Forsyth County Research Articles

Age-related trends in cardiovascular morbidity and physical functioning in the elderly: the Cardiovascular Health Study.

To describe relationships between age and sub-clinical cardiovascular disease, manifest chronic disease, and physical functioning and limitations among persons aged 65 years and older, with emphasis on the "oldest old," those 85 years and older. Observational population-based study. Four U.S. communities: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania. 5,201 men and women aged 65 years and older. Demographic data; histories of cardiovascular disease (CVD), chronic lung disease, arthritis, diabetes, and hypertension; measures of subclinical disease including arm and ankle blood pressures, internal carotid wall thickness and stenosis, ejection fraction, left ventricular mass, fractional shortening, and diastolic function, electrocardiographic left ventricular hypertrophy and cardiac injury score, forced expiratory flow and volume; functional status including self-reported physical functioning, hearing and sight limitations and health status, and performance-based measures of function. These variables were examined among men and women in three age groups: 65-74 years, 75-84 years, and 85 + years. Subgroups of participants with and without manifest CVD were also examined. In women, the prevalence of CVD and other chronic conditions increased with age, and the highest rates occurred among those 85 years and older. In men, prevalence rates increased between the two younger groups, but the oldest group had lower than expected rates for coronary heart disease, cerebrovascular disease, hypertension, and chronic lung disease. In contrast, there were strong age-related linear trends in most of the subclinical measures of blood pressure, atherosclerosis and pulmonary function and in virtually all measures of functional status in both gender groups across the age range. There was a particularly marked decline in functional status between the two older age groups. While subclinical disease was greater and functional status was poorer among those with manifest CVD, with few exceptions, age-related trends were not significantly different between the two groups. Lower than expected prevalence rates of CVD among those aged 85 years and older, particularly among men, in this study of community-dwelling elderly may represent selection bias or a real plateauing in disease prevalence with age. However, subclinical disease appears to increase and functional status to decline across the age range in both men and women regardless of the presence of CVD. The apparent increase in subclinical disease with age indicates potential for CVD prevention after age 65.

Smoking and Lung Function in Elderly Men and Women

To investigate relationships between cigarette smoking and pulmonary function in elderly men and women. Cross-sectional analysis of baseline data from a prospective, population-based study of risk factors, preclinical, and overt cardiovascular and pulmonary disease. Defined communities in Forsyth County, North Carolina; Pittsburgh, Pa; Sacramento County, California; and Washington County, Maryland. A total of 5201 noninstitutionalized men and women 65 years of age and older. Pulmonary function; means of forced expiratory volume in 1 second (FEV1) and forced vital capacity and prevalence of low FEV1 levels. Prevalence of cigarette smoking was 10% to 20% and higher in women than men and in blacks than whites. Forced vital capacity and FEV1 levels were related positively to height and white race and negatively to age and waist girth. Age- and height-adjusted FEV1 means were 23% and 18% lower in male and female current smokers, respectively, than in never smokers but not reduced in never smokers currently living with a smoker. Smokers who quit before age 40 years had FEV1 levels similar to never smokers, but FEV1 levels were lower by 7% and 14% in smokers who quit at ages 40 to 60 years and older than 60 years, respectively. Lung function was related inversely to pack-years of cigarette use. Prevalence rates of impaired lung function were highest in current smokers and lowest in never smokers. Regression coefficients for the smoking variables were smaller in persons without cardiovascular or respiratory conditions than in the total cohort. Cigarette smoking is associated with reduced pulmonary function in elderly men and women. However, smokers who quit, even after age 60 years, have better pulmonary function than continuing smokers.

