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PubMed2007

Family Medicine Curriculum Resource Project: the future.

Under contract to the Health Resources and Services Administration (HRSA), the Society of Teachers of Family Medicine (STFM) created an undergraduate medical education curricular resource designed to train physicians to practice in the 21st century. An interdisciplinary group of more than 35 educators worked for 4 years to create the Family Medicine Curriculum Resource (FMCR). By consensus, the Accreditation Council for Graduate Medical Education (ACGME) competencies were adopted as the theoretical framework for this project. The FMCR provides materials for the preclerkship years, the third-year family medicine clerkship, the postclerkship year, and faculty development, as well as guidance for integrating topics of special interest to the federal government (such as, geriatrics, Healthy People 2010, genetics, informatics) into a 4-year continuum of medical education. There are challenges inherent in implementing each component of the FMCR. For example, can the ACGME competency-based approach be adapted to undergraduate medical education? Can the densely packed preclerkship years be adapted to include more focused effort on developing these competencies, and whose job is it anyway? What is "core" to being a competent clinician, and what information can be obtained when needed from medical informatics sources? Will family medicine educators embrace the FMCR recommendations for their third-year clerkships? Will exit assessment of the competency levels of graduating medical students be achieved, and can it make them more capable residents? Can faculty in different clinical and educational settings integrate the teaching of "how to learn" into their repertoire? How will faculty development innovation progress in a time of increasing emphasis on clinical productivity? Developing a common language and adoption of core competencies for all levels of medical education is imperative in a society that is focusing on improving health care quality and outcomes. The FMCR Project has developed a curricular resource to assist medical educators in this task. The challenge for the future is to measure how the FMCR is used and to ascertain if it has an influence on better patient and system outcomes.

Curriculum↗
PubMed1998

Awareness of cancer-related programs and services among rural African Americans.

African Americans are at increased risk for cancer and represent an important target population for programs such as Healthy People 2000, the Cancer Information Service (CIS), and the 5 a Day for Better Health Initiative. Yet, awareness of such programs among rural blacks is unknown. This study assessed awareness of these programs and determined related knowledge and beliefs among rural African Americans. It was undertaken as part of the baseline survey for the Black Churches United for Better Health project, a National Cancer Institute-funded initiative. A minority of respondents (n = 3737) demonstrated name recognition of Healthy People 2000 (23.4%), the CIS (42.4%), and the 5 a Day Program (40.7%). Far fewer (7.4%) were able to correctly identify the recommended daily number of servings of fruits and vegetables. Reported family history of cancer was associated with a greater tendency believe that eating more fruits and vegetables can prevent disease. These findings underscore the need for efforts to reach the rural black community with culturally sensitive and stage appropriate cancer prevention messages. Knowledge of family history of cancer may play an important role in targeting subgroups and delivering effective cancer prevention messages.

Black or African American↗
PubMedDate not supplied

Hypertension in elderly people in a preventive health program.

Control of hypertension is increasingly being recognized as a significant component of any preventive health care program for the elderly because of the high prevalence of hypertension in this group and its impact on health, particularly cardiovascular diseases. This study evaluates the hypertension screening component in one of the oldest and largest health promotion programs for the elderly in the United States, the Preventive Health Care for the Aging Program (PHCAP) in California. Our findings show that 26.7% of PHCAP participants had hypertensive readings on examination. Of these, 20% had mild hypertension, 5.6% moderate hypertension, and 1.1% severe hypertension. Urban participants were more likely than rural participants to have hypertension. Of those with severe hypertension, living alone was a significant factor when controlling for other variables. Overall, 40.2% of the hypertensive patients were not aware of their hypertension, and whites and Hispanics were less aware than blacks of their hypertensive status. Men were also less aware than women. These findings suggest ways to improve hypertension control programs for healthy elderly people who are self-referred to community-based preventive health care programs.

Aged↗
PubMed2006

Promoting healthy people 2010 through small grants.

