Feature Articles

Teen Pregnancy Prevention Programs: Linking Research and Practice

Marilyn J. Johns
Youth Development, Nutrition, Family & Consumer Science Advisor
University of California Cooperative Extension
Half Moon Bay, California
Internet address: Mjjohns@ucdavis.edu

Fe Moncloa
Youth Development Advisor
University of California Cooperative Extension
San Jose, California
Fxmoncloa@ucdavis.edu

Elizabeth J. Gong
Program Representative
University of California Cooperative Extension
San Jose, California
Ejgong@ucdavis.edu

Introduction

The United States has the highest teen pregnancy rate of any industrialized country, and California continues to have one of the highest teen pregnancy rates in the nation. Although the overall rate of teen pregnancy has been declining since 1991, the rates have remained high for teens who are most vulnerable, such as younger unmarried teens. The national unmarried teen birth rate steadily decreased from 62 in 1991 to 54 births per 1,000 females in 1996--a 12% decline. The teen birth rate decreased among all races (Annie E. Casey Foundation, 1998).

Comparable to the rest of the nation, California's teen pregnancy rates have also decreased since 1991 by 16%. In 1996, the teen birth rate was 63 births per 1000 females. Although the teen (ages 15-19) birth rate in California has also decreased among all races since 1991, Hispanic teens showed the smallest decrease, from 122 in 1991 to 104 births per 1,000 females in 1996--a 15% decline. This is compared to a 23% decrease in African Americans and a 24% decrease in Non-Hispanic Whites (Annie E. Casey Foundation, 1998).

California's population of 13-19 year olds is expected to increase dramatically to 6 million (a 35% increase) by the year 2005. This is compared to an expected 13% increase in teens nationally. Unless the teen birth rate declines markedly, there will be a significant increase in the number of pregnant and parenting teens. By 2005, Hispanic youth will be the largest ethnic youth group (California Department of Health Services, 2000).

The persistent and complex problem of teen pregnancy prompted Cooperative Extension Human Resource (Family & Consumer Sciences and Youth Development) staff in three urban California counties, San Francisco, San Mateo, and Santa Clara, to jointly focus efforts on a research project in this area. These three urban San Francisco Bay Area counties have a combined population of nearly two million, with an increasing ethnic diversity that is presently 20% Hispanic, 25% Asian, 6% African American, and 49% Caucasian (1999, Association of Bay Area Governments Data Center).

What role might Cooperative Extension play in strengthening community-based programs working with pregnant and parenting teens? We synthesize "best practices" from the literature and from the field, and work with community practitioners to implement these practices as a model for improved teen pregnancy prevention.

Literature Review of "Best Practices"

Major reviews of best practices aimed at preventing adolescent pregnancy have generally focused on organized programs (Card et al., 1996; Franklin & Corcoran, 2000; Frost & Forrest, 1995; Kirby, 1997; Miller et al., 1992; Moore et al., 1995). The National Campaign to Prevent Teen Pregnancy recently released a comprehensive report reviewing research on the roles of parents and families in reducing teen pregnancy (Miller, 1998). This document indicates the important influence of parents/families in preventing teen pregnancy and highlights programs that are culturally sensitive.

Adolescent pregnancy is a complex problem. There is no single or simple approach that will reduce adolescent pregnancy among all groups of teenagers. Because the causes of teen pregnancy are complicated, the strategies should be multi-pronged (Kirby, 1997).

Over the past two decades, there has been dramatic growth in the number and variety of programs aimed at preventing adolescent pregnancy. These have included education programs, family planning/contraceptive services, school-based health centers, youth development programs, and multi-component programs. Unfortunately, recent comprehensive reviews of adolescent pregnancy prevention programs concluded that few programs have been well evaluated. Of those that have been evaluated, none have been significantly successful in reducing adolescent pregnancy. However, although there are studies that indicate that some programs can have some success at reducing one or more sexual behaviors for at least a brief period of time, few studies have measured long-term effects (Kirby, 1997, 1999; Moore et al., 1995).