Prevalence of Cardiovascular Diseases among Older Adults

The Cardiovascular Health Study is a population-based longitudinal study of 5,201 adults aged 65 years and older. Prevalences of myocardial infarction, angina pectoris, congestive heart failure, peripheral artery disease, stroke, and transient ischemic attack were ascertained between June 1989 and May 1990 in participants recruited from Forsyth County, North Carolina; Washington County, Maryland; Sacramento County, California; and Pittsburgh, Pennsylvania. A medical history was taken to obtain self-reports of prevalent disease. For all participants, use of nitrates was ascertained to document angina, electrocardiograms were used to document prevalent myocardial infarction, and ankle-arm blood pressure studies were used to document peripheral artery disease. Self-reports of disease that were not confirmed by examination findings were further investigated by examination of medical records. Reported disease that was confirmed by examination findings or by medical records was classified as "definite." Disease that was documented by examination, but not reported by the participant, was classified as "unreported." The prevalence rates of definite myocardial infarction and angina were 11% and 15%, respectively, among men aged 65-69 years, 18% and 17% among men aged 80-84 years, 4% and 8% among women aged 65-69 years, and 3% and 13% among women aged 80-84 years. Twenty-three percent of men and 38% of women with electrocardiographic evidence of myocardial infarction did not report it. These results suggest that prevalent disease estimates based only on self-report may underestimate the prevalence of cardiovascular diseases in older Americans.

Short-term intraindividual variability in lipoprotein measurements: the Atherosclerosis Risk in Communities (ARIC) Study.

Much epidemiologic research is based on estimation of an association between a putative risk factor and a health outcome--for example, plasma concentration of lipoproteins and ischemic heart disease. Since the repeatability of a risk factor measurement determines, in part, the ability to ascertain its association in populations, the Atherosclerosis Risk in Communities (ARIC) Intraindividual Variability Study was conducted to estimate various components of variation in analyte data and to estimate the repeatability of these measurements. A total of 40 subjects (17 males and 23 females) from Forsyth County, North Carolina, Minneapolis, Minnesota, Jackson, Mississippi, and Washington County, Maryland, were studied in 1988. Fasting blood was collected three times from each subject, with a 1- to 2-week interval between each visit. The contributions of between-person variability, within-person variability, and processing and assay variability were estimated. From these components, the reliability coefficient, R, the correlation between measures made at repeat visits, was estimated. R was above 0.85 for total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglycerides, and lipoprotein(a). Low repeatability was obtained for apolipoprotein A-I (R = 0.60). High density lipoprotein subfractions 2 and 3 were intermediate in repeatability. Reliability coefficients from the ARIC Intraindividual Variability Study are generally higher than those found in other studies, and this is related to relative variability in populations studied, to the time between measurements, and to differences in laboratory variability. Only for apolipoprotein A-I would the findings strongly suggest the need to adjust for measurement variability in estimation using one of these analytes as an independent variable.

Postprandial Lipemia: Reliability in an Epidemiologic Field Study

Ten subjects from the Forsyth County, North Carolina, and Washington County, Maryland, field centers in the Atherosclerosis Risk in Communities Study had two fat tolerance tests within a 10-day period from September 1988 to February 1989 to determine the reproducibility of markers for postprandial lipemia. No significant differences between visits were found in fasting mean plasma lipids, lipoproteins, and apolipoproteins. Postprandial triglycerides and retinyl palmitate were measured at 3.5 and 9.0 hours after the test meal in whole plasma. There were no significant differences in the mean levels of these analytes between visits. The correlation of triglycerides between repeat visits at 9.0 hours (r = 0.87) was stronger than in fasting samples (r = 0.67) or at 3.5 hours (r = 0.69). The mean plasma retinyl palmitate level at 3.5 hours was 15% higher than at the 9.0-hour level. The correlation of repeat measures of retinyl palmitate at 9.0 hours (r = 0.94) was much stronger than at 3.5 hours (r = 0.79). In conclusion, estimates of reliability in postprandial measurements of 9.0-hour triglycerides and retinyl palmitate levels were as strong as fasting lipid measurements of total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol, and both postprandial triglyceride measurements exceeded that of fasting triglyceride (r = 0.67).

