The WISEWOMAN Workgroup

Background: The WISEWOMAN projects are examining the feasibility and effectiveness of adding a cardiovascular disease (CVD) prevention component to a nationwide program of early detection for breast and cervical cancer aimed at financially disadvantaged women. This paper describes the rationale and design of the WISEWOMAN projects, the baseline findings of the screenings, and the plans for evaluation.

Methods: In selected breast and cervical cancer screening sites throughout Massachusetts, Arizona, and North Carolina, blood pressure, body weight, cholesterol, smoking, diet, and physical activity were assessed at baseline, 6 months, and 12 months. To evaluate the effectiveness of CVD prevention, these sites were assigned to either a minimum or an enhanced intervention group. The enhanced interventions, tailored to the populations served, featured skill building and facilitating activities to improve nutrition and increase physical activity.

Results: Baseline screenings of 4,842 women revealed a high prevalence of CVD risk factors. High cholesterol was found among 40% of the women in North Carolina and Massachusetts, hypertension was found among 63% of the women in North Carolina, and overweight was found among 83% of the women in Arizona.

Conclusions: It is appropriate to expand breast and cervical cancer screening programs to include screening for CVD ©1999 American Health Foundation and Academic Press.

Key words: cardiovascular disease; cerebrovascular disease; prevention; women; screening.

The WISEWOMAN Workgroup includes Tim Byers, M.D., with the University of Colorado; Virginia Bales, M.P.H., Earl Ford, M.D., Barbara Massoudi, M.P.H., Ph.D., Ali Mokdad, Ph.D., Gary Myers, Ph.D., Julia Pruden, M.Ed., R.D., S. Jay Smith, M.I.S., M.S., and Julie Will, Ph.D., with the Centers for Disease Control and Prevention; Becky Bolduc, M.S., Linda Jo Doctor, M.P.H., Christina Economos, Ph.D., Cristina Garces, B.A., Debbie Katz, M.S., Kathleen Lowney, M.H.S., Maria Madison, Sc.D., and Ruth Palombo, M.S., R.D., with the Massachusetts Department of Public Health; Anne Stoddard, Sc.D., with the University of Massachusetts; Kathryn Coe, Ph.D., Karen Fleming, B.S., Joan Smith, B.S.N., M.B.A., and Linda Simpson, M.P.H., with the Arizona Department of Health Services; James Marshall, Ph.D., and Lisa Staten, Ph.D., with the University of Arizona; Kristin Lockwood, B.S.N., M.S., with the Maricopa County Department of Public Health Services; Peter Andersen, M.Ed., M.B.A., Deborah Hilgenberg, M.P.H., and Joe Holliday, M.D., M.P.H., with the North Carolina Department of Health and Human Services; and Wayne Rosamond, Ph.D., and Alice Ammerman, Dr.P.H., R.D., with the University of North Carolina.

Correspondence and reprint requests should be addressed to Julie C. Will, Ph.D., Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS K-26, Atlanta, GA 30341. Fax: (770) 488-6000. E-mail: jxw6@cdc.gov

Cardiovascular Disease Risk Factor Intervention in Low-Income Women:
The North Carolina WISEWOMAN Project
Preventive Medicine
Vol. 31, No 4, October 2000

Wayne D. Rosamond, Ph.D., Alice S. Ammerman, Dr.P.H., Joseph L. Holliday, M.D., Kathy W. Tawney, Ph.D., Kelly J. Hunt, Ph.D., Thomas C. Keyserling, M.D, M.P.H., Julie C. Will, Ph.D., Ali H. Mokdad, Ph.D.

University of North Carolina at Chapel Hill, School of Public Health, Department of Epidemiology (WDR, KJH), Department of Nutrition, Schools of Public Health and Medicine (ASA), Department of Medicine, School of Medicine (TCK, KT). North Carolina Department of Health and Human Services, Raleigh, North Carolina; Department of Adult Health, Division of Health Promotion (JH). National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta (JCW, AHM).

Objectives: The North Carolina WISEWOMAN project was initiated to evaluate the feasibility of expanding an existing cancer screening program to include a cardiovascular disease (CVD) screening and intervention program among low-income women.

Methods: Seventeen North Carolina county health departments were designated as minimum intervention (MI) and 14 as enhanced intervention (EI). The EI included three specially constructed counseling sessions spanning 6 months using a structured assessment and intervention program tailored to lower income women.

Results: Of the 2,148 women screened, 40% had elevated total cholesterol (>= 240 mg/dL); 39%, low high-density lipoprotein cholesterol (HDL-C) levels (<45 mg/dL); and 63% were hypertensive (systolic blood pressure =140 and/or diastolic blood pressure = 90 mm Hg or on hypertensive medication). The majority of women (86%) had at least 1 of these 3 risk factors. Seventy-six percent were either overweight or obese. After 6 months of follow-up in the EI health departments, changes in total cholesterol levels, HDL-C levels, diastolic blood pressure, and BMI were observed (-5.8 mg/dL, -0.9 mg/dL, -1.7 mm Hg, and -0.3 kg/m2, respectively), but were not significantly different from MI health departments. A dietary score that summarized fat and cholesterol intake improved by 2.1 units in the EI group, compared with essentially no change in the MI group.

Conclusions: Expanding existing cancer screening programs to include CVD intervention was feasible and may be an effective means for promoting healthful dietary practices among low-income women. Copyright 2000 American Health Foundation and Academic Press.

Key words: cardiovascular disease; risk factors; dietary factors; intervention.

Address for correspondence: Wayne D. Rosamond, PhD, Department of Epidemiology, University of North Carolina at Chapel Hill, 137 E. Franklin Street, Suite 306, Chapel Hill, North Carolina 27514. phone: 919.962.3230 fax: 919.966.9800 email: wayne_rosamond@unc.edu