Policy as intervention: environmental and policy approaches to the prevention of cardiovascular disease.

This paper describes the evolution of efforts to prevent cardiovascular disease, from individual health education approaches to broader community education efforts and, finally, to comprehensive and integrated programs addressing environmental, policy, and individual behavior change. Policies are divided into two areas: legislation/regulation and organizational policy. Environmental strategies are measures that alter or control the physical or social environment. Dimensions along which these strategies might be implemented are provided. Policy and environmental approaches can be justified on economic, strategic, and theoretical grounds. Experiences from other fields and other countries provide a framework for conceptualizing cardiovascular disease prevention approaches.     

New York inmates' HIV risk behaviors: the implications for prevention policy and programs.

OBJECTIVES: The median incidence rate of acquired immunodeficiency syndrome (AIDS) among prisoners is 7 times higher than for the general population. Yet high-risk sexual activity and drug use in US correctional facilities remain unexamined. This study explores inmate perceptions of high-risk behavior in New York state prisons and New York City jails and seeks to generate hypotheses to inform policies and future research. METHODS: Participants were 22 former New York state prisoners and 28 current New York City inmates. Participants attended one of six focus groups and completed an anonymous questionnaire. Audiotapes of the groups were transcribed and evaluated. RESULTS: A range of consensual and nonconsensual sexual activity occurs among inmates and between inmates and staff. Without official access to latex barriers, prisoners use ineffective makeshift devices, like rubber gloves and used plastic wrap, in attempts to practice safer sex. Prisoners also shoot drugs intravenously with used syringes and pieces of pens and light bulbs. CONCLUSIONS: The absence of harm-reduction devices behind bars may create a greater risk of HIV transmission there than in the community. Officials should consider distributing risk-reduction devices to prisoners through anonymous methods.     

Progress in prevention of cardiovascular disease

Remarkable progress has been made in understanding the basic processes involved in cardiovascular diseases, as well as in our ability to detect and treat these diseases. This in turn has led to a striking decrease in mortality from cardiovascular disease. At the same time, it is evident that primary prevention must be our ultimate goal. Given the limitations in resources, this is clearly the most cost-effective approach. Epidemiologists and other researchers have defined a large number of cardiovascular risk factors, of which the major ones are age, male sex, hypertension, cigarette smoking, plasma LDL and HDL cholesterol, and blood glucose. Other risk factors include overweight, sedentary lifestyle, water hardness, family history of heart disease before age 65, personality type and stress. The National Heart, Lung, and Blood Institute has launched a three-pronged attack, aimed ultimately at primary prevention and involving activities throughout the biomedical research continuum. We must: (a) support more varied and creative research into the basic mechanisms in the etiology and pathophysiology of arteriosclerosis and hypertension—two processes whose primary mechanisms are still not fully understood, but whose devastating consequences produce most of the morbidity: (b) support clinical trials and other definitive validation exercises to test the assumption that alteration of risk factors will decrease risk; (c) support joint research between the behavioral and biomedical communities so that they may unite their efforts toward learning how to change lifestyles and helping our citizens help themselves. We must be ready today to expeditiously translate to the public those findings that have already been validated and will lead to a healthier and longer life. Areas of controversy should be publicized so that individuals may make their own choices. Public awareness of and attention to risk factors within the past decade appears to have played a major role in the decline in cardiovascular mortality.     

Understanding of cardiovascular disease risk factors among Bangladeshi immigrants in New York City

Objectives: Among all South Asians, Bangladeshis have the highest prevalence of cardiovascular disease (CVD). The purpose of our study was to compare the understanding of CVD risk factors among Bangladeshi immigrants to the general Caucasian population in the U.S.

Design: We surveyed Bangladeshi immigrants in Queens, New York using a CVD risk factor knowledge instrument used in the Coronary Artery Risk Development in Young Adults (CARDIA) study to assess awareness of risk factors. Using multivariate regression modeling, we compared scores on the knowledge instrument between Bangladeshis we surveyed and Caucasians from the CARDIA study, controlling for potential confounders. We subsequently examined the frequency of mentioning each risk factor to understand what was driving the difference in the overall score.

Results: The proportion of Bangladeshis scoring low on the knowledge assessment was 0.53, where as the proportion of whites scoring low in the CARDIA study was 0.32 (p value?<?.001). Whites were 34% more likely to score high than Bangladeshis (adjusted odds ratio [aOR] 1.34, 95% confidence interval [CI] 1.19–1.52). Bangladeshis were more likely to mention diet and cholesterol as risk factors and less likely to mention lack of exercise, being overweight, and smoking as risk factors.

Conclusion: Understanding of cardiovascular disease risk factors was lower among Bangladeshis than whites. This was driven by Bangladeshis having less awareness regarding how exercise and being overweight contribute to CVD. Community based interventions and community health partnerships should target these behavioral risk factors in the Bangladeshi population.     

Israel's prevention programs and screening policies for cardiovascular disease

For all four broad ethnic groups in Israel, mortality rates declined over the last decade for both ischemic heart disease (IHD) and cerebrovascular disease (CVD), the first and third most important causes of death in the country. The four broad ethnic groups consist of persons born in Israel, Asia, North Africa, and Europe. Mortality data also indicate a low male to female ratio in mortality from IHD, a definite female predominance in mortality from CVD, and high mortality rates for IHD and CVD in males and females born in North Africa. Morbidity data, especially incidence, are scarce for CVD in both sexes and IHD in females. The feasibility of preventive intervention needs to be tested under the specific conditions of Israel. Although a multiple risk factor trial in Jerusalem showed that such a program can be conducted in a primary care framework, it clearly still needs to be tested in clinics rather than in a model teaching institution. The best place for intervention would seem to be the primary health care system, which has almost complete access to the country's population. Kupat Holim (the Health Insurance Institute of the General Federation of Labour) is attempting systematically to identify and manage hypertension patients. To date, management of acute coronary disease has been emphasized in Israel. Although additional resources are needed for primary prevention services, other options are suggested for obtaining those services.     

