Risk Factor For Chronic Conditions Research Articles

Canadian family medicine residency program survey of physical activity curriculum content

Background: Physical activity (PA) is an important contributor to the health of Canadians. However, the extent that PA is included in family medicine residents' education is largely unknown. This study surveyed curriculum experts in Canadian family medicine residency programs to understand what residents learn about PA and to what extent this varies across programs. Methods: Seventeen family medicine residency program websites were reviewed for information pertaining to their PA curriculum. Additionally, curriculum experts were asked to complete a survey to better understand the extent that PA curriculum is included in their programs. Results: Most (82.4%) of the eligible programs responded to the survey; of which, the majority (92.9%) indicated that residents learn that physical inactivity is a risk factor for chronic conditions, to incorporate into patient care plans, and to recommended PA as prevention for chronic diseases. However, half (50.0%) of the programs stated that they believe residents will be sufficiently prepared to incorporate PA in the care they provide patients, less than half (42.9%) teach PA guidelines, and few (21.4%) teach about PA referral to an allied health care provider or community program. Conclusions: The instruction about PA that family physicians receive in Canadian residency programs varied depending on the program. A standard to ensure residents are sufficiently and competently prepared to recommend and advise physical activity as treatment and prevention is needed. Additional studies are needed to understand the opinions and teachings of preceptors who may have an influence over the residency training of Canadian family physicians.

Oral microbiota and periodontitis severity among Hispanic adults.

Periodontitis, one of the most common bacterial infections characterized by chronic inflammation, is also known to be a risk factor for chronic conditions, including cardiovascular disease and cancer. This inflammation is driven by an altered microbiotawith an increase in pathogenic bacteria. We evaluated the association between oral microbiota and periodontitis severity in high-risk Hispanics. This cross-sectional study recruited 134 sexually active participants aged 21 to 49 years old from STI Clinics in Puerto Rico. A periodontal examination, saliva collection, and an interviewer-administered questionnaire were performed. Periodontal severity was categorized as: having no disease, mild, and moderate/severe and BOP and tooth loos was noted. Saliva samples were collected for genomic DNA extraction, downstream 16S rDNA amplification sequencing, and bioinformatics analyses. The structure, composition, and diversity of bacterial communities differed significantly according to periodontal severity. The richness and overall diversity also differed between participants without periodontitis and participants with some level of periodontal disease. A higher abundance of Prevotella, Veillonella, or Treponema was attributed to periodontal disease and Aggregatibacter to severe bleeding on probing, while Neisseria was found in higher abundance in healthy participants, decreasing its levels with drinking, smoking, and oral sex practices. Our findings indicate that dysbiosis occurs as periodontal disease progresses, and both alcohol consumption and smoking habits pose risk factors for oral dysbiosis. These results are of public health and clinical impact, as several bacteria identified could serve in the future as biomarkers for periodontitis and oral cancer risk.

The 2022 hormone therapy position statement of The North American Menopause Society: no news is good news

The 2022 position statement of The North American Menopause Society (NAMS) on hormone therapy1 is an excellent read that keeps alive discussion on a topic of interest for a wide audience of practitioners in the field of women's health. Indeed, menopause is a universal process among women at midlife (ranging 46–52 years globally) and some of them might have distressing symptoms and develop risk factors for chronic conditions with an impact on healthy longevity.2

The relative impact of underweight, overweight, smoking, and physical inactivity on health and associated costs in Indonesia: propensity score matching of a national sample

