Worksite and Community Health Promotion/ Risk Reduction Project -- Virginia, 1987-1991

Because cardiovascular disease (CVD) is a leading cause of premature disability and death in the United States (1), approaches are needed to prevent this problem at the community level. In the Mount Rogers Health District (MRHD) (1990 population: 178,000), a six-county area in southwestern Virginia, age-adjusted death rates for CVD substantially exceed state and national averages (Table 1). In August 1987, the MRHD implemented the Worksite and Community Health Promotion/Risk Reduction Project to help residents of this large, rural area improve their health by adopting healthy lifestyles and, consequently, reduce their risks for CVD and cancer. This report summarizes activities associated with the project and changes in health indicators for participants from April 1989 through May 1990.

The project -- a collaborative effort involving state and local governments, community groups, and businesses--focused on reducing risk factors associated with CVD and cancer among employees at their worksites and residents in the community. This project was coordinated by three paid, full-time staff members who directed efforts toward approximately 6000 persons at intervention sites including senior citizen facilities (27), health department clinics (23), schools (22), churches (19), businesses (15), civic group meetings (nine), and health fairs (seven). Volunteers who had been trained in planning and developing individualized worksite programs provided technical assistance. The staff developed two documents -- a manual for organizing worksite health promotion programs and a community resource guide for worksite wellness--to foster a longstanding commitment to comprehensive employee health programs.

A CDC health-risk appraisal survey (2) that had been administered in 1990 at worksites and screening events indicated that, of the 6306 persons surveyed, 3909 (62%) persons did not exercise regularly*; 3342 (53%) were overweight**; 3216 (51%) had never had their cholesterol levels checked; 2017 (32%) were smokers***; and 1261 (20%) knew they were hypertensive. In addition to its rural location, this community was characterized by low median family income ($14,604 annually), limited medical services, education levels below the state average, and unemployment levels higher than the state average -- all factors underscoring the need for intensified health promotion and risk reduction efforts.

Activities designed to provide positive reinforcement for prevention-oriented health practices included educational presentations and group discussions, health fairs and screenings, individual counseling, and radio and television public service announcements. Screenings by the MRHD staff included evaluations for cholesterol, hypertension, overweight, smoking, and exercise; counseling services included follow-up contact and referrals for persons at risk for CVD and cancer.

Follow-up data collected from 424 employees of the Smyth County School System (the group for which the most comprehensive data had been collected) 2 years after they joined the wellness program indicated that 93% of the school system employees had participated in at least one segment of the school-based health promotion program; 86% self-reported they had increased their health awareness; 40% had increased their levels of regular physical activity; and 30% reduced their intake of high-fat foods. Moreover, 44% of smokers attempted to quit within 9 months after joining the program; 32% of the overweight employees lost weight. Total average serum cholesterol levels declined from 237 mg/dL to 203 mg/dL during a 6-month period.**** From August 1989 to August 1990, school employee health insurance claims decreased 20%.

During 1989, second-year program efforts emphasized cancer awareness in addition to cardiovascular risk reduction. Approximately 115 women used the program's mobile mammography service; based on the mammography findings, seven asymptomatic women received further prompt medical evaluation.

The MRHD's health screenings and educational programs also helped to promote policy changes. For example, one company established a policy to reduce exposure of nonsmokers to environmental tobacco smoke (i.e., the cafeteria was divided into smoking and nonsmoking areas; smoking was not allowed elsewhere in the building), received assistance from the MRHD to select a new food vendor, and hired another company to instruct the vendor in the preparation of low-fat, low-cholesterol, and low-sodium foods for employees. In addition, school cafeteria managers in Smyth County consulted with registered dietitians at MRHD regarding healthier menu selections. Reported by: B Wild, C Smith, MD, J Martin, MS, Mount Rogers Health District, Marion; M Shook, MPH, Virginia Dept of Health. Community Health Promotion Br, Div of Chronic Disease Control and Community Intervention, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: At least two elements may have contributed to the successful implementation of the MRHD Worksite and Community Health Promotion/Risk Reduction Project. First, the project was supported by the superintendent of Smyth County Schools, who enabled the in-kind services of a school nurse for organizing the worksite volunteer leaders. Second, a variety of incentives (e.g., quickly earned rewards) and a points system may have motivated and reinforced positive health behaviors and helped participants set wellness goals. However, because this project was not designed as a community intervention trial with controls, the findings cannot be generalized.

The Mount Rogers health promotion programs had five key factors: 1) they addressed the specific health needs and interests of persons, industries, businesses, schools, and community groups; 2) they gave employees a sense of ownership of the program by soliciting and applying their feedback; 3) they were flexible and could be replicated in a variety of settings; 4) they increased the visibility of community resources; and 5) they strengthened working relations between the state and local health departments, businesses, and the community.

Based on the Mount Rogers project, the General Assembly in Virginia implemented resolutions requiring local health departments to assess the availability of worksite health promotion activities in their areas. The MRHD has received additional state funding to continue its programs. In addition, in recognition of its contribution to community health promotion, the Worksite and Community Health Promotion/Risk Reduction Project received the 1990 Secretary's Community Health Promotion Award for Excellence from the U.S. Department of Health and Human Services.

Additional information about the Mount Rogers project is available from Dr. Craig Smith, MRHD Health Director, 645 Park Boulevard, Suite 200, Marion, VA 24354; telephone (703) 783-9060.

References

1. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

2. CDC. Health risk appraisal -- United States. MMWR 1981;30:133-5.

3. Metropolitan Life Insurance Company. New weight standards for men and women. State Bulletin of the New York Metropolitan Life Insurance Company 1959;40:1-4.

• Any type of exercise performed for at least 20 minutes, two or more times a week. ** Weighing 20% more than ideal body weight (3). *** Current smokers at the time of the appraisal. **** In measuring cholesterol levels, the staff used the Boehringer Mannhein Reflotron and followed standards set by the Virginia Department of Health. Use of trade names is for identification only and does not imply endorsement by the Public Health Service or the U.S. Department of Health and Human Services.

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