RESUMO
The Behavior Change Consortium (BCC), a collective of 15 National Institutes of Health-funded behavior-change projects, was conceived with the goal of evaluating the efficacy and effectiveness of novel ways of intervening in diverse populations to reduce tobacco dependence, and improve physical activity, nutrition and other health behaviors. The purpose of this article is to provide a general introduction and context to this theme issue by: (1) reviewing the promises and challenges of past efforts related to promoting change for three key health behaviors; (2) reviewing successful intervention strategies and principles of health behavior change; (3) discussing major theoretical approaches for obtaining successful behavior change; (4) setting BCC activities within the context of recent recommendations for the behavioral and social sciences; and (5) providing an organizational framework for describing each of the projects within this consortium. In addition to the rich database on behavioral outcomes for tobacco dependence, physical activity and diet, the BCC represents a unique opportunity to share data and address cross-cutting intervention research issues critical for strengthening the field of behavior change research.
Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde , Programas Nacionais de Saúde/organização & administração , National Institutes of Health (U.S.) , Humanos , Desenvolvimento de Programas , Saúde Pública , Estados UnidosRESUMO
BACKGROUND: Rates of physical inactivity and poor nutrition, which are 2 of the most important modifiable risk factors for cardiovascular disease in women, are substantial. Even so, studies of interventions designed to improve lifestyle behaviors in women have been limited and often confined to particular geographical areas. OBJECTIVE: To evaluate the effect of Choose to Move on increasing women's physical activity, improving their knowledge of heart disease and stroke, and improving their nutrition. PARTICIPANTS AND METHODS: A prospective, nonrandomized, 12-week educational intervention designed by the American Heart Association for women across the United States. Participants received a welcome kit and manual with weekly information about how to manage cardiovascular disease risk factors and how to build a support system for lifestyle change. Women (N = 23 171) aged 25 years or older were recruited by direct mail, the media, health care providers, and other means. Follow-up evaluations were returned from 6389 women at 2 weeks, 5338 at 4 weeks, 4209 at 8 weeks, 3916 at 10 weeks, and 3775 at 12 weeks. Participants self-reported their physical activity, diet, and knowledge about heart disease, stroke, and related symptoms. RESULTS: Ninety percent of the participants were white and 56% were aged between 35 and 54 years. Among the participants who completed the week 12 follow-up evaluation, the percentage who reported being active (at least moderate exercise > or =5 times per week or >2(1/2) hours per week for the past 1 to 6 months) increased from 32% at baseline to 67% at the program's end (P =.001). Participants currently limiting excess calories or fat increased from 72% to 91% at week 10 follow-up evaluation (P =.001). The proportion correctly identifying heart disease as the leading cause of death increased from 84% to 91% at week 10 follow-up evaluation (P<.001). CONCLUSIONS: Women who completed the Choose to Move program evaluation reported that they significantly increased their levels of physical activity, reduced their consumption of high-fat foods, and increased their knowledge and awareness of cardiovascular disease risk and its symptoms. This program provides an important model for public health, voluntary, and other health organizations of population-based, targeted low-cost self-help programs that support the Healthy People 2010 objectives for physical activity, nutrition, and cardiovascular health.
Assuntos
Doença das Coronárias/prevenção & controle , Exercício Físico , Promoção da Saúde , Estilo de Vida , Acidente Vascular Cerebral/prevenção & controle , Adulto , Idoso , American Heart Association , Doença das Coronárias/etiologia , Comportamento Alimentar , Feminino , Seguimentos , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Acidente Vascular Cerebral/etiologia , Estados UnidosRESUMO
High-protein diets have recently been proposed as a "new" strategy for successful weight loss. However, variations of these diets have been popular since the 1960s. High-protein diets typically offer wide latitude in protein food choices, are restrictive in other food choices (mainly carbohydrates), and provide structured eating plans. They also often promote misconceptions about carbohydrates, insulin resistance, ketosis, and fat burning as mechanisms of action for weight loss. Although these diets may not be harmful for most healthy people for a short period of time, there are no long-term scientific studies to support their overall efficacy and safety. These diets are generally associated with higher intakes of total fat, saturated fat, and cholesterol because the protein is provided mainly by animal sources. In high-protein diets, weight loss is initially high due to fluid loss related to reduced carbohydrate intake, overall caloric restriction, and ketosis-induced appetite suppression. Beneficial effects on blood lipids and insulin resistance are due to the weight loss, not to the change in caloric composition. Promoters of high-protein diets promise successful results by encouraging high-protein food choices that are usually restricted in other diets, thus providing initial palatability, an attractive alternative to other weight-reduction diets that have not worked for a variety of reasons for most individuals. High-protein diets are not recommended because they restrict healthful foods that provide essential nutrients and do not provide the variety of foods needed to adequately meet nutritional needs. Individuals who follow these diets are therefore at risk for compromised vitamin and mineral intake, as well as potential cardiac, renal, bone, and liver abnormalities overall.
