Preventing cardiovascular disease through community-based risk reduction: the Bootheel Heart Health Project.

OBJECTIVES: The purpose of this study was to determine whether a community-based risk reduction project affected behavioral risk factors for cardiovascular disease. METHODS: Community-based activities (e.g., exercise groups, healthy cooking demonstrations, blood pressure and cholesterol screenings, and cardiovascular disease education) were conducted in six southeastern Missouri counties. Evaluation involved population-based, cross-sectional samples of adult residents of the state and the intervention region. Weighted prevalence estimates were calculated for self-reported physical inactivity, cigarette smoking, consumption of fruits and vegetables, overweight, and cholesterol screening. RESULTS: Physical inactivity decreased within the intervention region, that is, in communities where heart health coalitions were developed and among respondents who were aware of these coalitions. In addition, the prevalence rates for reports of cholesterol screening within the past 2 years were higher for respondents in areas with coalitions and among persons who were aware of the coalitions. CONCLUSIONS: Even with modest resources, community-based interventions show promise in reducing self-reported risk for cardiovascular disease within a relatively brief period.

Physician advice to reduce chronic disease risk factors.

The U.S. Preventive Services Task Force recommends that physicians advise their patients regarding smoking cessation, weight loss, and physical inactivity. Few studies, however, have assessed the extent to which persons with these risk factors receive advice from their physicians. Using data from the 1990-1991 Missouri Behavioral Risk Factor Surveillance System (BRFSS), a random digit-dialed telephone survey of adults, we identified Missouri residents with one or more of these modifiable risk factors. We examined whether these persons reported being advised by their physicians to modify their behavior(s) within the past year. Of the 2,791 respondents, 764 (26%) smoked, 1,720 (59%) were sedentary, and 686 (23%) were overweight. Five hundred and thirty-five smokers reported having a routine checkup within the past year, but only 224 (42%) reported being advised by their physicians to stop smoking. Of the 1,246 sedentary persons who had a routine checkup within the past year, 192 (15%) reported being told by their physicians to exercise more. Of the 521 overweight respondents who had a routine checkup within the past year, 225 (43%) reported being advised to lose weight. Physician advice for these risk factors was less frequently reported among men, blacks, younger persons, and persons from rural areas. Although most Missouri residents with these modifiable risk factors reported seeing their physicians within the past year, less than half reported that they received advice from their physicians to alter their risk behavior(s). Further efforts are necessary to increase the effectiveness of physician advice for at-risk patients about quitting smoking, losing weight, and increasing physical activity.

Reliability of information on chronic disease risk factors collected in the Missouri Behavioral Risk Factor Surveillance System.

The Behavioral Risk Factor Surveillance System (BRFSS) is widely used by state health agencies to measure the prevalence of chronic disease risk factors. We completed a test-retest study to assess the reliability of the Missouri Behavioral Risk Factor Surveillance System. We conducted telephone reinterviews for 222 respondents of completed Behavioral Risk Factor Surveillance System interviews from March and April 1993. The second interview was completed between 6 and 30 days after the first interview. Agreement was high for sociodemographic variables (kappa values from 0.85 to 1.00). Reliability of information on chronic conditions and risk factors was also high, with kappa values from 0.82 for hypertension to 1.00 for current smoking status. Regarding cancer screening practices, reliability was lower for knowledge of the prostate-specific antigen test (kappa = 0.21) than for women's cancer screening practices (that is, the mammogram and Papanicolaou smear). Questions on attitudes toward environmental tobacco smoke showed lower reliability than did questions on individual actions to reduce exposure to environmental tobacco smoke.

Racial differences in the prevalence of cardiovascular risk factors among persons with diabetes.

Persons with diabetes are at greater risk of numerous health complications including coronary heart disease and stroke. We used telephone survey data to assess racial variations in the level of cardiovascular risk factors among Missouri diabetics. The four risk factors included physical inactivity, obesity, hypertension, and cigarette smoking. Each risk factor except smoking was more common among persons with diabetes than among non-diabetics. In addition, these risk factors were more common among Blacks than among Whites. Our results suggest the need for expanded efforts at controlling diabetic complications among person at high-risk.

Exposure to environmental tobacco smoke among Missouri children.

Childhood exposure to environmental tobacco smoke (ETS) increases the risk of lower respiratory infections (e.g., bronchitis and pneumonia), exacerbates childhood asthma, and increases the prevalence of fluid in the middle ear. Using self-reported telephone survey data, we examined the attitudes and practices of Missouri residents related to ETS exposure of children. Ninety-five percent of all respondents believed that ETS exposure is harmful to children and the percentage was similar for households with children (96%) and without children (94%). ETS was present in 42% of households and the percentage was similar for households with children (41%) and without children (44%). Childhood exposure to ETS remains a problem in Missouri, despite widespread awareness of the hazards. More active intervention is needed to reduce ETS exposure in the home.

Consumption of fruits and vegetables in Missouri.

High consumption of fruits and vegetables has been linked with a reduced risk of several important chronic diseases. The authors utilized telephone survey techniques to assess the level of fruit and vegetable consumption among adult Missouri residents. Only 28% of respondents reported consumption of five servings of fruits and vegetables per day. Older females had the highest rate of consuming five servings per day, while young males had the lowest rate. These findings, in conjunction with national data, show the need for increasing emphasis on the "5 A Day" campaign.

Variations in three cardiovascular disease risk factors in Missouri, 1986-1992.

In 1991, cardiovascular disease claimed the lives of over 22,000 Missourians. Recent studies show that much of this mortality can be eliminated through risk factor reduction and early detection. This article examines the regional and demographic differences in three major cardiovascular disease risk factors and outlines some steps that physicians and other health care providers can take to reduce their prevalence.

Patterns of obesity in Missouri.

Obesity is a major preventable health problem in Missouri and in the nation. Using survey data, we examined the prevalence of obesity in population subgroups and the overall trend. Prevalence of obesity was higher among blacks, middle-aged persons, and persons with less education or lower family income. Without additional attention, Missouri is unlikely to achieve the year 2000 objective of < or = 20% prevalence of obesity.

Demographic and socioeconomic differences in beliefs about the health effects of smoking.

To assess sociodemographic differences in beliefs about the health effects of cigarette smoking and passive smoke exposure, we recently surveyed 2092 adults in St. Louis and Kansas City, Mo. The percentages of respondents who knew that smoking causes lung cancer, emphysema, and heart disease were 76.7, 74.1, and 67.2, respectively. After multivariate adjustment, knowledge about smoking's health effects was generally lower among women, older respondents, those of lower education level, and current smokers. Blacks were generally less likely to appreciate the health effects of active smoking, but were more likely to acknowledge the health effects of passive smoking.

Surface observations for the evaluation of geophysical measurements from seasat.

The surface observations used in the initial assessment of Seasat are discussed with emphasis on their ability to describe the synoptic-scale winds over the ocean.