Glenn H. Hughes

CARDIA: study design, recruitment, and some characteristics of the examined subjects.

In 1984, a prospective cohort study, Coronary Artery Risk Development in Young Adults (CARDIA) was initiated to investigate life-style and other factors that influence, favorably and unfavorably, the evolution of coronary heart disease risk factors during young adulthood. After a year of planning and protocol development, 5,116 black and white women and men, age 18-30 years, were recruited and examined in four urban areas: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota, and Oakland, California. The initial examination included carefully standardized measurements of major risk factors as well as assessments of psychosocial, dietary, and exercise-related characteristics that might influence them, or that might be independent risk factors. This report presents the recruitment and examination methods as well as the mean levels of blood pressure, total plasma cholesterol, height, weight and body mass index, and the prevalence of cigarette smoking by age, sex, race and educational level. Compared to recent national samples, smoking is less prevalent in CARDIA participants, and weight tends to be greater. Cholesterol levels are representative and somewhat lower blood pressures in CARDIA are probably, at least in part, due to differences in measurement methods. Especially noteworthy among several differences in risk factor levels by demographic subgroup, were a higher body mass index among black than white women and much higher prevalence of cigarette smoking among persons with no more than a high school education than among those with more education.

Psychological, Social, and Health Consequences of Caring for a Relative with Senile Dementia

While providing home care for a family member with senile dementia is clearly extremely stressful, there has been little controlled research assessing the specific effects of this stress on caregiver psychological, social, and health functioning. To address this question, 44 primary caregivers of senile dementia patients and 44 matched controls completed a series of questionnaires and interview assessments. Caregivers reported significantly higher levels of depression and negative affect toward their relatives, and lower overall life satisfaction than controls. Caregivers also had significant impairment of their social activities, including visits with friends, vacations, and church attendance when compared with controls. Caregivers expressed less satisfaction with their social networks than did controls, but the groups did not differ in objective size of social network or number of network contacts. Caregivers reported poorer health, more prescription medication use, and higher utilization of health care than controls. Results clearly indicate the serious and wide‐ranging effects of the stress of caregiving, and reinforce the importance of providing comprehensive services for caregiving families.

Cardiovascular risk factors in young adults: The CARDIA baseline monograph

Gary R. Cutter, PhD*(1), Gregory L. Burke, MD (2), Alan R. Dyer, PhD (3), Gary D. Friedman, MD (4), Joan E. Hilner, MPH, MA, RD (5), Glenn H. Hughes, PhD (6), Stephen B. Hulley, MD (7), David R. Jacobs Jr., PhD (2), Kiang Liu, PhD (3), Teri A. Manolio, MD, MHS (8), Albert Oberman, MD (9), Laura L. Perkins, PhD (5), Peter J. Savage, MD (8), Joyce R. Serwitz, MEd (5), Stephen Sidney, MD (4), Lynne E. Wagenknecht, Dr PH (5)

Recruitment in the Coronary Artery Disease Risk Development in Young Adults (Cardia) study

Coronary Artery Disease Risk Development in Young Adults (CARDIA) is a longitudinal study designed to trace the development of risk factors for coronary heart disease in 5100 individuals 18-30 years old. The study will compare, by cross-sectional and longitudinal analyses, trends and processes involved in risk factor development by sex, race, age, and other sociodemographic characteristics. Participants for the approximately 4 1/2-hour baseline examination were randomly selected and recruited by telephone from census tracts in Minneapolis and Chicago, by telephone exchanges within the Birmingham city limit, and from lists of the Kaiser-Permanente Health Plan membership in Oakland and Berkeley. A major issue was the desirability of sampling approximately equal numbers by age, race, sex, and education as compared with sampling numbers representative of the population base. The recruitment goal of 5100 was achieved on schedule.

Alcohol intake and blood pressure in young adults: The CARDIA study

Associations between self-reported average daily alcohol intake and blood pressure were assessed in 5031 black and white men and women ages 18-30 from the Coronary Artery Risk Development in Young Adults Study (CARDIA). In general, intake was positively but weakly related to both systolic and diastolic blood pressure. Associations with systolic pressure were generally stronger than those with diastolic pressure. With average daily alcohol intake categorized as none, 0.1-9.9 ml, 10.0-19.9 ml, 20.0-29.9 ml, and 30.0+ ml, mean systolic pressure, adjusted for age, body mass index, education, smoking, and physical activity, increased progressively with increasing intake in black and white men and in white women. Mean diastolic pressure increased progressively with increasing intake only in white men and women, but was highest for those averaging 30.0+ ml per day in black women as well as white men and women. Mean pressures were also compared for those averaging 75.0+ ml per day (men) or 50.0+ ml per day (women) vs those reporting no intake. Differences in adjusted mean pressures for white men were 3.2 mmHg (95% confidence limits (CL) -0.3, 6.8) for systolic pressure and 1.7 mmHg (-1.6, 5.0) for diastolic pressure. In black men differences were 4.4 mmHg (1.4, 7.4) and 3.4 mmHg (0.6, 6.3), respectively. Differences in white women were 1.4 mmHg (-2.5, 5.3) for systolic pressure and 0.9 mmHg (-2.7, 4.5) for diastolic pressure and for black women, -0.2 mmHg (-4.3, 3.8) and 1.9 mmHg (-1.9, 5.8). Separate analyses in smokers and nonsmokers of the associations between alcohol intake and blood pressure suggested that associations may differ by smoking status in some sex-race groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Cook-Medley Hostility scale and subsets: relationship to demographic and psychosocial characteristics in young adults in the CARDIA study.

