John C. Erfurt

Socio-ecological stress, suppressed hostility, skin color, and Black-White male blood pressure: Detroit.

&NA; Four areas in Detroit were selected by factor analysis of all census tracts as varying widely in socio‐ecological stressor conditions. High Stress areas were marked by rates of low socio‐economic status, high crime, high density, high residential mobility, and high rates of marital breakup; Low Stress areas showed the converse conditions. All areas were racially segregated. The sample in each area provided about 125 married males, living with spouse, aged 25‐60, with relatives in the city. Blood pressure levels were highest among Black High Stress males and showed no difference among Black Low Stress and White areas. Suppressed Hostility (keeping anger in when attacked and feeling guilt if ones anger is displayed when attacked) was related to high blood pressure levels and percent hypertensive for Black High Stress and White Low Stress males; Black Low Stress men with high pressures were associated with anger in but denying guilt. White High Stress high readings were most associated with guilt after anger. For Blacks, skin color was related positively to blood pressure and High Stress males had darker skin color than Black middle class males. Black High Stress men with dark skin color and suppressed hostility had the highest average blood pressure of all four race‐area groups.

Socioecological stressor areas and black-white blood pressure: Detroit

Abstract 1. 1. Blood pressure does appear to vary with ‘socioecological niches’ or combinations of sex, race and residence, which reflect social class position as well as degree of social stressor conditions. Black High Stress males had higher adjusted levels than Black Low Stress males, while White High Stress females had higher adjusted pressures than White Low Stress females. Black High Stress females had significantly higher observed levels than Black Low Stress females. 2. 2. Black High Stress males had a significantly higher per cent of Borderline and Hypertensive blood pressure than other male race-area groups; White Low Stress females had the lowest of all eight sex-race-stress area groups. 3. 3. For Black males, the younger, overweight High Stress residents had significantly higher Borderline and Hypertensive levels than did a similar Black Low Stress subgroup. Further, for both groups, being raised in Detroit and not migrating from elsewhere was related to higher readings. Tests for age-stress area interaction, however, were not significant.

Worksite wellness programs: incremental comparison of screening and referral alone, health education, follow-up counseling, and plant organization.

Background. Worksite wellness programs vary considerably in their design. This study tested four models to compare effectiveness at controlling high blood pressure, obesity, and cigarette smoking. Methods. Baseline screening was conducted in four manufacturing plants. Site 1 offered screening only, with referral recommendations for those found to have CVD risks. Site 2 also provided health education information and classes. Site 3 added routine follow-up counseling and a menu of intervention types, and Site 4 added social organization within the plant. Random samples of 400 to 500 employees were rescreened at the end of three years. Results. Major improvements in risk levels were found with the addition of routine follow-up counseling and a menu of interventions (Sites 3 and 4, compared with Sites 1 and 2). More hypertensives entered treatment and showed greater reductions in blood pressure. Participation in worksite weight loss and smoking cessation programs was significantly increased, and those who participated showed significantly better maintenance of improvements where follow-up was provided. Discussion. The program models that offered short-term interventions promoted through local media suffered in comparison with models that included personal outreach to people at risk, a variety of health improvement intervention modalities, and ongoing follow-up counseling to help people make decisions and sustain health improvements.

Hypertension control at the work site. Comparison of screening and referral alone, referral and follow-up, and on-site treatment.

Four methods for improving hypertension control among employees were tested in one manufacturing plant each: screening and referral to a physician but no other intervention; referral to a physician and semiannual follow-up; referral to a physician and more frequent follow-up as needed; and on-site treatment or care by a family physician. All methods significantly increased the proportion of subjects under treatment, but only the three programs offering follow-up or treatment significantly improved the adequacy of control. At the end of the three years of the project, 56 to 62 per cent of the hypertensive employees in these three programs had blood-pressure readings below 140/90 mm Hg, and 86 to 90 per cent had readings below 160/95. In contrast, among employees who received no intervention after screening, only 21 per cent had readings below 140/90 mm Hg at the end of the study, and only 47 per cent had readings below 160/95. Employees selecting on-site treatment had the highest level of blood-pressure control, but this finding appeared to be due to self-selection of previously untreated patients into on-site treatment and to exclusion of employees with other medical problems. We conclude that work-site hypertension programs can produce substantial improvements in blood-pressure control if they include systematic, routine follow-up that provides employees with information about their condition and offers support for maintenance of therapy.

A family set method for estimating heredity and stress. I. A pilot survey of blood pressure among Negroes in high and low stress areas, Detroit, 1966-1967.

A pilot survey designed to test the feasibility of measuring genetic and stress variables as they relate to blood pressure levels was carried out among Negroes residing in high and low stress census tracts in Detroit, 1966–1967. Fifty-six “family sets” or 280 persons were interviewed and blood pressure recordings were taken by trained nurses. Each family set was composed of an index, a spouse, a sibling and a first cousin of index, and an unrelated person in the census tract matched to index. The method and findings of obtaining such family sets is discussed and found to be encouraging enough to initiate a larger study. It was also found that proportions of persons with hypertensive levels were significantly greater in the high stress tract (32 per cent; N = 102) than in the low stress tract (19 per cent; N = 113).

Improving Participation in Worksite Wellness Programs: Comparing Health Education Classes, a Menu Approach, and Follow-Up Counseling

Findings are presented from a study to compare four types of worksite wellness programs to reduce cardiovascular risks. Using a quasi-experimental design, the study was implemented in four large manufacturing plants, similar in demographic characteristics. At the end of the three-year study period, the two sites that included individual outreach and counseling had engaged about 46 percent of identified smokers and 54 percent of the overweight into smoking cessation and weight loss activities, respectively. This compares with fewer than 10 percent at the site offering health education classes only, and less than one percent at the control site. In order to achieve these results, the outreach and follow-up counseling was coupled with a menu of interventions for smoking cessation and weight loss, to accommodate the needs of people who cannot or will not participate in classes. The menu includes guided self-help, one-to-one counseling, mini-groups, and full classes.

Health promotion in small business: what works and what doesn't work.

Wellness programs were tested in three sites, representing three different types of small businesses. The sites ranged in size from 296 to 5 employees. The program at each site included: 1) wellness screening, 2) referral to community physicians for high blood pressure or cholesterol, 3) on-site wellness programs, and 4) long-term follow-up counseling. At sites 2 and 3, the respective company paid the full cost of these services; at site 1, the companys financial support was limited to 50% of the cost of screening. Results showed that participation in screening was severely reduced in the third company, and participation in follow-up and wellness programs dropped to zero. In contrast, there was full participation in all facets of the program at the two sites that paid all costs. Twelve-month follow-up data showed improvements in blood pressure, cholesterol, cigarette smoking, weight control, and oxygen uptake.

Controlling Hypertension: A Cost-Effective Model

Abstract A model system for controlling hypertension that was developed and tested in three industrial settings and three community settings is described. Data

Cost-effectiveness of work-site blood pressure control programs.

The cost-effectiveness of work-site hypertension programs was examined at three manufacturing plants. A fourth plant was used as a control site to estimate expected levels of hypertension control from screening without further intervention. The annual cost per hypertensive employee of the three intervention programs was

Heredity, stress and blood pressure, a family set method--I. Study aims and sample flow.

26.26 for semiannual follow-up,