Correlates of adherence to behavioral contracts for cholesterol reduction

Abstract

There is considerable evidence that total serum cholesterol is related to coronary heart disease (CHD) (1-3). The Lipid Research Clinics Coronary Prevention Trial and the Multiple Risk Factor Intervention Trial (MRFIT) have both reported substantial reductions in CHD risk from lowering serum cholesterol (4-5). The American Heart Association (AHA) advocates reducing elevated serum cholesterol by follOWing a diet low in total fat, saturated fat and dietary cholesterol (6-8). However, dietary interventions for cholesterol reduction have had varying degrees of success (9-14), and the majority of studies which have employed long term follow-up measures of dietary change and serum cholesterol have not been encouraging (12, 15). Behavioral contracting is an intervention technique in which a client signs an agreement to make certain behavior changes within a specified time frame, in return for a desired reinforcement or reward. Contracting has been successfully employed to increase programmatic adherence in a variety of health behavior change programs (16, 17), but has not been widely used in cholesterol reduction interventions (18). This paper presents follow-up results from 52 individuals who signed behavioral contracts to adhere to the AHA dietary guidelines for cholesterol reduction. Data are presented to address the following questions: a) How do demographic variables and baseline body weight and serum cholesterol relate to initial contract signing and level of contract adherence? b) Do those individuals who successfully achieve their contract goals to adopt the AHA diet also experience a reduction in serum cholesterol? c) How well