POSTER SESSIONS

POSTER SESSIONS THURSDAY, APRIL 11

Location Abstract Title Presenter
P-1 Health Smart Church Program: A Successful Cardiovascular Health Intervention Doris Ann Donovan, B.S.N.

P-2 Faith-Based Cardiovascular Model Gregory J. Harris, M.A.S.S.

P-3 Phase One of a Comprehensive Community-Based Approach to CVD Prevention Nan Pheatt, M.P.H.

P-4 The Role of Food Phenolics in Reducing CVD Risks Joe S. Hughes, Ph.D.

P-5 Congestive Heart Failure and Cardiac Rehab . . . Do They Mix? Deborah S. Croy

P-6 Community-Based Health Promotion Kay R. Parent, M.P.H., R.N.

P-7 Whole Grain Intake in the United States: How Do We Achieve Three or More Servings Per Day? Joel J. Pins

P-8 Online CME To Assist Primary Care Physicians With Tobacco Cessation Treatment Mary P. Metcalf, Ph.D.

Attitutes, Knowledges, and Practices of Tobacco Cessation and Intervention

P-9 Juan Carlos Zevallos, M.D.
Among Health Care Providers in a Hispanic Border Community

A Process of Diagnostic Testing Data Retrieval Increases Eligibility; Hence Appropriate

P-10 Miriam Cannon-Wagner
Medication Management for an Elderly Heart Failure Population

Influence of Lovastatin Therapy on Serum Concentrations of Autoantibodies

P-11 Tatjana Metodi Ruskovska, M.Sc.
Against Oxidized LDL in Patients With Severe Primary Dyslipidaemia

P-12 Heart and Soul: A Faith-Based Approach to Cardiovascular Health in the Delta Susanne S. Hill

Methodological Considerations in the Assessment of Physical Activity

P-13 Nora L. Constantino, Ph.D.
for Free-Living Mothers and Preschool Children

P-14 Provision of Nutrition Advice in Primary Care Practices Patrick E. McBride, M.D., M.P.H.

P-15 Nutritional Interventions in Interdisciplinary Rural Health Settings Kim Shovelin, M.P.H., R.D.

P-16 Pulse Wave Velocity: An Early Indicator of Arteriosclerosis in Premenopause and Menopause Helen Marcoyannopoulou-Fojas, M.D.

P-17 Arterial Stiffness Changes Among Four Gender-Ethnic Groups of Children and Adolescents WayWay M. Hlaing, M.B.B.S., Ph.D.

P-18 Patient Perceptions of Heart Failure Self-Management: A Test of Two Nursing Interventions Kay Setter-Kline, Ph.D., R.N.

P-19 Fit for Learning and Life: Virginia's Model School Cardiovascular Health Project Christy Colvin Mason, M.Ed.

P-20 Heartworkers: Virginia's Model Cardiovascular Worksite Project Sue Curry Whittaker, R.N.

P-21 Development of a Hypertension Management Service in an Underserved Urban Population Charlene Aerilyn Hope, Pharm.D.

P-22 Community Cardiovascular Project Marilyn Lauffer, R.N., M.S.

Implementation of an Innovative Community-Based Heart Disease

P-23 Brenda S. Mitchell, Ph.D.
and Stroke Risk Reduction Program (INTERxVENT)

Clinical Effectiveness and Reproducibility of a Corporate

P-24 Susan M. Pickel, B.S.N., M.H.M.
CVD Risk Reduction Program

P-25 Cardiovascular Health Risk Behavioral Practices of African Americans in Mississippi During the 1990s Clifton C. Addison, Ph.D.

P-26 Addressing the Risk of Patients With "Isolated" Low HDL—Should Raising HDL Be the Sole Obejctive? James D. Otvos, Ph.D.

Women's Hearts Are Different: The Development and Implementation of a

P-27 Mary R. Dortenzo, M.S.N., N.P.-C.
Primary Prevention Program, the WomanCare Heart~Check Program

P-28 Addressing Health Disparities in Middle School Nutrition and Exercise Marilyn Frenn, Ph.D., R.N.

84 CVH 2002
THURSDAY, APRIL 11 CONTINUED
Location Abstract Title Presenter
P-29 A Web-Based Tobacco Cessation Counseling Program: Pilot Test Results Kim Ashcraft, M.S., M.S.N., R.N., C-F.N.P.

P-30 Incidence, Location, and Observation Status of Out-of-Hospital Cardiac Arrest in Two Community Cohorts Lambert Anthony Wu, M.D.

Menu Labeling To Encourage the Selection of Entrees With Less Than 1,000 mg
P-31 Rebecca Sue Hoffman
Sodium, Less Than 500 Calories, and Less Than 7% Saturated Fat

Attempts at Changing Diet and Exercise to Lower the Risk of Coronary

P-32 Randal J. Thomas, M.D.
Heart Disease and Stroke: Who's Doing What in the Community?

P-33 Dietary Guidelines for Americans 2000: Maryland Training Initiative Carol R. Miller, R.D., L.D.

P-34 Provider Feedback Improves Adherence With AHCPR Guideline Jeannette O. Andrews

P-35 A Model for Medical Student Training in Nutrition and CVD Prevention Kimberly Ruth Welch, M.P.H.

P-36 Walking and Resting Blood Pressure: A Meta-Analysis George A. Kelley, D.A.

Coronary Calcium Scores by Electron Beam Computed Tomography Correlated With

P-37 Edwin Cesar Pereira
Positive Changes in Lifestyles, Including Healthier Diet, More Exercise, and Less Smoking

POSTER SESSIONS
P-38 The Availability and Cost of DASH Diet Foods in the Jackson, Mississippi, Metropolitan Area Alan David Penman, M.D., M.P.H.

P-39 On the Move: Blood Pressures on the Bus Anita Peden Sherer, R.N., M.S.N.

P-40 Easy Access, Better Control Anita Peden Sherer, R.N., M.S.N.

P-41 Assessing and Improving Knowledge of Heart Attack Symptoms Bianca Grigorian

P-42 Nutritional Behaviors of Cardiac Rehabilitation Patients Charles Jeffrey Frame, Ph.D., R.D.

P-43 S.T.E.P.S. for a Healthy Heart: Strategies Toward Environment and Policy Success Cathy Ryan

P-44 Addressing Health in Urban Communities of Color: Partnering With Faith Communities Margaret O. Casey, R.N., M.P.H.

Growing the Program: Two and a Half Years of Centers for Disease Control and Prevention’s
P-45 Margaret O. Casey, R.N., M.P.H.
Support to the New York State Healthy Heart Program

P-46 Cardiac Troponin I in Patients With Acute Myocardial Infarction and Unstable Angina Najla'a Abdul Aziz Ben Selim, M.D.

P-47 Issues in Recruiting Mothers and Children for a Family-Based Weight Loss Program Nora L. Constantino, Ph.D.

Gender and Ethnic Differences in Obesity and Related Cardiovascular

P-50 Paul Stephen Fardy, Ph.D.
Health Measures in Urban Adolescents: The PATH Program

Analysis of Prehospital Treatment—Delaying Factors With Early Cardiac Death

P-51 Terri L. Bono, R.N., M.S.N., A.C.N.P.
After Acute Coronary Syndrome in Socioeconomically Differing Populations

P-52 Weight Loss and Metabolic Improvement With a Mediterranean Diet in Patients With Heart Disease Mary M. Flynn, Ph.D., R.D.

P-53 Use of Transtheoretical Model Processes Across Exercise Stages of Change of College Students Danielle Danese Williams, M.S.

P-54 Reduction of CVD in Rural Communities Deborah S. King, Pharm.D.

Analysis of the Relationship Between Exercise Capacity and Heart Rate

P-56 Phil Tonkins, Jr., M.S., A.T.C.
Variability in Trained and Untrained Individuals

CVH 2002 85
 POSTER SESSIONS FRIDAY, APRIL 12
Location Abstract Title Presenter
P-57 Eating To Live in the 21st Century Velonda Thompson, Ph.D.

New Secondary Prevention Strategies: Effectiveness of Intensive Outpatient Interventions

P-58 Nan Pheatt, M.P.H.
That Complement the American Heart Association's Get With the Guidelines Program

P-59 An Analysis of Coronary Heart Disease Risk in a Cardiology Population Maria Cannito

P-60 Faith Community Site Intervention Trials: Socioeconomic Status as a Predictor of CVD Risk Factor Profiles Frederick E. Munschauer, M.D.

P-61 Intervention Plan To Increase Physical Activity Levels in the Inner City Michael J. Welch, Ph.D.

Linking the Library and the Farm With Nutrition Education: An Innovative
P-62 Luanne J. Hughes, M.S., R.D.
Delivery Method for Delivering the Five a Day Message to Children

Dietary Fat Assessment: Identification of Food Frequency Questionnaires

P-63 Nalini N. Jairath, R.N., Ph.D.
With Limited Measurement Burden

P-64 Case Report: Rapid Assessment and Management of an Acute Coronary Syndrome Terri L. Bono, R.N., M.S.N., A.C.N.P.

P-65 Preventing CVD in Women: A Community-Based Project Mary J. Boylan, M.D.

Assessment of the Prevalence of CVD and

P-66 Mohammad I. Ullah, M.D.
Associated Risk Factors in South Carolina Using Behavioral Risk Factor Surveillance System Data

P-67 Population Strategies for Hypertension: Japanese Male Workers Study Machi Suka

P-68 HEART: Helping Educators Attack CVD Risk Factors Together Shari K. Wiley, M.S.N., C.C.R.N., C.F.N.P.

Multifactor Risk Reduction in Low Income Patients: Opportunities

P-69 Kathy A. Berra
and Challenges in Implementing a Case Management Model

The Use of Self-Regulation Skills, Exercise Self-Efficacy and

P-70 Michelle Renee Umstattd
Exercise Outcome-Expectancy Values of Employed Women

P-71 Exercise Stages of Change Do Not Accurately Reflect Exercise Behavior in Employed Adults Danielle D. Williams, M.S.

P-72 Evaluation of Antihypertensive Effectiveness in Clinical Practice Sunny Anne Linnebur

Increased Prevalence of Cardiovascular Risk Factors in a Rural Appalachian Area of Eastern

P-74 Judy Zielke
Kentucky Is Associated With Lower Educational and Income Levels: The Coronary Valley Project

P-75 Improving LDL Goal Attainment Through Provider Education in a Health Maintenance Organization Amber Rochelle Polk, Pharm.D.

P-76 Triage Decisions by Emergency Department Nurses Cynthia Arslanian-Engoren, Ph.D., R.N.

P-77 Rasmussen Center for CVD Prevention Lynn G. Hoke, R.N., F.N.P.

P-78 Mississippi MCIC-AHA Capitol Day 2001 Deborah S. King, Pharm.D.

P-79 A School-Based Program To Heighten Adolescent Obesity Awareness Among Medicine-Pediatric Residents Marion R. Wofford, M.D., M.P.H.

Assessment of Blood Pressure, Blood Glucose, and Blood Cholesterol, and

P-80 T. Kristopher Harrell
Body Mass Index Awareness in a Rural Mississippi High School

P-82 Advanced Lipid Measures in Family Practice: Clinical Outcomes and Cost-Effectiveness Maureen R. Courtney

P-83 A Unique Multirisk Factor Reduction Program in Family Practice Maureen R. Courtney

Lone Mothers Are at Higher Risk for CVD Compared to Partnered Mothers:
P-84 Lynne E. Young, Ph.D.
Data From the National Health and Nutrition Examination Survey III (NHANES III)

P-85 A Comparison of Stroke Risk Factors in Men and Women With Disabilities Janice L. Hinkle, Ph.D.

86 CVH 2002
FRIDAY, APRIL 12 CONTINUED
Location Abstract Title Presenter
P-86 Benefits of a Pre-ESRD Education Program Betsy B.D. Ripley, M.D.

P-87 Nurse-Managed Blood Pressure Telemonitoring With African Americans Nancy T. Artinian, Ph.D.

P-88 Perceptions of the Environment for Physical Activity Among High- and Low-Risk Counties Emily Corbet Spangler, M.D.

P-89 Nutrient Intakes of Rural, 5th Grade Children at Risk for CVD Colleen Ann Kelley

P-90 Outcomes of Medical Nutrition Therapy for Postmenopausal Women Debra Ann Krummel, Ph.D.

P-91 Impact of a Nutrition Intervention on Quality of Life in Subjects With High Risk Factors for CVD Sandra Marie Magnetti, P.HG., Dr.P.H.

P-92 Faith Communities and Informal Long-Term Care Bonnie Hartman Arkus

P-93 The Prescription for a Walkable Community—The Role of Public Health Practitioners Deborah A. Spicer

P-94 CVD Risk Factors Knowledge Improvement: A Community-Based Educational Intervention Laurens Holmes

P-95 Worksite Internet Nutrition Torin J. Block

POSTER SESSIONS
P-96 Gender and Racial Disparities in Pre-AMI Diagnosis: Missed Opportunities? Arlene S. Ash, Ph.D.

P-97 Weight Loss and Risk Factor Management in the Community Setting Mary Catherine Vernon, M.D.

P-98 Cambodian Community Health 2010 Sidney Liang

P-99 Existing and Developing Community Health Promotion Programs in New York State Christopher C. Ashley, M.D.

Cardiovascular Risk Reduction Clinic: A New Health Care Intervention

P-100 Kwai Dzy Mak
Promoting Health and Disease Prevention in Patients With Established CVD

P-101 The Evaluation of Secondary Prevention Practices in an Acute Care Setting—A Heartcare Partnership Jack William Taylor, M.S.

P-102 Supports and Barriers to Healthy Eating and Physical Activity Identified From Diverse Low-Income Focus Group Participants Teresa B. Kaley, R.D., L.D.

P-103 Sedentary Lifestyle in Adult, Working Women: A Group Intervention for Exercise Judith Ellen Swasey, M.S.N., R.N.

P-104 CVD Risk Assessment and Prevention in PS 17 Srigouri Maguluri

P-105 The Role of Sleep-Disordered Breathing in CVD Terry Young, Ph.D.

Increasing the Intake of Flavanol-Rich Foods: One Approach to

P-106 Carl L. Keen
Reducing the Risk of Coronary Heart Disease and Stroke

P-107 Healthy People 2010 Knowledge Test Richard Edward Miller

P-108 Development of a Coronary Heart Disease Decision Support Tool Lambert Anthony Wu, M.D.

P-109 Epidemiologic Correlates of Excessive Gestational Weight Gain Isabel Diana Fernandez, M.D., Ph.D.

P-110 Twenty-five Years of Corporate Health Promotion Ronald John Cook

P-111 Influence of CVD on Racial Disparity in Life Expectancy La Mar Hasbrouck, M.D., M.P.H.

P-112 Risk Factors for Atherosclerosis Among College Students of Eastern Nepal Vijay Prakash Sharma

CVD in Iowa: An Applied Logistic Regression Model to

P-112 Jude Igbokwe
Iowa's 2000 Behavioral Risk Factor Surveillance System Survey Data

CVH 2002 87
 Health Smart Church Program: A Successful vital statistics, and more. The faith-based prevention
P-1
Cardiovascular Health Intervention model, a CSAP promising program, was modified. Each
church (N = 10) implemented separate youth and adults
Cheryl Anne Martin, Ph.D., Anne Arundel County programs based on needs, assets, and outcome data.
Department of Health, Maryland Project baseline percent data (postdata will be available in
The Health Smart Church Program is a partnership of the September) as compared to Healthy People 2010 (African
Anne Arundel County Department of Health, 3 medical American) data:
partners, and 39 local minority churches. The program
provides free blood pressure screenings and health infor- Concept Youth N = 115 Adult N = 220 HP Youth HP Adults
mation on blood pressure, nutrition, and physical fitness Leisure time activities 57.4 33.2 80
30 minutes exercise 64.3 43.7 30 30
to participants. Church members are trained and certified
Avoid cigarette smoking 77.4 77.4 84 82
in blood pressure measurement by staff from the health Tried to quit smoking 25.2 13.6 75
department. Blood pressure measurement equipment, High blood pressure 69.6 75 84
health information, and other supplies are provided to Healthy weight 73 53.2 60
each church. Churches agree to conduct one blood pres- Two servings of fruit 53.9 38.6 24 24

sure screening event per month from October through

June each year. In 2001, 139 blood pressure screening
events were conducted. A total of 2,230 persons partici- P-3 Phase One of a Comprehensive
pated in these events, and a total of 4,969 blood pressure Community-Based Approach to
measurements were taken. Thirty-six percent of the blood Cardiovascular Disease Prevention
pressures taken were elevated (≥ 140/90 mmHg), and 10
Liana S. Lianov, California Heart Disease and Stroke
percent were significantly elevated (≥ 160/100 mmHg). Program, California Department of Health Services,
Those with high blood pressure are contacted by the Nan Pheatt, M.P.H.
medical partner and are rescreened free of charge. They Purpose: The aim was to identify and develop a plan for
are referred to care if it is needed. At the screening overcoming barriers at the local level that prevented
events, 317 participants found out for the first time that California’s San Bernardino County communities from
their blood pressure was elevated. Overall, the Health working collaboratively to reduce their county’s heart dis-
Smart Church Program enables people to become aware ease death rate. Because San Bernardino County has the
of their blood pressure and ways to help keep it under highest heart disease death rate in the State, community-
control. based organizations (CBOs) and the county health depart-
Faith-Based Cardiovascular Model ment had accepted the challenge of reducing the heart
P-2
disease burden by implementing a hypertension preven-
Gregory J. Harris, M.A.S.S., Health Promotion Program tion and control project. However, they were unable to
Initiatives, Inc. develop a collaborative having leadership with enough
This 19-month African American cardiovascular project is capacity or community representation to satisfy potential
designed to decrease ethnic disparities. The community funders.
was mobilized, and resources were coordinated to sup- Methods: The California Heart Disease and Stroke
port effective/sustainable African American programs Prevention (CHDSP) Program assisted the community in
addressing illness (strokes, cigarette smoking, physical developing a planning grant proposal that would enable
inactivity, weight monitoring, and high blood pressure); (1) GIS mapping of relevant health resources in the coun-
learn of unhealthy lifestyles (coordinated public relations ty, (2) research and identification of the most effective
campaigns); educate/participate in screening (blood pres- health promotion interventions for the target populations,
sure, weight); community activities (awareness; alterna- (3) identification of novel interventions that had been
tives; informational; educational; individual, family, and used for other diseases and might have a role in hyper-
intergenerational; environmental); increase culturally sen- tension and other risk factors, (4) identification of all con-
sitive activities (community, church-based, or beauty stituencies in the community, and (5) selection of the
shop); and examine data/make appropriate adjustments. most appropriate organization to take the lead in the
Strategies included church committee implemented/eval- hypertension and other cardiovascular disease (CVD) pre-
uated church-community programs, beauty shop activi- vention projects.
ties, or activities at places people gather.
Results/Conclusions: Through this research and self-
The presentation shares successful church committee examination process, the community-based organizations
processes and data: exercise (exercise to church music), were able to develop new linkages with each other, devel-
nutritional practices (cooking classes), tobacco prevention op capacity, and implement CVD prevention projects with
activities, stress management groups, blood pressure and a greater likelihood of success. Phase 2 of the project will
weight screening/referral/followup, special church holi- implement and evaluate a comprehensive tool for public
days related to cardiovascular health, achievement recog- health workers, which will include this intervention.
nition, intergenerational, community awareness, data col-
lection, presurveys, postsurveys, monthly activity reports,

88 CVH 2002
 The Role of Food Phenolics in Reducing nology to improve patient communication, physician edu-
P-4
Cardiovascular Disease Risks cation, and further integration with inpatient CHF services.

