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Biomedical subjects

R A Carleton

Publications and source records attributed to R A Carleton.

At least 73 records · Page 4Linked to original sources
PubMed1988

Pawtucket Heart Health Program: the process of stimulating community change.

The Pawtucket Heart Health Program (PHHP) is a community-based research and demonstration project in cardiovascular disease (CVD) prevention located in the United States. Targeted risk factors include high blood pressure, elevated blood cholesterol, cigarette smoking, obesity and sedentary living. Evaluation methods included biennial household risk factor surveys in the education and comparison communities, morbidity and mortality surveillance in hospitals serving each community, and both formative evaluation and process tracking. Intervention methods are theoretically derived from social learning theory and seek to motivate, enable and maintain individual behavior change; modify social networks; and introduce environmental change in organizations and normative shifts in the community in ways that reduce the prevalence of CVD risk factors. The intervention strategy began as an organization-based model, and has evolved into a community-wide effort in which marketing research tools and techniques are employed. In the past 4 years, over 40,000 individual contacts have been made with PHHP programs, including 1,260 persons who have volunteered their time to deliver risk factor programs.

Cardiovascular Diseases↗
PubMed1987

Plasma beta-endorphin levels in silent myocardial ischemia induced by exercise.

Although silent myocardial ischemia is a well recognized phenomenon, the reasons for the lack of symptoms in patients with coronary artery disease (CAD) is unclear. Because the endogenous opioid beta-endorphin has been related to pain modulation, plasma beta-endorphin levels were studied before, during and after exercise-induced ischemia in symptomatic and asymptomatic men. Because beta-endorphin responses have been closely linked to adrenocorticotropic hormone (ACTH) and cortisol responses, these hormones also were measured. Nine symptomatic and 12 asymptomatic patients with a high probability (at least 95%) of CAD and 8 apparently healthy men completed a Bruce protocol treadmill test. Blood samples were drawn before, during and 10 minutes after exercise. During exercise the measured hormones showed no significant increases from basal levels. However, plasma beta-endorphin, ACTH and cortisol levels were significantly elevated (p less than or equal to 0.01) 10 minutes after exercise in all 3 groups. There was no significant difference in plasma beta-endorphin levels during or after exercise between the symptomatic and asymptomatic patients with CAD. Thus, differences in circulating levels of beta-endorphin, ACTH and cortisol are not associated with the presence or absence of pain during exercise-induced myocardial ischemia.

Adrenocorticotropic Hormone↗
PubMed1987

Theory and delivery of health programming in the community: the Pawtucket Heart Health Program.

The Pawtucket Heart Health Program is one of the community studies examining whether population-based efforts to lower cardiovascular risk factors will reduce cardiovascular morbidity and mortality. The Pawtucket Heart Health Program intervention is based on a blend of social learning theory, community organization models, community psychology tenets, and diffusion research. This model allows for multifaceted programs that target individuals, groups, organizations, and the entire community to alter their cardiovascular risk through managing blood pressure, lowering blood cholesterol, quitting smoking, increasing fitness, and maintaining desirable weight levels. A dominant feature of the intervention is the emphasis that it places on volunteers for program delivery. The role of volunteers in providing direct services to help citizens lower their blood pressure and lose weight is highlighted to demonstrate the feasibility and effectiveness of these services. In addition, church-based programming which utilizes volunteers to manage and direct programs is also presented as an example of community-based health promotion efforts that promote collective efficacy.

Adolescent↗
PubMed1987

Evaluation of two community-wide smoking cessation contests.

The Pawtucket (Rhode Island) Heart Health Program is designed to effect a community-wide change in heart disease morbidity and mortality by reducing smoking prevalence and other behavioral risks for this disease. The initial emphasis of the Pawtucket Heart Health Program was on the development of risk factor programs within specific churches, work sites, and other organizations in the community. At the end of 9 months of programming, however, only one organization had elected to begin a stop-smoking program. Given the community smoking prevalence of 43.4%, it was decided that larger-scale interventions would be required if a significant public health impact was to be realized. Therefore, a community-wide campaign was mounted to recruit as many participants as possible into the "Up in Smoke" cessation program. A lottery was attached to this program, with the contingency based on program attendance rather than cessation per se. One hundred three participants, including residents of neighboring communities, enrolled in three Up in Smoke lottery groups. At a 3-month follow-up, only 11 (7%) of smokers from the Up in Smoke lottery reported that they were not smoking (10% of those actually contacted). For a variety of reasons, the "Quit and Win" approach was later adopted by the Pawtucket Heart Health Program as the primary smoking intervention. One month after the end of the contest, 20% of those contacted reported not smoking. The percentage of quitters for the Up in Smoke program increased while the Quit and Win rate decreased over longer periods of follow-up. These and other data were compared with those of participants of a screening program conducted concurrently. Lotteries in general and face-to-face recruitment in large crowds were shown to be effective recruiting methods for large-scale smoking cessation programs.

Adult↗
PubMed1987

Characteristics of participants in community health promotion programs: four-year results.

