Susan L Davies

University of Alabama at Birmingham, Birmingham, Alabama, United States

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Publications (39)158.69 Total impact

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    ABSTRACT: Abstract Most studies on the impact of playing violent video games on mental health have focused on aggression. Relatively few studies have examined the relationship between playing violent video games and depression, especially among preadolescent youth. In this study, we investigated whether daily violent video game playing over the past year is associated with a greater number of depressive symptoms among preadolescent youth, after controlling for several well-known correlates of depression among youth. We analyzed cross-sectional data collected from 5,147 fifth-grade students and their primary caregivers who participated in Wave I (2004-2006) of Healthy Passages, a community-based longitudinal study conducted in three U.S. cities. Linear regression was conducted to determine the association between violent video game exposure and number of depressive symptoms, while controlling for gender, race/ethnicity, peer victimization, witnessing violence, being threatened with violence, aggression, family structure, and household income level. We found that students who reported playing high-violence video games for ≥2 hours per day had significantly more depressive symptoms than those who reported playing low-violence video games for <2 hours per day (p<0.001). The magnitude of this association was small (Cohen's d=0.16), but this association was consistent across all racial/ethnic subgroups and among boys (Cohen's d values ranged from 0.12 to 0.25). Our findings indicate that there is an association between daily exposure to violent video games and number of depressive symptoms among preadolescent youth. More research is needed to examine this association and, if confirmed, to investigate its causality, persistence over time, underlying mechanisms, and clinical implications.
    Cyberpsychology, Behavior, and Social Networking 07/2014; · 2.41 Impact Factor
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    ABSTRACT: Identifying sexual risk patterns associated with HIV/sexually transmitted infections (STI) and early parenthood within population subgroups is critical for targeting risk reduction interventions.
    Sexually transmitted infections. 05/2014;
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    ABSTRACT: To identify the risk and protective factors for cigarette smoking and future intentions among racially/ethnically diverse preadolescent children. We analyzed data from 5,119 fifth-grade children and their parents living in three U.S. metropolitan areas. Using the multivariate logistic regression models, we examined how cigarette smoking and intentions to smoke within 1 year are associated with (1) number of friends who smoke, (2) parental disapproval of smoking, (3) parental communication about not smoking, (4) performance in school, and (5) educational aspirations. Twenty-nine percent of the children were black, 44% were Hispanic, 22% were white, and 5% were of another race/ethnicity. Mean age was 11.1 years. The prevalence of ever smoking a cigarette among black, Hispanic, and white children was 9.8%, 5.6%, and 4.9%, respectively. In adjusted analyses, children were more likely to have smoked a cigarette if their friends smoked (adjusted odds ratio [aOR] 5.1, 95% confidence interval [CI] 3.8-6.9), they frequently had trouble with schoolwork (aOR 2.1, 95% CI 1.5-3.1), or their parents were not college graduates (aOR 2.0, 95% CI 1.2-3.5 for high school graduate). They were less likely to have smoked cigarettes if their parents disapproved of smoking (aOR .3, 95% CI .1-.6). Parental communication (aOR .1, 95% CI .0-.6) and disapproval (aOR .2, 95% CI .1-.7) had protective associations for future intentions among children who had ever and had never smoked, respectively. Fifth-graders share many of the same risk factors for smoking identified in older adolescents, some of which are modifiable. Antismoking policies and programs should be designed for preadolescents as well as adolescents, and campaigns targeting parents should place greater emphasis on communication and expressed disapproval of smoking.