Joe S. Hughes, Ph.D., California State University, San P-6 Community-Based Health Promotion
Bernardino
Kay R. Parent, R.N., M.P.H., Center for Healthy
Considerable research interest is currently focused on
Communities
food phenolics because of their antioxidant and free radi-
cal scavenging abilities and their potential for reducing Purpose: Community nursing centers were created in
cardiovascular disease risk and improving human health. Dayton, OH, to detect risk factors for cardiovascular dis-
Food phenolics (commonly called polyphenolics) come in ease (CVD) within vulnerable populations who have poor
many forms and are widely distributed in a broad range access to health services. Individualized screening, educa-
of foods. Most research interest has been focused on one tion, behavioral change planning, and followup are ele-
class of phenolic compounds—the flavonoids. Flavonoids ments utilized to increase the proportion of adults who
in wine and tea have been most extensively studied for are taking action to control high blood pressure and to
their heart-healthy benefits and are believed to be prima- modify other risk factors.
rily responsible for the low incidence of heart disease in Method: Screening for blood pressure, cholesterol, glu-
France, commonly referred to as the “French Paradox.” cose, and weight/body mass index (BMI) is provided.
However, the antioxidant capacity of flavonoids in a vari- Assessment of physical activity, diet, and other risk fac-
ety of other foods has also been reported, including tors is gathered for baseline. An individualized health
flavonoids in green tea, grape juice, beer, dry beans, and plan, education, and referrals for needed health care serv-
chocolate and in a wide range of fruits and vegetables. ices are provided. The nursing clinics run twice per week
Though the antioxidant capacity of flavonoids varies, sev- at two urban neighborhood locations—one in conjunction
eral researchers have reported finding flavonoids that are with a food pantry and the other during a weekly free

POSTER SESSIONS
more potent as antioxidants than are vitamin E and vita- meal. A registered nurse, a community health advocate,
min C. A better understanding of flavonoids, their distri- and nursing students assist in the clinics.
bution in foods, their antioxidant abilities, and their Results: Behavioral change is noted in decreased BMI,
potential benefits in protecting against cardiovascular dis- improved diet, increased activity, and smoking reduction.
ease is needed. Coalitions are being developed in neighborhoods to pro-
mote walking programs, health and nutrition programs,
P-5 Congestive Heart Failure and
and grassroots campaigns.
Cardiac Rehab . . . Do They Mix?
Conclusions: Neighborhood-based services with the
Jeannie Garber, Carilion Medical Center, Karen Warsaw involvement of community residents in the development
Carilion Roanoke Memorial Hospital implemented a con- of health promotion programming are a means of risk
gestive heart failure (CHF) outpatient education/activity reduction for CVD.
program in 1996. The main objectives of the CHF Center
are (1) to address CHF readmission rates, (2) to facilitate P-7 Whole Grain Intake in the United States:
the educational needs and treatment compliance, and (3) How Do We Achieve Three or More
to develop a CHF Center model that could be duplicated. Servings Per Day?
Because of similar patient population, staff expertise, uti-
Mark A. Pereira, Department of Medicine, Children’s
lization of space, and equipment, the center is based in Hospital, Boston
the Cardiac Rehab. The center is staffed by registered
Healthy People 2010 objective 19–7 states: “Increase the
nurses, an exercise physiologist, a C.N.S., a R.D.E., and a
proportion of persons aged 2 years and older who con-
psychologist. Individual assessments, activity progres-
sume at least six daily servings of grain products, with at
sion, counseling, and group education are components of
least three being whole grains.” Scientific evidence sug-
each visit. To date, 246 patients have enrolled in the CHF
gests that the achievement of this goal will lower rates of
Center. During fiscal year 2000, 54 patients were followed.
cardiovascular disease. Recent estimates suggest that
During the first, second, and fourth quarters, there were
only 2 percent of the population is meeting this goal and
no readmissions; in the third quarter, one out of five
that average whole grain intake per capita is less than
patients were readmitted at a rate of 20 percent. The inpa-
one daily serving. We propose several strategies to
tient readmission rate of noncenter patients was at 15.16
increase the likelihood of achieving this goal. These
percent; potential prevented readmissions could save
strategies include (1) community-based and national cam-
$81,761. This CHF Center model has been implemented
paigns to educate the general public, (2) the inclusion of
across the Carilion Health System with varying degrees of
whole grain education in schools and government nutri-
success. Barriers identified include a lack of patient trans-
tion programs, (3) more whole grain foods in menus of
portation, poor physician support, and the absence of
schools and nutrition programs, and (4) increased usage
reimbursement. Further plans to develop the program
of whole grain flours in the food supply by replacing
include the use of telephone followup, computerized tech-
some refined flour with whole grain flour. The latter

CVH 2002 89
 approach is analogous to replacing saturated fats in the Self-administered questionnaires were delivered to 205
food supply with unsaturated fat—a strategy that probably physicians, 28 NP, and 20 PA. Information from returned
contributed to reduced rates of coronary disease. questionnaires showed that although the smoking cessa-
Academia, government, and industry must work together tion intervention demonstrated a reduction in tobacco
to achieve the nutrition and overweight goals of Healthy use, and despite the high number of current smokers in El
People 2010; otherwise, these goals are unlikely to be Paso, only 12 percent of providers considered treating
met. tobacco-dependent patients their top priority, and 13 per-
cent did not consider treating tobacco-dependent patients
P-8 Online CME To Assist Primary Care a priority at all. It was also reported that 67 percent of
Physicians With Tobacco providers have attended only 0–2 hours of tobacco cessa-
Cessation Treatment tion education programs in the past 4 years.
Mary P. Metcalf, Ph.D., Clinical Tools, Inc. A Process of Diagnostic Testing Data
P-10
The primary care physician can play a significant role in Retrieval Increases Eligibility; Hence
the success of tobacco cessation attempts. Two-thirds of Appropriate Medication Management for an
all smokers are seen by a physician each year, and of Elderly Heart Failure Population
those, smokers who were advised to quit were 1.6 times
more likely to attempt quitting. Yet many physicians are Miriam Cannon-Wagner, CorSolutions, David Walker,
Diane Soule, Richard Vance
still not making the effort. In one study, only 51.6 percent
of physicians approached patients and advised them to Purpose: The purpose of this study was to report the
stop smoking. Many of the physicians who do inquire effectiveness of a heart failure (HF) condition manage-
about their patients’ smoking habits do not offer specific ment (CM) program in obtaining diagnostic testing results
cessation plans and thus are frustrated by their patients’ to evaluate HF patients for recommended practice guide-
lack of success. New treatment guidelines released in line medications, such as ACEi and beta blockers.
June 2000 are not yet familiar to many practicing physi- Methods: Diagnostic test (ECHO, MUGA, and/or catheter-
cians: physicians are not aware of appropriate treatment ization) results were requested for all HF participants
regimes with medications or the efficacy of counseling/ enrolled in a CM program. In the analysis, 11,597 partici-
followup. We developed an Internet-based course, pants who were active in the program from April through
Tobacco Cessation: Four Case Studies, based on the 2000 June 2001 were included. The average age of a partici-
Clinical Practice Guidelines and existing NCI materials. An pant was 73.3 years, and 52.3 percent were female. The
evaluation with 20 resident physicians demonstrated sig- participants were referred from commercial and
nificant improvements in knowledge, attitude, and intend- Medicare-Risk managed care insurers. HF diagnosis was
ed behavior. Evaluation is ongoing, and early data indi- identified by a recent hospitalization or emergency room
cate that online CME on tobacco cessation is interesting event. Diagnostic testing and hospital records were
to physicians and is likely to be successful in influencing requested from all providers. Clinical decision support
their behavior with patients who use tobacco. software assisted nurses in obtaining testing, tracking
retrieval rates, and documenting findings to verify sys-
P-9 Attitudes, Knowledge, and Practices of
tolic dysfunction and medication eligibility.
Tobacco Cessation and Intervention
Among Health Care Providers in a Results: Nurses requested diagnostic testing for the
Hispanic Border Community 11,597 participants during their time in the program. As
of June 30, 2001, 79 percent of the participants had diag-
Juan Carlos Zevallos, M.D., Community Voices, Luan nostic testing results returned, regardless of their time in
Maria Coalwell, Mary Helen Mays, Ph.D., M.B.A., M.P.H.
the program. The return rate for diagnostics for those in
El Paso is a border community with more than 80 percent the program for at least 90 days was 88.9 percent.
Hispanics located at the juncture of Texas and the Eligibility for medications was restricted to systolic HF
Mexican city of Juarez in the State of Chihuahua. A recent participants with diagnostics confirming LVEF ≤ 40 per-
random-digit-dialed telephone survey conducted among a cent and further evaluation screens for medication con-
representative sample of adults over 18 years of age liv- traindications or side effects. Initial and subsequent eval-
ing in El Paso showed that 23 percent were current smok- uation screens revealed that 46 percent of participants
ers (those reporting having smoked at least 100 cigarettes were eligible for practice guideline medications.
and who smoked at the time of the survey).
Conclusion: A systematic diagnostic testing retrieval sys-
The objective of the survey was to obtain information on tem in an elderly HF CM population increases the utiliza-
attitudes, knowledge, and practices of tobacco cessation tion of appropriate medications as directed by practice
intervention programs among physicians, nurse practi- guidelines.
tioners (NP), and physician assistants (PA) affiliated with a
local not-for-profit health organization, to develop a com-
prehensive tobacco cessation program tailored to a
Hispanic community.

90 CVH 2002
 Influence of Lovastatin Therapy on Serum cessation classes, and to learn cardiopulmonary resusci-
P-11
Concentrations of Autoantibodies tation and first aid. It is anticipated that participants will
Against Oxidized LDL in Patients be able to lead healthier lives as a result of this project.
With Severe Primary Dyslipidaemia
P-13 Methodological Considerations in the
Tatjana Metodi Ruskovska, M.Sc., CVZU - Voena Bolnica, Assessment of Physical Activity for
Jordanka Dimovska, Anica Vasileva Free-Living Mothers and Preschool Children
There is increasing evidence for elevated serum concentra-
Nora L. Constantino, Ph.D., Department of Health Ecology
tions of autoantibodies against oxidized LDL (anti-oxLDL) in and Nutrition Education Research, Suzanne Perumean-
populations with increased risk for atherosclerosis. Cheney, Enid Coulston, Sachiko T. St. Jeor
The aim of this study was to determine the short-term Physical activity (PA) plays a critical role in disease pre-
influence of lovastatin therapy on serum concentrations of vention and the treatment of obesity. The ability to accu-
anti-oxLDL in patients with severe primary dyslipidaemia. rately measure PA is fundamental to developing strate-
gies for obesity treatment. Preschool children, either free-
We selected 10 patients with severe primary dyslipi-
living or in a controlled setting, are a population in which
daemia and measured their lipid status and anti-oxLDL
PA has not been adequately assessed. Health
status before lovastatin administration and 6 weeks later.
Opportunities for Preschool Children to Optimize Their
None of the patients experienced a change in his or her
Cardiovascular Health (HOPSCOTCH) was developed to
general health condition during the study, and there were
prevent obesity in preschool children (3 to 5 years of age)
no changes in patients’ standard therapy.
and employs the mother (34.80 ± 6.85 years 32.62 ± 5.29
There was significant improvement in lipid status in body mass index [BMI]) as the change agent. PA was
patients during the lovastatin treatment. At the same assessed utilizing three instruments for the mothers (7-
time, we found a significant decrease of anti-oxLDL for day activity records; 7-day Computer Science

POSTER SESSIONS
12.1 ± 9.7 percent from starting values, p < 0.01. Starting Applications, Inc., [CSA] accelerometers; International PA
values of anti-oxLDL were very different and varied from questionnaire [IPAQ]) and two instruments for the chil-
88 to 2,160 mU/mL. dren (7-day activity records and 7-day CSA accelerome-
ters). For the mothers, accurate record keeping and wear-
The lowering of anti-oxLDL at the same time that lovas-
ing of the monitors significantly limit the accuracy of the
tatin improves lipid status suggests the possibility for
data. For the children, compliance, proper fit of the moni-
involvement of anti-oxLDL in atherogenesis as a risk factor.
tor, and accurate record keeping by the mother can also
It remains unclear whether lovastatin is the only and the
confound the data collected. Adequate number of days of
most efficient therapy for lowering anti-oxLDL and whether
data collection is also a consideration for the dyad. When
hypothetic lowering of anti-oxLDL independently from
assessing PA in both mothers and preschool children,
improving lipid status could lower the atherogenic risk.
multiple measures of PA help elucidate complex data.
Heart and Soul: A Faith-Based Approach to This study is unique because PA was assessed in 3- to 5-
P-12 year-old children in a free-living condition and concur-
Cardiovascular Health in the Delta
rently with the mothers.
Susanne S. Hill, Heart and Soul, Delta Area Health
Education Center P-14 Provision of Nutrition Advice in
Primary Care Practices
The National Heart, Lung, and Blood Institute (NHLBI) has
contracted with the Delta Area Health Education Center to Gail L. Underbakke, R.D., M.S., University of Wisconsin,
establish an enhanced dissemination and utilization cen- Mary Beth Plane, Ph.D., Patrick E. McBride, M.D., M.P.H.
ter. The purpose of the center is to develop and imple-
Nutrition assessment and counseling of patients in pri-
ment interventions to improve cardiovascular health and
mary care is recommended for health maintenance and
to increase the percentage of adults who engage in heart-
disease prevention. The HEART Project reviewed medical
healthy behaviors. The center will also distribute NHLBI
records (MR) and patient questionnaires (PtQ) from 5,333
literature. The project will concentrate on two Arkansas
patients in 45 primary care practices in 4 mid-Western
Delta counties, St. Francis and Lee, both in the top 15 per-
States and collected questionnaires from 160 physicians
cent in the Nation for coronary heart disease and stroke
and 338 staff in those practices. According to MR reviews,
mortality. This project will be implemented in 16 Delta
43 percent of patients had documentation of any type of
churches, eight African American and eight Caucasian.
nutrition advice; on PtQ, 34 percent of these patients
Screenings of participants will occur during the initial
reported receiving nutrition advice. Approximately half of
health fair to be held in each church. Participants will
hypertensive patients and patients with cholesterol > 200
receive a free personal wellness profile and various other
mg/dL had MR documentation of nutrition advice, but on
health screenings. Over the next 3 years, participants will
PtQ, 57 percent of hypertensive patients and 86 percent of
have the opportunity to attend presentations on healthy
patients with cholesterol > 200 mg/dL reported receiving
living, to have regular blood pressure checks, to attend a
nutrition advice. Seventy-two percent of all patients said
heart-healthy cooking school, to participate in smoking
that they wanted their physicians to talk to them about

CVH 2002 91
 nutrition, and 88 percent of those who received nutrition ically asymptomatic, non-obese individuals of average
advice were satisfied with it. Practice staff reported pro- heights with normal blood pressure and ECG in sinus
viding nutrition advice less often than physicians provid- rhythm and normal blood lipids and sugar were studied.
ed it, but 92 percent of patients who received staff advice Of these 58 subjects, 29 were males (23 to 68 years of
were satisfied with it. The provision and documentation age), and 29 were females (19 to 69 years of age) without
of nutrition advice in primary care is important but is cur- hormonal replacement therapy. The study showed that
rently less than optimal. Practical and routine improve- below the age of 39 years, the time of the PWV was sig-
ments likely will require organized practice systems and nificantly higher among females compared to males, and
an increased role for practice staff. after this age (39 years), the time of the PWV in females
became significantly lower. There is a definite statistically
P-15 Nutritional Interventions in Interdisciplinary significant difference in the slopes for the corresponding
Rural Health Settings curves: males - (0.0005x) and females - (0.0015x), with p <
0.05. We conclude that in our study, the PWV is higher
Kim Shovelin, M.P.H., R.D., East Carolina University,
NUHM, Sylvia Escott-Stump among females than among males before the age of 39
years and shows a definite statistically significant reversal
North Carolina ranks 16th in the Nation for poor intake of
after this age. Being in the premenopausal age, we may
fruits and vegetables and for overweight. Poor nutritional
assume that menopause adversely affects the elasticity of
intake is a risk factor for numerous chronic diseases,
the arterial walls.
including cardiovascular disease. The current rural envi-
ronment in eastern North Carolina provides only limited Arterial Stiffness Changes Among
P-17
access to dietetic professionals. Our purpose was to Four Gender-Ethnic Groups of
develop nutritional interventions in interdisciplinary rural Children and Adolescents
health sites that currently do not provide dietetic services.
This goal was achieved through the Dietetic Internship WayWay M. Hlaing, M.B.B.S., Ph.D., Florida International
Program at East Carolina University, by using dietetic University, Ronald J. Prineas, M.D., Ph.D.
interns to provide regularly planned nutrition programs Brief Statement of Purpose: Most arterial stiffness stud-
and individual counseling. ies have been conducted cross-sectionally in adult popu-
lations. The purpose of this study is to assess the longitu-
Creative forms of nutrition education were used for both
dinal change of arterial stiffness among four gender-eth-
patients and interns via a traveling nutrition kit with
nic groups of the Minneapolis Children’s Blood Pressure
videotapes, other visuals, food models, recipe adapta-
Study (MCBPS).
tions, cooking demonstrations, and nutritional materials
that are appropriate for various levels of literacy and Statement of Methods: There are various ways of meas-
vision. A new tool was created to address some of the uring arterial stiffness, and arterial pulse pressure (APP) is
key issues for this region. often used as a surrogate measure. APP is defined as the
difference between systolic blood pressure (SBP) and
The project demonstrated effective patient outcomes
fourth phase diastolic blood pressure (DBP4). The MCBPS
through interdisciplinary rural health nutritional interven-
is a prospective cohort study, and the initial measure-
tions. The intent of the project was to serve 440 individu-
ments of SBP and DBP4 were made in 1978 (time 1).
als and 440 group participants (880 total contacts). Interns
Measurements were made 12 years later in 1990 (time 2).
and one half-time coordinator contacted 3,289 persons in
The mean ages were 7.7 and 18.3 years at times 1 and 2,
the region and, through the media, reached 60,000 view-
respectively. Analysis was restricted to those subjects
ers during 1 year. In the upcoming year, interns will
who completed both timed measurements (n = 728).
recontact participants to assess their current nutritional
needs. This model has been implemented in other parts Results: There were 269 white males (WM), 224 white
of the region where transportation to and from a health females (WF), 117 black females (BF), and 118 black
care provider is difficult. males (BM). Mean APP levels at both times 1 and 2 were
compared among the four gender-ethnic groups. Means
P-16 Pulse Wave Velocity: An Early and standard deviations of APP (mmHg) at time 1 were
Indicator of Arteriosclerosis in 38.4 + 11.9 (WM), 35.8 + 11.3 (WF), 35.6 + 12.8 (BF), and
Premenopause and Menopause 33.7 + 10.6 (BM) (p < 0.01). At time 2, APP levels were
46.2 + 10.7 (WM), 39.4 + 8.9 (WF), 39.8 + 10.6 (BF), and
Helen Marcoyannopoulou-Fojas, M.D., Evangelismos
University Hospital 45.6 + 11.4 (BM) (p < 0.01).

The purpose of this study is to determine whether there is Conclusions: Arterial stiffness levels were significantly
a difference in pulse wave velocity (PWV) in females different among the four gender-ethnic groups both in
before and after the age of menopause, compared to childhood and adolescent phases. These results would
males. The PWV was determined indirectly, using infrared serve as a foundation for future etiologic studies.
sensors to pick up the arterial pulses. The left external
carotid and left dorsalis pedis arteries were taken as the
central and peripheral pulses, respectively. Fifty-eight clin-

92 CVH 2002
 Patient Perceptions of Heart Failure ly. The data identified environmental and policy barriers,
P-18
Self-Management: A Test of such as a lack of time for physical activity, limited à la
Two Nursing Interventions carte items in the school menu, and parents’ perceptions
of the school lunch program. A coalition including local
Kay Setter-Kline, Ph.D., R.N., BSN Program, Grand Valley stakeholders and community partners used the data to
State University, Linda D. Scott, Ph.D., R.N., Agnes S. develop a strategic plan and to guide phase II strategy
Britton, M.S., R.N.
implementation. Through assessing the environment and
One aim of home health care is to assist in clients’ devel- policies of the schools, opportunities have been identified
opment of self-management skills that will improve for community organizations to collaborate to overcome
health, minimize complications, and reduce health care barriers to physical activity and healthy dietary patterns,
costs. Yet, nursing interventions used to strengthen self- thereby enhancing school health education programs.
management skills vary within agencies, and evidence of
their effectiveness is limited. The identification of specific P-20 Heartworkers: Virginia’s Model
nursing interventions that will strengthen self-manage- Cardiovascular Worksite Project
ment and reduce hospitalizations for persons with heart
Sue Curry Whittaker, R.N., Hanover Health District, Crystal
failure (HF) is imperative. Therefore, this study will test
Michelle Rasnake, Jody Stones, Eric Walker
the effectiveness of supportive-educative and mutual
goal-setting nursing approaches on patient perceptions of Worksite health promotion programs are a recognized
HF self-management. A convenience sample of 100 sub- avenue to improve the health and well-being of employ-
jects will be randomly assigned to 3 treatment groups in ees. Heartworkers is a health promotion program
this blind, experimental study of patients receiving home designed to reduce the risk of cardiovascular disease by
care for HF. Currently, 80 subjects have been enrolled. All providing supportive workplace environments and poli-
subjects receive nursing care for self-management as rou- cies that increase opportunities for healthy eating prac-
tices and physical activity for employees of Hanover

POSTER SESSIONS
tinely administered by the home care agency.
Additionally, subjects are assigned to one of the following County, VA. Heartworkers, begun in February 2000, is a
intervention groups: group I, a placebo approach in which collaborative project of Hanover Health District, Virginia
subjects receive general health teaching; group II, a sup- Department of Health’s Cardiovascular Health Project, and
portive-educative approach in which subjects receive other local partners. This project consists of four phases:
health teaching based on Orem’s conceptual model; or assessment, strategic planning, implementation, and
group III, a mutual goal-setting approach in which sub- monitoring. Data collection tools, including a worksite
jects receive teaching based on King’s conceptual model. assessment instrument, key informant questionnaire, and
The supportive-educative and mutual goal-setting an employee survey, were developed. The completed
approaches incorporate the HF guidelines from the assessment phase indicated that employees had limited
Agency for Healthcare Research and Policy. Patient per- access to healthy vending choices and facilities for physi-
ceptions of their HF self-management abilities are cal activities, such as safe walking trails. In addition, key
assessed at baseline and at 3 and 6 months. Data collec- informant interviews revealed no formal policies support-
tion will be completed by December 2001. Repeated ing physical activity and healthy eating practices. Data
analysis of variance with post hoc comparisons will be will be used to design interventions and encourage envi-
used for data analysis. ronmental and policy changes. By identifying and increas-
ing awareness of environmental and policy barriers to
P-19 Fit for Learning and Life: Virginia’s Model healthy behaviors, employers can implement strategies to
School Cardiovascular Health Project overcome these barriers. Environmental and policy data
can serve as a catalyst to encourage employers to sup-
Christy Colvin Mason, M.Ed., Hanover Health District, Sue port increased participation in healthy lifestyles.
Curry Whittaker, Crystal Michelle Rasnake, Jody Stones,
Eric Walker Development of a Hypertension
P-21
Fit for Learning and Life is a model school project award- Management Service in an
ed to Goochland County Public Schools and Hanover Underserved Urban Population
Health District by the Virginia Department of Health’s
Cardiovascular Health Program. This project, which began Charlene Aerilyn Hope, Pharm.D., Hope Med-
Management and Wellness Services
in February 2000, focuses on creating environmental and
policy changes to support increased physical activity and The purpose of this study is to develop and implement a
healthy dietary patterns to decrease the development of hypertension management program that empowers
risk factors associated with cardiovascular disease. Phase patients to take control in managing their disease. The
I of the project, completed in summer of 2001, included objectives of this study are to increase the proportion of
assessment and strategic planning. Tools, including a site adults with high blood pressure who are making neces-
assessment instrument, key informant interview ques- sary lifestyle modifications to control their blood pres-
tions, and parent and student surveys, were developed to sure, such as losing weight, increasing physical activity,
collect baseline data. Response rates for parent and stu- and reducing sodium intake. Medication compliance sig-
dent surveys were 54 percent and 73 percent, respective- nificantly impacts the achievement of desired treatment