The Department of Health and Human Services initiated a pilot "microgrant" or small grants program in 2001 to promote Healthy People 2010 (HP 2010) implemented by the Yale-Griffin Prevention Research Center. This article describes the 103 agencies funded under this initiative and 67 control group agencies. It evaluates the HP 2010 focus areas targeted and the effectiveness of promoting HP 2010 objectives through microgrants. Forty-four percent of the grant recipients and 79% of the control group agencies indicated low levels of familiarity with HP 2010 goals. Changes in knowledge of HP 2010 goals for the microgrant group increased significantly from 5.24 +/- 3.67 to 7.83 +/- 1.86 (p < .05). The results suggest that microgrants can be a useful mechanism to plant the seeds for developing community and organizational capacity to define local health priorities, practice and test new initiatives or expand existing programs and promote knowledge about HP 2010.

Connecticut↗
PubMedDate not supplied

[People taking care of people: the art of caring through radio waves].

The nurse as a primary care provider professional participates actively in health education activities. Within the spoken language, the radio, because of its power of penetration, assumes an important role in the dissemination of health information. Thus, the School of Nursing at Santo Amaro University, in São Paulo, Brazil, initiated a series of community health programs using the services of the university radio. The purpose of this paper is to report on the experience of elaborating and implementing the weekly programs "Healthy Life" and "People taking care of People", in first one implemented in 1996. Due to the positive results obtained, this activity became part of the University Extension Program with the participation of teachers and students.

Brazil↗
PubMed2002

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗
PubMed2004

Health-promotion behaviors that promote self-healing.

A large body of evidence has shown that health-promotion programs in smoking cessation, stress management, fitness, nutrition, weight control, and medical self care have been successful in helping people improve their health practices and related health conditions. However, the impact of these programs on promoting self-healing among people with acute and chronic diseases is mixed. The purpose of this paper is to identify research opportunities important to fostering a better understanding of health promotion behaviors that promote self healing. To provide context, the health-promotion concept is discussed, as is the literature on workplace health-promotion programs provided to overtly healthy people. Next, examples of the literature on health-promotion programs for people with chronic illness are provided. Finally, a research agenda and opportunities for research are presented.

Attitude to Health↗
PubMedDate not supplied

National Black Nurses Association community collaboration model.

In 1991, the National Black Nurses Association was awarded a contract from the Division of Nursing, United States Department of Health and Human Services to develop a community education program addressing eight Healthy People 2000 objectives. Healthy People 2000 is the United States Public Health Services's statement of national priorities for improving the health of all Americans. It provides a framework to reduce preventable deaths and disabilities, and equalize disparities in health status for specific populations. The NBNA Board of Directors chose to address five priority areas: infant mortality, HIV/AIDS, cardiovascular disease, cancer, and recruitment and retention of Blacks in nursing. For each area, specific nursing responsibilities were identified: health promotion, health protection, disease prevention, preventive clinical services, and surveillance and data requirements. The authors developed a model for implementation of the NBNA's Healthy America Report recommendations. The model and data from program implementation are presented with commentary on the efficacy of community partnership models to achieve preventive health goals.

Black or African American↗
PubMedDate not supplied

Using health observances to promote wellness in community pharmacies.

