Health-risk appraisal with or without disease management for worksite cardiovascular risk reduction.

BACKGROUND AND RESEARCH OBJECTIVE: Worksite health promotion programs use health risk appraisal (HRA) surveys to identify employees at increased risk, then provide a range of interventions to encourage high-risk individuals to improve their health. Our objective was to determine how the intensity of intervention after HRA affected cardiovascular risk after 1 year, comparing individual follow-up counseling with environmental supports. SUBJECTS AND METHODS: 133 employees of Vanderbilt University with cardiovascular risk factors were randomly assigned to worksite HRA plus targeted disease management (DM group) or HRA plus information about worksite health promotion programs (HRA group). The DM group received longitudinal individualized counseling for risk reduction, whereas the HRA group members received one feedback session about their risk factors and information about free worksite health promotion programs. The main outcome measure was the difference between groups in the change in average Framingham risk score from baseline to 1 year. RESULTS: There was no significant baseline difference between groups in the Framingham risk score. Among DM participants, the mean (SD) Framingham risk score decreased by 22.6%; among HRA participants, the mean score rose by 4.3% (P = .017 for the difference between groups). CONCLUSIONS: In this study of employees with cardiovascular risk factors, HRA followed by individual counseling was more effective than providing information about free worksite health promotion programs.

Smoking rates among pregnant women in Tennessee, 1990-2001.

BACKGROUND: Pregnant smokers represent a major public health challenge. The objective of this study was to determine trends in smoking during pregnancy in Tennessee, a state with one of the highest smoking burdens in the nation, and to confirm characteristics of high-risk groups to target for smoking prevention. METHODS: Population-based cohort study of pregnant women in Tennessee who delivered live births from 1990-2001. Trends in smoking were determined by maternal age, race and insurance status using vital records and Medicaid data. Characteristics of women who smoked during pregnancy were described for 2001. RESULTS: Among 900,986 pregnant women in the cohort, there were statewide decreases in smoking rates during pregnancy; however, smoking among pregnant women younger than 25 years in Medicaid increased from 1996 to 2001: among whites from 31% to 34%, and among blacks from 6% to 9% (P values for trend shifts <0.0001). Characteristics of pregnant women who smoked during pregnancy included white race, Medicaid enrollment, nonurban residence, and less than a high school education. CONCLUSIONS: Smoking rates increased significantly among pregnant women <25 years enrolled in Medicaid between 1996 and 2001. Tennessee needs smoking cessation and prevention efforts that target young, low-income women with less than a high school education.