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Biomedical subjects

M A Winkleby

Publications and source records attributed to M A Winkleby.

At least 37 records · Page 2Linked to original sources
PubMed1996

Sociodemographic influences on Hispanic-white differences in blood pressure.

DATA ARE PRESENTED for 933 Hispanic and 7087 white men and women, ages 25 to 74, who participated in biennial cross-sectional surveys in California from 1979 to 1990. Using an unadjusted analysis, white women and men had significantly higher mean systolic blood pressures (123.4 mmHg versus 119.6 mmHg) and higher levels of hypertension (29.0% versus 22.9%) than Hispanic women and men (P values greater than 0.001). To reduce bias from confounding, a subset of 702 Hispanics were matched to 702 whites on age, gender, education, city of residence, and time of survey. All ethnic differences in blood pressure became nonsignificant in this analysis. The mean systolic blood pressure for whites was 120.0 mmHg; for Hispanics, 120.7 mmHg (24.4% hypertension for both groups, P values greater than 0.10). These findings show the importance of taking sociodemographic factors into account when examining ethnic differences in blood pressure.

Adult↗
PubMed1995

Community intervention trials: reflections on the Stanford Five-City Project Experience.

In the past two decades several community intervention studies designed to lower the risk of cardiovascular disease in populations have been completed. These trials shared the rationale that the community approach was the best way to address the large population attributable risk of mild elevations of multiple risk factors, the interrelation of several health behaviors, and the potential efficiency of large-scale interventions not limited to the medical care system. These trials also shared several threats to internal validity, especially the small number of intervention units (usually cities) that could be studied. The purpose of this paper is to reflect on the lessons learned in one of the studies, the Stanford Five-City Project, which began in 1978. The anticipated advantages were observed, including the generalizability of the intervention components, the potential for amplification of interventions through diffusion in the community, and the efficiency of the mass media and other community programs for reaching the entire population. Numerous components of the intervention proved effective when evaluated individually, as was true in other community studies. However, the design limitations proved difficult to overcome, especially in the face of unexpectedly large, favorable risk factor changes in control sites. As a result, definitive conclusions about the overall effectiveness of the communitywide efforts were not always possible. Nevertheless, in aggregate, these studies support the effectiveness of communitywide health promotion, and investigators in the field should turn to different questions. The authors have learned how little they know of the determinants of population-level change and the characteristics that separate communities that change quickly in response to general health information from those that do not. Future studies in communities must elucidate these characteristics, while improving the effectiveness of educational interventions and expanding the role of environmental and health policy components of health promotion.

Adult↗
PubMed1995

Hispanic versus white smoking patterns by sex and level of education.

Although past studies have compared cigarette smoking patterns in Hispanics and whites, few have examined differences within sex and educational subgroups. Data are presented for 1,088 Hispanic women and men (89% Mexican-American origin) and pairwise matched white women and men (544 pairs), aged 25-74 years, who participated in population-based cross-sectional surveys in California in 1979-1990. Each pair was matched on age, sex, educational level, city of residence, and survey time period. There were large differences in smoking prevalence rates between Hispanic and white pairs with low educational attainment. White women and men with less than a high school education were approximately twice as likely to be current daily cigarette smokers as were similarly educated Hispanic women and men (46.1 vs. 20.6% for women and 52.7 vs. 30.1% for men). As the level of education increased, these ethnic differences in smoking decreased and became negligible among those who completed college. Virtually all low-educated white men (92.5%) and most low-educated white women (73.1%) were either current or former daily smokers. There were large ethnic differences in rates of smoking cessation advice from a physician; only 8.3% of low-educated Hispanic men who were current daily smokers had ever been advised by a physician to stop smoking, compared with 59.6% of low-educated white men. These data confirm ethnic differences in smoking behavior and identify the high smoking rates of white men and women with low educational attainment, thus delineating an often unrecognized group toward whom tobacco prevention and cessation activities should be directed.

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

Health-related risk factors of homeless families and single adults.