OBJECTIVES: To provide pharmacists in community practice a framework for using national health observances as opportunities to promote patients' health through education and screenings, to discuss obstacles pharmacists may encounter when developing services within their pharmacies, and to outline examples of activities pharmacists can perform for specific health observances. DATA SOURCES: Articles published between January 1970 and April 2002 were identified through MEDLINE using the search terms wellness, disease prevention, health promotion, Healthy People 2010, treatment of high cholesterol, treatment of high blood pressure, and levels of participation. Additional articles were identified from Web sites and reports from the federal Office of Disease Prevention and Health Promotion (ODPHP), American Heart Association, American Diabetes Association, National Osteoporosis Foundation, National Cancer Institute, American Cancer Society, National Heart, Lung, and Blood Institute, Consumer Product Safety Commission, and Centers for Disease Control and Prevention. DATA SYNTHESIS: Healthy People 2010 is a federal program with the goal of increasing the quality and years of healthy life and eliminating health disparities among populations. ODPHP publishes a list of national health observances each year. Community pharmacists can use these month- and week-long observances as opportunities to work toward achieving Healthy People 2010 goals by advocating, facilitating, and/or providing education and screenings to their patients. This article presents advice for pharmacists who want to develop pharmacy-based health promotion activities at various levels of resources and commitment. Specific suggestions include tips on preparing for and implementing education and screening programs and overcoming potential obstacles. CONCLUSION: As the most accessible health care professionals, pharmacists are in a unique position to help the nation achieve the goals of Healthy People 2010 through their involvement in the promotion of wellness.

Community Pharmacy Services↗
PubMed2005

Using outcome measures to monitor the performance of the National Heart Disease and Stroke Prevention Program: current capabilities and future challenges.

To determine the success of a state prevention program and to make timely and effective public health decisions, the program's outcomes must be monitored and evaluated. Twenty-one performance measures for the National Heart Disease and Stroke Prevention Program have been developed from the Healthy People 2010 objectives for heart disease and stroke, from performance measures developed in response to the Government Performance and Results Act (GPRA), and from a fiscal year program announcement. We assessed the availability of state surveillance systems that could address these measures. Current state data were available for only six of the 16 Healthy People 2010 objectives, one of the two GPRA performance measures, and for all three of the surveillance-related measures recommended in the program announcements. If states are to meet the Healthy People 2010 objectives related to high blood pressure, cholesterol, and emergency care during a cardiac arrest, new surveillance resources will be required at both the national and state levels. These would include a national surveillance system of state registries of acute cardiac arrest care, as well as state health examination surveys.

Adult↗
PubMedDate not supplied

Private sector worksite health promotion programs in Missouri: a comparison with national survey findings and Healthy People recommendations.

Questionnaries with 22 multiple-choice questions were mailed to a random sample of 450 Missouri employers with 250 or more employees to determine the prevalence and types of workplace health promotion programs; 262 (58%) responded. Only 34% of the responding companies offered any kind of program and 65% of these offered only awareness programs, but most offered programs on all 18 topics listed in the questionnaire; 48% had a full-time program manager, 79% had some form of evaluation, and 36% had some form of financial incentives.

Cross-Sectional Studies↗
PubMedDate not supplied

A comparison of Omaha worksite health promotion activities to the 1992 national survey with a special perspective on program intervention.

PURPOSE: The purpose of this study was to compare the results from a survey of Omaha worksite health promotion activities with the results of a 1992 national survey. Comparisons were made on: (1) the kinds of health promotion activities offered, (2) progress toward the Healthy People 2000 worksite objectives, (3) types of program intervention offered, and (4) administrative factors. DESIGN: A one-time, written, mail-out/mail-back survey design was used. SETTING: The study took place in Omaha, Nebraska. SUBJECTS: All area public and private worksites with 250 or more employees were sent surveys. Individuals who were preselected and identified as the best qualified within the company completed the survey instrument. Of the 176 worksites surveyed, 86 completed the survey (49%). MEASURES: Descriptive statistics (percentages) were used to compare the two surveys on kinds of programs offered, progress toward Healthy People 2000 related to worksite health promotion, the types of program intervention offered, and administrative factors. RESULTS: Generally, a greater percentage of respondent worksites from the national survey are offering more health promotion activities and have made more progress toward the Healthy People 2000 worksite objectives than the Omaha worksites. Results from both surveys showed that low levels of intervention are more prevalent than high levels of intervention, and that health promotion activities in most worksites are coordinated by human resources departments and not by someone professionally prepared in health education. CONCLUSIONS: Traditionally, major goals of worksite health promotion programs have focused on important organizational outcomes such as improved productivity/morale, reduction in absenteeism, and health care cost-containment. It is important to recognize, however, that low levels of intervention have less impact than more intensive programs on these desired outcomes. Future goals for local and national worksite health promotion programs may need to encourage implementation of more intensive intervention programs.

