An evaluation of Choose to Move 1999: an American Heart Association physical activity program for women

BACKGROUND

Rates of physical inactivity and poor nutrition, which are 2 of the most important modifiable risk factors for cardiovascular disease in women, are substantial. Even so, studies of interventions designed to improve lifestyle behaviors in women have been limited and often confined to particular geographical areas.

OBJECTIVE

To evaluate the effect of Choose to Move on increasing women's physical activity, improving their knowledge of heart disease and stroke, and improving their nutrition.

PARTICIPANTS AND METHODS

A prospective, nonrandomized, 12-week educational intervention designed by the American Heart Association for women across the United States. Participants received a welcome kit and manual with weekly information about how to manage cardiovascular disease risk factors and how to build a support system for lifestyle change. Women (N = 23 171) aged 25 years or older were recruited by direct mail, the media, health care providers, and other means. Follow-up evaluations were returned from 6389 women at 2 weeks, 5338 at 4 weeks, 4209 at 8 weeks, 3916 at 10 weeks, and 3775 at 12 weeks. Participants self-reported their physical activity, diet, and knowledge about heart disease, stroke, and related symptoms.

RESULTS

Ninety percent of the participants were white and 56% were aged between 35 and 54 years. Among the participants who completed the week 12 follow-up evaluation, the percentage who reported being active (at least moderate exercise > or =5 times per week or >2(1/2) hours per week for the past 1 to 6 months) increased from 32% at baseline to 67% at the program's end (P =.001). Participants currently limiting excess calories or fat increased from 72% to 91% at week 10 follow-up evaluation (P =.001). The proportion correctly identifying heart disease as the leading cause of death increased from 84% to 91% at week 10 follow-up evaluation (P<.001).

CONCLUSIONS

Women who completed the Choose to Move program evaluation reported that they significantly increased their levels of physical activity, reduced their consumption of high-fat foods, and increased their knowledge and awareness of cardiovascular disease risk and its symptoms. This program provides an important model for public health, voluntary, and other health organizations of population-based, targeted low-cost self-help programs that support the Healthy People 2010 objectives for physical activity, nutrition, and cardiovascular health.

Cardiovascular health interventions in women: What works?

Women's Cardiovascular Health Network members representing 10 Prevention Research Centers completed a literature review of approximately 65 population-based studies focused on improving women's cardiovascular health through behavior change for tobacco use, physical inactivity, or diet. A framework was developed for conducting the search. Databases (Medline, Psychlit, Smoking and Health, Cumulative Index to Nursing and Allied Health Literature) of studies published from 1980 to 1998 were searched. The review was presented at a meeting of experts held in Atlanta, Georgia. Output from the meeting included identification of what has worked to improve cardiovascular health in women and recommendations for future behavioral research. Additional information is available at www.hsc.wvu.edu/womens-cvh. Cardiovascular health interventions geared toward women are scant. Based on the available studies, program components that emerged as effective included personalized advice on diet and physical activity behaviors and tobacco cessation, multiple staff contacts with skill building, daily self-monitoring, and combinations of strategies. Recommendations for community-based tobacco, physical activity, and diet interventions are discussed. A few overarching recommendations were to (1) conduct qualitative research to determine the kinds of interventions women want, (2) examine relapse prevention, motivation, and maintenance of behavior change, (3) tailor programs to the stage of the life cycle, a woman's readiness to change, and subgroups, that is, minority, low socioeconomic, and obese women, and (4) evaluate policy and environmental interventions. The effects of cardiovascular interventions in women have been inappropriately understudied in women. Our review found that few studies on cardiovascular risk factor modification have actually targeted women. Hence, adoption and maintenance of behavior change in women are elusive. Intervention research to improve women's cardiovascular health is sorely needed.

Project Joy: faith based cardiovascular health promotion for African American women

OBJECTIVE

The authors tested the impact on cardiovascular risk profiles of African American women ages 40 years and older after one year of participation in one of three church-based nutrition and physical activity strategies: a standard behavioral group intervention, the standard intervention supplemented with spiritual strategies, or self-help strategies.

METHODS

Women were screened at baseline and after one year of participation. The authors analyzed intention-to-treat within group and between groups using a generalized estimating equations adjustment for intra-church clustering. Because spiritual strategies were added to the standard intervention by participants themselves, the results from both active groups were similar and, thus, combined for comparisons with the self-help group.

RESULTS

A total of 529 women from 16 churches enrolled. Intervention participants exhibited significant improvements in body weight (-1.1 lbs), waist circumference (-0.66 inches), systolic blood pressure (-1.6 mmHg), dietary energy (-117 kcal), dietary total fat (-8 g), and sodium intake (-145 mg). The self-help group did not. In the active intervention group, women in the top decile for weight loss at one year had even larger, clinically meaningful changes in risk outcomes (-19.8 lbs).

CONCLUSIONS

Intervention participants achieved clinically important improvements in cardiovascular disease risk profiles one year after program initiation, which did not occur in the self-help group. Church-based interventions can significantly benefit the cardiovascular health of African American women.

