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Monday, September 04, 2006

Program Planning Example

Introduction

Recently a student wellness committee, Healthy Gators 2000, was formed through the Student Health Care Center. It’s purpose is to promote a comprehensive and integrated SHCC-wide approach to health promotion for all students, faculty, and staff who utilize services at the SHCC. The functions and responsibilities of this committee include: 1) expanding the SHCC’s mission statement to more strongly emphasize health promotion and wellness; 2) developing a climate within the SHCC which fosters enhanced health and well-being among the students, staff, and faculty; 3) defining health promotion, wellness, risk reduction, and disease prevention concepts; 4) establishing health promotion priorities for the SHCC based on needs assessment data; 5) designing an annual calendar of themes that would promote health and prepare creative strategies for SHCC staff to promote each theme; 6) coordinating health promotion activities with related campus resources; 7) evaluating health promotion efforts of the SHCC on an annual basis; and 8) creating a long-term plan which ultimately expands “Healthy Gators 2000” from solely a SHCC Wellness Committee to a campus-wide wellness committee.
The committee is chaired by a health educator. A minimum of twelve additional members including a health education program assistant, two additional health educators, two medical staff, two mental health professionals, two nursing staff, and two students from the Student Health Advisory Board form the remainder of the committee. The committee meets at least three times a year, and the first meeting is planned for the second week in May.

Purpose: To provide recommendations for expanding Healthy Gators 2000 to a campus-wide wellness program. (For the purpose of this project, we will use alcohol abuse prevention as a running example for one of the proposed health promotion themes.)
Justification for a Campus-Wide Wellness Program
The justification for a campus-wide wellness program can be divided into two main categories: 1) improving the health of the campus community and 2) achieving the goals of the university.
Improving the Health of the Campus Community
“A significant amount of morbidity and mortality experienced by Americans of all ages today is preventable” (Fish, 1996). The leading causes of death in the United States are chronic and degenerative disorders resulting from an array of lifestyle and health behavior problems including improper diet, lack of exercise, substance abuse, and stress. Many college students, living away from home for the first time, are challenged with the responsibility for their personal health. “The promotion and maintenance of healthy lifestyles for young adults are essential to avert the development of chronic diseases as they progress through life (U.S. Department of Health and Human Services, 1992). The consequences of high risk behavior such as smoking, drinking, and unprotected sexual intercourse, often initiated in young adulthood, can have lasting impact (Butler, 1994). Enabling the nation’s youth to avoid risk behaviors and their associated health problems is a commitment of the Centers for Disease Control (Kolbe, 1992).
Health promotion activities in an academic setting have the potential to significantly reduce illness and disease. However, the staples of traditional campus health education programs, including awareness weeks and text-intensive pamphlets have been disappointing at best. As a result, a major change in college health has been an emphasis on community and culture. Dr. Richard Keeling, director of university health services and professor of medicine at the University of Wisconsin, has stated, “All health behavior occurs, of course, in context. Every decision about drinking, drug or tobacco use, relationships, intimacy, sex, eating, or exercise happens in a framework created by social norms, community standards and values, local traditions, and customs of groups….When we listen to students we hear a lot about the power of these environmental factors and especially about how perceptions of the norm govern students’ assessments of their own behavior.” Accordingly, health promotion efforts should be contextual, environmental, and cultural. They should include strategies to gradually alter the prevailing norms toward patterns of health behavior. A campus-wide wellness program utilizing a social norms approach has great potential in improving the health of the campus community.
Achieving the Goals of the University
“American colleges and universities share the fundamental educational mission of teaching students….The formation of educated people, the transformation of mind through learning, and the launching of a lifetime of intellectual growth: these goals remain central to every university” (UF Graduate Catalog, 1994/1995). However, the level of wellness in a population can determine whether it has the ability to reach its potential and achieve its goals (Fish, 1996). Sullivan and Bogden (1993) suggest that the social, emotional, and physical needs of students and staff are a concern of successful school communities. Educators are faced with students with social, emotional, physical, and family problems, and these factors can have a direct effect on both the student’s ability to learn and the academic environment itself. As stated by the National Commission on the Role of the School and the Community in Improving Adolescent Health (1991), “Health behaviors are an important reason why a large percentage of young people are unable or not motivated to learn.” Indicators of a successful school include academic progress, low absenteeism, and low rates of student drop-outs. A campus-wide wellness program would serve to reduce morbidity and mortality that impairs student abilities to accomplish educational objectives. Such a program would aid in keeping students in class, preventing students from dropping courses, and helping students graduate on time by reducing health risks, preventing illnesses and injuries, and improving the wellness of the campus community.

Target Population
The target population for the health promotion campaign on the campus of the University of Florida is the student body. Although, they are collectively referred to as college students, they are a very diverse group of individuals. They are from all over the world, practice different religions, represent very distinct and diverse cultures, choose different majors, and participate in a variety of personal and professional activities. They do, however, have some things in common. They are here in the pursuit of knowledge and personal growth. Most of them chose to attend the University of Florida and they are expecting an environment that promotes their academic achievement and personal development. Also, for all students, the college years represent a time of great transition and adjustment, whether from high school to college, college to the working world, or the working world back to college. When planning a health promotion campaign, the programs should be designed to meet the actual needs of the students in a manner that is conducive to their learning, based on their current knowledge, attitudes, and behaviors, as well as the available resources and support from the institution.
The University of Florida is the seventh largest university in the country. In the fall of 1996, the total student enrollment, including undergraduate students (30,008), graduate students (7,475), and first-professional degree seeking students (2,380), was 39,863. This is expected to increase further over the next few years.

