Monday, October 24, 2005—8 a.m.-6 p.m.
Tuesday, October 25, 2005—7 a.m.-noon
- Constructing a Circular Slide Chart To Increase
Awareness About Walking and Running at Public-Access
Venues
Authors
C.D. Pettitt1; T. Espinoza1; S. Orth1;
R. Pettitt2.
1Mesa County Health Department-Steps to a
Healthier Mesa County, Grand Junction, CO;
2California State University, Fresno, Fresno,
CA.
Background
We recently developed a circular slide chart (CSC) that
informs the user about public-access venues for
walking/running. Our CSC also informs the user on caloric
expenditure for walking/running on these paths/trails.
This presentation summarizes the process of constructing
and implementing a community-specific CSC.
Methods
A capacity evaluation is necessary to identify
paths/trails accessible to the public. Subsequently,
distance and fractional grade for each path/trail is
determined. A majority of this information can typically
be obtained from Hiking books, the Internet, and Parks and
Recreation brochures; however, altimeter data, global
positioning system data, or similar technology is more
precise. Using a combination of these methods, we designed
a two-sided CSC for Mesa County, Colorado.
Results
Side 1 labels 64 paths/trails numerically on a county map.
The user turns the chart to reveal information about a
specific path/trail including round trip distance,
difficulty rating, along with "caloric costs" for walking
(3.5 mph) and running (5.0 mph), respectively. Paw symbols
denote "dog-friendly" paths/trails. "Caloric cost" values
were derived using previously validated equations that
take into account speed, metabolic equivalent of resting
oxygen uptake, oxygen equivalent of walking versus
running, horizontal component of activity, vertical
component of activity, and the caloric equivalent per
liter of oxygen. These "caloric cost" values, located on
Side 2, determine the number of calories expended for
walking/running on a given path/trail. Specifically, the
user aligns their body weight, ranging 100 to 290 lbs,
with a specific calories burned value.
Discussion
Use of our CSC was marketed with a community health
program as part of the Steps to a HealthierUS Initiative.
We also offered this CSC as an educational tool for
healthcare professionals to use in their offices as a
simple way to provide, community-specific, physical
activity prescriptions to their patients.
- Promoting Healthier Choices at Restaurants: Just Ask
Us!
Authors
C. Bordes1; R. Ackerman2.
1New York State Department of Health, New York,
NY;
2Mather Hospital, NY.
Background
The average American eats 4. 2 meals out in a week, and
approximately one-third of his or her calories are
consumed at restaurants. Foods eaten away from home
generally have higher total fat and cholesterol levels.
The NYS Healthy Heart Program (HHP) in an effort to
promote the heart health of the state's residents has
provided funding to select organizations to promote
healthier options at local restaurants. One of the funded
programs is the Suffolk County, New York restaurant
program- Just Ask Us! (JAU). This intervention is
coordinated by J.T Mather Hospital, a State HHP-funded
organization.
Methods
The Mather Hospital JAU! restaurant campaign provides
people with more healthful choices when eating away from
home. As part of the program, a nutritionist recruited
fourteen restaurants, and in collaboration with the
restaurant's chef reviewed each menu to identify or create
healthier options. In addition, restaurant owners and
servers were trained on promoting the healthier choices.
The program also included the provision of promotional
materials to the restaurants. Promotional activities
involved extensive advertising in papers, healthier option
discount coupons, and presentations at senior centers.
Results
All the Just Ask Us! restaurants have voluntarily added or
identified 2-3 healthier menu options. About 28% of the
participating restaurants have demonstrated an increase in
healthier alternatives ordered. As part of the campaign,
restaurant servers have suggested a healthful modification
or choice to customers. Some of the choices combined with
special promotion incentives were low-fat salad dressing,
no added salt, broiled rather than fried entrees, a
portion of the dish to go.
Discussion
The program is in its second year of implementation, and
during this period it will be expanded. The expansion will
include eliciting additional restaurants participation,
and partnerships with other organizations involved in food
preparers training.
- "Success Weight-Loss" Program Lives Up to Its Name
Authors
D. Dunn1; K. Bonham1.
1ACAC Fitness and Wellness Centers,
Charlottesville, VA.
Background
Traditional diet counseling has been narrow in its attempt
to address the different issues that clients experience
with food. The idea of "prescribing" a calorie level
"diet" is outdated and ineffective, at best. With the
borage of nutrition information dive-bombing people at
every turn, getting the correct information is difficult.
At ACAC Fitness and Wellness Centers in Charlottesville,
the Food and Diet staff aimed at creating a better
solution to America's rising obesity. The progressive
approach that emerged is geared towards successful weight
loss through a combination of nutrition education and
lifestyle coaching, using metabolism assessment as a tool
for meal plan development. This novel approach to diet
counseling was developed as a way to get people to bridge
the gap between "knowing what to do" and actually creating
the behavior change.
Methods
Provide in-depth nutrition education combined with
wellness coaching techniques and Med Gem metabolism
assessments in an 8 week program, titled, "Success Weight
Loss." The first four weeks covers nutrition education and
involves two 1-hour sessions to cover whole grains, fruits
and vegetables, proteins and fats. The next 2 sessions are
half hours that cover portion sizes and the developed meal
plan (based on ADA recommendations). The second four weeks
of the program are focused on overcoming the individual
obstacles that a client may experience. The program is
taught by Registered Dietitians who have undergone
wellness coaching training.
Results
A decreased risk for DM, CAD, HTN, and reduction of, or
stopping of medications was seen. In six months an average
of 73 pounds were lost per month for approximately 15-20
clients. The average weight loss follows the prevailing
recommendation of 1-2 lbs lost per person per week,
encouraging safe and maintainable weight loss.