BackgroundIndonesia is in the middle of a rapid epidemiological transition with an ageing population and increasing exposure to risk factors for chronic conditions. This study examines the relative impacts of obesity, tobacco consumption, and physical inactivity, on non-communicable diseases multimorbidity, health service use, catastrophic health expenditure (CHE), and loss in employment productivity in Indonesia.MethodsSecondary analyses were conducted of cross-sectional data from adults aged ≥ 40 years (n = 12,081) in the Indonesian Family Life Survey 2014/2015. We used propensity score matching to assess the associations between behavioural risk factors and health service use, CHE, employment productivity, and multimorbidity.ResultsBeing obese, overweight and a former tobacco user was associated with a higher number of chronic conditions and multimorbidity (p < 0.05). Being a former tobacco user contributed to a higher number of outpatient and inpatient visits as well as CHE incidences and work absenteeism. Physical inactivity relatively increased the number of outpatient visits (30% increase, p < 0.05) and work absenteeism (21% increase, P < 0.06). Although being underweight was associated with an increased outpatient care utilisation (23% increase, p < 0.05), being overweight was negatively associated with CHE incidences (50% decrease, p < 0.05).ConclusionCombined together, obesity, overweight, physical inactivity and tobacco use contributed to an increased number of NCDs as well as medical costs and productivity loss in Indonesia. Interventions addressing physical and behavioural risk factors are likely to have substantial benefits for individuals and the wider society in Indonesia.

Development and evaluation of a decision support system for integration of primary diabetes and periodontal healthcare

IntroductionThere is conflicting evidence for the effect of clinical decision support systems (CDSS) for improving health care. While there have been success stories, other studies have highlighted potential pitfalls for CDSS. It is also uncertain whether and how a CDSS could improve integration of health care. This abstract reports the development and evaluation of a CDSS to improve integration of primary diabetes and periodontal healthcare.MethodsThe CDSS was developed using focus group and individual discussions with general practitioners (GPs) and dentists. These resulted in decision trees which acted as the basic structure for the CDSS. After the development, a case vignette study was conducted to evaluate the impact of the CDSS on decision making. Two sets of vignettes were developed, one set for GPs (n=200) and one set for dentists (n=200). Each participant was presented three different vignettes, with one chosen at random to include support from the CDSS. Logistic regression analysis was performed to assess the influence of the CDSS on the recommended decisions.ResultsThe CDSS was developed for both GPs and dentists. Based on risk scores for diabetes and periodontitis, the CDSS gives tailored information, warnings and recommendations to the healthcare providers. The case vignette study showed that if assisted by the CDSS the GPs more often provided information on common risk factors for chronic conditions and dental problems (OR 3.3) and GDPS more often provided information regarding the bi-directional relationship between periodontitis and diabetes (OR 1.6). Both groups were also more likely to refer to each other when the CDSS was activated (GP OR 4.1; GDP OR 4.3). GDPs were also more likely to ask for a patient's HbA1c value when prompted by the CDSS (OR 3.2)DiscussionsA CDSS for cooperation between primary and dental healthcare might provide innovative and novel possibilities to improve integration of healthcare through more awareness and better informed decision making.ConclusionsWe have developed a CDSS to raise awareness among general practitioners and dentists about the bi-directional link between diabetes and periodontitis and to promote integration of primary diabetes and periodontal healthcare.Lessons learned The vignette study suggested that the CDSS will help to raise awareness among healthcare providers and facilitates intersectoral cooperation. The CDSS may act as a blue-print for further oral-systemic interaction and integration.Limitations The decision trees and CDSS were developed using expert opinions from healthcare providers due to a lack of clinical guidelines for patients suffering from both conditions. These opinions may not be generally representative. The participants in the case vignette study are not a representative sample for GPs and GDPs in Germany, so the results cannot be generalized.Suggestions for future researchThe CDSS could be improved by integration of electronic dental and general health records. For the time being, the necessary information needed by the CDSS can be reported by the patients during the visit. Future research may focus on implementation of this CDSS and exploration of other oral-systemic interactions for which this DSS might be extendable.

Promoting the get healthy information and coaching service (GHS) in Australian-Chinese communities: facilitators and barriers.

