Biomedical subjects

S P Fortmann

Publications and source records attributed to S P Fortmann.

At least 55 records · Page 3Linked to original sources

PubMed1995

Mortality from coronary heart disease and stroke for six ethnic groups in California, 1985 to 1990.

Coronary heart disease and stroke death rates were compared for six ethnic groups (non-Hispanic white, Hispanic, African-American, Chinese, Japanese, and Asian Indian) by sex and age (25 to 44, 45 to 64, 65 to 84, and 25 to 84 years old) using California census and 1985 to 1990 death data. African-American men and women in all age groups had the highest rates of death from coronary heart disease, stroke, and all causes (except for coronary heart disease in the oldest men). Hispanics, Chinese, and Japanese in all age-sex groups had comparatively low death rates for coronary heart disease and stroke, although stroke was proportionally an important cause of death for Chinese and Japanese groups. Coronary heart disease was an important cause of death for Asian Indians although death rates were generally not higher than those for other ethnic groups. Ethnic differences were most marked for women and younger age groups.

Adult↗

PubMed1995

Nicotine gum and self-help behavioral treatment for smoking relapse prevention: results from a trial using population-based recruitment.

Smokers aged 18 to 65 years (N = 1,044) who were able to quit for 24 hr were randomized using a 2 x 2 factorial design to compare nicotine gum to no gum use and self-help materials to no use of materials. All participants were offered a $100 incentive to quit and stay quit for 6 months. Six-month abstinence was 27% in the gum groups, compared with 19% in the no-gum group (p = .002). Compared with the no-gum group, relapse occurred at a significantly lower rate in the gum group for the entire 12 months of follow-up (odds of relapse in the gum group was 0.72, 95% confidence interval, 0.62 to 0.83). There was no significant main effect for the self-help materials, no interaction between gum and materials, and no evidence that the effectiveness of gum differed between the sexes or between heavy and light smokers. Nicotine gum is an effective adjunct to minimal-contact smoking cessation materials plus monetary incentive in a population-based sample of smokers.

Adult↗

PubMed1994

Who shall quit? Comparison of volunteer and population-based recruitment in two minimal-contact smoking cessation studies.

To better understand the generalizability of experimental smoking studies, the authors compare volunteer and population-based recruitment in two randomized clinical trials of smoking cessation methods, one that used a volunteer sample and one that used a random, population-based sample. Participants are compared with nonparticipants within each study, to the participants in the other study, and to the general population. Smokers aged 18-65 years without contraindications to using nicotine polacrilex who were able to quit unassisted were eligible for the two studies. In the first study (1984-1989), advertising recruited 3,758 eligible smokers (75% of all inquiries) who were willing to give a baseline telephone interview. Of these 3,758 eligible smokers, 2,592 attempted to quit and 1,226 succeeded for 48 hours and were randomized. In the second study (1988-1993), 7,135 smokers were identified through a random household telephone survey, and of these 7,135 smokers, 5,124 (72%) agreed to the telephone interview, 2,209 made a quit attempt, and 1,170 succeeded for 24 hours and entered the study. Compared with nonparticipants who provided an interview, subjects in both studies were more likely to be male, married, and employed, and were older and better educated. Compared with population-based recruitment, volunteer recruitment produced subjects who were less likely to be male and married, and were older, more educated, only slightly less representative of all ethnic subgroups, and heavier, more addicted smokers. Women were less likely than men to quit in the first 24-48 hours. The authors conclude that volunteer recruitment to smoking cessation studies appears to produce a reasonable sample of smokers, especially of heavy smokers, and that, compared with men, women may have more difficulty with the initial stages of smoking cessation.

Adolescent↗

PubMed1994

Hispanic/white differences in dietary fat intake among low educated adults and children.