    Journal of Adolescent Health 04/2014; · 2.97 Impact Factor
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    ABSTRACT: Children who experience bullying, a type of peer victimization, show worse mental and physical health cross-sectionally. Few studies have assessed these relationships longitudinally. We examined longitudinal associations of bullying with mental and physical health from elementary to high school, comparing effects of different bullying histories. We analyzed data from 4297 children surveyed at 3 time points (fifth, seventh, and tenth grades) in 3 cities. We used multivariable regressions to test longitudinal associations of bullying with mental and physical health by comparing youth who experienced bullying in both the past and present, experienced bullying in the present only, experienced bullying in the past only, or did not experience bullying. Bullying was associated with worse mental and physical health, greater depression symptoms, and lower self-worth over time. Health was significantly worse for children with both past and present bullying experiences, followed by children with present-only experiences, children with past-only experiences, and children with no experiences. For example, 44.6% of children bullied in both the past and present were at the lowest decile of psychosocial health, compared with 30.7% of those bullied in the present only (P = .005), 12.1% of those bullied in the past only (P < .001), and 6.5% of those who had not been bullied (P < .001). Both chronic and current bullying are associated with substantially worse health. Clinicians who recognize bullying when it first starts could intervene to reverse the downward health trajectory experienced by youth who are repeated targets.
    PEDIATRICS 02/2014; · 4.47 Impact Factor
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    ABSTRACT: Purpose To identify the risk and protective factors for cigarette smoking and future intentions among racially/ethnically diverse preadolescent children. Methods We analyzed data from 5,119 fifth-grade children and their parents living in three U.S. metropolitan areas. Using the multivariate logistic regression models, we examined how cigarette smoking and intentions to smoke within 1 year are associated with (1) number of friends who smoke, (2) parental disapproval of smoking, (3) parental communication about not smoking, (4) performance in school, and (5) educational aspirations. Results Twenty-nine percent of the children were black, 44% were Hispanic, 22% were white, and 5% were of another race/ethnicity. Mean age was 11.1 years. The prevalence of ever smoking a cigarette among black, Hispanic, and white children was 9.8%, 5.6%, and 4.9%, respectively. In adjusted analyses, children were more likely to have smoked a cigarette if their friends smoked (adjusted odds ratio [aOR] 5.1, 95% confidence interval [CI] 3.8–6.9), they frequently had trouble with schoolwork (aOR 2.1, 95% CI 1.5–3.1), or their parents were not college graduates (aOR 2.0, 95% CI 1.2–3.5 for high school graduate). They were less likely to have smoked cigarettes if their parents disapproved of smoking (aOR .3, 95% CI .1–.6). Parental communication (aOR .1, 95% CI .0–.6) and disapproval (aOR .2, 95% CI .1–.7) had protective associations for future intentions among children who had ever and had never smoked, respectively. Conclusions Fifth-graders share many of the same risk factors for smoking identified in older adolescents, some of which are modifiable. Antismoking policies and programs should be designed for preadolescents as well as adolescents, and campaigns targeting parents should place greater emphasis on communication and expressed disapproval of smoking.
    Journal of Adolescent Health. 01/2014;
  • Robin Gaines Lanzi, Sheila Tyson, Susan L. Davies
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    ABSTRACT: Depression among women in the US is common, expensive, and often undertreated, reducing significantly one's level of functioning and quality of life. A dearth of relevant programs coupled with heightened stigma in the African American community inhibits depressed mothers from seeking social support and/or treatment. Academic researchers and community residents formed a coalition to address these issues. Formative research methods were used to identify the most salient factors contributing to mental health functioning of women in an urban southern community. The purpose of the proposed presentation is three-fold: (1) describe our successful community-partnered strategy (including guiding framework and principles); (2) illustrate best practices that emanated from our lessons learned through this community-partnered process; and (3) highlight significant local community organizational policy changes that are taking place as a direct result of this community-based participatory research. Examples include: the local health department initiating maternal depression screens; libraries providing significant space for resource and referral information on maternal depression; a county-wide conference planned by the Children's Policy Council to address the mental health needs of mothers. Throughout this process, the importance of and critical role of community partners in community based public health was clear. None of these changes would have happened without the trailblazing efforts of our community partner who served many roles including pioneer (the first ever to have such impact), innovator (the creative new ways of making things happen), initiator (ideas, plans, strategies were from the community), architect (making things happen in the right place at the right time).
