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Sampling Issues and Strategies

          Pyramids usually tend to be easy to understand and work well to capture tiered concepts, so pyramids have been used to depict the tiered nature of primary healthcare, secondary healthcare, and tertiary healthcare services, which is the inverse relationship of effort needed and health impact of different interventions and nutrition recommendations (Issel et al., 2022). The public health pyramid is divided into four categories: direct healthcare services, enabling services, population-based services and infrastructure services.

          The direct services level of the public health pyramid focuses on health programs for individuals. Due to the fact that this service focuses on individuals, the sampling may be a challenge because of who would be participating and non-participating in an intervention or non-interventions. Instead of randomly assigning individuals to either the program or a control group, it might be feasible for participants to become their own type of control (e.g., pretest and posttest) or perhaps future participants can serve as controls while they remain on a waiting list. Additionally, the costs can vary greatly depending on the type of data, and the frequency of data collection as well.

          The enabling services, as mentioned above, focuses on groups of individuals and are provided in a wide range of contexts. The sampling issue in this case would be because of the several outcomes. It may be a challenge to recognize and recruit a comparison group with the same characteristics as the program’s participants considering the broad range of contexts. Thus, health services programs may not be appropriate for experimental designs, but can be suitable for quasi-experimental designs instead. Perhaps initiating random assignments can be a possibility depending on the group or at a community level as well.

          The population-based level focuses on providing to the entire population. A sampling issue may be that, because this level focuses on a wider range of people, there are limitations of evaluation options to design that can be appropriately implemented among populations. In this case, time-series designs can be useful for evaluating population-level programs. Thus, existing data on populations are likely to be less costly to conduct as well.

          The infrastructure services level focuses on all said levels, and interventions touches on changing healthcare operations in an organization or the overall public health system. With that said, the outcome evaluation is likely to determine whether the evaluation show actual changes in the infrastructure or changes to the health status of patients (or clients). Perhaps repeated measures or a time-series design is suitable based on whether the focus is for long-term change, depending on the data that is available at the individual or population level. Additionally, this might be the case for studies of funding changes during economic hardships in the healthcare industry. Nonetheless, if program focuses on knowledge of individuals, many of the pretest and posttest designs  that use data and comparison groups, at the individual level, might also be suitable.

Spreading the Message: Drug and Alcohol Misuse

            My target objective from Healthy People 2030 is to reduce the substance use (tobacco, drug and alcohol) or misuse amongst middle to late adolescence, and help people with addiction by finding the treatment or resources they need. The target community that I anticipate meeting would be the low-socioeconomic status communities in Miami-Dade County, preferably Homestead and Florida City, as the number of children prone to being surrounding by tobacco, drugs and alcohol is prevalent. My main goal is to focus on young African American and Hispanic children, ages 10-18, who are exposed to early substance use and misuse. A sample size of no more than at least 100 adolescents, between the ages of 10-18, who are currently attending grade school, in Homestead and Florida City will be selected. The start date for the intervention will begin at the beginning of April and run until the first week of May, and participants will attend at least twice a week for the full 6-week term. This will conclude at least 8-interventional sessions with 8 pre-tests and 8 post-tests as well. The interventional sessions will consist of videos on health risks, behaviors and characteristics, and a summary on the overall topic. My idea for a health promotion program to meet my HP 2030 objective has the potential to improve substance abuse outcomes among adolescents; however, it does require further research.

          School students have previously attended sessions on awareness surrounding social pressures, enhancing social skills and equipping them with resources to help them with their behavioral skills. Young individuals who experiment with substances are more likely to develop a mental disorder, and other health risks such as cardiovascular, lung, liver diseases, Hepatitis B & C, STDs, HIV, stroke, cancer, unintended teenage pregnancies, poor school performance in young children and even death (Bauman & Phongsavan, 1999). In 2018, studies showed that approximately 9% of young people in this category engaged in alcohol use, 80% engaged in illicit drugs, and about nearly 7% engaged in the use of marijuana within one month (Healthy People 2030, 2020). 

          Proven methods of interventions in order to follow quality research and follow trends and areas where there needs to be improvement. School students attended different sessions on awareness surrounding social pressures, enhancing social skills and equipping them with resources to help them with their behavioral skills; whereas community-based programs included healthcare educational workers or local youth workers to educate the young population on behavioral techniques and create effective safe space groups to allow for open communication and prevent experimenting drugs or regular use of substances. Programs that include state and community interventions, far-reaching health communication interventions, ceasing interventions, surveillance and evaluations, and infrastructure and administrative programs are all different ways to maintain effective control  of substance use (Healthy People 2030, 2020).


Bauman, A., & Phongsavan, P. (1999). Epidemiology of substance use in adolescence: Prevalence, trends and Policy Implications. Drug and Alcohol

Dependence, 55(3), 187–207.

Healthy People 2030. (2020). Reduce the proportion of adolescents who used drugs in the past month – su‑05. Reduce the proportion of adolescents who

used drugs in the past month – SU‑05 – Healthy People 2030.

Issel, L. M., Wells, R., & Williams, M. (2022). Health Program Planning and Evaluation: A practical, systematic approach for Community Health.

Burlington, Massachusetts. Jones et Bartlett Learning.

Edited by Leah Abbondandolo on Oct 25 at 11:30pm 

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