Obesity and being overweight are major public health concerns that health coaching can assist people to manage through encouraging self-management and behaviour change. The Get Healthy Information and Coaching Service (GHS) is a telephone health coaching service in Australia that has effectively improved the health of the general population but has had less participation of culturally and linguistically diverse (CALD) populations. The Chinese population is the largest migrant group in Australia with increased risk of diabetes but had reduced access to the GHS program due to communication barriers. The GHS developed a pilot program for Chinese (Mandarin and Cantonese-speaking) communities using bilingual coaches and translated material to address these barriers. Qualitative research was undertaken with Chinese stakeholders (14 interviews) and 11 program participants from the group which had completed the program (2 focus groups in Mandarin and Cantonese) to understand their experiences and the success of promotional activities. This research does not contain the experiences of the people that withdrew from the program. The bilingual program was culturally and linguistically appropriate and addressed risk factors for chronic conditions. Participants formed positive relationships with bilingual coaches who they preferred to interpreters. They felt the program promoted healthy eating, weight and physical activity. Although Chinese stakeholders had concerns about participants' ability to goal set, participants said they met their health goals and were committed to the GHS program. Strategies to enhance the program included promoting the bilingual GHS to the communities and stakeholders. Factors to consider beyond language in adapting the program to the Australian Chinese communities include meeting the heterogenous needs of the older population, ensuring community engagement and addressing cultural beliefs and practices.

Change in Physical Activity after Diagnosis of Diabetes or Hypertension: Results from an Observational Population-Based Cohort Study.

Background: Chronic diseases like diabetes mellitus or hypertension are a major public health challenge. Irregular physical activity (PA) is one of the most important modifiable risk factors for chronic conditions and their complications. However, engaging in regular PA is a challenge for many individuals. The literature suggests that a diagnosis of a disease might serve as a promising point in time to change health behavior. This study investigates whether a diagnosis of diabetes or hypertension is associated with changes in PA. Methods: Analyses are based on 4261 participants of the population-based KORA S4 study (1999–2001) and its subsequent 7-and 14-year follow-ups. Information on PA and incident diagnoses of diabetes or hypertension was assessed via standardized interviews. Change in PA was regressed upon diagnosis with diabetes or hypertension, using logistic regression models. Models were stratified into active and inactive individuals at baseline to avoid ceiling and floor effects or regression to the mean. Results: Active participants at baseline showed higher odds (OR = 2.16 [1.20;3.89]) for becoming inactive after a diabetes diagnosis than those without a diabetes diagnosis. No other significant association was observed. Discussion: As PA is important for the management of diabetes or hypertension, ways to increase or maintain PA levels in newly-diagnosed patients are important. Communication strategies might be crucial, and practitioners and health insurance companies could play a key role in raising awareness.

Patterns of SES Health Disparities Among Older Adults in Three Upper Middle- and Two High-Income Countries.

To examine the socioeconomic status (SES) health gradient for obesity, diabetes, and hypertension within a diverse group of health outcomes and behaviors among older adults (60+) in upper middle-income countries benchmarked with high-income countries. We used data from three upper middle-income settings (Colombia-SABE-Bogotá, Mexico-SAGE, and South Africa-SAGE) and two high-income countries (England-ELSA and US-HRS) to estimate logistic regression models using age, gender, and education to predict health and health behaviors. The sharpest gradients appear in middle-income settings but follow expected patterns found in high-income countries for poor self-reported health, functionality, cognitive impairment, and depression. However, weaker gradients appear for obesity, hypertension, diabetes, and other chronic conditions in Colombia and Mexico and the gradient reverses in South Africa. Strong disparities exist in risky health behaviors and in early nutritional status in the middle-income settings. Rapid demographic and nutritional transitions, urbanization, poor early life conditions, social mobility, negative health behavior, and unique country circumstances provide a useful framework for understanding the SES health gradient in middle-income settings. In contrast with high-income countries, the increasing prevalence of obesity, an important risk factor for chronic conditions and other aspects of health, may ultimately change the SES gradient for diseases in the future.