BACKGROUND: This comparative study tests for ethnic differences in dietary fat consumption in a community-based sample of Hispanic and white adults with low educational attainment (< 12 years of schooling) and a separate sample of their children. METHODS: Data are presented for adults (age 20-64, n = 886) and youths (age 12-19, n = 170) from four California cities who participated in one of four sequential cross-sectional surveys (1981-1990). RESULTS: After adjustment for age, sex, city of residence, and time of survey, white adults were significantly (P < 0.03) more likely than Hispanic adults to have eaten high-fat foods in the last 24 hr, such as red meat (75.7% vs 68.4%), cured meats, (39.1% vs 25.8%), and cheese (41.4% vs 32.7%). Furthermore, white adults consumed significantly (P < 0.001) more fat, as measured by percentage of calories from total fat (37.7% vs 33.3%) and saturated fat (13.7% vs 11.8%), and consumed significantly less dietary carbohydrate (45.5% vs 49.7%) and fiber (17.1 g vs 26.0 g) than Hispanic adults. Ethnic differences were similar for the youth sample (except for carbohydrates), but were generally not significant. A graded relationship was found between acculturation and dietary measures, where more acculturated Hispanics (English-speaking) were intermediate between less acculturated Hispanics (Spanish-speaking) and whites in their dietary intake. CONCLUSIONS: This study illustrates the high dietary fat consumption of whites with low educational attainment, the increasing fat consumption of Hispanics at higher levels of acculturation, and the need for effective dietary interventions for low educated whites and Hispanics.

Acculturation↗

PubMed1994

The capacity-building approach to intervention maintenance implemented by the Stanford Five-City Project.

Increasingly, agencies supporting community health promotion interventions require participating communities and evaluators to specify how the intervention will be maintained once agency funding ends. The Stanford Five-City Project (FCP) implemented two different strategies to maintain its heart disease education program, with the second strategy designed to overcome the barriers to implementation that were encountered by the first. This paper provides a practice-oriented description of the initial 'community network' maintenance strategy of the FCP, the barriers that were encountered as this network strategy was implemented, the alternative 'capacity-building' strategy directed at local health educators and the successful implementation of this alternative. Also discussed are the community organization issues underlying the shift in intervention maintenance strategies and the specific components of the capacity-building strategy, including its focus on health educators, and its application of a training of trainers model and cooperative learning methods to provide professional development, technical assistance and other resources to a target group of community health educators. Our experience indicates that capacity-building is a viable method for intervention maintenance and that it may also facilitate efforts to disseminate model health promotion programs to communities lacking experience in community health promotion intervention.

California↗

PubMed1994

Role of nicotine dependence in smoking relapse: results from a prospective study using population-based recruitment methodology.

Results of a prospective examination of factors influencing smoking relapse are reported for a sample of smokers (N = 522) obtained through population-based recruitment. All subjects were given a modified Fagerstrom Tolerance Questionnaire (modified FTQ), which is a 5-item self-report instrument characterizing smokers according to their degree of nicotine dependence. At 30 days post-cessation, those placing in the lowest quartile of the modified FTQ at baseline had the highest survival rate (79%) and those placing in the highest quartile at baseline had the lowest survival (non-relapse) rate (43%). The difference in survival among the groups was statistically significant (p < .001). At 12 months, those placing in the lowest quartile of baseline cigarette consumption had the highest survival rate (34%) and those placing in the highest quartile had the lowest survival rate (14%; p < .001). It seems increasingly clear that level of dependence, even as indexed by comparatively crude self-report measures such as amount smoked is associated with the rate and pattern of smoking relapse.

Journal Article↗

PubMed1993

Associations between changes in physical activity and risk factors for coronary heart disease in a community-based sample of men and women: the Stanford Five-City Project.

Aerobic exercise training studies involving volunteers generally result in an improved cardiovascular risk factor profile. Little is known, however, about associations between physical activity change and risk factor change in a more representative sample, such as a community. This investigation evaluated correlations between a composite physical activity change score and change in cardiovascular risk factors from 1979 to 1985 in the cohort sample of the Stanford Five-City Project. Men (n = 380) and women (n = 427) between the ages of 18 and 74 years were evaluated for change in self-reported physical activity and change in total cholesterol, high density lipoprotein cholesterol (HDL cholesterol), systolic blood pressure, resting pulse rate, and body mass index (weight (kg)/height (m)2). For men, improvement in the composite physical activity score significantly correlated with an increase in HDL cholesterol (r = 0.14, p = 0.005) and decreases in body mass index (r = -0.16, p = 0.001) and estimated 10-year coronary heart disease risk score (r = -0.10, p = 0.056). For women, improvement in the physical activity score was associated with changes in HDL cholesterol (r = 0.11, p = 0.028) and resting pulse rate (r = -0.15, p = 0.001). These data demonstrate that an increase in physical activity over 5 years is favorably associated with changes in major cardiovascular disease risk factors in men and women and support the public health efficacy of community-wide promotion of physical activity.