Discussion
The innovative "Success Weight-Loss" program is an answer
to the dilemma of providing accurate nutrition information
and achieving the behavior change, resulting in healthy
body weight and decreased risk of various disease states.
-
Student Artists for Healthy Lifestyles Visual Arts
Contest
Author
A. Lorenzo, Arizona Department of Health Services,
Phoenix, AZ.
Background
Bi-national project, collaboration between American
Academy of Pediatrics, AZ Dept. of Health Svcs; AZ Dept.
of Education, US Mexico Border Comm, Oficina de Salud
Pública de la Frontera Sonora AZ of the Secretaría de
Servicios de Salud de Sonora. Goal: promote healthy
lifestyle behaviors among high school students by having
them develop messages on good nutrition, physical
activity, and being tobacco-free.
Methods
Open to students grades 9 through 12, in selected schools
w/in AZ STEPS communities. Entries need be visual art,
i.e.: Print-poster, painting; Video-commercial, dance;
Internet - web design, video game. Entries to focus on
one/combo of healthy lifestyles-good nutrition, physical
activity, being tobacco-free. Spanish/O'odham language
entries accepted. Judges consisted of creative directors &
associated personnel. Entries judged on strategy, creative
concept, overall look. Schools received $500 grant for
arts program. Students received t-shirt, winners received:
1st-$100, plaque, 2 tickets to AZ Diamondback's baseball;
2nd-$50, plaque, 2 tickets to AZ Diamondbacks baseball;
3rd -$25, plaque, 2 tickets to AZ Diamondbacks baseball.
Results
193 students from 8 schools submitted 91 entries. Through
contest was able to generate an interest in healthy
lifestyles among high schools students opening the doors
for further discussion by them and amongst them.
Discussion
Teens are hard-to-capture audience-hip, MTV generation
being cool is what it's all about-bigger issues to
overcome. Contest proved good method for reaching this
unique audience in a way that captured their interest.
Through visual arts contest we were able to get their
perceptions on these health topics & how to capture their
attention. Had to learn about topic to make appropriate
message teens would find visually appealing-messaging for
teens by teens. Entries submitted will be used in
marketing campaigns for teen audiences. Next year, plan to
have the contest open to high schools statewide. Contest
strengthened working public health relationship between
the two borders of Arizona and Sonora.
-
Community Approach to a Healthier Lifestyle
Authors
M. Pollan1; M. Flautt1.
1Mississippi State University Extension
Service, Stoneville, MS.
Background
Mississippi has the highest prevalence of overweight and
obese residents in the United States. Mississippi is also
second in prevalence of diabetes and third in heart
disease. With this knowledge, MSU Extension Service and
Delta Coalition for Disease Prevention took a lead role in
an 8-week educational program designed to teach healthy
eating and exercise habits to the underserved population
of the Mississippi Delta.
Methods
Local residents were invited to participate in Shape-Up
Washington County free of charge. During the initial
meeting participants had individual interviews with a
dietician and data collected (height, weight, BMI).
Pre-tests were also given to indicate baseline diet and
exercise habits. As part of the educational sessions,
participants were given step-counters, Healthy Habits for
Life notebooks, and weekly handouts. At the final meeting,
ending weights were measured and post-tests were
administered.
Results
Of the 1000 total participants, data could only be
analyzed from the 341 persons who attended both the first
and last sessions. Final data indicated that 71% of the
participants maintained or lost weight during the program.
Of these participants the total weight lost was 954
pounds. Post-test results revealed a significant increase
in the categories of fruit and vegetable intake, regular
exercise, and step-counter usage.
Discussion
By hosting educational sessions as mentioned above,
participants learn that lifestyle changes are necessary
for long-term weight loss and disease prevention. While
the data show that there was weight gain by some
participants, it is important to remember that the most
basic step in the Stages of Change Theory is the desire to
learn more about a topic. This program was successful in
educating those who were ready to learn and in helping
those who were ready to change. Programs of this type are
useful in building awareness and affecting change at the
individual, family, and community levels.
-
Healthy Choices—Healthy Families
Authors
G. Spires1; T. Clark1.
1American Heart Association, Little Rock, AR.
Background
- Arkansas has seen a 77% increase in obesity for
1991-2000.
- Over 60% of Arkansas adults are at an unhealthy weight
and 37% of these are obese.
- Poor eating habits are directly linked to the burden of
chronic disease in Arkansas and the increased risk of
Arkansans.
- One third of children entering kindergarten are already
overweight or at risk of becoming overweight.
The American Heart Association in partnership with the
Garland County Department of Health and Human Services
with a grant funded by the Stroke Belt Consortium
implemented a concurrent program dedicated to monitoring,
promoting, improving, and evaluating nutrition and
physical activity for WIC (Women, Infants and children)
recipients.
Methods
Partner with and build onto an already existing program
with new and innovative ideas addressing the problem of
obesity among young, low-income families in rural
Arkansas. A cohort of 200 women, infant and children
enrolled in the Garland County WIC program was asked to
participate in a six-week program entitled "Healthy
Choices; Healthy Families. Base line data was taken during
their initial application for WIC assistance by the
nutrition supervisor. Each individual or family was
assessed each week for weight, Body Mass Index and blood
pressure. They were also surveyed for changes in diet and
physical activity. Incentives such as pedometers and
grocery store certificates were awarded.
Results
4 classes have been completed and evaluated over a 5 month
period resulting in a 20% decrease in weight and 32%
decrease in blood pressure.
Discussion
Counseling one-on-one and giving appropriate resources can
produce beneficial changes in diet, weight and
hypertension.
-
Narratives for Health: Sex, Secrets, and HIV
Author
M. Rivera-Trudeau, Centers for Disease Control and
Prevention (CDC), Atlanta, GA.
