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Biomedical subjects

S P Fortmann

Publications and source records attributed to S P Fortmann.

At least 91 records · Page 5Linked to original sources
PubMed1987

Associations of dietary fat, regional adiposity, and blood pressure in men.

Mediterranean populations have low incidence rates of cardiovascular disease and hypertension that may be due, in part, to dietary factors, particularly a relatively high intake of monounsaturated fat as olive oil. In this study, nutritional components (as grams per 4200 kJ) (1 kcal = 4.2 kJ) from three-day food records were examined in association with resting blood pressure in a cross-sectional survey of 76 sedentary middle-aged American men, aged 30 to 55 years, with resting blood pressures below 160/100 mm Hg. Systolic and diastolic blood pressures correlated significantly and inversely with monounsaturated fat consumption. Polyunsaturated fat consumption also correlated inversely with diastolic blood pressure; however, this relationship became nonsignificant when adjusted for an index of regional adiposity that characterizes the male-type obesity pattern. Detailed analyses of specific fatty acids showed that the correlations with monounsaturates were specific to oleic acid, and the correlation with polyunsaturates was specific to linoleic acid. Multiple regression analysis suggested that 18.2% of the variance in systolic blood pressure and 23.2% of the variance in diastolic blood pressure were related to monounsaturated and polyunsaturated fat consumption and regional adiposity. Thus, increased consumption of monounsaturated fat is related inversely to resting blood pressure, although causality remains to be determined.

Adipose Tissue↗
PubMed1987

Consequences of worksite hypertension screening. Changes in absenteeism.

To confirm reports of increased absenteeism after worksite hypertension screening, we performed a three-stage blood pressure screening among 5888 self-selected heterogeneous workers at 11 electronics plants using standardized screening and labeling procedures. A total of 296 subjects with mean systolic blood pressure of 140 mm Hg or greater or diastolic blood pressure of 90 mm Hg or greater on all three occasions were considered to have sustained hypertension. From the untreated normotensive subjects matched for eight sociodemographic and occupational variables, we prospectively selected one to three controls for each sustained hypertensive subject. Uncorrected absenteeism rates for sustained hypertensive subjects increased 22% from baseline in the postscreening year. Correction by logarithmic transformation for skewed distributions and by rates for matched controls for temporal trends reduced these changes to statistical insignificance with high statistical power. Several subgroups exhibited trends to increased absenteeism. At 12-month follow-up, the blood pressure of the sustained hypertensive subjects showed mean decreases of 12.6/6.7 mm Hg (p less than 0.0001) after the majority had received pharmacological antihypertensive treatment. These results suggest that worksite hypertension screening and labeling produce insignificant absenteeism change overall among self-selected heterogeneous work force populations.

Absenteeism↗
PubMed1987

Smokers' challenge: immediate and long-term findings of a community smoking cessation contest.

The present study examined the effectiveness of a community-based smoking contest in helping 500 smokers maintain three months postcontest and one year postcontest abstinence. The majority were chronic smokers with a limited number of previous quit attempts. The three- and 12-month postcontest quit rates were 19 per cent and 15 per cent, respectively, rates exceeding naturally occurring community cessation rates. The contest was found to be more cost-effective than quit smoking classes.

Adult↗
PubMed1987

The cost-effectiveness of three smoking cessation programs.

This study analyzed the cost-effectiveness and distribution of costs by program stage of three smoking cessation programs: a smoking cessation class; an incentive-based quit smoking contest; and a self-help quit smoking kit. The self-help program had the lowest total cost, lowest per cent quit rate, lowest time requirement for participants, and was the most cost-effective. The most effective program, the smoking cessation class, required the most time from participants, had the highest total cost, and was the least cost-effective. The smoking contest was in-between the other two programs in total costs, per cent quit rate, and cost-effectiveness; it required the same time commitment from participants as the self-help program. These findings are interpreted within the context of community-based intervention in which the argument is made that cost-effectiveness is only one of several factors that should determine the selection of smoking cessation programs.

Adult↗
PubMed1987

Nicotine yield and measures of cigarette smoke exposure in a large population: are lower-yield cigarettes safer?