There are several examples of creative programmatic approaches that have shown to be promising. The National Campaign to Prevent Teen Pregnancy (Kirby, 1997) examined nearly 200 research articles on more than 75 programs and recommended components that should be integrated into more comprehensive pregnancy prevention initiatives.

An Assessment of Current Practices

Assessments of schools and community agencies with teen pregnancy prevention programs in San Francisco, San Mateo, and Santa Clara (California) counties were conducted using surveys, interviews, and site visits.

Thirty-five surveys were sent to schools and agencies known to have pregnant and parenting teen programs, as well as to programs trying to prevent first pregnancies in teens. Every attempt was made to reach as many programs as possible through advisors, networks, coalitions, directories, and staff. Telephone calls and reminders (mail and fax) were made to programs with unreturned surveys. After second mailings, phone calls, and faxes, we received 18 completed surveys, or a 51% response rate. In addition, 25 programs were visited. Staff members were interviewed at these site visits to get more details of their programs and complete the surveys. As a result, 23 surveys were completed (a 66% response rate).

A wide variety of primary prevention efforts was found in clinics, schools, and community agencies. A school district from each county has received a 5-year grant from the California Department of Education for primary pregnancy prevention. In addition, 11 local community-based agencies, schools, and clinics have received California Department of Health Services Community Challenge Grants for primary prevention. All three counties have adolescent sibling pregnancy prevention programs, targeting the high-risk siblings of pregnant/parenting teens. In addition, a few male involvement programs have been included in teen pregnancy prevention efforts. School-based (or school-linked) health clinics also deliver pregnancy prevention services. The primary prevention programs represent a broad spectrum of services focused on the local, specific target population.

Secondary pregnancy prevention programs, providing services and care to pregnant and parenting teenagers, were also surveyed and visited. These included county health services/public health programs, such as Adolescent Family Life Programs (intervention and case management) and Cal-Learn (for Temporary Assistance for Needy Families recipients); school programs, such as Pregnant Minors Program and School Age Parent and Infant Development Program; and community agency programs (home visitation to teen parents).

We identified and applied the following criteria to distill "best practices" based on knowledge gained from the literature and field. It is not always easy or even possible to incorporate all criteria into every program, but these criteria can provide a starting point for assessing program strengths and weaknesses in program efforts.

1. Is the best practice research-based?
2. Does evaluation show positive impact?
3. Does the best practice meet the needs of multi-ethnic audiences? Is the best practice culturally relevant?
4. Does it meet the needs of various socio-economic populations?
5. Does the identified best practice have application in a variety of settings?
6. Is it sustainable? Does it stand the test of time?

Using local program information, as many of these criteria as possible, and additional reviews (Card et al., 1996; Franklin & Corcoran, 2000; Hutchins, 1999; Kirby, 1999; Miller, 1998; Moore et al., 1995; Sonenstein, 1997), we identified the following 10 best practices for practitioners in teen pregnancy prevention (Gong, et al., 1999):

• Youth Development
• Involvement of Family and Other Caring Adults
• Male Involvement
• Cultural Relevance
• Community-Wide Campaigns
• Service Learning Programs
• Programs to Improve Employment Opportunities
• Sexuality Education and AIDS Education Programs
• Outreach in Teen Pregnancy Prevention Programs
• Access to Reproductive Health Services

The Role of Cooperative Extension in Teen Pregnancy Prevention

Of these best practices, we identified three to emphasize in partnering with local agencies to strengthen their practices and produce better outcomes for teens: youth development, family involvement, and cultural relevance. We chose these three because of Cooperative Extension's historic experience and expertise in these areas. Many of the community agencies have youth development and family components. However, schools with pregnant and parenting programs usually have difficulty incorporating family involvement. Practitioners expressed a need for more culturally relevant practices.