Assuntos
Dieta Redutora/normas , Proteínas Alimentares/administração & dosagem , American Heart Association , Deficiência de Vitaminas/etiologia , Deficiência de Vitaminas/prevenção & controle , Dietas da Moda/efeitos adversos , Dieta Redutora/efeitos adversos , Carboidratos da Dieta , Gorduras na Dieta , Ingestão de Energia , Humanos , Distúrbios Nutricionais/etiologia , Distúrbios Nutricionais/prevenção & controle , Obesidade/dietoterapia , Obesidade/prevenção & controle , Risco , Resultado do Tratamento , Redução de PesoAssuntos
Teste de Esforço , Exercício Físico , Adolescente , Adrenérgicos , Adulto , Arritmias Cardíacas/etiologia , Doença das Coronárias/prevenção & controle , Aconselhamento , Ecocardiografia , Eletrocardiografia , Feminino , Coração/diagnóstico por imagem , Coração/efeitos dos fármacos , Coração/fisiologia , Cardiopatias/diagnóstico , Hemodinâmica , Humanos , Consentimento Livre e Esclarecido , Masculino , Pessoa de Meia-Idade , Miocárdio/metabolismo , Consumo de Oxigênio , Cooperação do Paciente , Exame Físico , Cintilografia , VasodilatadoresAssuntos
American Heart Association , Doenças Cardiovasculares/dietoterapia , Colesterol na Dieta , Dieta com Restrição de Gorduras , Educação em Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/prevenção & controle , Colesterol na Dieta/efeitos adversos , Seguimentos , França , Frutas , Parada Cardíaca/dietoterapia , Parada Cardíaca/prevenção & controle , Humanos , Região do Mediterrâneo , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Estados Unidos , Verduras , Ácido alfa-Linolênico/administração & dosagem , Ácido alfa-Linolênico/uso terapêuticoAssuntos
Doenças Cardiovasculares/prevenção & controle , Gorduras na Dieta/farmacologia , Ácidos Graxos/farmacologia , Neoplasias/prevenção & controle , Ciências da Nutrição/educação , American Heart Association , Animais , Plaquetas/efeitos dos fármacos , Plaquetas/metabolismo , Pressão Sanguínea/efeitos dos fármacos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/metabolismo , Ensaios Clínicos como Assunto , Gorduras na Dieta/metabolismo , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Ácidos Graxos/metabolismo , Ácidos Graxos Insaturados/metabolismo , Ácidos Graxos Insaturados/farmacologia , Óleos de Peixe , Hemostasia/efeitos dos fármacos , Humanos , Insulina/metabolismo , Secreção de Insulina , Neoplasias/epidemiologia , Neoplasias/metabolismo , Política Nutricional , Óleos de Plantas , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
There is a general lack of health-related research focusing on gender-specific differences within a working population. This research attempts to address that void. Our study relied on the Health Enhancement Research Organization (HERO) database, which consists of claims, enrollment information, and health risk data for 39,999 employees of six large employers. The research objective was to determine the gender-specific association between coronary heart disease (CHD) and (1) the prevalence of modifiable health risks and (2) medical expenditures. To accomplish this, the International Classification of Diseases, 9th Revision-Clinical Modification and Current Procedural Terminology codes were used to identify 2452 employees with CHD within the HERO database. These individuals made up the study group, which included 66% male and 34% female participants. Health risk data were obtained from voluntary participation in a health risk appraisal and biometric evaluation provided by the employers. Health risks evaluated were tobacco use, hypertension, obesity, elevated cholesterol, high blood glucose, sedentary lifestyle, stress, depression, and excessive use of alcohol. Descriptive and multivariate statistical techniques were used to analyze the HERO database. We found that obesity was the most consistent predictor of CHD. It was number one (of 10 health risks) in the male and female group, number two in the male-only group, and number one in the female-only group. High stress was the second most consistent predictor. There was no such consistency relative to medical expenditures. This lack of consistency across the male and female groups relative to the association between health risks and medical expenditures was demonstrated for nearly all other health risks evaluated. This study suggests that within a group of employees with CHD, there are important similarities and differences between men and women with respect to the prevalence of risk factors and the association between health risks and medical expenditures.
Assuntos
Doença das Coronárias/etiologia , Comportamentos Relacionados com a Saúde , Gastos em Saúde/estatística & dados numéricos , Adulto , Doença das Coronárias/epidemiologia , Feminino , Humanos , Estilo de Vida , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores SexuaisAssuntos
American Heart Association , Doenças Cardiovasculares/dietoterapia , Doenças Cardiovasculares/prevenção & controle , Dietoterapia/normas , Adolescente , Adulto , Idoso , Pressão Sanguínea , Peso Corporal , Criança , Pré-Escolar , Colesterol na Dieta/normas , Gorduras na Dieta/normas , Gorduras Insaturadas na Dieta/normas , Proteínas Alimentares , Grão Comestível/normas , Ingestão de Energia , Exercício Físico , Produtos Pesqueiros/normas , Frutas/normas , Comportamentos Relacionados com a Saúde , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos , Verduras/normasAssuntos
Institutos de Cardiologia , Doença das Coronárias/diagnóstico , Testes de Função Cardíaca/efeitos adversos , Admissão do Paciente , Alta do Paciente , Algoritmos , Angina Instável/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Valor Preditivo dos Testes , Prognóstico , Padrões de Referência , Medição de Risco , Segurança , TriagemRESUMO
OBJECTIVES: A telephone survey of over 2000 American adults was conducted to determine their awareness of Physical Activity and Health: A Report of the Surgeon General and their knowledge of the health messages contained within the report. A related purpose was to determine if awareness and knowledge were a function of age, ethnicity, gender, and education level. METHODS: A random sample of American adults was drawn and a national telephone survey was conducted in the 48 contiguous states and the District of Columbia. RESULTS: Approximately one third of the adult population had heard of the report. Awareness was a function of age, ethnicity, and educational level. Knowledge of the relationship between physical inactivity and specific chronic diseases was a function of age, ethnicity, and gender. CONCLUSIONS: Differential awareness of the Report and its contents by various segments of the population has significant implications for the messages transmitted and interventions developed to help individuals adopt and maintain active lifestyles.