Body image preferences among urban African Americans and whites from low income communities

OBJECTIVE

The purpose of this study was to determine (1) how African-American and white men and women from similar low income communities perceive their body mass relative to others in the population; and (2) whether ethnic and gender differences exist in the selection of ideal body image sizes for the same and opposite sex.

DESIGN

A street survey of African-American and white men and women was conducted using a census tract sampling schema. Participants (N = 927) were interviewed and asked to provide their height and weight and to select body size images from a standardized ethnic-specific Figure Rating Scale to represent their current self, ideal self, and their estimation of ideals for the opposite sex. Sociodemographics and co-morbidity were assessed by self-report.

RESULTS

All ethnic and gender groups showed a significant correlation between their body mass index and selected body image size, r = .63 to .74, all P<.001. Average ideal body image size for self was the same for African-American and white men, while African-American women had a significantly greater ideal image size compared with white women (P = .004). Ideal body image size preferences for members of the opposite sex were greater for African-Americans. White women had a notable preference for the smallest body image sizes. Multiple linear regression analyses showed that, independent of sociodemographic variables and co-morbidity, body image sizes for current self, ideal self, and ideal for the opposite sex were all significantly greater in African-Americans.

CONCLUSION

Strategies to ameliorate overweight and its attendant diseases may require a shift in social norms, particularly among African-American women in low socioeconomic communities. This has implications for the design of community-based interventions and suggests a need for ethnic-specific interventions.

The impact of including incentives and competition in a workplace smoking cessation program on quit rates

PURPOSE

To determine the effectiveness of a multicomponent smoking cessation program supplemented by incentives and team competition.

DESIGN

A quasi-experimental design was employed to compare the effectiveness of three different smoking cessation programs, each assigned to separate worksite.

SETTING

The study was conducted from 1990 to 1991 at three aerospace industry worksites in California.

SUBJECTS

All employees who were current, regular tobacco users were eligible to participate in the program offered at their site.

INTERVENTION

The multicomponent program included a self-help package, telephone counseling, and other elements. The incentive-competition program included the multicomponent program plus cash incentives and team competition for the first 5 months of the program. The traditional program offered a standard smoking cessation program.

MEASURES

Self-reported questionnaires and carbon monoxide tests of tobacco use or abstinence were used over a 12-month period.

RESULTS

The incentive-competition program had an abstinence rate of 41% at 6 months (n = 68), which was significantly better than the multicomponent program (23%, n = 81) or the traditional program (8%, n = 36). At 12 months, the quit rates for the incentive and multicomponent-programs were statistically indistinguishable (37% vs. 30%), but remained higher than the traditional program (11%). Chi-square tests, t-tests, and logistic regression were used to compare smoking abstinence across the three programs.

CONCLUSIONS

Offering a multicomponent program with telephone counseling may be just as effective for long-term smoking cessation as such a program plus incentives and competition, and more effective than a traditional program.

Women, work and health: issues and implications for worksite health promotion

This paper identifies issues related to worksite health promotion programs for women by examining ways that work factors, health behaviors, family roles and responsibilities, and women's health are linked. Work conditions may affect women uniquely, as in the case of chemical exposure affecting reproductive health; disproportionately, such as the interaction between work and family roles; or differently from men, as in women's experience of stress in the workplace. The focus is on the differences and uniqueness of working women's health. Drawing on a public health perspective, implications for consideration by worksite health promotion programs specialist, human resource managers, and researchers are presented.

Environmental and policy interventions to control tobacco use and prevent cardiovascular disease

Despite its declining prevalence during the past few decades, tobacco use remains one of the most significant public health issues of the 1990s. Environmental and policy interventions are among the most cost-effective approaches to control tobacco use and prevent cardiovascular diseases. In this article, the authors review and offer to state and local health departments and other public health partners a summary of recommended policy and environmental interventions that have either reduced or show potential to reduce tobacco use. Priority recommendations include clean indoor air policies, restrictions on tobacco advertising and promotion, policies limiting youth access to tobacco, comprehensive school health programs, and excise taxes and other economic incentives. Many of these recommendations should be integrated with other health promotion interventions to also improve nutrition and physical activity. The authors also highlight several successful interventions and strategies used to establish policies at the state and local levels.

Non-traumatic dislocation of the radial head in cerebral palsy

To our knowledge, there has been only one previous description of dislocation of the radial head associated with cerebral palsy. This paper describes nine such dislocations, eight of which were bilateral and posterior and one, unilateral and anterior. There was an incidence of this abnormality of 2.4 per cent in 368 of the cases surveyed. Of those patients with cerebral palsy and with flexion contracture of the elbow and pronation contracture of the forearm, 27 per cent had the dislocation.

Equilibration Temperatures of Iron and Magnesium in Chondritic Meteorites

The distribution coefficients for Fe(++) and Mg(++) were calculated from new microprobe analyses of coexisting olivine, orthopyroxene, and calcic pyroxene in chondritic meteorites. Interpretation of the data shows that (i) the equilibration temperatures were of the order of 850 degrees C, and (ii) the olivineorthopyroxene partition does not reflect ideal behavior. This equilibration temperature is much lower than previous estimates.