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      Reconsidering Community-Based Health Promotion: Promise, Performance, and Potential

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      American Journal of Public Health
      American Public Health Association

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          Abstract

          Contemporary public health emphasizes a community-based approach to health promotion and disease prevention. The evidence from the past 20 years indicates, however, that many community-based programs have had only modest impact, with the notable exception of a number of HIV prevention programs. To better understand the reasons for these outcomes, we conducted a systematic literature review of 32 community-based prevention programs. Reasons for poor performance include methodological challenges to study design and evaluation, concurrent secular trends, smaller-than-expected effect sizes, limitations of the interventions, and limitations of theories used. The effectiveness of HIV programs appears to be related in part to extensive formative research and an emphasis on changing social norms.

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          Most cited references120

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          A review of collaborative partnerships as a strategy for improving community health.

          Collaborative partnerships (people and organizations from multiple sectors working together in common purpose) are a prominent strategy for community health improvement. This review examines evidence about the effects of collaborative partnerships on (a) community and systems change (environmental changes), (b) community-wide behavior change, and (c) more distant population-level health outcomes. We also consider the conditions and factors that may determine whether collaborative partnerships are effective. The review concludes with specific recommendations designed to enhance research and practice and to set conditions for promoting community health.
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            Getting research findings into practice: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings

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              Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology.

              Part I of this paper traced the evolution of modern epidemiology in terms of three eras, each with its dominant paradigm, culminating in the present era of chronic disease epidemiology with its paradigm, the black box. This paper sees the close of the present era and foresees a new era of eco-epidemiology in which the deployment of a different paradigm will be crucial. Here a paradigm is advocated for the emergent era. Encompassing many levels of organization--molecular and societal as well as individual--this paradigm, termed Chinese boxes, aims to integrate more than a single level in design, analysis, and interpretation. Such a paradigm could sustain and refine a public health-oriented epidemiology. But preventing a decline of creative epidemiology in this new era will require more than a cogent scientific paradigm. Attention will have to be paid to the social processes that foster a cohesive and humane discipline.
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                Author and article information

                Journal
                American Journal of Public Health
                Am J Public Health
                American Public Health Association
                0090-0036
                1541-0048
                April 2003
                April 2003
                : 93
                : 4
                : 557-574
                Article
                10.2105/AJPH.93.4.557
                1447790
                12660197
                cb78dd45-a0dd-4e9d-be4b-ca89edcc465d
                © 2003
                History

                Molecular medicine,Neurosciences
                Molecular medicine, Neurosciences

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