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Julie C Will

Publications and source records attributed to Julie C Will.

18 recordsLinked to original sources
PubMed2006

Environment, obesity, and cardiovascular disease risk in low-income women.

BACKGROUND: Financially disadvantaged populations are more likely to live in communities that do not support healthy choices. This paper investigates whether certain characteristics of the built environment are associated with obesity or coronary heart disease (CHD) risk among uninsured low-income women. METHODS: Using a sample of 2001-2002 data from 2692 women enrolled in the WISEWOMAN program of the Centers for Disease Control and Prevention, the study team performed regression analysis (conducted in January-April 2005) to estimate body mass index (BMI) and the log of 10-year CHD risk as a function of the built environment and socioecologic measures. RESULTS: For women living in an environment of maximum mixed land use (i.e., an environment more conducive to healthy living), BMI was lower by 2.60 kg/m2 and CHD risk was lower by 20% than for women living in single-use uniform environments (i.e., environments less conducive to healthy living). An additional fitness facility per 1000 residents was associated with BMI and CHD risk that were lower by 1.39 kg/m2 and 15.1%, respectively. Crime was positively associated with BMI and CHD risk, whereas neighborhood affluence was negatively associated. Living in more racially segregated areas was negatively associated with CHD risk among black, Hispanic, and Asian women and positively associated with CHD risk among American Indian women. CONCLUSIONS: The built environment and socioecologic characteristics of financially disadvantaged women were associated with BMI and CHD risk. More research is needed to understand the effects of racial segregation or acculturation on health for specific subpopulations.

Adult↗
PubMed2006

Cost-effectiveness of WISEWOMAN, a program aimed at reducing heart disease risk among low-income women.

OBJECTIVE: To quantify the cost-effectiveness of the WISEWOMAN program. WISEWOMAN is a Centers for Disease Control and Prevention (CDC)-funded lifestyle intervention program that provides low-income uninsured women aged 40-64 with chronic disease risk factor screenings, lifestyle interventions, and referral services in an effort to prevent coronary heart disease (CHD) and improve health. METHODS: We used data for 3015 WISEWOMAN participants who completed baseline and 1-year follow-up screenings. We quantified the average per capita cost of providing WISEWOMAN over the last 6 months of the reporting period. We assessed 1-year reductions in select CHD risk factors. We calculated the cost-effectiveness ratio by dividing the average per capita cost by average predicted life-years gained. RESULTS: The cost of providing WISEWOMAN services to each additional participant averaged 270 US dollars per participant. Participants significantly improved their systolic (1.3%) and diastolic (1.7%) blood pressure, total (2%) and high-density lipoprotein (HDL) (0.7%) cholesterol, and 10-year risk of CHD (8.7%). There were also significant reductions in percent of women who smoked (11.7%) or had high blood pressure (15.8%) or high cholesterol (13.1%). The bestcase cost-effectiveness ratio was 470 US dollars per percentage point reduction in CHD risk, or 4400 US dollars per discounted life-year gained; however, sensitivity analysis revealed substantial uncertainty around this estimate. CONCLUSIONS: Although more research is needed to confirm the assumptions used in the model, results of our analysis suggest that the WISEWOMAN program is a cost-effective approach for reducing CVD risk among low-income, uninsured women aged 40-64, especially if improvements in risk factors are sustainable when program participation concludes.

Cardiovascular Diseases↗
PubMed2006

Linking clinical care to community resources for cardiovascular disease prevention: the North Carolina Enhanced WISEWOMAN project.

