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Objectives. The Minnesota Heart Health Program is a 13-year research and demonstration project to reduce morbidity and mortality from coronary nary heart disease in whole communities. Methods. Three pairs of communities were matched on size and type, each pair had one education site and one comparison site. After baseline surveys, a 5 to 6-year program of mass media, community organization, and direct education for risk reduction was begun in the education communities, whereas surveys continued in all sites. Results. Many intervention components proved effective in targeted groups. However, against a back-ground ground of strong secular trends of increasing health promotion and declining risk factors, the overall program effects were modest in size and duration and generally within chance levels. Conclusions. These findings suggest that even such an intense program may not be able to generate enough additional exposure to risk reduction messages and activities in a large enough fraction of the population to accelerate the remarkably favorable secular trends in health promotion activities and in most coronary heart disease risk factors present in the study communities. (Am J Public Health. 1994;84:1383-1393), Intensive health education at the community level may not significantly reduce risk factors for heart and cardiovascular disease, beyond the changes that occur from general information. The Minnesota Heart Health Program was designed to evaluate the effect of intensive community-level health education on health-related factors, such as blood cholesterol levels, blood pressure, exercise and smoking. Three communities received a mass media campaign and health education. Three similar communities, also in the upper Midwest, received no special programs. The health promotion messages and education already widespread in the US have led to declines in high blood pressure, high cholesterol and levels of smoking. The Minnesota programs did not have a noticeable additional effect in either specific behaviors or overall risk.

Results are reported from a survey of trends in blood cholesterol levels among residents of Minneapolis-St. Paul, Minnesota, during two periods: 1980 to 1982 and 1985 to 1987. Data were collected for the Minnesota Heart Survey, a study of risk factors for coronary heart disease begun in 1979, and analyzed for trends over time in subjects' cholesterol levels, rate of hypercholesterolemia (levels of 240 milligrams per deciliter or higher), and awareness of and treatment for this problem. One person in each of several thousand households between the ages of 25 and 74 was interviewed, then asked to attend a clinic where diet, medication use, health-related behavior, and physiological variables were evaluated. Blood pressure, blood lipid (fats) levels, and height and weight were monitored. No one participated in both periods of the study. Results showed decreases between the two periods in the levels of total blood cholesterol for almost all age groups, with the greatest decrease, of 9.7 milligrams per deciliter (from 238 to 228.3 milligrams per deciliter), occurring among women 65 to 74. For the sample as a whole, cholesterol levels for men dropped from 205 to 200 milligrams per deciliter; for women, from 201 to 195 milligrams per deciliter. The rate of hypercholesterolemia decreased, as did the proportion of female (but not male) subjects with this condition who were unaware of it. However, two thirds of the subjects with hypercholesterolemia who were studied at the later time were not aware of their condition. A greater proportion of subjects with hypercholesterolemia were under treatment with drugs to lower cholesterol levels in the 1985-1987 survey, and cholesterol levels had been reduced in more people by such treatment at this later date. The specific medications used are described. Data concerning hyperlipidemia (elevated blood levels of certain fats) are also presented. Much of the decline in cholesterol levels in the Twin Cities appeared to be the result of better diets and more exercise, reported as part of physicians' recommendations more often in the later survey than in the earlier one. (Consumer Summary produced by Reliance Medical Information, Inc.)

