white haven heart health project
DESCRIPTION
White Haven Heart Health Project. Bonnie Gregory RN, BSN Bloomsburg University. Heart Disease as Primary Concern. Objective Data at County vs. State Level: ⌘ Heart Disease is the #1 Cause of Death and is on the rise ⌘ Rates for Pennsylvania rose from 135.8 in 1997 to 237.6 in 2005 - PowerPoint PPT PresentationTRANSCRIPT
White Haven Heart Health White Haven Heart Health Project Project
Heart Disease as Primary Concern
Objective Data at County vs. State Level:⌘Heart Disease is the #1 Cause of Death and is
on the rise⌘Rates for Pennsylvania rose from 135.8 in
1997 to 237.6 in 2005 ⌘Rates are significantly higher in Luzerne
County, they rose from 173.3 in 1997 to 284 in 2005
(see next slide for chart of above information)
Age Adjusted Death Rates for Heart Disease*
*Per 100,000 People
Comparison of Heart Disease in Luzerne and Three Bordering Counties
2005 Behavioral Health Risks Associated with Heart Disease
Luzerne County 14% Cardiovascular
Disease 28% Tobacco Use 38% Elevated
Cholesterol Levels 51% Report Not Enough
Physical Activity 26% Obesity 28% Hypertension
Pennsylvania 12% Cardiovascular
Disease 24% Tobacco Use 37% Elevated
Cholesterol Levels 49% Report Not Enough
Physical Activity 25% Obesity 27% Hypertension
Subjective Data Supporting Need for Heart Disease Intervention
What are Members of the Community Saying?
Subjective Data Two women of the focus group
noted that their spouses had suffered from heart related issues and one man in the group also noted that his father passed away from a heart attack
Poor nutrition habits were discussed during the focus group with concern over a diet mainly consisting of “meat and potatoes”
Information on heart attacks was noted as an educational need by one of the focus group members
Lack of healthy places to eat and obesity were noted during the windshield survey
A member of the volunteer ambulance company reported that chest pain and breathing problems were the top two reasons for emergent calls
Previous Study Findings
The Stanford 5-City Project (S 5-C Project) over was a low-cost, comprehensive program in California that resulted in about 26 hours of exposure to multichannel education. Risk factors were assessed in representative cohort and cross-sectional surveys at baseline and in three later surveys. After 30 to 64 months of education, significant reductions in plasma cholesterol level (2%), blood pressure (4%), and smoking rate (13%). These risk factor changes resulted in decreases in mortality risk scores (15%) and coronary heart disease risk scores (16%) for persons aged 25-74 based on Framingham Risk Factors.
Previous Study Findings
Researchers employed a multi-faceted approach during the North Karelia Project (NK Project) in Finland and found that men and women aged 29-59 had a 17% heart disease risk reduction for men and 13% for women in the first 5 years. At 10 years they found a 28% reduction in smoking, a 3% reduction in mean serum cholesterol concentration, and a 3% fall in mean systolic blood pressure. *This study is a great example of cultural diet modification because the community believed meat and fatty foods are good for hard working individuals and growing children.
According to the International Tobacco Control Four Country Survey (ITC4C) cigarette packages with graphic images such as diseased lungs and mouths were more effective in promoting smoking-related knowledge and smoking cessation when compared to packages with text warnings alone for all individuals aged 18 and older.
Who, What, & When?
• Target Population: Men and Women Aged 30-60 • Healthy People 2010 Objective: Improve cardiovascular
health and quality of life through the prevention, detection, and treatment of risk factors
• Multi-modal data-driven program involving community leaders, health professionals, media, education, & contests to affect the top 4 factors with the most modifiable outcome measures: diet, cholesterol, blood pressure, and smoking cessation based on a combination of methods from the NK Project, S 5-C Project, and ITC4C Survey
• Minimum 2 year program (ideally 5-10 years dependant on initial program results and funding) starting in 2010
Key Factors to Make Program Work• Using Influential Leaders in the Community who are to be
determined by speaking to residents and asking them to name the top 5 most active community members that can create change (adapted from NK Project). These leaders will assist in diet education, spreading word in community about program, and setting an example for other community members.
