Lifestyle Intervention and Cardiovascular Risk Reduction in the Illinois WISEWOMAN Program (original) (raw)
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Journal of Community Health, 2014
Cardiovascular disease (CVD) is the leading cause of death for Hispanic women in the United States. In 2001, the Illinois Department of Public Health received funding from the Centers for Disease Control and Prevention to implement the enhanced WISEWOMAN program (IWP) to address the disproportionate CVD risk among uninsured and underinsured women enrolled in the Illinois Breast and Cervical Cancer Early Detection Program. This paper presents the results of the Spanish-language arm of the IWP. Spanish speaking IWP participants were recruited from two sites, and randomized into either the minimum intervention (MI) or the enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational handouts. The EI group also received an integrated 12-week nutrition and physical activity lifestyle change intervention. Of the 180 Spanish-speaking immigrants in this sample, 90 (50 %) received the EI and 90 (50 %) received the MI. At baseline there were no significant differences between group demographics or clinical values. At post-intervention, the EI group showed improvements in fat intake, fiber intake, moderate intensity physical activity, and total physical activity. At 1 year only the change in fiber intake remained. A significant improvement was also seen in body mass index (BMI) at the 1-year follow-up. The IWP Spanish-language arm was moderately successful in addressing risk factors for CVD in this population. The behavior changes that sustained up to a year were an increase in fiber intake and a decrease in BMI.
American Journal of Public Health, 2011
African American women are at increased risk for morbidity and mortality from cardiovascular disease (CVD) compared with White women 1 because of their higher prevalence of CVD risk factors and lower socioeconomic status. 1---3 Interventions embedded in primary care settings, such as locally based, patient-driven community health care centers, have the unique potential to address these health disparities because they provide a large proportion of comprehensive health care services to medically underserved, vulnerable populations, regardless of ability to pay. About 66% of these centers' patients are members of minority groups, 90% have incomes below 200% of the federal poverty line, and 39% lack health insurance. 4,5 The delivery of health behavior change interventions through these centers holds additional promise because providers are trusted sources of health information 6 and can reach underserved populations that are more likely than the general population to suffer from CVD risk factors. Despite this great potential, interventions have not been widely tested in this setting.
Journal of the American Dietetic Association, 2007
Background Brief dietary assessment tools are needed to guide counseling in underserved populations to reduce cardiovascular disease (CVD) risk. The Dietary Risk Assessment is one such tool modified over time to reflect emerging evidence concerning diet and CVD risk. Objective To examine the capacity of the modified Dietary Risk Assessment tool to measure aspects of diet quality in a sample of underserved, midlife (aged 40 to 64 years) women, by comparing Dietary Risk Assessment results to those of a longer food frequency questionnaire (FFQ) and with serum carotenoids. Design This study used baseline data from women enrolled in a CVD risk reduction intervention trial. The Dietary Risk Assessment was administered to 236 women and results were compared to those from a longer FFQ administered to 104 women, and to serum carotenoids results from all participants. Results Correlations between Dietary Risk Assessment indexes and corresponding measures from the FFQ were statistically significant: fruit and vegetable, rϭϪ0.53 (PϽ0.0001, correlation is negative as a lower Dietary Risk Assessment score indicates greater fruit and vegetable intake); saturated fat, rϭ0.60 (PϽ0.0001). In linear regression models stratified by smoking and adjusted for body mass index, low-density lipoprotein cholesterol level, high-density lipoprotein cholesterol level, very-lowdensity lipoprotein cholesterol level, and age, the Dietary Risk Assessment fruit and vegetable index was significantly associated with serum carotenoids (parameter estimate for nonsmokers Ϫ0.22, Pϭ0.01; smokers Ϫ0.45, Pϭ0.003). Correlation coefficients between Dietary Risk Assessment total score and three diet quality index scores derived from FFQ variables were statistically significant, ranging in magnitude from 0.57 to 0.60. Conclusions The modified Dietary Risk Assessment provides a reasonable assessment of dietary factors associated with CVD risk; thus, it is appropriate for use to guide dietary counseling in CVD prevention programs for underserved, midlife, women. Diamond JJ. Validation of the dietary risk assessment food frequency questionnaire against the Keys score for saturated fat and cholesterol. J Nutr Educ Behav. 2005;37:152-153. 9. Will JC, Farris RP, Sanders CG, Stockmyer CK, Finkelstein EA. Health promotion interventions for disadvantaged women: Overview of the WISEWOMAN projects. . 13. Kristal AR, Feng Z, Coates RJ, Oberman A, George V. Associations of race/ethnicity, education, and dietary intervention with the validity and reliability of a food frequency questionnaire: The Women's Health Trial Feasibility Study in Minority Populations. Am J Epidemiol. 1997;146:856-869.
Women's Health Issues, 2003
Methods. For the behaviors cited, USPSTF and CTF recommendations and their associated systematic evidence reviews (SERs) were retrieved. Individual articles from the USPSTF healthy diet and physical activity SERs that met our inclusion criteria were systematically examined to determine the applicability of this research to women. We supplemented findings from these sources with comprehensive federal research summaries and SERs from focused searches of systematic review databases relevant to primary CVD prevention in women through healthy behavior change.
American Journal of Health Promotion, 2016
Purpose. We combined data from the National Breast and Cervical Cancer Early Detection (NBCCEDP) and Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) programs in South Carolina to assess whether cancer screening outcomes in NBCCEDP impacted participation in WISEWOMAN lifestyle interventions, and whether the status of WISEWOMAN baseline risk factors (obesity, diabetes, hypercholesterolemia, hypertension, and smoking) determined subsequent completion of lifestyle interventions. Design. Case-control. Setting. Three WISEWOMAN implementation sites in South Carolina. Subjects. The study comprised 7841 NBCCDEP participants in three WISEWOMAN program sites. The two programs serve financially disadvantaged women. Measures. Outcome measures were participation in WISEWOMAN lifestyle interventions and completion of lifestyle interventions. The main predictor measures were cancer screening outcomes and baseline chronic disease risk factors. Covariate measures included age, race, body mass index, smoking status, and education. Analysis. We used multivariable logistic regression models to examine the odds of participation in and completion of WISEWOMAN lifestyle interventions. Results. The association between cancer screening outcome and participation in WISEWOMAN lifestyle interventions among NBCCEDP participants differed significantly by education and smoking status. Among smokers or highly educated women, having an outcome of cancer or precancerous lesion through the NBCCEDP screening compared to normal screening outcomes was significantly associated with participation in lifestyle interventions, with odds ratios of 2.69 (95% confidence interval [CI], 1.10-6.58) for highly educated women and 1.82 (95% CI, 1.00-3.31) for smokers. Similarly, smokers or diabetics were more likely than nonsmokers or nondiabetics, respectively, to complete lifestyle interventions. Conclusion. Nonsmokers and women with lower education in NBCCEDP may need additional navigation to lifestyle interventions in an integrated program implementation approach to improve participation in and completion of WISEWOMAN interventions.