Search

Blood cholesterol screening programs offer an important venue for nutrition counseling aimed at lowering blood cholesterol levels. This paper presents a screening, counseling and referral protocol that has been developed by the Pawtucket Heart Health Program (PHHP). A review of general considerations for counseling strategies in the screening context highlights the necessity for brief, focused, behaviorially oriented tactics. The PHHP Summary and Referral protocol includes a review of multiple risk factors for heart disease, a discussion of blood cholesterol levels, recommendations for eating pattern changes based on response to a food frequency questionnaire, and a final summary and referral as needed. The training of lay volunteers and health professionals in delivery of the program is also reviewed.

In Reply . — I am concerned about their conclusion that screening programs should not attempt to reach all potential participants since "such efforts appear to bring out the most "fragile subjects." I would hope that readers of our article would conclude the opposite; that is, more extensive efforts need to be made to screen people for high blood cholesterol—especially given the very high prevalence of people who are unaware of their cholesterol level—and that our recommendations might serve as guideposts for the design of summary and referral protocols that will attenuate labeling effects. While we certainly do not condone coercive efforts to recruit participants for blood pressure, cholesterol, or any type of risk factor screening program, well-designed programs should reach as broad an audience as possible. Without such a goal, the more laissez-faire approach recommended by Drs Rudd and Fortmann will lead us to the dilemma of having "hard to

The present paper is directed toward the conceptualization of disease states and their management from the cognitive point of view. The role of cognitive sytles and self-statements in the pathogenesis of disease and the execution of coping styles is presented. A review of the literature on the cognitive treatment of medical disorders has documented the utility of such approaches with several medical problems, but a need for more rigorous empirical efficacy remains. The necessity of analyzing the coping processes elicited by specific disease states is viewed as essential to the understanding of the patient and the design of intervention strategies. Finally, a cognitive analysis of patient compliance to treatment regimens is presented.

This case study highlights the use of multi-level nutrition programming to lower employees' blood cholesterol level. Participants in a self-help program of blood cholesterol screening, dietary counseling and follow-up achieved an average blood cholesterol reduction of 26 mg/dl. Educational activities, weight loss groups, and a menu-labeling program in the cafeteria provide additional opportunities for employees to learn about diet and blood cholesterol and to adopt healthy eating behaviors.

Current physician attitudes and behavior concerning elevated blood cholesterol, recent changes, and reasons for change were measured in a survey of physicians in two cities. Those in a community with both continuing medical and public education programs reported changing their practice significantly over the past two years, more so than those in a comparison community. The physicians did not identify specific elements of a continuing medical education program as important in these differences. Physicians in Pawtucket, Rhode Island, identified requests from the public as important and statistically significant factors in their changed behavior, suggesting that the public education program has become an important influence on physician behavior.

The rapid proliferation of community-based health education programs has out- paced the knowledge base of behavior change strategies that are appropriate and effec tive for public health interventions. However, experiences from a variety of large-scale studies suggest that principles and techniques of social marketing may help bridge this gap. This article discusses eight essential aspects of the social marketing process: the use of a consumer orientation to develop and market intervention techniques, ex change theory as a model from which to conceptualize service delivery and program participation, audience analysis and segmentation strategies, the use of formative research in program design and pretesting of intervention materials, channel analysis for devising distribution systems and promotional campaigns, employment of the "marketing mix" concept in intervention planning and implementation, development of a process tracking system, and a management process of problem analysis, planning, implementation, feedback and control functions. Attention to such variables could result in more cost-effective programs that reach larger numbers of the target audience.

Sufficient data exist to support approaches to lowering cardiovascular disease risk which target populationwide reductions in elevated blood cholesterol levels. Within the context of a multi- factorial cardiovascular disease prevention program, a 2-month cholesterol education campaign was launched to encourage citizens to "Know Your Cholesterol" by attending screening, coun seling, and referral events (SCOREs) held throughout the community. These events featured assessment of dietary fat and cholesterol, rapid blood cholesterol analyses with a fingerstick procedure and the Kodak Ektachem DT60, and immediate dietary counseling by trained vol unteers. A total of 1439 persons attended 39 SCOREs: nearly 60% were found to have blood cholesterol levels that exceeded recommended goal levels. At a 2-month follow-up of 1040 of these same individuals, 600 had lowered their blood cholesterol level by an average of 29.1 mg/dl. This experience suggests that similarly modeled campaigns may have a significant impact on the distribution of blood cholesterol levels in the entire U.S. population.

Rapid and reliable techniques for the measurement of blood cholesterol are a necessary first step in implementing effective mass screening efforts to reduce the risks of cardiovascular disease. This paper reports preliminary data gathered on the Kodak Ektachem DT60, one of the first of a new generation of dry chemistry analyzers to appear on the market. The results of the first study demonstrated high reproducibility of the methodology (r = .98, p

Conceptual and theoretical issues concerning the assessment of assertive behavior are discussed. A summary of a variety of instruments utilized in experimental and clinical settings is offered that reflects these issues. This review is followed by the presentation of a new assessment device developed by the authors—the Assertive Interaction Coding System. Research evidence as to its reliability and validity in experimental and clinical settings is presented. Implications for its use in clinical and research protocols are addressed.

Introduction As part of its mission, the US Food and Drug Administration (FDA) communicates with the public regularly about the benefits and risks of prescription and over-the-counter (OTC) drugs. Effectively communicating risk, however, is a significant public health challenge. Objective To better understand how different populations understand information communicated by the FDA about drug safety, we conducted a randomized experiment to examine comprehension and other measures of effectiveness of drug safety messages that occurred in a post-market surveillance phase. Methods We used an Internet panel survey of 1244 consumers, of whom 58 % used prescription drugs in the past year. Half of the sample panel was randomized to read a previous FDA Drug Safety Communication (DSC) with the drug name changed, and the other half was randomized to read a revised version of the same DSC. We examined how making certain modifications to the way drug risk information is communicated has an impact on comprehension and behavioral intentions, including the user’s likelihood of discontinuing the drug. We also studied how comprehension varied by respondent characteristics, health literacy skills, risk perceptions, and trust in the message. Results Based on a five-item comprehension index, the revised version of the message was associated with significantly greater comprehension of the information relative to the standard version (63 vs 52 % correct, p

SYNOPSIS 26 consecutive headache patients treated with biofeedback completed the Hopkins Symptom Checklist before and two months following treatment. Contrary to psychoanalytic and systems theories, successfully treated patients demonstrated significant reduction in both somatic and general psychological symptomatology, compared to nonsuccessfully treated patients. Additionally, pretreatment headache diagnosis and measures of depression and anxiety predicted treatment outcome.