&NA; This report describes the relationships between scores obtained on the Cook‐Medley Hostility (Ho) scale and race, education, gender, and age in a sample of 5115 young adult participants in a prospective study of coronary heart disease (CHD) risk factors. Large differences were observed in total Ho scale scores and in six recently identified subsets according to race, education, gender, and age. Young black males with limited education had the highest Ho scale levels (mean = 26.2) while older white females with more education had the lowest levels (mean = 15.5). In all subgroups, education was inversely associated with hostility. The findings suggest a possible mechanism whereby CHD risk is higher in males than females, in the less educated than the more educated, and in blacks than whites. In all race and gender subgroups, total Ho scale scores and the six subsets were positively correlated with negative life events and negatively correlated with social support, supporting a pattern of psychosocial vulnerability found in other studies.

Cigarette smoking behavior is strongly related to educational status: The cardia study☆

The prevalence and correlates of cigarette smoking were examined in 5,116 men and women ages 18-30 years including both blacks and whites of varied educational levels. Prevalence of smoking was approximately 30% in each race by gender subgroup after adjusting for age and education. The prevalence decreased with increasing education, from 54% among participants with less than a high school education to 12% among those with graduate degrees (P less than 0.001). Cessation rates followed a similar pattern, with former smokers twice as common among those with more education. Differences in smoking prevalence across occupational groups were largely explained by differences in educational achievement. More educated individuals smoked fewer cigarettes per day and chose brands with lower nicotine yield. Race and gender were not strongly related to smoking prevalence. However, among smokers, whites reported smoking 50% more cigarettes per day than blacks but the average nicotine and tar content of the cigarette was nearly three times higher among blacks than whites. The strong inverse relationship between education and cigarette smoking patterns has important implications for public health efforts directed at the prevention of cigarette smoking.

The multiple risk factor intervention trial (MRFIT). V. Intervention on smoking.

Abstract The development, implementation, and results of the smoking cessation program of the Multiple Risk Factor Intervention Trial (MRFIT) are presented. The MRFIT is a 6-year clinical trial designed to investigate the effects of reducing cardiovascular risk factors—elevated cholesterol, hypertension, and cigarette smoking—in a group of asymptomatic men at high risk of cardiovascular disease. The men participated in an integrated intervention program that offered both group and individual formats, a structured maintenance program for those who stopped smoking, and an extended intervention program for those unable to quit initially. Results among the original 4,103 smokers included a 47.3% quit rate 4 months after program initiation and a 45.9% quit rate after 4 years. Of those reporting no smoking at 4 months, 56% were abstinent at all visits through 48 months. Most recidivism occurred soon after initial cessation, with 17% of the men who reported quitting at 4 months reporting smoking 4 months later. The quit rates were strongly associated with the initial level of smoking, with light smokers reporting higher quit rates and lower recidivism rates at all visits through 4 years. Results exceed trial goals whether measured by self-reports or by thiocyanate levels, an objective assessment of smoking behavior. Discussion focuses on understanding the variables contributing to smoking cessation and to achieving the goals of reduction of risk of cardiovascular disease.

Recruitment of elderly volunteers for a multicenter clinical trial: The SHEP pilot study☆

Few large trials have involved the elderly, and little is known about the feasibility of recruiting such participants for study and the validity of inferences drawn from them. This article reviews the recruitment experience of the Systolic Hypertension in the Elderly Program (SHEP) pilot study. That program involved five clinical centers, and contacted approximately 75,000 persons in order to enroll a cohort of 551 individuals over 60 years old isolated systolic hypertension. The enrolled cohort was somewhat older and more highly educated than those screened. Except for deliberate oversampling of blacks and those over 70 years old, the enrolled population resembled the U.S. population, although individuals in the SHEP group were initially healthier, and more likely to have had some college education than those in the general population. There was substantial variation among sites in number of staff hours spent per participant recruited. The SHEP experience indicates that older persons are willing to volunteer for clinical trials research and that problems of inference are probably not any greater for that age group than for any other.

Effects of Treatment for Isolated Systolic Hypertension on Cognitive Status and Depression in the Elderly

The Systolic Hypertension in the Elderly Program (SHEP) was designed as a feasibility study and in part dealt with the effects of the treatment of isolated systolic hypertension on cognitive status and depression. Subjects were 60 years of age or older with a systolic blood pressure of 160 mmHg or greater and diastolic of less than 90 mmHg; free of several specified illnesses or chronic conditions. These volunteers were randomly assigned to treatment (n = 443) and placebo (n = 108) groups. The behavioral assessments at baseline and 1 year later were the SHORT‐CARE instrument for depression, cognitive impairment, and disability and other tests of cognitive status (Digit Symbol Substitution and the Trail Making tests). Although the treatment regime was highly successful in controlling the hypertension, it did not have a significant impact on changes in cognitive function or level of depression; a behavioral benefit was not evident but the results are consistent with the view that an effective treatment regime for isolated systolic hypertension in the elderly can be behaviorally safe.