Adolescent↗

PubMed1993

Health-related risk factors in a sample of Hispanics and whites matched on sociodemographic characteristics. The Stanford Five-City Project.

Although past studies have compared health-related risk factors in Hispanics and whites, few studies have controlled for potential confounding from sociodemographic variables. Using data on men and women aged 25-74 years who responded to biennial cross-sectional surveys conducted in four diverse California cities from 1979 to 1990, the authors employed a matched-pairs design in which 756 Hispanic respondents were matched to 756 white respondents according to age, sex, educational level, city of residence, and time of survey. No significant differences between Hispanics and whites were found for any of the blood pressure indicators (systolic and diastolic blood pressure, prevalence of hypertension, and use of antihypertensive medication), caloric intake, total cholesterol, alcohol intake, or physical activity. The only variables for which Hispanics had higher levels of risk factors than whites were body mass index (weight (kg)/weight (m)2; 27.5 vs. 25.6, p < 0.001) and high density lipoprotein cholesterol (48.6 mg/dl vs. 50.1 mg/dl, p < 0.03). Whites, on the other hand, were significantly more likely to be current smokers than Hispanics (34.2% vs. 24.0%, p < 0.001) and, among smokers, to smoke a greater number of cigarettes per day (19.7 vs. 11.4 cigarettes/day, p < 0.001). Whites were also significantly more likely to have higher-fat diets, as measured by percentages of calories derived from total fat (37.6% vs. 35.1%, p < 0.04) and saturated fat (13.6% vs. 12.3%, p < 0.03). Examination of interactions indicated further risk factor differences by ethnicity across several sex, age, and educational subgroups.

Adult↗

PubMed1993

Effect of community health education on plasma cholesterol levels and diet: the Stanford Five-City Project.

This paper examines the effects of community-wide health education on diet-related knowledge and behavior and on plasma cholesterol levels during an experimental field study in medium-sized cities in northern California. Samples of the population aged 12-74 years were drawn at baseline and every 2 years thereafter to obtain four cross-sectional surveys; participants aged 25-74 years are included in this paper (n = 6,814 or about 425 per city per survey). The baseline sample was asked to return to three follow-up surveys, also 2 years apart, constituting the cohort survey sample (n = 777). Diet was assessed by 24-hour recalls. In the serial cross-sectional survey samples, nutritional knowledge increased over time in both men and women in all cities; among women, this increase was significantly greater in the treatment cities. Plasma cholesterol declined significantly only in men and in neither sex was there evidence of a larger decline in treatment than in control cities. Dietary saturated fat intake tended to decline, but not significantly in either sex, and there was no evidence of treatment impact. Dietary cholesterol intake declined in both sexes. Results in the cohort samples were similar, except plasma cholesterol levels were unchanged over time in men and increased in women, and dietary saturated fat intake declined significantly among women. Secular improvements in knowledge of nutrition and in dietary cholesterol intake occurred during the early 1980s in both men and women in these four cities, while there was less consistent improvement in dietary saturated fat intake. Only nutritional knowledge among women achieved greater improvement in treatment cities than in control cities. Continued and greater change in nutrition probably requires more sustained effort and broader methods, including changes in the food supply.

Adult↗

PubMed1993

Changes in coronary heart disease risk factors in the 1980s: evidence of a male-female crossover effect with age.