Health Promotion↗
PubMed2004

Hawaii's healthy start home visiting program: determinants and impact of rapid repeat birth.

OBJECTIVE: Healthy People 2010 calls for reductions in rapid repeat births (RRBs), defined as births occurring within 24 months after a previous birth for women of all ages, and prevention of repeat births during adolescence, regardless of the birth interval. Home visiting has been promoted as a mechanism to prevent child abuse and neglect and to improve pregnancy outcomes. This study aims to assess the impact of home visiting in preventing RRB and its malleable determinants and assesses the influence of RRB on the mother and the index child. We hypothesized that maternal desire to have a RRB, access to a family planning site, and use of birth control would be significant malleable determinants and that the effects of the program in preventing RRB would be mediated through its influence on these variables. We also hypothesized that the occurrence of RRB would result in increased stress and family dysfunction, resulting in adverse maternal and child outcomes such as severe maternal stress, maternal neglect of the index child, decreased maternal warmth toward the index child, and increased behavior problems of the index child. METHODS: The Healthy Start Program (HSP) is a home visiting program to prevent child abuse and neglect and to promote child health and development among newborns of families identified as being at risk for child maltreatment. This study was a randomized, controlled trial of Hawaii's HSP, in which eligible families were randomly assigned to home-visited and control groups. A total of 643 families at risk for child abuse were enrolled between November 1994 and December 1995. Data to measure RRB and malleable determinants were collected through structured maternal interviews and observation of the home environment. We measured RRB through maternal self-report by asking about a subsequent birth in follow-up interviews at 1, 2, and 3 years. To measure the malleable determinants, we measured the mother's desire for a RRB at baseline and at the 1-year interview and determined whether she had access to a family planning site. The mother was also asked which contraceptive methods she had ever used in the past and which methods, if any, she used in the year following the index child's birth. We measured 3 maternal parenting outcomes at the year 3 follow-up interview, ie, parenting stress, neglectful behavior toward the index child, and warmth toward the index child. We used odds ratios with 95% confidence intervals (CIs) to measure the strength of associations. Multiple logistic regression was used to assess 1) program effects on RRB and its malleable determinants, 2) the impact of the malleable determinants on RRB, and 3) the association between RRB and adverse maternal and child outcomes. RESULTS: Each year, 88% of the sample completed a follow-up interview; 81% completed all 3 follow-up interviews. There was no program impact on RRB for mothers overall (HSP: 21%; control: 20%; adjusted odds ratio [AOR]: 1.05; 95% CI: 0.69-1.58). HSP and control groups did not differ significantly in any of the malleable determinants of RRB. When we combined the 2 study groups, malleable determinants had significant effects on RRB. Mothers with a desire to have a child within 2 years after the index birth were significantly more likely to have a RRB, whether this desire was expressed at baseline (AOR: 2.48; 95% CI: 1.32-4.64) or at the year 1 interview (AOR: 2.86; 95% CI: 1.57-5.22). Lack of access to a family planning site at baseline was not associated with RRB, but there was a trend toward a greater likelihood of RRB among those lacking a site at 1 year (AOR: 1.61; 95% CI: 0.93-2.79). Women who had never used birth control before the index birth were more likely to have a RRB (AOR: 1.89; 95% CI: 1.20-2.98), and there was a trend toward a greater likelihood of RRB among women who did not use birth control in the year following the index child's birth (AOR: 1.67; 95% CI: 0.98-2.82). At the 3-year follow-up interview, mothers with a RRB were more likely to have adverse maternal and child outcomes. There was greater likelihood of severe maternal parenting stress (AOR: 2.29; 95% CI: 1.17-4.48), neglectful behavior toward the index child (AOR: 2.42; 95% CI: 1.41-4.18), and poor warmth toward the index child (AOR: 2.84; 95% CI: 1.71-4.42). In families with a RRB, the index child was more likely to exhibit internalizing behavior (AOR: 1.64; 95% CI: 1.04-2.58) and there was a trend toward higher odds of externalizing behavior (AOR: 1.56; 95% CI: 0.98-2.49). CONCLUSIONS: Overall, 20% of the mothers in our sample of at-risk families had a RRB, which was far greater than the national average of 11%. RRB was associated with a greater likelihood of adverse consequences for both the mother and the index child. The lack of program effects can be traced to shortcomings in the program's design and implementation system. HSP contracts required only that family planning be introduced any time during a family's first year of enrollment. Because conception can occur very soon after the index birth, a better design would be to introduce family planning counseling early in a family's enrollment in home visiting. Another shortcoming was that, although fathers could be included in counseling, they took part in only approximately one-fifth of home visits. It is possible that program effects were attenuated in families in which the father wanted a child. In conclusion, the Hawaii HSP did not reduce RRB or alter its malleable determinants. RRB was associated with adverse outcomes for both the mother and the index child. This is particularly relevant for this population of families that are already at risk for child maltreatment, for which we have found parenting stress to be associated with abusive parenting behavior by the mother. Our findings support and broaden the rationale for the Healthy People 2010 objective to reduce RRB. We think our findings are valuable for guiding the future development of home visiting in general and this widely replicated paraprofessional model in particular.