BACKGROUND: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project addresses the need for effective cardiovascular disease (CVD) prevention among underserved, midlife women. We describe an Enhanced Intervention that addressed environmental and individual factors within the context of a clinic-based intervention. We also present the study design and baseline results of the randomized trial to evaluate the enhanced intervention. METHODS: The multicomponent behavior change intervention addressed many elements of the Chronic Care Model (CCM), including the community resources and policy element, wherein Enhanced Intervention participants were encouraged to overcome environmental barriers to a healthy lifestyle by using community resources. Study participants were enrolled at one community health center; all were low-income, underinsured, midlife (40-64 years) women. RESULTS: A total of 236 participants were randomized to receive the Enhanced Intervention or the Minimum Intervention. At baseline, over three fourths of the participants were overweight or obese. Participants reported a variety of problematic neighborhood characteristics, including a paucity of restaurants with healthy food choices (41% reported as a problem); not enough farmer's markets or produce stands (50%), not enough affordable exercise places (52%), not enough physical activity programs that met women's needs (42%), heavy traffic (47%), and speeding drivers (53%). Overall, women knew little about affordable exercise venues and nutrition classes. CONCLUSIONS: In this clinic-based intervention, we addressed environmental factors related to a healthy lifestyle. Results indicate the need for effective and feasible intervention strategies to address the environments in which individuals are making behavior changes. The effectiveness of the WISEWOMAN Enhanced Intervention will be assessed in a randomized trial.

Adult↗
PubMed2006

Fruit and vegetable consumption of older Mexican-American women is associated with their acculturation level.

Little is known about the association between acculturation and fruit and vegetable (FV) consumption among older Mexican-American (MA) women. Environmental and lifestyles changes experienced by immigrants to the United States may markedly affect their diet and health and increase their risk for chronic diseases. Our objectives were to: 1) describe FV consumption by ethnicity, acculturation, and sociodemographic characteristics, and 2) compare effects of acculturation and sociodemographic variables on FV intake in a population of older MA and non-Hispanic White (NHW) women from the Well-Integrat-ed Screening and Evaluation for Women Across the Nation (WISEWOMAN) Study. This report examines baseline FV intake of 346 underinsured women aged 50-76 years, assessed through 24-hour dietary recalls. Acculturation was measured with a five-item Likert-type scale. Twenty percent of more acculturated MA women, 24% of less acculturated MA women, and 36% of White women consumed > or = 5 servings of FV servings per day. Fruit and vegetable (FV) intake was associated with acculturation, education, and smoking status. Being more acculturated was associated with lower consumption of FVs among MAs, while having a higher education and no smoking was associated with higher intakes of FV servings among NHWs. Public health efforts to improve the intake of FVs among MA women should be sensitive to their acculturation status.

Acculturation↗
PubMed2004

Using success stories to share knowledge and lessons learned in health promotion.

BACKGROUND: Compelling success stories, rich with details about real-life events and people, are a tool that health agencies can use to convey how their health promotion programs work, why they are successful, what lessons they have learned, and how others can launch similar programs. Success stories describe project accomplishments that are not easily captured by quantitative evaluation methods, such as surveys. METHODS: Although success stories have not been widely used in public health, the North Carolina Department of Health and Human Services developed a series of stories, the Community Change Chronicles, to highlight environmental and policy changes that promote cardiovascular health. In 2003, the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program used the Community Change Chronicles as a model to develop success stories about WISEWOMAN projects. RESULTS: WISEWOMAN Works: A Collection of Success Stories from Program Inception Through 2002 includes 12 stories and offers advice on how to create and use success stories in public health. This paper reviews the rationale for developing the stories, presents one success story as an example, and describes the process used to gather information, write the stories, and produce a resource for others interested in developing success stories. We also discuss how the WISEWOMAN success stories are being used to promote women's health and cardiovascular health. CONCLUSIONS: As the WISEWOMAN experience suggests, healthcare providers and organizations can use success stories to gain support for successful activities, inform the public about program benefits, complement other quantitative and qualitative evaluation methods, and publicly acknowledge the contributions of staff and organizational partners.

Alaska↗
PubMed2004

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.

Black People↗
PubMed2004

Heart disease prevention for Alaska Native women: a review of pilot study findings.