The cardiovascular health study: Design and rationale

The Cardiovascular Health Study (CHS) is a population-based, longitudinal study of coronary heart disease and stroke in adults aged 65 years and older. The main objective of the study is to identify factors related to the onset and course of coronary heart disease and stroke. CHS is designed to determine the importance of conventional cardiovascular disease (CVD) risk factors in older adults, and to identify new risk factors in this age group, especially those that may be protective and modifiable. The study design called for enrollment of 1250 men and women in each of four communities: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania. Eligible participants were sampled from Medicare eligibility lists in each area. Extensive physical and laboratory evaluations were performed at baseline to identify the presence and severity of CVD risk factors such as hypertension, hypercholesterolemia and glucose intolerance; subclinical disease such as carotid artery atherosclerosis, left ventricular enlargement, and transient ischemia; and clinically overt CVD. These examinations in CHS permit evaluation of CVD risk factors in older adults, particularly in groups previously under-represented in epidemiologic studies, such as women and the very old. The first of two examination cycles began in June 1989. A second comprehensive examination will be repeated three years later. Periodic interim contacts are scheduled to ascertain and verify the incidence of CVD events, the frequency of recurrent events, and the sequellae of CVD.

Implementation of mass media community health education: the Forsyth County Cervical Cancer Prevention Project.

The Forsyth County Cervical Cancer Prevention Project (FCP) is a community-based health education project funded by the National Cancer Institute. The target population includes around 25 000 black women age 18 and older who reside in Forsyth County, North Carolina. The overall goal of the program is to prevent mortality from cervical cancer by promoting Pap smears and return for follow-up care when needed. Based on the principles of social marketing, a plan to reach the target population with mass media educational messages through electronic and print channels was developed. Guided by marketing objectives, the target population was divided into relatively discrete segments. The segments included church attenders, patients in waiting rooms of public and selected health providers, female students at local colleges, shoppers, viewers of radio and television, newspaper readers, and business owners and managers. Introduction of the program was based on strategies developed for reaching the target population in each segment with television, radio and print mass media messages. Qualitative assessment of the mass media developed by the program indicated that all forms of communication helped to increase awareness of the program.

The role of focus groups in health education for cervical cancer among minority women

Focus groups were used in the development of community-based public health education designed to reduce mortality from cervical cancer among black women in Forsyth County, North Carolina. The educational goals of this National Cancer Institute (NCI) funded project were to increase the proportion of black women, age 18 and older, who obtain Pap smears on a regular basis and return for followup care when necessary. A series of four focus groups were conducted to help develop the conceptual basis for designing educational messages and materials. The groups were led by a black, female professional focus group moderator, and explored a variety of health-related topics ranging from general, ordinary concerns of daily living to knowledge and attitudes about cancer screening. The group discussions suggested that health is regarded as very important to the target population, particularly when related to family functioning. Regarding the Pap smear, most women knew about the test, but had little awareness of its role in the early detection of cervical cancer. Fear and fatalism were clearly the dominant, top-of-mind reactions to cancer, and there was little differentiation among sites or types of cancer. Despite the overall pessimism, the groups agreed that early diagnosis and treatment provide the best hope for good outcomes with cancer.

Identification of community leadership in the development of public health education programs

This paper deals with the identification of community leadership within the context of a community cancer prevention education program. An unusually high age-adjusted black/white mortality ratio exists for cervical cancer in Forsyth County, North Carolina. In response to this problem, a comprehensive public education program dealing with cervical cancer prevention was developed and currently is being implemented. Black community leaders have played an important role in planning for the program and in providing assistance for program implementation. Leaders were identified by means of a modified snowball technique in which ten recognized leaders in the black community initially were contacted and asked to name at least five other leaders in areas of leadership that included social/civic, political, religious, business, and less visible leaders. This process continued until no new names were generated. Interviews were conducted with 103 persons, and 589 leaders were identified. A cohort of 54 top-ranked leaders were identified, and the characteristics of these leaders are presented. The value of the leadership identification process is discussed in terms of (a) the identification process itself, (b) the generation of a list of key individuals who can serve as sources of advice for development and implementation of the program and as the beginning point for dissemination of new information on the project, and (c) a mechanism for development of a sense of community ownership of the project.