The freshman class in the fall of 1996 accounted for 3,318 of the total student enrollment. Over ninety percent of these students were in-state residents, representing each of Florida's 67 counties. Over 9.0% were out-of-state residents, representing all 50 states, and 0.3% were international students, representing more than 100 countries. Because the freshman year is full of adjustments, it is beneficial for most students to live relatively close to their families. This allows a greater support system during difficult times. Factors such as proximity to family should be considered when planning programs, such as alcohol and drug counseling. For students who live far from home, the university may be the best and only source of support and intervention.
Although the majority of this freshman class consider themselves Caucasian (74%), other ethnic backgrounds are represented. Over six percent classified themselves as African-American, 0.3% as American Indian, 7.6% as Asian, 9.5% as Hispanic, 0.3% as Non-resident Alien, and 1.6% reported "other" or provided no information. Regarding the entire student body, there are 2,433 African-American students, 2,278 Asian-Americans, 3,563 Hispanic students, and 3,683 International students. The differences in ethnicity and cultural upbringing are apparent not only in the physical characteristics of the students, but in their attitudes, beliefs, and behaviors. These factors will influence the perceived needs of the students as well as how they respond to particular health promotion programs. Certain cultures, ethnic backgrounds, and religions may have established views about alcohol, including its proper level of consumption and what is considered too much alcohol. These are factors that must be considered when trying to reach a particular group. If the educational plan calls for complete elimination of alcohol from the student's life, someone from a culture that promotes consumption of alcohol may not respond at all.
Some other factors that should influence the direction and methodology of a health education program, especially one regarding alcohol are age and gender. The average age of the entering freshman is 18. This becomes a crucial factor when designing a health program. If the activities are not suited for the particular age group, they will not respond. Also, the breakdown of students according to gender is another key point. Females account for approximately 47% of the student body. Because the two genders have different attitudes and behaviors regarding alcohol, health education programs should account for these differences.
A problem stemming from over consumption of alcohol by students is successful completion of their degree within a reasonable time. Students who have drinking problems may perform poorly in class and on projects and exams, or may simply not attend. This could lead to an increase in the dropout rate and an increase in the length of time it takes a student to complete his or her bachelor's degree. Approximately 90% of freshman students return for their sophomore year. However, only 32% graduate within four years. Overall, the University of Florida has a 63% graduation rate. This ranks seventeenth on the list of AAU Public Universities. According to the article "Measuring University Performance: Student Quality," the students "represent one of the primary reflections of university quality." If the students suffer from problems with drinking, they will not be able to perform up to their potential. Not only will this damage the student, but also the school's overall success with the student population.
According to the same article, the quality of the student "comes both from the initial scores of the entering class and from the performance of students after they leave the university." The University of Florida ranks third among public universities and sixth among all universities in the number of freshman National Merit Scholars attending. Also, about 90% of all entering freshman score above the national average on standardized college entrance exams. The freshman at Florida rank in the top ten AAU public universities based on SAT scores and high school class standing. These statistics show that the students at Florida have the academic potential to succeed. The university has a responsibility to foster this academic growth as well as to provide an atmosphere conducive to learning. This should include strict and publicized rules and regulations regarding alcohol and productive educational programs and support systems for the students.
According to a survey of alumni in 1993 conducted by the Florida Survey Research Center, 94% remembered their overall experience at the University of Florida as positive and half rated their undergraduate experience as excellent. Also, 85% of the alumni served said they would definitely recommend the University of Florida to a relative or friend considering college. By producing a higher caliber student, the university produces a better means for evaluating the programs. According to the article on Student Quality, "the better the students and the better their performance, the more important their evaluations of our programs."

Barriers To Program Development
The development of Healthy Gators 2000 could be affected by numerous aspects which are already present in the Student Health Care Center. Factors such as current programs offered, structure of the center, philosophy of the organization, job descriptions, current priorities, and other traditionalisms which exist. The largest dilemma which will influence the program occurs on several levels. It is the basis of the system and must be overcome in order for any significant achievements to be gained. Without some change in this philosophy, no community synthesis of health will occur. What is being referred to here is the emphasis which is placed on curative medicine. Although maintaining the optimal health of students is listed in the mission of the Student Health Care Center, it does not seem to be a very high priority. Until recently, the Health Education Department was so understaffed that they were unable to develop any programs of their own. They had been resigned to completing projects or other short-term assignments that were given to them. With the addition of a few staff, they now have begun a few independent endeavours. However, they are still understaffed and extremely underfunded. The vast majority of money being spent goes to hiring clinicians whose role is to treat the wide-variety of illnesses that show up in our student population. The concept that greater funding of health prevention efforts will be more cost-effective in reducing the number of sick students has not been adequately grasped. Until administrators understand that health education serves to lessen the need for curative medicine, the Health Education Department will retain its backseat to other programs. Clinical departments at the infirmary may not even be aware of the benefits health education can provide. This lack of knowledge further contributes to the emphasis in financial, public, and medical support that continues to head towards treatment options rather than prevention efforts. The makeup of the Healthy Gators 2000 committee will be completely internal to the Student Health Care Center. It will be made up of representatives from health education, mental health, radiology, nurses, and other departments. One of the first essential functions will be to guarantee that these committee members from clinical disciplines understand that they are on a health promotion council. If they are not able to comprehend the significance of health promotion, their inclusion on this committee is useless. Another possible limitation of the committee is that all of the councils programs and actions will be implemented solely by the health educators. This means that the clinical representatives only have to put forth ideas that are to be acted out by someone else. After the meeting ends, all of their responsibilities have been taken care of. It can be difficult to get a person’s complete effort if they are not involved in a substantial portion of the project. The interest placed into the project quickly diminishes.
There are also other limitations which may influence the program. As mentioned earlier, funding is significantly low for health education. If they are also supposed to be responsible for the implementation of Healthy Gators 2000, budgetary problems could quickly arise. There is also a lack of human resources. The health education staff are competent in there jobs, but their work load is tremendous. Hiring more help would ease the load and allow for greater program effectiveness. The use of unpaid internships could provide some aid. Overall, it seems as if they are expecting wondrous results through a health promotion program that they are unwilling to adequately support.
Another potential factor that may contribute to the development of Healthy Gators 2000 concerns the council’s autonomy. Everything that is done at the Student Health Care Center has to be approved by its director, Dr. Huey. This has the potential to constrain the program if problems arise as ideas passed by the committee begin to be turned down by the director. Having the full support of Dr. Huey would be a great advantage in avoiding probable future difficulties.
As a whole, there are multiple deficiencies in the organization of the Student Health Care Center concerning health promotion. The emphasis is placed in the traditional direction of curative treatments. There must be some shift towards health prevention efforts if any gains are to be made through the use of Healthy Gators 2000. This shift should occur in funding, administrative backing, staff attitudes, personnel additions, and director support. Without changes, these could all serve as barriers to health promotion programs. But with proper mental, social, physical, and financial alterations, Healthy Gators 2000 could prove to unite the University of Florida campus under an umbrella of health prevention.

