The development of a program takes much time and dedication. However, much deliberation goes into the process as well. Chapter four of Community Health Promotion Ideas That Work holds three major themes that touch upon the importance of organization, consideration and reflection. A major obstacle to starting a program is determining what specific behavioral change is desired. How exactly does a group of people with conflicting ideas decide what problem to address and how? Kreuter, Lezin, Krueger, and Green (2003) list seven steps to determine the targets of change for program development. The steps include identifying various risk factors, determining their importance in affecting a specific behavior and establishing their degrees of changeability (whether or not the specific behavior can be easily changed or not).

Creating a two-by-two matrix, which will show which risk factors the group deemed the most significant and holds greater chances for change. The foundation on which the program will be grounded will be constructed with these risk factors. The last step is then to create objectives, specific measurable goals, for the program to attain. The Precede-Proceed Model is used to identify the causes of the risk factors. Why does the target group engage in such behaviors? The model identifies three types of factors that influence behavior. Predisposing factors entails knowledge, attitudes, beliefs, values and perception.

Reinforcing factors are interpersonal actions that reward or support a given behavior. Lastly, enabling factors are those that enable an action to be taken (how the environment allows or prohibits a specific behavior), (p 96). Lastly, the importance of evaluation is discussed. Evaluation is essential because it allows the program participants, staff, and interested groups to critique the program's progress. Kreuter et al.

emphasize that solid data is integral to a noteworthy evaluation. The sentiments of community members claiming the program "made a difference" is wonderful; having support from the community is always a plus. However, having statistical information that show positive changes among the targets population will hold much more significance to those who ultimately decide to continue or abort the program, the administrators, shareholders, and community leaders. The context of chapter four is important in program development because it provides steps on how to establish the backbone of the program. What will the program be based on? How does one decide what behavior to change? What do objectives entail? Chapter four answers all those questions by allowing risk factors to be prioritized and organized to create a foundation for the program. Furthermore, the chapter stresses the importance of keeping documentation and providing evidence for evaluation.

The concept of evaluation should be integrated in all aspects of the program to ensure staff, participant and administrative satisfaction throughout its implementation. In this chapter there is only one main issue or problem that was tackled by a group of concerned individuals. The problem was the high number of underage drinking and drug abuse in a particular community. The area in which this issue was encountered and of concern to all was a community called Whitehall. One of the main concerns was that youth aged 16-18 reported that they drink and drive and there was a lack of law enforcement. These young people could illegally obtain alcohol or cigarettes and therefore, put not only their life in danger but everyone else's.

A group of parents who called themselves Villagers Who Care were the first to take action on the problem. They soon joined forces with Whitehall YMCA, the YWCA, the PTA and the local cooperative extension office. The name was therefore changed to Our Kids Count Coalition. To put an end to the problem, that was affecting the entire community, the Our Kids Coalition put together a workshop in which many important figures attended to contribute and helped find a solution.

Rachel Warren the leader and coordinator of Villagers Who Care was present in the workshop, there was also a health educator Dick Loan and a Mayor Carl Crawford and many volunteers. During the workshop the idea of a grant application came up and the Whitehall school board joined the coalition. This grant was the instrument needed to try to solve the problem. The coalition worked on developing an application where no important information was left out. They included a clear case where they showed the many ways in which substance abuse compromised the quality of life of Whitehall. For example, school dropouts, absenteeism, crime, vehicular injuries and death (p.

83). In order for the application to be accepted by the Centre for Substance Abuse Prevention (CSAP), the coalition needed to develop a program that helped them untangle the problem and analyze it from different perspectives to be able to find a way to solve it. First the group established the overall program objective: "By the year 2000, as a result of coordinated prevention program, reduce fatal injuries among those aged 13-24 caused by motor vehicle crashes in the community to mo more than 17 per 100, 000 population. (The current local rate is 33 per 100, 000) " (p.

88). To achieve this objective there were a few steps the group had to follow. The first step was to list the risk factors of the potential behavioral and environmental factors known to be risk factors for vehicle injuries, and that may affect or explain why the young people in the community drinks and drives. Then differentiate between behavioral and environmental factors. Step three was to shorten the list to make sure to pay attention to the factors that would only help to achieve the program objective. The next step was to determine factor importance and step five was to determine changeability.

Since the coalition was dealing with youth, they had a greater opportunity to try to change them because the behavior was in its early developmental stage. In the sixth step the group created a matrix where they isolated the factors that were more changeable and more important. Two of these factors were drinking and driving and sales to minors. For each of these factors the group stated a measurable objective that incorporates the essential elements of the following question: Who will do how much of what by when? Two objectives are, Drinking and diving; by September 2000, we will reduce by 50% the number of youth aged 16 to 18 who report that they drink and drive. And the other objective, sales to minors; by June 1998, local government authorities will implement and actively support a policy calling for full enforcement of laws prohibiting sales of alcohol to minors. After following these steps the group developed an evaluation plan for the program following another set of steps and putting the program into practice.

With the grant that the Our Kids Coalition received from CSAP of $1. 3 million the coalition was able to increase enforcement of existing laws and therefore reduce sales to minors and reduce the number of underage drinking and driving by identifying and working with the causes. The causes were worked on by using predisposing factors, reinforcing factors, and interpersonal actions. The group worked on the program for a long time until they were sure it would work and make a difference in the Whitehall community.

Thanks to all the effort put in by the community members and the effective organization and implementation of the program, the community will soon see the results they want. Reference: Kreuter, M. W. , Lezin, N. A. Kreuter, M.

W. & Green, L. W. (2003). Community Health Promotion Ideas That Work. Second ed.

Sudbury, Massachusetts: Jones and Bartlett.