CVH 2002 93
 outcomes as well as health care costs and utilization. The Implementation of an Innovative
P-23
second objective of this study is to increase the propor- Community-Based Heart Disease and Stroke
tion of adults with high blood pressure on drug therapy Risk Reduction Program (INTERxVENT)
to maintain medication compliance and persistence.
Neil F. Gordon, INTERxVENT USA, Inc., Brenda S.
Patients will either be referred by their primary care Mitchell, Ph.D., N. Gordon, R. Salmon, C. Faircloth, I.
provider (PCP) or may self-enroll for services. Patients will Levinrad, W. Saxon, K. Reid, S. Salmon
be assessed and educated about risk factors for cardio-
We have developed, tested, and successfully implement-
vascular disease. Patients will be encouraged to set their
ed an affordable, evidence-based, comprehensive cardio-
own health care goals (e.g., to lose 10 pounds, to walk 30
vascular disease (CVD) risk reduction program for use in
minutes daily) and will be given recommendations on
primary and secondary prevention settings. The program,
how to reach these goals. Patients on drug therapy will
INTERxVENT, can be administered in a standardized, but
be assessed for medication compliance through a phar-
individualized, way to large numbers of people with or at
macist-administered questionnaire. After barriers to com-
risk for atherosclerotic CVD and stroke in a variety of
pliance have been identified, the pharmacist will imple-
medical and nonmedical environments. Program delivery
ment patient-specific interventions. Strategies to improve
sites have been established in many cities and towns in
compliance include, and are not limited to, patient educa-
the United States and currently include (a) hospitals, (b)
tion regarding medication and disease state, pill boxes,
physician practices, (c) cardiac rehabilitation programs,
providing patients with home blood pressure monitors,
(d) shopping malls, (e) worksites, and (f) health clubs. The
and applying for medications through the manufacturer
program is also delivered from a call center using tele-
prescription patient assistance programs. The measured
phone, the Internet, and mail. Program staff are guided
outcome will involve the ability of service to support
by a computerized participant management and tracking
patients in reaching their health care goals and PCP clini-
system. Lifestyle interventions are based on several
cal goals.
behavioral change models, primarily, social learning theo-
P-22 Community Cardiovascular Project ry, the stages of change model, and single concept learn-
ing theory. At most sites, the program is administered
Cindi Miller, R.N., M.S., Community Health Education, entirely by nonphysician health care professionals.
Howard County General Hospital: A Member of Johns Outcome data, including data from randomized clinical
Hopkins Medicine trials, have confirmed the cost-effectiveness and repro-
Purpose: A random community survey of 515 households ducibility of this approach. Practical experiences support
determined that 27 percent of the respondents had not the feasibility of increasing access to affordable CVD risk
been tested for high blood pressure in the previous 2 reduction services throughout a community via the wide-
years. The purpose of the project is to detect hyperten- spread implementation of INTERxVENT programs.
sion in community residents, educate them on control,
and refer them for treatment. P-24 Clinical Effectiveness and Reproducibility of a
Corporate Cardiovascular Disease
Method: Through a collaborative effort with 23 faith com- Risk Reduction Program
munities, Howard County General Hospital: A Member of
Johns Hopkins Medicine developed the Community Neil F. Gordon, INTERxVENT USA, Inc., Sheldon Warman,
Cardiovascular Project. It includes a training session and Richard Salmon, Brenda S. Mitchell
all-inclusive kits for nurse volunteers in faith communi- Rapidly escalating health care costs are causing employers
ties. These kits contain blood pressure measurement sup- to focus unprecedented attention on chronic disease pre-
plies, educational posters, handouts, wallet cards, and vention. In this study, we evaluated the clinical effective-
physician referral letters. The nurses conduct the screen- ness and reproducibility of a comprehensive cardiovascu-
ings a minimum of once a month. lar disease (CVD) risk reduction program (INTERxVENT)
administered to employees at companies in three differ-
Results: During the first 15 months of the project, a total
ent U.S. cities (designated A, B, and C). Employees (n =
of 1,087 persons were screened for hypertension and
1,483) were evaluated at baseline and after approximately
educated about whether their blood pressure was normal
12 weeks. The program was administered in each city by
or high. Through physician referrals and education by the
nonphysician health care professionals guided by a com-
nurses, many participants have been placed on medica-
puterized participant management system. For partici-
tion and are engaging in lifestyle changes for hyperten-
pants with abnormal baseline risk factors, clinically rele-
sion control.
vant improvements were observed for multiple variables
Conclusions: Large numbers of people can be screened, as follows (p < 0.05 unless otherwise indicated):
educated, and treated for hypertension control through col- systolic/diastolic blood pressure, City A = -17/-10 mmHg,
laborative efforts between hospitals and faith communities. City B = -20/-12 mmHg, City C = -13/-13 mmHg; total cho-
lesterol, City A = -30 mg/dL, City B = -44 mg/dL, City C = -
34 mg/dL; LDL cholesterol, City A = -16 mg/dL, City B = -
29 mg/dL, City C = -21 mg/dL; HDL cholesterol, City A = 5

94 CVH 2002
mg/dL, City B = 4 mg/dL (p = NS), City C = 0.4 mg/dL (p = as a low level of HDL-cholesterol (HDL-C) without elevat-
NS); triglycerides, City A = -73 mg/dL, City B = -30 mg/dL ed LDL-cholesterol (LDL-C), is necessary for the develop-
(p = NS), City C = -53 mg/dL; weight, City A = -3 lbs, City B ment of optimal treatment strategies. There are two sepa-
= -9 lbs, City C = -5 lbs; and fasting glucose, City A = -32 rate and independent contributors to low HDL risk: (1) the
mg/dL, City B = -35 mg/dL, City C = -36 mg/dL. These data absence of the protection that would otherwise exist with
demonstrate that a comprehensive CVD risk reduction a higher level of HDL and (2) the presence of the metabol-
program can elicit clinically relevant and reproducible ic syndrome, characterized, in part, by insulin resistance;
improvements in the risk factor status of employees with elevated triglycerides; a lipoprotein subclass pattern of
abnormal baseline values. predominantly large VLDL, small LDL, and small HDL; and
elevated numbers of LDL particles relative to LDL-C lev-
P-25 Cardiovascular Health Risk Behavioral els. In clinical practice, it is important to differentiate the
Practices of African Americans in low HDL patients who carry the added risk burden of the
Mississippi During the 1990s metabolic syndrome from those who do not, since treat-
ment decisions and targets of therapy will differ. Insights
Clifton C. Addison, Ph.D., Jackson Heart Study
into the origins of low-HDL risk are provided by the
Background: Cardiovascular disease is the leading cause lipoprotein subclass profiles of more than 3,400 subjects
of death and the single greatest contributor to excess from the Framingham Offspring Study, measured by
mortality in African Americans. The atherosclerotic progress nuclear magnetic resonance spectroscopy. The variation
begins in childhood and progresses into adulthood. A of these profiles as a function of HDL-C provides striking
limited number of behaviors contribute markedly to car- evidence that excess LDL particle number and small LDL
diovascular disease. These behaviors, often established size are important contributors to the risk of many indi-
during youth, include tobacco use, unhealthy dietary viduals with low levels of HDL-C. These people, who
behaviors, inadequate physical activity, and obesity. would not normally be recognized as having an LDL prob-

POSTER SESSIONS
Methods: Data were collected using the Youth Risk lem, would benefit from LDL-lowering therapy in addition
Behavior Survey (YRBS) for students and the Behavior to treatments designed to raise HDL.
Risk Factor Surveillance System (BRFSS) for adult, exam-
P-27 Women’s Hearts Are Different:
ining four health risk behaviors, tobacco use, dietary
The Development and Implementation
behaviors, physical activity, and overweight. These data
of a Primary Prevention Program,
provide an important insight into the apparent origins of
the Womancare Heart~Check Program
cardiovascular disease and cardiovascular-related dis-
eases in African Americans. Mary R. Dortenzo, M.S.N., N.P., Women’s Specialty
Program, Magee-Women’s Hospital of UPMCHS
Results: Both youths and adults have decreased their
participation in regular/sustained exercise. The frequency Recognizing that heart disease is the leading cause of
of poor dietary practices was considerable, and even death in women in the United States, the Womancare
though the numbers of overweight African American Heart~Check Program is a unique program designed to
youths have declined slightly, the number of overweight address cardiovascular disease in women. The major
adults increased. African American youths have increased focus of this program is on the primary prevention of
cigarette smoking, and the adult smokers have increased heart disease. Our goals are early detection of heart dis-
in numbers throughout the 1990s. ease, identification of women who are at an increased
cardiovascular risk, and education on aggressive risk
Conclusions: A very important challenge for the preven- reduction strategies.
tion of cardiovascular disease is to decrease the number
of people engaged in unhealthy lifestyle behaviors. The idea that women’s hearts are different has provided
Recent research has shown that overall mortality and car- the foundation for the development of this program.
diovascular disease mortality are higher in African While we have long recognized the gender difference in
Americans than in Whites. This investigation provides heart disease, unfortunately most women have not. In
evidence that the extent of health risk behaviors, such as fact, most health care professionals have not. Through
a lack of physical activity, poor dietary habits, overweight, our program, we have been able to heighten the aware-
and cigarette smoking in late childhood and early adoles- ness in both the lay and medical communities that heart
cence may constitute important risk factors for the onset disease is a women’s health issue.
of cardiovascular disease in adulthood. The Heart~Check Program is a consultative service offer-
Addressing the Risk of Patients With ing a complete cardiovascular risk assessment during a 1-
P-26 hour session with a nurse practitioner practicing in cardi-
“Isolated” Low HDL—Should Raising HDL
Be the Sole Objective? ology. During the 1-hour visit, risk factors are identified. A
lipid profile is completed and resulted immediately.
J.D. Otvos, Ph.D., LipoMed, Inc., and Lipoprotein and Recommendations are made according to the National
Metabolic Disorders Institute, W.C. Cromwell Cholesterol Education Program Guidelines. Blood pres-
Understanding the origins of the enhanced cardiovascular sure is measured, body mass index is calculated, and a 3-
disease risk of patients with “isolated” low HDL, defined day dietary log is reviewed and analyzed with the help of

CVH 2002 95
 a computer program. Individual counseling on risk reduc- nate training to all providers with Internet access. The
tion strategies consumes the majority of the 1-hour session. purpose of this study is to pilot test the ability of a Web-
based tobacco cessation provider training program to
From 27 participants in the first 6 months to approximate-
improve knowledge of tobacco cessation counseling
ly 400 by the end of 48 months of operation, the number
strategies and to increase the acceptance of using these
of women participating in this comprehensive risk assess-
strategies in practice.
ment program continues to steadily increase.
Methods: Eleven internal medicine residents participated
P-28 Addressing Health Disparities in in a pilot test of the educational materials to be used in
Middle School Nutrition and Exercise the Web program. Residents took a pretest, received
training, and then took a posttest. Pretest and posttest
Marilyn Frenn, Ph.D., R.N., Marquette University College
of Nursing, Shelly Malin, Yvonne Greer, M.P.H., R.D., results were compared using student’s t-test.
Michael Havice Results: We found significant improvement in attitudes
Purpose: A four-session (Internet and video) with healthy about current knowledge of cessation counseling (p <
snack and gym labs intervention was tested in two urban, 0.001), comfort level in using the counseling (p < 0.001),
low-to-middle income middle schools to examine and confidence that the provider would be effective (p =
improvement in Healthy People 2010 Objectives 19–9, 0.01). Confidence that the training would be used in prac-
22–6 and 7 and as a cost-effective approach to increase tice was not significantly increased but was already high
the number of schools addressing nutrition and exercise in the pretest. A knowledge score, calculated by combin-
(Objective 7–2). Differences in response to the interven- ing the results of seven clinical vignette questions, was
tion for race, income, and gender will be described, given significantly increased after the training (p = 0.005).
those with low income; especially females of African
Discussion: Pilot results show that the content of a Web-
American and Hispanic heritage have the greatest risk of
based tobacco cessation provider training program is
inactivity and obesity.
effective at increasing knowledge of tobacco cessation
Methods/Process: The intervention incorporated con- counseling strategies and improving attitudes towards
cepts from the transtheoretical and health promotion using these strategies. Future research will test the Web
models using instruments previously found to be valid program in medical and nursing students and compare
and reliable with a culturally diverse middle school popu- the Web training to traditional lecture format.
lation. An experimental design was used with assignment
to group by classroom. P-30 Incidence, Location, and Observation Status
of Out-of-Hospital Cardiac Arrest in
Results: Two Community Cohorts
• Moderate and vigorous activity were increased
(p = 0.014) for Black, Caucasian, Hispanic, and Asian Lambert Anthony Wu, M.D., Mayo Clinic, Thomas E.
students. Kottke, M.D., M.S.P.H., Mark J. Brekke, M.S., Lee N.
Brekke, Ph.D.
• The gym lab was particularly beneficial (p = 0.002)
for low-income students and females. Background: We wanted to define the locations of out-of-
• Fat in diet decreased with each Internet session in hospital cardiac arrest (OHCA) in a community to assist in
which students participated and was reduced signifi- determining a strategy to decrease morbidity and mortali-
cantly (p = 0.018) for Black, Hispanic, and Caucasian ty from cardiovascular disease.
girls. Methods: We reviewed two cohorts of residents from
Conclusions: The tailoring of interventions delivered Olmsted County, MN. Cohort 1 included Rochester, MN,
through modern technology may enable the reduction of individuals who suffered an OHCA as an incident CHD
health disparities in students consuming no more than 30 event between 1960 and 1979. Cohort 2 was a 10 percent
percent of calories from fat and increasing the proportion random sample of Olmsted County individuals with
of adolescents who engage in moderate and vigorous OHCA from coronary heart disease between 1981 and
physical activity. Given the need for cost-effective inter- 1994. Event rates were age- and gender-adjusted to the
ventions in schools, such approaches may help to 1980 U.S. population, 30 years or older.
address a number of Healthy People 2010 objectives.
Results: In cohort 1, 81 percent of the events occurred in
A Web-Based Tobacco Cessation private homes, and 19 percent occurred in public areas.
P-29
Counseling Program: Pilot Test Results The event was definitely observed in 24 percent and defi-
nitely not observed in 21 percent. In cohort 2, 79 percent
Lynne Janice Goebel, Marshall University, Todd W. Gress, of events occurred in private homes; 15 percent occurred
Kim Ashcraft, M.S., M.S.N., R.N., C-F.N.P. in public places; and 6 percent occurred in unknown loca-
Introduction: Many tobacco users do not receive cessa- tions. The event was definitely observed in 37 percent,
tion counseling from their providers. Providers may not definitely not observed in 50 percent, and of unknown
have access to the training necessary to offer effective status in 13 percent. The event rates were 61/100,000 and
counseling. A Web-based program would easily dissemi- 137/100,000 person-years in cohorts 1 and 2, respectively.

96 CVH 2002
Conclusions: These data indicate that a significant pro- Attempts at Changing Diet and
P-32
portion of out-of-hospital cardiac arrests occurring either Exercise to Lower the Risk of
as sentinel or recurrent coronary events are not observed, Coronary Heart Disease and Stroke:
and a significant proportion occur in private homes. Who’s Doing What in the Community?
Strategies to impact the problem should go beyond
enhancing resuscitation in public places and include pri- Randal J. Thomas, M.D., Mayo Clinic and Foundation,
mary prevention, community education to call 911, and Thomas E. Kottke, M.D., M.S.P.H., Stephen W. DeBoer,
Mark Brekke
maintenance of an effective first-responder team, in addi-
tion to the strategic placement of automatic external Methods: While few people follow a low-fat diet and do
defibrillators in public locations. daily physical activity, it is unclear how many are trying to
improve these lifestyle habits. We performed a random
P-31 Menu Labeling To Encourage the Selection telephone survey of 1,232 adults, who were more than
of Entrees With Less Than 1,000 mg Sodium, 20 years of age and were from Olmsted County, MN, to
Less Than 500 Calories and Less Than 7 assess their attempts at improving their dietary and exer-
Percent Saturated Fat cise habits to lower their cardiovascular disease (CVD)
risk.
Thomas E. Kottke, M.D., M.S.P.H., Mayo Clinic/CardioVision
2020, Rebecca Sue Hoffman, B.A. Results: Fifty-nine percent of respondents reported
Purpose: Dining in restaurants can interfere with an indi- attempts to improve exercise their habits, 71 percent
vidual’s dietary goals because they are unaware of the reported attempts to improve their eating habits, and 50
portion size or sodium and fat content of the menu items percent reported attempts to improve both. In all, 80 per-
that they may select. To address this problem, CardioVision cent reported trying to improve their exercise and/or
2020 organized a voluntary menu-labeling program to dietary habits. Of those trying to change their exercise
allow restaurant patrons to select meals of limited sodi- habits, 69 percent reported daily physical activity

POSTER SESSIONS
um and fat content and limited calorie content. (Pearson correlation = 0.34). Of those attempting to
change their dietary habits, 31 percent reported eating at
Methods: Restaurant managers in Olmsted County, MN, least five servings of fruits and vegetables daily (Pearson
were asked in person whether they would be willing to correlation = 0.14). Attempts to change diet or exercise
participate in the program. Interested managers were were highest in persons trying to lose or maintain weight
invited to submit menu items that they thought contained and in persons who reported having received previous
< 1,000 mg sodium, < 500 calories, and < 7 percent of physician advice to change their dietary and exercise
calories from saturated fat. Submitted menu items were habits.
analyzed using Computrition®, and those that met the cri-
teria were identified with the CardioVision 2020 “runner.” Conclusions: Most adults in Olmsted County, MN, are
A label was attached to each menu reading, “The attempting to change their exercise and dietary habits to
CardioVision 2020 runner indicates that the entree con- reduce CVD risk, but only a minority are meeting the rec-
tains < 1,000 mg sodium and < 500 calories of which < 7% ommended goals. Since most people are in the action
come from saturated fat.” The full analysis of the labeled phase of lifestyle change, health promotion messages
menu items was filed in the restaurant office. should include information on how best to improve and
maintain current lifestyle modification efforts.
Results: Restaurant managers have been enthusiastic Furthermore, there is an opportunity for health care
about the program. Even though many of their menu providers to impact their patients’ health by providing
offerings do not meet CardioVision 2020 criteria, labeling advice to improve their patients dietary and exercise
adds value to their menu and results in free promotion of habits.
their restaurant. The program also advertises
CardioVision 2020, a comprehensive heart disease pre- P-33 Dietary Guidelines for Americans 2000:
vention and treatment program. Maryland Training Initiative
Conclusion: A voluntary menu-labeling program is feasi- Carol R. Miller, R.D., L.D., Maryland Department of Health
ble and offers the opportunity for patrons to identify and Mental Hygiene, Division of Cardiovascular Health &
menu items that meet goals of low fat and sodium and Nutrition
limited calories. The Division of Cardiovascular Health & Nutrition,
Maryland Department of Health and Mental Hygiene, col-
laborated with the Maryland Department of Education to
obtain a USDA Team Nutrition Training Grant to conduct
effective nutrition education activities on the Dietary
Guidelines for Americans 2000. Grant objectives included
training a cadre of health professionals, school teachers,
administrators, nurses, and food service employees and
the development of a center to distribute nutrition educa-

CVH 2002 97
 tion materials. All training sessions included pretesting A Model for Medical Student Training in
P-35
and posttesting of attendees; training on the Dietary Nutrition and Cardiovascular
Guidelines for Americans, with activities modified for the Disease Prevention
target audience; and followup use of educational materi-
als. Tabletop exhibits for each Dietary Guideline were Kimberly Ruth Welch, M.P.H., Nutrition and Chronic Disease
developed, which emphasized serving size and education- Prevention, Mercer University School of Medicine, Brian W.
Tobin, Ph.D., Colleen M. Smith, Ph.D., M. Marie Dent, Ph.D.
al activities. To date, workshops have been conducted for
more than 500 attendees, and more than 6,000 pieces of To reduce cardiovascular disease (CVD) risk and prema-
nutrition education materials have been distributed. Grant ture disability, Mercer University School of Medicine initi-
training activities continue through December 2001, when ated the Nutrition and CVD Prevention Program for train-
overall grant evaluations will be summarized. This grant ing medical students. Healthy People 2000/2010 goals
demonstrates the strengths of collaborative nutrition edu- were used to develop program objectives, which include
cation training programs to a large audience of health (1) enhancing medical students’ recognition of the impor-
professionals and school personnel statewide. tance of nutrition and overweight and physical fitness and
activity in the prevention of CVD and (2) promoting
P-34 Provider Feedback Improves appropriate lifestyle changes in patients.
Adherence With AHCPR Guideline
Presentations in the Medical Education Seminar Series
Jeannette O. Andrews, Medical College of Georgia educate faculty on preventive medicine curricula. Utilizing
the Northwestern University School of Medicine Nutrition
Background: This study evaluated the effect of primary
Attitude Survey will assess the impact of the curriculum
care providers’ adherence to the AHCPR Smoking
on medical students.
Cessation Guideline after receiving a multicomponent
intervention. The Guideline recommendations are sum- In addition, several curricular interventions were intro-
marized as the “4As”: (1) all patients are asked about duced to the problem-based curriculum. In this curricu-
smoking status, (2) smokers are advised to quit smoking, lum, Community Medicine integrated a session entitled
(3) smokers are assisted to quit smoking, and (4) arrange- “Disease Prevention and Health Promotion: A Focus on
ments are made for the followup for smokers who are Lifestyle Determinants of Health.” Basic Sciences devel-
committed to quit. oped specific behavioral learning objectives and incorpo-
rated appropriate “clues” into case histories for cellular,
Methods: A quasi-experimental study with one interven-
cardiology, and endocrinology phases. During these phas-
tion and one control team was conducted in a southeast-
es, students are encouraged to apply nutrition and exer-
ern VA primary care setting. Chart reviews (n = 637) of
cise principles to their own health by (1) determining their
providers’ adherence to the 4As (ask, advise, assist,
own blood glucose levels and (2) conducting a dietary
arrange) were conducted over three phases: baseline,
recall for nutrient analysis.
after an educational intervention, and after provider feed-
back. The implementation of this program is designed to train
physicians who will serve as role models for their
Results: A nested, repeated measures, two-factor analy-
patients and communities by adopting a preventive
sis of variance was performed for each of the following
health lifestyle. A preclinical medical student wellness
outcomes: ask, advise, assist, and arrange. Data analyses
program is also proposed as part of this curriculum to
revealed that both teams had 100 percent compliance in
increase retention and cognition of physical fitness and
asking the patient about smoking status. Education on
preventive medicine among students.
tobacco dependence and the AHCPR Guideline had no
significant impact on provider performance with the Walking and Resting Blood Pressure:
advisement, assistance, and arrangement of followup. P-36
A Meta-Analysis
However, significant improvements occurred in the inter-
vention team in the advisement (p = 0.05), assistance (p = George A. Kelley, D.A., MGH Institute of Health
0.001), and arrangement of followup (p = 0.001) phase Professions, Kristi Sharpe Kelley, Zung Vu Tran
after individual and team feedback was provided. This Introduction: Walking is the most popular physical activi-
research supports that feedback impacts individuals and ty among adults in the United States, and elevated rest-
team performances and facilitated positive system ing blood pressure is a major public health problem in
changes to improve provider adherence to the AHCPR the United States.
recommendations in treating tobacco dependence.
Major Objective: The major objective is to use the meta-
analytic approach to examine the effects of walking on
resting systolic and diastolic blood pressure in adults.
Methods: Studies were retrieved via (1) computerized lit-
erature searches, (2) cross-referencing from original and
review articles, and (3) an expert’s review of the reference
list. Inclusion criteria were as follows: (1) randomized and

98 CVH 2002
nonrandomized trials that included a nonintervention con- 0.912 exercise) was seen between increases in CAC
trol group or control period; (2) walking as the only inter- scores and greater changes in dieting and exercise.
vention; (3) subjects apparently sedentary; (4) English lan-
Conclusion: Coronary calcium scoring results can pro-
guage journal articles, masters theses, and doctoral dis-
mote significant favorable changes in lifestyle, including
sertations; (5) resting systolic and/or diastolic blood pres-
healthier diet, more exercise, and less smoking.
sure assessed; and (6) training studies lasting a minimum
of 4 weeks. All studies were coded independently by the The Availability and Cost of DASH Diet
P-38
first two authors, and every item was reviewed for accu- Foods in the Jackson, Mississippi,
racy and consistency. Discrepancies were resolved by Metropolitan Area
consensus. Net changes in blood pressure were calculat-
ed as the exercise minus control group difference. Alan David Penman, M.D., M.P.H., Mississippi State
Health Department
Results: Sixteen studies that included 37 groups (21 exer-
Purpose: Widespread adoption of the DASH diet could
cise, 16 control), 650 subjects (410 exercise, 240 control),
lead to a population shift in BP levels and consequent
and 24 primary outcomes for analysis met our criteria for
reductions in hypertension prevalence and stroke mortali-
inclusion. Using a random effects model, statistically sig-
ty, both of which are high in Mississippi. Important barri-
nificant and clinically important decreases of approxi-
ers to adopting the DASH diet may be the availability and
mately 2 percent were found for both resting systolic and
cost of the foods, particularly for low-income persons. We
diastolic blood pressure (systolic, mean ± SEM = -3 ± 1
determined the availability and cost of DASH diet foods
mmHg, 95 percent confidence interval = -5 to -2 mmHg;
purchased at different locations across the Jackson met-
diastolic, mean ± SEM = -2 ± 1 mmHg, 95 percent confi-
ropolitan area.
dence interval = -3 to -1 mmHg). Changes in blood pres-
sure were independent of changes in body weight, body Methods: A list of DASH diet foods was drawn up, with a
fat, and body mass index. A statistically significant, exer- description of each item, manufacturer, and quantity/size.