Program Goals
· To develop health promotion programs based on the students’ actual needs.
· To improve the health and wellness of the campus community.
· To reduce morbidity and mortality that impairs student abilities to accomplish educational objectives.
· To show justification for the continuing support of a campus-wide wellness program.

Program Objectives
By the end of the first year of the program:
· 25% of the students will recognize the Healthy Gators 2000 logo and motto.
· A committee representative will meet with the dean of each academic college to discuss possible curriculum infusion.
· Future program themes with specific objectives will be determined based on a needs assessment.

Educational Component

The Educational Component for Healthy Gators 2000 is based upon two broad, campus-wide strategies. The first of these strategies concerns a mass-media campaign designed to increase the University of Florida’s awareness to what Healthy Gators is, what purpose it serves, and what programs and/or activities are currently being implemented. This marketing approach will also seek to gain broad participation from individuals and organizations in support of the promotions established by Healthy Gators 2000. The second strategy utilized in this approach involves curriculum integration. Curriculum integration aims to increase the number of health-related assignments given throughout the University of Florida’s courses. Also essential concerning curriculum, is the use of faculty resources. Faculty carry a significant influence in determining assignments as well as giving academic counseling. These factors, along with faculty maintaining a crucial position in identifying and effectively sending troubled students to the proper campus organizations, are to be utilized in providing valuable assistance in Healthy Gators 2000.
Mass-Media Campaign
The marketing campaign to be used in conjunction with Healthy Gators 2000 needs to be vast and effective. The University of Florida is made up of an extremely diverse population. Within this population, these is even greater variety when one considers all of the possible organizations to which one can belong. Because of this, there is no one simple approach to enlightening our total campus. It will be very important to achieve as much awareness as possible prior to Healthy Gators 2000 even beginning any programs.
Before any education has occurred, steps should be taken to spread the goals and purpose of Healthy Gators 2000. Students, staff, and faculty need to be targeted in describing the potential assistance this can provide. Activities such as a “Name the Healthy Gator Contest”, a Healthy Gator 2000 slogan or motto contest, and any other type of contest promotion can be effective ways of getting information spread concerning the program. Contests such as these also may be good ways of eliciting campus participation. Participation which is initiated early on in any program’s existence is a practical method of establishing long-term support for the future. In addition to these contests, getting wide-spread materials into every sector of the University of Florida is needed. Posters should be placed in every office of meeting place imaginable. Dorms should be targeted along with fraternity and sorority houses. Advisement offices, department offices, program offices, and even the offices of faculty should be given the opportunity to display information concerning Healthy Gators 2000. Any place across the campus where student services are offered should be utilized as an opportunity to educate the populace of this new promotion and its benefits. Banners and signs should also be placed in the student congregation areas throughout the university. These areas such as the Plaza of the Americas, Turlington Plaza, and the Reitz Union should all be utilized for their marketing power. Posters should not be used exclusively. The proper placement of bumper stickers, pins, and even t-shirts allow for greater recognition of Healthy Gators 2000 and its goals. This factor will become more effective once a face and motto have been established to coincide with healthy gators.
There are other marketing elements which should be employed to achieve greater dissemination of our message. Here, references are being made to television, newspaper, and radio advertisements. Any Public Service Announcement (PSA) slot which may be attained on the radio or television should be utilized. Using the campus radio (WUFT-FM) and television stations (WUFT-TV) can be effective method of strictly reaching our University of Florida population. Any air time which may be arranged on other area radio stations should also be applied towards greater public awareness. Television advertisements, other than the campus station, will probably be suffer from lack of cost-effectiveness. Unless a Public Service Announcement (PSA) spot can be found, time and money could probably be better spent in other areas. One of the more significant impacts should be reached through the use of the Independent Florida Alligator. This newspaper is probably read by more students, staff, and faculty at the university than any other. According to information derived from The Higher Education Center for Alcohol and Other Drug Prevention, campus newspapers serve as the primary source of information for students with 75% of the student body reading the paper every day. The Gainesville Sun could also be helpful during crucial stages of promotion. However, when it concerns continuous coverage of Healthy Gators 2000, the Alligator will keep the campus up-to-date on what healthy gators are doing now, what activities are coming up, and where the health focus for the University of Florida is heading.
One technological element which should be exploited for its marketing potential is e-mail. Now that the university has been connected through the establishment of GATORLINK, messages can be sent to students and faculty without a great deal of energy or time spent. These messages can serve to explain the objectives and goals of Healthy Gators 2000 or simply update the populace of what programs are currently running throughout campus. This technological method could aid in promoting participation as well as the knowledge base concerning health. Although this innovative element could be useful, local and community networks should also be employed. Placing Healthy Gators 2000 materials in more minor media newsletters is also necessary. Using church newsletters, University Police Department mailings, and local businesses could prove to be very beneficial. Simply having brochures available at local hair salons and barber shops provides a unique opportunity to reach students at a moment when they are likely to possess the spare time to read. This is exactly when having educational materials available makes the difference. Capitalizing on these chances is required if complete integration of the entire university population is to be achieved. Inserts which can be put into each bag when purchases are made at the book stores could also be beneficial. An important step would be to disseminate material to each student who visits the health care center. By doing this, you would be able to reach part of the population which may be more at risk of health problems.