We examined the relationship of machine-estimated nicotine yield by cigarette brand with the level of cigarette consumption and two biochemical measures of smoke exposure (expired-air carbon monoxide and plasma thiocyanate) in a large, population-based sample of smokers (N = 713). The lower the nicotine yield of the cigarette, the greater the number of cigarettes smoked per day. Prior to adjusting for number of cigarettes smoked per day, nicotine yield was not related to the actual measures of smoke exposure. Smokers of ultralow-yield cigarettes had laboratory tests of smoke exposure which were not significantly different from those of smokers of higher-yield brands. Only after adjustment for number of cigarettes smoked per day did nicotine yield become significantly related to expired-air carbon monoxide and to plasma thiocyanate. In multivariate analysis, the number of cigarettes smoked per day accounted for 28 per cent and 22 per cent of the variance in observed expired-air carbon monoxide and plasma thiocyanate levels, respectively, whereas nicotine yield accounted for only 1 per cent and 2 per cent of the variance, respectively. The relative lack of an effect of nicotine yield on the biochemical measure appears to be due to the fact that smokers of lower nicotine brands smoked more cigarettes per day, thereby compensating for reduced delivery of smoke products. Our data do not support the concept that ultralow-yield cigarettes are less hazardous than others. Machine estimates suggesting low nicotine yield underrepresent actual human consumption of harmful cigarette constituents.

Adult↗
PubMed1986

Consequences of worksite hypertension screening. Differential changes in psychosocial function.

To evaluate reports of psychosocial dysfunction after worksite screening, a three-stage blood pressure screening was performed using standardized screening and labeling procedures. Of a heterogeneous group of 5,888 workers, 296 with sustained hypertension were identified and randomly assigned to traditional arousal or reassurance debriefings, matching each hypertensive subject with one to three normotensive control subjects on eight sociodemographic and occupational variables. Subjects exhibiting absenteeism increases or persistent hypertension six months after screening were randomly assigned to worksite health education programs or no intervention. After adjustment for values among matched control subjects, previously unaware hypertensive subjects had significant post-screening decreases in anxiety that were significantly associated with specific worksites and with reassurance rather than traditional debriefing (p less than 0.05). The health education program did not significantly affect anxiety, blood pressure, or absenteeism. Increased absenteeism was associated with higher baseline anxiety levels (p less than 0.05). It is concluded that worksite hypertension screening produces minimal adverse psychosocial changes, reassurance debriefing may be beneficial, and unspecified worksite characteristics may determine consequences of similar preventive medicine efforts.

Absenteeism↗
PubMed1986

Vigorous physical activity and cardiovascular risk factors in young adults.

There are conflicting data regarding the effects of vigorous physical activity (PA) and cardiovascular disease risk factors. Representative samples of adults aged 20-35 from four northern California cities were studied both cross-sectionally and longitudinally in order to examine the relationships between vigorous PA and selected physiological risk factors. A self-report measure of habitual vigorous PA was validated by pulse rate. There were relationships, in both cross-sectional and longitudinal analyses between self-reported vigorous PA and HDL/LDL ratio, especially for women. Relationships in cross-sectional analyses only were found between PA and diastolic blood pressure, total cholesterol, HDL-cholesterol, triglycerides, and alveolar carbon monoxide. The results of the present study generally tend to confirm investigations of other samples.

Adult↗
PubMed1986

Predictors of adoption and maintenance of physical activity in a community sample.

Predictors of changes in three measures of physical activity over 1 year were examined in a community sample of 1,411 California adults. Five percent of women and 11% of men adopted vigorous activities (e.g., running), and 26% of men and 34% of women adopted regular moderate activity (e.g., walking). About 50% of vigorous exercisers and 25-35% of moderate exercisers dropped out in 1 year. About 9% reported large 1-year increases in globally rated activity level, while about 7% reported decreases in global activity. In multivariate analyses, adoption of vigorous activity was predicted by young age, male gender, and self-efficacy. Maintenance of vigorous activity was predicted by attitudes toward physical activity. Adoption of moderate activity was predicted by health knowledge, and maintenance was predicted by specific exercise knowledge, female gender, and self-efficacy.

Adult↗
PubMed1986

Moderate-intensity physical activity and cardiovascular risk factors: the Stanford Five-City Project.

