Comprehension assessment of diabetes education program participants.

Diabetes education program participants were assessed to determine their reading and comprehension skill levels, and written and oral instructions were evaluated to determine the reading level of information presented in the education program. A significant mismatch was found between the reading and comprehension levels of program participants and the level of oral instruction and printed materials. More than half of the program participants could not fully comprehend educational materials at 5th-grade level, while nearly all written materials and oral instructions were presented at the 9th-grade level or above.

Diabetes and pregnancy in South Carolina: prevalence, perinatal mortality, and neonatal morbidity in 1978.

Through retrospective analysis of vital records and hospital discharge data, this study examines the prevalence of diabetes in pregnancy and diabetes-related perinatal mortality and neonatal morbidity in South Carolina in 1978. Diabetes was observed in 5.9/1000 deliveries. Diabetic natality rates for whites and nonwhites were 5.1/1000 and 6.9/1000, respectively. In comparison with comprehensive screening programs, these rates suggest that more than half of all diabetic pregnancies in South Carolina are unrecognized. The overall diabetic perinatal mortality rate was 102 deaths/1000 deliveries, in contrast to the nondiabetic perinatal mortality rate of 25 deaths/1000 deliveries. The risk of perinatal mortality is greater for nonwhites (153 deaths/1000 deliveries) and for women on insulin (182 deaths/1000 deliveries). One-fourth of the pregnancies among nonwhite women on insulin resulted in fetal or neonatal death. Observed neonatal morbidity was high, with respiratory distress syndrome, hypoglycemia, infections, and congenital anomalies the most frequent complications reported. Documentation of assessment for other common neonatal complications was limited.

The use of a county hospital emergency room by diabetic patients.

The use of a county hospital emergency room (ER) by diabetic patients was investigated by comparing ER visits for diabetes to a sample to total ER visits over a period of 1 yr. The major problems of ER use by diabetic patients were an excessive number of visits for diabetes complications, a high rate of hospital admissions from the ER, and the high cost of ER use. Approximately 20% of visits for diabetic patients were attributed to preventable complications of diabetes. The rate of hospital admissions from the ER was over four times greater for the diabetic patients than for the random sample. The median cost of an ER visit was nearly three times higher for diabetic patients than for the random sample. These problems may be best resolved through improved access to primary care and educational services that can assist the person with diabetes in self-management and prevention of the acute complications of the disease.

Is race related to glycemic control? An assessment of glycosylated hemoglobin in two South Carolina communities.

To consider the relationship between race and long-term glycemic control, as measured by glycosylated hemoglobin (GHb), we analyzed data from a community-based sample of 3175 adults in the South Carolina Cardiovascular Disease Prevention Project. A clinically meaningful difference for mean GHb levels (10.5 vs 8.4%, P < 0.001) was present between black people and white people reporting diabetes. Similarly, a significant association between race and GHb was present among people reporting "borderline diabetes" or no diabetes. Logistic regression confirmed this finding in all three diabetic categories, however, controlling for insulin use in the diabetic group reduced (P < 0.001) the association between GHb and race. These findings confirm that further improvements in glycemic control are necessary, especially for black patients and that black people not reporting diabetes have higher GHb levels compared to white people, possibly due to undiagnosed diabetes.

Are race differences in the prevalence of hypertension explained by body mass and fat distribution? A survey in a biracial population.

Body mass and body fat distribution are important considerations in the study of hypertension. However, few studies have investigated the relationships with regards to race differences in elevated arterial pressure. A population-based sample of black and white adults was assessed by interview and physical measurement. The prevalence of hypertension (defined as 140/90 mmHg and/or medically treated) was disproportionately higher among blacks than whites. In addition, blacks had a higher prevalence of the more severe hypertension (160/95 mmHg) and hypertension with higher prevalence at earlier ages than whites. Black females had a significantly higher distribution of body mass index (BMI) than white females, while no difference was found in the distributions of males. White males had a higher distribution of waist to hip ratio (WHR) than black males, while black females had the higher values compared to white females. The prevalence of hypertension increased with BMI and WHR. Blacks maintained higher rates of hypertension after controlling for BMI and WHR, however, the margin of difference diminished when BMI and WHR was considered together. The black-white difference in hypertension was not completely explained by BMI and WHR. In addition, the strength of the association of hypertension and body size was different for blacks and whites which suggests possible differences in the mechanisms regulating blood pressure.

The validity of self-reported hypertension and correlates of hypertension awareness among blacks and whites within the stroke belt.