A final possible marketing event that could aid greatly in obtaining broad participation is that establishment of “fun runs”. These one-mile, 5K, or 10K runs would serve several purposes. First, it gets part of the University of Florida engaged in a very health-benefiting exercise. In addition, students and faculty are taking part in cooperation with Healthy Gators 2000. This sets a trend for future joint ventures. And finally, “fun runs” are a creative means of allowing the community to become introduced to this healthy promotion program. It lets society take notice of the efforts that the University of Florida is making.
Each of these potential media outlets serves a purpose that could provide assistance in ensuring that Healthy Gators 2000 becomes a campus-wide health function at the University of Florida. As well as aiding in the establishment of the program, these marketing strategies allow healthful practices to become an ingrained dominion associated with the everyday lifestyle of Florida students, staff, and faculty.
Curriculum Integration
While mass-media is necessary in spreading the message of Healthy Gators 2000, it is not nearly enough. The University of Florida is a large and diverse population. Reaching a populace which is brought together through school education must include some classroom tactics. The first possible integration of health into the general curriculum of the university comes through the undergraduate curriculum committee. This committee decides matters on courses and the overlap of material among courses for undergraduate classes. There is also a graduate curriculum committee. However, the graduate committee deals more specifically with aspects of why a course is needed at the graduate level and if it covers any identical information as another class. It does not make broad ranging decisions concerning the implementation of topic themes throughout the university. Because of this and the fact that most students are undergraduates, the undergraduate curriculum committee would be the appropriate council to lobby. Attending one of their board meetings and presenting the case of Healthy Gators 2000 would be a positive plan. By doing this, you are talking directly to a persuasive factor in affecting curriculum. This board should be urged to establish any and all health-related assignments within their specialty. For example, those faculty in the advertising college could be driven to include advertising for health agencies as an assignment. Any potential task which could be related to health, should be. It is understood that not every homework job given will be able to focus on medical agendas. But, every assignment which requires to student to achieve any health knowledge in order to successfully complete the task will be a contributor. It will contribute to that student’s knowledge and potentially influence the decisions made in his or her life. Every bit of health information gained assists in creating a healthier society for the University of Florida. While the curriculum committee poses a substantial link which should be explored, there are other avenues to be taken as well. The faculty union may be one of these. This organization allows one to solicit the teaching populace all at once. Getting the backing of the faculty union could go a long ways towards getting thorough integration of health within a significant proportion of the classrooms. However, two distinct problems come to mind concerning this. First off, faculty members tend to be very busy with teaching, research, and any other duties they carry along with their position. Because of these obligations, it is not easy for them to simply add something else into their classes. This is especially true when it may be something that they themselves are not very familiar with, such as health. Also, it may be difficult for certain majors to utilize health in their school work. Mathematics is a good example. How does a calculus class find a way to appropriately bring health related information into their coursework? Certain classes simply may not be able to locate any medical focus for their students. There does not appear to be any clear solution to this problem. Something else which may contribute to obstacles developing involves motivation. Why should faculty feel compelled to add health projects into their coursework? They are getting essentially nothing in return. Yes, they will be assisting to the betterment of student health, but is that enough. It probably will not be. When most of society already sees the answer to health problems in curative medicine, what is going to convince the faculty population that it is any different. That will be very difficult to do in a community with over 40,000 people. Teachers are already pressed for time. In order for them to receive the needed persuasion, influence which comes from the top of the university’s hierarchy may be necessary. If Healthy Gators 2000 can gain the backing of one or several upper position members (including President Lombardi), the needed motivation to comply with curriculum integration may be present. If this influential backing can be attained, promotion of this program can begin to work its way down the power structure until it reaches the individual program departments. At this point, letters from department heads to faculty members and graduate assistants will contain significant credibility as they attempt to foster health themes in a wide variety of courses. Utilizing the chain of command is important if the organizational structure of the University of Florida is to be taken advantage of. Pressure from the appropriate offices can be very effectual in enacting any plan of action. However, some sort of reinforcement for those faculty who do comply with the coercion should be considered. Positive feedback in the form of public recognition, potential cost-benefits, or relief from certain duties may be instrumental in faculty complying with the curriculum wishes of Healthy Gators 2000. Simple contemplation of these elements is required. They could prove to be very convincing. A final element which may be included in curriculum integration deals with the use of internships. Because the Health Education Department of the Student Health Care Center is to be responsible for the implementation of Healthy Gators 2000 programs, any help they can receive will be well appreciated. Since health promotion is extremely comprehensive, internships can be utilized to fill several functions. To begin with, the assistance provided to the program is needed. Interns would allow a portion of the workload to be diverted without spending a part of the budget. Also, specialists from the different university colleges can be brought in to their own particular aspect of the program. For example, a marketing representative could be used to handle the media elements. This would allow for potentially higher-quality work as well as letting the health educators focus in on what they do best. Additionally, these interns could be made responsible for returning to their own college and providing information on what they have completed and its significance. This will contribute to further curriculum integration as well as the spread of health knowledge in general. Hopefully, this would also serve to reinforce the behaviors of department heads by providing positive results in regards to health curriculum integration.