The Stanford Five-City Project was initiated in 1978 to evaluate the effects of community-wide health education on coronary heart disease risk factors in two control (San Luis Obispo and Modesto) and two treatment (Monterey and Salinas) cities. This paper examines sex differences in the prevalence of smoking, hypercholesterolemia, and hypertension from the baseline survey in 1979-1980 through the conclusion of the intervention in 1985-1986. Four independent cross-sectional surveys (n = 1,713, 1,709, 1,848, and 1,768) and four repeated surveys of a cohort (n = 817) were conducted. This analysis presents findings separately for a younger age group (25-49 years) and an older age group (50-74 years). Smoking, hypercholesterolemia, and hypertension were more prevalent among younger men than younger women in both treatment and control cities. In general, this excess risk among younger men disappeared or reversed in the older age group. Over the 7-year study, the prevalence of hypertension and smoking decreased for both men and women in all surveys, the prevalence of hyper-cholesterolemia displayed no definite change, and male/female ratios of risk factor prevalence showed either no change or a slight decrease. This study confirms a higher prevalence of the three major risk factors for coronary heart disease among younger men, with the prevalence of hypercholesterolemia and, to a lesser extent, the prevalence of smoking becoming greater among women than men in the older age group and the prevalence of hypertension becoming equivalent.

Adult↗

PubMed1993

Changes in adult cigarette smoking prevalence after 5 years of community health education: the Stanford Five-City Project.

To determine the effects of 5 years of community-wide cardiovascular health education on smoking prevalence and cessation, the authors analyzed data from the Stanford Five-City Project, an experimental field study with two treatment cities and two control cities. Representative samples of the population aged 12-74 years were drawn at baseline and every 2 years thereafter to obtain four independent cross-sectional surveys; participants aged 25-74 years are included in this paper (n approximately 440 per city per survey; total n = 6,981). The baseline sample was asked to return to three follow-up surveys, also 2 years apart, and those that did (n = 805) constitute the cohort survey sample. Self-reported cigarette smoking was confirmed by plasma thiocyanate and expired-air carbon monoxide levels. Smoking prevalence decreased over time in all cities, but in the cohort the decrease tended to be greater in treatment than in control cities (p = 0.10, two-tailed); the treatment-control difference was consistent over time (-1.51 percentage points/year in treatment vs. -0.78 percentage points/year in control, p = 0.007, two-tailed). In contrast, smoking prevalence in the independent samples declined similarly in treatment and control cities, changes were not linear, and rates varied within cities between times. Baseline smokers in both the cohort and the follow-up independent surveys were significantly more likely to quit in the treatment cities than in the control cities.

Adult↗

PubMed1993

The favorite cigarette of the day.

The choice of a favorite cigarette smoked during a given day varies considerably. Preferences are related to nicotine dependence and the lifestyles of smokers. In a sample of 5124 smokers, the "after-dinner cigarette" was chosen as the cigarette which they would miss most, while the next largest proportion of smokers (33%) said that they would miss the "first cigarette of the morning" most. The latter group scored highest on tests of nicotine dependence. In contrast, infrequent smokers ("chippers") chose the after-dinner cigarette.

Adolescent↗

PubMed1993

Reduced plasma ascorbic acid concentrations in nonsmokers regularly exposed to environmental tobacco smoke.

Oxidants in cigarette smoke accelerate metabolic turnover of ascorbic acid (AA), and thereby deplete body stores of this potent antioxidant and putative anticarcinogen in active smokers. We examined plasma AA concentrations and vitamin C intakes in nonsmokers regularly exposed to environmental tobacco smoke (ie, passive smokers; n = 44), as compared with active smokers (n = 47) and nonexposed nonsmokers (n = 50), to determine whether passive smokers also exhibit altered AA nutriture suggestive of oxidant exposure. Plasma AA concentrations in passive smokers were intermediate between those of active smokers (P = 0.0001) and nonexposed nonsmokers (P = 0.01) despite similar dietary vitamin C intakes. Hypovitaminosis C (< 23 mumol/L) was observed in 24% of active smokers and 12% of passive smokers but not in nonexposed nonsmokers. Reduced plasma AA concentrations were associated with low vitamin C intakes within smoke-exposed populations only. We conclude that chronic smoke exposure, particularly in association with low vitamin C intake, may reduce AA pools in both active and passive smokers.

Adult↗

PubMed1993

Cardiovascular disease risk factors: improvements in knowledge and behavior in the 1980s.

