A Community Health Advisor Program to reduce cardiovascular risk among rural African-American women.

The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and training, community intervention and maintenance. Formative data collected to develop the training, intervention and evaluation methods and materials indicated the need for programs to increase knowledge, skills and resources for changing behaviors that increase the risk of CVD. CHAs worked in partnership with staff to develop, implement, evaluate and maintain strategies to reduce risk for CVD in women and to influence city officials, business owners and community coalitions to facilitate project activities. Process data documented sustained increases in social capital and community capacity to address health-related issues, as well as improvements in the community's physical infrastructure. This project is unique in that it documents that a comprehensive CHA-based intervention for CVD can facilitate wide-reaching changes in capacity to address health issues in a rural community that include improvements in community infrastructure and are sustained beyond the scope of the originally funded intervention.

The effect of risk assessment in conjunction with health promotion education on compliance with preventive behaviors.

In this study, 55 subjects were given prevention-oriented recommendations from general, detailed nutritional, and Type A personality risk assessments in conjunction with health promotion education. Changes in compliance with health behaviors were measured 13 months after the first assessment, using the same three risk assessment instruments. Based on self-report, a statistically significant number of persons changed from noncompliance to compliance on three nutritional behaviors, three behaviors related to health-promoting exercise and recreation, and one medical screening behavior. A statistically significant reduction in mean from the first to second year was observed for daily sodium intake and percent of calories from fat, and a significant increase in mean percent of time using seatbelts. Though limited by study design, the results provide encouraging evidence in support of the proposition that risk assessment in conjunction with health promotion education can effect positive change in preventive behaviors.

Factors influencing duration of breast feeding among low-income women.

Forty low-income breast feeding primiparous women were interviewed to determine whether family member and peer attitudes toward breast feeding and available postpartum support were associated with continued or early termination of breast feeding. Mean breast feeding duration equalled 20.5 weeks (range, 1 to 52 weeks). When an outside source of assistance (a doula) was available during the first 2 weeks postpartum, mean duration was 23.4 weeks compared with 12.3 weeks when a doula was unavailable (p less than .05). Breast feeding duration was independent of the doula's attitude regarding breast feeding. Duration of breast feeding was significantly longer for breast feeding women who participated in the USDA Special Supplemental Program for Women, Infants, and Children (WIC) than for those who did not participate. All of the women claimed to like breast feeding; 93% of the husbands or boyfriends, 83% of the women's mothers, and 81% of the women's best friends had positive attitudes toward breast feeding. The more breast feeding friends the woman had, the longer she breast fed (r = .32, p less than .05). Termination of breast feeding was not due to perceived negative attitudes of family members and peers regarding breast feeding.