Background. Smoking among young women is associated with a variety of negative health outcomes. Gender specific influences on smoking, quitting and attempting to quit are hypothesized to occur and may have implications for cessation programs. Methods. Telephone surveys were conducted in a large (n = 6,711) cohort of young men and women (average age 19.2 years) which was first established in 1979 and has been resurveyed several times since then. Questions concerned smoking, suecessful and unsuccessful attempts to quit, withdrawal symptoms during quit attempts, and concerns about quitting. Results. More women than men reported current smoking (26.5 vs 22.6 percent), but quitting attempts, successful and unsuccessful, were equally common. Withdrawal symptoms were reported equally, except for wanting to eat more than usual and weight gain, both of which were reported more often by women than men. Women smokers reported substantially more concern about weight gain if they quit smoking (57.9 vs 26.3 percent expressing concern). Conclusions. Targeted programs are needed to address issues of concern to young women smokers, particularly fear of gaining weight. (Am J Public Health 1991;81:324-327), Women are not quitting smoking at the same rate as men; indeed, among very young adults, the proportion of female smokers is beginning to exceed the proportion of male smokers. Since women smokers jeopardize not only their own health, but also that of their children, programs to help them quit smoking should be given a high public health priority. To learn more about smoking and quitting behavior in young adults, a study was carried out of 3,455 males and 3,256 females who were initially enrolled in the seventh grade in suburban Minneapolis-St. Paul, Minnesota in 1979 and 1980. The subjects were interviewed by telephone regularly between 1984 and 1988; the data presented are from the 1986 to 1987 survey, when the subjects were just out of high school (average age, 19.2 years). Most were white, and all except 7 percent had graduated from high school. A greater proportion of women (26.5 percent) than men (22.6 percent) currently smoked, and more had smoked at some time. Similar proportions of men and women had tried to quit. Women who had tried to quit and failed reported similar withdrawal symptoms as men, except women said they had gained more weight when trying to quit and that they wanted to eat more than usual. Female quitters had not gained more weight than those who had failed; however, among males, quitters were heavier than smokers. Quitting was associated with fears of gaining weight for women, who also expressed a sense of social pressure about quitting. The results may imply that quitting is no less often successful for women than for men, indicating that a trend toward fewer women smokers could be anticipated. However, the fact that more young women than men currently smoke is disheartening. Public health programs for female smokers should take into account their expressed concerns, particularly those about weight gain. (Consumer Summary produced by Reliance Medical Information, Inc.)

A widespread assumption in education suggests educational curricula can be more effectively implemented and subsequent student outcomes improved if teachers are first properly trained in using the curriculum. Thus, teachers [...]

Members of the Teenage Health Teaching Modules Evaluation Expert Work Group collaborated on this article to discuss what was learned from the evaluation, how the findings might be interpreted and [...]

The Child and Adolescent Trial for Cardiovascular Health (CATCH) is a multisite intervention research study that builds on significant progress made in school health education research in the 1980s. The study has three phases: Phase I deals with study design, intervention, and measurement development, Phase II involves the main trial in 96 schools in four states, and Phase III focuses on analysis. The intervention program targets third-fifth grade students and focuses on multiple cardiovascular health behaviors, including eating habits, physical activity, and cigarette smoking. Classroom curricula, school environmental change, and family involvement programs are developed for each grade level and behavioral focus. This paper describes Phase II of CATCH with a rationale for cardiovascular health promotion with youth. The process of change that appears to be necessary for school-based health promotion and that will be tested in CATCH are presented as a framework to guide these efforts. (J Sch Health. 1990;60(8):406-413), During the past decade, a revolution in school health education occurred, with expanded objectives and demonstrable behavioral outcomes. Before 1980, the goal of school health education was similar to that [...]

To examine accuracy of reporting of large food portions, 50 adults were invited to eat a restaurant meal that included a hamburger patty, french fries, and ice cream. After eating, participants were asked to estimate the amount of food consumed using commonly used and larger-sized food models as a guide. With the use of commonly used models, underreporting was evident for all three foods. For example, the amount of hamburger patty consumed was on average 4.01 oz, although the average amount reported was 3.04 oz (P<.05). When larger-sized models were used, the amount reported more closely matched the amount consumed, although underreporting persisted for the hamburger patty and french fries. In summary, significant underreporting of large food portions may result when commonly used food models are used to assist individuals in reporting food portions. J Am Diet Assoc. 2004;104:804-806.

