A community-based cholesterol screening program in Rochester, NY, a metropolitan area of over 700,000 people, is proposed. The objective is to develop a system that will serve as a model for other urban communities interested in screening efforts as part of the National Cholesterol Education Program.
Major specific aims are: 1) to determine if the medical community can be prepared to ensure availability of follow-up for screenees whose cholesterol levels fall above the 75th percentile, a referral cut-off proposed by the 1984 NIH Consensus Conference; 2) to determine whether community screenings held in supermarkets will reach the target populations at highest risk and most likely to benefit from referral; 3) to evaluate the effectiveness of strategies, singly and cumulatively, to enhance referral complaints; 4) to assess the precision and accuracy of a new instrument, under operational conditions, capable of performing rapid total cholesterol determinations using a small volume of capillary blood. A community-based screening program will be conducted in supermarkets, reaching a projected population of 15,000. The referred population (N=3,000) will be randomly assigned to sequential interventions to enhance compliance with referral: 1) receipt of exit counseling by a lay or health professional communicator; and 2) monetary incentive, mailed reminder, or control. A 3-month post-screening questionnaire will provide assessment of referral compliance (to be validated by physician questionnaire) and referred population characteristics. A sample of the referred population (N=900) will be surveyed at 12-months post-screening to assess dietary behavior, cholesterol knowledge, medical treatment and labeling effects. A subsample (blood cholesterol 241-280 mg/dl) will have cholesterol reassessments (3-months post-screening, N=200; 12-months post-screening, N=400). Samples of the non-referred population with borderline (221-240 mg/dl) or """"""""normal"""""""" (greater than or equal to 220 mg/dl) blood cholesterols will receive reassessments at 3- and 12-months post-screening and a questionnaire at 12-months post-screening to assess effects of labeling, false reassurance, and change in cholesterol values. A survey of a sample of primary care physicians (N=375) will provide assessments of cholesterol-related education, attitudes, and assessment and management activities of physicians, following a Preliminary Physician Education Program. Following the 18-month screening and follow-up Phase, data analysis will be completed. Information from this model cholesterol screening program will be used to help guide future efforts of the National Cholesterol Education Program.
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