American journal of preventive medicine
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To describe and identify factors associated with tobacco sales in a metropolitan county. ⋯ In a county that has adopted many of the required youth access laws, opportunities still exist to reduce sales of tobacco products to minors. Asking for age and photo identification still appears to be an effective strategy in reducing sales of tobacco products to minors.
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Universal, school-based programs, intended to prevent violent behavior, have been used at all grade levels from pre-kindergarten through high school. These programs may be targeted to schools in a high-risk area-defined by low socioeconomic status or high crime rate-and to selected grades as well. ⋯ Program effects were consistent at all grade levels. An independent, recently updated meta-analysis of school-based programs confirms and supplements the Community Guide findings.
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Meta Analysis
School-based interventions for aggressive and disruptive behavior: update of a meta-analysis.
Research about the effectiveness of school-based psychosocial prevention programs for reducing aggressive and disruptive behavior was synthesized using meta-analysis. This work updated previous work by the authors and further investigated which program and student characteristics were associated with the most positive outcomes. ⋯ Schools seeking prevention programs may choose from a range of effective programs with some confidence that whatever they pick will be effective. Without the researcher involvement that characterizes the great majority of programs in this meta-analysis, schools might be well-advised to give priority to those that will be easiest to implement well in their settings.
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Randomized Controlled Trial Clinical Trial
Low-literacy interventions to promote discussion of prostate cancer: a randomized controlled trial.
Professional organizations recommend that physicians discuss prostate cancer with patients to make individual screening decisions. However, few studies have tested strategies to encourage such discussions, particularly among high-risk populations. We examined the effects of two low-literacy interventions on the frequency of prostate cancer discussion and screening. ⋯ Two simple low-literacy interventions significantly increased discussion of prostate cancer and PSA test orders but not performance of DRE. Both interventions were effective in empowering low-literacy patients to initiate conversations about prostate cancer with their physician.
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Review
Limitations of the randomized controlled trial in evaluating population-based health interventions.
Population- and systems-based interventions need evaluation, but the randomized controlled trial (RCT) research design has significant limitations when applied to their complexity. After some years of being largely dismissed in the ranking of evidence in medicine, alternatives to the RCT have been debated recently in public health and related population and social service fields to identify the trade-offs in their use when randomization is impractical or unethical. This review summarizes recent debates and considers the pragmatic and economic issues associated with evaluating whole-population interventions while maintaining scientific validity and credibility.