Youth Development

Youth development programs focus on supporting and encouraging young people, on providing young people with skills that will help them succeed as adults, and on helping them form meaningful relationships with adults and older peers. Young people need opportunities to acquire a broad range of skills and to build connections within their community. There is a strong relationship between educational and career plans and protection from adolescent pregnancy. Improving girls' education and life options are correlated with reduced pregnancy and birth rates (Kirby, D., 1997).

Recently, there has been a rapid growth of interest in youth development in teen pregnancy prevention efforts. National organizations have recognized youth development as a promising approach to reducing adolescent pregnancy (National Campaign to Prevent Teen Pregnancy, 1998). In addition, some federal agencies are supporting youth development models in adolescent pregnancy prevention (Family and Youth Services Bureau/U.S. Department of health and Human Services, and Community Coalition Partnership/Centers for Disease Control and Prevention). In California, the Departments of Education and Health Services have large initiatives to develop and implement youth development programs to reduce teen pregnancy.

Critical elements of a youth development program include the following characteristics:

• being responsive to the needs and interests of youth and their community;
• staff are knowledgeable about adolescent development and are trained to work with youth;
• young people are regarded as resources in planning and program development; and
• the program collaborates with community organizations, government agencies, schools and families (Carnegie, 1996).

Service learning is one aspect of a youth development program that has a positive impact in reducing teen pregnancy. Service learning results when community service, the experiential learning process, and disciplined reflection are combined. Evaluations of a service learning program, from data collected across the nation, have provided some of the most consistent and strongest evidence that youth development has reduced teen pregnancy (Allen et al., 1997; Philliber and Allen, 1992). In addition to reduced pregnancy rates, service learning was effective in reducing problem behaviors, school suspensions, and school dropouts.

Cooperative Extension has a comparative advantage in youth development and has played a key role in developing programs such as academic enrichment, sports, job training, mentoring, community service, service learning, and leadership development. The role of Cooperative Extension is to continue promoting youth development programs and to document the positive impact these programs have on adolescents, specifically pregnant and parenting teens.

Involvement of Family and Other Caring Adults

While some of the programs surveyed involved families and other caring adults, most did not. Family dynamics are embedded in culture. Programs need a broad perspective, including strategies that develop family strengths and enhance parenting skills, and provide information about reproduction and contraceptive services (Moore et al., 1995).

Families play a critical role in affecting the risk of adolescent pregnancy. Family involvement should complement any program's best practices recommendations (Moore et al., 1995). The following factors have been noted to reduce the risk of adolescent pregnancy: parents with higher education and income; parental supervision; parents who hold strong opinions about the value of abstinence (or protected intercourse); teens who have supportive family relationships (connectedness) (Miller, 1998); and teens who participate in a large number of shared activities with parents (Resnick et al., 1997). The following factors can increase the risk for adolescent pregnancy: little supervision for teens; strict/overly controlling parents; low socioeconomic status; a single parent; older, sexually active siblings or pregnant/parenting teenage sisters (Miller, 1998); lack of religious affiliation (Kirby, 1997); and the experience of violence or abuse (Miller, 1998).

Family members, particularly parents if appropriate, need to be incorporated into teen pregnancy prevention programs in order to enhance the life opportunities of pregnant and parenting teenagers and their infants (Hanson, 1992). The complexities of multigenerational families need to be addressed (Chase-Lansdale et al., 1992). Although family involvement is labor-intensive, involving families and developing stronger family connectedness are recommended best practices in adolescent pregnancy prevention efforts.

An appropriate role for Cooperative Extension is to promote family involvement to practitioners working with pregnant and parenting teens, and to document the involvement efforts through formative and summative evaluation.

Cultural Relevance

Choosing culturally appropriate and locally relevant interventions will increase the effectiveness of efforts to reduce teen pregnancy. Understanding and sensitivity to the cultural and individual needs of the population are important in the design and implementation of any program.

