Kim M. Gans

Dietary differences in smokers and nonsmokers from two southeastern New England communities

OBJECTIVEnPrevious studies based on 24-hour dietary recall data have shown that smokers tend to consume less healthful diets than nonsmokers. We tested this hypothesis using data from food frequency questionnaires (FFQs) in a group of men and women.nnnDESIGNnCharacteristics of smokers and nonsmokers were compared using data collected from a cross-sectional household health survey.nnnSUBJECTSnAdults aged 18 through 64 years from two communities in southeastern New England were randomly selected for the study and interviewed in their homes by trained personnel. The interview included questions on demographic and behavioral characteristics. Height, weight, blood pressure, and serum lipids were measured using standard protocols. The Willett FFQ was completed by 1,608 of 2,531 eligible respondents who made up our study sample.nnnSTATISTICAL ANALYSES PERFORMEDnRespondents were categorized as current cigarette smokers or nonsmokers. Demographic, behavioral, physiologic, and dietary characteristics were compared between smokers and nonsmokers by analysis of covariance with age as the covariate.nnnRESULTSnEligible respondents who did not complete the FFQ differed from respondents with respect to age, gender, smoking prevalence, and several other demographic characteristics. Smokers consumed more energy, fat, alcohol, and caffeine than nonsmokers. Smoking status was inversely associated with intake of vitamins A and C, dietary fiber, folate, and iron among women, whereas differences were smaller and not significant among men. Women who smoked consumed fewer servings of fruits and vegetables than nonsmokers, but this trend was not noted in men. The association between diet and smoking was only slightly diminished by multivariate adjustment for age, income, regular exercise, marital status, and working status but most clinically relevant associations remained. The interaction between gender and smoking was not statistically significant for most dietary variables.nnnCONCLUSIONSnThese results suggest that health promotion messages targeted to smokers should include dietary instructions, especially for women.

Synthesis of Findings and Issues from Religious ..Based Cardiovascular Disease Prevention Trials

Purpose: Widespread prevention of cardiovascular disease (CVD) requires significant aggregate lifestyle behavior changes. Extensive resources including money, time, access, facilities, materials, and programs are needed to bring about such behavior changes on a large scale. Over the past several decades, funds for large scale public health efforts and related CVD research have become more difficult to acquire, and prevention efforts have been shifting to state and community sites. Thus, large scale behavior modification for CVD prevention requires active efforts to access resources from partnerships with multiple private sector organizations. Methods: Religious organizations (ROs) are a potentially valuable channel with many advantages for undertaking behavior change programming in partnership with public health researchers. ROs have a broad, direct “reach” with people and provide social support structures, facilities, volunteers, communication channels and access to many sub-populations as well as a compatible mission and history of interest in health. In spite of the many advantages of partnerships between CVD health researchers and ROs, very few formal research studies have been conducted. Existing reports have emphasized the feasibility and powerful benefits of implementing RO-based health programs; however, little data or formal hypothesis testing have been reported. Very few formal CVD research projects have employed scientifically acceptable research designs with random assignment of intact groups to intervention and comparison conditions. Results: In this review, conducted by the current authors, only six projects have been identified that meet these more rigorous scientific criteria. In a discussion of these projects, we classify RO-based studies into four levels of involvement of the RO: 1) use of ROs as sites for recruitment and tracking of experimental subjects; 2) use of RO facilities to conduct interventions; 3) involvement of RO members in delivering behavior change programs; and 4) the addition of significant religious components as an integral part of the intervention. This paper discusses the design, results and implications of these studies including information on what we already know about conducting research with ROs, gaps in existing research and recommendations for future studies. Conclusions: There is enormous untapped potential for RO-based CVD prevention research, but considerably more work is required to achieve the level of research that is currently conducted in other channels such as worksites and schools. Health practitioners/researchers and ROs are increasingly seizing the opportunity for partnerships to improve health. The knowledge gained from these projects and their documented successes will hopefully encourage other components of the public health system such as hospitals, managed care organizations and departments of health to continue developing ways of including ROs in health research and behavior change programming.

Rate your plate: An eating pattern assessment and educational tool used at cholesterol screening and education programs

Elevated blood cholesterol has been established as an important risk factor for coronary heart disease (CHD) (1-3). Currently, approximately 57% of adult Americans have blood cholesterol levels of200 mg/dl or higher, with approximately 27% having high levels of 240 mg/dl and above (4). The development of portable desktop analyzers, which allow for simple, rapid and accurate measurement of cholesterol levels, has permitted widespread screening for blood cholesterol. Public blood cholesterol screenings offer an opportunity for detecting large numbers of individuals with high blood cholesterol levels as a supplement to those identified by traditional physician office testing (6). In October 1988, the National Heart Lung and Blood Institute (NHLBI) published recommendations regarding public screening for measuring blood cholesterol (7). This report stressed the need to educate participants concerning the relationship of diet to blood cholesterol, the importance of a balanced healthy eating pattern to lower blood cholesterol, and clear information on cholesterollowering dietary alternatives (7). In order for screening staff to provide participants with relevant cholesterol-lowering dietary recommendations, an assessment of their current eating pattern status is necessary. Most generally accepted dietary assessment methods, e.g., food diaries and lengthy food frequency questionnaires, are too expensive and time-consuming for a community screening setting, or do not give an indication of the usual eating pattern, i.e., 24 hour recall (8-16). Brief dietary assessment tools are becoming increasingly popular (17-19), but there is still a need

Effects of a community-based intervention on physical activity: the Pawtucket Heart Health Program.