Development of a direct education workshop for cervical cancer prevention in high risk women: The Forsyth County project

With funding from the National Cancer Institute, a public health education program was developed with the primary objective of increasing the proportion of black women in Forsyth County, North Carolina, who receive Pap smears on a regular basis. This paper reports on the development and implementation of the direct education component of the program. The content of the workshop was based on community analysis of current knowledge, attitudes, and behaviors in the target population, and a review of relevant literature on cervical cancer and the Pap smear. Methods for presentation of the content were refined through three pilot tests. Audiovisual materials were also developed to illustrate key points. The direct education component of the program was designed to function as a short workshop and includes an overview of healthy lifestyles, coverage of the importance of early detection of cancer, a description and discussion of the pelvic exam and the Pap smear, and a discussion of common barriers to obtaining Pap smears on a regular basis. Evaluation of the workshop emphasizes process measures, including a questionnaire to collect demographic information and impressions of the presentation. Interim results of the evaluation are discussed.

Searches for fractional electric charge in meteorite samples

The magnetic levitation technique has been used to test for fractional electric charge on samples of several types of meteorite material, thus providing the first mass-independent search for free quarks or other fractionally-charged particles in natural nonterrestrial materials. The tests were made on diced samples of the Hoba and Forsyth County iron-nickel meteorites, and the Murchison stony meteorite, the latter being plated with iron to allow magnetic levitation. No evidence for fractional charge was found, the quantities tested being 1.3 mg (Hoba), 1.1 mg (Forsyth), and 0.4 mg (Murchison).

The Effects of Greenspace Tax Laws on Urban Development

This paper provides an analysis of the effects of greenspace land taxes on the allocation of land between competing uses over time. Describing development with estimated linear equations permits the dynamic model to be used to quantify the effect of different taxes on the rate of urbanization. Using data from Forsyth County, N.C., it is shown that land taxes can slow the pace of development- as they are intended to do-but also that the efficiency gains or losses associated with the taxes are modest at best.

THE ATHEROSCLEROSIS RISK IN COMMUNIT (ARIC) STUDY: DESIGN AND OBJECTIVES

Abstract Atherosclerosis Risk in Communities (ARIC) is a new prospective study to investigate the etiology of atherosclerosis and its clinical sequelae and variation in cardiovascular risk factors, medical care, and disease by race, sex, place, and time. in each of four US communities—Forsyth County, North Carolina, Jackson, Mississippi, suburbs of Minneapolis, Minnesota, and Washington County, Maryland—4, 000 adults aged 45–64 years will be examined twice, three years apart. ARIC has coordinating, ultrasound, pulmonary, and electrocardiographic centers and three central laboratories. Three cohorts represent the ethnic mix of their communities; the Jackson cohort, its black population. Examinations include ultrasound scanning of carotid and popliteal arteries; lipids, lipoprotelns, and apolipoproteins assayed in the Lipid Laboratory; and coagulation, inhibition, and platelet and fibrinolytic actmty assayed in the Hemostasis Laboratory. Surveil lance for coronary heart disease will involve review of hospitalizations and deaths among community residents aged 35–74 years. ARIC aims to study atheroscle rosis by direct observation of the disease and by use of modem biochemistry.