Background
The HIV/AIDS epidemic is a serious threat to the Hispanic
community. In 2001, among Hispanics aged 35 to 44,
HIV/AIDS was the third leading cause of death among men
and fourth among women. Although many Hispanic communities
are increasingly engaging in the fight against HIV/AIDS,
some have been slow to join the effort, partly because of
cultural values such as machismo and a reluctance to
acknowledge sensitive yet risky behaviors, such as
homosexuality.
Methods
To provide the Hispanic community with a model for healthy
decision-making behaviors and to reduce stigma surrounding
HIV/AIDS, CDC developed a novel approach called Narratives
for Health. This project proposes using telenovelas to
reach the US Hispanic population with accurate HIV
prevention information. Telenovelas are Latin American TV
shows that develop plots over time, thereby attracting
audiences day after day, month after month. We developed
HIV prevention vignettes that writers and producers could
incorporate into their telenovela storylines. We used
epidemiologic and demographic data, formative research
results, and anecdotal information from grantees. We
followed Miguel Sabido's formula for successful telenovela
storylines (hook, trigger, crisis, cliff hanger,
resolution). The vignettes convey effective HIV prevention
messages through themes, characters, and visual content
relevant to Hispanic viewers. The characters model
behaviors that support CDC's Advancing HIV Prevention
initiative. One vignette depicts the effect of an HIV
diagnosis on a 28-year-old farm worker, Pedro, and his
social network of family, friends, lovers, partners, and
boss.
Results
This model has been used on a tip sheet developed for the
Norman Lear Center, and the TV show "ER" has picked up 2
of the storylines. Narratives for Health has shown that
writers and producers are receptive to tackling serious
health issues and that HIV-related issues create the
personal drama that can provide dramatic storylines for
telenovelas.
Discussion
Discussion will cover the role of the telenovela as an
approach to reach Hispanic populations in the US.
-
Implementing the Vision: Healthy People Living in a
Healthy Community
Author
L.W. Meredith, Marin County, Department of Health & Human
Services, San Rafael, CA.
Background
Marin County, is located on the California coast north of
the Golden Gate Bridge. The population is 80 percent white
and can be characterized as educated and affluent, with a
decidedly liberal bent. In 2000, the Department of Health
& Human Services (HHS) conducted its first scientific
survey of health conditions and practices. The data
documented that serious threats to personal and community
health were created by: youth alcohol consumption,
particularly binge drinking; tobacco; poor diet; and
physical inactivity.
Methods
HHS initiated a community-focused approach to changing the
social, physical and policy environment to support healthy
behaviors in the workplace, schools and community. Guiding
concepts included: Determinants of Health (CDC); Spectrum
of Prevention; the tobacco control movement; youth
involvement; and, environmental prevention approaches.
Workplace: A "walk the talk" philosophy energized policies
and practices that incorporate "healthy choices" into the
daily life of employees: healthy food policy, food
tasting, converted vending machine, physical activities
and employee publications. Schools: A Health & Nutrition
Collaborative assisted schools assess current practices
then implement school food policies, garden projects, and
nutrition education. Youth surveyed youth, made
recommendations, and developed best practice models.
Community: Replacing the County Fair's prime sponsor, a
brewery, with a coalition of health agencies and creating
a Prevention Pavilion, highlighted family values and
healthy choices at the fair. Media advocacy keeps healthy
choices in the public eye. Community and professional
collaborations support healthier choices earlier in life.
Results
Social dialogue in the workplace, at schools and in the
community increasingly involve issues of health and its
maintenance. Another community health survey is currently
underway.
Discussion
Marin County is implementing the vision "healthy people
living in a healthy community". This PowerPoint documents
the complimentary approaches that support healthier
choices earlier in life.
-
Liver Wellness—An Effective Approach To Prevent
Substance Abuse and Hepatitis
Author
T.K. Thiel, Hepatitis Foundation International, Silver
Spring, MD.
Background
Our goal is to alleviate health disparities and to
motivate young adults of all races and ethnic backgrounds
to protect themselves and to avoid activities that can
cause life-threatening diseases including viral hepatitis,
AIDS, etc.; to assess their own risk behaviors; to adopt
healthier lifestyle behaviors; and to seek medical
evaluation of the status of their liver. The absence of
information about the liver and hepatitis in education
programs over the years has been a major factor in the
spread of viral hepatitis through unknowing participation
in liver damaging risk behaviors. All young adults need to
understand the importance of the liver and how viruses and
drugs can damage its ability to keep them alive and
healthy. Many who are currently infected were unaware of
the risks that exposed them to viral infections and
ultimate serious life altering health problems.
Methods
Knowledge is the key to prevention. Unique and effective
communication techniques presented in a lecture and video
presentation will provide participants with
easy-to-replicate motivational and memorable analogies to
encourage and empower their students/clients to take
responsibility for their own healthcare.
Results
The ultimate goal of this presentation is to help teachers
and students identify their own risk behaviors; to
motivate them to seek testing; to accept hepatitis A and B
vaccines as a routine health preserving necessity; to
avoid transmitting infections to others; to understand the
importance of participating in their own health care,
thereby, reducing the use and abuse of drugs. Extensive
evaluations following each training session for teachers,
healthcare providers, and substance abuse counselors have
clearly demonstrated that once informed of a few vitally
important liver functions, they, themselves, have been
motivated to avoid liver damaging activities, and to adopt
healthier lifestyles.
Discussion
Participants will be asked to evaluate these new teaching
methods designed to enhance retention of information and
to promote healthy lifestyle behaviors.
-
HATE (HIV, Alcohol, Tobacco, Emergency) Free Summers
Lead to Healthy Living
Authors
D.M. White1; O. Brown1; T. Savage1;
B. Ayomike1; L. McClain1.
1Howard University Hospital Communiversity,
Washington, DC.