Birth Intervals↗
PubMed2004

Elimination of measles and of disparities in measles childhood vaccine coverage among racial and ethnic minority populations in the United States.

The gap in measles vaccine coverage between white and nonwhite children was as large as 18% in 1970. During the measles epidemic of 1989-1991, attack rates among nonwhite children <5 years of age were 4- to 7-fold higher than rates among white children. Because of the epidemic and of the known disparity in vaccine coverage and risk of disease, a dual strategy to eliminate measles in the United States was implemented: universal interventions likely to reach the majority of children and targeted interventions more likely to reach nonwhite children. In 1992, the gap in coverage between white and nonwhite children was reduced to 6% (from 15% in 1985); the risk of disease among nonwhite children was narrowed to <or=4-fold the risk of white children. During the 1990s, further implementation of the dual strategy resulted in narrowing the gap in vaccine coverage to 2% and elimination of endemic disease in all racial and ethnic populations. This dual strategy deserves close scrutiny by health professionals and policy makers in devising programs to meet the Healthy People 2010 objectives for the elimination of other health disparities.

Black People↗
PubMed2006

Monitoring progress toward achieving Maternal and Infant Healthy People 2010 objectives--19 states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2003.

PROBLEM/CONDITION: Certain modifiable maternal behaviors and experiences before, during, and after pregnancy are associated with adverse health outcomes for the mother and her infant (e.g., physical abuse, insufficient folic acid consumption, smoking during pregnancy, and improper infant sleep position). Information about these behaviors and experiences is needed to monitor trends in maternal and infant health, enhance understanding of the relation between maternal behaviors and infant health outcomes, plan and evaluate maternal and infant health programs, direct policy decisions, and monitor progress toward achieving the national Healthy People 2010 [HP 2010] objectives (US Department of Health and Human Services. Healthy people 2010. 2nd ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington, DC: US Department of Health and Human Services; 2000). REPORTING PERIOD COVERED: 2000-2003. DESCRIPTION OF SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants. PRAMS employs a mixed mode data-collection methodology; up to three self-administered surveys are mailed to a sample of mothers; nonresponders are followed up with telephone interviews. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets that can be used to produce statewide estimates of perinatal health behaviors and experiences among women delivering live infants. This report summarizes data for 2000-2003 from 19 states (Alabama, Alaska, Arkansas, Colorado, Florida, Hawaii, Illinois, Louisiana, Maine, Nebraska, New Mexico, New York, North Carolina, Ohio, Oklahoma, South Carolina, Utah, Washington, and West Virginia) that measured progress toward achieving HP 2010 objectives for eight perinatal indicators: 1) pregnancy intention, 2) multivitamin use, 3) physical abuse, 4) cigarette smoking during pregnancy, 5) cigarette smoking cessation, 6) drinking alcohol during pregnancy, 7) breastfeeding initiation, and 8) infant sleep position. RESULTS: In 2003, prevalence of intended pregnancy among women having a live birth ranged from 48.1% in Louisiana to 66.5% in Maine; during 2000-2003, no