This study surveyed 4158 adults residing in two control cities of the Stanford Five-City Project. Analysis of five cross-sectional surveys (conducted in 1979 through 1990) demonstrated improvements in respondents' general cardiovascular disease risk factor knowledge and behaviors. Cholesterol-related knowledge and behavior showed particularly marked improvements.

Adult↗

PubMed1992

Impact of a clinical preventive medicine curriculum for primary care faculty: results of a dissemination model.

BACKGROUND: This study was designed to test a dissemination model for providing clinical preventive medicine (CPM) training to general internal medicine faculty across the United States. METHODS: The model incorporated direct instruction of a few faculty as seminar facilitators who, in turn, taught a CPM curriculum to their faculty colleagues, who then could teach it to housestaff and students. The CPM curriculum consisted of six seminars that focused primarily on the risk factors for chronic diseases and on behavior change methods for modifying smoking, diet, and exercise. RESULTS: Faculty who participated in the seminars had significant pre- to post-test increase in knowledge and reported self-efficacy to implement CPM strategies with patients, as well as changes in CPM clinical practices. These faculty, in turn, successfully disseminated CPM information to their housestaff, who also had increases in self-efficacy and changed clinical practices regarding CPM topics. CONCLUSIONS: The successful implementation of the dissemination model attests to its viability as a mechanism for disseminating CPM curricula and increasing the emphasis on CMP issues in both clinical teaching and clinical encounters with patients.

Adult↗

PubMed1992

Trends in cardiovascular disease risk factors by educational level: the Stanford Five-City Project.

BACKGROUND: Trends in blood pressure, smoking, and cholesterol were examined from 1979-1980 through 1985-1986 in four cities in California by level of education (< high school, high school graduate, some college, college or postgraduate). METHODS: Four biennial cross-sectional surveys (n = 6,580) were conducted in two treatment and two control cities to evaluate a 6-year community health education intervention, conducted as part of the Stanford Five-City Project. RESULTS: Over the 8-year study period, men and women ages 25-74 from each educational group in the treatment cities showed significant declines in smoking prevalence and levels of blood pressure and cholesterol (with the exception of cholesterol in women). In general, declines in the least educated group (< high school) were stronger than declines in the most educated group (college or postgraduate). Similar declines occurred in each educational group in control cities. CONCLUSIONS: These results illustrate that persons from all educational levels can modify their risk for CVD and are of particular importance because of the higher prevalence of CVD risk factors among those with less education. The similarity of time trends in treatment as well as control cities suggests that the broad-based, multisource health education efforts in the United States are succeeding across the educational spectrum.

Adult↗

PubMed1992

Who will relapse? Symptoms of nicotine dependence predict long-term relapse after smoking cessation.

Results of a prospective examination (N = 618) of factors associated with smoking relapse are reported. At 1-year follow-up, a modified version of the Fagerstrom Tolerance Questionnaire (Dependence Index; DI) and a measure of craving entered the logistic model (odds ratio of 2.7 [p less than .001]). At Year 2, only the DI entered the model (odds ratio of 2.2 [p less than .001]). The ability of signal detection analysis (SDA) to produce clinically useful decision rules was also examined. At Year 1, SDA produced 1 subgroup with a 25% nonrelapse rate and another with a 9% nonrelapse rate (odds ratio of 3.4 [p less than .001]). At Year 2, SDA produced 1 subgroup with a nonrelapse rate of 19% and another with a nonrelapse rate of 7% (odds ratio of 3.0 [p less than .001]). The use of signal detection methods may help clinicians to identify those at greater or lesser risk of relapse.

Adult↗

PubMed1992

The medical origins of homelessness.

In 1989 through 1990, we conducted a cross-sectional survey of 1437 homeless adults in northern California (98% response rate). Prevalences of alcohol abuse, illegal drug use, and psychiatric hospitalization when adults first became homeless were 15% to 33% lower than prevalences following homelessness. The largest differences between the homeless and a comparison group of 3122 nonhomeless adults were for psychiatric hospitalization (odds ratios [ORs] of 4.6 for men and 5.9 for women) and alcohol abuse (ORs of 2.3 for men and 4.0 for women). However, when prehomeless prevalences of addictive and psychiatric disorders were compared with prevalences among the nonhomeless, absolute differences were no greater than 12%.

Adolescent↗