Reducing cardiovascular disease risk using patient navigators, Denver, Colorado, 2007-2009.

INTRODUCTION: Early identification of cardiovascular disease (CVD) risk is important to reach people in need of treatment. At-risk patients benefit from behavioral counseling in addition to medical therapy. The objective of this study was to determine whether enhanced counseling, using patient navigators trained to counsel patients on CVD risk-reduction strategies and facilitate patient access to community-based lifestyle-change services, reduced CVD risk among at-risk patients in a low-income population. METHODS: We compared clinical characteristics at baseline and 12-month follow-up among 340 intervention and 340 comparison patients from community health centers in Denver, Colorado, between March 2007 and June 2009; all patients had a Framingham risk score (FRS) greater or equal to 10% at baseline. The intervention consisted of patient-centered counseling by bilingual patient navigators. At baseline and at 6-month and 12-month follow-up, we assessed health behaviors of intervention participants. We used an intent-to-treat approach for all analyses and measured significant differences by χ(2) and t tests. RESULTS: We found significant differences in several clinical outcomes. At follow-up, the mean FRS was lower for the intervention group (mean FRS, 15%) than for the comparison group (mean FRS, 16%); total cholesterol was lower for the intervention group (mean total cholesterol, 183 mg/dL) than for the comparison group (mean total cholesterol, 197 mg/dL). Intervention participants reported significant improvements in some health behaviors at 12-month follow-up, especially nutrition-related behaviors. Behaviors related to tobacco use and cessation attempts did not improve. CONCLUSION: Patient navigators may provide some benefit in reducing risk of CVD in a similar population.

New options for child health surveillance by state health departments.

Until recently there were no child health surveillance instruments available to state health departments for children 1-14 years old. In recent years, several states have developed new surveillance instruments. This article includes information about examples of four types of child health surveys: (1) Behavioral Risk Factor Surveillance System (BRFSS) follow-back survey [phone-based in Colorado]; (2) Pregnancy Risk Assessment Monitoring System (PRAMS) re-interviews [PRAMS-based in Rhode Island]; (3) elementary school child health survey combined with dental screening and physical measurements of height and weight [school-based in Maine]; and (4) freestanding elementary school survey [school-based in Oregon]. The PRAMS-based survey was moderate in expense but addressed only issues related to 2 year olds. The phone-based survey was the most expensive but addressed issues of children 1-14 years old. The school-based surveys were moderate in expense, logistically complex, and were least likely to provide robust generalizable data.

Parent opinions about the appropriate ages at which adult supervision is unnecessary for bathing, street crossing, and bicycling.

OBJECTIVE: To describe parent opinions about when typical children can engage in activities unsupervised. DESIGN: Telephone survey combined with the Behavioral Risk Factor Surveillance System. SETTING: Colorado. PARTICIPANTS: Nine hundred forty-five households with children aged 1 to 14 years. Main Exposures Family and household characteristics and caregiver behaviors. MAIN OUTCOME MEASURES: Mean ages at which the caregiver believes typical children can bathe without an adult present, cross busy streets without holding hands, and bicycle in busy streets unsupervised. RESULTS: For bathing, the mean age was 6.6 (range, 2-15) years; mean ages were 1.0 year older among Hispanic white parents (95% confidence interval [CI], 0.5-1.4 years) and 0.8 year younger among parents whose child rode with an impaired driver in the past month (95% CI, -1.5 to -0.1 years). For street crossing, mean age was 9.0 (range, 3-16) years; mean ages were 1.2 years older among Hispanic white parents (95% CI, 0.6-1.8 years), 0.7 year older in single-parent households (95% CI, 0.1-1.3 years), and 0.3 year younger among parents whose child rode with a speeding driver in the past month (95% CI, -0.5 to 0.0 year). For bicycling, mean age was 12.2 (range, 6-21) years; mean ages were 1.5 years younger in households with a risky drinker (95% CI, -2.5 to -0.5 years) and 0.5 year younger among parents whose child rode with a speeding driver in the past month (95% CI, -0.9 to -0.1 year). CONCLUSIONS: Parent opinions about when adult supervision is unnecessary varied with parent behavior and family and household characteristics. Differential supervision may partially explain reports of lower child injury rates among Hispanic and less educated families. Identification of parent and household factors associated with supervision practices might help pediatricians target counseling about age-appropriate supervision.