state experienced a statistically significant (p< or =0.05) increase in prevalence of intended pregnancy, and one state experienced a significant decrease. In 2003, prevalence of multivitamin use at least four times per week during the month before pregnancy ranged from 23.0% in Arkansas to 45.2% in Maine; during 2000-2003, multivitamin use increased significantly in three states (Illinois, North Carolina, and Utah). In 2003, prevalence of physical abuse by a husband or partner during the 12 months before pregnancy ranged from 2.2% in Maine to 7.6% in New Mexico; during 2000-2003, significant decreases were recorded in three states (Alaska, Hawaii, and Nebraska). In 2003, prevalence of abstinence from cigarette smoking during the last 3 months of pregnancy ranged from 72.5% in West Virginia to 96.1% in Utah; during 2000-2003, a significant increase was recorded in Utah. In 2003, prevalence of smoking cessation during pregnancy ranged from 30.2% in West Virginia to 65.8% in Utah; during 2000-2003, a significant increase was recorded in Utah. In 2003, prevalence of abstinence from alcohol during the last 3 months of pregnancy ranged from 91.3% in Colorado to 98.0% in Utah; during 2000-2003, abstinence increased significantly in Louisiana and Utah but decreased significantly in Florida and Nebraska. In 2003, prevalence of mothers who breastfed their babies in the early postpartum period ranged from 51.2% in Louisiana to 90.3% in Alaska; during 2000-2003, significant increases were recorded in six states (Arkansas, Illinois, Louisiana, Nebraska, North Carolina, and South Carolina). In 2003, prevalence of healthy full-term infants who were placed to sleep on their backs ranged from 50.0% in Arkansas to 78.7% in Washington; during 2000-2003, significant increases were recorded in eight states (Alaska, Colorado, Illinois, Louisiana, Maine, Nebraska, North Carolina, and West Virginia). In 2003, all 19 states achieved or exceeded the HP 2010 objective for smoking cessation during pregnancy, and 16 states achieved the HP 2010 objective for abstinence from alcohol during the last 3 months of pregnancy. In addition, nearly half of the states achieved the objectives for breastfeeding in the early postpartum period and infant back sleep position. However, no state achieved the HP 2010 objectives for intended pregnancy, multivitamin use before pregnancy, absence of physical abuse before pregnancy, or abstinence from smoking during pregnancy. INTERPRETATION: PRAMS data indicate variability among states regarding progress toward achieving HP 2010 objectives in the area of maternal and child health. More progress has been made in achieving objectives focused on the period during and after pregnancy (e.g., smoking cessation and proper infant sleep position); less progress has been made in achieving objectives related to behaviors and experiences in the preconception period (e.g., pregnancy intention and multivitamin use). PUBLIC HEALTH ACTION: State maternal and child health programs can use these state- and population-based data to monitor progress toward achieving HP 2010 objectives, identify indicators to target for intervention, and plan and evaluate programs that promote positive maternal and infant health behaviors, experiences, and outcomes. These data also can be used to guide policy decisions that could affect the health of mothers and infants.

Adult↗
PubMed2001

An evaluation of Choose to Move 1999: an American Heart Association physical activity program for women.

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.

Adult↗