Four years of participant tracking data (N = 24,995) for community-based programs targeting cardiovascular disease risk factors are presented. Over two-thirds of contacts were female; age segment representation in these programs was comparable to the city's demography. However, the data show that programs of varying formats which target specific risk factors attract different types of participants. Implications for marketing strategy are discussed.

Adolescent↗
PubMed1987

Primary prevention of coronary heart disease: a challenge for behavioral medicine.

Arteriosclerosis is importantly influenced by blood cholesterol level, blood pressure, and cigarette smoking. Each of these major risk factors is influenced by behavioral choices made by individuals and supported by societies. Behavioral medicine has a rich tradition of dealing with individuals and small groups. The public health perspective of disease challenges behavioral medicine to develop new strategies and tactics for behavioral modification for health promotion on a population-wide basis. Additional research is needed to test effective methods for influencing population behavior, population risk factors, and ultimately population morbid and mortal event rates. Several major community projects are now investigating the health promotion process targeting individuals, small groups, organizations, and the entire community. School, worksites, and churches are particularly conducive to health promotion programming. Each has unique advantages and disadvantages; each deserves careful experimentation to determine its efficacy for population-wide health promotion efforts. A public health dimension to behavioral change promises widespread impact, generalization to other health promotive behaviors, maintenance of new cultural behavioral norms, and significant reductions in the incidence of many chronic diseases.

Behavior Therapy↗
PubMed1986

Organizational and community approaches to community-wide prevention of heart disease: the first two years of the Pawtucket Heart Health Program.

The Pawtucket Heart Health program (PHHP) is a federally funded research and demonstration project for the primary prevention of coronary heart disease (CHD) in a community. This article presents a discussion of the first 26 months of this intervention, divided into its three phases. PHHP staff initially approached the intervention city through local organizations to accomplish risk-factor behavior change in the population. After 11 months, PHHP complemented its programs in organizations with activities open to all city residents, in order to accelerate participation by the population. Seven months into this phase, it was decided that community activities should be the major focus of the intervention approach to assure a level of participation adequate to make a measurable impact. The third has shown the greatest percentage of public participation, demonstrating the complementary nature of organization and community interventions and of the translation of social learning theory into principles for primary prevention in a community.

Advertising↗
PubMed1986

Community intervention to lower blood cholesterol: the "Know Your Cholesterol" campaign in Pawtucket, Rhode Island.

Sufficient data exist to support approaches to lowering cardiovascular disease risk which target population-wide reductions in elevated blood cholesterol levels. Within the context of a multifactorial cardiovascular disease prevention program, a 2-month cholesterol education campaign was launched to encourage citizens to "Know Your Cholesterol" by attending screening, counseling, and referral events (SCOREs) held throughout the community. These events featured assessment of dietary fat and cholesterol, rapid blood cholesterol analyses with a fingerstick procedure and the Kodak Ektachem DT60, and immediate dietary counseling by trained volunteers. A total of 1439 persons attended 39 SCOREs: nearly 60% were found to have blood cholesterol levels that exceeded recommended goal levels. At a 2-month follow-up of 1040 of these same individuals, 600 had lowered their blood cholesterol level by an average of 29.1 mg/dl. This experience suggests that similarly modeled campaigns may have a significant impact on the distribution of blood cholesterol levels in the entire U.S. population.

Cholesterol↗
PubMed1985

Multivariate evaluation of health attitudes and behaviors: development and validation of a method for health promotion research.

Many self-reported measures of health status, attitudes, and knowledge used by clinicians and researchers suffer from a variety of shortcomings, including limited empirical justification, excessive complexity, assessments of nonmodifiable historic or hereditary factors, and limited utility for public health program planning. The Health Attitudes and Behavior Scale is an instrument designed to overcome many of these shortcomings and direct public health professionals toward more efficacious interventions. One hundred sixty-four subjects responded to true-false and Likert scale items related to health beliefs, attitudes, and behavioral practices. A principal component analysis of the Likert items yielded six components, tentatively labeled (a) Lack of Social Support, (b) Hurdles to Health, (c) Health Attitudes/Weight Concerns, (d) Positive Environment, (e) Disease Concerns, and (f) Time and Work Pressure. Analyses of these scales using coefficient alpha indicated adequate internal consistency for each of them. These scales were then related to demographic variables of age, educational level, sex, and marital status. Next, these scales were correlated with individual true-false items reflecting self-reported behavioral practices or health histories. A component analysis of the true-false items yielded four principal components labeled (a) Organizational Health Concerns, (b) Smoking and Exercise Concerns, (c) Coronary and Weight Concerns, and (d) Blood Pressure and Risk Factor Programs. Finally, a cluster analysis yielded six typical profiles reflecting different levels of the original six components. Of interest is the fact that the Lack of Social Support and Time and Work Pressure scales had a very limited integration into the overall patterns. The assumption that organizational and environmental factors can have an important impact on health was supported. The need for further research in this area is also discussed.

Adolescent↗