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Declines in HIV care and treatment adherence among HIV-infected women from pregnancy to the postpartum period have significant implications for the clinical outcomes and overall well-being of HIV-infected women, especially due to immunosuppression during the postpartum period. While the overall increased risk for mortality associated with HIV care discontinuation is well established, the reasons for HIV care nonadherence among HIV-infected postpartum women are largely unknown. Eighteen HIV-infected women were recruited from four clinics in Alabama to participate in focus groups or individual interviews to discuss barriers and facilitators impacting postpartum HIV care adherence. Sessions were audio-recorded, transcribed, and coded; content analysis was used to analyze the verbatim transcripts. Mixed methods analysis procedures were used to triangulate data from three sources (focus group transcripts, individual rankings of barriers and facilitators according to the Nominal Group Technique, and individual questionnaires of sociodemographic and adherence data). The majority of participants were African-American (83.3%), single (66.7%), with more than half of the participants living on less than $1000 a month (55.6%). Barriers to retention in HIV care included access to and cost of transportation and fitting HIV care into work and childcare schedules. Facilitators to HIV care adherence included wanting to stay healthy for their own well-being as well as for the care of their children, receiving family support, and appointment reminders. The current study highlights contextual factors contributing to poor HIV care adherence among HIV-infected postpartum women. Intervention studies need to be cognizant of the specific needs of HIV-infected postpartum women to improve long-term clinical outcomes among this population, who have children.
    AIDS Care 10/2013; · 1.60 Impact Factor
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    ABSTRACT: We appreciate the opportunity to respond to Nathan's insightful questions and to elucidate several aspects of our research. Nathan asks about the implications of grouping together all discrimination sources. As she notes, Greene et al. suggest that discrimination source plays a role in health outcomes, with peer discrimination more highly related to mental health than adult discrimination.(1) However, the Healthy Passages fifth-grade survey did not ask separate questions about discrimination by adults and discrimination by peers. Measuring and analyzing the distinct effects of different discrimination sources on health disparities in this age group would be an important contribution to the field. (Am J Public Health. Published online ahead of print September 12, 2013: e1. doi:10.2105/AJPH.2013.301570).
    American Journal of Public Health 09/2013; · 3.93 Impact Factor
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    ABSTRACT: Objectives. We examined the contribution of perceived racial/ethnic discrimination to disparities in problem behaviors among preadolescent Black, Latino, and White youths. Methods. We used cross-sectional data from Healthy Passages, a 3-community study of 5119 fifth graders and their parents from August 2004 through September 2006 in Birmingham, Alabama; Los Angeles County, California; and Houston, Texas. We used multivariate regressions to examine the relationships of perceived racial/ethnic discrimination and race/ethnicity to problem behaviors. We used values from these regressions to calculate the percentage of disparities in problem behaviors associated with the discrimination effect. Results. In multivariate models, perceived discrimination was associated with greater problem behaviors among Black and Latino youths. Compared with Whites, Blacks were significantly more likely to report problem behaviors, whereas Latinos were significantly less likely (a "reverse disparity"). When we set Blacks' and Latinos' discrimination experiences to zero, the adjusted disparity between Blacks and Whites was reduced by an estimated one third to two thirds; the reverse adjusted disparity favoring Latinos widened by about one fifth to one half. Conclusions. Eliminating discrimination could considerably reduce mental health issues, including problem behaviors, among Black and Latino youths. (Am J Public Health. Published online ahead of print April 18, 2013: e1-e8. doi:10.2105/AJPH.2012.301073).