Hypertension surveillance activities increasingly are relying on information obtained by self-report. However, limited information is available concerning the validity of such data, especially among populations residing within the stroke belt. We used interview information and blood pressure measurements from the South Carolina Cardiovascular Disease Prevention Project to determine the validity of self-reported hypertension and the correlates of hypertension awareness among 2,210 whites and 704 blacks who participated in the program in 1987. The sensitivity, specificity, positive predictive value, and negative predictive value of self-reported hypertension were 79%, 91%, 76%, and 93% among white women; 82%, 88%, 79%, and 89% among black women; 62%, 91%, 75%, and 85% among white men; and 72%, 89%, 78%, and 85% among black men, respectively. Groups with highest sensitivity included women, persons older than age 39 years, and those who had seen a physician for preventive care within the last year. Correlates of hypertension awareness included an older age, visit to a physician for preventive care, and a family history of high blood pressure. Among hypertensive blacks, overweight persons were substantially more likely than nonoverweight persons to be aware of their hypertension (odds ratio [OR] = 4.6, 95% confidence intervals [CI] = 1.9, 10.7 in black women and OR = 4.4, 95% CI = 1.0, 17.9 in black men). The validity of self-reported hypertension was relatively high in all race-sex groups. There is a need to increase hypertension awareness among hypertensive blacks who are not overweight.

Changes in blood cholesterol awareness: final results from the South Carolina Cardiovascular Disease Prevention Project.

We examined changes in five indicators of blood cholesterol awareness in two comparable biracial communities in South Carolina. One community received three years of cholesterol education and intervention activities implemented by a state health department and the other served as a comparison. Cross-sectional, interviewer-administered, random digit-dialed telephone surveys of 11,070 adults 18 years and older were conducted in 1987, 1988, 1989, and 1991. Changes in community levels of knowledge, preventive behavior, risk awareness, and treatment were assessed and compared between the two communities with analysis of covariance techniques that adjusted for age, race, and sex. Significant increases in knowledge, behavior, and risk awareness were observed for most groups defined by race, sex, or age in both communities. Significant net intervention increases between 1987 and 1991 were seen for knowledge of good cholesterol level (+16.4%, P < .001); behavioral action of ever having blood cholesterol checked (+18.6%, P < .001); and knowledge of personal level of blood cholesterol (+16.0%, P < .01). These results suggest that a community-wide blood cholesterol screening and education program can be effective in increasing blood cholesterol knowledge, risk awareness, and preventive behavior, thus serving as part of a public health strategy to lower and treat high blood cholesterol levels in a community.

Demographic and educational differences in smoking in a tobacco-growing state.

National studies have documented an excessive rate of cigarette smoking in black men; however, a 1987 survey conducted in two urban areas in South Carolina documents a high rate of smoking in young white men with fewer than 12 years of education (67%; 95% confidence interval [CI] = 58.3, 75.7). Differences in smoking rates by educational level were significant only for those younger than 40. Young blacks were less likely to smoke and smoked fewer cigarettes than whites. As a result, the population burden of cigarettes in young black men with fewer than 12 years of education was only 27% of the burden carried by their white peers. Television, physicians, and radio were all seen as likely sources of health information to prevent heart disease, but newspapers were less likely to be cited by those younger than 40 or by those with fewer than 12 years of education. Reported physician counseling for smoking cessation did not differ significantly by race, sex, or educational level of the patient, but reported counseling was higher for individuals with a personal history of cardiovascular disease (odds ratio [OR] = 2.32, CI = 1.27, 4.25) and somewhat lower for the elderly. We highlight the population burden of cigarettes, a predictor of the eventual disease burden attributable to smoking, as a useful priority measure for smoking intervention efforts.

Waist-to-hip ratio in a biracial population: measurement, implications, and cautions for using guidelines to define high risk for cardiovascular disease.

Cutoff points for high waist-to-hip ratio (WHR) that may define high risk for cardiovascular disease have been suggested for men (0.95) and women (0.80). The WHRs of groups defined by age, race, and sex among 3,118 South Carolina adults were compared with these cutoff points. Measurement methodology, mean WHRs, and prevalence of elevated WHR in this biracial study population were compared with data from other populations. A review of anthropometric measurement methods used in recent epidemiologic studies indicates that a standard method for measuring waist and hip girth is required before comparisons of mean levels can be valid. The paucity of evidence that a high WHR is associated with cardiovascular disease mortality in black populations, and the high number of women who have an elevated WHR in this and other epidemiologic studies, support the following conclusion: Current WHR cutoff points, which are based on evidence from primarily white populations, may not be appropriate for women, older age groups, and some racial or ethnic groups in the United States.

Community intervention and trends in dietary fat consumption among black and white adults.