Background
In the District of Columbia, unintentional accidents were
the leading cause of death for ages 1-14 years, which
accounted for 25.9 percent of a total of 27 deaths in
2003. Unintentional injuries are also a leading cause of
disability, which carries additional burdens to society in
terms of lost work productivity and high costs of medical
care and rehabilitation. In the 1-4 year age group, there
were 15 deaths, an increase of one from 1999. Among
children 5-9 years, deaths decreased by one, from eight to
seven. For intentional injuries homicide continues to be
the leading cause of death among young persons aged 15 to
24 years as a whole and the leading cause of death for
Blacks/ African Americans.
Methods
Parents, children, and pre-teens learn about the benefits
of remaining HIV, Alcohol, Tobacco, and Emergency (HATE)
Free. Campers receive scholarships to attend District of
Columbia Parks & Recreation programs from June - August
and receive free breakfast and lunch through the Free
Summer Meals Program. Bus transportation is provided by
contributions to the Howard University Hospital Boarder
Babies Prevention Program. Communiversity Interns funded
by Howard University utilize the bus trip to and from camp
to discuss an age specific curriculum, while camps provide
fun and safety during the summer months.
Results
The summer programs began in 1997 and have served nearly
1000 children and youth between the ages of three and 18.
This program and services provide children, pre-teens and
parents with opportunities to learn, grow, and thrive
during the summer months. Parents gain school readiness
skills.
Discussion
Howard University Hospital Communiversity is proud to
present HATE Free Summer Fun. This program provides
low-income children, youth and parents living in the
Howard University community with life skills and
opportunity to have fun, educational, nutritious and safe
summers.
-
Evaluation of the American Lung Association's "Breathe
Well, Live Well: An Asthma Management Program for Adults"
Authors
B.M. Kaplan1; C. Kohler2; J. Mangan3;
L. Gerald4.
1American Lung Association, Washington, DC;
2School of Public Health, University of Alabama
at Birmingham, Birmingham, AL;
3University of Alabama at Birmingham,
Birmingham, AL;
4Lung Health Center, University of Alabama at
Birmingham, Birmingham, AL.
Background
Asthma remains a health problem of staggering proportions.
One of the basic steps toward asthma management is asthma
education. While there have been numerous programs and
initiatives targeting children with asthma there is a lack
of comparable focus on the needs of adults with asthma.
The goal of the American Lung Association's three-year
CDC-funded grant project is to adopt and disseminate a
validated adult asthma education program. In year one of
the project, the ALA identified the educational needs of
adults with asthma, identified and analyzed existing adult
asthma education programs, and selected one that was best
suited for adaptation and dissemination. Year two focused
on translating the validated clinic-based intervention
into a community-based program. The American Lung
Association has just concluded the final phase of the
project - evaluating the American Lung Association Breathe
Well, Live Well program in six local Lung Association
sites representing diverse communities across the country.
Methods
A formative evaluation was conducted with adults, aged 25
- 64 with newly diagnosis and/or persistent asthma
(defined as those who are prescribed daily controller
medications) to determine acceptability and feasibility of
materials and implementation processes. Pretests and
posttests were completed by pilot-test participants to
provide preliminary data on potential efficacy of the
program to improve asthma patients' self-management
knowledge and practices. Measures include self-management
knowledge, self-management practices (e.g. trigger
avoidance, medication adherence, peak flow monitoring,
inhaler use skills), and attitudes.
Results
The study is underway. Results should be available by
October 1, 2005.
Discussion
The American Lung Association anticipates positive results
from the community-based adaptation and implementation in
a community-based setting.
-
Steps to Better Breathing
Author
L. Young, Rockland County Department of Health,
Pomona, NY.
Background
Steps to Better Breathing is a case management program for
pediatric asthma patients offered at no cost to Rockland
County residents. It is conducted by trained nurse
practitioners. The program is designed to help families
and children to better manage their asthma, reduce the
frequency and severity of asthma attacks, to reduce school
absenteeism and emergency room visits and
hospitalizations. . The program is offered in English,
Spanish and Creole. The child can be referred to the
program by Health Care Practitioners, other professional
and community partners.
Methods
The evaluation has measurement tools to collect pre and
post-program, and follow-up data from both parents and
children in the program.
Results
The evaluation measures are designed to assess changes in:
1) asthma symptoms, 2) knowledge about managing asthma, 3)
emotions and stress related to having or caring for
someone with asthma, and 4) behavior (use of medication,
tools and ability to avoid triggers). Preliminary Program
Outcomes: I know how to help calm my child down when an
asthma attack is starting Beginning of program: yes=14%
End of program: yes=93% I know what triggers my child's
asthma Beginning of program: yes=21% End of program:
yes=79% I now understand my child's asthma action plan
Beginning of program: yes=7% End of program: yes=93%
Discussion
The program's history resulted from an identified gap in
service in Rockland County, a large immigrant population,
and local hospital admission rates and emergency room data
for asthma. We have also partnered with the American Lung
Association to conduct the Open Airways programs in our
schools. This program is based on existing best
practices. It is evaluated using validated tools from
American Academy of Pediatrics. In order for our program
Steps to Better Breathing to offer the program to a client
they must qualify by using different criteria ranging
from; medication misuse, misunderstanding the disease,
frequent emergency room or physician office visits, etc.
-
Management of Asthma in the School Setting:
Cost-Effective, Approaches
Authors
J. Lawrence1; A.S. Aftab1; A.
Fournier1.
1University of Miami, Miami, FL.
Background
School based health centers (SBHCs) are proven providers
of health for school aged children. Asthma is an example
of one illness that may be better managed through SBHCs.