Trans fat and cardiovascular disease mortality: Evidence from bans in restaurants in New York

This paper analyzes the impact of trans fat bans on cardiovascular disease (CVD) mortality rates. Several New York State jurisdictions have restricted the use of ingredients containing artificial trans fat in food service establishments. The resulting within-county variation over time and the differential timing of the policy's rollout is used in estimation. The results indicate that the policy caused a 4.5% reduction in CVD mortality rates, or 13 fewer CVD deaths per 100,000 persons per year. The averted deaths can be valued at about $3.9 million per 100,000 persons annually.     

Occupational and environmental medicine in New York State

New York State (NYS) is home to 7.2% of the population and producer of 8.4% of the gross domestic product of the United States. The history and the current status of occupational and environmental medicine (OEM) research, educational resources, clinical practice patterns, and regulatory framework in NYS are reviewed. Changes anticipated or already taking place in health care financing, clinical practice patterns, occupational safety and health regulations and enforcement, and funding for research and medical education at the national level, are already having an impact in OEM activities in NYS. Received: 11 December 1996 / Accepted: 20 December 1996     

Translating evidence into policy for cardiovascular disease control in India

Cardiovascular diseases (CVD) are leading causes of premature mortality in India. Evidence from developed countries shows that mortality from these can be substantially prevented using population-wide and individual-based strategies. Policy initiatives for control of CVD in India have been suggested but evidence of efficacy has emerged only recently. These initiatives can have immediate impact in reducing morbidity and mortality. Of the prevention strategies, primordial involve improvement in socioeconomic status and literacy, adequate healthcare financing and public health insurance, effective national CVD control programme, smoking control policies, legislative control of saturated fats, trans fats, salt and alcohol, and development of facilities for increasing physical activity through better urban planning and school-based and worksite interventions. Primary prevention entails change in medical educational curriculum and improved healthcare delivery for control of CVD risk factors-smoking, hypertension, dyslipidemia and diabetes. Secondary prevention involves creation of facilities and human resources for optimum acute CVD care and secondary prevention. There is need to integrate various policy makers, develop effective policies and modify healthcare systems for effective delivery of CVD preventive care.     

Lifestyle intervention for the prevention of cardiovascular disease

The high cardiovascular disease prevalence in western countries is largely attributable to the contemporary lifestyle. Interventions in the area of nutrition and physical activity have been shown to be effective in the prevention of cardiovascular disease. Successful implementation of lifestyle intervention programmes may be just as effective as drug treatment. In combination with drug treatment, intervention in the area of nutrition and physical activity is the recommended treatment for patients at a high risk of cardiovascular disease. Addition of new drugs to those presently available is associated with low absolute risk reductions and high costs, particularly in the presence of successful lifestyle interventions.     

Nutrition protocols for the prevention of cardiovascular disease

Cardiovascular disease is the number one cause of death in the United States, and prevention of cardiovascular disease is at the top of the public health agenda. Evidence shows that reducing the incidence of coronary heart disease with diet is possible. More than a half century of evidence from epidemiologic, experimental, and clinical trials pinpoints a positive correlation between lifestyle and dietary factors as they relate to blood lipids, blood pressure, and coronary heart disease risk, and a number of evidence-based nutrition guidelines have emerged. The National Cholesterol Education Program's Therapeutic Lifestyle Changes diet includes unsaturated fats, fiber, and plant sterols/stanols. The whole foods approach incorporates increased consumption of fruits, vegetables, whole grains, and fish; and the American Heart Association guidelines emphasize functional foods like soy protein, nuts, and alcohol. These guidelines display the rationale for nutrition intervention as a primary prevention for cardiovascular disease. In addition, body weight, body mass index, waist circumference, and waist-to-hip ratio are examined as risk factors for cardiovascular disease. This article highlights key nutrients and lifestyle factors in preventing cardiovascular disease and identifies practical applications for clinicians.     

Regular use of aspirin for cardiovascular disease prevention in Italy

ObjectiveOnly a few European studies focused on aspirin use in the general population. We provide updated information on the prevalence and determinants of regular aspirin use for the prevention of cardiovascular disease (CVD) in the Italian adult population.MethodWe used data from a survey conducted in Italy in 2013, on a sample of 3000 individuals, representative of the general Italian population aged ≥ 15 years.ResultsOverall, 10.9% of Italians reported a regular use of aspirin, 11.2% of men and 10.5% of women. Aspirin use significantly increased with age. The highest prevalence of aspirin use was observed among the elderly (30.3%), ex-smokers (22.6%), and in individuals with a diagnosis of diabetes (52.0%), hypertension (42.6%) or hypercholesterolemia (38.6%). After adjustment for several covariates, no significant heterogeneity in aspirin use was observed according to education, body mass index, and physical activity. Only 1.2% of low CVD risk individuals regularly used aspirin versus 48.3% of individuals with high CVD risk.ConclusionAbout 3.4 million high CVD risk Italians do not regularly use aspirin for primary or secondary prevention. Thus, more widespread preventive strategy is recommended for this population, once individual benefits of regular aspirin use exceed harms.