OBJECTIVE: This study assessed whether a state public health department could effectively implement an affordable nutrition intervention program at the community level. DESIGN: Cross-sectional data were collected via telephone surveys of 9,839 adults, aged 18 years or older, in 1987, 1989, and 1991 in two South Carolina communities. Nutrition education programs began in 1988 in one community. The other community served as a comparison site. We assessed and compared changes in community levels of dietary fat and weekly meat consumption, salt use, and nutrition promotion awareness with analysis of covariance regression techniques that included race, sex, and age as covariates. RESULTS: We observed favorable changes in most eating behaviors and levels of awareness in both communities. The intervention community experienced greater absolute changes that the comparison community in use of animal fats (-8.9% vs -4.0%; P = .02) and liquid or soft vegetable fats (+8.4% vs +3.6%; P = .04), and in awareness of restaurant nutrition information (+33.0% vs +19.4%; P = .0001). Although the primary type of dietary fat used differed between black and white respondents, we observed significant change among both groups. CONCLUSIONS: These results suggest that community-wide nutrition education programs may have augmented regional or national changes in dietary behavior among white and black adults in the intervention community.

Evaluation of the Heart To Heart Project: lessons from a community-based chronic disease prevention project.

PURPOSE: To present an evaluation of a 5-year, community-based, chronic disease prevention project managed by a state health department to determine whether the department could replicate similar previous projects that had received more funding and other resources. DESIGN: The evaluation used a matched comparison design and a review of archive and interview data. SETTING: Florence, South Carolina (population: 56,240). SUBJECTS: A random sample of 1642 persons in Florence (and 1551 in the comparison) who responded to a risk factor questionnaire and underwent a physical assessment; 70.7% of baseline subjects participated in the postintervention. Forty key persons were interviewed concerning project effectiveness. INTERVENTIONS BY PROJECT: Walk-a-thons, a speakers' bureau, media messages, restaurant food labeling, and cooking seminars. More than 31,000 participants were involved in 585 activities. MEASURES: Questionnaires focused on hypertension, obesity, high cholesterol, smoking, and exercise. Physical assessments determined lipid, lipoprotein, apolipoprotein, and blood pressure levels. Analysis of covariance was used for baseline and postintervention comparisons. Content analysis was used on archive and interview data. RESULTS: The project had a slightly favorable intervention effect on cholesterol and smoking, but failed to have an effect on other risk factors for cardiovascular disease. The project influenced community awareness, enlisted influential community members, and fostered linkages among local health services. CONCLUSIONS: Health departments can be instrumental in community risk reduction programming; however, they may not replicate projects having greater resources.

Self-reported frequency of serum cholesterol testing, awareness of test results, and laboratory cholesterol values in two South Carolina communities.

Self-reported frequency of cholesterol testing and awareness of test results were collected from 5,246 adults 18 years and older in two semirural communities in South Carolina. Serum cholesterol was also measured for about 60 percent of this group. More than half of these persons had serum cholesterol values greater than 200 milligrams per deciliter (mg per dL) and 21 percent had values greater than 240 mg per dL. One-third of the population had had their cholesterol level measured within the past year; 40 percent reported that their cholesterol level had never been measured. Among persons whose cholesterol was 240 mg per dL or more, 39 percent reported that their cholesterol had never been measured or that they did not know if it had been measured, 37 percent reported that their cholesterol had been measured but that they were not told that it was high, and 18 percent reported that their cholesterol had been measured and that they were advised to reduce it. Among persons whose cholesterol was 200 mg per dL or more, and who reported that they had cardiovascular disease, 25 percent reported that they were advised to reduce their cholesterol. These results emphasize the need to increase the proportion of the population who have had their cholesterol level measured, who know their test results, and who have been properly counseled about the results.

Legislative Cardiovascular Health Check: a multidisciplinary health promotion experience for South Carolina lawmakers.

The South Carolina Department of Health and Environmental Control has conducted a Legislative Cardiovascular Health Check for the past 4 years. The primary purpose of the event, held in the lobby of the State Capitol Building, is to increase the awareness of State legislators about the leading causes of death in South Carolina and about community-based health promotion services that are available. The health check emphasizes the relationship between modifiable risk factors and the development of heart disease, cancer, and stroke. These legislative events are organized by State health department staff members, but they are conducted by local health department personnel from throughout South Carolina. This approach is intended to build the capacity of these local staff members to communicate more effectively with their legislators and to carry out similar events at the county or community level. The health check is staffed by a trained multidisciplinary team, including persons designated as legislative liaisons. The liaison people contact legislators prior to the event and provide them with health status data specific to their respective districts. The Legislative Cardiovascular Health Checks have been attended by members of the General Assembly and their staffs, members of the Governor's staff and the Lieutenant Governor's office, and other employees of the State Capitol. An average of 380 people have participated annually. Screening activities have included blood pressure and blood cholesterol checks, with risk factor counseling and educational materials provided to each screened participant. During the past year, activities were expanded to include a variety of interactive exhibits related to nutrition, exercise, and smoking. Feedback from participants has been positive. The Legislative Cardiovascular Health Check is encouraged and supported by the upper management of the State health department and is now established as an annual event of mutual benefit to legislators and to State and local health department staff members.