    American Journal of Public Health 04/2013; · 3.93 Impact Factor
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    ABSTRACT: Mothers raising children in disordered neighborhoods are disproportionately affected by negative health outcomes, poverty, and other stressors that compromise optimal mental health. Because untreated depression in mothers has adverse long-term effects on her children, efforts to reduce depression could benefit mothers, children and potentially, future generations. However, a dearth of relevant programs coupled with heightened stigma in the African American community inhibits depressed mothers from seeking social support and/or treatment. Academic researchers and community residents formed a coalition to address these issues. Formative research methods were used to identify the most salient factors contributing to mental health functioning of mothers in an urban southern community. Based on the needs and stressors identified, the coalition developed and pilot tested a culturally appropriate mental health promotion intervention. Key aspects of successful implementation identified by community partners: 1) direct and ongoing involvement of those affected by maternal mental health; 2) capitalizing on each partners expertise (academic partners increased community members' data management and analysis skills, while community partners increased academicians' understanding of the extent to which community issues can affect the validity and reliability of results); 3) novel implementation strategy that is both self-sustaining and community-owned; and 4) equal voice among partners throughout planning, implementation and evaluation. Key mental health findings identified the need to: 1) shift the focus from mental illness to mental and emotional health; 2) create a public awareness campaign of women's mental health needs; 3) improve local policies to increase community access to existing mental health services.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: For many health-related behaviors and outcomes, racial and ethnic disparities among adolescents are well documented, but less is known about health-related disparities during preadolescence. We studied 5119 randomly selected public-school fifth-graders and their parents in three metropolitan areas in the United States. We examined differences among black, Latino, and white children on 16 measures, including witnessing of violence, peer victimization, perpetration of aggression, seat-belt use, bike-helmet use, substance use, discrimination, terrorism worries, vigorous exercise, obesity, and self-rated health status and psychological and physical quality of life. We tested potential mediators of racial and ethnic disparities (i.e., sociodemographic characteristics and the child's school) using partially adjusted models. There were significant differences between black children and white children for all 16 measures and between Latino children and white children for 12 of 16 measures, although adjusted analyses reduced many of these disparities. For example, in unadjusted analysis, the rate of witnessing a threat or injury with a gun was higher among blacks (20%) and Latinos (11%) than among whites (5%), and the number of days per week on which the student performed vigorous exercise was lower among blacks (3.56 days) and Latinos (3.77 days) than among whites (4.33 days) (P<0.001 for all comparisons). After statistical adjustment, these differences were reduced by about half between blacks and whites and were eliminated between Latinos and whites. Household income, household highest education level, and the child's school were the most substantial mediators of racial and ethnic disparities. We found that harmful health behaviors, experiences, and outcomes were more common among black children and Latino children than among white children. Adjustment for socioeconomic status and the child's school substantially reduced most of these differences. Interventions that address potentially detrimental consequences of low socioeconomic status and adverse school environments may help reduce racial and ethnic differences in child health. (Funded by the Centers for Disease Control and Prevention.).
    New England Journal of Medicine 08/2012; 367(8):735-45. · 54.42 Impact Factor
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    ABSTRACT: Adolescent development is a complex, interactive process that involves individuals, families, peer groups, institutions, and communities. Resilience is a process reflecting one's ability to respond positively to the multitude of risks inherent in growth and development. This article focuses on strategies for enhancing resilience and health outcomes among young people. We explore the conditions under which young people, their families, and community institutions promote positive health outcomes. We review emerging issues with an emphasis on building social capital and cohesion to foster resilience through family and community relationships and resources. We provide examples of evidence-based interventions, including those with demonstrated cost-effectiveness. Informed by these data, we make recommendations for the practice of adolescent medicine and further research focused on physician involvement in strengthening family and community resilience and social capital to improve the lives of young people.
    Adolescent medicine: state of the art reviews 12/2011; 22(3):402-40, x.
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    ABSTRACT: Despite challenges facing HIV-positive women in the U.S., some maintain strong desires and intentions for motherhood. We explore correlates of desire for another child-particularly current parenting experiences (number of children, parenting efficacy, parenting satisfaction, parenting practices, parental distress, and child-related quality of life), age, spirituality/religiosity, stress, coping, hopelessness, partner's desire for a child, social support, and stigma-among a sample of HIV-positive mothers (n = 96) in Alabama. Partner's desire for a child, participation in private religious practices, avoidant coping, and parity were significantly associated with desire for a child in multivariate models. Such findings indicate a need for reproductive counseling and education that is sensitive to the role of religious norms and values in fertility decision-making and suggest opportunities for partnership with faith-based organizations. Further studies examining the impact of relationship dynamics on childbearing desires among U.S. women living with HIV/AIDS are also needed.