Evaluating the Factors Associated With the Completion of a Community-Based Group Exercise Program Among Older Women.

Despite the well-known benefits of exercise, only 50% of U.S. women met recommended physical activity levels in 2014. To combat this issue, the Healthy Aging Regional Collaborative of South Florida has been offering the EnhanceFitness (EF) program in community-based settings since 2008. In the current study, we examined the factors associated with the program completion among older women (≥ 60 years). During the first 4 years, 3,829 older women attended EF sessions. Of these, 924 (24.2%) attended the recommended 32 sessions within first 4 months. Results revealed that women who lived in Miami-Dade County, were ≥ 80 years, and did not report depression and/or risk factors for chronic conditions were more likely to complete EF. Black women were less likely to complete the program. Recognition of these factors might help identify at-risk individuals. More efforts are needed to improve completion rates. Theory-based interventions would allow comprehensive understanding of all factors and, therefore, should be explored in the future.

Characterising the extent of misreporting of high blood pressure, high cholesterol, and diabetes using the Australian Health Survey.

BackgroundMeasuring and monitoring the true prevalence of risk factors for chronic conditions is essential for evidence-based policy and health service planning. Understanding the prevalence of risk factors for cardiovascular disease (CVD) in Australia relies heavily on self-report measures from surveys, such as the triennial National Health Survey. However, international evidence suggests that self-reported data may substantially underestimate actual risk factor prevalence. This study sought to characterise the extent of misreporting in a large, nationally-representative health survey that included objective measures of clinical risk factors for CVD.MethodsThis study employed a cross-sectional analysis of 7269 adults aged 18 years and over who provided fasting blood samples as part of the 2011–12 Australian Health Survey. Self-reported prevalence of high blood pressure, high cholesterol and diabetes was compared to measured prevalence, and univariate and multivariate logistic regression analyses identified socio-demographic characteristics associated with underreporting for each risk factor.ResultsApproximately 16 % of the total sample underreported high blood pressure (measured to be at high risk but didn’t report a diagnosis), 33 % underreported high cholesterol, and 1.3 % underreported diabetes. Among those measured to be at high risk, 68 % did not report a diagnosis for high blood pressure, nor did 89 % of people with high cholesterol and 29 % of people with high fasting plasma glucose. Younger age was associated with underreporting high blood pressure and high cholesterol, while lower area-level disadvantage and higher income were associated with underreporting diabetes.ConclusionsUnderreporting has important implications for CVD risk factor surveillance, policy planning and decisions, and clinical best-practice guidelines. This analysis highlights concerns about the reach of primary prevention efforts in certain groups and implications for patients who may be unaware of their disease risk status.

A systematic review of financial incentives given in the healthcare setting; do they effectively improve physical activity levels?

BackgroundAccording to current physical activity guidelines, a substantial percentage of the population in high-income countries is inactive, and inactivity is an important risk factor for chronic conditions and mortality. Financial incentives may encourage people to become more active. The objective of this review was to provide insight in the effectiveness of financial incentives used for promoting physical activity in the healthcare setting.MethodsA systematic literature search was performed in three databases: Medline, EMBASE and SciSearch. In total, 1395 papers published up until April 2015 were identified. Eleven of them were screened on in- and exclusion criteria based on the full-text publication.ResultsThree studies were included in the review. Two studies combined a financial incentive with nutrition classes or motivational interviewing. One of these provided a free membership to a sports facility and the other one provided vouchers for one episode of aerobic activities at a local leisure center or swimming pool. The third study provided a schedule for exercise sessions. None of the studies addressed the preferences of their target population with regard to financial incentives. Despite some short-term effects, neither of the studies showed significant long-term effects of the financial incentive.ConclusionsBased on the limited number of studies and the diversity in findings, no solid conclusion can be drawn regarding the effectiveness of financial incentives on physical activity in the healthcare setting. Therefore, there is a need for more research on the effectiveness of financial incentives in changing physical activity behavior in this setting. There is possibly something to be gained by studying the preferred type and size of the financial incentive.

