The objective was to assess the effect of changes in leisure time physical activity on high-density lipoprotein cholesterol (HDL-C) levels among community-based participants. Data from a randomly selected cohort were obtained in 1987, with follow-up measurements in 1991. Two medium-sized South Carolina communities were study sites. The study population included women participants of the 1987 survey and assessment who were available for follow-up measurements in 1991, including 1,003 white and 348 African American women aged 18–89 years. Changes in HDL-C levels in four leisure time physical activity groups, adjusting for age, education, body composition, baseline HDL-C levels, and cigarette smoking status, were measured. Overall, over the 4-year period, mean HDL-C levels increased among women in both age groups, but this change was significant only among women age 50 and older. However, HDL-C increases for inactive women who increased their reported physical activity level at the time of the follow-up survey were found only among white women. Among African American women, changes in HDL-C levels did not appear to be associated with changes in leisure time physical activity. These results support other work that suggests that factors other than physical activity and the covariates in the adjusted model were responsible for the increases in HDL-C levels in these women.

OBJECTIVE:In 1998, the Catawba Diabetes and Health Survey (CDHS) was conducted among adult members of the Catawba Indian Nation living in the Carolinas to determine the prevalence of diabetes and other health conditions, and to assess the population's health-related behaviors.DESIGN:A population-based sample of adult members of the Catawba Indian Nation (N = 633) were surveyed by telephone or in person regarding health status and health-related behaviors. Logistic regression was used to determine demographic and behavioral correlates of diabetes, hypertension, and overweight among the Catawba.RESULTS:Age-adjusted prevalence rates of self-reported diabetes, hypertension and overweight were 12.3%, 29.1%, and 63.8%, respectively. Older age was related to diabetes, hypertension, and overweight (P<.0001 each), and heavier weight status was related to diabetes (P = .026) and hypertension (P<.0001). Nearly 40% of the Catawba are physically inactive (29.5% men, 46.5% women). Physical inactivity was related to diabetes and hypertension among men only, and related to overweight among women only (P<.05 each). Current smoking was inversely related to overweight among men and women (P = .002). Dietary behavior was not associated with the health outcomes.CONCLUSION:Given the high rates of overweight and physical inactivity, reducing the rates of both may be very important for the health of the Catawba, considering their association with diabetes and hypertension.

BACKGROUND:The prevalence of selected health indicators were compared among the Catawba Indians, African Americans, and whites in South Carolina, considering the possible role of rural locality and education.METHODS:Catawba members were respondents of a 1998 survey (N = 808). Other South Carolina residents were respondents of the 1995-1997 Behavioral Risk Factor Survey (4,150 whites and 1,413 African Americans). Prevalence of cardiovascular disease, diabetes, hypertension, overweight, poor health, smoking, physical inactivity, and poor diet were compared among the racial/ethnic groups. Logistic regression analyses were conducted within strata of urban/rural locality and education to determine whether these factors were associated with the adverse health indicators.RESULTS:Both Catawba and African Americans had higher prevalence of diabetes, hypertension, overweight, poor health, physical inactivity, and poor diet than whites. In addition, prevalence of diabetes, poor health, smoking, and poor diet were higher among the Catawba than among African Americans. Restricting the analyses to comparisons within urban/rural locality had little effect, whereas restricting the analyses to comparisons by education level eliminated many of the disparities among those with low education.CONCLUSIONS:Prevalence of chronic disease and adverse health behavior are higher among the Catawba than among other residents of South Carolina, especially compared with white residents.

The objective of this study was to assess physical activity patterns on a walking trail in a community park. During a two-week period, 200 trail users were interviewed, and an infrared sensor was used to measure trail use. Most respondents (84%) reported participating in regular activity. The environment, park location, safety, pavement, presence of a mile marker, and the absence of motorists were cited as positive trail characteristics. Trail use was heaviest during weekdays in early morning and late afternoon. The presence of a trail within a community park may provide the environmental support needed to maintain suggested levels of physical activity to achieve positive health outcomes.