BACKGROUND: Although historically Alaska Native women have had a relatively low incidence of cardiovascular disease (CVD), this pattern has changed dramatically in recent years. Alaska Native leaders have identified decreasing cardiovascular risk as an intervention priority. METHODS: From October 2000 to April 2001, Southcentral Foundation, an Alaska Native-owned and managed health corporation in Anchorage, conducted a pilot randomized controlled trial of a heart disease prevention program tailored for Alaska Native women. The aim was to assess feasibility and cultural acceptability and to develop enrollment procedures. Of 76 women who enrolled, 44 were randomized to the intervention group. Thirty-seven of 44 attended at least two intervention sessions, 23 completed prequestionnaires and postquestionnaires, and 27 returned for 12-month follow-up screening. Thirty of 32 control group participants returned for 12-month follow-up screening. The intervention included 12 weekly sessions on lifestyle change and goal setting. At baseline and 12 months, participants' height, weight, resting blood pressure, fasting lipid levels, and blood glucose were measured. At sessions 1 and 12, participants completed assessments regarding diet, physical activity, tobacco use, and psychosocial status. RESULTS: At 12 weeks, significant improvements were noted in moderate walking and physical activity self-efficacy. Also observed was substantial movement from the contemplation and preparation stages to the action stage regarding physical activity and heart-healthy eating. CONCLUSIONS: Although the small sample size precludes drawing conclusions about the intervention's effect, participants reported lifestyle and psychosocial changes. The pilot study resulted in protocol changes that improved the design and implementation of a subsequent large-scale study.

Adult↗
PubMed2004

Effects of a tailored follow-up intervention on health behaviors, beliefs, and attitudes.

BACKGROUND: The high rates of relapse that tend to occur after short-term behavioral interventions indicate the need for maintenance programs that promote long-term adherence to new behavior patterns. Computer-tailored health messages that are mailed to participants or given in brief telephone calls offer an innovative and time-efficient alternative to ongoing face-to-face contact with healthcare providers. METHODS: Following a 1-year behavior change program, 22 North Carolina health departments were randomly assigned to a follow-up intervention or control condition. Data were collected from 1999 to 2001 by telephone-administered surveys at preintervention and postintervention for 511 low-income, midlife adult women enrolled in the Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program at local North Carolina health departments. During the year after the behavior change program, intervention participants were mailed six sets of computer-tailored health messages and received two computer-tailored telephone counseling sessions. Main outcomes of dietary and physical activity behaviors, beliefs, and attitudes were measured. RESULTS: Intervention participants were more likely to move forward into more advanced stages of physical activity change (p = 0.02); control participants were more likely to increase their level of dietary social support at follow-up (p = 0.05). Both groups maintained low levels of reported saturated fat and cholesterol intake at follow-up. No changes were seen in physical activity in either group. CONCLUSIONS: Mailed computer-tailored health messages and telephone counseling calls favorably modified forward physical activity stage movement but did not appreciably affect any other psychosocial or behavioral outcomes.

Attitude to Health↗
PubMed2004

Health promotion interventions for disadvantaged women: overview of the WISEWOMAN projects.

BACKGROUND: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program aims to remove racial and ethnic disparities in health by addressing the screening and intervention needs of midlife uninsured women. This paper describes the WISEWOMAN program requirements, the design of the 12 projects funded in 2002, the use of a standardized data reporting and analysis system, risk factors among participants, effective behavioral strategies, and plans for the future. METHODS: The WISEWOMAN demonstration projects are examining the feasibility and effectiveness of adding a cardiovascular disease (CVD) prevention component to the early detection of breast and cervical cancer. Women aged 40-64 are eligible if they are enrolled in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in selected U. S. states and are financially disadvantaged and lack health insurance. The primary outcome measures are blood pressure, lipid levels, and tobacco use. Intermediate measures include self-reported diet and physical activity, measures of readiness for change, and barriers to behavior change. RESULTS: During 2002, the 10 projects that were fully operational screened 8164 financially disadvantaged women and developed culturally and regionally appropriate nutrition and physical activity interventions for a variety of racial and ethnic backgrounds. Twenty-three percent of the women screened had high total cholesterol, with 48% of these being newly diagnosed. Thirty-eight percent of the women had high blood pressure, with 24% being newly diagnosed. Approximately, 75% of participants were either overweight or obese, and in some sites up to 42% were smokers. CONCLUSIONS: The WISEWOMAN demonstration projects have been successful at reaching financially disadvantaged and minority women who are at high risk for chronic diseases. These projects face challenges because they are generally implemented by safety net providers who have limited resources and staff to conduct research and evaluation. On the other hand, the findings from these projects will be especially informative in reducing health disparities because they are conducted in those settings where the most socially and medically vulnerable women receive care.

