Critical Perspectives on Racial and Ethnic Differences in Health in Late Life (2004) / Chapter Skim
Currently Skimming:
Section IV--The Challenge Of Identifying Effective Interventions17 Behavioral Health Interventions: What Works and Why?
Section IV--The Challenge Of Identifying Effective Interventions17 Behavioral Health Interventions: What Works and Why?
Pages 641-674
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 641... ...
Section IV The Challenge Of Identifying Effective Interventions
|
From page 643... ...
The most important individual intervention trial is the Multiple Risk Factor Intervention Trial (MRFIT) conducted in the 1970s.
|
From page 644... ...
Risk factors and health outcomes did not improve any more rapidly in the intervention sites than in the control sites. In contrast to the failure of community-level encouragement, public policies have been shown to have large effects on health behaviors.
|
From page 645... ...
Some speculate that individual and community interventions do not have major effects because they are not implemented for a long enough period of time. But this chapter shows that many national interventions achieve large behavioral changes within a shorter period of time than typical individual- and community-level interventions.
|
From page 646... ...
Among white males, for example, mortality fell by 52 percent. For both men and women, the racial gradient in cardiovascular disease mortality has increased.
|
From page 647... ...
. A more complex intervention would target people with several risk factors and encourage a variety of behavioral changes: eliminating cigarette smoking, lowering consumption of fatty foods, reducing overall caloric intake, exercising more regularly, visiting physicians for hypertension and cholesterol screening, and adhering to medication guidelines.
|
From page 648... ...
The most important of these interventions was the Multiple Risk Factor Intervention Trial (Gotto, 1997; Multiple Risk Factor Intervention Trial Research Group, 1982, 1990, 1996)
|
From page 649... ...
Differential changes in blood pressure, cigarette smoking, and cholesterol were statistically significant; changes in mortality rate were not. SOURCE: Data are from Multiple Risk Factor Intervention Trial Research Group, 1982, 1990, 1996.
|
From page 650... ...
SOURCE: Multiple Risk Factor Intervention Trial Research Group (1982)
|
From page 651... ...
If this theory were correct, the change in risk factors between the treatment and control groups should be increasing over time, as more treatment group members adopt healthier lifestyles. In fact, however, the risk factor change is relatively constant from year 1 to year 6 (Multiple Risk Factor Intervention Trial Research Group, 1982)
|
From page 652... ...
The failure of the MRFIT to achieve risk reduction on the scale hypothesized led to a series of community-level interventions to reduce cardiovascular disease risk. These community-level interventions are described in the next section.
|
From page 653... ...
Each trial had one or more treatment cities matched with an equal number of control cities (two treatment and two control cities in the Stanford Five City Project; three treatment and three control cities in the Minnesota Heart Health Program; and one treatment and one control city in the Pawtucket Heart Health Program)
|
From page 654... ...
and some factors activity Index in Coronary factors cholesterol, mortality cholesterol, factors Index cardiovascular risk of program Murray treatment cities in factors cities in Mass cities on on on in risk reduction to risk Mass physical risk in in in in Body effect effect control change effect control change Luepker, Trials of knowledge factors Body treatment cities exposure and in or and risk changes differential in years changes increase changes 5 Program: differential differential differential differential mortality differential exception Increase (CHD) Positive cities Modest obesity No treatment No Significant after Positive treatment No pressure, Modest No or Positive treatment No the Intervention Results · · · · · · · · · · · · Health risk and Heart Disease cities direct cities year and and five media, city activity and factors to per community control physical control usage Minnesota prevention mass nonsmoking, risk control smoking and media four physical three for cholesterol two and one of labeling)
|
From page 655... ...
In the Stanford Five City Project and the Minnesota Heart Health Program, for example, knowledge of coronary heart disease risk factors rose significantly more in the treatment group than in the intervention group. Thus, the programs achieved their first goal of making people aware of disease risk.
|
From page 656... ...
The improvement in the risk factor profile in both treatment and control cities was large; only the differential between the two was small. In addition to these multifaceted interventions, other interventions have focused on particular risk factors.
|
From page 657... ...
Knowledge of cardiovascular disease risk improved when it was measured, and people interacted with the program in the intended ways. Rather, the knowledge did not produce appropriate action.
|
From page 658... ...
Overall, the finding that cigarette taxes discourage utilization is not in much dispute. Other public policies also affect cigarette consumption.
|
From page 659... ...
Although price increases are a good way to discourage smoking, price increases have distributional implications that trouble some people. Because people with lower incomes smoke at much higher rates than those with higher incomes, tax increases would be paid more by those with lower incomes (although the benefits of smoking cessation go to lower income people more than higher income people as well)
|
From page 660... ...
In this section, I review three national interventions: information about the harms of tobacco; the movement against drunk driving; and information about appropriate dietary habits. These interventions were chosen because there is some evidence they were at least partly effective.
|
From page 661... ...
It is clear that much of the response in lower cigarette consumption was individual decisions to quit smoking. What community-level interventions could not do -- bring about large changes in smoking rates -- the national interventions were able to accomplish.
|
From page 662... ...
Figure 17-5 shows that smoking rates declined by much more for better educated groups than for less educated groups. In 1966, smoking rates were 6 percentage points lower for people with a college degree compared to high school dropouts.14 By 1995, smoking rates were 19 percentage points lower for college graduates than for high school dropouts.
|
From page 663... ...
The drunk driving example is so salient because, as with smoking, a national intervention accomplished major behavioral changes that community-level interventions had failed to do. In the years after World War II, it became increasingly clear that drinking and driving presented a public health challenge.
|
From page 664... ...
Some studies find positive effects, others find inconclusive effects, and still others find negative effects. Because the methodology is similar to the community-level cardiovascular disease interventions discussed earlier, details are not presented here.
|
From page 665... ...
. By 1987, drunk driving fatalities seemed to have plateaued.
|
From page 666... ...
Heart disease and many other conditions are affected by the overall amount of caloric intake and the type of calories consumed. Excessive caloric intake leads to obesity, diabetes, and hypertension, all leading risk factors for cardiovascular disease.
|
From page 667... ...
Accurate cholesterol levels require blood samples from a large share of the population, which standard population surveys do not measure. The only viable data are from the National Health and Nutrition Examination Surveys (NHANES)
|
From page 668... ...
In this case, the worsening of health status did not increase the racial or socioeconomic disparities in health. Summary of National Interventions Although the evidence is not crystal clear, many national health interventions seem to have had a large impact on health behaviors.
|
From page 669... ...
The harm in each of the national interventions is clear-drunk driving kills children; smoking causes lung cancer. The solution is also clear: don't drive while drunk; stop smoking.
|
From page 670... ...
The first is a theory of intensity. One reason why national information interventions may have greater impacts on behavior than community interventions may be the fact that national information permeates more widely and deeply in people's minds.
|
From page 671... ...
The focus on the degree to which information permeates is not to deny that the message being conveyed is important. One of the features of all of the successful health information interventions is that their prescriptions are simple: one should not smoke; high cholesterol should be managed; drunk driving is bad.
|
From page 672... ...
. The Pawtucket Heart Health Pro gram: Community changes in cardiovascular risk factors and projected disease risk.
|
From page 673... ...
. Effects of communitywide educa tion on cardiovascular disease risk factors: The Stanford Five City Project.
|
From page 674... ...
, 1795-1801. Multiple Risk Factor Intervention Trial Research Group.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.