    AIDS and Behavior 08/2011; 15(6):1233-42. · 3.49 Impact Factor
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    ABSTRACT: Background: Qualitative methods were used to compliment quantitative analysis in describing overall program effects and identifying most useful elements of two behavioral interventions for mothers living with HIV. MOMS (Making Our Mothers Stronger), was a randomized, controlled trial comparing a theoretically grounded parenting intervention (Parenting Skills for MOMS) to a health focused intervention (Healthy MOMS) on various parenting and health outcomes. Methods: We conducted post-intervention focus groups (N=4) to elicit participants' (N=16) perceived responses to MOMS participation. Two focus groups were conducted with participants from each intervention condition. Constant comparison analyses of transcripts by three independent coders led to the development of a codebook outlining primary and supporting themes. Results: Participants from both groups expressed significant emotional benefits from the group support and connection (meeting new people, having others identify with their experiences). Benefits identified only by parenting intervention participants included acquired parenting skills (i.e., family management, less harsh discipline, consistent use of rewards and consequences) and increased acceptance of their child (and feeling at peace with their child). Benefits expressed only by health focused intervention participants included better medication adherence and increased reliance on prayer as a coping tool. Conclusions: While intervention content varied greatly, participants in both conditions valued the group support experience of sharing of themselves, trusting group members and being a resource for others. Using a qualitative, phenomenological approach to gain insight on participant experiences in this way can inform future efforts to engage similarly vulnerable, socially isolated populations currently underserved for HIV and other services.
    138st APHA Annual Meeting and Exposition 2010; 11/2010
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    ABSTRACT: The Making Our Mothers Stronger (MOMS) Project is a randomized controlled behavioral trial, comparing a stress-reduction and social support intervention (Healthy MOMS) to a parenting skills intervention (Parenting Skills for MOMS) for mothers living with HIV. Outcomes include maternal mental and physical health, parenting behaviors, and children's behavior. To ensure that these interventions were tailored to the needs of HIV+ mothers, extensive formative work was conducted with members of the intended audience and relevant service providers. Findings from focus groups and semi-structured interviews highlighted the need for Healthy MOMS to: (1) include appropriate approaches to group discussion and problem solving; (2) address the stressors of being both a parent and a woman living with HIV; and (3) enhance social support. Six weekly group sessions focused on topics including coping with stress and anxiety; enhancing nutrition, exercise, and sexual health; improving medical adherence; improving communication with health care providers; and communicating health needs to family, friends, and co-workers. Initial anecdotal responses from participants suggest that the Healthy MOMS intervention addresses several salient issues for the growing population of HIV+ mothers who can benefit from long-term support in adapting to this chronic disease.
    AIDS Care 06/2009; 21(5):552-60. · 1.60 Impact Factor
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    ABSTRACT: Background: A leading cause of adolescent morbidity and mortality is related to violent crime. Gang involvement likely plays an important role in this crisis and endangers many of our communities. Objective: The study measures levels of neighborhood connectedness and attitudes toward gang involvement among African American adolescent males. Methods: 34 African American adolescent males grades 6-8 were recruited from an inner city public school in Birmingham, AL for an after-school mentoring intervention focused on identity building and violence prevention. At enrollment, surveys were completed assessing neighborhood resources, connectedness and attitudes toward gang involvement. Results: A 13 item scale was used to assess neighborhood connectedness. A score of 13 represented the highest level of resources and connectedness (26 represented the lowest). The range of scores was 14-23 (mean = 19). A 9 item scale was used to determine attitudes toward gang involvement. A score of 0 represented the most negative attitude toward gang involvement (9 represented the most positive). The range of scores was 0-6 (mean = 3). Of the 8 males with more positive attitudes toward gang involvement, 63% reported low levels of connectedness. Conclusion: This study suggests that adolescents who are more connected to their neighborhoods may be less likely to have positive attitudes toward gang involvement. Programs that promote youth community involvement and connectedness may have greater impact on fostering safer neighborhoods.