There is evidence that low to moderate levels of physical activity can reduce risk of cardiovascular disease, even though they do not produce substantial changes in cardiorespiratory function. In this study of a representative population sample of 5,930 adult men and women, participants in moderate-intensity activities, such as walking and climbing stairs, were compared with nonparticipants. Men and women who reported more moderate activities were less overweight than sedentary peers. Moderate activity was associated with more risk factor benefits in men than in women. The apparent health benefits of moderate-intensity physical activity have implications for public health education.

Adult↗
PubMed1986

Community surveillance of cardiovascular diseases in the Stanford Five-City Project. Methods and initial experience.

The Stanford Five-City Project is a long-term field evaluation of the effects of community health education on cardiovascular disease risk factors and event rates. One major end point of the project is the difference between treatment and control group trends in morbidity and mortality rates ascertained through community-wide surveillance of deaths and hospital discharges. This surveillance system includes continuous review of death certificates and hospital discharge records, interviews with the families and physicians of decedents who died outside the hospital, abstraction of the hospital records of possible myocardial infarction and stroke cases (fatal and nonfatal), and systematic validation of diagnosis by the use of standard criteria. Initial experience with information access, availability of diagnostic information, costs, and reliability are described. This standardized approach to community surveillance of cardiovascular disease events rates, both fatal and nonfatal, is a feasible method for evaluating large-scale intervention programs and may be applicable to monitoring secular trends in the absence of intervention.

Adult↗
PubMed1985

Attitudes and practices of physicians regarding hypertension and smoking: The Stanford Five City Project.

A survey was sent to 318 physicians in Monterey County, California, to assess their attitudes and practices regarding hypertension and cigarette smoking. After three mailings, 62% returned completed questionnaires. Eight percent of the respondents were smokers, 5% were women, and 34% were in primary care specialties. Older physicians and primary care specialists were less aggressive in their treatment of high blood pressure, but none of the assessed attitudes was significantly associated with treatment practice. Only half of the sample advised all patients to quit smoking. Physicians who doubted the effectiveness of their anti-smoking advice or who did not know what to say to smoking patients were less likely to provide advice. Most physicians felt that their smoking patients lacked sufficient motivation to quit. Programs to encourage physicians to increase smoking cessation activities should address these attitudes.

Adult↗
PubMed1985

Mediated smoking cessation programs in the Stanford Five-City Project.

Two mediated smoking cessation programs were subjected to a field evaluation. The Quit Kit is a printed self-help package, and "Calling It Quits" consists of five segments which were aired on the local television news. A sample of 239 persons requested the Quit Kit and were followed. At the 2-month and 12-month follow-ups, respectively, 13.6% and 17.9% of those surveyed reported abstinence. Results indicate the potential of mediated interventions.

Adult↗
PubMed1985

Physical activity assessment methodology in the Five-City Project.

Previous measures of physical activity for epidemiologic studies were considered inadequate to meet the needs of a community-based health education trial. Therefore, new methods of quantifying the physical activity habits of communities were developed which are practical for large health surveys, provide information on the distribution of activity habits in the population, can detect changes in activity over time, and can be compared with other epidemiologic studies of physical activity. Independent self-reports of vigorous activity (at least 6 metabolic equivalents (METs) ), moderate activity (3-5 METs), and total energy expenditure (kilocalories per day) are described, and the physical activity practices of samples of California cities are presented. Relationships between physical activity measures and age, education, occupation, ethnicity, marital status, and body mass index are analyzed, and the reliabilities of the three activity indices are reported. The new assessment procedure is contrasted with nine other measures of physical activity used in community surveys.

Adolescent↗
PubMed1985

The Stanford Five-City Project: design and methods.

The Stanford Five-City Project is a large experimental field study of community health education for the prevention of cardiovascular disease. It will provide data on fundamental questions in cardiovascular disease epidemiology, communication, health education, behavior change, and community organization, and will also test the ability of a potentially cost-effective program to prevent cardiovascular disease at the community level. This paper describes the purposes, hypotheses, design, and methods of the Five-City Project as a reference for future papers describing results. It is hypothesized that a 20% decrease in cardiovascular disease risk will lead to a significant decline in cardiovascular disease event rates in two treatment communities compared with three reference communities as a result of a six-year intervention program of community-wide health education and organization. Risk factor change will be assessed through four surveys of independent samples and in a repeatedly surveyed cohort. Cardiovascular disease event rates will be assessed through continuous community surveillance of fatal and nonfatal myocardial infarction and stroke.

Adolescent↗