POSTER SESSIONS
cise-induced increase of approximately 12 percent was Each major food retailer was visited on three occasions at
observed for maximum oxygen consumption 1- to 2-week intervals to get an average price per item.
(mL/kg/min). Demographic and socioeconomic data were obtained
from the Bureau of the Census and commercial data ven-
Conclusion: Walking exercise programs reduce resting
dors. Cardiovascular disease (CVD) mortality data were
systolic and diastolic blood pressure in adults.
obtained from the Bureau of Public Health Statistics
Coronary Calcium Scores by Electron (Mississippi State Department of Health). Data were
P-37
Beam Computed Tomography Correlated mapped using ArcView 3.2 GIS software.
With Positive Changes in Lifestyles, Results: The availability and cost of DASH diet foods vary
Including Healthier Diet, More Exercise, across the metropolitan area. The availability and cost of
and Less Smoking foods in areas with different socioeconomic characteris-
tics and CVD mortality rates will be presented.
Thomas Knickelbine, Minneapolis Heart Institute
Foundation Conclusions: More attention should be given to the avail-
Purpose: This study examined the relationship between ability and cost of DASH diet foods.
coronary calcium scoring results as detected by Electron
Beam Computed Tomography (EBCT) and subsequent P-39 On the Move: Blood Pressures on the Bus
changes in dietary habits, smoking, and exercise level.
Anita P. Sherer, R.N., M.S.N., Moses Cone Heart and
Methods: A survey was conducted on the first 2,200 Vascular Center, Joan Behrens, R.N., B.S.N.
patients scanned at our institution from September 1999 It is hard to find time to have your blood pressure
to June 2000. Participants graded changes in their eating, checked. Why not check it the next time you ride the bus?
exercise, and smoking habits since their scan and Our heart disease prevention program has partnered with
whether they attributed the changes to knowledge of their our city’s transit authority to take our blood pressure
EBCT results. Changes were graded from -2 to +2 (four screenings on the road. Once a month, nurse health edu-
increment levels) for less healthy, less active, or smoke cators catch the bus and lots of high blood pressure too.
more versus more healthy, more active, or smoke less for Bus riders are offered free blood pressure checks while
the categories of diet, activity, and smoking, respectively. they ride to their destination. Brief counseling is provided
Zero represented no change in lifestyle. on lifestyle changes to prevent and control high blood
pressure. Thirty-nine percent of the passengers have high
Results: Of the 818 individuals who responded to our sur-
blood pressure. These passengers receive focused coun-
vey, 38 percent (307) indicated that the EBCT scan signifi-
seling on medication administration, lifestyle changes,
cantly influenced their lifestyle. Seventy-one percent had
and physician followup. Approximately 3–5 new cases of
a more healthy diet, 61 percent were more active, and 62
high blood pressure are diagnosed at each screening and
percent smoked less after knowing their coronary calcium
referred for followup. This unique program provides easy
score result. A positive correlation (R2 value 0.966 diet,
access to free blood pressure screenings and offers on-

CVH 2002 99
 the-spot education targeted to the individual’s needs. We 0.02) was seen in the female group as compared to the
are on the move and are making a difference in the heart other groups.
health of our community.
Conclusion: Although this study was limited by a small
P-40 Easy Access, Better Control sample size, an improvement in participants’ knowledge
of heart attack warning signs was seen in all groups. The
Anita Peden Sherer, R.N., M.S.N., Moses Cone Heart and largest improvement was seen in the female population.
Vascular Center, Kristen Wither Yntema, M.B.A., M.H.S.A.,
Joan Behrens, R.N., B.S.N. Nutritional Behaviors of
P-42
A blood pressure check only takes 30 seconds, and it can Cardiac Rehabilitation Patients
save a life. Since one-third of those who have high blood
Charles Jeffrey Frame, Ph.D., R.D., Murray State
pressure do not even know it, our community blood pres- University
sure screenings offer easy access that can lead to better
control. Our heart disease prevention program offers free Selecting appropriate nutrition education for cardiac reha-
lunchtime blood pressure screenings at libraries, stores, bilitation patients requires a clear understanding of each
and restaurants once a week. Customers or visitors stop patient’s readiness to change nutritional behaviors. If a
for a quick blood pressure check as they run errands or patient’s readiness to change is understood, the optimal
go to lunch. Many of our participants are drop-ins, while change catalyst can be selected and applied through
others are regular visitors who make a special trip to our patient education.
various locations. Screenings are advertised via flyers A cross-sectional study of 226 newly admitted cardiac
and newspaper ads. Brief counseling is offered on ways rehabilitation patients assessed patients’ readiness to
to prevent and control high blood pressure and on the change nutritional behaviors using Prochaska’s five-stage
need for physician followup. In the past 18 months, 5,650 readiness to change model: precontemplation, contem-
participants have been screened. Fifty-four percent have plation, preparation, action, and maintenance. To support
had normal blood pressures, as compared to 46 percent patients’ readiness to change nutritional behaviors, food
who had high blood pressures. Approximately 3–5 new frequencies measured energy intake from dietary fat and
cases of high blood pressure are diagnosed at each daily servings of fruits/vegetables.
screening. This free community service offers easy access
Results showed that 78.7 percent of patients were in
for adults to have their blood pressure checked, and if
action or maintenance stages for reducing dietary fat
participants’ pressures are high, the program provides
intake. In contrast, 81 percent of patients were in precon-
assistance to control their blood pressures.
templation or contemplation stages for increasing fruit
Assessing and Improving Knowledge of and vegetable intakes to five a day. Food frequency data
P-41
Heart Attack Symptoms supported nutrition behavior assessments. Results were
consistent irrespective of patients’ body mass index, age,
Bianca Grigorian, Mount Sinai Medical Center, Leslie Zun, education, or family cardiac history.
Pilar Guerrero
This study indicates strong support that cardiac patients
Objective: The objective of this study was to determine
are in different readiness stages simultaneously for two
whether the use of an information pamphlet in an emer-
different nutritional behaviors, even though both behav-
gency department would improve patients’ knowledge
iors are closely linked to cardiac health. Patients could
about symptoms of a heart attack.
benefit with stage-matched health education on specific
Methods: Adult communicative patients were enrolled food groups, enabling the patient to adopt optimal, long-
from a level 1 trauma center. Patients completed a ques- term change in nutritional behavior.
tionnaire on the most common warning signs of a heart
attack. A pamphlet, “Signs of a Heart Attack,” was distrib- P-43 S.T.E.P.S. for a Healthy Heart: Strategies
uted and reviewed with the patients. After completing the Toward Environment and Policy Success
survey, patients were told that they would receive a
Cathy Ryan, S.T.E.P.S. for a Healthy Heart: Strategies
phone call in 1 and 4 weeks to assess their retention Toward Environment and Policy Success, Nebraska
level. IRB approved the study. Department of Health and Human Services
Results: Sixty enrolled, 33 were available for followup, Purpose: It is estimated that the cost of cardiovascular
and 27 were lost to followup. Demographics included 61 disease in the United States in 2000 was $326.6 billion.
percent female, 39 percent male, 52 percent African Cardiovascular disease continues to be a major health
American, 42 percent Hispanic, 55 percent under 45 years problem, and achieving the Healthy People 2010 objec-
of age, and 45 percent at 46 years of age or older. A tives, particularly in the case of cardiovascular disease
paired samples test showed a significant improvement in prevention, requires widespread application of communi-
the number of correct responses (p = 0.00; 95 percent CI ty-based interventions.
between 1.43–3.06). A significant difference in the mean
Methods/Process: Well-funded, community-based
improvement on the knowledge of the warning signs (p =
research and demonstration programs have enhanced

100 CVH 2002

our understanding of methods to improve the cardiovas- Growing the Program: Two and a Half Years
P-45
cular health status of entire communities. A multilevel, of Centers for Disease Control and
multifactorial approach is needed to comprehensively Prevention’s Support to the
prevent and control cardiovascular disease. Such an New York State Healthy Heart Program
approach is being integrated in communities across
Nebraska by ensuring that each community can access Margaret O. Casey, R.N., M.P.H., Healthy Heart Program,
resources for the improvement of cardiovascular health. New York State Department of Health
The Nebraska Health Initiative lays out the necessary Objective: The objective of this study was to summarize
tools to assist public and voluntary health agencies in the growth of the New York State Healthy Heart Program
implementing community-based initiatives. The initiative since Centers for Disease Control and Prevention (CDC)
contains supportive data, planning and assessment tools, comprehensive State funding began.
and intervention strategies that empower communities to
CDC support to the established New York State cardiovas-
develop a comprehensive plan to address the promotion
cular health (CVH) prevention and control program has
of cardiovascular health or to augment an already exist-
already produced a variety of results in the program’s
ing one.
infrastructure, network of internal and external partners,
Results/Conclusions: A wealth of research makes it clear depth of program monitoring and surveillance capacity,
that inactivity and poor nutrition are responsible for thou- and intensity of commitment to environmental and policy
sands of unnecessary deaths, illnesses, and disabilities approaches to CVH promotion. These will be described
associated with chronic diseases. Physical activity and critically. Program areas needing additional energy and
good nutrition play critical roles in promoting and reduc- resources will also be presented.
ing the risk for chronic diseases. Communicating this
Conclusions: After just 2 1/2 years, CDC funding has pro-
message alone is not enough. If people are to maintain
duced benefits beyond those defined in the original
healthy behaviors, such changes must be supported by

POSTER SESSIONS
request for funding. CDC funding brings with it national
programs and policies and by the environments in which
attention and new connections with colleagues in other
people live.
States. These are significant byproducts of the current
Addressing Health in Urban Communities of comprehensive grant.
P-44
Color: Partnering With Faith Communities
P-46 Cardiac Troponin I in Patients With Acute
Margaret O. Casey, R.N., M.P.H., Healthy Heart Program, Myocardial Infarction and Unstable Angina
New York State Department of Health
Najla’a Abdul Aziz Ben Selim, M.D., Northern Area Armed
Purpose: The purpose of this study was to increase phys- Forces Hospital
ical activity and healthy eating in urban areas of New York
Objective: The objective of the research was to assess
State by promoting environmental and policy changes.
the place of cTnI in the initial management of acute
Methods: A workgroup of leaders of faith-based organi- myocardial infarction (AMI) and unstable angina in our
zations was formed to provide insights into barriers to institution and the concordance between creatine phos-
healthy behaviors within their congregations and sugges- phokinase MB and cTnI.
tions for strategies to overcome these barriers. Seven
Patients and Methods: We reviewed retrospectively the
focus groups were held in faith communities throughout
charts of 32 patients having AMI or unstable angina
New York City; participants were asked about their beliefs
admitted to ICU from the emergency room of King Khalid
and practices regarding nutrition, physical activity, and
Military City Hospital. The time of admission to ICU
cardiovascular disease and about barriers to healthy
(which corresponds to the beginning of thrombolytic ther-
nutrition and physical activity within their communities.
apy), the time when cardiac enzymes (CK MB and cTnI)
Community-tailored approaches were developed and
are available, the number of cTnI determinations before
used as the basis of a Request for Applications for mini-
obtaining a significant positive result (> 2 ng/mL), and the
grants to faith-based organizations in New York City and
delay between admission and the first significant positive
Buffalo.
result of cTnI were evaluated.
Results: Eleven individual faith communities in New York
Results: Sixteen patients had confirmed AMI based on
City and 15 coalitions in Buffalo were provided with fund-
the association of typical chest pain, ECG findings with
ing, which was used to develop sustainable programs
ST segment elevation, and significant increase of the ratio
that increased healthy eating and physical activity for con-
CK/CK MB > 10 percent. Sixteen patients had unstable
gregation members and residents of the local community.
angina. Thirteen out of the 16 patients (81.25 percent)
Conclusions: Small amounts of funding can be utilized by with AMI received thrombolytic therapy, which was initi-
local faith-based groups to make permanent changes in ated on the basis of typical clinical history and electrocar-
communities of color, changes that promote health and diographic features, before the availability of cardiac
reduce risks for chronic diseases. enzymes. Troponin I was available in only 13 cases. The
number of tests performed in these patients was 32. The

CVH 2002 101

 first positive result of cTnI was available within a mean Gender and Ethnic Differences in Obesity
P-50
time of 16.66 ± 20.8 hours from admission. The number and Related Cardiovascular Health Measures
of negative tests performed before obtaining a frank posi- in Urban Teenagers: The PATH Program
tive result was 9 in 12 patients. The number of positive
tests after having obtained the first frank positive cTnI Paul Stephen Fardy, Ph.D., Queens College, Ann E.
result was 10 in 12 patients. In all cases, cTnI results were Azzollini, Chris Pitsikoulis, John R. Magel
concordant with CK MB results. Purpose: The purpose of the study was to assess gender
and ethnic differences in obesity and related cardiovascu-
In the 16 patients having unstable angina, only 11
lar health measures in a diverse population of urban
patients had cTnI serum level. A total of 21 tests were
teenagers.
performed. In 9 patients, 14 cTnI tests were < 2 ng/mL.
This was correlated with the normal CK/CKMB ratio. In Methods: Teenage girls (N = 812) and boys (N = 467)
two patients, seven cTnI tests were positive. Both of them from three New York City high schools participated in
had a significant increase of CK/CKMB ratio and ECG fea- school-based health promotion. The ethnicity of the sam-
tures of myocardial ischemia and were referred for urgent ple consisted of 20 percent Asian American, 40 percent
coronary angiography. African American, 25 percent Hispanic, and 15 percent
White. Obesity was estimated by body mass index (BMI)
Conclusion: cTnI levels are not helpful in the initial man-
from height and weight and percent body fat (BF) from
agement of patients with AMI, so thrombolytic therapy
skinfolds. Cardiovascular health-related measures includ-
should be instituted before the availability of cTnI results.
ed systolic (SBp) and diastolic (DBp) blood pressures,
However, cTnI results are concordant with CKMB in retro-
estimated maximal oxygen uptake (VO2), habitual physi-
spective confirmation of the diagnosis of AMI few hours
cal activity (PA), dietary habits (DH), cholesterol (Ch), and
after onset.
heart health knowledge (HHK).

P-47 Issues in Recruiting Mothers and Children Results: Compared with boys, girls had significantly (p <
for a Family-Based Weight Loss Program 0.05) greater BF (29.8 versus 16.5 percent) but significant-
ly lower height (63 versus 67 in), and weight (129 versus
Vicki Bovee, Nutrition Education and Research Program,
Suzanne E. Perumean-Chaney, Kathy Peele, Sachiko T. St. 143 lb), although BMIs were not different. Girls demon-
Jeor strated lower SBp (111 versus 117 mmHg), lower DBp (71
The Health Opportunities for Preschool Children to versus 72), more favorable DH (43 versus 48 times/week
Optimize Their Cardiovascular Health (HOPSCOTCH) intake of foods high in fat, salt, or sugar), and greater
study was faced with the task of recruiting 50 overweight HHK (52 versus 48 percent correct responses to a written
mothers with an overweight preschool child. Recruitment test). Boys had more favorable Ch (146 versus 158
began in June 2000 with a focus on pediatricians and mg/dL), greater VO2 (46 versus 36 mL/O2.kg.min), and
daycare providers. In October, several issues became greater PA (5.7 versus 4.6 times/week of activities > 15
apparent. Overweight mothers were easily accessible min). Significant ethnic differences were observed in
(body mass index [BMI] 25 to 35); yet recruitment was height, weight, BMI, and Ch in girls and in BMI and BF in
failing because mothers did not perceive their children as boys. Ethnic group comparisons revealed that obesity
overweight. Thus, a recruiter was hired to assist in the was most prevalent in African American and Hispanic
effort. The recruitment methods included advertisements girls and in Hispanic boys.
in newspapers and on television and radio; fliers; letters; Conclusions: In urban adolescents, estimated obesity
phone contacts; personal contacts; and e-mail. Of these appears to be more prevalent in females than in males
recruitment sources, the top three successful strategies in and is highest in Hispanic and African American girls and
terms of eligible participants were newspaper ads (53 per- in Hispanic boys. Boys demonstrated more favorable car-
cent), television spots (14 percent), and word of mouth diovascular risk profiles based on greater physical activi-
(friends, 13 percent). Based on the recruiter’s observa- ty, lower cholesterol, less obesity, and higher VO2, even
tions, the ability to know and understand the target popu- though HHK was lower than in girls.
lation was extremely important in the success of the
recruitment, which ended in April 2001. In terms of costs P-51 Analysis of Prehospital Treatment—
(recruiter’s salary, advertisement, and supplies), recruit- Delaying Factors With Early Cardiac Death
ment exceeded $14,500. Recruitment issues can hinder After Acute Coronary Syndrome in
the start of a clinical trial. Thus, the importance of timely, Socioeconomically Differing Populations
effective recruitment is evident.
Terri L. Bono, R.N., M.S.N., A.C.N.P., Seton Hall University,
Kelly Gangwer
Treatment delay after an acute coronary event is associat-
ed with various prehospital factors, including patient
demographics, premorbidities, mode of transportation,
and setting characteristics. The authors retrospectively

102 CVH 2002

reviewed the incidence of these factors in cases of early Use of Transtheoretical Model Processes
P-53
cardiac death after acute myocardial infarction (AMI) in Across Exercise Stages of Change of
two socioeconomically differing populations. Data were College Students
collected from 192 patient files from both a private and
public institution and were statistically analyzed for the Danielle Danese Williams, M.S., The University of
relative frequency of various treatment-delaying charac- Mississippi
teristics at the different sites. Acts of self-treatment, The USDHHS specifically identifies postsecondary institu-
physician referrals, daytime presentation, self/family tions as settings where young adults should be targeted
transportation, and premorbidities (hypertension and for exercise promotion. The Centers for Disease Control
angina) were significantly more common in the private and Prevention reports a decline in total physical activity
community patients, while the setting of symptoms, wit- during college years. One explanation for this decline is
ness to symptoms, marital status, history of diabetes, or the lack of theory-based exercise promotion programs
previous myocardial infarction did not statistically differ. (EPPs) at the college level. The transtheoretical model
The results of this study indicate that the incidence of (TTM) offers a framework to develop EPPs that may
treatment-delaying factors may be population specific. increase the adoption and maintenance of exercise
Community education programs to improve prehospital behavior by college students; yet the use of the TTM
treatment delay inpatients with acute coronary syndrome processes by this population is unknown. Therefore, the
need modification to address population-specific factors. purpose of this study was to describe the use of the TTM
processes in a college student population across the exer-
P-52 Weight Loss and Metabolic Improvement cise stages of change. Questionnaires were distributed to
With a Mediterranean Diet in 708 students resulting in 699 useable questionnaires.
Patients With Heart Disease Each instrument has established validity and reliability.
MANOVA was used to examine differences in the 10 TTM
Mary M. Flynn, Ph.D., R.D., The Miriam Hospital Nutrition

POSTER SESSIONS
Center, The Miriam Hospital processes across the 5 stages. Post hoc analyses were
used to examine differences between stages. The results
This outpatient study compared an American Heart
show significant differences for each process across all
Association (AHA) diet with a Mediterranean diet (Med) in
levels of stage. Post hoc analysis revealed seven different
patients with heart disease and body mass index > 25.0
processes that were significant between adjacent stages.
for 8 weeks of weight loss and metabolic improvement.
There is a linear increase in all processes across stages
The AHA diet group was allowed total fat up to 30 percent,
except for the environmental reevaluation process. It
primarily polyunsaturated fats (PFA) and excluding food
appears the TTM processes may be useful in promoting
sources of monounsaturated fat (MFA). The Med group
the exercise behavior of college students. Future research
had a daily fat goal of at least 35 percent from extra virgin
should examine how stage-matched EPPs can increase
olive oil and excluded food sources of PFA. Baseline lipids
exercise adoption and maintenance of college students.
were established after 14 days of a saturated fat diet (SFA).
Results for the 10 completed (20 enrolled) are as follows: Reduction of Cardiovascular Disease
P-54
in Rural Communities
AHA (1M/4F) Med (1M/4F) p=
Percent of Nutrient (3-day diet diaries) Deborah S. King, Pharm.D., University of Mississippi
Tot. fat (base) 39.7 ± 7.6 40.3 ± 2.2 0.185 This presentation describes the design and initial
Tot. fat (wk 8) 27.5 ± 5.7 45.2 ± 4.0 0.000 progress of a small, rural community pilot project
PFA/Tot. fat wk 8 26.4 ± 10.6 9.9 ± 1.2 0.009 designed to reduce cardiovascular risk factors. This is an
MFA/Tot. fat wk 8 30.9 ± 4.6 63.2 ± 4.1 0.000 enabling intervention, leading the establishment of car-
Percent Change from Baseline (SFA diet) diovascular educational programs targeted to community
Total cholesterol -2.1 ± 18.3 -0.38 ± 13.1 0.870 groups, health care providers, and individuals with specif-
Triglycerides +28.7 ± 29.2 -4.1 ± 22.3 0.085 ic risk factors.
HDL-C -5.4 ± 9.8 -4.3 ± 5.9 0.835 A baseline risk factor assessment in every eligible com-
LDL-C -0.1 ± 0.4 +6.2 ± 0.24 0.351 munity member is being followed by interventions over
Insulin +4.2 ± 54.1 -31.8 ± 11.6 0.183 12 to 18 months. Efforts include increasing awareness,
Glucose +1.8 ± 6.0 -12.1 ± 5.0 0.004 comprehensive risk factor detection, and improving
Body weight -1.7 ± 1.4 -3.19 ± 0.8 0.084 health care access. Persons with identified risk factors are
tracked for optimal management.
Mean + SD The primary outcome variable will be changed in cardio-
vascular risk factor status from baseline to post-interven-
All Med patients had decreases in their fasting insulin tion, including control rates for hypertension, dyslipi-
(range 18–49 percent) and glucose (6–19 percent). These demia, and diabetes. Secondary measures include treat-
preliminary data suggest that compared to an AHA diet, a ment rates for hypertension, dyslipidemia, and diabetes,
Med has comparable weight loss and may result in better along with body weight assessments, self-reported physi-
metabolic improvement. cal activity measures, and smoking rates.