Breast Neoplasms↗
PubMed2004

Spatial analysis of body mass index and smoking behavior among WISEWOMAN participants.

BACKGROUND: The WISEWOMAN program focuses on reducing cardiovascular disease (CVD) risk factors by providing screening and lifestyle interventions for many low-income and uninsured women. To provide the most effective interventions possible, it is important to understand the characteristics of WISEWOMAN participants and their communities. METHODS: We used baseline data collected for WISEWOMAN participants from five states (Connecticut, Michigan, Nebraska, North Carolina, and South Dakota) who had enrolled in WISEWOMAN between January 2001 and December 2002 in order to examine body mass index (BMI) and smoking behavior for evidence of spatial clustering. We then examined whether neighborhood characteristics in clusters of high-risk factors differed from neighborhood characteristics in other locations. RESULTS: Six percent of the WISEWOMAN participants lived in ZIP codes with high-BMI clusters, and 4% lived in ZIP codes with high-smoking clusters. High-BMI and high-smoking clusters occurred, however, in different locations from each other. The high-BMI-clustered ZIP codes were, on average, located in more disadvantaged areas. Most of the differences between the high-smoking-clustered ZIP codes and the remaining ZIP codes were not statistically significant. CONCLUSIONS: Our analysis revealed spatial clustering in CVD risk factors among WISE-WOMAN participants. We also found evidence of a correlation between high-BMI clusters and low socioeconomic status of the surrounding community. A more in-depth analysis of the relationship between risk factors (e.g., BMI) and community characteristics in clustered locations will provide further information concerning the role of the community in affecting individual behavior and should allow for tailoring interventions to reduce these risk factors more effectively.

Adult↗
PubMed2004

Implementing the WISEWOMAN program in local health departments: staff attitudes, beliefs, and perceived barriers.

BACKGROUND: Although most health departments recognize the need for programs to reduce the risk of cardiovascular disease (CVD) among older, low-income women, they face numerous barriers to successfully implementing such programs. This paper explores counselors' attitudes and beliefs about patients and perceived barriers to implementing the North Carolina Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program. METHODS: Health departments were assigned to provide patients with either an enhanced intervention (EI) or a minimum intervention (MI). Cross-sectional baseline and 12-month follow-up surveys were completed by health department counselors designated to deliver the MI or EI. Both surveys addressed counselors' beliefs about patients' motivation and attitudes, their counseling practices, and their personal diet and physical activity behaviors and attitudes. The follow-up survey also addressed opinions about the feasibility of long-term WISEWOMAN implementation. RESULTS: Counselors were skeptical about patients' motivation to improve their lifestyle, citing high perceived cost and burden. At follow-up, EI counselors reported having higher self-efficacy for counseling, incorporating more behavioral change strategies, and spending more time counseling than did counselors at MI sites. They were also more likely to report making healthful personal lifestyle choices. All counselors identified lack of time as a major barrier to counseling, and most cited obtaining low-cost medications for patients, ensuring that patients made follow-up visits, and implementing the program with existing staff as key challenges to the long-term sustainability of WISEWOMAN. CONCLUSIONS: Our findings provide insight into the organizational challenges of implementing a CVD risk-reduction program for low-income women. We discuss ways in which intervention and training programs can be improved.

Adult↗
PubMed2004

Cardiovascular disease risk reduction: the Massachusetts WISEWOMAN project.