In 1996, there were 34,035 deaths in South Carolina. Almost 70 percent of these deaths were due to chronic diseases. There are known ways to prevent chronic diseases from developing or at least delay their developmental process, thereby lengthening years of life. The purpose of this paper is to report modifiable risk factors for mortality related to leading causes of death. The top ten causes of death in South Carolina were obtained from the South Carolina Department of Health and Environmental Control. Estimates of the number of deaths due to certain modifiable risk factors were made using results of a study published by McGinnis and Foege. The percentage of deaths due to each cause was adapted to South Carolina death certificate data from the national estimates. Results indicate that small modifications in individual lifestyles could prevent or delay nearly 50 percent of deaths in South Carolina annually. Tobacco use, diet and physical activity, and misuse of alcohol contribute to the largest number of deaths. Other modifiable behaviors contributing to the 50 percent mortality are microbial agents, toxic agents, firearms, sexual behavior, motor vehicle accidents, and illicit use of drugs. The implication in these findings is that these risk factors for mortality are mainly modifiable. There are many causes of death that may be delayed due to these modifiable risk factors. By looking at preventable causes of death, rather than focusing on traditional causes of death, it becomes clear that prevention strategies are critically important.

15 Social marketing strategies suggest that targeted interventions are most effective among people interested in changing desired behaviors. For physical activity (PA), these people are irregularly active. They do some PA, but with insufficient frequency (F) or duration (D) to meet PA guidelines. The purpose of this study was to identify the PA characteristics of irregularly active South Carolinians, ages 18-99 years. Data were obtained from the 1994-96 SC BRFSS (N=6,023). Population prevelances were calculated with SUDAAN. Regular PA was defined as F ≥ 5 d/wk & D ≥ 150 min/wk for all activities(n=996). Irregular PA was defined as: (1) F≤5 d/wk & D≤150 min/wk(n=2,007); (2) F≤ 5 d/wk & D≥150 min/wk (n = 191); (3) F≥5 d/wk & D≤150 min/wk (n=873). Data are in [horizontal bar over]x± SD and percent for each group. There were few differences between groups for age ([horizontal bar over]x = 42-48 years),% women (53-63%),% employed (69-80%),% high school education or higher (79-86%). PA was similar for groups with adequate frequencies (about 6 days/wk) and/or durations (over 300 min/wk). TableTableIntervention efforts should focus to help irregularly active people increase the frequency and/or duration of PA they are already doing to obtain recommended levels of PA for good health.

Implementation is underway for many of these programs, and there are descriptions of activities elsewhere in this symposium. The Board recognizes that in dealing with the complications of a chronic disease like diabetes, many years of intense effort will be needed before significant results may be appreciated. Progress will be monitored regularly by the Surveillance Council and SCDCP/DHEC, and modifications of the plan will be made by the Board at intervals after review of the data. We are optimistic that over the next decade, this system will make a significant impact to reduce mortality, morbidity, and costs of diabetes, and the result will be an increased quality of life for people affected by diabetes in South Carolina.

OBJECTIVEThis is the first study to assess the role of waist-to-hip ratio in explaining race differences in levels of serum apolipoprotein A1, a protective risk factor for atherosclerosis.METHODSLinear regression analyses were used in a community-based survey of 3,043 adults (23.5% African-American) to assess associations of race, age, anthropometric measures, education, diabetes, blood pressure medication use, cigarette smoking, and leisure-time physical activity with apolipoprotein A1 levels.RESULTSHigher apolipoprotein A1 levels were observed among African-American than among white adults (African-American men: +15.6 mg/dl than white men, African-American women: +3.1 mg/dl more than white women; p < 0.05). Waist-to-hip ratio and other variables did not account for race differences among men. African-American women had +8.6 mg/dl higher levels than white women after adjustment for differing distributions of waist-to-hip ratio, age, body mass index and education. Cigarette smoking, physical activity, and medical history accounted for no further differences among women.CONCLUSIONSHigher levels of obesity indicators and lower educational attainment among African-American women reduced a potentially greater beneficial race difference in apolipoprotein A1. These findings also suggest that other environmental and biochemical factors may play roles in explaining the higher protective levels of apolipoprotein A1 observed among African-American children and adults.