Asthma currently affects nearly 5 million children younger
than eighteen years of age in the United States. This
accounts for more than 3 million physician visits,
approximately 570,000 emergency room visits, 165,000
hospital stays, 8.7 million prescriptions and 10 million
missed school days per year. The objective of this study
is to identify the potential cost effectiveness of asthma
treatment programs implemented in SBHCs.
Methods
A review of the literature and survey of various SBHCs, is
designed to explore the effectiveness of school-based
asthma intervention programs and the potential reduction
of costs related to asthma. This review has been
incorporated into the treatment of asthmatic children in
our own school health program, the Dr. John T. MacDonald
Foundation signature program on School Health.
Results
(1) SBHCs have implemented various asthma educational and
treatment programs, resulting in a 75% decrease in
hospitalization rates after initiation of asthma detection
and treatment programs. Other sites have reported as much
as an 80% decrease in rescue treatments for students with
individualized asthmatic action plans. (2) Estimates of
direct and indirect medical care costs have been derived
from data of the National Center for Health Statistics.
The largest indirect expenditure, $1 billion, was related
to reduced productivity due to the loss of school days.
(3) In our program serving over 6000 school children, all
children with asthma have been identified and enrolled in
prevention and early detection programs.
Discussion
Emergency room visits, hospital stays, days missed from
school, and a reduction in adverse outcomes may be avoided
through education, earlier detection and treatment in the
school setting. SBHCs offer a unique capability of
reaching asthmatic children who otherwise might not be
seen in the traditional medical office setting.
-
Increasing Years of Healthy Life and/or Reducing
Disparities
Author
K. Keppel, Centers for Disease Control and Prevention
(CDC), Hyattsville, MD.
Background
The overarching goals of Healthy People 2010 are to
increase years of healthy life and to eliminate
disparities among subgroups of the population. Progress
toward both of these goals can be evaluated for each of
500 population-based objectives. Progress toward the first
goal is evaluated in terms of the target for each
objective. Progress toward the second goal is evaluated in
terms of reductions in relative differences from the
"best" group for each population characteristic. It is
important to understand, however, that these two goals are
independent. Progress toward the target does not
necessarily entail progress toward reducing disparities
and vice versa.
Methods
Trends in disparities for prostate cancer deaths, new HIV
AIDS cases, rates of diabetes and suicide are used to
illustrate the independence of these two goals.
Results
Changes that are consistent with increasing years of
healthy life can be associated with either increases or
decreases in disparity. For example, although prostate
cancer deaths have decreased, racial and ethnic
disparities have increased. On the other hand a decrease
in new AIDS cases has been accompanied by a decrease in
racial and ethnic disparities. Conversely, changes that
are consistent with decreasing years of healthy life can
also be associated with either increases or decreases in
disparity. The increasing prevalence of diabetes has been
accompanied by a decrease in disparity among education
groups, while an increase in suicide has been accompanied
by an increase in disparity among racial and ethnic
groups.
Discussion
In some situations a single intervention strategy would
promote both goals. In other situations, however,
interventions that increase years of healthy life may not
reduce disparities. Policy makers and program managers
must decide what weight to give these two goals. In order
to achieve the second goal, an independent commitment to
eliminating disparities is required.
-
Assessing Breast Cancer Knowledge and Health Literacy
Levels in Senior African American Women
Author
D.T. Otey, Columbia University, Bronx, NY.
Background
Numerous studies assert that although Black women are less
likely to be diagnosed with breast cancer than White
women, they are more likely to die from the disease.
Because older minority women are less likely to adhere to
screening guidelines than White women, high mortality
rates, particularly for women 65 and older, may be linked
to the underutilization of preventive measures and
nonadherence to treatment once a diagnosis is made. Both
factors have been linked to low health literacy levels,
especially amongst seniors. The primary aim of this study
is to determine the relationship between health literacy
levels and breast cancer knowledge in a sample of
African-American women in Harlem, New York, using two
validated literacy instruments and a semi-structured
interview. A secondary aim is to examine the perceptions
of healthcare providers who treat African-American cancer
patients regarding their patients' knowledge.
Methods
A convenience sample of African-American women, aged 55
and older, will be recruited for participation. Reading
ability will be assessed via the Rapid Estimate of Adult
Literacy in Medicine (REALM) and comprehension will be
assessed via the Short Test of Functional Health Literacy
in Adults (STOFHLA). Participants will also be asked to
participate in an interview to assess breast cancer
knowledge. Harlem-based providers will be asked to
participate in interviews to assess their beliefs about
patient knowledge. Open-ended responses from the
interviews will be evaluated, and data will be analyzed to
determine the relationships between reported literacy
scores and cancer knowledge, attitudes, and practice
variables.
Results
Data from provider interviews will be compared with
knowledge scores to determine if a mismatch exists between
what women in the community actually know with what
providers in the community think they know.
Discussion
Results will be used to inform cancer communication
recommendations for healthcare personnel and to guide the
creation of comprehensible breast cancer materials.
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Predictors of Preventive Service Use Among Medicare
Beneficiaries
Authors
R.J. Ozminkowski1; R. Goetzel2; D.
Shechter3; D. Stapleton4; O. Baser5;
P. Lapin6.
1Thomson Medstat, Ann Arbor, MI;
2Thomson Medstat, DC;
3Thomson Medstat, CA;
4Cornell University, DC; 5
Thomson Medstat, MI;
6Center for Medicare and Medicaid Services, MD.
Background
Despite Medicare coverage, receipt of clinical preventive
services is less than optimal. The objective of this study
was to identify factors that predict the use of preventive
services among Medicare beneficiaries.