• Using a Public Health Nurse to assist in screening and follow up with individuals & treatment regimen adherence (NK Project) as well as project leader
• A Community Support approach where members are encouraged to support each other and have a sense of patriotism toward the community in wanting to change as a whole (NK Project)
• Use of Media-local newspaper, TV new station, flyers, and brochures (S 5-C Project) for education and program awareness & Smoking Cessation Graphic Images (ITC4C Survey) flyers
Diet Modification
Initiatives for Diet Modification
Making a Community Garden downtown on a lot left empty by fire years ago to increase fresh produce and create a “sense of community togetherness”
“Parties for a Long Life”-like Tupperware Parties where women get together and are shown how to cook new healthy recipes that are budget friendly
Information in local grocery store showing healthier choices with lower trans-fat and taste testing Cooking Classes and Healthy Cooking Competitions
Collaboration with local restaurants by community leaders to add healthier items to menu
(All of above adapted from NK Project except Community Garden)
Cholesterol✓Levels lowered through diet modification methods
mentioned previously
✓Strength of Community: Luzerne had 4% higher cholesterol awareness compared to state levels so that individuals may be more responsive to screenings
Levels will be assessed during screenings with follow up by public health nurses to assure pt made aware of elevated levels and follow up with physician
Framingham Heart Disease Risk Factors Survey filled out during screenings
All specimens done by one lab to standardize test
Blood Pressure
3 Blood Pressure Screenings done along with Cholesterol Checks with follow up by nurse 3Providing information on low salt diets at
supermarket and cooking classes3Establishing a community weight loss
competition with prizes for the “biggest losers”3 Use of local media (new station, paper, and
flyers) to promote overall program, screenings, classes, and weight loss competition
Smoking Cessation
Use of tobacco will be assessed at baseline and post program via surveys
Information on smoking cessation distributed throughout community
Smoking support groups will be utilized in community
Signs outside of buildings, including local hang-outs and bars using graphic images of diseased lungs and mouths, encouraging people not to smoke
Utilizing Strengths in the Community
✜Teaming up with Luzerne County’s Steps Program who partnered with a local television station to create public service announcements and other programming that shows people how small changes in nutrition and physical activity can help prevent many chronic conditions
✜Utilizing individuals that currently volunteer at a local church to help organize and participate in screenings and education as appropriate
✜83% of Luzerne County reported ever having their blood cholesterol checked as compared to only 79% for Pennsylvania according to the 2005 PA Health Risk Behaviors, which may be evidence for increased likelihood of community “buy in”
Measurable Objectives
80% of target population screened for BP and cholesterol by 6 months
2-4% decrease in serum cholesterol levels after 1 year
2-5% decrease in BP after 1 year10% decrease in tobacco use after 1 year5% decrease in risk for heart disease in 2 years
based on Framingham Measures
ReferencesFarquhar, J. W., Fortmann, S., Flora, J., Taylor, C., Haskell, W., Williams, P., . . . Wood,
P. (1990). Effects of Community Wide Education on Cardiovascular Disease Risk Factors: Stanford 5-city project. Journal of American Medicine, 264, 359-365.
McAlester, A., Puska, P., Salonen, J., Tuomilehto, J., & Koskela, K. (1982). Theory and action for health promotion: Illustrations from the North Karelia project. American Journal of Public Health, 72, 43-50.
Thompson, M. E., Fong, G. T., Hammond, D., Bordreau, C., Driezen, P., Hyland, A., . . . Lauz, F. L. (2006). Methods of the international tobacco control (ITC) four country survey. Tobacco Control, 15, 12-18. Retrieved from tobaccocontrol.bmj.com