Women with Blood Pressure Improvement in the Well-Integrated Screening and Evaluation for Women Across the Nation Program by Race and Ethnicity, 2014-2018

Background: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program aims to improve the cardiovascular health of women aged 40-64 years with low incomes, and who are uninsured or underinsured. The objective is to examine WISEWOMAN participants with hypertension who had high blood pressure (BP) improvement from January 2014 to June 2018, by race and ethnicity. Also examined was participation in WISEWOMAN Healthy Behavior Support Services (HBSS) and adherence to antihypertensive medication. Materials and Methods: WISEWOMAN data from January 2014 to June 2018 were analyzed by race and ethnicity. BP improvement was defined as at least a 5 mm Hg decrease in systolic or diastolic BP values from baseline screening to rescreening. The prevalence of HBSS participation and antihypertensive medication adherence were calculated among hypertensive women with BP improvement. Results: Approximately 64.2% (4,984) of WISEWOMAN participants with hypertension had at least a 5 mm Hg BP improvement. These improvements were consistent across each race and ethnicity (p = 0.56) in the study. Nearly 70% of women who had BP improvement attended at least one HBSS. Hispanic women (80.1%) had the highest HBSS attendance percentage compared to non-Hispanic Black women (64.1%) and non-Hispanic White women (63.8%; p < 0.001). About 80% of women with BP improvement reported being adherent to antihypertensive medication in the previous 7 days. Conclusions: The proportion of women achieving BP improvement in the WISEWOMAN program was consistent across race and ethnicity. In addition, women with BP improvement reported adherence to antihypertensive medication and participation in HBSS.

Smoking Cessation Efforts Among WISEWOMAN Program Participants, 2014-2018

Smoking is a preventable risk factor for cardiovascular disease (CVD), indicating the importance of smoking cessation. The Centers for Disease Control and Prevention's Well-Integrated Screening and Evaluation for WOMen Across the Nation (WISEWOMAN) Program funded 21 recipients to provide preventative health services, including healthy behavior support services, to low-income, uninsured, or underinsured women, between 40 to 64 years of age, aimed at lowering CVD risk for women from January 2014 to June 2018. This article explores WISEWOMAN's smoking prevalence and smoking cessation efforts. Analyses were conducted to assess smoking status and other CVD risk factors among 71,671 unique women from all 21 WISEWOMAN funded recipients. Information on CVD risk factors, including smoking status, were collected. Women who were identified as currently smoking during their initial visit were referred to smoking cessation services and their smoking status was revisited during their rescreening. The overall smoking cessation prevalence was 16.9% during the funding cycle. This small increase from the previous iteration of WISEWOMAN (14.9%), supports WISEWOMAN's continued emphasis on smoking cessation through community-clinical linkages. The distribution of smoking cessation did vary by race and ethnicity (p < 0.001). Hispanic women had a higher smoking cessation (38.1%) compared to non-Hispanic American Indian/Alaska Native, non-Hispanic Black, and non-Hispanic White women (17.4%, 15.1%, and 13.7% respectively). In the next iteration of the WISEWOMAN Program, it is anticipated that continued emphasis will be placed on achieving health equity among women who smoke, to reduce CVD risk.

Medical Follow-Up Received by Women with Blood Pressure Alerts in the WISEWOMAN Program by Race and Ethnicity, 2014-2018

