American Journal of Health Promotion

This review of the literature examines the relationship between abdominal fat distribution and specific health outcome measures, modifiable risk factors, the impact of intervention efforts, and the significance of measurement methods.

The research material that was received was found through several on-line data bases, including MEDLINE and CINAHL, an examination of references from selected articles, a manual review of recent relevant journals, and interviews with several physicians and epidemiologists who are experts in this field of inquiry. Forty-three research articles were reviewed for the section on health risk outcomes and abdominal fat distribution. Twenty studies were reviewed in the section on modifiable variables associated with fat distribution. Finally, 10 studies which examined the effect of behavior change on fat distribution were included in this review.

Recent research indicates that people whose body fat is deposited more in the central or abdominal area, especially the intra-abdominal area, than it is in the gluteofemoral area are at increased risk for cardiovascular disease. This risk is independent of but exacerbated by, the degree of obesity. Several nonmodifiable factors such as age, gender, and menopause as well as some modifiable factors such as obesity, smoking, physical inactivity, and alcohol intake are positively associated with abdominal fat deposition.

Intervention results indicate that it is possible to decrease abdominal fat with total weight loss or smoking cessation.

Relationships between positive health behaviors and abusable substance use in preadolescent, urban, African-American schoolchildren were investigated.

Personal interviews and classroom surveys were used to assess health behavior and abusable substance use cross-sectionally.

All respondents resided in the District of Columbia and attended the public school system.

The sample consisted of 303 urban, African-American fourth and fifth graders (151 boys, 152 girls).

Classroom surveys assessed drinking, drinking without parental knowledge, smoking, use of other abusable substances, friends' use, self-esteem, and academic performance. Personal interviews assessed children's diet, exercise, overall health behavior, and socioeconomic status.

Logistic regressions showed that children who engaged in more health behaviors (exercise and proper nutrition) were one-third less likely to have smoked (OR=0.66) or to have drunk alcohol (OR=0.63) than those who engaged in fewer healthful activities. However, when gender, socioeconomic status, self-esteem, academic performance, personal use, and friends' use of other abusable substances were controlled, relationships were no longer statistically significant.

These findings suggest that although positive health behaviors appear to be inversely related to abusable substance use in urban, African-American préadolescents, the relationship may be spurious.

The impact of a workplace health promotion program was evaluated to determine changes in the number and level of seven behavioral risks and self-reported illness days.

The study employed a pretest/posttest intervention group (N=7,178) with a two-year follow-up and a time-lagged, nonequivalent comparison group (N=7,101).

The study population was drawn from a large manufacturing company with more than 100 United States locations.

Approximately one half of the study population was 40 years of age or older, 75 % were males, 90 % were white, and about 40 % were hourly manufacturing employees.

The program consisted of 1) training and support of coordinators; 2) health risk appraisals; 3) on-site classes, safety meetings, and self-help options; 4) environmental changes, e.g., smoking policy, cafeteria offerings, and blood pressure machines; and 5) recognition.

A 38-item health appraisal included self-report of illness days and behavioral risks, as well as information from company physical examinations.

Both the number and the level of behavioral risk factors improved over two years. The proportion of employees with three or more risk factors decreased by 14% (p<.001). The number of self-reported illness days in this group decreased by 12% during the same period (p<.001). No change in illness days was observed in the group with fewer than three risk factors. Risk levels improved (range = 4.5% to 79%) for six of seven factors among high-risk individuals.

This intervention appears to have had a positive impact on the number and level of behavioral risk factors; most of the improvement occurred among high-risk participants. The extent to which this study's results can be generalized to other populations is limited by several methodological limitations including several key variables are self-reported, a time-lagged rather than concurrent comparison group was used, the intervention group response rate was low, and the intervention group differed from the comparison group on four of five demographic variables.

The purpose of this study was to investigate whether participation in a comprehensive worksite health promotion program was associated with reduced employee health care costs.

Four independent study groups, two treatment and two comparison, were identified based on type and date of first participation in the intervention. Two years of pre-program health cost data and five years of post-program data were collected for each subject. The Jonckheere-Terpstra statistical test was used to analyze the data.

The health promotion program was offered at Blue Cross and Blue Shield of Indiana corporate headquarters. The study period began on January 1, 1976, and continued through December 31, 1982.

Seven hundred and forty-three men and women employed continuously by Blue Cross and Blue Shield of Indiana throughout a seven-year period were studied.

The health promotion program consisted of four progressive phases which involved 1) health risk reduction mass education, 2) completion of a health risk appraisal and risk reduction counseling, 3) health promotion classes such as smoking cessation and nutrition education, and 4) follow-up and maintenance.

The principal dependent variable was pre-program to post-program changes in health costs as measured by employee health care expense claims paid for by the company's health insurance plan.

This study found that program participation was not associated with reduced health care costs.

It would be prudent to remain guarded about the health cost savings effects of worksite health promotion programs.