CVH 2002 103

 Mississippi has the highest overall cardiovascular mortali- we recognize and understand that a healthy diet is an
ty rate among the 50 States. While research into causes important contributing factor to disease prevention, we
of regional and racial disparities in mortality is urgently realize that a substantial change in America’s eating
needed, currently available strategies for reducing risk habits is needed. Eating To Live in the 21st Century is an
should be used most effectively. Population-based strate- effort to provide health practitioners with a fresh
gies to improve health behaviors are one approach to approach to promoting healthy eating. This presentation
improving large disparities. This project is intended to will feature two dietary programs designed to help people
form the basis for the development of a statewide strate- improve their dietary habits and focus on maintaining a
gy for improving cardiovascular risk factor prevention healthy weight.
and management and, ultimately, a reduction in morbidi-
ty and mortality. P-58 New Secondary Prevention Strategies:
Effectiveness of Intensive Outpatient
P-56 Analysis of the Relationship Between Interventions That Complement the
Exercise Capacity and Heart Rate Variability American Heart Association’s
in Trained and Untrained Individuals Get With the Guidelines Program

Phil Tonkins, Jr., M.S., A.T.C., Morgan State University Liana S. Lianov, California Heart Disease and Stroke
Public Health Program Program, California Department of Health Services, Nan
Pheatt, M.P.H.
Objectives: This study examines (1) the relationship
between exercise capacity and measures of heart rate Purpose: The American Heart Association’s (AHA’s) Get
variability (HRV) in trained and untrained males and (2) With the Guidelines (GWTG) program encourages hospi-
whether different types of sports training affect HRV in a tals to develop protocols that maximize the likelihood of
different manner. coronary artery disease (CAD) patients being discharged
on medications and counseling consistent with the
Methods: Thirty-nine college-aged (21.2 ± 3 years) male AHA/American College of Cardiology guidelines.
athletes and nonathletes voluntarily participated in this Compliance is high right after discharge when this proto-
study. Subjects completed a questionnaire describing col is initiated in the hospital, but rates of compliance
their training history and then performed a graded maxi- over the long term in the community setting are unclear.
mal exercise test using the Bruce treadmill protocol. The purpose of this study is to determine whether inten-
Following the test, an ambulatory Holter monitor was sive outpatient support will benefit compliance and
placed on the subjects for 24-h to record HRV. The rela- patient outcomes. If successful, future projects will test
tionship between time to exhaustion (exercise capacity) and apply this intervention in cardiology and primary care
and measures of HRV was determined using correlation settings that follow patients long term.
analysis. Additionally, HRV for endurance-trained, anaero-
bic-trained, or nontrained subjects was compared using a Methods: This nonrandomized, prospective intervention
one-way analysis of variance. study uses a convenience sample of patients with con-
firmed CAD at Loma Linda University Medical Center. All
Results: Significant correlations were observed between patients undergo the GWTG protocol before hospital dis-
time to exhaustion and the mean of the R-R intervals (r = charge. Patients in the intervention group are followed in
0.507, p = 0.001) and standard deviations of R-R intervals the intensive clinic. Patients in the control group receive
during 24-h (r = -0.380, p = 0.017). Additionally, exercise the usual care. At 12-month post-discharge, the groups
capacity tended to correlate with the square root of the are compared with respect to adherence to smoking ces-
mean for the sum of squares of differences between adja- sation; exercise; body mass index (BMI); use of recom-
cent R-R intervals (52.9 ± 23.6, r = 0.31, p = 0.053) and in mended drugs; and lipid, blood pressure, and hemoglo-
the proportion adjacent R-R intervals having differences bin A1C levels.
of 750 milliseconds (22.7 ± 14, r = 0.29, p = 0.074). No sig-
nificant differences were observed between types of train- Results/Conclusions: In April 2002, preliminary compli-
ing or measures of HRV. ance and patient outcome data for the first 10 months will
be presented.
Discussion: Sports training positively affects selected
measures of HRV and may help decrease risk of arrhythmia An Analysis of Coronary Heart Disease Risk
P-59
or sudden death. However, the type of sports training in a Cardiology Population
does not appear to influence this potential health benefit.
Maria Cannito, Pfizer, Inc.
P-57 Eating To Live in the 21st Century Background: Cardiovascular disease is the leading cause
Velonda Thompson, Ph.D., Be-Fit, Inc. of death in American adults. The high prevalence of coro-
nary heart disease (CHD) can be attributed to the levels of
Studies show that more than half the adults in the United uncontrolled risk factors for this disease.
States are overweight and that 11 percent of the 6- to 19-
year-olds are considered overweight or obese. Across the Objective: This analysis assesses the CHD 10-year risk of
country, health professionals and researchers are strug- selected hypertensive patients in relation to the standard
gling with the question of how to reduce obesity. Because risk based on the Framingham Heart Study.

104 CVH 2002

 P-59. Hypertensive population treated with usual care in a cardiology practice.

CHD Risk Category Age (%) Diabetes (%) HDL < 35 (%) Smoker (%) TC > 240 (%)
Below standard 25 1.4 4 1.4 16
1–2 x standard 43 30 32 36 30
2–3 x standard 17 24 25 32 30
> 3 x standard 16 45 39 30 24

Methods: The objectives of the review were to determine and 3.4 percent, respectively. There was little variation
CHD risk according to age, diabetes, total cholesterol, (1.6 percent) between the two site groups regarding high
smoking, and JNC VI category. A randomized, retrospec- cholesterol.
tive chart review was completed for 353 hypertensive
Conclusion: Faith community sites of LSES have a higher
patients, utilizing the CHD Risk Calculator.®
rate of CVD risk factors than faith community sites of
Results: In a hypertensive population (mean age 67.9 ± HSES. The level of disparity differs depending upon the
12.01 years) treated with usual care in a cardiology prac- specific risk factor. Community intervention trials random-
tice, risk categories according to the Framingham Heart ized by the socioeconomic status of the faith site location
Study were defined as shown above. can be predicted to reflect the risk factor profiles of the
congregation members.
Conclusion: Analysis of CHD risk in a cardiology popula-
tion demonstrates that therapeutic efforts still leave a Intervention Plan To Increase
P-61
high percentage of patients under treated and at Physical Activity Levels in the Inner City

POSTER SESSIONS
increased risk for a CHD event. This risk analysis identi-
fies high-risk subgroups for aggressive management per Michael J. Welch, Ph.D., Chronic Disease, Richmond City
current guidelines. Department of Public Health
The health benefits of physical activity are well docu-
P-60 Faith Community Site Intervention Trials: mented. Inner city environments construct several barri-
Socioeconomic Status as a Predictor of ers to physical activity participation. Two prominent barri-
Cardiovascular Disease Risk Factor Profiles ers are convenient facilities and safe environments. The
Richmond City Department of Public Health initiated
Gretchen Fierle, Research Center for Stroke and Heart
Disease ROCK! Richmond in 1997 to increase the physical activity
levels of inner city residents. Our targeted population is at
Background: Risk factors for heart disease and stroke are
a higher risk of sedentary lifestyle: women, lower socioe-
more prevalent among populations of lower socioeco-
conomic levels, and members of a minority ethnicity.
nomic status (LSES) than higher socioeconomic status
Physical fitness instructors conduct free classes in church-
(HSES).
es, community centers, elderly housing complexes,
Objective: The objective of this study is to determine schools, and worksites. After 4 years, nearly 600 partici-
whether faith community sites located in areas of LSES pants attend on a weekly basis at more than 30 locations.
experience higher rates of cardiovascular disease (CVD) From self-reported surveys, only 34 percent of the present
risk factors than faith community sites of HSES. participants were physically active three times per week
before ROCK! Richmond. Currently, 86 percent of partici-
Results: Six faith sites, three of LSES and three of HSES,
pants are active three times per week. A weight loss of at
participated by completing a standardized health ques-
least 10 pounds has been reported by 24 percent, and 30
tionnaire addressing the following CVD risk factors: smok-
percent have reported a reduction in blood pressure. With
ing, overweight, diabetes, hypertension, and high choles-
regards to their general health and well-being, 89 percent
terol. A total of 3,345 questionnaires were distributed,
of the participants reported an improvement in overall
2,095 to sites of HSES and 1,250 to sites of LSES. The
health since participating in the program.
cumulative rate of return was 46 percent, with return
rates of 60 percent and 44 percent for sites of LSES and ROCK! Richmond serves as a model for public health ini-
HSES, respectively. Results revealed a higher prevalence tiatives that desire to increase the physical activity levels
of risk factors among sites of LSES than among those of for a high-risk population, a major goal of Healthy People
HSES. The LSES sites reported higher rates in every risk 2010. Strategies for implementation will also be dis-
factor category; however, the level of disparity differed. cussed, with what worked and what did not.
There were larger gaps between the LSES sites and the
HSES sites for diabetes and hypertension, with a differ-
ence of 9.8 percent and 12.3 percent, respectively. Smaller
gaps between sites of LSES and HSES were observed for
smoking and overweight, with a difference of 4.5 percent

CVH 2002 105

 Linking the Library and the Farm With (c) appropriateness for use with diverse populations, and
P-62
Nutrition Education: An Innovative Delivery (d) potential for use in client self-monitoring and incorpo-
Method for Delivering the Five a Day ration into interventions to reduce dietary fat intake.
Message to Children Results: Eight dietary fat FFQs with acceptable psycho-
metric properties and limited measurement burden were
Luanne J. Hughes, M.S., R.D., Rutgers Cooperative
Extension identified.

Innovative nutrition education programs are required to Conclusions: Measurement burden may be reduced
effectively and efficiently deliver nutrition education mes- through careful selection of dietary fat FFQs. Additional
sages about increasing fruit and vegetable consumption selection considerations include instrument sensitivity
to families with children. and specificity, ability to assess intake of foods specific to
particular cultural groups, ability to accurately estimate
A new program in New Jersey, called From Our Farms,
portion sizes, and sensitivity to time-dependent changes
does just that. From Our Farms is an innovative program
in dietary fat intake.
designed to help New Jersey children and their families
learn about the importance of good nutrition, the value of Case Report: Rapid Assessment and
P-64
local agriculture, and the role that farms play in enriching Management of an Acute Coronary Syndrome
our communities and the environment.
Terri L. Bono, R.N., M.S.N., A.C.N.P., Seton Hall University
This initiative is a collaboration between Cooperative
Extension (Family & Consumer Sciences, Agriculture and Practitioners in both acute care and primary care settings
Resource Management, and 4-H Youth Development), will find that identifying specific strategies to improve
public libraries, farmers/growers, master gardeners, the assessment skills leading to rapid diagnosis for chest pain
local board of agriculture, county government, the local is essential. Advanced practitioners as effective care coor-
dietetic association, and the local industry. dinators and facilitators can play an active role in ensur-
ing positive results when managing an acute coronary
Through storybooks, activities, electronic multimedia, syndrome (ACS). This specific case report focuses on spe-
farm and market field trips, and original lessons, From cial considerations with detailed chest pain history; physi-
Our Farms teaches an increasingly suburban population cal, differential diagnosis; and laboratory finding.
(many of whom have relocated from nearby urban Rationales were provided by recent research and with a
Philadelphia) about the appeal of the farm and its food. focus to rapidly meet the needs of an ACS patient.
This results in two important, key facts: Special focus on evaluating patients on whether they
1. Public appeal and public support, which result in would benefit from thrombolytics and/or other adjunct
funding to develop and maintain a consumer educa- pharmacological therapies (such as, GP IIB,IIIA inhibitors,
tion program platelet aggregation inhibition, and low-molecular-weight
2. Consumer interest and good participation in pro- heparin) as well as a variety of mechanical/interventional
grams, which result in outreach that produces signifi- devices (angioplasty, stent) used to improve coronary
cant, meaningful impacts artery blood flow and prevent the worsening of myocar-
dial ischemia. Combined needs in the direction of
P-63 Dietary Fat Assessment: Identification of
patients’ educational needs, such as on dietary modifica-
Food Frequency Questionnaires With Limited
tion, high-risk behavior reduction (smoking, sedentary
Measurement Burden
lifestyle), and lipid management.
Nalini N. Jairath, R.N., Ph.D., School of Nursing,
University of Maryland, Tracey Reinecke-Kashima, P-65 Preventing Cardiovascular Disease in Women:
Stephanie Glenn, Diane Vail Skojec A Community-Based Project
Purpose: Measurement burden from the perspective of Mary J. Boylan, M.D., Thoracic and Cardiovascular
the client and the clinician/researcher is an important con- Surgery, Julie Knuths, M.S.N., R.N., Colleen M. Renier,
sideration when dietary fat intake is determined as a prel- Jane L. Erjavec
ude to or concurrent with interventions to reduce dietary Background: Cardiovascular disease (CVD) remains the
fat intake. This comparative analysis identified a subset of number one cause of death for women, often resulting in
brief food frequency questionnaires to assess dietary fat the sudden death of women without prior diagnosis.
intake (dietary fat FFQs), which have limited measure- Northeast Minnesota has the highest prevalence of CVD
ment burden. in the State, yet no organized attempt has ever been
Methods: Dietary fat FFQs suitable for use with North made to offer primary prevention health screenings and
American populations were identified through extensive community education to regional women.
literature review. A subset with acceptable psychometric Methods: This community-based, 1-year, group-random-
properties and limited measurement burden was identi- ized, intervention-control study was designed to test a pri-
fied. Measurement burden was evaluated in terms of the mary prevention model for reducing cardiovascular risk
(a) administration requirements (including personnel, FFQ factors in women. Three hundred seventy-one women,
length, and administration time), (b) scoring approaches, 20–50 years of age (mean = 42.0) and without previously

106 CVH 2002

diagnosed CVD, were enrolled. Twelve clinics (five col- Conclusion: From the BRFSS data, we found that 1 in 45
lege-based), three hospitals, parish/temple nurses, and had a history of stroke and 1 in 20 had a history of MI in
two large local employers recruited participants. the State of South Carolina. Results indicate that people
Participants were screened for cardiovascular risk factors having past history of stroke or MI are much more likely
at baseline and 1 year. One hundred sixty-eight interven- to be elderly (65+), overweight, female, and diabetic.
tion women participated in educational sessions (stress
management, exercise, diet, and smoking), with progress P-67 Population Strategies for Hypertension:
monitored via telephone throughout the study. Japanese Male Workers Study

Results: At baseline, 50.7 percent of participants were Machi Suka, St. Marianna University School of Medicine
found to have total cholesterol > 200 mg/dL, 14.0 percent Purpose: The purpose of this research was to develop
had blood pressure > 140/90 mmHg, 66.8 percent had effective preventive strategies for hypertension based on
body mass index < 18.5 or > 24.9 kg/m2, 54.6 percent the evaluation of the population attributable risk percent-
exercised < 3 days/week, and 82.8 percent reported age (PAR percent).
stress/anger 1+ days/week. Positive behavioral changes in
diet, exercise, and stress were seen in the intervention Methods: In a longitudinal study of Japanese male work-
group at 6 months and continued through 1 year (p < ers aged 35, 40, 45, and 50, at baseline (n = 1,058, 2,201,
0.05). In addition, 87.6 percent of women with abnormal 2,739 and 1,191, respectively), the relationships between
baseline glucose, cholesterol, and blood pressure visited seven variables (family history of hypertension, obesity,
their physician, as advised (p < 0.05), resulting in signifi- salt intake, vegetable intake, alcohol drinking, exercise,
cant improvement in blood pressure (p < 0.01) and cho- and sleep) and the 5-year incidence of hypertension were
lesterol (p < 0.001). analyzed by using multiple logistic regression models.

Conclusions: Comprehensive, community-based screen- Results: PAR percent showed obvious differences in con-

POSTER SESSIONS
ing and review decrease women’s risk for CVD, with edu- tribution of the seven variables to the incidence of hyper-
cation and one-on-one followup significantly changing tension among the four age groups. PAR percent of obesi-
behavior. ty in the 35-, 40-, 45-, and 50-year-old groups were 35 per-
cent, 20 percent, 13 percent, and 21 percent, respectively
P-66 Assessment of the Prevalence of (decreasing with age), whereas those of alcohol drinking
Cardiovascular Disease and Associated Risk were 25 percent, 20 percent, 37 percent, and 53 percent,
Factors in South Carolina Using Behavioral respectively (increasing with age). Insufficient exercise
Risk Factor Surveillance System Data showed about 20 percent of contribution in the 40- and
45-year-old groups. Dietary habits showed modest contri-
Mohammad I. Ullah, M.D., M.P.H., St. Barnabas Hospital, bution in every age group.
New York
Background: Cardiovascular disease, including stroke Conclusion: In terms of population strategies for hyper-
and myocardial infarction (MI), is a leading cause of death tension, health professionals should change their target
in the United States. The purpose of this study was to risk factors by age group. Weight control is recommended
assess the prevalence of stroke and MI and the associated for the younger, whereas alcohol moderation is recom-
risk factors in South Carolina. mended for the older. Exercise may be recommended
especially for persons under age 50.
Methods: Using the cardiovascular module of the
Behavioral Risk Factor Surveillance System (BRFSS, 1996) P-68 HEART: Helping Educators Attack
data for the State of South Carolina, descriptive analyses Cardiovascular Disease
were performed with the Statistical Analysis System Risk Factors Together
(SAS). The relationship of age, sex, obesity, and diabetes
Shari Wiley, C.C.R.N., M.S.N., C.F.N.P., St. Mary’s Hospital
were assessed as the risk factors for stroke and MI.
St. Mary’s Hospital has partnered with the West Virginia
Results: In the past, 2.2 percent of the population had a
Department of Education, West Virginia Bureau for Public
history of stroke. These people were 1.6 times more likely
Health, and the West Virginia Chapter of the American
to be female (95 percent CI = 1.595–1.650), 1.5 times more
Heart Association to implement “HEART” (Helping
likely to be overweight, and 16 times more likely to be
Educators Attack Cardiovascular Disease Risk Factors
diabetic (95 percent CI 15.847–16.269). In the past, 5 per-
Together). HEART will target 45 public elementary schools
cent of the population had a history of MI. People having
in Cabell, Wayne, and Lincoln Counties beginning in
previous MI were more likely to be female (odds ratio =
September 2001. We will be educating approximately
1.021, 95 percent CI = 1.010–1.032), 1.7 times more likely
8,000 children and their parents on the prevention of car-
to be overweight, and 3.7 times more likely to be diabetic
diovascular disease during the 3 years of our program.
(95 percent CI 3.68–3.79). The people who had a history of
stroke were 7.8 times more likely to have had a history of Children will be screened to detect cardiovascular risks by
suffering from MI (95 percent CI = 7.677–7.935). The measuring fingerstick cholesterol, blood pressure, height,
majority of people having stroke (68.55 percent) or MI weight, and body mass index. Familial risks will be deter-
(78.35 percent) were in the 65+ age group. mined by a family health survey. Strategies to decrease

CVH 2002 107

 cardiovascular risk factors will include curriculum The Use of Self-Regulation Skills, Exercise
P-70
changes to increase the knowledge of cardiovascular dis- Self-Efficacy and Exercise Outcome-
ease and risk factors and the implementation of the Expectancy Values of Employed Women
Feelin’ Good Mileage Club to promote increased physical
activity during recess time; physical education classes will Michelle Renee Umstattd, M.D., Center for Health
be encouraged to increase the time spent on exercise and Promotion, The University of Mississippi, Jeffrey S. Hallam
aerobic activity by students, and lunch menus will be Utilizing stage-matched interventions to enhance the
changed to promote healthy choices. The program will be adoption and maintenance of exercise behavior is receiv-
expanded beyond the classroom by the inclusion of fami- ing considerable attention in the exercise behavior litera-
lies in the following risk reduction activities: Low Fat ture. The theoretical variables that influence exercise
Cooking School; smoking cessation classes; and the behavior at different stages of exercise are not well
Families in Training Walking Program, which promotes understood. Therefore, the purpose of this study was to
physical activity for the entire family. examine the level of exercise self-efficacy, exercise self-
regulation, and exercise outcome-expectancy values at
Students who present with cardiovascular risk factors will
each stage of exercise behavior, as defined by the trans-
be referred to the pediatric Cardiac Clinic at Marshall
theoretical model and self-reported exercise behavior. An
University for followup. Over the 3-year period, HEART
exercise stage-of-change instrument was sent to all
will monitor and evaluate the effects of changes in physi-
employees (N = 2,200) of two worksites. Employees who
cal activity and diet on risk factor reduction.
returned the stage-of-change instrument were asked to
Multifactor Risk Reduction in Low Income complete a questionnaire that measured exercise self-effi-
P-69
Patients: Opportunities and Challenges in cacy, exercise self-regulation, outcome-expectancy value,
Implementing a Case Management Model stages-of-exercise, current exercise behavior, and demo-
graphic information. All instruments had established reli-
Kathy A. Berra, Stanford University School of Medicine, ability and validity. The results did not show any signifi-
William L. Haskell, Annette Clark, Linda H. Klieman cant differences (p > 0.05) between selected stage com-
Purpose: The Heart Disease on the Mend (HDOM) Project parisons on the use of the social cognitive theory vari-
was undertaken to evaluate the effectiveness of a case- ables. Comparisons between regular exercisers and non-
managed multifactor risk reduction program (MRRP) in regular exercisers on the three social cognitive theory
high-risk, low-income patients with either no or limited variables were statistically significant (p = 0.0001).
health insurance. Regular exercisers had significantly higher levels of self-
efficacy, self-regulation, and outcome-expectancy value (p
Methods: High-risk patients eligible for medical care from
= 0.0001). The exercise stage-of-change data were com-
not-for-profit hospitals in Santa Clara County are identi-
pared with exercise behavior data, and 17 percent of the
fied and randomized to MRRP or usual care. MRRP is pro-
subjects’ behavior did not match their reported stage.
vided by a specially trained nurse and dietitian. Risk fac-
Since exercise stage determination is based on current
tor and clinical evaluations are performed at baseline, 6
exercise behavior, these data indicated that the exercise
and 12 months.
stage-of-change instrument may not be valid. Future
Results: Data from the first 50 patients randomized research should examine these variables across the con-
demonstrate a substantial need for assistance to achieve tinuum of exercise. Furthermore, the validity of the exer-
chronic risk management and a number of significant bar- cise stage-of-change instrument should be examined.
riers. Patients are at high risk for clinical events based on
existing disease and risk factors: hypercholesterolemia = P-71 Exercise Stages of Change
85 percent, hypertension = 90 percent, diabetes = 70, cig- Do Not Accurately Reflect
arette smoking = 15 percent, BMI = 34.9 percent, poor Exercise Behavior in Employed Adults
nutrition = 30 percent, and inadequate physical activity =
Michelle Renee Umstattd, M.D., The University of
30 percent. Barriers include diverse languages spoken Mississippi, Danielle Danese Williams, M.S., Jeffrey S.
(only 26 percent speak English), low literacy, lack of Hallam
access to basic medical care services and medications,
Many researchers use the exercise stages of change to
limited understanding regarding the care of chronic dis-
examine the effectiveness of interventions designed to
ease, long-term health a low priority, and lack of social
increase exercise behavior and to categorize participants
support for sustaining long-term lifestyle changes.
for stage-matched interventions. The popularity of using
However, once patients understand what actions need to
the exercise stages of change as a dependent variable by
be taken and are provided readily accessible support, clin-
both researchers and practitioners is continuing to grow.
ically important changes in medical management and
Given that the exercise stages of change are defined by
lifestyle are achieved.
the intention to exercise and current exercise behavior,
Conclusions: The case management of risk factors in participants’ reported exercise stage of change should
high-risk, low-income patients can be of significant bene- reflect the participants’ current exercise behavior. A
fit; however, strategies need to be implemented to deal review of the exercise stage-of-change literature reveals
with numerous barriers. that researchers consistently collapse stages based on