Impact of disability and chronic conditions on health

BackgroundToday one in five Americans have a disability and nearly half of Americans experiences a chronic condition. Whether disability results from or is a risk factor for chronic conditions, the combined effects of disability and chronic conditions warrants further investigation. ObjectivesExamine the added impact of chronic conditions among those with and without disability on self-reported health status and behaviors. Methods2009 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed to examine the association of disability with unhealthy behaviors and poor health stratified by number of self-reported chronic conditions (0, 1, or 2+). Linear and logistic regression models accounting for the complex survey weights were used. ResultsParticipants with disability were 6 times more likely to report fair/poor self-rated health, reported 9 more unhealthy days in a month and 6 more days in a month when poor health kept them from usual activities, were 4 times more likely to be dissatisfied with life, had greater odds of being a current smoker, and were less likely to be physically active. Presence of chronic conditions in addition to disability was associated, in a dose–response manner, with poor health status and unhealthy behaviors. ConclusionsPeople living with both chronic diseases and disability are at substantially increased risks for poor health status and unhealthy behaviors, further affecting effective management of their chronic conditions. Multi-level interventions in primary care and in the community that address social and environmental barriers that hinder adults with disability from adopting more healthy lifestyles and improving health are needed.

Adverse childhood experiences and the cardiovascular health of children: a cross-sectional study

BackgroundAdverse childhood experiences (ACEs), such as abuse, household dysfunction, and neglect, have been shown to increase adults’ risk of developing chronic conditions and risk factors for chronic conditions, including cardiovascular disease (CVD). Much less work has investigated the effect of ACEs on children’s physical health status that may lead to adult chronic health conditions. Therefore, the present study examined the relationship between ACEs and early childhood risk factors for adult cardiovascular disease.Methods1 234 grade six to eight students participated in school-based data collection, which included resting measures of blood pressure (BP), heart rate (HR), body mass index (BMI) and waist circumference (WC). Parents of these children completed an inventory of ACEs taken from the Childhood Trust Events Survey. Linear regression models were used to assess the relationship between experiencing more than 4 ACEs experienced, systolic BP, HR, BMI and WC. In additional analysis, ACEs were assessed ordinally in their relationship with systolic BP, HR, and BMI as well as clinical obesity and hypertension status.ResultsAfter adjustment for family education, income, age, sex, physical activity, and parental history of hypertension, and WC for HR models, four or more ACEs had a significant effect on HR (b = 1.8 bpm, 95% CI (0.1-3.6)) BMI (b =1.1 kg/m2, 95% CI (0.5-1.8)), and WC (b = 3.6 cm, 95% CI (1.8-5.3)). A dose–response relationship between ACE accumulation and both BMI and WC was also found to be significant. Furthermore, accumulation of 4 or more ACEs was significantly associated with clinical obesity (95th percentile), after controlling for the aforementioned covariates.ConclusionsIn a community sample of grade six to eight children, accumulation of 4 or more ACEs significantly increased BMI, WC and resting HR. Therefore, risk factors related to reported associations between ACEs and cardiovascular outcomes among adults are identifiable in childhood suggesting earlier interventions to reduce CVD risk are required.