Methods
Multiple regression analyses were conducted using Medicare
Current Beneficiary Survey (MCBS) data for 2001. We
estimated the relationship between having low (< 4),
medium (5 or 6), or high (7) numbers of services and the
following factors: socioeconomics, health plan type,
health status, underlying health risks, and ability to
care for daily needs. These factors were expected to
influence receipt of: pneumococcal vaccination, influenza
vaccination, glaucoma screening, cholesterol screening,
blood pressure testing, mammography screening and Pap
smear (for females only), and digital rectal exams and
prostate specific antigen (PSA) tests (for males only).
Analyses adjusted for the complex sampling design used for
the MCBS. Results are nationally representative for the
study year.
Results
More than half of the respondents received each service,
except for Pap smears (only 36.3% of females had a Pap
smear in the previous 12 months). Medicare beneficiaries
with a significantly lower number of preventive services
tended to be: African Americans, low income beneficiaries,
those who were dually enrolled, persons who suffered a
broken hip, heavy drinkers, those who were paralyzed, and
those who had difficulty shopping or using a telephone.
Discussion
Except for blood pressure and cholesterol screening,
approximately 1/3 to 2/3 of Medicare beneficiaries did not
receive recommended and covered preventive services.
Interventions to promote appropriate use of clinical
preventive services should target segments of the
population where use is low. The initial preventive
physical examination, which is covered under the new
Medicare drug law, provides an excellent opportunity to
introduce new Medicare beneficiaries to clinical
preventive services and to educate them about their
recommended use. However, strategies must be developed to
ensure appropriate use of these services over time.
-
Healthy for Life Programs
Authors
S. Eber1; E. Haslag2.
1Healthy for Life Programs, Kirksville, MO;
2Healthy for Life Programs, Loose Creek, MO.
Background
Healthy for Life is a diabetes, heart disease, and obesity
prevention program housed at A.T. Still University, funded
by a three-year grant from the Missouri Foundation for
Health. The incidence of chronic disease is high in
Northeast Missouri. Healthy for Life is a collaborative
effort among health institutions to develop grassroots,
community- based effort to increase exposure of area
residents to healthy lifestyle choices. The program is
exceeding its goal to provide healthy lifestyle education
and programs and to develop community action groups
(coalitions) in the eight target communities to integrate
healthier lifestyle choices into day-to-day community
life. This is a pilot program targeting 6 counties.
Methods
Each coalition develops outcomes based on their unique
community needs. Leaders in each coalition maintain
communication, facilitate problem identification and
potential solutions, and engage the community to work with
the coalition to meet goals. Coalition activities,
programs, and relevant data are collected and forwarded
monthly to the Healthy for Life office, where the data is
assessed for community contribution.
Results
The Healthy for Life program supports 10 coalitions, 68+
community-initiated meetings and/or education programs and
has provided 1016 individual preventative health
screenings to date. Community contribution to date
includes: walking trails (measured and marked) in two
communities; a new Farmer's Market; chronic disease
self-management courses and support groups; changes in
school food policy; healthy snacks and exercise
opportunities available at community events; and exercise
classes available daily, free of charge, for people with
special needs.
Discussion
The grassroots approach is necessary to facilitate healthy
lifestyle behaviors. The coalitions provide credible
resources (health care providers) to guide consumer
decision-making on demand. The concept of a community
action group empowers members to live healthier lifestyles
and reduces chronic diseases, thereby reducing the burden
of chronic disease on the community.
-
The Relationship of Perceived Diabetic Control to
Diabetic Retinopathy and Hemoglobin A1c (HbA1c)
Authors
A.Y. Ting1; C.J. Rudnisky1; E. Weis2;
M.T. Tennant1; B.J. Hinz1; M.D.
Greve1.
1University of Alberta, Edmonton, Alberta;
2University of Ottawa, Ottawa, Ontario.
Background
The Diabetes Control and Complications Trial shows that
intensive diabetic control targeting HbA1c of <7% resulted
in 76% reduction in development of and 54% reduction in
the progression of diabetic retinopathy. This study
investigates diabetic self-perception and HbA1c awareness,
and if those factors further translate into increased
compliance and improved clinical outcome.
Methods
The study population was derived from diabetic patients
attending a group retina practice. Consenting patients
completed a questionnaire detailing self-perception of
diabetic control and underwent seven-field digital stereo
fundus photography and HbA1c testing. The level of
retinopathy and a chart review of diabetes-related eye
procedures were used to establish a clinical measure of
ophthalmic complications.
Results
167 patients completed the study. 66% were male and 34%
were female, with an average age of 62. Average diabetes
duration was 18.7 years, with 17% having type-1 and 83%
type-2. Average BMI was 30.2 and average systolic blood
pressure was 142 mmHg. Ideal HbA1c lab values (<7.0%) were
not met in 70% of patients. Blood sugar was underreported
as HbA1c lab values corresponded to the upper range of
self-reported blood sugars. HbA1c awareness was not
correlated with diabetic education; however, diabetes
education did significantly decreased the odds of a high
HbA1c (p=0.011). Of the 64% aware of HbA1c, only 35%
claimed they could recall their last HbA1c. Self-reported
recollection of HbA1c correlated with a lower level of
retinopathy (p=0.039) and decreased odds of requiring
laser photocoagulation (p=0.013). Self-reported good
diabetic control decreased the odds of requiring surgery
(p<0.001) while self-reported poor control increased the
odds of requiring laser (p<0.001).
Discussion
Self-perception of diabetic control appears to correlate
with level of diabetic retinopathy and retinal procedures
required. Current HbA1c testing guidelines are supported.
Diabetic education is important but needs to further
emphasize the value of HbA1c as a quarterly report card
for diabetic control.