“A Chance to Serve”

Twenty-five years later, racial violence is illegal. When racial violence does occur such as in Howard Beach, New York or Forsyth County, Georgia it's illegal and the perpetrators are put in the judicial system, tried, and given their just punishment. Racial violence is moving the direction of racial justice. Just as we replaced racial violence with racial justice, we must replace economic violence with economic justice. Economic violence is the critical issue of

Forsyth County Public Library and the Constitution's Bicentennial: Building Relationships for Our Library

Forsyth County Public Library and the Constitution's Bicentennial: Building Relationships for Our Library

Noncompliance in screening follow-up among family planning clinic patients with cervical dysplasia

This investigation estimated the extent of noncompliance with follow-up to screening for cervical dysplasia at a public health family planning clinic. Available data also permitted examination of the relationship between selected background characteristics and compliance with follow-up. Noncompliance was defined as failure to respond to notification of an abnormal cervical smear (Class III, IV, or V) by failing either to make a follow-up appointment or to keep such an appointment after it was made. The sample consisted of 177 women with abnormal cervical smears who were screened at the Forsyth County Family Planning Clinic between January 1, 1980, and June 30, 1981. Information on the women's compliance with the request for follow-up was obtained from a file specifically kept for this purpose by the clinic nurse. Background characteristics were obtained by reviewing clinic records. Results indicated that approximately 17% of the sample was noncompliant. Noncompliant patients were more likely to be unmarried, less educated, younger, and to have fewer total health problems than women who returned for follow-up. Logistic regression analysis revealed that the number of health problems and educational attainment were the most important predictors of noncompliance.

The relationship between weight-height indices and the triceps skinfold measure among children age 5 to 12.

This study examines several weight for height indices--Quetelet's index W/H2, W/H, and Rohrer's index W/H3--for their appropriateness in estimating adiposity among young children. Data were obtained for a sample of 1,668 children age 5-12 residing in Forsyth County, North Carolina. Although W/H2 was found to be the most useful of these indices, the results suggest that no index, including the tricep skinfold measure, can be considered completely satisfactory in estimating adiposity among children.

Review: The Historic Architecture of Cabarrus County, North Carolina, by Peter R. Kaplan and David William Brown; Wilson County's Architectural Heritage, by Kate Ohno; Cabins and Castles: The History and Architecture of Buncombe County, North Carolina, by Douglas Swaim; and From Frontier to Factory: An Architectural History of Forsyth County, by Gwynne Stephens Taylor

Review: <i>The Historic Architecture of Cabarrus County, North Carolina</i>, by Peter R. Kaplan and David William Brown; <i>Wilson County's Architectural Heritage</i>, by Kate Ohno; <i>Cabins and Castles: The History and Architecture of Buncombe County, North Carolina</i>, by Douglas Swaim; and <i>From Frontier to Factory: An Architectural History of Forsyth County</i>, by Gwynne Stephens Taylor

Rocky Mountain Spotted Fever

Serological tests for Rocky Mountain spotted fever were performed on single serum specimens from sixth graders from Forsyth County, North Carolina, an area highly endemic for this disease. Five of 508 *.098%) sera were positive (titer greater than or equal to 1:64) using the indirect fluorescent antibody method. Elevated Proteus agglutination antibody titers (greater than 1:160) to OX-19, but not ot OX-2, were common (19.6%) in these children. No correlation of those with positive OX-19 titers could be made with the cases demonstrating elevated indirect fluorescent antibody titers or with a history of urinary tract infection. These data suggest that the increased prevalence of elevated Proteus OX-19 antibody levels makes a single high titer unreliable in the diagnosis of Rocky Mountain spotted fever and that naturally acquired mild or asymptomatic subclinical cases of Rickettsia rickttsii infection occur.

Maternal serum alpha-fetoprotein screening: A report of the Forsyth County Project

A pilot screening program for the prenatal detection of neural tube defects has been conducted in Forsyth County, North Carolina. During the first 2 years of the program, 3,476 women were screened by quantitating levels of maternal serum alpha fetoprotein. Three neural tube defects and one case of multiple congenital anomalies with severe gastroschisis were detected as a result of the screening program. Outcome of pregnancy has been monitored in this group of women and no false negatives have been reported. No false positive amniotic fluid alpha-fetoprotein values were observed and no normal fetuses were aborted. Data gathered from this screening program again document the validity of maternal serum screening. The method of implementing a program for the prenatal detection of neural tube defects in urban areas is discussed.