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Introduction: The purpose of this research is to examine the state-of-the-art in community health report card development and use in order to increase their effective integration into community health improvement efforts., Methods: A mailed survey was sent to 115 "report card" communities nationwide. This list was generated through multiple key informants at the national, regional, and state levels. Seventy-four percent (85/115) were eligible for the study. The report cards returned were inventoried for: quality of their data, comprehensiveness, presentation, appropriateness to target audiences, purpose and sponsorship, relevance to policy development, community involvement, comparability, replicability, and other factors., Results: Of the 85 eligible projects, 65 responded. The report cards varied significantly in all areas. Only one half of communities used pre-existing formats or the experience of others to guide this resource-intensive development process. Data collection was the greatest challenge encountered in development. Local health departments, hospitals, and non-profit civic groups were the community groups most likely to be involved in development., Conclusion: There is need for infrastructure, technical assistance, and improved, easy-to-use tools to facilitate the report card development process and the sharing of expertise and experience among involved communities. Greater systematization of the process would enhance the reasonableness and sustainability of the effort. Broad community involvement, including support of the local health department, other community agencies, as well as the local business community, may be key to their success.

To evaluate the incremental effectiveness of a worksite cholesterol control management program when added to an established, comprehensive health promotion program at the worksite, we conducted a randomized, controlled trial including both blue- and white-collar employees at four geographically dispersed worksites. One hundred twenty-seven employees with serum cholesterol levels of 240 mg/dL or greater were assigned to receive an enhanced intervention program (the IMPACT program) while 125 were assigned to a regular screening and referral group, which included a comprehensive worksite health promotion program. One hundred eighteen program and 116 control subjects had one-year follow-up measures recorded. We used venipuncture specimens to obtain standardized baseline and follow-up cholesterol measures. Program subjects experienced a mean decline of 16.6 mg/dL as compared to a decline of 10.0 mg/dL in control subjects. The crude intergroup difference was 6.6 mg/dL (95% confidence internal [CI] = 1.1, 14.3), while the adjusted difference was 6.9 mg/dL (95% CI = 0.5, 14.3). Neither difference was significant at the .05 level. The percentage of program subjects who reduced their cholesterol level to below 240 mg/dL (36%) was significantly greater than the corresponding percentage among control subjects (21%). The enhanced worksite cholesterol control program provided incremental benefit in the percentage of individuals with elevated cholesterol in a population already exposed to a comprehensive worksite health promotion program that includes regular cholesterol screening, referral, and education activities.

Adolescent pregnancy, often unplanned and unwanted, has a negative impact on the physical, emotional, educational, and economic condition of the pregnant teenager. Forty percent of the one million adolescents who became pregnant in 1986 chose abortion, and, of the remainder, 61% were unmarried. Teenage mothers in greater numbers and at younger ages are opting to keep and raise their children. In 1987 over $19 billion in federal monies were expended on families begun when the mother was a teenager. The preferred approach to this problem is prevention of teenage pregnancy rather than abortion, with emphasis on sex education and access to family planning information and contraceptive devices for both females and males. Sex education in schools is presented in widely varying formats; in fact, prevention of pregnancy may not even be presented. Family planning clinics are subject to the whims and biases of the funding agencies. Clinicians have an important role in providing guidance for teenage patients and their parents, but can also influence school and community leadership to ensure that all teenagers receive sound sex education in school programs and that family planning agencies are permitted to counsel teenagers and provide contraceptive devices.

Data from the National Survey of Worksite Health Promotion Activities include information about health risk assessment (HRA) activities available at private sector worksites in the United States. HRA activities were found at 29.5% of all worksites. Of those worksites, 24% provided HRA questionnaires and 77.4% provided periodic health/physical examinations. Screening tests provided as part of the health/physical exams included blood pressure screening (55.4%), cancer screening (19.5%), blood tests for cholesterol (28.3%) and sugar (39%), and tests of physical fitness (15.1%). In most cases, the frequency increased as worksite size increased, regional variations were small, and there was significant variation among different industry types. HRA activities were overrepresented at worksites where the majority of workers were women, over 30 years of age, not blue collar, and not represented by a union. On-site health personnel increased the likelihood of the presence of HRA activities. At 85% of the worksites with HRA activities all permanent employees were eligible. The full costs of screening were paid by 87.9% of the worksites, activities were held on company time at 74.5%, and time off to participate was available at 78.2% of worksites. The most commonly mentioned benefit of HRA activities was improved employee health (47.1%). Other health promotion activities frequently found in association with HRA activities were smoking cessation (54.1%), care and prevention of back pain (50.8%), and stress management (49.6%).