Midlife Fitness Predicts Less Burden of Chronic Disease in Later Life

To investigate the relationship between midlife fitness in healthy adults and the development of nonfatal chronic conditions (CCs) in older age. Cohort study. Data on participants were drawn from the Cooper Center Longitudinal Study and linked with US Medicare claims made in the years 1999 through 2009. The cohort included 18 670 participants (median age, 49 years; 21% women) who had received a comprehensive clinical examination between 1970 and 2009 at the Cooper Center, were ≥65 years of age and covered by Medicare between 1999 and 2009, and who reported no baseline history of CCs such as cardiovascular disease, diabetes, and cancer. The participants tended to be from upper educational and socioeconomic strata. Fitness was assessed by maximal treadmill effort using the modified Balke protocol. The participants' treadmill times were classified into age- and sex-specific quintiles (Q) of fitness (Q1, least fit) and converted into metabolic equivalents (MET). Clinical and anthropometric variables and physical activity were measured. The main outcome measure was the association between level of fitness in midlife (ie, at study entry) and the development of chronic conditions (specifically, congestive heart failure, ischemic heart disease, stroke, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, Alzheimer's disease, and colon or lung cancer), recorded by Medicare. The conditions were each assigned a value of 1, and those present were summed for survivors at ages 70, 75, 80, and 85 years. Death was an additional outcome. Total follow-up was 120 780 person-years. At study entry the participants had, overall, low levels of traditional risk factors for CCs, with the less fit having somewhat less healthy risk factor profiles. The highest level of midlife fitness (Q5) was associated with developing fewer CCs compared with low midlife fitness (Q1) in men (15.6; 95% confidence interval [CI], 15.0-16.2 vs 28.2; 95% CI, 27.4-29.0 per 100 person-years) and women (11.4; 95% CI, 10.5-12.3 vs 20.1; 95% CI, 18.7-21.6 per 100 person-years). After multivariate adjustment, higher fitness remained associated with a lower risk of developing CCs (men: hazard ratio [HR], 0.95; 95% CI, 0.94-0.96 per MET; and women: HR, 0.94; 95% CI, 0.91-0.96 per MET). Level of fitness was similarly associated with the development of CCs in younger and older participants. Among the 2406 participants who died during the study period, the number of CCs among the more fit persons was significantly lower than that among the less fit; thus, in their final 5 years of life, 58.3% of fitness Q4 and Q5 versus 43.5% of Q1 had ≤1 CC and 9.5% of Q4 and Q5 versus 18.3% of Q1 had ≥4 CCs. Healthy, fit, middle-aged adults developed fewer chronic conditions in later life than unfit persons and had a lesser burden of chronic disease before death.

Social determinants of oral health inequalities: implications for action

For over 30 years, the WHO has been advocating an integrated approach in chronic disease prevention. The concept of the common risk factor approach (CRFA) highlighted shared risk factors for chronic conditions including oral diseases has provided the basis for closer integration of oral and general health promotion activities. Although considerable progress has been undoubtedly made in combating the isolation and compartmentalization of oral health, this paper will argue that future action on tackling oral health inequalities requires a reorientation of oral health policy away from a fixation on changing oral health behaviours to instead action on the common social determinants of oral health inequalities. The narrow and restricted interpretation of the CRFA is a serious threat to developing effective action to address oral health inequalities. Based upon the WHO conceptual framework on the social determinants of health inequalities, an overview will be presented of a range of actions that could be implemented to tackle the social gradients in oral health outcomes.

Healthy convenient prepared meals improve dietary quality during structured dietary intervention for heart disease risk factor reduction.