PRECEED/PROCEED Model for Healthy Gators 2000 Programs
Healthy Gators 2000 program themes should follow the PRECEDE/PROCEED model for health promotion planning and evaluation. This model allows for comprehensive health education and health promotion. The PRECEDE framework takes into account the multiple factors that shape health status and intervention. It also generates specific objectives and criteria for evaluation. The PROCEED framework provides additional steps for initiating the implementation and evaluation process. The following is an example of an alcohol abuse prevention program based on the PRECEDE/PROCEED model. (See Appendix A for the general framework of the PRECEDE/PROCEED model to be used with each health promotion theme.)

Healthy Gators 2000: Alcohol Abuse Prevention Program
Phase 1: Social Diagnosis
According to surveyed college administrators, unsafe sex and alcohol top the list of most serious student problems (Wechsler, H., Moeykens, B.A., & Dejong, W.). These administrators have also reported that three problems are “nearly always” or “in most cases” alcohol-related: sexual assault, unsafe sex, and physical assaults. In addition, administrators reported that alcohol contributes significantly to vehicular accidents, drug abuse, and suicide. The University of Florida also recognizes the seriousness of alcohol use by its students. It’s student guide states:
“There are significant risks associated with the use of alcohol and other drugs. These risks include impaired academic or work performance; lost potential; financial problems; poor concentration; blackouts; conflicts with friends and others; vandalism, theft, and murder; sexual assault and other unplanned sexual relationships; spouse and child abuse; sexually transmitted diseases; and unusual or inappropriate risk taking which may result in physical or emotional injury or death.”
Irene Stevens, Assistant Dean of the Office for Student Services at the University of Florida, has written in a recent letter to selected faculty, “As you know, alcohol and other drugs are a problem on our campus, as it is on most college campuses….The University needs to step up its educational efforts to reduce alcohol and other drug abuse on our campus.”
Among the indicators most likely to be identified by school administrators as reflecting success for a school are academic progress, low absenteeism, low rate of dropped courses, and minimal disciplinary problems, all of which can be influenced by the use of alcohol. Thus, it is evident that alcohol-related problems not only carry serious risks of disease, injury, and death, but they also interfere with the mission of higher education.
However, when asked to rank their personal health needs, college students rank the topic of “alcohol and other drugs” as a low priority (Fish, 1996). No matter what their level of consumption is, very few students believe they have a problem with alcohol. This is often the result of a discrepancy between the perceived norm and the actual norm regarding drinking behavior. According to the 1997 Alcohol and Drug Survey conducted by the Campus Alcohol and Drug Resource Center at the University of Florida, only 11.4% of the students thought they might have had a problem with alcohol/drugs during the previous year. However, 87.4% of the students surveyed believed “Heavy alcohol use” was a moderate to major problem for University of Florida students. UF students, like those at other colleges and universities, believe that other students drink much more than they personally drink.

Phase 2: Epidemiological Diagnosis
A national survey on binge drinking (Wechsler, H., Dowdall, G.W., Davenport, A., & DeJong, W.) revealed the following findings:
· Overall, 44% of U.S. college students engaged in binge drinking during the two weeks prior to the survey.
· At almost one-third of the colleges surveyed, more than half the students were binge drinkers during the past two weeks.
· Compared to non-binge drinkers, a higher percentage of binge drinkers had experienced alcohol-related problems since the beginning of the school year.
· Percentage of binge drinkers reporting alcohol-related problems since the beginning of the school year by gender:
Alcohol-Related Problem % of Women % of Men
Have a hangover 81 82
Do something you later regretted 48 50
Engage in unplanned sexual activity 26 33
Not used protection when you had sex 15 16
Argue with friends 29 32
Damage property 6 24
Get hurt or injured 14 17
Miss a class 42 45
Get behind in school work 31 34

A 1997 Spring survey of undergraduate University of Florida students revealed:
· Only 19% of the students did not use alcohol within the previous 30 days
· 50.8% of the students had drank five or more drinks at one sitting during the previous 2 weeks.
· 61.9% of the students reported that they consume less that 4 drinks per week.
· Percentage of students who experienced problems due to alcohol/drug use during the previous year:
Had a hangover 69.8%
Drove under the influence 46.9%
Had unexpected or unplanned sexual activity 26.2%
Had unprotected sex 17%
Performed poorly on test or project 31.8%
Missed a class 48.5%
Fell behind in academic work 29.5%

Phase 3: Behavioral and Environmental Diagnosis
Behavioral Targets
· Binge drinking
· Underage drinking
· Driving under the influence of alcohol
· Unplanned and/or unprotected sex under the influence of alcohol

Environmental Targets
· On-campus alcohol marketing
· Alcohol-related events on campus
· Regulatory policies

Objectives
· Reduce the percentage of University of Florida students who binge drink to 40.8% by one year after the start of the program.
· Reduce the number students who missed a class due to alcohol to 38.5% by one year after the start of the program.

Phase 4: Educational and Organizational Diagnosis
Predisposing Factors
Alcohol is generally associated with “good times” and college traditions, especially in regard to fraternities and sororities. There is also a prevailing attitude that you have to drink in order “fit in”. Many college students feel that binge drinking is the norm. In addition, many believe that they personally drink less than the typical student does, and one result of this is that many students don’t feel they have a problem with alcohol. In addition, students often fail to see the potential consequences of their drinking behavior or they simply just don’t believe that anything bad (like a car accident from driving under the influence) will happen to them. In an effort to change the knowledge, attitude, and beliefs of college students concerning alcohol, the following strategies should be used:
· Curriculum infusion
· Mass media campaign using a social norms approach (see Appendix B)
· Newspaper column / advertisements
· TV / radio announcements
· Posters
· Flyers
· Banners
· Buttons
· Electronic message board
· Email messages / Web page

To highlight positive and moderate drinking norms and alter the prevailing misperception of these norms, the following messages could be used:
· “No more than four.”
· “The majority of UF students consume less than 4 drinks a week.”
· “The majority of college students drink four or fewer drinks in one sitting.”