108 CVH 2002

exercise behavior. A secondary analysis of two studies, and BBs) are highly effective in clinical practice, consis-
conducted by the researchers, found discrepancies in the tent with what is reported in clinical trials.
participants’ reported exercise behavior and their exercise
stages of change. These discrepancies may influence the P-74 Increased Prevalence of Cardiovascular
conclusions and the categorization of participants for Risk Factors in a Rural Appalachian Area of
stage-matched intervention. Therefore, the purpose of Eastern Kentucky Is Associated With
this study was to examine the accuracy of the exercise Lower Educational and Income Levels:
stages of change to reflect current exercise behavior as The Coronary Valley Project
measured by a 7-day recall instrument. Data were collect-
Vivian M. Abascal, M.D., University of Kentucky, Judy
ed from 551 employed adults. The data show that 18 per- Zielke, R.N., M.S.N., Jay W. Mason, M.D., Thomas F.
cent of the subjects reported exercise behavior did not Whayne, Jr., M.D., F.A.C.C.
accurately reflect their current exercise behavior. These
Background: Coronary heart disease (CHD) mortality
results are consistent with other data showing that
varies geographically, the highest occurring along the
between 20 percent and 46 percent of subjects’ reported
Ohio and Mississippi river valleys, including the
stage of change does not accurately reflect current exer-
Appalachian region of eastern Kentucky. This area is
cise behavior. These results have significant implications
referred to as the Coronary Valley (CV). The prevalence of
for the exercise promotion specialists and exercise behav-
cardiovascular risk factors (RF) and its association with
ior researchers.
educational and income levels in this rural area are not
Evaluation of Antihypertensive known.
P-72
Effectiveness in Clinical Practice Methods: The CV Project is being conducted in a rural
Appalachian area of eastern Kentucky to determine the
Sunny Anne Linnebur, Department of Pharmacy Practice,
prevalence of traditional RF (phase I) and to implement a
University of Colorado Health Sciences Center, Timothy J.

POSTER SESSIONS
Hartman community-based risk reduction program (phase II).
Phase I consisted of a survey including demographic,
Purpose: Antihypertensive effectiveness in clinical prac-
educational, and income information. Medical, smoking,
tice may differ from clinical trial results. This study com-
and family history were recorded. Blood pressure (BP),
pared blood pressure lowering after the initiation or addi-
random finger-stick cholesterol, and capillary blood glu-
tion of antihypertensive agents in clinical practice.
cose level (BS) were also obtained. Clustering of RF was
Methods: A medical record review of 1,117 patients with assessed using Adult Treatment Panel (ATP) III
hypertension (ICD-9 code 401.9) identified 300 patients Guidelines, and its prevalence was compared with data
from two primary care clinics. Inclusion criteria were initi- from the National Health and Nutrition Examination
ation of a new antihypertensive within the past 24 Survey III (NHANES III) and the Centers for Disease
months and available pretreatment and posttreatment Control and Prevention (CDC).
blood
Results: From April 1999 until July 2001, 1,376 partici-
pressures.
pants, mean age 45 ± 16 years, 94 percent Caucasian, 64
Results: Thiazides, beta-blockers (BBs), and ACE percent female, were screened. The prevalence of RF was
inhibitors were initiated more frequently than calcium- increased when compared to national statistics: BP ≥
antagonists, angiotensin-receptor blockers, and alpha- 140/90 mmHg 32 percent versus 20 percent, current
blockers. Hydrochlorothiazide, atenolol, and lisinopril smoking 30 percent versus 22 percent, physical inactivity
were utilized the most. Mean decreases (mmHg) in 46 percent versus 27 percent, and overweight (BMI ≥ 25
SBP/DBPs from baseline with hydrochlorothiazide 12.5, kg/m2) 65 percent versus 55 percent (all p < 0.0001), while
25, and 50 mg/day were 24.4/13.4 (p < 0.05), 20.8/7.4 (p < the prevalence of cholesterol 200 mg/dL was lower, 39
0.05), and 11.2/3.8 (p = NS), respectively. With atenolol 25, percent versus 51 percent (p < 0.0001). However, 12 per-
50, and 100 mg/day, mean decreases were 14.3/9.9 (p < cent of participants had cholesterol ≥ 240 mg/dL. The
0.05), 18.7/14.5 (p < 0.05), and 19.5/13 (p < 0.05/p = NS), prevalence of BS ≥ 140 mg/dL was similar, 15 percent ver-
respectively. Mean decreases with lisinopril 5, 10, 20, and sus 14 percent (p = ns) when compared to national statis-
40 mg/day were 9.6/8.3 (p < 0.05), 16.1/12.4 (p < 0.05), tics. Forty-six percent of participants reported a family
11.3/6.2 (p < 0.05), and 9.3/6.8 (p = NS/p < 0.05), respec- history of CHD, and 23 percent had no health insurance.
tively. There were no differences between individual drug Using ATP III Guidelines, 43 percent of participants had
doses. At low doses, hydrochlorothiazide 12.5 mg/daily no RF, 57 percent had at least 1 RF, and 25 percent had ≥ 2
decreased DBP from baseline more than lisinopril 10 RF. Compared to participants with ≤ 1 RF, those with ≥ 2
mg/daily (p = 0.037). RF had lower educational level (< high school diploma)
(26 percent versus 49 percent, p < 0.001) and lower annu-
Conclusion: Hydrochlorothiazide, lisinopril, and atenolol
al income (≤ $30,000) (54 percent versus 79 percent, p <
were effective at lowering SBP and DBP. In our popula-
0.007).
tion, low-dose hydrochlorothiazide appears to be more
effective than low-dose lisinopril at lowering DBP. These Conclusion: The prevalence of hypertension, smoking,
data indicate JNC-VI-defined, first-line agents (diuretics overweight, and physical inactivity is higher in eastern

CVH 2002 109

 Kentucky when compared to national statistics, while that ferent when presented with similar risk factors and
of cholesterol was lower. However, a proportion of partici- patient cues for MI, but different patient gender.
pants still had high cholesterol per ATP III Guidelines. The
Methods: A nonexperimental, descriptive study will be
clustering of RF was associated with lower educational
conducted using computer-generated vignettes to quanti-
and income levels. Phase II Coronary Valley is in progress
fy the decisionmaking processes of 3,000 registered nurs-
as a community-based effort to decrease cardiovascular
es who triage men and women for complaints suggestive
risk in this Appalachian region of eastern Kentucky.
of coronary heart disease. It is posited that if nurses are
Improving LDL Goal Attainment better able to interpret and associate the cues presented
P-75
Through Provider Education in a by women with cardiac disease, rather than ascribing
Health Maintenance Organization them to neuromuscular, psychological, or gastroentero-
logical causes, they would be better able to (1) identify
Amber Rochelle Polk, Pharm.D., University of Maryland the presence of an acute cardiac event and (2) more
The Lipid Treatment Assessment Project (L-TAP) conduct- quickly and aggressively initiate intervention strategies
ed a cross-sectional analysis of adult patients with dyslipi- that could reduce morbidity and mortality.
demias receiving lipid-lowering therapy and found that Data Analysis: Data analysis will include descriptive,
large proportions of these patients were not achieving bivariate, and multivariate analyses and is expected to be
National Cholesterol Education Program (NCEP) low-den- completed by December 2001.
sity lipoprotein (LDL) target levels. This study will deter-
mine the impact of an educational program on LDL goal P-77 Rasmussen Center for
attainment by NCEP Adult Treatment Panel (ATP) III risk Cardiovascular Disease Prevention
categories. The educational intervention will be provided
by clinical pharmacists and will consist of lectures and Jay N. Cohn, M.D., Cardiovascular Division, University of
Minnesota Medical School, Lynn G. Hoke, R.N., F.N.P.,
one-on-one sessions with each physician to discuss NCEP Wayne B. Whitwam, M.D., University of Minnesota
ATP III Guidelines and to demonstrate the utility of a Medical School, Paul A. Sommers, Ph.D., R. Roessler,
statin selection tool to achieve goal LDL levels. The inter- Anne Taylor
vention will occur in a health maintenance organization The Rasmussen Center for Cardiovascular Disease
(HMO). The impact of this educational program will be Prevention was opened in October 2000 to screen healthy
determined by comparing the percentage of patients at (asymptomatic) individuals in the Minneapolis-St. Paul,
goal LDL prior to and after the educational programs. MN, area. A comprehensive array of noninvasive tests
Patients were identified from the HMO’s pharmacy claims were administered to detect the earliest markers of vascu-
database as having at least one prescription for an lar and cardiac disease. In addition, modifiable risk factors
antilipemic agent, from October 1, 2000, through June 30, that could serve to steer interventions in those with mark-
2001. A random sample of patients will have their charts ers for disease were measured. More than 250 women
reviewed to collect baseline data (e.g., demographics, risk and men have been screened to date. Fifty-seven percent
factors for coronary artery disease, serum lipid levels, and have been found with vascular disease; 21 percent with
drug therapy). The educational program will occur, and cardiac abnormalities; 68 percent with documented risk
repeat data will be collected 6 months after the educa- markers; and 84 percent with moderate-to-high likelihood
tional program. Results will be available for presentation of premature cardiovascular disease.
at the meeting. This study should determine whether a
physician-directed educational program improves LDL The screening procedure consists of three phases: (1) risk
goal attainment in patients already prescribed antilipemic category assignment, (2) early disease assessment, and
agents. (3) modifiable disease contributor assessment. Screening
elements include health risk appraisal, personal/family
P-76 Triage Decisions by Emergency history, blood sampling for markers of cardiovascular dis-
Department Nurses ease, urine test for early evidence of blood vessel abnor-
malities, stress blood pressure response test, lung func-
Cynthia Arslanian-Engoren, Ph.D., R.N., University of tion analysis, photo of arteries in the eye, vascular com-
Michigan
pliance, ultrasound measurement of the left ventricle,
Background: Although empirical evidence exists that ECG, and a preventive physical examination. Tests are
indicate women who suffer a myocardial infarction (MI) administered by a nurse-practitioner, assisted by a med-
are less likely than men to be diagnosed based on their ical assistant. The results are reviewed with a staff cardi-
presenting symptoms, to receive aggressive treatment, ologist, and a summary report of findings and recommen-
and to survive an acute cardiac event, the majority of dations is developed for each individual screened. Copies
studies conducted to date are retrospective chart reviews of the report are provided to those authorized by the
examining the triage decisionmaking practices of physi- patient, e.g., typically the patient’s primary care provider.
cians.
A database has been developed and contains complete
Purpose: The purpose of this study is to ascertain if information on each individual screened. Statistical appli-
triage decisions performed by registered nurses are dif- cations focus on traditional test development considera-

110 CVH 2002

tions and include standard reliability and validity meas- Objectives:
ures. Insurance coverage has been made available by • Heighten awareness among medicine-pediatric resi-
area payors but varies considerably. The early data sug- dents about the epidemic of obesity in adolescents.
gest that the type of screening performed by the • Provide a training site for residents in a community-
Rasmussen Center could greatly reduce the cost of health based setting.
care if early diagnosis can be linked to effective preven- • Promote partnerships between future health care
tive therapy. providers and other partners (including local educa-
tion systems) in the Morton Have-a-Heart Project.
P-78 Mississippi MCIC-AHA Capitol Day 2001
Methods: Medicine-pediatric residents from the
Deborah S. King, Pharm.D., University of Mississippi University of Mississippi Medical Center will conduct a
Medical Center survey on the awareness of health risks associated with
Mississippi has the highest overall cardiovascular mortali- overweight and obesity, provide education on the lifestyle
ty rates among the 50 States. Even more alarming are the changes that impact adolescent obesity, and perform CVD
data for trends showing this disparity in disease outcome risk assessment among students aged 12–18 in a small
worsening. For several risk factors, Mississippians have but ethnically diverse community in Morton, MS.
among the highest prevalence rates nationwide. To Outcomes:
increase legislator awareness, the Mississippi Chronic • Residents will receive training on risk assessment in
Illness Coalition (MCIC) and the American Heart adolescents.
Association (AHA) partnered to sponsor Capitol Day 2001. • Residents will screen for CVD risk among students.
Events included: • Adolescents will be more aware of the heart-healthy
• Health screenings and risk factor education: obesity, lifestyle.
blood pressure, blood sugar/cholesterol, bone densi- Conclusion: The Morton Have-a-Heart Adolescent Obesity

POSTER SESSIONS
ty, and physical activity Project will create training opportunities for medicine-
• Cardiopulmonary resuscitation (CPR) training by the pediatric residents, educate adolescents, and foster non-
youngest trainers nationwide traditional partnerships between a residency training pro-
• Launching “Know Your Numbers,” a statewide edu- gram and local school systems.
cational campaign
• Youth advocates delivering petitions supporting CPR P-80 Assessment of Blood Pressure,
instruction in schools Blood Glucose, and Blood Cholesterol,
• Conferences supporting legislation to create a State and Body Mass Index Awareness in a
cardiovascular task force Rural Mississippi High School
• Delivering resolutions calling for maintaining health
T. Kristopher Harrell, School of Pharmacy, University of
care trust fund integrity and use of tobacco settle- Mississippi, Deborah S. King, Marion R. Wofford, M.D.,
ment funds only for health initiatives M.P.H., Daniel W. Jones
Legislators, like many adults, are often unaware of the Mississippi leads the Nation in the number of deaths
risks of chronic diseases, such as hypertension, diabetes, associated with cardiovascular disease. Alarmingly, the
obesity, and dyslipidemia. Increasing legislator awareness prevalence rates of cardiovascular disease risk factors
is the first step toward gaining support for effective policy have increased, and public awareness of these risk factors
and program changes. Educational campaigns with has declined. Since the onset of many risk factors is at an
strong organizational support and partnerships can early age, it is important to increase the awareness of risk
increase legislator awareness and consciousness. Capitol factors among adolescents. This poster presentation will
Day 2001 was extremely successful, with avid legislative discuss results from a cardiovascular risk factor aware-
participation and full media coverage and publicity. ness assessment in students attending a rural high school
in Morton, MS.
P-79 A School-Based Program To Heighten
Adolescent Obesity Awareness Among A “Do You Know Your Numbers” questionnaire was
Medicine-Pediatric Residents developed and administered to all Morton High School
students agreeing to participate. Parental consent was
Marion R. Wofford, M.D., M.P.H., Division of also obtained. The questionnaire consisted of five multi-
Hypertension, University of Mississippi Medical Center ple-choice questions regarding the normal values for
The incidence of obesity has become an epidemic among blood pressure, glucose, cholesterol, and body mass
adolescents. Training in residency programs on adoles- index parameters. The main outcome variables were
cent obesity is essential to heighten awareness among awareness rates for each of the risk factors.
future health care providers. Age-specific educational pro-
A total of 246 students completed the questionnaire.
grams on cardiovascular disease (CVD) risks and preven-
Approximately 55 percent were female, 55 percent were
tion may impact the occurrence of adolescent obesity.
Caucasian, 37 percent were African American, and 3 per-
cent were Hispanic. The mean age of students was 15.7

CVH 2002 111

 years. Awareness rates were as follows: blood pressure A Unique Multirisk Factor Reduction
P-83
49 percent, blood glucose 29 percent, blood cholesterol Program in Family Practice
25 percent, and body mass index 8 percent. Fewer than 1
percent of students answered all questions correctly, and Maureen R. Courtney, University of Texas at Arlington
more than 40 percent could not correctly identify normal Purpose: This study investigates an innovative clinical
values for any risk factor. program to identify and reduce cardiovascular risk factors
To reach Healthy People 2010 objectives, increasing for patients in a busy family practice. The Cardiovascular
health awareness among high school students is impera- Assessment, Prevention, and Disease Management (CAP-
tive. As a result of these findings, educational programs D) Program is located within the family practice and is
have been implemented in conjunction with the Morton managed by a family nurse-practitioner (FNP) in consulta-
Have-a-Heart Project at the high school and community tion with the medical director. Patients are referred to the
levels to increase awareness. FNP by their primary care providers (PCPs) in the practice
for targeted cardiovascular risk assessment, which
P-82 Advanced Lipid Measures in Family Practice: includes an in-depth lifestyle and medical history, select-
Clinical Outcomes and Cost-Effectiveness ed physical exams, advanced lipid measures (LipoMed,
hs-CRP, Lp(a), and homocysteine), ankle-brachial index,
Maureen R. Courtney, University of Texas at Arlington, and body composition per BIA. A comprehensive
Amy Griffith, Amy Andrew, Joy Gibbs
Cardiovascular Risk Report with a recommended plan for
Purpose: This study was a clinical investigation to lifestyle and medical management is developed. CAP-D
describe patient profiles of advanced lipids (using patients are then managed by the FNP or returned to their
LipoMed) and emerging cardiovascular disease (CVD) risk PCP for ongoing management. If managed by the FNP,
factors (hs-CRP, Lp[a], and homocysteine) in a family patients receive lifestyle counseling and medical manage-
practice population. This study, focused on primary pre- ment for their diabetes, hypertension, and/or dyslipi-
vention patients, evaluated the importance of advanced demia. Patients return to the FNP for risk reduction fol-
lipid testing to identify those patients with significant lowup every 2–3 months or as indicated.
abnormalities who were not identified by a traditional
lipid panel. The usefulness of tracking advanced lipid Methods: Patient data (process and outcome) for the first
measures as a guide to more effective treatment and risk year of the CAP-D Program operation have been collected
management was also determined. prospectively and entered in a SPSS database by a
research assistant. Health care costs also have been
Methods: Lipid data were collected on 300 patients who examined.
were managed by a family physician or nurse-practitioner
using LipoMeds and other advanced tests for a period of Results: Data analyses are currently underway and are
3 months to 1 year. Data were obtained through retro- planned to yield (1) a descriptive profile of typical patients
spective chart review, inputted to a Teleform Scan sheet, in a family practice population deemed in need of com-
and then entered into SPSS for analysis. prehensive cardiovascular risk management; (2) patient
outcomes regarding the management of multiple risk fac-
Results: Preliminary data analyses reveal that many tors; and (3) determination of the cost-effectiveness of a
patients had hidden lipid risk factors, identifiable only by specialized program operating within a family practice,
the advanced lipid measures. Medical treatment was particularly one that uses advanced lipid measures.
implemented for many patients who otherwise might not
have been selected for treatment. Analyses are ongoing Conclusions: Assisting patients to reduce cardiovascular
to determine the degree of success in reaching recom- risk factors requires an in-depth assessment and rigorous
mended clinical outcomes using the advanced lipid data. management—factors that are difficult to achieve in a
Requirements for combination drug therapy to reach goal busy family practice. The availability of a specialized CAP-
will be a special focus. All analyses will be completed by D Program operated by an FNP within the family practice
December 2001. may be a cost-effective intervention to reduce the burden
of unnecessary cardiovascular disease.
Conclusions: Study results support the importance of pri-
mary care providers becoming competent in the use of P-84 Lone Mothers Are at Higher Risk for
advanced lipid measures to reduce risk factors through Cardiovascular Disease Compared to
aggressive lifestyle and medical management. Care Partnered Mothers: Data From the
received and health care outcomes are significantly differ- National Health and Nutrition
ent when primary care clinicians use advanced lipid Examination Survey III (NHANES III)
measures with their primary prevention patients. The clin-
Lynne E. Young, University of Washington, Susanna
ical utility and cost-effectiveness of these measures for
Cunningham, Diana Buist
use in primary care have been initially validated through
this study. Purpose: The purpose of this study was (1) to compare
selected cardiovascular disease (CVD) lifestyle risks
(smoking, obesity, and physical activity) and relevant
socio-demographic variables, health, and psychosocial

112 CVH 2002

characteristics in partnered versus lone mothers and (2) square used to test for differences in the self-reported
to examine the relationship between partner status and rates of AF, TIA, and diabetes will be presented.
having experienced a CVD or CHD event.
This study has important implications for increasing the
Methods: Data from NHANES III were used to identify proportion of persons appropriately counseled about
1,446 women < 60 years with 1 or more children < 17 stroke risks. The identification of differences in stroke risk
years. Weighted logistic regression was used to compare factors between men and women with a disability can be
the prevalence of CVD risk factors in 2 groups of mothers, used to develop appropriate health promotion interven-
lone (43 percent) versus partnered (57 percent). tions to decrease stroke in this population.
Results: Compared to partnered mothers, lone mothers
P-86 Benefits of a Pre-ESRD Education Program
were heavier, current smokers, less educated, less likely
to have health insurance, and more likely to have an Betsy B.D. Ripley, M.D., Virginia Commonwealth
income < 1 of the poverty index ratio (PIR) and to have University, Ann Compton, M.S.N., F.N.P., Emily Kutzer-
received Medicaid, food stamps, and WIC. Additionally, Rice, Michele Heny, F.N.P.
lone mothers were more likely to report having had an Pre-End-Stage Renal Disease (ESRD) education has been
MI, to have diabetes and/or hypertension, and to report increasingly recommended, although few studies have
fair/poor health. After adjusting for age, PIR, receipt of evaluated the outcomes. A case control study of the out-
Medicaid, education, obesity, and physical activity, comes of a multidisciplinary 9-week pre-ESRD education
women who had experienced a CVD event (MI, CHF, or program was evaluated. The weekly program included
stroke) were 3.28 times more likely to be a lone mother options, diet, medications, psychosocial, BP, and rehabili-
than a partnered mother (95 percent confidence interval tation. Sixteen case HD patients (6M/10F, age 57 ± 13
[CI] 1.80 and 1.84). Multivariate analyses demonstrated years, 14 Blacks/2 Whites, etiology 11 DM, 4 HTN, 1
that lone mothers were also significantly more likely to PCKD) who had attended the options and at least 2 other