Using data from two cross-sectional surveys, we examine how homeless adults living with children differ in sociodemographic characteristics, adverse childhood experiences, and addictive and psychiatric disorders from homeless adults who are not living with children. The surveys were conducted in late 1989 and early 1990 in Santa Clara County, California. Women (n = 100) and men (n = 41) with children were sampled from the two largest family shelters in the County (94% response rate); women (n = 169) and men (n = 1268) without children were sampled from the three main adult shelters in the County (98% response rate). Adults with children (especially women) were significantly younger, less educated, less likely to have experienced full-time employment, and more likely to have been supported by public assistance before first becoming homeless than adults without children. In addition, adults with children became homeless at younger ages, had been homeless for less time, and were less likely to experience multiple episodes of homelessness. Further differences were found for addictive and psychiatric disorders--adults with children were significantly less likely to enter homelessness with histories of excessive alcohol intake (both men and women) and psychiatric hospitalizations (women only) than adults without children. The distinct risk factor profile of homeless adults living with children renders them a critically important demographic group on which to focus new public health programs and social strategies.

Adult↗
PubMed1994

Effects of life-style on body mass index change.

The objective of this study was to determine the effects of age and life-style factors on body mass index (BMI) in a longitudinal, community-based sample. A total of 568 men and 668 women (20-60 years of age) were randomly chosen from four Northern California communities and followed for up to 7 years. Age, sex, marital status, smoking status, hours of television watched, frequency of consumption of several food items, and physical activity were used to predict rate of change of body mass index (BMI-slope). BMI increased the most for both sexes through at least age 54. The BMI-slope was higher for women compared with men, and for smokers who stopped compared with those who never smoked or continued to smoke during the study. The BMI-slopes were lower for individuals who increased activity. Other life-style variables had weak or inconsistent effects on the BMI-slope. We conclude that the BMI-slope increases over age for both sexes and that increased physical activity may reduce the BMI-slope.

Adult↗
PubMed1994

A community-based heart disease intervention: predictors of change.

OBJECTIVES: This paper presents a prospective examination of sociodemographic, psychosocial, and physiologic characteristics associated with positive change in cardiovascular disease risk factors during a 6-year multiple risk factor intervention study. METHODS: Data are presented on 221 women and 190 men (aged 25 through 74 years) who participated in four cohort surveys (1979 through 1985). A signal detection model was used to identify baseline variables that best divide the sample into subgroups on the basis of the probability of positive change in a composite risk factor score. RESULTS: Sixty-nine percent of the respondents showed a positive change in risk factor score during the intervention. The subgroup with the highest proportion of positive changers (83%) was composed of older adults (> 55 years) with the highest perceived risk, highest health media use, and highest blood pressure and cholesterol levels. The subgroup with the lowest proportion of positive changers (42%) was the least educated, was the most likely to be Hispanic, and had the lowest health knowledge and self-efficacy scores. CONCLUSIONS: The differing composition of subgroups who respond or do not respond to community cardiovascular disease interventions illustrates the need to develop specific interventions that target different age, socioeconomic, and cultural subgroups.

Adult↗
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

Cigarette smoking trends in adolescents and young adults: the Stanford Five-City Project.

BACKGROUND: Data on smoking prevalence from four cross-sectional community-based surveys (1979-1990) are presented for 2,605 adolescents and young adults 12-24 years of age. METHODS: The surveys were conducted in two treatment and two control cities in Northern California as part of the Stanford Five-City Project, a multifactor cardiovascular disease prevention study. RESULTS: Over the 12-year study period, prevalence of daily smoking declined in all cities by approximately 50% among 16- to 19- and 20- to 24-year-olds but showed little change among those 12-15 years old. Although the declines were especially large in the two treatment cities and in one control city, the declines in treatment cities were not significantly different from those in control cities. During each period, smoking prevalence escalated most sharply between the ages of 12-15 and 16-19, the period of development when students advanced from junior high to high school. CONCLUSIONS: Despite impressive secular declines, it appears that the Five-City Project community intervention, which targeted smoking in adults, did not have a diffusion effect on the tobacco use habits of adolescents.

Adolescent↗
PubMed1992

Sexual abuse of children. The detection of semen on skin.