- Morbid Obesity in Financially Disadvantaged Women:
Opportunities for Diabetes Prevention Through CDC's
WISEWOMAN Program
Authors
J.C. Will1; E.A. Finkelstein2; O.A.
Khavjou2.
1Centers for Disease Control and Prevention
(CDC), Atlanta, GA;
2RTI International, Research Triangle Park, NC.
Background
A rapid increase in the prevalence of morbid obesity [MO]
(body mass index >= 40) has occurred in the US placing
more people at risk for diabetes mellitus (DM). WISEWOMAN
provides low-income uninsured women with chronic disease
risk factor screenings, lifestyle interventions, and
referral services in an effort to prevent DM and other
chronic diseases. WISEWOMAN offers programs that help
participants develop a healthier diet, increase physical
activity, and quit using tobacco.
Methods
We used 1998-2004 baseline and one-year followup data from
the WISEWOMAN program to assess racial/ethnic disparities
in (1) baseline prevalence of MO; (2) baseline prevalence
of self-reported DM among morbidly obese participants; and
(3) one-year changes in weight among morbidly obese
participants. The analysis allows for examining the
implications for diabetes prevention in this extremely
high-risk group.
Results
Approximately 10% of WISEWOMAN participants are morbidly
obese. The age- and education- adjusted prevalence of MO
was higher for Blacks (15.0%) and Native American/Alaskans
(11.5%) compared to Whites (9.8%) or Hispanics (5.8%).
Among morbidly obese women, 21% reported DM, with the
highest prevalence among Native American/Alaskans (24.5%)
and the lowest prevalence among Hispanics (14.3%). Over
the one-year period, morbidly obese participants
experienced an average 1.7% (4.3 pound) weight loss.
Weight reductions were consistent across White, Black, and
Hispanic participants while Native American/Alaskan women
experienced the largest weight loss.
Discussion
A substantial number of WISEWOMAN participants with MO
have not yet developed DM. This presents a unique
opportunity for DM prevention in this high risk
population. As demonstrated in the Diabetes Prevention
Program, modest weight loss can lead to a delay in DM
development. Thus, our results suggest that WISEWOMAN may
be an effective strategy for reducing the incidence of
diabetes in this financially disadvantaged, and extremely
high-risk population.
-
Good Health Begins With Breastfeeding: Breastfeeding
Promotion Strategy for High-Risk Populations
Authors
M.A. Young1; G. West2.
1Howard University Hospital, Washington, DC;
2Howard University, Washington, DC.
Background
Research continues to demonstrate that many health
challenges that face Americans – obesity, hypertension,
Type I and Type II diabetes, asthma- are less frequent in
individuals who were breastfed. Disparity in breastfeeding
rates for African Americans adds to the burden of these
diseases in our community. To bring the health care goals
of the Healthy People 2010 for breastfeeding (75%
initiation, 50% at 6 months, 25% at one year) into focus
for our community we embarked on an effort to improve
breastfeeding rates at Howard University Hospital
especially in our high risk community of WIC eligible
pregnant women.
Methods
The BLESS (Breastfeeding Lactation Education and Support
Services) Initiative is a project of the Department of
Pediatrics and Howard University Hospital WIC Family
Services. This initiative provides prenatal
childbirth/breastfeeding support classes, a monthly
breastfeeding support group, inpatient post-partum
breastfeeding support and National Breastfeeding Support
Center for pregnant and breastfeeding women and their
families. The initiative provides education to health care
professionals on how to support the breastfeeding dyad
through lecture series, hands-on rounds, and an annual
breastfeeding conference.
Results
The breastfeeding rates in Howard University Hospital WIC
program increased from 22% to 36% over a two year period.
Our pilot childbirth class had a 92% initiation rate.
Discussion
Key to the increase are the availability of specialized
lactation services, and a coordinated network of support
which recruits pregnant women from all Washington, DC WIC
sites, as well as the local agency, into prenatal classes
designed to educate about breastfeeding as integral to the
process of childbearing. The implementation of childbirth
education classes with the aid of WIC resources has
demonstrated the efficacy of recognizing breastfeeding in
the continuum of childbearing, and reinforces the evidence
that shows that breastfeeding messages introduced to women
during the third trimester of pregnancy are influential in
the decision to breastfeed.
-
Improving Cardiovascular Health Among Chinese
Americans Through an Innovative Community-wide Campaign
Authors
G. Lu1; D. Hong1; K. Kwong1.
1Charles B. Wang Community Health Center, New
York, NY.
Background
The rising rate of cardiovascular disease among Chinese
Americans, compounded by a lack of awareness and knowledge
of the disease and poor access to health care, is a
growing health problem in the US. The "You Are What You
Eat" program was launched to address the problem by
promoting a heart healthy lifestyle through culturally and
linguistically appropriate interventions targeting Chinese
Americans in New York City. The Charles B. Wang Community
Center led the program with the support of the Chinese
American Healthy Heart Coalition.
Methods
The one-year pilot program consisted of four components:
increasing community awareness and education through
community health forums; preventing cardiovascular disease
in high-risk senior citizens through multi-session
workshops; promoting healthy food availability in the
community by working with local eateries to create heart
healthy dishes; and a social marketing campaign.
Results
Seven forums and four series of workshops were conducted
at a variety of community-based organizations; two popular
local chain eateries were recruited to create `Heart
Healthy Menus'; and 20 newspaper articles covering the
program were printed in local newspapers. Different means
were employed to evaluate the program's activities.
Surveys were administered to participants who attended the
forums and to eateries' customers to assess the menu
offerings; pre- and post-workshop screenings were
conducted among the workshop participants to measure the
impact of the intervention on lowering their risk for
cardiovascular disease.
Discussion
With all of the components working together, the program
effectively delivered community-wide preventive education
and helped senior citizens lower their risk for disease.