POSTER SESSIONS
have hypercholesterolemia, hypertension, and nongesta- classes were matched to 16 control patients (8M/8F, age
tional diabetes. 51 ± 14 years, 14 Blacks/2 Whites, etiology 10 DM, 6 HTN).
Conclusions: Low-income lone mothers need to be sin- Chart reviews were performed to determine demograph-
gled out for primary prevention, with a focus on weight ics, access at time of initiating HD, status of first dialysis,
control, smoking, hypercholesterolemia, hypertension, pre-HD, 60- and 90-day labs, hospitalizations, employ-
and diabetes. Professionals and low-income lone mothers ment, and treatment compliance. T-tests were performed
should collaborate to develop programs and policies in to compare the case and control patients with signifi-
support of lone mothers’ healthy lifestyles and conditions cance at p < 0.05. Significantly more class attendees had
of living. a functioning permanent access (69 percent versus 25
percent) and an elective first treatment (69 percent versus
P-85 A Comparison of Stroke Risk Factors in 31 percent) compared to the control patients. Mean arteri-
Men and Women With Disabilities al pressure was higher in the control subjects at the time
of first dialysis (case 108 ± 16, control 127 ± 19 mmHg)
Janice L. Hinkle, Ph.D., Villanova University but was similar at 90 days (case 108 ± 14, control 108 ±
Early recognition and treatment of stroke uses health pro- 17). Phosphate (case 5.6 ± 1.6, control 6.5 ± 3.1 mg/dL)
motion efforts that focus on the modifiable risk factors of and hematocrit (case 29 ± 5, control 27 ± 3 percent) were
high blood pressure, history of transient ischemic attack similar before dialysis. Compliance with treatment time
(TIA), atrial fibrillation (AF), and diabetes. The incidence and duration was significantly better for the case patients.
of these four modifiable risk factors is high in the dis- Patients who receive pre-ESRD education are better pre-
abled population in general, but it is not known if it differs pared for dialysis, as shown by the higher rate of func-
between men and women in this population. This is tioning permanent access and the predominance of elec-
essential information to have before proceeding with the tive first treatments. Pre-ESRD education can have a ben-
development of targeted health promotion activities to eficial impact on improving patient outcomes.
reduce stroke.
P-87 Nurse-Managed Blood Pressure
The purpose of this descriptive study was to compare Telemonitoring With African Americans
males and females with a disability on risk factors for
stroke. The specific aims were to identify whether male Nancy T. Artinian, Ph.D., Wayne State University, Olivia
and female individuals with a disability differed in their G.M. Washington, Thomas N. Templin
mean systolic or diastolic blood pressure (BP) or in self- There is an urgent need to find better ways to control and
reported rates of TIA, AF, or diabetes. treat high blood pressure. The specific aims of this ran-
domized controlled trial are (1) to compare usual care
Data were collected on the four modifiable risk factors at
only with home telemonitoring/telecounseling plus usual
a variety of conferences and meetings targeted at individ-
care to determine which has the greatest effect on change
uals with a disability. Results of the analysis of variance
in blood pressure from baseline and (2) to examine why
(ANOVA) used to compare the mean diastolic and systolic
the intervention works to control blood pressure by
BPs of the men and women with a disability and the chi-

CVH 2002 113

 examining selected mediators, i.e., dietary habits, physi- Nutrient Intakes of Rural, Fifth Grade
P-89
cal activity level, weight loss, reduced alcohol intake, Children at Risk for Cardiovascular Disease
compliance with an antihypertensive medication regimen,
and contact with a primary care provider. Otherwise Debra Ann Krummel, Ph.D., West Virginia University,
healthy African American, English-speaking men and Colleen Ann Kelley, Elizabeth Gonzales, William Neal
women (n = 400) who are > 18 years with a SBP >140 Purpose: The purpose of this study was to determine the
mmHg and a DBP > 90 mmHg will be conveniently select- nutrient intakes of children living in a county with a high
ed from community sites. Participants will be randomly prevalence of cardiovascular disease.
assigned to one of two treatment groups that are strati-
Methods: The dietary intakes of 250 fifth graders were
fied by use or nonuse of antihypertension medication—
assessed using the Youth/Adolescent Food Frequency
group A, home telemonitoring/telecounseling plus usual
Questionnaire. Children were categorized by risk status
care, or group B, usual care only. Participants in group A
(at-risk or not-at-risk using standard risk factors of high
will receive usual care plus 18 sessions of weekly tele-
body mass index, blood pressure, or cholesterol) and
monitoring and feedback combined with lifestyle modifi-
level of fat in the diet (< 30 percent fat or > 30 percent
cation telecounseling. Data will be collected at baseline
fat).
and at 3, 6, and 12 months. Analyses will include mixed
design analysis of variance, general mixed linear model Results: At-risk children consumed significantly less calo-
approach to repeated measures, and MANOVA. ries, carbohydrates, protein, fat, vitamin E, and calcium (p
< 0.01). Children consuming higher fat diets consumed
P-88 Perceptions of the Environment for significantly more protein, fat, and vitamin E, and signifi-
Physical Activity Among cantly less carbohydrate and vitamin C (p < 0.01).
High- and Low-Risk Counties
Discussion: The lower consumption of nutrients by at-
Emily Corbett Spangler, M.D., West Virginia University, risk children suggests that some family modification of
Paul Gordon, Debra Krummel, Ph.D., Nicole Morrison diet may have occurred due to family risk status.
As a part of the West Virginia Cardiovascular Health Consistent with the literature, higher fat eaters consumed
Program funded by the Centers for Disease Control and diets higher in calories, which can contribute to obesity,
Prevention, a qualitative study was conducted to find out and lower in vitamin C, suggesting that fewer fruits and
whether differences existed between a low-risk county for vegetables were being consumed.
cardiovascular disease (CVD) and high-risk counties for
CVD in relation to community members’ and public offi- P-90 Outcomes of Medical Nutrition
cials’ perceptions of the environment as they relate to Therapy for Postmenopausal Women
physical activity (PA). The selection of counties was based Debra Ann Krummel, Ph.D., Department of Community
on cardiovascular mortality rates, prevalence of obesity, Medicine, West Virginia University
sedentary behavior, ruralness, median income, and popu-
Purpose: The purpose of this study was to assess the
lation. Upshur County was selected as the low-risk coun-
impact of a medical nutrition therapy employing a cogni-
ty, while Lewis and Doddridge Counties (combined due to
tive-behavioral approach on cardiovascular health out-
population density and aggregation of Behavioral Risk
comes in postmenopausal women.
Factors Surveillance System data) were chosen as the
high-risk counties. Twelve public officials were surveyed Methods: Fifty-one women with hypercholesterolemia
by telephone in each county, while 100 community mem- (mean age 58 years) were randomized to a usual care
bers in Upshur County, 76 community members in Lewis (one counseling session with a dietitian and no further
County, and 75 community members in Doddridge followup) or an intervention group (four sessions plus
County were surveyed in person. Community members in telephone counseling) for 6 months. Dietary goals were a
the low-risk county reported more opportunities for PA high-fiber, low-fat (20 percent of calories) eating plan.
(i.e., more safe sidewalks, more indoor facilities for PA, Physical activity was encouraged. Repeated, computer-
and more adult sport leagues) than in the high-risk coun- ized 24-hour recalls and food behavior instruments were
ties. Public officials in the low-risk county also reported used to assess dietary intake and patterns before and
more opportunities for PA (i.e., more walkable streets; after the intervention. Blood lipids were measured in a
more indoor facilities for PA; and more parks, play- standardized, clinical laboratory.
grounds, and trails) than did the public officials in the
Results: Forty-two women completed the study (19 per-
high-risk counties. The perceptions of environmental
cent attrition). At baseline, there were no significant dif-
opportunities and policies for PA in a low-risk county
ferences in risk factors between the groups. As expected,
could contribute to the lower prevalence of risk factors
the prevalence of risk factors was high: 68 percent for
and cardiovascular mortality rate in that county.
obesity, 76 percent for waist-to-hip ratio > 0.08, and 54
percent for sedentary lifestyle. There was a significant
increase in knowledge following the intervention (p <
0.0005). While significantly more women in the interven-
tion group met dietary (p = 0.03) and lipid goals (p =

114 CVH 2002

0.02), most women were unable to achieve lipid goals. nant young women, cost containment efforts need not
The number of contacts was not related to changes in compromise quality care.
lipids; however, the number of nutrition classes attended
As the project manager for the Women’s Heart
was significantly related to intake of calories, cholesterol,
Foundation’s (WHF’s) Healthy Hearts Program for Faith
and fat.
Communities, Ms. Arkus has developed the essential
Discussion: Individual and group counseling produced tools and guidelines for more effectively managing care
some behavioral change in women. However, more con- within faith communities. Various care structures will be
tacts or intensive intervention would be necessary for presented with options for delivery of informal, nonskilled
most women to achieve lipid goals. care based on available resources. The proper identifica-
tion of and response to risk, recommendation for basic
P-91 Impact of a Nutrition Intervention on infrastructure, and data sets for managing volunteer skills
Quality of Life in Subjects With High and client needs utilizing Microsoft Office Suites will be
Risk Factors for Cardiovascular Disease introduced. The WHF Healthy Hearts Program for Faith
Communities will be available for purchase, including
Sandra Marie Magnetti, P.HG., Dr.P.H.,West Virginia
University School of Medicine, Debra Krummel, Ph.D. health screening tools, wellness guides, risk assessments,
and health data forms/records for consumers to better
The purpose of this study was to assess the impact of a
manage their own health information.
medical nutrition therapy employing a cognitive-behav-
ioral approach on health outcomes and quality of life in The Prescription for a Walkable Community—
P-93
postmenopausal women. Fifty-one women were random- The Role of Public Health Practitioners
ized to a usual care (one session with a dietitian) or inter-
vention group (four sessions plus telephone contact). This Deborah A. Spicer, New York State Department of Health
abstract will discuss the impact of the intervention on National and international health organizations are calling

POSTER SESSIONS
quality of life (QOL) as measured by the SF–36. for changes in our environment that will make it easier
Our results revealed significant changes in two of the for people of all ages and abilities to be more physically
eight components of QOL as measured by the SF–36. active. Walking is the activity that can most readily be
There were significant improvements in the intervention incorporated into daily life. Because of our auto-centered
group regarding the measures of vitality (VT), p < 0.002, environment and policies, many people do not have a
and general health (GH), p < 0.01, from below the nation- safe and comfortable place to walk. The Healthy Heart
al norms at baseline to above the norms at the end of the Program of the New York State Department of Health,
3-month treatment period. Significant differences were under a Comprehensive Cardiovascular Health Grant from
evidenced only in high school graduates and above (75 the Centers for Disease Control and Prevention, has
percent of group) for VT and GH. Additionally, those who engaged numerous nontraditional State and local part-
reported improvements in VT and GH also significantly ners in initiatives that improve pedestrian safety, access,
improved their triglycerides. and aesthetics. We have learned that one important role
of the public health sector is to help raise the demand for
We conclude that this type of nutrition therapy using a more walkable communities among citizens and commu-
cognitive-behavioral approach with subjects has a posi- nity leaders. This session will describe how we have cre-
tive impact on two elements of QOL: vitality and general ated new partnerships and some of the joint efforts that
health in subjects who have a high school education or we have undertaken at the State and local levels to create
above. this demand. In part as a result of interest generated by
Future studies should examine the relationship between the public health sector, we are beginning to see changes
triglycerides and VT and GH. We also recommend that in State level policies; these results will also be discussed.
further study be devoted to using this method in lower
P-94 Cardiovascular Disease Risk Factors
educational groups.
Knowledge Improvement: A Community-
Faith Communities and Based Educational Intervention
P-92
Informal Long-Term Care
Laurens Holmes, Global Health Research Institute
Bonnie Hartman Arkus, Women’s Heart Foundation Objectives: The objectives of the study were to assess
Long-term care needs of patients with congestive heart the cardiovascular disease risk factor knowledge, corre-
failure and patients with complications related to preg- late knowledge with cardiovascular disease status, and
nancy (e.g., HTN, abnormal blood sugar) present untold improve cardiovascular health knowledge among African
challenges to health care professionals. Care is best man- Americans in Crosby, TX.
aged through a continuum. Methods: A self-assessment survey of cardiovascular
By developing informal care guidelines for faith commu- health status was administered to 98 African American
nities to better assist persons with congestive heart fail- males (50) and females (48), aged 45 to 79. A 20-item
ure or promote/foster mentoring relationships for preg- questionnaire on knowledge of cardiovascular risk factors

CVH 2002 115

 was presented as pretest and posttest in evaluating those reported some success. Substantial stage-of-
knowledge and was correlated with cardiovascular health change movement was seen: two-thirds to three-fourths
status. A 1-hour educational material based on standard- of those initially “not planning or “thinking about” mak-
ized curriculum on risk factors prevention was presented ing dietary changes moved to a higher stage, for both fat
to the study participants. Analysis was performed using a intake and fruit/vegetable/fiber intake.
one-way analysis of variance, paired t-test, and p-values
Conclusions: This is a very cost-effective way to help
of 0.05.
employees and their families improve their dietary
Results: This preliminary study results indicates a statisti- behaviors.
cally significant difference between pretest and posttest.
Secondly, though not statistically significant, knowledge P-96 Gender and Racial Disparities in Pre-AMI
of cardiovascular risk factor after adjustment for income Diagnosis: Missed Opportunities?
level, gender, and educational background correlated pos-
itively with cardiovascular health status. Christine E. Chaisson, M.P.H., Data Coordinating Center,
Boston University School of Public Health, Jeong-Min
Conclusion: Educational intervention appears to be effec- Lee, Karen Freund, Lindsey Bramwell, Arlene S. Ash,
tive in enhancing knowledge of cardiovascular risk fac- Ph.D.
tors. However, the attitude towards cardiovascular health Women and black patients often present with more
was not examined by this study. Therefore, to examine severe disease and have poorer coronary heart disease
the role of education in cardiovascular disease prevention (CHD) outcomes, perhaps because their early risk factors
or health protection, design must include the evaluation and initial CHD symptoms are under-recognized. For peo-
of attitude towards cardiovascular health as a component ple hospitalized for acute myocardial infarction (AMI), we
of the intervention. see whether gender and race affect the likelihood of a
CHD diagnosis in the pre-AMI year, either overall or for
P-95 Worksite Internet Nutrition those with other atypical presentations.

Torin J. Block, Block Dietary Data Systems We examine ICD-9-CM inpatient and outpatient diagnostic
codes during the 365 days preceding each of 306,175
Purpose: The purpose of this study was to develop and
1999 Medicare fee-for-service AMI admissions. "Marker"
test an e-mail-driven, worksite-based program to improve
conditions that may represent misdiagnosed CHD are
dietary intake.
non-CHD heart disease; pulmonary diseases; digestive
Methods: Eighty-four employees (the majority of those to disorders; general symptoms (including syncope, dizzi-
whom it was offered) completed a dietary questionnaire ness, fatigue); and musculoskeletal (including costochon-
on their fruits/vegetables/fiber and dietary fat intake. They dritis and noncardiac chest pain). We compare the preva-
then chose to work on one of those dietary areas for the lence of pre-AMI CHD diagnoses within marker condition
subsequent 12-week program. Weekly e-mails were based cohorts, by race and gender.
on behavioral change principles and tailored to individual
CHD was recorded in the pre-AMI year for 35.8 percent
lifestyle characteristics. Each e-mail contained health
overall, with black men least likely to have recognized
information (e.g., the role of saturated fat in heart dis-
CHD (32.1 percent) and white men most likely (38.2 per-
ease), tailored tips for improving their diet, and small
cent).
steps to try the following week.
Recognition of CHD prior to an AMI is far from universal
Results: More than half said that they were budget-con-
and differs by race and gender. Within cohorts of people
scious when buying food. Eighty-three percent of respon-
with CHD-like symptoms, CHD recognition is more com-
dents said they read at least half the e-mails and would
mon but substantially less so for black women as
recommend the program to others; 91.5 percent found
opposed to white men.
the tips helpful, and more than half talked with someone
else about improving their diets. Eighty-three percent
tried to make changes in their diet, and 90 percent of

P-96. Percentage With Any CHD Diagnosis in the Pre-AMI Year, Within Marker Condition Cohorts

Non-CHD Heart Pulmonary Digestive General Sx Musculoskeletal

White Female 51.1 51.0 46.3 45.5 55.2
White Male 57.6 55.3 52.1 53.6 60.0
Black Female 46.9 49.2 45.3 45.1 52.7
Black Male 49.0 50.0 48.2 49.3 53.2

116 CVH 2002

 Weight Loss and Risk Factor Management in services, thus gaining better health care. We provide serv-
P-97
the Community Setting ices such as interpreting, providing referrals to needed
services, and providing one-on-one education about CVD
Mary Catherine Vernon, M.D., Lawrence Family Practice and diabetes.
Center
Summary of Results: The Cambodian population of
Obesity is a leading cause of death in the United States,
Lowell has numerous risk factors, including high smoking
making it urgent that effective obesity treatments be iden-
rates, and has limited awareness of CVD and treatment
tified that can be easily implemented in the community
options. This places them at a disproportional risk for
setting. The purpose of this study was to determine the
morbidity and mortality due to CVD.
effect of a clinic-based diet and/or medication weight-loss
program on weight and serum lipids. Conclusions: Outreach and advocacy interventions in the
community and health care system will continue to be
We performed a retrospective chart review of patients
implemented as stated in our community action plan.
attending an outpatient family practice clinic using a mul-
ticomponent, outpatient weight management program Existing and Developing Community Health
P-99
including periodic individual visits, and either a low-fat Promotion Programs in New York State
diet/medication (MED) or a low-carbohydrate (< 20
grams/day) diet program (LC) over a 3-month period. The Christopher C. Ashley, M.D., New York State Department
main outcome measures were body weight and serum of Health, Margaret O. Casey, R.N.
lipids. Clinical data were collected on standardized flow- Brief Statement of Purpose: The intent of this interven-
sheets and abstracted for data analysis. tion is to promote the introduction of environmental well-
ness programs in communities across New York State
Of 174 patients identified, 76 patients had complete pre-
and to assess existing health promotion programs.
treatment and posttreatment data. The demographics of

POSTER SESSIONS
the two groups were similar. The baseline BMI was 38.9 Statement of Methods or Process Used: All hospitals in
kg/m2 (SD = 8.6), the mean age was 45.6 years (SD = 9.9), New York State were invited to attend one of several col-
70.6 percent were female, and 91.2 percent were loquia across the State. Information on environmental
Caucasian. After 3 months, there was a loss of body interventions was provided, and workshops were held to
weight of 12.7 percent for the MED group and 8.2 percent develop action plans at each site. Participating hospitals
for the LC group (p < 0.05 for the difference between disclosed the nature of their existing prevention pro-
groups). For MED and LC respectively, the mean change grams and those present in their communities.
in total cholesterol was -12.8 percent and -10.4 percent; Participants were followed up and surveyed to assess
LDL-C: -11.8 percent and -5.0 percent; triglycerides: what further action had been taken based upon their
-32.2 percent and -39.2 percent; HDL-C: -2.4 percent and experience at the colloquium attended. Interventions tar-
+6.3 percent; cholesterol/HDL ratio: -12.5 percent and - geted physical activity, heart-healthy eating, and smoking
19.6 percent. There were no adverse effects. cessation.
An outpatient weight management program including a Summary of Results: Environmental programs to pro-
low-fat diet/medication or low-carbohydrate diet program mote community health were effectively introduced to
was effective in improving weight and lipid parameters in communities where these methods were not previously
the community setting. used.
Statement of Conclusions: The prevalence of environ-
P-98 Cambodian Community Health 2010
mental programs is low in communities across New York
Sheila Fernández, Lowell Community Health Center, State. Simple educational programs can effectively intro-
Sidney Liang duce environmental programs into communities.
Purpose: The goal of the Cambodian Community Health
2010 (CCH 2010) is to eliminate health disparities among P-100 Cardiovascular Risk Reduction Clinic:
A New Health Care Intervention Promoting
the Cambodian population of Lowell in regards to cardio-
Health and Disease Prevention in Patients
vascular disease (CVD) and diabetes.
With Established Cardiovascular Disease
Statement of Methods Used: Our outreach efforts
involve creative strategies such as learning tours at local Oanh Martin, Pharm. D., Providence VA Medical Center,
Peter Petropoulos, M.D., Tracy Uriati, R.D., Thomas H.
hospitals, health centers, police department, and fire sta- Wheeler, P.T.
tion; holding exercise groups where participants practice
Tai Chi; educational fruit and vegetable picking tours Long-term health benefits of cholesterol reduction, tobac-
where nutritional facts are discussed; educational groups co cessation, lowering blood pressure, and tight glycemic
where we speak about CVD and diabetes; and health fairs. control in patients with cardiovascular disease have been
well established. Recent studies, however, have demon-
Our advocacy has and continues to link Cambodians who strated that the majority of patients with established car-
have CVD or diabetes to culturally appropriate health diovascular disease fail to achieve target goals as set