According to the National Council of La Raza, Hispanic teens 15-19 years of age are twice as likely to become parents as Caucasian teens. Hispanic teenage mothers are considerably less likely to complete high school. A large percentage of Hispanic teen births are out-of-wedlock, contributing to the increase in single-parent families and the greater likelihood that these girls and their children will spend some or all of their lives in poverty (Perez and Duany, 1992). The Latino population is the fastest growing major racial/ethnic group in the United States; Latinas have the highest teen birth rate among major groups in the U.S. (National Campaign to Prevent Teen Pregnancy, May 1999).

The National Council of La Raza identified key characteristics of effective programs targeting Hispanic pregnant and parenting teens (Perez and Duany, 1992). These include recognizing and sensitively responding to cultural values regarding gender roles; for example, some Hispanic teen mothers might not immediately see the importance of becoming self-sufficient.

Adolescent pregnancy in the Hispanic community warrants attention; however, research on this group is limited. Programs targeting Hispanic sub-groups have been identified, but rigorous evaluations are lacking.

Cooperative Extension has extensive experience and knowledge in working with multicultural populations through both the Expanded Food and Nutrition Education Program and the 4-H Youth Development Program. In conducting the literature review, we found limited science-based information on culturally appropriate practices with Hispanics, African Americans, and Asian Americans. Our challenge is to conduct applied research in this multicultural context to identify culturally appropriate practices that work with pregnant and parenting teens.

Conclusion

This article focused on suggested "best practices" from the literature and from the field, and identified the role that Cooperative Extension can play to strengthen community-based programs to improve outcomes for teen parents and their children, with a focus on multi-ethnic teenagers living in urban communities. Multiple strategies for addressing the risk factors of adolescent sexual behaviors, pregnancy, and childbearing are recommended.

For our communities in San Francisco, San Mateo, and Santa Clara Counties, we focused on the "best practices" of including youth development, involvement of family and other caring adults, and culturally relevant practices to provide activities to encourage teens to think about the future and life opportunities. With the large percentage of Hispanic adolescent pregnancies, it is important to address the unique characteristics and needs of this group.

We are currently partnering with six local sites that conduct teen pregnancy prevention programs, to strengthen their capacity to deliver improved programs by incorporating the "best practices" identified in our literature and field research. We are working now to provide technical assistance in the adoption and implementation of "best practices" and in program evaluation. In this way, we renew our historic role as providers of science-based information in response to a contemporary need in our communities.

References

Allen, J. P., Philliber, S., Herrling, S., & Kuperminc, G. P. (1997). Preventing teen pregnancy and academic failure: Experimental evaluation of a developmentally based approach. Child Development, 64(4), 729-742.

Annie E. Casey Foundation. (1998). Kids count special report, when teens have sex: Issues and trends. Baltimore, MD.

Card, J. J., Niego, S., Mallari, A., & Farrell, W. S. (1996). The program archive on sexuality, health & adolescence: Promising prevention programs in a box. Family Planning Perspectives, 28, 210-220.

Carnegie Council on Adolescent Development. (1996). Great transitions: Preparing adolescents for a new century. New York: Carnegie Corporation.

Chase-Lansdale, P. L., Brooks-Gunn, J., & Paikoff, R. L. (1992). Research and programs for adolescent mothers: missing links and future promises. American Behavioral Scientist, 35(3), 290-312.

Franklin, C., & Corcoran, J. (2000). Preventing adolescent pregnancy: A review of programs and practices. Social Work, 45(1), 40-52.

Frost, J. J., & Forrest, J. D. (1995). Understanding the impact of effective teenage pregnancy prevention programs. Family Planning Perspectives, 27, 188-195.

Gong, E., Johns, M., Lee, F., Moncloa, F., Russell, S., & West, E. (1999). Best practices in teen pregnancy prevention: Practitioner handbook. University of California Cooperative Extension.

Hanson, S. L. (1992). Involving families in programs for pregnant teens: Consequences for teens and their families. Family Relations, 41, 303-311.