As result of the initiatives, there was increased
awareness and knowledge, changes in attitudes and beliefs,
and enhanced behavioral changes in the community. Due to
the effectiveness demonstrated in the evaluation results,
this model was continued and expanded into a project
funded by the USDHHS Office of Minority Health.
-
The Red Dress: The Power of an Effective Symbol To
Raise Awareness of Women and Heart Disease
Author
J. Wayman, Ogilvy Public Relations Worldwide, Washington,
DC.
Background
Essential to the success of any social marketing campaign
is reaching the target audience to influence attitudes and
beliefs. The Heart Truth campaign's powerful marketing
symbol—a Red Dress—has been successful in reaching women
across the country with the message that heart disease is
the #1 killer of women. In 2000, only 34% of women knew
that heart disease is their #1 killer. Most women think of
heart disease as "a man's disease" and don't realize they
are at risk, even when they know they have risk factors
such as high blood pressure and high cholesterol.
Methods
Based on extensive formative research and message testing
with its target audience, The Heart Truth campaign created
and launched the Red Dress as the symbol for women and
heart disease awareness, symbolizing the message, "heart
disease doesn't care what you wear." First forging a
partnership with the fashion industry and introducing a
Red Dress lapel pin to launch the symbol, The Heart Truth
has produced a number of tools and resources for
grassroots partners to use in holding their own red dress
events.
Results
The powerful Red Dress symbol has captured the attention
of individuals and organizations nationwide. Local
communities pair red dress events with opportunities to
hold screenings and share educational information with
women. According to data released by the American Heart
Association, women's awareness that heart disease is their
#1 killer rose to 57% in 2004. Additionally, more than
800,000 Red Dress pins have been sold to date and are
being worn by women across the country to raise awareness.
Discussion
A powerful marketing symbol can catapult the objectives of
your health promotion campaign by enabling the
public—individuals as well as community and corporate
organizations—to make a personal connection with your
campaign message.
-
Overweight and Obesity Among Korean Americans in
California; California Health Interview Survey (CHIS) 2003
Analysis
Authors
J. Cho1; H. Juon1. 1Johns
Hopkins University, Baltimore, MD.
Background
The prevalence of obesity has increased substantially
since the 1980s in the U.S., but little is known about
overweight and obesity of sub-group of Asian Americans
(AA). The AA have been reported as the least overweight
and obese ethnic group and usually considered as they do
not have much risk of obesity. However, past studies
showed that AA recorded higher prevalence high blood
pressure, heart disease and type II diabetes at the same
level of BMI compared to Caucasians. The proportion of
Asian people with risk factors for type II diabetes and
cardiovascular disease is substantial even below the BMI
cut-off point of 25 kg/m2 which usually represents an
increasing but acceptable risk stage for white or other
ethnic groups.
Methods
A cross-sectional study using 2003 CHIS data was performed
to estimate the prevalence of overweight and obesity among
Korean Americans (KA) in California, and to describe the
relationships between higher BMI and social behavior
factors. The risk of obesity among KA was measured by a
new BMI criterion suggested by the WHO as a trigger point
for public health action, especially for Asian population.
Results
Of 492 respondents, 37.4% of KA in California were
overweight and 10.2% were obese. There was a statistically
significant difference of becoming overweight or obese
between males and female after adjusting all social and
behavior factors. Length of stay had strong association
with higher BMI. There were also associations between BMI
and marital status, poverty, English fluency, and binge
drinking.
Discussion
The study indicates that KA in California appear to assume
a similarly high prevalence of obesity as Caucasians
adults, and early interventions on diet and physical
activity may represent an important opportunity to prevent
weight gain, obesity, and obesity related chronic illness.
BMI of Korean American adult in California
| BMI |
Female |
Male (n=189) |
Total (n=492) |
| <23 |
195 |
63 |
258 |
| 23-27.5 |
82 |
102 OR 3.85 |
184 |
| <=27.5 |
26 |
24 OR 2.86 |
50 |
-
Prevention of Obesity in Early Childhood
Authors
K. Palumbo1; P. Blackett2; E. Lee2;
D. Campbell-Sternlof2.
1University of Oklahoma Health Sciences Center,
Oklahoma City, OK;
2University of Oklahoma Health Sciences Center,
OK.
Background
The prevalence of obesity in childhood has increased over
the past three decades and is associated with Type 2
Diabetes in adolescence. This pilot study is designed to
explore possible strategies to prevent obesity in early
childhood by educating Native American families on healthy
feeding practices, including breastfeeding. Nursing
mothers benefit from breastfeeding by lowering their risk
of breast and ovarian cancers, and also helps protect
against osteoporosis. Society benefits by breastfeeding as
total medical costs are reduced.
Methods
Study participants are recruited from the United States
Public Health Service, Lawton Service Unit. Data being
collected includes tribal affiliation, maternal age and
education, marital status, socioeconomic status, brief
medical history, and support system. Breastfeeding rates
collected will be compared to Healthy People 2010, state
and national rates. Strategies to prevent obesity in early
childhood include promoting breastfeeding through prenatal
education, training for health care providers, and
community outreach programs.
Results
Preliminary findings indicate a low initiation rate of
breastfeeding, 59%, as the prevailing preference in the
target population. Interviews indicate barriers to
breastfeeding include lack of education and support from
immediate and extended family, and clinical staff. To
date, 83 mothers have been enrolled, 38 babies have been
born, of which 32 have been breastfed. This is an 84%
breastfeeding initiation rate.
Discussion
Risk factors for childhood obesity can be identified in
the population including gestational diabetes, high
maternal BMI, and absence or short duration of
breastfeeding. This pilot study is on-going and expansion
of the survey to other areas is planned.