In conclusion, South Carolina has a higher prevalence of diabetes compared to the national average. Age is a major factor associated with increased prevalence. African Americans had a disproportionately higher prevalence of diabetes relative to white Americans in South Carolina. Compared to the standards of diabetes care recommended by the ADA, health care practice by people with diabetes and health professionals still needs to be improved. Diabetes communication programs, including diabetes education for people with diabetes and health professional education, continue to be necessary for the improvement of diabetes care.

A substantial proportion of mortality in the United States can be attributed to three major behaviors: using tobacco, maintaining an unhealthy diet, and being physically inactive. Using data from the South Carolina mortality files and Behavioral Risk Factor Surveillance System we were able to document state trends in mortality, cigarette smoking, physical inactivity, and unhealthy dietary practices. We found that, in spite of the declines in heart disease and stroke mortality noted nationally and in the state, the risk factor profiles for most women in South Carolina did not improve. This analysis further suggests that physical inactivity and dietary issues (excess caloric intake, low fruit and vegetable consumption) would be good choices for lifestyle interventions among women in South Carolina, not only because they ultimately affect mortality, but also because they exert interim effects on morbidity, including physical functioning and independence.

Few epidemiologic studies have investigated the impact of body mass index, low educational attainment, cigarette smoking, and physical activity on the considerable black-white difference in waist-to-hip ratio. These relationships were assessed with multivariable linear regression among 3,094 adults (24% black) who were examined in 1987 in South Carolina. The unadjusted mean waist-to-hip ratio was lower for black men than for white men (-0.03 units) and higher for black women than for white women (+0.03 units). After adjustment for age, body mass index, education, smoking, and physical activity, the black-white difference in mean waist-to-hip ratio was -0.02 units (p < 0.001) among men and +0.01 units (p < 0.01) among women. Although differing distributions of age, body mass index, and educational attainment accounted for a 59% reduction in the black-white difference among women, these factors did not explain the difference among men. Thus, these results suggest that other environmental or biologic factors may also play an important role in the marked variation in body fat distribution between the two ethnic groups. The results also support the importance of the prevention of cigarette smoking and overweight in potentially preventing abdominal obesity in both black adults and white adults.

Hypertension surveillance activities increasingly are relying on information obtained by self-report. However, limited information is available concerning the validity of such data, especially among populations residing within the stroke belt. We used interview information and blood pressure measurements from the South Carolina Cardiovascular Disease Prevention Project to determine the validity of self-reported hypertension and the correlates of hypertension awareness among 2,210 whites and 704 blacks who participated in the program in 1987. The sensitivity, specificity, positive predictive value, and negative predictive value of self-reported hypertension were 79%, 91%, 76%, and 93% among white women; 82%, 88%, 79%, and 89% among black women; 62%, 91%, 75%, and 85% among white men; and 72%, 89%, 78%, and 85% among black men, respectively. Groups with highest sensitivity included women, persons older than age 39 years, and those who had seen a physician for preventive care within the last year. Correlates of hypertension awareness included an older age, visit to a physician for preventive care, and a family history of high blood pressure. Among hypertensive blacks, overweight persons were substantially more likely than nonoverweight persons to be aware of their hypertension (odds ratio [OR] = 4.6, 95% confidence intervals [CI] = 1.9, 10.7 in black women and OR = 4.4, 95% CI = 1.0, 17.9 in black men). The validity of self-reported hypertension was relatively high in all race-sex groups. There is a need to increase hypertension awareness among hypertensive blacks who are not overweight.

Cutoff points for high waist-to-hip ratio (WHR) that may define high risk for cardiovascular disease have been suggested for men (0.95) and women (0.80). The WHRs of groups defined by age, race, and sex among 3,118 South Carolina adults were compared with these cutoff points. Measurement methodology, mean WHRs, and prevalence of elevated WHR in this biracial study population were compared with data from other populations. A review of anthropometric measurement methods used in recent epidemiologic studies indicates that a standard method for measuring waist and hip girth is required before comparisons of mean levels can be valid. The paucity of evidence that a high WHR is associated with cardiovascular disease mortality in black populations, and the high number of women who have an elevated WHR in this and other epidemiologic studies, support the following conclusion: Current WHR cutoff points, which are based on evidence from primarily white populations, may not be appropriate for women. older age groups, and some racial or ethnic groups in the United States.