Hutchins, J. (1999). Promising approaches to preventing teen pregnancy. In T. Kreinin, S. Kuhn, A. B. Rodgers, & J. Hutchins (Eds.), Get organized: A guide to preventing teen pregnancy. Volume 1 (pp. 5-28). Washington D.C.: The National Campaign to Prevent Teen Pregnancy.

Kirby, D. (1997). No easy answers: Research findings on programs to reduce teen pregnancy. Washington, D.C.: The National Campaign to Prevent Teen Pregnancy.

Kirby, D. (1999). Reducing adolescent pregnancy: Approaches that work. Contemporary Pediatrics, 16(1), 83-94.

Miller, B. C. (1998). Families matter: A research synthesis of family influences on adolescent pregnancy. Washington, D.C.: The National Campaign to Prevent Teen Pregnancy.

Miller, B. C., Card, J. J., Paikoff, R. L., & Peterson, J. L. (Eds.). (1992). Preventing adolescent pregnancy: Model programs and evaluations. Newbury Park, CA: Sage Publications.

Moore, K. A., Sugland, B. W., Blumenthal, C., Glei, D., & Snyder, N. (1995). Adolescent pregnancy prevention programs: Interventions and evaluations. Washington, D.C.: Child Trends, Inc.

National Campaign to Prevent Teen Pregnancy. (1998). Start early, stay late: Linking youth development and teen pregnancy prevention. Washington, D.C.: Author.

National Campaign to Prevent Teen Pregnancy. (1999, May). Fact Sheet. Teen pregnancy and childbearing among Latinos in the United States. Washington, D.C.: Author.

Perez, S. M., & Duany, L. A. (1992). Reducing Hispanic teenage pregnancy and family poverty: A replication guide. Washington, D.C.: National Council of La Raza.

Philliber, S., & Allen, J.P. (1992). Life options and community service: Teen outreach program. In Miller, B. C., Card, J. J., Paikoff, R. L., & Peterson, J. L. (Eds.), Preventing adolescent pregnancy: Model programs and evaluations (pp. 139-155). Newbury Park, CA: Sage Publications.

Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., Tabor, J., Beuhring, T., Sieving, R. E., Shew, M., Ireland, M., Bearinger, L. H., & Udry, J. R. (1997). Protecting adolescents from harm: Findings from the national longitudinal study on adolescent health. Journal of the American Medical Association, 278(10), 823-832.

Sonenstein, F. L., Stewart, K., Lindberg, L. D., Pernas, M., & Williams, S. (1997). Involving males in preventing teen pregnancy. A guide for program planners. Washington, D.C.: The Urban Institute.

Health and Safety Behaviors: Reduced Risks Promote Health

Susan M. Smith
Assistant Professor
Department of Health and Safety Sciences
The University of Tennessee Knoxville
Internet address: smsmith@utk.edu

Martha Keel
Associate Professor
Agricultural Extension
The University of Tennessee Agricultural Extension Service

Michael Ballard
Assistant Professor
Department of Public Health
Western Kentucky University

Introduction

Extension employees, working at the local, regional, or state level, are involved in a profession with many rewards. These include working with people of all ages, having the respect of people in the community, helping solve real problems, serving as leaders, and being on the cutting edge of change. Some rewards are immediate, while others come after years of working to build a prosperous community. An often-heard comment about this profession is that no two days are ever the same.

On the other hand, a job with so many varying and interesting aspects can generate very high levels of stress. These stresses include working on long-term problems with limited short-term resources or working with people whose problems are so varied and complex that some of them go beyond the expertise, networking, or resources of the Extension office. Because success generates more demand for Extension services, the most productive staff may quickly create more demand than existing resources can meet. Extension's success may bring stress as well as rewards, as more requests for services requires a more complex process of setting priorities and stretching resources.

A successful and experienced Extension worker finds a constant demand on his/her time. Periods away from home can be extremely difficult, especially on young families (Bowen et al., 1994). Staying up-to-date in so many subject areas requires attendance at numerous training sessions, learning new information, acquiring additional skills, as well as exploring new technologies (Gibson et al., 1994). Because Extension is publicly funded, numerous reports are inevitable, which requires considerable time and energy.