Enabling Factors
Alcohol is readily available to college students at parties, fraternity/sorority
functions, campus events, etc. In addition, there is a lack of enforcement of the minimum drinking age to discourage underage drinking. However, many students lack the skills to drink responsibly or the skills to deal with peer pressure to binge drink. Also, there is a lack of alcohol-free alternatives to students. The following strategies could be used to address these issues:
· Address skills for responsible drinking and dealing with peer pressure through curriculum infusion and the mass media campaign.
· Promote alcohol-free entertainment and stress-relief for students through the mass-media campaign.
· Increase collaborative efforts with the University Police Department regarding programs and referrals for students in need.

Reinforcing Factors
Lack of disciplinary action for disorderly conduct and other alcohol-related problems
reinforces the behavior. In addition, teachers often fail to recognize or take action when students have problems with alcohol. Acceptance and encouragement of irresponsible drinking by peers also leads to a continuation of the behavior. The following strategies could be used to address these issues:
· Create a change in social norms (peer influence/ reinforcement) through curriculum infusion and mass media campaign.
· Train teachers to recognize students with problems and provide referral resources.

Phase 5: Administrative and Policy Diagnosis
Resources needed to implement the program:
1. Time
One Month Prior (or earlier):
It is at this point that several of the utilized media methods should be first established.
Included in these methods are possible television, radio, and newspaper contacts, poster and brochure formation, and community-resource cooperation.
· Contact should be made with the Independent Florida Alligator. At this time, you should discuss some of the activities which will be on-going throughout the semester as well as what the purpose of the program is. After this explanation, ask what kind of media coverage the Alligator may be able to provide on a continuous basis. Seek any unpaid spots available for advertisements. Any materials published in this newspaper must be written by one of the newspapers journalists. They do not accept independently written articles with the exception of letters to the editor. Establishing a friendly working relationship with this newspaper could be very advantageous. Any positive feedback which Healthy Gators 2000 gets via the press will provide a boost of credibility.
· At this same time, contact should also be made to the Gainesville Sun. Although it will be more difficult to setup a long-term coalition with this paper, it’s media power should be utilized at key moments. Before the kickoff of any new semester program, they must be reached in order to place some sort of article or advertisement. A weekly use of this newspaper would probably not be cost-effective enough to sustain.
· Radio stations should also be contacted one month prior to the program start date. Here, the acquisition of Public Service Announcements is sought. Different stations may have different policies on how these are generally handled. For this reason, it is important to make contact early enough to allow for variations. Utilizing the campus radio station, WUFT-FM Classic 89, would be a solid beginning. However, since most of our college population listens to a variety of different stations, it is necessary to contact other local stations. Inquiring into what public service spots they have available could serve to be quite useful.
· Utilization of television’s media capability is a must. Due to the lack of cost-effectiveness of this source, there is probably only one viable option for this program’s application. This option is the campus television station, WUFT-TV Channel 5. Getting onto any University of Florida discussion shows would be advantageous. Again, contact should be made as early as possible to avoid as many potential drawbacks as possible.
· Design of potential Healthy Gators 2000-Alcohol Prevention brochures and posters should be started early. It is at this point that the services of an art major would be useful. The higher the quality of these advertisements, the greater response they will bring. This would be an opportunity to utilize curriculum integration by setting up an assignment within the college of art. Listing all semester activities of the program on these advertisements is necessary.
· It is also at this time that contact with potential community-resource organizations should be made. Any cooperation that can be established between a local alcohol treatment center or alcoholics anonymous would be beneficial. This would allow for a more thorough community saturation of alcohol-related materials and information. Contacting organizations listed in the phone book under “Alcoholism Information & Treatment Centers” is an excellent place to begin this process.
Two-weeks Prior
· At this time, follow-up contact should be made between all newspaper, radio, and television companies. If these companies were able to provide advertisement space, a sample of what is to be said or written should be provided at this time. This allows for modifications to be completed prior to any deadline.
· Poster and brochure art work should have been decided on and preparation made for the printing of this material. The accurate proofing prior to any printing completion is an absolute necessity. Make sure every word, date, and activity is completely correct. This will assist in avoiding future problems.
· The creation and setup of banners should also occur. These banners should be finished two-weeks in advance of the start date. The actual placement of these banners should occur between 10 days and one week of the begin of the program. Choosing the proper location to place these banners is equally important. They need to be seen on a regular basis by a large portion of the campus community. Locations such as Turlington Plaza, the Plaza of the Americas, and the Reitz Union should be utilized.
· Two-weeks prior to the start date would be a good opportunity to send e-mail messages along GATORLINK to a large percentage of the population. These messages should be short and to the point. Anything too long will not be given adequate attention. These provide unique chances to inform the university about upcoming events and ongoing projects. (provide example of a short e-mail message)
One Week Prior
· At one-week prior it is important to finalize all printed and public materials that are being produced. Contact with radio, television, and newspapers as well as the printers is necessary. At this point you are simply attempting to ensure that no mistakes will be made. Upon the reception of completed banners and brochures, efforts to place these materials should be immediately made.
· Banners should be appropriately placed around campus. This should occur prior to the overall start of the program as well as prior to specific activities or events that will be taking place. Thorough coverage of the campus is required. Every building, every dorm, every sorority and fraternity house should be covered. Also, frequent local hotspots should be targeted. Businesses such as hair salons should be utilized as well as community gathering places such as churches.
· A subsequent e-mail message should be sent. This message is again short and simply a reminder of when, where, and what activities will be occurring.