    136st APHA Annual Meeting and Exposition 2008; 10/2008
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    ABSTRACT: Women living with HIV are especially vulnerable to discrimination because of the stigma associated with the disease, as well as their race, gender and class status. To investigate the association between self-reported HIV discrimination and health outcomes among African- American and white women living with HIV, 366 women living with HIV were recruited from HIV/AIDS clinics in Georgia and Alabama. In this cross-sectional study, participants completed an interview that assessed self-reported HIV discrimination and depressive symptomatology, suicidal ideation, self-esteem, stress, quality of life, sexual health and HIV/AIDS related health care seeking. Nearly a sixth of the sample reported experiencing HIV discrimination. Women reporting HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely to have not sought medical care for HIV/AIDS. In race-specific analyses, none of the relationships between HIV discrimination and health outcomes were significant for white women. African-American women who reported HIV discrimination had higher mean scores for stress, suicidal ideation, depressive symptoms, number of unprotected sexual episodes; they had lower mean scores for self-esteem, and quality of life, and were more likely not to have sought medical care for HIV/AIDS. The findings indicated that HIV discrimination adversely affects women's mental, sexual and physical health. However, separate race-specific analyses indicated that compared to white women, African-American women were markedly more likely to experience the adverse affects of HIV discrimination. Eradication of HIV discrimination remains an important public health priority.
    Women & Health 02/2007; 46(2-3):99-112. · 1.05 Impact Factor
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    ABSTRACT: To assess the independent effects of various behavioral and psychosocial antecedents on contraceptive use among a sample of low-income African-American adolescent females. Stepwise logistic regression was used to calculate odds ratios for baseline predictors of inconsistent contraceptive use six months later. Study participants include 375 nonpregnant African-American girls aged 14-18 years who reported sexual activity in the previous six months. Data were collected using a self-administered survey, individual interview and urine pregnancy test. Adolescents who were inconsistent contraceptive users at follow-up were more likely to have reported a desire for pregnancy, previous inconsistent contraceptive use, less frequent communication with their partners about prevention issues, and an increased number of lifetime sexual partners at the baseline assessment. Of equal importance was the finding that a previous pregnancy or sexually transmitted infection did not influence future contraceptive behaviors. Clinicians can play an important role in counseling adolescents about sexual health and dispelling misperceptions that hinder consistent contraceptive use. Findings from this research could have significant implications for the development of effective sexually transmitted infection (STI) and pregnancy prevention programs for adolescents and can help in guiding clinicians toward relevant treatment practices.
    Journal of Adolescent Health 08/2006; 39(1):43-9. · 2.97 Impact Factor
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    ABSTRACT: We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.
    American Journal of Public Health 07/2006; 96(6):1085-90. · 3.93 Impact Factor
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    ABSTRACT: This article describes the development of a peer-led home-based intervention to increase fruit and vegetable (FV) intake and family interaction among fourth graders and their families. Hi5+ intervention content and delivery strategies were developed using two complementary processes: cognitive mapping (CM), a consumer-based approach to identifying salient issues, and intervention mapping (IM), a comprehensive planning model. Step 1 involved creating plans to guide the design, implementation, and evaluation of Hi5+. We delineated our performance objectives and then prioritized those determinants we felt were most salient and changeable. Step 2 involved selecting and utilizing cognitive and behavioral theory constructs to develop intervention methods and strategies. Step 3 involved designing and pilot testing the instructional materials and other intervention components. Step 4 entailed developing plans for program adoption and implementation, while the final step (Step 5) involved creating a comprehensive evaluation plan. Implications of this multistep approach to intervention development are discussed.
    Health Promotion Practice 05/2005; 6(2):190-201. · 0.55 Impact Factor