While some amount of stress can be beneficial, when job stressors are combined with individual health risk behaviors, (e.g., smoking, diet, driving practices), the health status and quality of life of Extension personnel may be reduced. Although the particular southern state used for this study remains relatively stable, many states have experienced financial cutbacks that may create feelings of instability that result in additional stress, thereby hampering the ability of staff to help clientele (Smith et al., 1988). Increased pressure to acquire, participate in, and maintain outside (grant and gift) funding also adds stress, as do societal changes such as the increase in single parent families, working couples, and an aging population (Bowen et al., 1994).

Taking effective action to reduce present and future health problems requires that Extension staff members must first recognize job-related and personal risk factors. Second, they must minimize the effect of certain stressors through improvements in personal life-style. Risks can be minimized through changes in behavior. Such changes include proper exercise, improved diet, and reduction in alcohol and tobacco use to improve overall health. This, in turn, will increase the ability of the Extension staff member to deal with other stressors that cannot be eliminated.

Purpose

The primary purpose of this study was to identify the most frequent and serious self-reported health and safety risk behaviors of Extension personnel. A secondary purpose was the development of recommendations for future programs to reduce injury and improve health for Extension staff. Information generated from the study can serve as a guide to focus future programs to support Extension personnel in the area of risk reduction. A greater awareness of the most frequently self-reported risk behaviors can increase the success of future opportunities to reduce risk exposure and adopt healthier lifestyle choices.

Heightened awareness of safety and health risks may generate more opportunities for staff to develop strategies to reduce specific risks affecting their own personal health and safety. The long-term results of such reduced risk behaviors can include a healthier and safer workforce and increased job effectiveness and quality of life for Extension personnel and their families. The health status of Extension employees can improve when health promotion programs are provided. Extension as an organization also benefits when staff reduce health and safety risks.

Method

Information pertaining to health and safety risk behaviors was collected via a questionnaire completed by approximately 50% of the state Extension specialists and county agents in a large southern agricultural state. The questionnaire focused on individual health behaviors and perceptions. Participant responses were optically scanned for analysis. The health risk assessment was created and licensed by Eris Survey Systems of Scotts Valley California. Health and safety data were collected in the following categories: overall physical health status, exercise, alcohol use, tobacco use, seatbelt use, driving habits, dietary intake, personal losses experienced in the last year, and life satisfaction.

Questionnaires were included in the annual state Extension conference registration packet. Participation was voluntary. Respondents filled out a scan card questionnaire and returned the completed form to a designated location at the state conference. No names or identification numbers were required, and all data collected were confidential. Data were gathered and initially analyzed utilizing the ERIS software program, a computerized health risk assessment computer programs. The SPSS statistical program was used for more extensive analysis after responses were optically scanned into a group database.

Of the 400 Extension staff attending the conference, 203 voluntarily completed the 47-item instrument. Questionnaires were analyzed to identify specific risky behaviors affecting health and safety and to isolate key risk areas that might be incorporated in future safety and health risk reduction programs sponsored by either state, regional, or local organizations for Extension personnel.

Results

Approximately 50% of the conference attendees participated by returning completed questionnaires. A descriptive profile of the participants revealed that 29 (14.3%) were in the 20-29 age group, 45 (22.2%) were in the 30-39 age group, 77 (37.9%) were in the 40-49 age group, and 50 (24.6%) were more than 50 years of age. Two respondents, or 1%, did not report their age.

Safety and Health assessment responses revealed that 146 (71.9%) exercised fewer than three times per week, 122 (60.1%) ate food high in cholesterol, 97 (47.7%) drove more than 5 miles above the speed limit, 37 (18.2%) never or sometimes used a seatbelt, 10 (5.4%) had driven or ridden drunk as a passenger in the last month, 17 (8.4%) used smokeless tobacco, and 14 (6.9%) smoked cigarettes.