This marketing strategy is based on the beginning of a program. However, throughout the program, each of these elements should be continuously updated with relevant materials. As the semester continues, forthcoming activities should be emphasized in order to keep the campus on top of the workings of Healthy Gators 2000. Remember that every word written or said about these health promotion efforts is an opportunity to reach another segment of the population that had previously been out or reach. Positive feedback by individuals, media, or organizations can go along ways towards increasing credibility as well as participation.
2. Personnel
Personnel for implementation of the program will come from four distinct areas. The first area is the SHCC Wellness Committee. However, the health educators serving on this committee will most likely be more involved than the other committee members. Another source of personnel includes campus organizations such as the Campus Alcohol and Drug Resource Center (CADRC), Student Alcohol and Drug Educators (SADE), the Student Health Outreach Team (SHOT), and the Florida Association of Public Health Educators (FAPHE). Interns from various departments also provide personnel for the program. And finally, student volunteers can be used. However, student volunteers are not always dependable, and this should be kept in mind when delegating responsibilities.
3. Budget
The bulk of the program’s budget will go towards the development of print materials. Estimates for printing costs should be obtained. Once a dollar amount for the budget has been determined, the scope of print materials to be developed can be decided.

Barriers to implementation:
If the staff does not agree with the objectives of the program, it is unlikely to be
successful. For example, if they feel underage students should abstain from drinking, they may not agree with program goals to reduce, as opposed to eliminate alcohol consumption. Also, there must be cooperation between the committee and campus organizations to prevent unnecessary duplication of activities. For example, during previous Alcohol Awareness Weeks, efforts were coordinated for certain activities. However, many campus groups distributed essentially the same information instead of touching on all aspects of alcohol on a college campus. Another barrier could be the complexity of the program. Because alcohol abuse prevention is a complex health issue and adequate time is needed for a change in social norms to occur, at least one semester should be allocated for implementation.

Phase 6: Implement the Program
Delegate tasks and responsibilities based on strengths and limitations of personnel. Also, see section entitled “Educational Component”.

Phase 7: Evaluation


Summary



Appendix A
PRECEDE/PROCEED Framework
Phase 1: Social Diagnosis
Perform a needs assessment. Determine the quality of life concerns of the students and staff. Determine what the students’ health priorities are through short surveys attached to teacher evaluation forms in selected classes. Make the students feel like active participants in the process of program development. Inform those who participate in surveys that results will determine the most effective way to spend student fees and improve the health of students on this campus. Health promotion needs of a college community often include physical fitness, nutrition, mental health, alcohol and other drugs, human sexuality, and personal health care.

Phase 2: Epidemiological Diagnosis
Describe the health problems/concerns in detail. Obtain a complete view of the health problems/concerns in relation to the campus community. Determine the importance of health problems/concerns through objective measurement, rather than subjectively perceived importance. Use already existing data, and if possible conduct other surveys for additional statistics.

Phase 3: Behavioral and Environmental Diagnosis
Identify behavioral and environmental targets for intervention.
Behavioral Diagnosis
Step 1: Separate behavioral and nonbehavioral causes of the health problem.
Step 2: Develop an inventory of behaviors.
Step 3: Rate behaviors in terms of importance.
Step 4: Rate behaviors in terms of changeability.
Step 5: Choose behavioral targets.

Environmental Diagnosis
Step 1: Separate behavioral and nonbehavioral causes of the health problem.
Step 2: Eliminate nonbehavioral causes that cannot be changed.
Step 3: Rate environmental factors in terms of importance.
Step 4: Rate environmental factors in terms of changeability.
Step 5: Choose environmental targets.

Develop objectives for the program. Objectives should be specific and include who is expected to change, what change is to be achieved, how much of a change is to be achieved, and when the change is expected to occur.

Phase 4: Educational and Organizational Diagnosis
Identify the factors that influence behavior.
· Predisposing factors – knowledge, attitudes, thoughts, beliefs, and values prior to the behavior.
· Enabling factors – availability, accessibility, and skills that allow the behavior to occur.
· Reinforcing factors – attitudes and behaviors of peers, teachers, etc. that encourage the behavior to continue.
Phase 5: Administrative and Policy Diagnosis
Assess the resources that are needed to implement the program:
· Time
· Personnel
· Budget

Assess barriers to implementation:
· Staff commitment and attitude
If the staff does not have a good attitude about the program and is not committed to it’s implementation then program success is unlikely to occur.
· Goal conflict
Do the goals of the new program conflict with existing goals?
· Rate of change
Incremental change is easier to implement than radical change, ambitious change. The program’s implementation should be broken down into manageable pieces.
· Familiarity
Are the procedures and methods to be used familiar to the staff members? Is special training or orientation required?
· Complexity of the program
The more complex the program, the more difficult it is to implement.



Phase 6: Implementation
Delegate tasks, duties, and responsibilities based on strengths and limitations of personnel.

Phase 7: Evaluation
· Process evaluation – evaluate the implementation of the program
· Impact evaluation – evaluate the immediate effect of the program on target behaviors and their predisposing, enabling, and reinforcing factors
· Outcome evaluation – evaluate the overall effects on health status and quality of life indicators













Appendix B
Developing a Mass Media Campaign based on a Social Norms Approach
Whether the topic is alcohol, physical fitness, nutrition, or any other area of health, a mass media campaign based a social norms approach can be used bring about changes in behavior. Five steps have been identified in the creation of a successful campus media campaign:
1. Collect baseline data.
2. Develop a message that highlights positive norms.
3. Ensure credibility of the message source.
4. Deliver the message to the target population.
5. Support message retention within the population.

