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Preventing cardiovascular disease through personal commitment & community action

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Preventing cardiovascular disease through personal commitment & community action

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  1. CardioVision 2020:A Community Responds to the Lifestyle SyndromeThomas E. Kottke, MD, MSPHInaugural Project Directortkottke@comcast.netPromoting and Enabling Healthy Choices:Linking the Desire for Health with the Decisions & Tools that Support HealthThe BroadmoorColorado Springs, CODecember 6th-8th, 2004

  2. Preventing cardiovascular disease through personal commitment & community action cardiovision2020.org CM862659-3

  3. CardioVision 2020:Produced by those who reside or work in Olmsted County, Minnesota and have acted to improve their own health and the health of their families, friends, and neighbors through personal commitment and community action

  4. CardioVision 2020Mission To partner with clinicians and community organizations to develop information systems, environment, skills, and encouragement needed to help individuals make informed choices that can lead to primary and secondary prevention of cardiovascular disease

  5. CardioVision 2020Personal Goals 1) Tobacco-free and zero exposure to environmental tobacco smoke 2) Five servings of fruits and vegetables per day; only lean/extra lean meats and low fat/fat-free dairy products 3) Total serum cholesterol <200 mg/dL; low density lipoprotein <100 mg/dL for individuals with coronary heart disease

  6. CardioVision 2020Personal Goals 4) Blood pressure <130 mm Hg systolic and <85 mm Hg diastolic 5) 30 minutes of physical activity on most, if not all, days of week

  7. To help the individual achieve and maintainthe behavior changes they desire... ...we have defineda vision for Olmsted County.

  8. Our Vision for Tobacco By the year 2020... • All public areas aresmoke-free • No advertising or promotion of tobacco products • Youth are unable to purchase tobacco products from vendors in community

  9. Our Vision for Nutrition By the year 2020... • All restaurants provide their customers with meal analysis • All grocery stores provide product analysis for total fat, saturated fat, cholesterol, and sodium • Schools offer and promote foods and beverages that meet Healthy People 2010 recommendations • Goal foods cost less per calorie than foods that are high in saturated fat, sodium, or sugar

  10. Our Vision for Physical Activity By the year 2020... • All residents of Olmsted County can travel throughout the county on foot or bicycle • All residents of Olmsted County have access to affordable and safe opportunities for physical activity • Affordable and attractive youth activity programs are available to all children and adolescents • Elementary and secondary school curricula include daily physical activity at all levels

  11. Our Vision for SecondaryPrevention By the year 2020... • All residents of Olmsted County with coronary heart disease, congestive heart failure or critical risk factor levels for these two conditions have access to a case management system

  12. Life-style syndrome (too many calories in, too few calories out, physical inactivity, tobacco use & exposure) ? origins Metabolic syndrome (hypertension, diabetes, dyslipidemia) ? origins Coronary heart disease and stroke

  13. Diseases of the life-style syndrome include • heart disease, • stroke, • cancer, • diabetes, • chronic obstructive lung disease, • osteoarthritis, • depression, • many other diseases Therefore, CardioVision 2020 focuses on lifestyle

  14. For how can we reassure the individual who has a total serum cholesterol of 199 mg/dl and a blood pressure of 130/80 mm Hg if (s)he smokes tobacco, lives on deep-fried fat and believes that a physical activity program is season tickets to their favorite teams?

  15. Nine lessons from CardioVision 2020

  16. Special thanks to Rebecca HoffmanCardioVision 2020 Director of Intervention www.RebeccaHoffman.com

  17. Lesson 1 Risk patterns and risk distribution are the same in Olmsted County as in the rest of the United States

  18. 4 3 2 1 0 5 *tobacco, diet, physical activity, serum cholesterol and blood pressure Population Meeting 0 to 5 CardioVision 2020 Goals* Olmsted County, Minnesota 1999 Women Age Men ≥70 60-69 50-59 40-49 30-39 20-29 100 50 0 0 50 100 % meeting goals Kottke et al. Mayo Clinic Proceedings. 2000

  19. 4 3 2 1 0 5 Expected Proportion of Eventsby Number of Goals MetOlmsted County, Minnesota 2000-2019for CHD and CVD Events Women Event Men CHD CVD 100 50 0 0 50 100 % of events

  20. Lesson 2 CardioVision 2020 is making an impact.

  21. Program Awareness on RDD Survey All p <.0001

  22. Program Approval on RDD Survey P = NS

  23. Reported Behavior Change (RDD Survey) P = .027

  24. Lesson 3 The messenger is a key component of the message.

  25. The following is an example of a technically outstanding video that was ineffective in engaging the population

  26. The following video is less technically sophisticated, but is more effective because it features a known community leader

  27. Lesson 4 If people are to climb on, they need to know that they can climb off.

  28. “Trialability”

  29. Post-Bulletin 9-21-00

  30. CardioVision 2020 Annual Cycle July Personal Behavior Change Monthlymediaevents • 60-day campaigns • Tobacco control • Physical activity • Nutrition • Know your numbers Kick-off Booster Prizes January Environmental Change Annual progressand needs assessment

  31. CardioVision 2020 General Model of Intervention Brief campaigns and clinical interventions Environmental change programs Environmental changes that support personal goals Personal behavior change to reduce risk

  32. Lesson 5 If the time line is realistic, big changes can be accomplished.

  33. The North Karelia Project (organized 1972) • Three key messages • More fruits and vegetables, less saturated fat • Tobacco-free • Hypertension control (search “Puska P”)

  34. /100,000 800 700 600 North Karelia 500 400 300 All Finland 200 100 Mortality from Coronary Heart Disease Men 35-64 years (1969-1994) Cardiac death rates have now dropped by 83%! Puska P: Cardiovasc Risk Factors 6:203-210, 1996 CM862659-35

  35. Predicted and Observed Decline in CHD MortalityEastern Finland – Men 35-64 years (1972-1992) 0 Changes in risk factor levels explain changes in disease rates 10 20 % 30 40 Predicted 50 Observed 60 Vartiainen E et al: BMJ 309:23-27, 1994 CM862659-36

  36. Lesson 6 Improvement in the community health requires continuous effort, resources, leadership, and marketing.

  37. Spring, 2003

  38. Visits to Cardiovision2020.org in 2003

  39. “Leadership” A position of authority Initiative taken by any member of a group to further the mutual interests of that group

  40. Leadership “. . . Energizing [people] to action.” (page 44) “. . . Is biographical.” “Leaders engender leadership traits in others. They teach others to be leaders.” (page 42) New York: Harper Business, 1997

  41. Lesson 7 The program needs to go where the people are.

  42. The CardioVision 2020 runner indicates the entrée contains less than 1000 mg ofsodium and 500 or fewer calories, of which less than 7% come from saturated fat. Zorba’s, Rochester, Minnesota CP1059786-55

  43. Lesson 8 Get data. Data help make the case and guide the program

  44. 70% prefer smoke-free!

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