Data analysis revealed that 4.9% reported having diabetes, 19 (8.9%) reported taking high blood pressure medication, 7 (3.4%) had high blood pressure, 17 (8.4%) used smokeless tobacco, and 14 (6.9%) were current cigarette users (see Table 1).

Table 1.

Self-Reported Health and Safety Risk Behaviors.

When responding to a question concerning perceived overall physical health, 48 (23.6%) reported being in excellent health, 126 (62.1%) in good health, and 27 (13.3%) in fair or poor health. When a question was asked concerning whether a respondent had suffered losses or misfortunes, 50 (29.6%) reported 1 or more serious losses or misfortunes within the last 12 months. When asked about satisfaction with life, 49 (24.2%) reported being partly or not satisfied with life. One hundred fifty-one (74.4%) reported being mostly satisfied with life (see Table 2).

Table 2.

Self-Reported Perceived Health Status and Life Satisfaction

Through the application of the Chi square test and analysis, a significant difference at the .05 level was found between respondents in the age group 20-39 and the 40 and over age group in the following health and safety risk areas.

1) A significantly higher number of active smokers were among respondents over the age of 40. Of those between the ages of 20-39, 98.6% did not currently smoke, and 1 (1.4%) reported current smoking behavior. Of those in the age group of 40 or more years, 90.4% (113) reported not smoking at the present time, and 9.6% (12) reported current smoking.

2) A significantly higher number of respondents (57%) reported driving five or more miles over the speed limit. In those under 40 years of age. 42% reported this behavior. Of those reporting driving not more than 5 miles over the speed limit, 31 (41.9%) were in the age group 20-39, and 71 (56.8%) were in the age group of 40 or more.

Using a Chi Square test to statistically analyze aggregate data, a significant difference at the .05 level was also found for the following health and safety risk areas.

1) Of those participants eating foods high in cholesterol, 18.3% reported also having a fair or poor health status. Only 5.3% of individuals reporting not eating foods high in cholesterol or fat indicated fair or poor physical health status.

2) When responses of those reporting always or nearly always wearing seatbelts and those never/seldom or sometimes wearing seatbelt were compared, to those responding "yes" to foods high in fat or cholesterol, 30 (25%) reported never/seldom or sometimes wearing seatbelts. The remaining 75% of respondents eating foods high in fat reported nearly always or always wearing their seatbelt. Of those responding "no" to eating foods high in fat or cholesterol, only 5 (6.6%) reported never/seldom or sometimes wearing seatbelts, and 93.4% reported always or nearly always wearing seatbelts.

3) Seventy-seven percent of participants reporting eating foods high in fat also reported exercising fewer than 3 times per week. Of those respondents reporting consumption of food, 23% reported exercising at least 3 times a week. Of participants not eating foods high in fat or cholesterol, 48 (63.2%) reported exercising fewer than 3 times a week, and 28 (36.8%) exercised at least 3 times a week.

4) A significantly higher percentage (55%) of those over 40 years of age reported high fat intake, compared to 45% of those reporting high fat intake in the under-40-years-old group. Concerning dietary fat intake, 55 (45.1%) of respondents in the 20-39 age group reported high fat intake, compared to 67 (54.9%) in the 40 years of age and older group. There was a significant difference between the 20-39 and 40 and over group in the reporting of not eating high amounts of cholesterol. Seventeen (23%) were in the age group 20-39, and 75 (77.0%) were in the age group of 40 or more.

5) Responses concerning cholesterol and fiber consumption were analyzed. Of those responding "yes" to foods high in fat or cholesterol, 106 (87.6%) reported that they ate high fiber foods. The remaining 15 (12.4%) respondents reported eating foods low in fiber. When comparing those 72 (63%) responding "no" to eating foods high in fat or cholesterol, 96% reported eating food high in fiber, and 4.0% reported eating food low in fiber.