Background: Hypertension is a preventable risk factor for heart disease and stroke. Immediate reduction in blood pressure (BP) is necessary for a person with dangerously high BP to prevent injuries related to heart disease and stroke. Differences in the prevalence of hypertension and dangerously high BP (BP alerts) and the distribution of medical follow-ups were examined by race and ethnicity among participants in the Well-Integrated Screening and Evaluation for WOMen Across the Nation (WISEWOMAN) program. Materials and Methods: Data (January 2014 through June 2018) were used to identify women, aged 40-64 years, with hypertension at their first WISEWOMAN screening. Women with BP alerts were identified as having an average systolic BP >180 mm Hg or diastolic BP >110 mm Hg at WISEWOMAN baseline screening or rescreening. CDC's WISEWOMAN program is a public health practice program and does not conduct human subject research. Results: Among 65,189 WISEWOMAN participants, 25,098 (38.5%) women had hypertension and 586 (2.3%) of those women had BP alerts. There were significant differences among Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW) women in the prevalence of hypertension (26.5%, 67.1%, and 40.2%, respectively, p < 0.001) and BP alerts (1.7%, 3.4%, and 2.1%, respectively, p < 0.001). Among women with BP alerts, 74.7% received a medical follow-up within 7 days and 12.4% received a medical follow-up after 7 days. There were no significant differences in the percentage of women with BP alerts who received a follow-up within 7 days among Hispanic, NHB, and NHW women (71.1%, 77.1%, and 74.4%, respectively, p = 0.085). Conclusions: BP alerts occurred in 2.3% of the WISEWOMAN hypertensive population, and approximately three in four women with BP alerts, regardless of race and ethnicity, received timely follow-up care within 7 days.

The WISEWOMAN program: smoking prevalence and key approaches to smoking cessation among participants, July 2008-June 2013

BACKGROUND

Tobacco use is a major risk factor for cardiovascular disease (CVD) and is the leading preventable cause of death, disease, and disability in the United States. The CDC's Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program addresses the heart health of low-income under- or uninsured women between the ages of 40 and 64 years. This article discusses WISEWOMAN's key approaches to smoking cessation and their impact on WISEWOMAN participants' cardiovascular health.

METHODS

A longitudinal retrospective analysis was conducted using data from 21 funded CDC programs from July 2008 to June 2013. Data were collected on 149,767 women to assess CVD risk, smoking status, and utilization of programs related to tobacco cessation.

RESULTS

The overall prevalence of smoking among the WISEWOMAN population during this period was 28%. Increases in referrals to tobacco quitlines, tobacco-cessation counseling, lifestyle interventions, and other community-based tobacco-cessation programs contributed to a 15% smoking-cessation rate among smokers who returned for a rescreening assessment over the 5-year program period.

CONCLUSION

The WISEWOMAN program has observed a smoking-cessation rate of 15% over the 5-year program period. WISEWOMAN's key approaches include continuous technical assistance that highlights quitline referrals, motivational interviewing done by program staff, and professional-development strategies for WISEWOMAN healthcare providers. WISEWOMAN will continue its programmatic emphasis on smoking cessation by partnering with state tobacco-cessation programs to work toward a lower smoking-prevalence rate among program participants.

Implementation of school policies to prevent youth tobacco use in Alabama

BACKGROUND

Public health professionals must monitor the effectiveness of school policies and programs to prevent youth initiation, promote quitting, and eliminate secondhand smoke. This analysis of school tobacco policies was preliminary to release of a state tobacco prevention and control plan for 2010-2015.

METHODS

University health educators collaborated with the state health agency to review policies of 33 school systems in 5 Metropolitan Statistical Areas and 9 public health areas. Authors developed a systematic approach of 8 steps useful to rate implementation of school tobacco control and prevention policies and discuss implications for health education program planning.

RESULTS

Thirty school policies prohibited possession and use of tobacco by students, faculty and campus visitors, and 26 of 33 specified disciplinary measures following violations. Only 4 public education agencies included 3 of the 6 elements of a model tobacco prevention and control policy as suggested by the state public health agency. None featured all 6 elements. None specified establishing school-community partnerships for tobacco prevention and control.

CONCLUSIONS

Preparing smoke-free youth requires implementing and evaluating tobacco education in grades K-12 including use of model guidelines from federal agencies and professional organizations. Determining the focus of existing school tobacco policies is an initial step to encourage adoption of comprehensive policies to reduce youth use of tobacco. Youth health advocates may act together with school administrators and legislators to strengthen policies to be consistent with model guidelines for tobacco prevention and control.