OBJECTIVESnThe effect of a community-based physical activity program in Pawtucket, RI, was evaluated relative to one in a comparison community.nnnMETHODSnCross-sectional surveys of 7529 residents of Pawtucket, RI, and 7732 residents of the comparison city were conducted at 2-year intervals during 7 years of intervention.nnnRESULTSnThere were no differences in self-reported knowledge of the benefits of physical activity, attempts to increase exercise, or prevalence of physical inactivity between Pawtucket and the comparison community.nnnCONCLUSIONSnFuture community-based physical activity interventions should attempt to involve a wider range of individuals.

A successful physician training program in cholesterol screening and management

METHODnThirty-six resident physicians received a blood cholesterol training program which included training in blood cholesterol screening using a fingerstick method and a desktop analyzer, diet assessment and counseling, and a management protocol for follow-up diet and drug treatment. The program also included feedback to residents about their blood cholesterol screening activity, incentives, and biweekly articles in the department newsletter.nnnRESULTSnBetween 1986-1987 (baseline) and 1987-1988 (intervention), the percentage of the target patient population (ages 20-65 years, nonpregnant, not screened in the previous year) that was screened for hypercholesterolemia in this primary care practice increased from 16.2 to 23.2% [rate difference (RD) = 7.0; 95% confidence interval (CI) = 4.75-9.25]. The mean value of the screening tests decreased from 5.36 mmol/liter (207.2 mg/dl) to 5.08 mmol/liter (196.6 mg/dl; t = 2.98, P = 0.003) and the percentage of the population screened needing further evaluation decreased from 36.8 to 27.6% (RD 9.2; CI = 2.00-14.00). In the intervention year, compared with the baseline year, patients with a borderline blood cholesterol and cardiovascular risk factors were more likely to have a follow-up test (28.8% vs 11.9%, RD = 16.9; 95% CI = 0.80-33.00) and the low-density lipoprotein cholesterol test was used less for screening (8.2% vs 19.4%, P less than 0.0001). Conclusion. We conclude that this program was effectively integrated into a busy primary care practice, leading to improvement in blood cholesterol screening and management practices.

Implementation and Institutionalization of Heart Health Programming in Schools: The Pawtucket Heart Health Program Experience

Abstract The Pawtucket Heart Health Program (PHHP) is a community research and demonstration project examining whether population-based interventions to decrease the prevalence of risk factors will reduce CVD morbidity and mortality. Intervention programs and materials have been promoted and implemented using a variety of channels including worksites, churches, physician offices, and schools. School interventions which targeted all 23 Pawtucket public and parochial schools included: curriculum materials; Heart Healthy Cook-Offs; Get Fit USA, an exercise campaign; after school Heart Health Clubs; Cholesterol SCOREs (screening, counseling, referral events); STOP, a smoking prevention program; Fun Foods for Kids, a nutrition program for young children; risk factor reduction campaigns for faculty and staff; and consultation to improve the school environment, i.e. smoking policy, school lunch. These comprehensive school interventions were designed to improve the heart health knowledge, attitudes, and behaviors...

A cholesterol screening and education program: Differences between older and younger adults

Abstract An estimated 24 million older adults are candidates for medical intervention for high blood cholesterol (BC) levels. Currently, little is known about the value of combining BC screening and education approaches for older adults. The current study investigated differences in recall and compliance between older (age 65 and above) and younger (age 18 to 64) individuals who attended a BC SCORE (Screening, Counseling and Referral Event) offered by the Pawtucket Heart Health Program (PHHP). SCORE participants were telephoned four to seven months after their initial SCORE contact to answer a 15-minute survey. With a few exceptions, results showed that older participants did not differ from younger in their recall of dietary, follow-up and referral recommendations. In addition, older participants were as likely as younger to say they changed their diet, contacted their physician and increased exercise as a result of the SCORE; however, more older than younger participants said they returned to PHHP for a follow-up measurement. Overall, there was no age difference in terms of accurate recall of BC level (within 5 mg/dl); however, more younger than older individuals accurately recalled their BC risk category and their exact BC number. Participants who said they visited their physician after the BC SCORE were asked what their physician told them. Physicians were more likely to say that high BC levels were “OK” for older than for younger participants. Implications for future BC screening and education activities that deal with older adults are discussed.

A Strategy for Accurate Collection of Incremental Cost Data for Cost-Effectiveness Analyses in Field Trials

With many community field trials or education interventions, the cost-effectiveness analyses are not given a high priority. However, this type of evaluation is important for purposes of future adoption of the intervention. The accurate measurement of costs can best be served by prospective collection of data This article describes a methodology for collection of cost data that coincides with the intervention implementation. This cost analysis strategy has seven discrete steps. The Minimal Contact Education for Cholesterol Change study is used as an example of the use of this strategy. This intervention provides cholesterol education at six different levels of intensity at four different sectors. The intensity levels vary along a continuum from very little education input to a maximum level of intervention that might be practical in a screening setting. The cost-effectiveness analysis component of the study will identify the incremental cost- effectiveness of each intervention along the continuum.