Caloric restriction is a typical approach for creating a negative energy balance for weight‐loss. Reduced food consumption may negatively affect dietary quality. Interventions that can maintain this in the face of caloric restriction are desirable.We examined the effects of a DASH‐Style (DS; n=62) diet and exercise or exercise only (EO, n=49) program on cardiovascular risk factors for 24 weeks (BMI 22‐40). Both groups received an exercise prescription recommending a minimum of 15 minutes of moderate physical activity, 3 days per week and progressing to 45 minutes, 4 days per week by week 12. They also met with an exercise physiologist once weekly for 12 weeks and biweekly thereafter. Additionally, the DS group followed a reduce calorie eating pattern and incorporated one commercially prepared healthy frozen meal and one other selected grocery item each day for 24 weeks and received dietary counseling from a dietician once weekly for 12 weeks and biweekly thereafter.After 24 weeks, DS reduced weight (‐18.04 ± 10.65 vs ‐6.05 ± 8.36lbs, p&lt;0.001), intake of calories (‐486.0 ± 555.1 vs ‐42.7 ± 569.9kcal, p&lt;0.001) total fat (‐39.0 ± 30.3 vs ‐5.2 ± 34.9g, p&lt;0.001), saturated fat (‐16.1 ± 13.5 vs ‐3.0 ± 12.6g, p&lt;0.001), cholesterol (‐123.6 ± 179.0 vs ‐38.1 ± 155.4g, p&lt;0.01) and sodium (‐704.1 ± 1092.0 vs ‐41.8 ± 1224.6mg, p&lt;0.01). Also, greater increases in fiber (9.8 ± 10.1 vs 2.8 ± 6.6g, p&lt;0.001), soluble (3.2±3.2 vs 1.4 ± 2.5g, p&lt;0.01) and insoluble fiber intakes (6.7±7.9 vs 1.1±5.5g, p&lt;0.001) were observed in DS.A structured calorie restricted diet including healthy prepared meals can help maintain, or improve, dietary quality thus reducing risk factors for chronic conditions.

Exercise training for African Americans with disabilities residing in difficult social environments

Objective To examine the feasibility, efficacy, and safety of a structured 12-week exercise training program for a predominantly African-American group of adults with multiple health conditions who reside in difficult social environments. Methods A total of 37 females and 7 males (mean age, 54.1 years) participated in an exercise training regimen 3 days per week for 60 minutes per day (cardiovascular, 30 minutes; strength, 20 minutes; and flexibility, 10 minutes). Outcome measures included peak VO 2 (mL min −1, mL kg −1 min −1); upper and lower body strength (strength); hand-grip strength (GS); body weight (BW); total skin folds (TS); waist-to-hip ratio (WHR); hamstring/low-back flexibility (HLBF); and shoulder flexibility (SF). Results Compared to the control group, the exercise group showed significant gains in peak VO 2 ( p < 0.01); strength ( p < 0.01); and body composition (TS, p < 0.01). There was no significant difference between the exercise and control groups on BW, WHR, HLBF, and GS. Of a total 1116 exercise sessions (31 experimental participants × 36 sessions), 87% of the sessions were attended. Conclusion A structured exercise-training program can provide substantial improvement in strength and cardiovascular fitness in low-income, sedentary adults with multiple chronic conditions and/or risk factors for chronic conditions. Future research should explore simple home-based and community-based physical activity interventions that provide ongoing support for increasing and maintaining physical activity participation in this cohort.

Guidelines for Community-Based Screening for Chronic Health Conditions

Preventive measures for many chronic diseases depend upon identification of asymptomatic individuals who have the disease or who may be at risk for developing it. A screening biochemical test can identify such individuals. Mass screening for biochemical markers or risk factors for chronic conditions, especially for elevated serum cholesterol and blood glucose, has been advocated in recent years and has become increasingly common in various nonmedical community settings. Although generally well intentioned, such programs may fall short of their goals and may even be counterproductive. In recognition of the use of biochemical screening in nonmedical community settings, and in an attempt to make such efforts as productive as possible, the California Department of Health Services (CDHS) has developed state guidelines for these screening programs. These guidelines make recommendations regarding: (1) the criteria for judging the effectiveness of biochemical screening tests; (2) the qualifications and training of screening program staff; (3) the proper use and maintenance of equipment used in screening programs and other quality control measures; (4) referral procedures for persons with abnormal test results; and (5) the lawful implementation of screening programs. Optimally, as pointed out by these guidelines, all community-based screening programs should complement a larger health education or risk-reduction program that guarantees appropriate medical follow-up and management. Preventive medicine practitioners and organizations embarking on such activities should be familiar with the issues addressed by these guidelines and may find adherence to them useful in developing effective community screening programs.