We examined changes in five indicators of blood cholesterol awareness in two comparable biracial communities in South Carolina. One community received three years of cholesterol education and intervention activities implemented by a state health department and the other served as a comparison. Cross-sectional, interviewer-administered, random digit-dialed telephone surveys of 11,070 adults 18 years and older were conducted in 1987, 1988, 1989, and 1991. Changes in community levels of knowledge, preventive behavior, risk awareness, and treatment were assessed and compared between the two communities with analysis of covariance techniques that adjusted for age, race, and sex. Significant increases in knowledge, behavior, and risk awareness were observed for most groups defined by race, sex, or age in both communities. Significant net intervention increases between 1987 and 1991 were seen for knowledge of good cholesterol level (+16.4%, P < .001); behavioral action of ever having blood cholesterol checked (+18.6%, P < .001); and knowledge of personal level of blood cholesterol (+16.0%, P < .01). These results suggest that a community-wide blood cholesterol screening and education program can be effective in increasing blood cholesterol knowledge, risk awareness, and preventive behavior, thus serving as part of a public health strategy to lower and treat high blood cholesterol levels in a community.

Purpose. To present an evaluation of a 5-year, community-based, chronic disease prevention project managed by a state health department to determine whether the department could replicate similar previous projects that had received more funding and other resources. Design. The evaluation used a matched comparison design and a review of archive and interview data. Setting. Florence, South Carolina (population: 56,240). Subjects. A random sample of 1642 persons in Florence (and 1551 in the comparison) who responded to a risk factor questionnaire and underwent a physical assessment; 70. 7% of baseline subjects participated in the postintervention. Forty key persons were interviewed concerning project effectiveness. Interventions by Project. Walk-a-thons, a speakers' bureau, media messages, restaurant food labeling, and cooking seminars. More than 31,000 participants were involved in 585 activities. Measures. Questionnaires focused on hypertension, obesity, high cholesterol, smoking, and exercise. Physical assessments determined lipid, lipoprotein, apolipoprotein, and blood pressure levels. Analysis of covariance was used for baseline and postintervention comparisons. Content analysis was used on archive and interview data. Results. The project had a slightly favorable intervention effect on cholesterol and smoking, but failed to have an effect on other risk factors for cardiovascular disease. The project influenced community awareness, enlisted influential community members, and fostered linkages among local health services. Conclusions. Health departments can be instrumental in community risk reduction programming; however, they may not replicate projects having greater resources.

Objectives This study assessed whether a state public health department could effectively implement an affordable nutrition intervention program at the community level.Design Cross-sectional data were collected via telephone surveys of 9,839 adults, aged 18 years or older, in 1987, 1989, and 1991 in two South Carolina communities. Nutrition education programs began in 1988 in one community. The other community served as a comparison site. We assessed and compared changes in community levels of dietary fat and weekly meat consumption salt use, and nutrition promotion awareness with analysis of covariance regression techniques that included race, sex, and age as covariates.Results We observed favorable changes in most eating behaviors and levels of awareness in both communities. The intervention community experienced greater absolute changes than the comparison community in use of animal fats (-8.9% vs -4.0%; P=.02) and liquid or soft vegetable fats (+8.4% vs +3.6%; P=.04), and in awareness of restaurant nutrition information (+33.0% vs + 19.4%; P=.0001). Although the primary type of dietary fat used differed between black and white respondents, we observed significant change among both groups.Conclusions These results suggest that community-wide nutrition education programs may have augmented regional or national changes in dietary behavior among white and black adults in the intervention community.

To consider the relationship between race and long-term glycemic control, as measured by glycosylated hemoglobin (GHb), we analyzed data from a community-based sample of 3175 adults in the South Carolina Cardiovascular Disease Prevention Project. A clinically meaningful difference for mean GHb levels (10.5 vs 8.4%, P < 0.001) was present between black people and white people reporting diabetes. Similarly, a significant association between race and GHb was present among people reporting "borderline diabetes" or no diabetes. Logistic regression confirmed this finding in all three diabetic categories, however, controlling for insulin use in the diabetic group reduced (P < 0.001) the association between GHb and race. These findings confirm that further improvements in glycemic control are necessary, especially for black patients and that black people not reporting diabetes have higher GHb levels compared to white people, possibly due to undiagnosed diabetes.