BACKGROUND: This report presents the effectiveness of the Massachusetts Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Project (MWWP) in reducing the cardiovascular disease (CVD) risk of uninsured and underinsured women aged > or =50. METHODS: Healthcare sites were randomly assigned to an enhanced intervention (EI) or minimum intervention (MI). Women enrolled at all sites received CVD risk factor screening, onsite counseling, education, referral, and follow-up as needed. Women enrolled at EI sites received additional services and specially designed interventions, including one-on-one nutritional and physical activity counseling and group activities, such as walking groups, nutrition classes, and cultural festivals. We report results for 1443 women who attended the initial screening in 10 study sites. Blood pressure, total cholesterol, number of servings of fruits and vegetables, and level of moderate or vigorous physical activity were assessed at baseline and 12-month follow-up screenings. Baseline data were collected between March and June 1996; follow-up data were collected 12 months later. RESULTS: The comprehensive screenings significantly lowered the overall prevalence of hypertension, resulting in a 7% reduction in high blood pressure among women at the EI sites (p = 0.02) and a 9% reduction at MI sites (p = 0.009). A significantly greater percentage of women became physically active at the EI sites (18%) than at the MI sites (6%) (p = 0.04). CONCLUSIONS: MWWP is a promising model for providing comprehensive preventive healthcare to uninsured and underinsured women.

Aged↗
PubMed2004

A replicable process for redesigning ethnically relevant educational materials.

BACKGROUND: To serve the populations targeted by Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) effectively, healthcare providers need educational materials that are evidence based and ethnically relevant and can be easily incorporated into busy clinic settings. We describe a replicable process used to redesign and tailor physical activity and diet education materials for African American women in the southeastern United States. METHODS: The process consists of seven phases. Quantitative and qualitative analyses were used on data gathered in 2000 from two expert panels and eight focus groups. RESULTS: Expert panelists preferred materials perceived to be high quality, easy to understand, organized to facilitate use by healthcare providers, and with content relevant to African American women. Focus group participants were mostly concerned with the visual appeal and content of educational materials. They liked high-quality materials that are brief; avoid jargon and use simple language, bright colors, and photographs; and provide useful information that acknowledges the context of their lives, including their family roles. CONCLUSIONS: The redesign process can produce ethnically and culturally appropriate educational materials for use by WISEWOMAN providers and other healthcare providers in conjunction with cardiovascular (CVD) risk reduction and behavioral counseling. To be effective, materials must address the needs and concerns of both providers and patients.

Black or African American↗
PubMed2004

Provider counseling, health education, and community health workers: the Arizona WISEWOMAN project.

BACKGROUND: The Arizona Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) project used provider counseling, health education, and community health workers (CHWs) to target chronic disease risk factors in uninsured, primarily Hispanic women over age 50. METHODS: Participants were recruited from two Tucson clinics participating in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Women were randomly assigned into one of three intervention groups: (1) provider counseling, (2) provider counseling and health education, or (3) provider counseling, health education, and CHW support. At baseline and 12 months (1998-2000), participants were measured for height, weight, waist and hip circumference, and blood pressure. Blood tests were conducted to check blood glucose, cholesterol, and triglyceride levels. At each time point, participants also completed 24-hour dietary recalls and questionnaires focusing on their physical activity levels. RESULTS: A total of 217 women participated in baseline and 12-month follow-up. Three fourths were Hispanic. All three intervention groups showed an increase in self-reported weekly minutes of moderate-to-vigorous physical activity, with no significant differences between the groups. Significantly more women who received the comprehensive intervention of provider counseling, health education, and CHW support progressed to eating five fruits and vegetables per day, compared with participants who received only provider counseling or provider counseling plus health education. CONCLUSIONS: All three interventions increased moderate-to-vigorous physical activity but not fruit and vegetable consumption. The intervention group with provider counseling, health education, and CHW support significantly increased the number of women meeting national recommendations for fruit and vegetable consumption.

Aged↗
PubMed2004

The WISEWOMAN projects: lessons learned from three states.

