Reducing Risk of Chronic Diseases in Disadvantaged Women Is Goal of CDC's WISEWOMAN Program Described in Journal of Women's Health.

LARCHMONT, N.Y. -- Disadvantaged women, including minority and low-literacy populations, tend to be at increased risk for chronic disorders including obesity and cardiovascular disease. These conditions can be addressed with targeted interventions such as the WISEWOMAN health promotion projects detailed in the just-released issue of Journal of Women's Health (Vol. 13, No. 5), a peer-reviewed journal published by Mary Ann Liebert, Inc. (www.liebertpub.com). The entire issue is available free online through the end of August 2004 at www.liebertpub.com/jwh and indefinitely at CDC's WISEWOMAN website (http://www.cdc.gov/wisewoman/).

This issue of the Journal highlights the design and goals of the WISEWOMAN program, showcases its achievements, and takes stock of the challenges that must be addressed to ensure that the program lives up to its promise and makes a difference in women's health. The overall goal of these papers is to review WISEWOMAN demonstration projects and to cull the best practices that can be useful to other programs and to potential future WISEWOMAN sites.

WISEWOMAN, which stands for Well-Integrated Screening and Evaluation for Women Across the Nation, is a program funded by the Centers for Disease Control and Prevention (CDC) for financially disadvantaged women in 14 states.

Papers in this issue examine a wide range of topics, such as issues in health disparities research, how to conduct local program evaluation, and specific programmatic strategies that boost success in a vulnerable population.

"WISEWOMAN is a grassroots program that is helping thousands of disadvantaged women across the country by providing them screenings for diabetes and cardiovascular risk factors as well as providing reliable lifestyle education to help them make lasting changes that improve their health." said CDC Director Dr. Julie Gerberding.

The unprecedented rates of obesity, diabetes, and cancer are only three examples of chronic diseases that are taking a huge toll on the nation's health. At the same time, promising programs need to be identified so that they can be delivered cost-effectively to people who need them, says Julie C. Will, PhD, MPH., CDC's lead scientist for this issue. WISEWOMAN is showing signs that it is just that kind of program, according to the 15 papers coauthored by 50 public health professionals.

According to the papers, the WISEWOMAN projects:

1) Reach their intended population -- a vulnerable group at high risk of chronic disease. Will and colleagues show that in some WISEWOMAN locations, more than 40% of women smoke cigarettes. Also, three out of four participants are overweight or obese. "Such findings are striking," says Guest Editor Claire I. Viadro, PhD, MPH, from the University of North Carolina at Chapel Hill Center for Health Promotion and Disease Prevention.

2) Show that screenings may reduce blood pressure, cholesterol, and weight gain in two of the states studied. In a study of the Massachusetts project, women who received comprehensive screenings had an average drop of 7-9% in the prevalence of high blood pressure after 12 months. In the Arizona evaluation, WISEWOMAN participants who had received comprehensive screenings showed an average decrease of 6-11 mg/dL in total cholesterol after 12 months. Also, participants maintained their weight over a one-year period - a positive behavioral change.

3) Go beyond screening to provide a comprehensive approach for behavioral change. Using a wide range of behavior change strategies (e.g., clinic-based counseling, group education and activities, community health worker support, cultural tailoring,) WISEWOMAN projects which were evaluated have improved nutrition education and increased physical activity in a variety of settings.

4) Contribute new knowledge on health disparities. Health disparities are related to a complex set of factors involving both individual and community characteristics, authors say. One study examines neighborhood characteristics that may be linked to obesity, after controlling for ethnic and individual factors. If residents in a neighborhood feel unsafe, then walking for healthy weight control is not a realistic option, suggests co-author Eric A. Finkelstein, PhD, MHA, a scientist with RTI, Inc., in Research Triangle Park, NC. "Efforts to eliminate the disparities are likely to require community-wide interventions that seek to 'even the playing field,' '' Finkelstein said.

5) Tap into broader community collaborations to boost community health clinic efforts. For example, a Michigan WISEWOMAN site collaborates with the League of Women Voters and a local sporting goods store to provide discounted walking shoes to program participants.

Also in this issue, authors provide detailed guidance gleaned from their research of WISEWOMAN sites. They offer observations on how to develop model programs, and they include "success stories" from local projects, techniques for staff training, and tested ways to boost cultural relevance.

Guest editor Antronette K. Yancey, MD, MPH, from the Department of Health Services at the UCLA School of Public Health in Los Angeles,

California, emphasizes the need for "boisterous leadership" by social networks and local coalitions to intervene at the environmental level. Community leaders could improve chronic disease control by understanding social and physical characteristics in underserved communities so that interventions can better target high-risk female subgroups, Yancey says.

Journal of Women's Health is an authoritative, peer-reviewed, multidisciplinary journal published ten times a year. Edited by Marjorie Bowman, MD, MPA, University of Pennsylvania, the Journal covers medical health issues affecting women across their lifespans and publishes papers on the gender differences in biological response between females and males.

Mary Ann Liebert, Inc., is a privately held, fully integrated media company known for establishing authoritative peer-reviewed journals in many promising areas of science and biomedical research, including Obesity Management, Thyroid, and Metabolic Syndrome and Related Disorders. Its biotechnology trade magazine, Genetic Engineering News (GEN), was the first in its field and is today the industry's most widely read publication worldwide. A complete list of the firm's 60 journals and books is available at www.liebertpub.com.