Encouraging Lifestyle Changes Research Articles

Core Competencies in Diabetes Care: Educating Health Professional Students

Regardless of their chosen fields or places of employment, all health care professionals (HCPs) need to be competent in the care of people with diabetes. There is no question that there is a worldwide diabetes pandemic.1 We rely on diabetes educators within all of the professions (nurses, dietitians, pharmacists, nurse practitioners, physician's assistants, and behaviorists) as well as endocrinologists and other physicians who specialize in diabetes to lead the charge against this menace. But in reality, it is not only such diabetes specialists, but also HCPs of all sorts who will come into contact with patients with diabetes or be in a position to affect the incidence of diabetes by encouraging lifestyle changes to reduce the risk of developing diabetes. Evidence-based standards for diabetes care and its associated risk factors have been establish and disseminated, yet limited progress has been made in reducing the risk factors associated with the complications of diabetes.2 Diabetes is a complex disease, and there are multiple reasons why the established patient targets for blood pressure, lipid, and glucose levels have not been met. These include but are not limited to medication costs, the burden of living with a chronic disease, systems issues related to the delivery of care, lack of patient education, limited provider time, and failure of providers to maximize medication …

An Ecological Risk/Protective Theory for Building Prevention Programs, Policies, and Community Capacity to Support Youth

Although scientific knowledge of youth development has grown dramatically over the last 2 decades, theoretical frameworks for translating research into more supportive environments for youth have lagged. This article proposes a risk/protective theoretical perspective grounded in ecological and developmental contextualist theories. Principles extrapolated from the theory are illustrated with the success of Wisconsin Youth Futures, a campus/community partnership that has built 18 community coalitions to promote positive youth development and prevent problem behaviors. Because adolescence is marked by dramatic changes in the individual and his or her relationships with significant others and society (Steinberg, 1991), it is often considered a critical period, a time of magnificent promise and insidious risk (Lerner, 1995; McCord, 1990; Newcomb, Maddahian, & Bentler, 1986). Almost one half of America's youth aged 10 to 17 are estimated to abuse alcohol and other substances, fail in school, commit crimes, or engage in early unprotected intercourse (Dryfoos, 1990b). Preventing these problematic behaviors and promoting positive youth development is an excellent investment in the future of our nation that can be postponed only at great cost to society (Committee on Economic Development, Research, and Policy, 1987); these costs can be measured not only in terms of personal suffering and lost potential, but also in such private and public expenditures as law enforcement, health care, and rehabilitation (Hawkins, Catalano, & Miller, 1992). What a tragic paradox that public confidence in its ability to do anything to help youth has hit bottom, just when our scientific knowledge of youth problems has reached an all-time high (Higgins, 1988a; Murray & Perry, 1987; Schorr, 1988). Although gaps still remain in our scientific understanding of these issues, the widest gap may be between what is known and what is applied, specifically, the lack of widely agreed upon theoretical frameworks that can integrate findings and guide efforts to translate research into action (Murray & Perry, 1987; Roosa, 1991; Schorr, 1988). Too often, prevention efforts are based on common sense, good intentions, myths about adolescent development, and the heroic efforts of committed staff (Roosa, 1991). Yet our most effective prevention efforts are based on strong theoretical and empirical foundations (Price, Cowen, Lorion, & Ramos-McKay, 1988) that shape program conceptualization, design, implementation, evaluation, and institutionalization (Hughes, 1994). Although several paradigms exist for addressing youth issues, two have gained prominence. First, one of the most successful prevention models in the last two decades has been the epidemiological risk-focused model used to prevent heart and lung disease (Hawkins, Catalano, & Miller, 1992). Informing people about the risks for heart disease (e.g., smoking, inactivity, high-fat diet) and encouraging lifestyle changes actually reduced the incidence of heart disease. Proponents have argued that human development, like heart disease, is influenced by multiple risk processes, and that taking steps to reduce or eliminate these risks holds promise for preventing youth problem behaviors as well (Bronfenbrenner, 1986; Hawkins, Catalano, & Miller, 1992; Segal, 1983). Yet a second model recently gaining prominence is the resiliency or protective process approach, which suggests that we must move beyond a focus on risks to create conditions that facilitate positive youth development. Proponents of this model (Benard, 1993a, 1993b, 1993c) cite studies of children who live in adverse circumstances (e.g., poverty, neglect, war, and parental alcoholism or criminality), yet grow up to lead successful adult lives (Garmezy, 1983; Rutter, 1979, 1983, 1987; Werner, 1990; Werner & Smith, 1982). Even with glaring disadvantages and the most adverse conditions, it is unusual for more than a third (Werner, 1992) to a half of children (Rutter, 1985) to succumb to serious disabilities or persistent disorders. …