BACKGROUND: The WISEWOMAN program provides chronic disease risk factor screening, lifestyle interventions, and referrals to financially disadvantaged women who participate in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Three states (Arizona, Massachusetts, and North Carolina) participated in Phase One (1995-1998). METHODS: Using a case study approach, we reviewed documents and conducted telephone interviews to compare the three projects' design and execution. The interviews, carried out in mid-2002, involved a convenience sample of project coordinators, project directors, researchers, and one CDC project officer (n = 9). RESULTS: Many providers were overwhelmed by WISEWOMAN's research component and disliked its lack of flexibility. Researchers emphasized that high-quality evaluation requires resources and attention. Informants described the challenges of integrating WISEWOMAN with state BCCEDP programs that are in varying development stages and recommended changes in organizational culture and provider practices. Regarding implementation, informants emphasized the need for adequate and appropriate planning, buy-in, training, professional support, and outreach. Our sample also noted that WISEWOMAN projects tend to be labor intensive. CONCLUSIONS: WISEWOMAN projects face challenges of integrating clinical and lifestyle interventions, reaching beyond a focus on individuals, marshaling substantial resources, and introducing complex interventions into stretched healthcare environments. The three Phase One projects were deemed successful in reaching underserved women, developing a more comprehensive women's health model, strengthening linkages to primary healthcare, experimenting with innovative behavioral interventions, and tapping into women's roles as social support providers and family/community gatekeepers.

Adult↗
PubMed2002

Obesity and associated coronary heart disease risk factors in a population of low-income African-American and white women: the North Carolina WISEWOMAN project.

BACKGROUND: Obesity has been associated with many co-occurring coronary heart disease (CHD) risk factors as well as CHD mortality. These associations have been shown to vary between African-American and white sample populations. METHODS: The authors examined whether obesity co-occurs with several CHD risk factors (diabetes, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol (HDL-C)), and estimated the 10-year risk for CHD in the North Carolina WISEWOMAN (Well Integrated Screening and Evaluation for Women Across the Nation) study sample. This sample includes low-income African-American and white women (> or = 50 years of age). RESULTS: Among white women (n = 1,284), 34% were overweight (BMI = 25.0-29.99 kg/m(2)) and 35% obese (BMI > or = 30 kg/m(2)); among African-American women (n = 754), 28% were overweight and 59% obese. Among obese and nonobese African-American women, the prevalence of three or more co-occurring risk factors was similar (obese = 17.7% (95% confidence interval (CI): 13.9, 21.6) and nonobese = 13.3% (95% CI: 8.7, 17.8)). By contrast, the prevalence among white women was greater among the obese (26.9% (95% CI: 22.9, 31.0)) than the nonobese (13.0% (95% CI: 9.7, 16.2)). CONCLUSIONS: The differences between and within African-American and white women may be accounted for by the high levels of HDL-C among obese and nonobese African-American women.

Black People↗
PubMedDate not supplied

Cost-effectiveness of a cardiovascular disease risk reduction program aimed at financially vulnerable women: the Massachusetts WISEWOMAN project.

OBJECTIVE: The Massachusetts WISEWOMAN Project is a cardiovascular disease (CVD) risk reduction program targeting older uninsured and underinsured women. The cost-effectiveness of providing CVD screening and enhanced lifestyle interventions (EI), compared with providing CVD screening and a minimum intervention (MI), was assessed at five El and six MI healthcare sites. METHODS: Cost calculations were based on data collected during screenings and intervention activities conducted with 1586 women in 1996. Risk factor data, including cholesterol and blood pressure measures, were used to create a summary effectiveness outcome, the 10-year probability of developing coronary heart disease (CHD). The cost-effectiveness ratio of the EI, compared with the MI, was calculated by dividing the incremental cost of the EI by the incremental effectiveness of the EI. RESULTS: The incremental cost of the EI was $191. During the 1-year study period, the 10-year probability of CHD decreased from 9.4% to 9.2% in the MI group and from 10.3% to 9.8%in the El group. Based on these results, it would cost $637 to achieve a 1 percentage point larger decrease in the 10-year probability of CHD for women enrolled in the El. However, because differences between groups were not statistically significant, we cannot reject the hypothesis that the El results in no greater reductions in CHD risk. CONCLUSIONS: Although women enrolled in both the MI and El showed decreases in CHD risk during the study period, future research is needed to assess the impact of lifestyle interventions targeting financially disadvantaged women.

Aged↗