Evaluating South Carolina's community cardiovascular disease prevention project.

A community cardiovascular disease prevention program was undertaken as a cooperative effort of the South Carolina Department of Health and Environmental Control and the Centers for Disease Control of the Public Health Service. As part of the evaluation of the project, a large scale community health survey was conducted by the State and Federal agencies. The successful design and implementation of the survey, which included telephone and in-home interviews as well as clinical assessments of participants, is described. Interview response rates were adequate, although physical assessments were completed on only 61 percent of those interviewed. Households without telephones were difficult and costly to identify, and young adults were difficult to locate for survey participation. The survey produced baseline data for program planning and for measuring the success of ongoing intervention efforts. Survey data also have been used to estimate the prevalence of selected cardiovascular disease risk factors.

Behavioral and demographic correlates of diabetes, hypertension and overweight among the Catawba Indian Nation.

OBJECTIVE: In 1998, the Catawba Diabetes and Health Survey (CDHS) was conducted among adult members of the Catawba Indian Nation living in the Carolinas to determine the prevalence of diabetes and other health conditions, and to assess the population's health-related behaviors. DESIGN: A population-based sample of adult members of the Catawba Indian Nation (N = 633) were surveyed by telephone or in person regarding health status and health-related behaviors. Logistic regression was used to determine demographic and behavioral correlates of diabetes, hypertension, and overweight among the Catawba. RESULTS: Age-adjusted prevalence rates of self-reported diabetes, hypertension and overweight were 12.3%, 29.1%, and 63.8%, respectively. Older age was related to diabetes, hypertension, and overweight (P<.0001 each), and heavier weight status was related to diabetes (P = .026) and hypertension (P<.0001). Nearly 40% of the Catawba are physically inactive (29.5% men, 46.5% women). Physical inactivity was related to diabetes and hypertension among men only, and related to overweight among women only (P<.05 each). Current smoking was inversely related to overweight among men and women (P = .002). Dietary behavior was not associated with the health outcomes. CONCLUSION: Given the high rates of overweight and physical inactivity, reducing the rates of both may be very important for the health of the Catawba, considering their association with diabetes and hypertension.

Body fat distribution and race differences in apolipoprotein A1.

OBJECTIVE: This is the first study to assess the role of waist-to-hip ratio in explaining race differences in levels of serum apolipoprotein A1, a protective risk factor for atherosclerosis. METHODS: Linear regression analyses were used in a community-based survey of 3,043 adults (23.5% African-American) to assess associations of race, age, anthropometric measures, education, diabetes, blood pressure medication use, cigarette smoking, and leisure-time physical activity with apolipoprotein A1 levels. RESULTS: Higher apolipoprotein A1 levels were observed among African-American than among white adults (African-American men: +15.6 mg/dl than white men, African-American women: +3.1 mg/dl more than white women; p < 0.05). Waist-to-hip ratio and other variables did not account for race differences among men. African-American women had +8.6 mg/dl higher levels than white women after adjustment for differing distributions of waist-to-hip ratio, age, body mass index and education. Cigarette smoking, physical activity, and medical history accounted for no further differences among women. CONCLUSIONS: Higher levels of obesity indicators and lower educational attainment among African-American women reduced a potentially greater beneficial race difference in apolipoprotein A1. These findings also suggest that other environmental and biochemical factors may play roles in explaining the higher protective levels of apolipoprotein A1 observed among African-American children and adults.

Leisure-time physical activity and high-density lipoprotein cholesterol in a biracial community sample.

The purpose of this analysis was to describe the association of leisure-time physical activity and high-density lipoprotein cholesterol levels among a large community sample of African-American and white men and women. Physical assessment of high-density lipoprotein cholesterol, weight, height, waist, and hip measurements were obtained for 3121 randomly selected community participants (969 white men, 1409 white women, 205 African-American men, and 538 African-American women). Leisure-time physical activity was assessed from responses to a standard series of questions about participation in various leisure-time activities. We found an inverse relationship between leisure-time activities and high-density lipoprotein cholesterol levels in African Americans, in contrast to a positive association observed in whites; however, these associations failed to reach statistical significance after controlling for age and body composition. These results confirm a strong association of body composition with high-density lipoprotein cholesterol and support continued interventions designed to reduce overall body weight, particularly upper body weight. The results further suggest that the relationships between some life-style factors and HDL levels may be different among minorities.