CVH 2002 117

 forth by national guidelines. To address the wide treat- State peer review organization to improve the care of
ment gap and eliminate patient, provider, and system bar- heart disease in West Virginia.
riers, an interdisciplinary Cardiovascular Risk Reduction
Clinic (CRRC) was developed. To evaluate the clinical out- P-102 Supports and Barriers to Healthy Eating and
come of a Pharm.D.-coordinated CRRC, a nonrandomized Physical Activity Identified From Diverse
pilot study was conducted after the first 6 months of Low-Income Focus Group Participants
operation. Complete data for before and 6 months after
Rebecca M. Mullis, Ph.D., R.D., L.D., Department of Foods
CRRC visits were available in 130 patients and demon- and Nutrition, The University of Georgia, Teresa B. Kaley,
strated a significant reduction in the mean Hgba1c from R.D., L.D.
8.73 percent to 7.54 percent (p < 0.005), mean LDL from
The Department of Foods and Nutrition at the University
116 mg/dL to 95 mg/dL (p < 0.005), mean systolic blood
of Georgia carried out the Georgia Cardiovascular
pressure from 141 mmHg to 127 mmHg (p < 0.005), and
Disease Prevention Initiative in partnership with the
mean diastolic pressure from 75 mmHg to 72 mmHg (p <
Georgia Department of Human Resources. The University
0.005). Of 61 patients available for tobacco cessation, 7 of
of Georgia conducted 15 focus groups in 11 rural and
15 patients interested in cessation have successfully quit.
urban areas of Georgia. The primary objective of this
A Pharm.D.-coordinated interdisciplinary CRRC health
work was to reduce the risk of cardiovascular disease
care intervention improves performance measures and
among Georgia residents by determining environmental
achieves target goals for cardiovascular risk factor reduc-
and policy supports and barriers to healthy eating and
tion through aggressive therapeutic lifestyle modification
physical activity and to solicit ideas about community
counseling and pharmacotherapy.
resources needed to foster healthy eating and physical
activity. One hundred and twenty low-income participants
P-101 The Evaluation of Secondary Prevention represented seven target populations: African Americans,
Practices in an Acute Care Setting—
A Heartcare Partnership Asians, Hispanics, African American and Caucasian senior
citizens and youths, rural residents, and nonsedentary
Jack William Taylor, M.S., St. Mary’s Regional Heart workers. Twelve health department nurse managers also
Center participated in the study. We observed some universal
Information was obtained in order to evaluate and themes across groups with respect to social supports, the
improve secondary prevention of patients who have environment, and specific messages.
experienced a myocardial infarction in a hospital setting The following objectives should be primary considera-
according to the guidelines of the American Heart tions for the future development of environmental and
Association (AHA). policy community interventions impacting healthy eating
Inpatient records were obtained on 50, 67, and 114 and physical activity: (1) incorporate age-appropriate
patients at baseline, 3 months, and 6 months, respective- buddy systems as a strategy for helping to initiate and
ly; these patients experienced a myocardial infarction maintain healthy behavior; (2) build community support
through the emergency department at St. Mary’s Hospital. in various forms, such as walking trails and free or com-
Following the initial assessment, protocols were devel- munity centers; (3) build healthy eating and physical
oped to encourage providers to adhere to the guidelines activity into community social activities; (4) develop
for secondary prevention of myocardial infarction (AHA). point-of-purchase assistance, taste test, and recipes in
grocery stores; and (5) provide nutritional values of foods
A higher incidence of compliance was observed at both and offer healthy choices in restaurants.
the 3-month and 6-month observation periods: LDL-C
measured, 32 percent - 38 percent - 62 percent; patients These findings will serve as one step in determining the
placed on lipid-lowering therapy, 43 percent - 45 percent - plan for the prevention of cardiovascular disease in
63 percent; counseling for smoking cessation, 85 percent - Georgia.
100 percent - 98 percent; appropriate physical activity rec-
ommended, 91 percent - 100 percent - 100 percent; P-103 Sedentary Lifestyle in Adult, Working
Women: A Group Intervention for Exercise
patients placed on beta blockers, 60 percent - 89 percent -
88 percent; and if the ejection fraction was less than 35 Judith Ellen Swasey, M.S.N., R.N., University of North
percent, 68 percent - 50 percent - 72 percent were placed Carolina at Chapel Hill
on an ACE inhibitor.
A 12-week, group, progressive exercise training program
In comparison to national norms, a higher incidence of for adult, sedentary, working women was developed and
compliance with the AHA guidelines was indicated and implemented as an intervention to decrease sedentary
improvement in compliance with the majority of these lifestyle and to promote the adoption and maintenance of
items over a 6-month period. Anticipated barriers were a regular exercise program. The program was conducted
identified, and specific measures were implemented with in 1995 and 1996 in the northeastern United States and in
success in order to improve compliance levels more in 2001 in the southeastern United States and was support-
line with actual AHA standards. Further improvement in ed by a local hospital, university, and the surrounding
the protocols is being developed in partnership with a communities. The theoretical framework for the interven-

118 CVH 2002

tion was Pender’s health promotion model and Bandura’s The aim of a community intervention program such as
social cognitive theory. Components of the intervention this one is to affect individual health through social chan-
included four phases: (1) recruitment and enrollment; (2) nels, which in this case is a school. One of the first steps
progressive educational, attitudinal, and exercise training; in this process is to assess current health knowledge in
(3) achievement of an established goal; and (4) long-term this population of children and parents and to appreciate
followup. The intervention addressed reducing perceived how this affects their health-related behaviors. By work-
barriers and enhancing benefits and facilitators associat- ing with the students, the project will also be able to
ed with exercise: environmental adjustment; role model- involve other family members in the effort to promote
ing and social support by group leader and guest run- education about CVD and subsequently deliver preventive
ners; and cognitive-behavioral restructuring and self-effi- measures geared towards a population that is mostly
cacy methods through mastery experiences, vicarious African American. Working with the children and their
experiences, verbal persuasion, and monitoring physio- families will enable them to feel that their health care
logic feedback. Short-term outcomes were program atten- concerns are being attended to, and perhaps this may
dance and race/walk goal completion. Long-term out- impact their inclination to seek preventive health care in
comes were exercise maintenance and positive changes the future. The preventive measures are in the form of
in attitudes towards exercise, existing health problems, education regarding proper nutrition and ways to be
and health behaviors. The convenience sample for the more active.
first 2 years consisted of predominantly white, profes-
Currently, we have just completed the data collection
sional women ranging in age from 22–71, with the largest
process and are evaluating the results and, therefore, do
subgroups aged 30–39 and 40–49. Of those registered, 34
not have a complete summary of the results and conclu-
(54 percent) completed the race/walk goal in year 1, and
sions.
26 (72 percent) completed the goal in year 2, a higher
than expected (> 50 percent) participation/completion
P-105 The Role of Sleep-Disordered Breathing in

POSTER SESSIONS
rate. A self-report questionnaire at 6 months provided Cardiovascular Disease
data on exercise maintenance, health behavior and atti-
tude changes, and program evaluation. The questionnaire Terry Young, Ph.D., Department of Preventive Medicine,
return rate at 6 months was 22 percent (1995) and 31 per- University of Wisconsin-Madison, Paul Peppard, Ph.D.
cent (1996), and of those, 71–91 percent maintained exer- Sleep-disordered breathing (SDB) is a condition of repeat-
cise, and 43–71 percent altered or adopted new health ed episodes of partial and complete upper airway closure
behaviors. Written comments from participants indicated (apnea and hypopnea) during sleep. The acute effects of
positive health behavior, health status and affect changes these episodes include dramatic fluctuations in heart rate
(body image, health, social support, and self-efficacy for and blood pressure, bursts of sympathetic nerve activity,
exercise) with ranges of 14–57 percent (year 1) and 9–63 increased intrathoracic negative pressure, and sleep frag-
percent (year 2). Additional followup data for the program mentation. Hypertension, cardiovascular disease, and
year 2001 will be collected and analyzed in December stroke are thought to be chronic consequences of untreat-
2001 to January 2002. ed SDB, but only within the past few years have epidemi-
ologic data emerged that adequately address these
P-104 Cardiovascular Disease Risk Assessment hypotheses. Findings from the Wisconsin Sleep Cohort
and Prevention in PS 17 Study, a population-based longitudinal study (n = 1,400)
provide the strongest evidence for a causal association of
Srigouri Maguluri, University of Rochester School of
Medicine and Dentistry SDB and the development of new hypertension. The like-
lihood of developing hypertension over a 4-year period in
The proposed study falls into an existing collaboration
adults with moderate or worse SDB (defined by the
between the Orchard Street community classroom and
occurrence of > 15 apnea and hypopnea events per hour
the University of Rochester Medical School. The study
of sleep) compared to those with no SDB was threefold
assesses the risk for cardiovascular disease (CVD) within
greater (independent of potential confounding factors).
the school-based population of students aged 5–10; in
Several other studies, including the Sleep Heart Health
addition, it organizes preventive measures to combat
Study, have shown cross-sectional associations of SDB
these risks. Assessment of risk is done via a question-
and hypertension and self-reported cardiovascular dis-
naire, where pertinent family history of CVD, diabetes,
ease and stroke. Because the prevalence of undiagnosed
hypertension, smoking, obesity, and other illnesses is
SDB is high in adults (4 percent of women and 9 percent
taken. Furthermore, students’ knowledge about cardio-
of men are estimated to have moderate or worse SDB), a
vascular health and their own health behaviors, such as
causal role of SDB in cardiovascular disease would result
diet and exercise, is included. After this assessment, stu-
in a significant number of cases. Greater clinical and pub-
dents are placed in either a control group or two experi-
lic health attention needs to be focused on the potential
mental groups receiving different preventive interven-
importance of SDB, a treatable disorder, in cardiovascular
tions. After a period of approximately 5 weeks, prelimi-
morbidity and mortality.
nary data will be gathered for evaluation of the treatment
effects.

CVH 2002 119

 interventions on coronary heart disease is needed to
P-106 Increasing the Intake of Flavanol-Rich Foods:
One Approach to Reducing the Risk of assist in understanding the impact of these interventions
Coronary Heart Disease and Stroke at the population level.
Methods: We created seven modules corresponding to
Carl L. Keen, Department of Nutrition and Department of
Rheumatology/Allergy and Clinical Immunology: MED, possible coronary heart disease states that are commonly
University of California at Davis, M. Eric Gershwin, Harold encountered, including congestive heart failure, tach-
H. Schmitz yarrhythmia, stable angina pectoris, acute coronary syn-
A large body of mechanistic, epidemiological, and clinical drome, bradycardia, postmyocardial infarction, postcoro-
research data supports the concept that flavanol-rich, nary artery bypass grafting, and a healthy individual mod-
plant-based foods and beverages, including some cocoas, ule. Within these modules, we have created decision-
teas, and grape juices, have the potential to enhance car- intervention-outcome flow pathways to simulate clinical
diovascular health. For example, research from several practice and have used a stochastic approach to calculate
different groups suggests that certain dietary flavanols the impact of the interventions on the incidence of coro-
have aspirin-like effects with regard to reducing platelet nary events and mortality. We can generate the outcome
activation. In this presentation, data will be reviewed on probabilities for an event based on the likelihood of
the bioavailability and bioactivity of select dietary fla- patient demographic characteristics and risk factors, treat-
vanols. The in vitro and in vivo effects of these flavanols ment efficacy and application, and candidacy for interven-
will be compared and contrasted. Results from three tions and disease prevalence. When fully implemented,
recent studies that we have conducted on the acute during a simulation run, we will simulate a population by
effects of flavanol-rich foods on platelet reactivity in randomly assigning demographic and risk characteristics
healthy adult subjects will be presented. Common find- according to community distributions. We can then run
ings in these studies are that dietary flavanols can be rap- each individual in the simulated population through a
idly absorbed, and this uptake can be associated with a treatment model, with outcomes generated stochastically,
rapid reduction in platelet reactivity. The magnitude of the age the population, and then evaluate outcomes, such as
effects on platelet reactivity is similar to that observed mortality and prevalence of disease. The effects of thera-
with low-dose aspirin. If long-term, randomized, multicen- peutic or technologic interventions could then be evaluat-
ter trials confirm these data, promoting the regular con- ed based on changing parameters within the treatment
sumption of specific flavanol-rich foods may present an models.
effective public health strategy for reducing the risk of Conclusions: We are developing a decision support tool
coronary heart disease and stroke. that will assist health professionals and health policy
planners in estimating the effects of resource allocation
P-107 Healthy People 2010 Knowledge Test and public policy on coronary artery disease outcomes.
Richard Edward Miller, George Mason University
P-109 Epidemiologic Correlates of Excessive
Multiple choice items measuring knowledge of Healthy Gestational Weight Gain
People 2010 objectives were constructed by the author
and were field tested on undergraduate students (n = 30) Isabel D. Fernandez, M.D., Ph.D., University of Rochester
School of Medicine
studying epidemiology. Knowledge test items were gen-
erated for each of the 467 objectives comprising Healthy Gestational weight gain has been implicated in increased
People 2010’s 28 focus areas. From student responses, postpartum weight retention, which in turn may con-
the author was able to examine validity and reliability tribute to subsequent overweight and obesity, established
qualities of the knowledge test items. These items will risk factors for cardiovascular disease morbidity and mor-
also be submitted to health promotion and disease pre- tality. The contribution of childbearing in the develop-
vention professionals in the field, to further establish the ment of obesity is of public health concern because the
validity and reliability of the items in measuring Healthy largest increases in obesity prevalence have been
People 2010 knowledge. Selected knowledge items have observed among women of reproductive age. Therefore,
been published by Haworth Press in the text, the identification of epidemiologic characteristics associ-
Epidemiology Applied to Health Promotion and Disease ated with excessive gestational weight gain will serve to
Prevention Professionals (Miller, 2001 in press). Copies of detect women who are at risk of becoming obese after
all 467 items will be available to conference attendees. pregnancy and to develop primary and secondary preven-
tion interventions. Here, the association among behav-
P-108 Development of a Coronary Heart ioral and psychosocial variables and an index of adequa-
Disease Decision Support Tool cy of prenatal care utilization with excessive gestational
weight gain was examined. Data were obtained from an
Lambert Anthony Wu, M.D., Mayo Clinic, Thomas E.
upstate New York population-based birth registry.
Kottke, M.D., M.S.P.H., Mark J. Brekke, Lee N. Brekke
Multinomial logistic regression was performed to model
Background: A decision support tool that is able to gestational weight gain according to the Institute of
model the effect of various therapeutic and technological Medicine’s recommendations as more than recommend-

120 CVH 2002

ed, recommended (reference category), and less than rec- leading causes of death that contributed to the LE differ-
ommended. Statistical significance was established at ential were heart disease (1.2 years; 27.3 percent), cancer
alpha less than 0.01. Results suggest that behavioral, psy- (0.5 years; 11.4 percent), and perinatal disease (0.4 years;
chosocial, and adequacy of prenatal care utilization vari- 9.1 percent). Stroke accounted for 0.3 years (6.8 percent)
ables are significantly associated with gaining excessive of the LE differential among females and 0.4 years (6.3
gestational weight. Interventions during pregnancy could percent) among males.
contribute to stop the upward trend in the prevalence of
Conclusions: More than one-third of the LE gap between
obesity.
Whites and Blacks was attributable to CVD. This under-
scores the importance of eliminating disparities in CVD
P-110 Twenty-five Years of
Corporate Health Promotion between these populations.

Ronald John Cook, Sentry Insurance P-112 Risk Factors for Atherosclerosis Among
College Students of Eastern Nepal
Health promotion at Sentry Insurance originated in the
1950s with the conversion of the old coalbunker into the Vijay Prakash Sharma, BPK Institute of Health Sciences,
“Bunker Health Club.” This humble beginning led to a Raju P. Paudel, Rajendra P. Khanal, Parimal K. Acharya
wellness/fitness center as part of the new corporate head- Background: Atherosclerotic coronary disease and stroke
quarters built in the 1970s. This presentation will provide are now assuming epidemic proportions in many devel-
an overview of the past 25 years of corporate health pro- oping countries, and Nepal is no exception. This change
motion. in the trend of disease is mostly due to a decline in infec-
This presentation will cover a historical review of health tious diseases, improvement in nutritional status, and
promotion activities, report on a comparison study of sick increase in the rate of risk behavior (smoking, obesity,
leave and health care claims of users and nonusers, sedentary lifestyle). These risk behaviors are often

POSTER SESSIONS
blood pressure screening data, and the Walking Club pro- acquired at a young age. Thus, we screened college stu-
gram. Regular fitness center exercisers had significantly dents for risk factors to discover the magnitude of the
smaller health claim utilization ($507 users, $1,602 problem, so that timely preventive measures can be
nonusers), and Walking Club members had a $363 taken.
decrease in 1 year ($974 to $611). Methodology: A cross-sectional survey of 385 students
Individual health is largely determined by factors outside (16 to 25 years) in a hill town of eastern Nepal was car-
of clinical medicine. Some experts project as high as 80 ried out with standardized questionnaire and physical
percent. The experiment in health promotion over the examination by medical doctors using a standardized
past 25 years has provided a supportive environment for technique. Hypertensives were further evaluated for sec-
employees, retirees, spouses, and dependents of Sentry ondary causes.
Insurance to engage in positive lifestyle behaviors. Results: The male to female ratio was 5:1. The body
mass index (BMI) of 100 students (26 percent) was
P-111 Influence of Cardiovascular Disease on between 20 and 25, whereas 285 (74 percent) students
Racial Disparity in Life Expectancy
had a BMI below 20. One hundred and nineteen students
La Mar Hasbrouck, M.D., M.P.H., Centers for Disease (31 percent) were using tobacco in one or other forms
Control and Prevention (cigarettes, bidis, chewing). Mild hypertension (JNC VI)
Purpose: The purpose of this study was to quantify the was detected in 19 students (5 percent).
contribution of cardiovascular disease (CVD) to the life Conclusion: Tobacco use is a major risk behavior in
expectancy (LE) gap between Whites and Blacks. young college students. Obesity is not a problem in this
Methods: NCHS mortality files for 1998 and multiple- age group. Rather, the subnormal range of BMI in two-
decrement life table techniques to decompose LE differ- thirds of people needs to be addressed, in light of the
entials by cause of death were used to examine differ- very small frame size of people. Hypertension in 5 per-
ence in LE between Whites and Blacks. cent of students at this age is quite significant and
emphasizes the need for hypertensive screening after 20
Results: In 1998, Whites lived 6.2 years longer than years of age.
Blacks. Overall, heart disease (1.7 years; 27.4 percent) was
the leading contributor to the difference, followed by can-
cer (1.2 years; 19.4 percent), homicide (0.6 years; 9.7 per-
cent), and stroke (0.5 years; 8.1 percent). The LE differen-
tial was 6.4 years for males and 4.4 years for females.
Among males, the leading causes of death that con-
tributed to the LE differential were heart disease (1.2
years; 19.0 percent), cancer (1.0 years; 15.6 percent), and
homicide (0.9 years; 14.1 percent). Among females, the

CVH 2002 121

 P-113 Cardiovascular Disease in Iowa:
An Applied Logistic Regression Model to
Iowa’s 2000 Behavioral Risk Factor
Surveillance System Survey Data

Jude E. Igbokwe, Center for Health Statistics, Iowa State

Center for Health Statistics, Mack Clayton Shelley,
Jingjing Chen
This study was aimed at investigating the risk factors
associated with Iowa’s cardiovascular disease (CVD)
development. Iowa’s 2000 Behavioral Risk Factor
Surveillance System (BRFSS) survey data were used to
perform the multiple logistic regression. The BRFSS is
based on a representative disproportionate stratified sam-
ple of Iowa residents over 18 years of age. The study
used the entire sample of the 3,611 respondents for the
analysis. The variables examined include health and dis-
ability indicators, demographic variables, health behavior
factors, and morbidity variables. Data were weighted to
represent Iowa’s total population. Multivariate logistic
regression was performed using a forward model selec-
tion procedure. The coefficients and odds ratio for each
model was examined.
Results indicate that in Iowa, CVD development was asso-
ciated with a decline in self-reported health status. The
population with diabetes, high blood pressure, or a high
level of blood cholesterol was substantially more likely to
have CVD. Adoption of healthy behavior, such as not
smoking, regular physical exercise, and weight control,
was associated with preventing CVD. The elderly and sin-
gle individuals were more likely to experience a greater
risk of CVD. Gender, race, and alcohol consumption were
not significantly associated with the incidence of CVD in
Iowa’s population.
The study suggests that the risk factors associated with
CVD and the awareness of healthy behaviors are differen-
tially distributed among social classes in Iowa, based on
age and marital status. Health policies should take into
account these disparities.

122 CVH 2002

Special Poster Presentation Section by the Health Resources and Services
Administration (HRSA)
Bureau of Primary Health Care (BPHC)
Cardiovascular Collaborative Health Centers

On April 11 from 12:15 p.m.–3:15 p.m. and on April 12 from 10:15 a.m.–2:15 p.m., there will be a special
display of posters, or story board presentations, by 18 HRSA BPHC-supported Cardiovascular Collaborative
Health Centers in Hall B North. Staff from the teams representing these 18 health centers will be available
to describe their projects and answer questions from 1:00 p.m.–2:00 p.m. on April 11 and from 11:00 a.m.–
12:00 noon on April 12.

Changing Practice/Changing Lives: Transforming Practice in America’s Health Centers

“Changing Practice, Changing Lives” describes the work of the Bureau of Primary Health Care (BPHC) Health Disparities
Collaboratives. The collaboratives assist organizations in changing primary care practice from a reactive mode to a
prepared, proactive model of care that is patient/family centered and results in improved health outcomes. The BPHC-
supported health centers provide comprehensive primary care services to 10 million medically underserved people
across the United States. These populations encompass many of our most vulnerable people, including migrant farm

POSTER SESSIONS
workers and homeless people. Since 1999, in partnership with the Institute for Healthcare Improvement and the Centers
for Disease Control and Prevention, more than 350 BPHC-supported health centers have participated in a collaborative
learning experience to support the implementation of a chronic care model with a shared goal to delay or decrease the
complications of chronic illness.

Thirty-four BPHC-supported health centers currently participate in the Cardiovascular Collaborative and measure their
progress toward improvement in processes and health outcomes with nationally defined shared measures. The
Cardiovascular Collaborative focuses on the adoption of heart-healthy lifestyles, control of high blood pressure, and
compliance with secondary prevention guidelines in patients who already have disease. Community- and state-level
partnerships have been developed to support the efforts of patients to manage their health. Health center senior leader-
ship support is essential to drive sustained improvements in primary care practice. Twenty of the participating health
centers are represented at the National Cardiovascular Health Conference 2002. These story board presentations capture
some of the stories of multidisciplinary health center teams committed to working together to improve the care deliv-
ered to medically underserved people and the resulting health outcomes of the populations served.

Presenting Health Centers are as follows:

▲ Community Health Care Systems, Inc.; ▲ Laurel Health System

Johnson County Center for Community Health
▲ Mendocino Community Health Center
▲ East Georgia Healthcare Center
▲ Montana Migrant
▲ Fair Haven Community Health Center
▲ North Woods Community Health Center
▲ Harvard Street Neighborhood Health Center
▲ Robeson Health Care Corporation
▲ Heart of Texas Community Health Center
▲ Stone Mountain Health Services/
▲ High Plains Community Health Center St. Charles Community Health Clinic

▲ Holzer Clinic (Black Lung Clinic) ▲ Sunrise Community Health Center

▲ Indian Chicano Health Center ▲ Tillamook County Health Department

▲ Kalihi Palama Health Center ▲ Venice Family Clinic

CVH 2002 123

124 CVH 2002