promotion interventions for adolescent cancer survivors, given their increased sus- ceptibility to adverse health risks i f they practice unhealthy behaviors. Approach& typically used with healthy adolescents may not be highly effective with young eancer patients given their unique educational needs secondary to their cancer treatment experience. Inter- ventions that capitalize on the perceptions of increased health vulnerability, characteristic of cancer survivors, may serve to enhance the impact of more traditional health education approaches. This strategy can be conceptualized from a theoretical model that focuses on the relationship between perceptions of health risk and behavior The application of this approach as it relates to health promotion with adolescent cancer survivors will be illustrated with an intervention targeting tobacco-use prevention and cessation in this vul- nerable population.

NG-TERM survivors o f c h i l d h o o d c a n c e r are at in- c reased risk fo r late med i ca l a n d neoplas t ic compl i -

cat ions tha t dec rease the i r hea l th - re l a t ed quali ty o f life

a n d increase early mor ta l i ty (Hudson , Jones , Boyett , Sharp, & Pui, 1997). Substant ia l da ta are available that

Cognitive and Behavioral Practice 6, 128-136, 1999 1077-7229 / 99/128-13651.00/ 0 Copyright © 1999 by Association for Advancement of Behavior Therapy. All rights of reproduction in any form reserved.

d o c u m e n t the late s eque lae o f t r e a t m e n t for c h i l d h o o d cancer , bu t l i t t le is known a b o u t the efficacy o f in te rven-

t ions tha t mot iva te survivors to a d o p t heahh -p ro t ec t i ve

behaviors to r e d u c e h e a l t h compl ica t ions . As g rea t e r

n u m b e r s o f c h i l d h o o d c a n c e r survivors are n o w r e a c h i n g

a d u l t h o o d (Bleyer, 1990), i nc rea sed a t t en t ion has b e e n

focused on hea l th p r o m o t i o n , mod i f i ca t i on o f ma ladap-

tive hea l th behaviors that c o m p r o m i s e the i r h e a l t h status,

and efficacy o f t e c h n i q u e s to p r o m o t e risk r educ t ion .

O n e m i g h t assume that pa t ien ts who have b e e n t r ea ted