Collection of baseline data:
· Local data specific to the target population has been found to elicit the most interest.
· Do not display findings in a negative light but rather use a “social norms” approach to advertise positive aspects of the data/findings.
Developing the message:
· Four rules apply:
1. Keep it simple.
2. Keep it truthful.
3. Be consistent
4. Highlight the positive norms.

Ensuring credibility:
· Research conducted by the HECAODP (Haines, 1996) indicates students rate print material more believable than other media.
· Health professionals were rated more believable than peer educators, friends, or other interpersonal sources of information.
· Cite the source of information used. Surveys demonstrate students felt authorities “made up statistics to get students to stop drinking”.
· The more scientific the source the more believable it was rated.
· Silly, satirical, cute, or juvenile formats were found to work against the credibility of the message.
· Photographs of students (people who look like students…not too old, too young, not professional models, etc.) were found to attract the most attention.
Delivering the message:
· Use print media (newspaper, letters to the editor, classified ads, brochures, posters, banners, etc.) and supplement with other forms.
· Pretest the media before releasing.
· Conduct random surveys of students in high traffic areas to ascertain if the message is being received.
Message retention:
· Keep it simple.
· Make it credible.
· Repeat the message. Make sure students have exposure to the information.
· Provide incentives to students who can remember the slogan. (For example, hand out prizes donated by local business to persons who can recite the slogan.)





















Appendix C
Public Service Announcement (PSA)
To place a public service announcement first tailor the script to conform to a set length (15 seconds, 30 seconds, 60 seconds) and target population. Do not send the PSA to more than one station at a time.
Follow script mailing with a phone call to the station in case further information is needed. Many stations provide an affidavit of the number of airings and value of the donation time. Be sure to send a thank-you letter to the general manager and public service director.

WUFT-FM PSA
ATTENTION: Bill Beckett
FAX: 392-5741

NOTE: Include the contact name and phone number of the person responsible for the PSA, date of the letter, dates to be aired, and desired number of airings. Allow a minimum of two weeks before expected air time. According to this office, a fax is fine.

WUFT-TV PSA
ATTENTION: Sue Wagner
1200 Weimer Hall
Gainesville, FL 32611

NOTE: Include the contact name and phone number of the person responsible for the PSA, date of the letter, dates to be aired, and desired number of airings. Allow a minimum of three weeks before expected air time. WUFT-TV prefers all PSA requests to be mailed.

Appendix D
To: University of Florida Students, Staff, and Faculty
From: Healthy Gators 2000
On Saturday, March 3rd, 1998, Healthy Gators 2000 will be sponsoring “Claw Your Way to Health,” a One-mile and 5K run. Sign-up for the event will begin at 8 a.m. the day of the run with the run itself beginning at 9 a.m. Sign-up will take place in front of the Florida Gym. Everyone and their families are invited to attend. Cost of the run is $7 per person and includes a Healthy Gators 2000 t-shirt. We hope to see you there!















CURRICULUM INTEGRATION
In order for curriculum integration to become a viable component of this health promotion program, support must come from the top of the university’s hierarchy. It should be considered a given that Healthy Gators 2000 should have the backing of President Lombardi. In addition to him, endorsement from several key positions within Florida’s structure could provide wondrous results. The first of these positions is the Dean of Student Services. (The name of this person) holds great influence in the distribution of funds. Her backing would also allow give Healthy Gators 2000 added integrity throughout the university. However, in order for proper curriculum advances to be made, the (Dean of educational affairs?) must be lobbied. This individual controls more of the classroom and educational components of a student’s life at the University of Florida. Support from (his name) could carry a long ways towards instituting health themes in coursework school-wide. If advocacy from these two positions can be maintained, it can be used to influence the various deans of the 17 colleges. Hopefully, this will serve to begin a trend that flows down the power system. From the deans it should progress onto the multiple department heads. Through the use of interdepartmental messages, this system can be utilized. Once it reaches the level of the various departments themselves, personal messages and verbal motivation should be used to persuade the faculty and graduate assistants. Reinforcing techniques throughout the organizational structure of the university should be established to reward positive outcomes.
The development of internship positions in the Department of Health Education at the infirmary would also be a profitable venture. Establishing contacts with the departments of art, marketing, advertising, journalism, and others allows for the spread of health ideas while accepting the aid of more specialized individuals. Crucial in this endeavor is the feedback given to each department during and following the completion of the internship. Making sure that health gains are reported is a necessity. This will set the tone for future participation as well as the transmission of health knowledge.




















References
Butler, J.T. (1994). Principles of health education and health promotion (2nd ed.). Englewood, Colorado: Morton Publishing Company.
Green, L.W., & Kreuter, M.W. (1991). Health promotion planning: An educational and environmental approach. Mountain View, California: Mayfield Publishing Company.
Fish, C. (1996). Health promotion needs of students in a college environment. Public Health Nursing, 13(2), 104-111.
Keeling, R. (1997). Beyond programming: Health promotion for a Campus Community. Newsletter of the National Wellness Association, 13(1), 1,6-7.
Kolbe, L.J. (1992). The role of the federal government in promoting health through the schools. Report from the division of Adolescent and School Health, Centers for Disease Control, Journal of School Health, 62(4), 135-137.
Northern Illinois University. (1997). Health enhancement services (HES) [On-line]. Available: http://www.stuaff.nie.edu/uhs/hes.htm
Sullivan, C., & Bogden, J.F. (1993). Today’s education policy environment. Journal of School Health, 63(1), 28-32.
University of Florida. (1993). Graduate Catalog, University Record 1994/1995. Gainesville, Florida: Office of the University Registrar, Academic Publications.
University of Florida 1997-98 Student Guide.
U.S. Department of Health and Human Services. (1992). Healthy people 2000: National health promotion and disease prevention objectives (Publication 91-50213). Washington D.C.: Author.

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