CENTERS FOR DISEASE CONTROL AND PREVENTION
Volume 15 • Number 1 • Winter 2002

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Research at State and Local Levels Benefits Communities Nationwide

Prevention research in one state or community often produces valuable findings that can be used nationwide. By sharing knowledge and lessons learned, state and local health departments can help others pursue the most successful approaches to preventing chronic disease. Several recent studies show how such research depends on the active involvement of health departments. 

State Collaboration Can Pinpoint Problems 
Maryland, New York, Ohio, and Texas participated in a CDC study to find out why many women eligible for free follow-up mammograms were not getting these routine screening tests. The screenings are covered under CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Researchers tested the following research questions: 

• Do NBCCEDP records correctly reflect the percentage of women who are actually returning for routine rescreening? 
• Are women going outside the program for mammography screening? 
• Are many women neglecting to return for follow-up screening after their initial mammogram? 

The four states were selected for the study because the racial and ethnic makeup of their participants was similar to that of participants in the overall program. Researchers used NBCCEDP data files to identify 625 eligible participants in each state (a total of 2,500 women). The women were placed in two cohorts—those who received enhanced interventions and those who received minimal interventions. Researchers selected only women who received a negative/benign or “probably benign” result and were aged 50–69 years at the time of the index screening in 1997. They interviewed the women by telephone at least 30 months after their index mammogram and then obtained records for mammographies reported during the interview. 

The final results, which will be reported later this year, will help all states improve their methods of tracking women in the NBCCEDP and identifying women who might need additional support to ensure that they receive routine mammograms. 

The four states were quite willing to participate after researchers addressed their concerns about patient confidentiality. “Good cooperation from the states made it possible to locate 90% of the women in each state, an unusually high rate of success,” said Janet Bobo, PhD, the study’s principal investigator.  

 
Targeted Programs Help Find What Works 
By evaluating interventions, researchers can expose gaps in care and reveal surprising strengths of interventions. A recent North Carolina study that compared two intervention groups did both. Heart disease, the leading cause of death in the United States, affects one in five people in North Carolina. Uninsured women are especially vulnerable because they are less likely to be screened for high blood pressure and cholesterol levels or to be counseled on healthy eating and smoking cessation. Changing the health-related behaviors of financially disadvantaged people can be especially difficult because such populations have other priorities, including money and transportation. In addition, local food sources may be limited, and they may not have access to safe public spaces for physical activity. 

The CDC-funded WISEWOMAN programs provide preventive services to NBCCEDP participants. To help determine whether the cardiovascular disease (CVD) risk factor screening and intervention services offered under WISEWOMAN are effective, CDC researchers compared two groups of underserved and uninsured women. One group received enhanced interventions; the other received minimal interventions. Investigators found that 91% of the women screened in North Carolina were at risk for CVD and thus were eligible for the interventions. Risk was defined as having high blood pressure, taking medication for high blood pressure, or having abnormal cholesterol levels. After 1 year, lipid and blood pressure values of both groups improved and their risk for death from heart disease and stroke declined. However, the differences between the group that received enhanced interventions and the group that received minimal interventions were insignificant. 

Because few intervention studies have been conducted in such populations, the WISEWOMAN evaluation was an opportunity to learn what might work not just in North Carolina, but in other states as well. “Changing health behaviors associated with CVD in low-income populations may require different strategies from those used in high-income populations,” said Julie Will, PhD, CDC WISEWOMAN team leader. “More intervention research is needed. We need to keep looking for effective interventions for underserved women and work more on getting women to adopt the behavior changes.” States involved in the WISEWOMAN evaluations will give health agencies nationwide the knowledge they need to reach more women with these life-saving strategies.

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This page last reviewed August 10, 2004

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