Although diffusion of most innovations involves both passive and active features the spread of an innovation can be conceptualized on a continuum. Passive diffusio (in which the spread is unplanned, informal, and largely mediated horizontally by peers and social networks) lies at one end of the continuum and active dissemination (in which the spread is much more planned, formal, centralized and likely to occur • through vertical hierarchies) is at the other end. There are three general pathways by which health behavior programs or innovations can be actively disseminated. These include (1) "direct to practice" distribution of materials and tools, (2) enactment and implementation of policies, legislation, or regulations, and (3) a systematic, sustained, and long-term approach that uses multiple strategies and methods, includin bongoing evaluation over time (Owen, Glanz, Sallis, and Kelder, 2006).