Implications for Extension

An analysis of the overall aggregate data provided by 203 Extension agents and specialists revealed that 122 (60%) respondents reported eating food high in cholesterol and fat. Sixty-nine (34%) reported exercising less than once a week, 77 (37.9%) reported exercising 1 to 2 times per week, and 57 (28.1%) reported exercising at least 3 times per week. These health risk behaviors reported by a majority of Extension respondents, specifically eating high cholesterol or fat and a lack of frequent exercise, can greatly increase the potential of experiencing future health problems such as cardiovascular disease, heart attack, or stroke.

This study supports strengthening efforts to improve the health status of Extension agents at the state, regional, and local levels. The strongest new programmatic emphases should be given to the most serious health risk factors identified. These include excessive levels of stress, elevated fat consumption, insufficient exercise, and excessive speed while driving. If left unchecked, these risk behaviors may have a significant impact on job effectiveness, performance, and quality of life.

Extension offices at the state and local levels must focus on reducing individual health risk factors to assist agents in reducing these risks through behavior change. Employees may at first be resistant or hesitant to make and sustain changes in lifestyle for a variety of reasons. These include time, costs, and comfort. Employee incentives can sustain risk-reduction efforts initiated by individual employees. A successful incentive used by other employers is to cost share expenses for employees and immediate family members to join local wellness or fitness centers.

Extension offices at the state level may also take a cue from business and industry for a second incentive. For years, business and industry have rewarded employees with lower health insurance premiums for participating at local wellness or fitness centers. An exercise plan for each employee is prescribed by the fitness center personnel, based on the worker's health needs. Extension employees would receive a reduced premium based on their level of activity and on reaching health-improvement goals set forth in the prescribed program. Because each agent serves as a role model within the community, more agents taking advantage of fitness programs and adopting additional health promoting behaviors will support health promotion in the community. While providing service to adults, adolescents, and children, agents can exemplify that "each person can enhance the quality of his or her life through a continual process of lifestyle improvement and balanced living" (Storlie, Baun, & Horton, 1992).

Because a significant self-reported risk factor for Extension agents was high fat intake, local, regional, and state offices should provide employees with access to healthy, low-fat dietary alternatives. Vending machines can provide food selections that are low in fat, sodium, processed sugars, and calories. Vending machines can provide healthier choices such as juices, bottled water, and other low-fat, nutritious snacks for agents to ensure that those with heavy travel schedules have access to nutritious foods.

An increased program focus by state and local organizations on safe driving practices of Extension personnel, including appropriate scheduling to reduce the need for high-speed driving, could reduce future injuries and fatalities caused by excessive speed and fatigue. Future state meetings and in-service training should be directed toward the improvement of individual health and well-being. Training sessions (individual sessions or workshops) can provide stimulating, complementary additions to current programming efforts at statewide conferences and in-service training. Improved health behaviors of each agent should become one of the goals for each Extension employee working at the state, regional, and local level.

Health and safety risk behaviors will continue to be a major factor affecting the personal and professional lives of Extension personnel in the next century. The results of this study serve to focus and support the need for an on-going dialogue to identify strategies to minimize health and safety risk behaviors of those working as a part of the Extension Service at the local, regional, and state level. This research also supports the need for a proactive approach to maintaining optimal health and a productive career for this valuable group of committed workers.

References

Bowen, C. F., Radhakrishna R., & Keyser R. (1994). Job satisfaction and commitment of 4-H agents. Journal of Extension [Online]. 32(1). Available: <http://www.joe.org/joe/1994june/rb2.html>.

Gibson, J. D., & Hillison, J. (1994). Training needs of area specialized Extension agents. Journal of Extension [Online]. 32(3). Available: <http://www.joe.org/joe/1994october/a3.html>.

Smith, Keith L., Denton, G. (1988). Dynamics of change. Journal of Extension [Online]. 26(4). Available: <http://www.joe.org/joe/1988winter/iw1.html>.

Storlie, J., Baun, W., & Horton, W. (1992). Guidelines for employee health promotion programs. Champaign, IL: Human Kinetics Books.

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