OBJECTIVE: The detection of semen on the skin of children who present within 72 hours of an episode of sexual assault is critical to medical, forensic, and legal personnel. The Wood's Lamp, a UV light that causes semen to fluoresce, and four forensic laboratory techniques were compared to determine their sensitivity and decline in sensitivity over time. DESIGN: A descriptive study. PARTICIPANTS: Eleven adult female volunteers. MEASUREMENTS/MAIN RESULTS: Semen was placed on the skin of the volunteers. Samples of the dried semen were assessed during a 28-hour period with the Wood's Lamp, microscopy, the acid phosphatase assay, and two assays for the prostatic protein p30 (counterimmunoelectrophoresis and enzyme-linked immunosorbent assay). The intensity of the Wood's Lamp fluorescence of semen diminished dramatically by 28 hours; in contrast, the fluorescence of urine persisted up to 80 hours. Over time, the p30-enzyme-linked immunosorbent assay technique was more sensitive than microscopy, the acid phosphatase assay, and p30-counterimmunoelectrophoresis in detecting semen on skin. CONCLUSIONS: The Wood's Lamp is not a sensitive screening tool and should be used with caution. To improve the detection of sexual abuse in children, we recommend that the p30-enzyme-linked immunosorbent assay be used because of its potential as a more sensitive assay than those in current clinical use.

Acid Phosphatase↗
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

Homeless adults without apparent medical and psychiatric impairment: onset of morbidity over time.

A cross-sectional study compared characteristics of homeless adults with and without substance abuse, physical health problems, and history of psychiatric hospitalization when they first became homeless. Self-report data on demographic characteristics, adverse events in childhood, and history of medical disorders were collected from 1,399 homeless adults who used three shelters in Santa Clara County, California, during a five-month winter period in 1989 and 1990 (96 percent response rate). A total of 45.6 percent of the respondents reported no impairments when they first became homeless. They were distinguished from those with impairments at onset of homelessness by their younger age, minority status, lower educational attainment, and lower frequency of adverse events in childhood. Respondents who reported no impairments when they first became homeless were likely to develop addictive and psychiatric disorders over time. Those who had been homeless five years or more reported high rates of alcohol abuse (34.5 percent), illegal drug use (24.1 percent), and psychiatric hospitalization (20.7 percent).

Adaptation, Psychological↗
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↗
PubMed1992

Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease.

BACKGROUND: Socioeconomic status (SES) is usually measured by determining education, income, occupation, or a composite of these dimensions. Although education is the most commonly used measure of SES in epidemiological studies, no investigators in the United States have conducted an empirical analysis quantifying the relative impact of each separate dimension of SES on risk factors for disease. METHODS: Using data on 2380 participants from the Stanford Five-City Project (85% White, non-Hispanic), we examined the independent contribution of education, income, and occupation to a set of cardiovascular disease risk factors (cigarette smoking, systolic and diastolic blood pressure, and total and high-density lipoprotein cholesterol). RESULTS: The relationship between these SES measures and risk factors was strongest and most consistent for education, showing higher risk associated with lower levels of education. Using a forward selection model that allowed for inclusion of all three SES measures after adjustment for age and time of survey, education was the only measure that was significantly associated with the risk factors (P less than .05). CONCLUSION: If economics or time dictate that a single parameter of SES be chosen and if the research hypothesis does not dictate otherwise, higher education may be the best SES predictor of good health.

Adult↗
PubMed1992

Job strain and prevalence of hypertension in a biracial population of urban bus drivers.

OBJECTIVES: In this study we tested the association between occupational stress--as measured by job demands, decision latitude, and job strain--and hypertension in a population of 1396 Black and White bus drivers. METHODS: Height, weight, blood pressure, and medical history were assessed by physical exam. Drivers completed a questionnaire assessing their work schedules, personal habits, and self-perceptions about job demands and decision latitude. RESULTS: Univariate analyses revealed significant inverse associations; lower levels of job demands and job strain were associated with a higher prevalence of hypertension for Blacks and Whites. After 12 confounding variables were controlled for, the association between these two measures of occupational stress and hypertension became nonsignificant. Decision latitude was also not significantly associated with hypertension. CONCLUSIONS: Our findings are inconsistent with previous studies' findings of a positive association between job strain and chronic diseases. The difference in results may be explained by our incorporation of individuals' perceptions in the measurement of occupational stressors and our use of individuals from a single occupation with comparable job responsibilities and income, thus controlling for potential confounding by social class.

Adult↗