Expanding the evidence for health promotion: developing best practices for WISEWOMAN.

Implementing effective programs to prevent chronic disease holds the promise of reducing morbidity and mortality, reducing health disparities, and promoting health. Yet many programs have demonstrated success only in highly controlled research settings and few address the needs of low-income, uninsured, minority women. Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN), a demonstration program funded by the Centers for Disease Control and Prevention (CDC), that provides chronic disease risk factor screening and lifestyle interventions for low-income, 40-64-year-old women is learning from our own successful programs but is also charting new territory. As the CDC, state health departments, tribal organizations, and other WISEWOMAN partners approach the end of the first decade of WISEWOMAN demonstration projects, we are seeking to understand what has worked and what has not. This paper describes the rationale and proposed methodology for assessing best practices in the WISEWOMAN program through a participatory process that will examine scientific evidence and quantitative and qualitative program data. By emphasizing practicality in addition to scientific rigor, we are expanding the base of evidence considered to identify effective approaches for reducing cardiovascular disease (CVD) risk in financially disadvantaged, ethnically diverse women. Results of the 3-year project will be disseminated in a format intended to encourage programs to select and adapt those strategies best suited to their particular contexts.

Racial/ethnic disparities in coronary heart disease risk factors among WISEWOMAN enrollees.

BACKGROUND: We used the baseline data collected for the Well-integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) participants to provide a snapshot of cardiovascular disease (CVD) risk on enrollment and to address racial/ethnic disparities in the following CVD risk factors: body mass index (BMI), systolic and diastolic blood pressure, high-density lipoprotein (HDL) and total cholesterol, diabetes and smoking prevalence, 10-year coronary heart disease (CHD) risk, and treatment and awareness of high cholesterol, hypertension, and diabetes. METHODS: We used linear regression analysis to (1) assess the presence of racial/ethnic disparities and test whether existing disparities can be explained by (2) differences in individual characteristics or by (3) differences in individual and community characteristics. RESULTS: Our results reveal a high degree of CVD risk among the WISEWOMAN participants and statistically significant racial/ethnic disparities in risk factors. Black participants were at the greatest risk of CVD, and Hispanic and Alaska Native participants were healthier in terms of CVD risk than white participants. Some racial/ethnic disparities were explained by differences in individual and community characteristics, but other disparities persisted even after controlling for these factors. CONCLUSIONS: Because differences in community characteristics explain many of the racial/ethnic disparities in CVD risk factors, eliminating disparities may require community-wide interventions. Successful WISEWOMAN projects are likely to not only reduce CVD risk factors overall but also to lessen racial/ethnic disparities in these risk factors.