Background: Survivors of childhood cancer exposed to cardiotoxic therapies are at significant cardiovascular risk. The utility of cardiac biomarkers for identifying the risk of future cardiomyopathy and mortality is unknown. Methods: N‐terminal pro–B‐type natriuretic peptide (NT‐proBNP) and cardiac troponin T (cTnT) were assessed in 1213 adults 10 or more years from a childhood cancer diagnosis; 786 were exposed to anthracycline chemotherapy and/or chest‐directed radiation therapy (RT). NT‐proBNP values above age‐ and sex‐specific 97.5th percentiles were considered abnormal. Generalized linear models estimated cross‐sectional associations between abnormal NT‐proBNP and anthracycline or chest RT doses as risk ratios with 95% confidence intervals (CIs). A Poisson distribution estimated rates and a Cox proportional hazards model estimated hazard ratios (HRs) for future cardiac events and death. Results: At a median age of 35.5 years (interquartile range, 29.8‐42.5 years), NT‐proBNP and cTnT were abnormal in 22.5% and 0.4%, respectively. Exposure to chest RT and exposure to anthracycline chemotherapy were each associated with a dose‐dependent increased risk for abnormal NT‐proBNP (P for trend <.0001). Among exposed survivors with no history of Common Terminology Criteria for Adverse Events–graded cardiomyopathy and with normal systolic function, survivors with abnormal NT‐proBNP had higher rates per 1000 person‐years of cardiac mortality (2.93 vs 0.96; P <.0001) and future cardiomyopathy (32.10 vs 15.98; P <.0001) and an increased risk of future cardiomyopathy (HR, 2.28; 95% CI, 1.28‐4.08) according to a multivariable assessment. Conclusions: Abnormal NT‐proBNP values were prevalent and, among survivors who were exposed to cardiotoxic therapy but did not have a history of cardiomyopathy or current systolic dysfunction, identified those at increased risk for future cardiomyopathy. Further longitudinal studies are needed to confirm this novel finding. In this longitudinal cohort study including 1213 adult survivors of childhood cancer, nearly 25% have an abnormal N‐terminal pro–B‐type natriuretic peptide (NT‐proBNP) value for age and sex at the baseline. Among survivors exposed to cardiotoxic therapy who have a normal ejection fraction at the baseline, those with an abnormal NT‐proBNP value have more than twice the risk of future cardiomyopathy; this is a significant finding. [ABSTRACT FROM AUTHOR]

Explorations of workflow development within primary care allow us to understand initial steps in the pace of knowledge and practice acclimatization within clinics. This study describes use of practice facilitation as an implementation strategy to communicate shared project goals and monitor and support refinement of practice behavior. This study engaged eight health care organizations, including 55 primary care practices, ≈380 clinicians, and ≈620 nursing and support staff in a guideline implementation project regarding United States Preventive Services Task Force use of aspirin recommendations for primary prevention of cardiovascular events. [ABSTRACT FROM AUTHOR]

Background: Cost-effective primary prevention of cardiovascular disease (CVD) relies on accuracy of risk assessment. Current risk scores require clinical and laboratory measures, are expensive and are often difficult to apply in the population setting. Objective: This study sought to estimate CVD risk from individuals' knowledge of their own CVD risk factors and compare it to the risk calculated from measured risk factors. Methods: Using the ACC/AHA Pooled Cohort Risk Equations (PCE), we calculated 10-year CVD risk for 9856 primary prevention individuals aged 40– 79 in the Minnesota Heart Survey (MHS). Using log-linear regression models, we estimated PCE risk from the individual's self-reported knowledge of four dichotomous risk factors: hypertension, hypercholesterolemia, diabetes, and smoking. Age was included in all models, and models were developed separately in women and men. Model performance was assessed internally using leave-one-out cross-validation. Results: The median measured PCE CVD risk in women was 2.1% (IQR: 0.8– 5.6%), and in men was 6.3% (3.1– 13.0%). Using the newly developed equations, the median estimated risk was 2.2% (0.9– 5.8%) in women, and 6.9% (3.2– 13.1%) in men. Using a threshold of 7.5% to categorize low and high risk, the novel risk calculation gave an accuracy of 95% for women and 87% for men compared to the measured PCE risk. The negative predictive value was 97% for women and 91% in men. Conclusion: Self-reported knowledge of risk may be useful in the identification of individuals at low risk for CV events, however, should always be followed up with measurement of risk factors if symptoms or history suggest CVD. [ABSTRACT FROM AUTHOR]