Center for h ea lth enhnce ment educa ti o n and

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Center for H ea lth Enh",nce ment Educa ti o n and Research (Co· d irect or). Un iversity of Calif ornia, L05 Angeles, CA 90024. can be derived from a consideration of how each target problem and related in tervention relate to a number of questions. 1. Has the target problem been causally associated with significant increases in mo rbidity and mort ality? 2. Is the problem prevalent in workers? 3. Are the increa se d ri sks associated with the problem reversible with changes in habits or with control measures? 4. Are there effective interventions that res ult in a change in target behavior a nd/or in physiological measures? 5. Are there good analyses that relate co sts and benefits a nd/ or costs and degree of effect? 6. To what degree have program co sts and effects been reported from experiences in the work environme nt ? To illustrate the range of information available to answer these qu est ions, four ri sk redu ctio n interve ntions will be considered: smoking cessation, hyp ertension con- trol, physical fitness programs and weight management programs. In addition, multifactorial int e rv entio ns to re- duce cardiovascular risk will be briefly examined. Hypertension Elevated blood pressure (> 140 /9 0 mm Hg) co nfers higher mortality and morbidity that can be reduced th rough low er ing of blood pre ss ur e. I - 3 On the average, individuals with hi gh blood pressure develop approximately thr ee times as much coronar y heart disease, six times as much congestive he art failure and seven times as many strokes as individuals with controlled or normal blood pressure. 3 ,4 In a five-year, 14-cent er cooperative trial in volving 11 ,00 0 h ype rtensive pa ti e nt s aged 30 to 69, those receiving care based on a standardi xc d an tih ype rt e n- sive protocol showed a sign ifi cant ly greater decline in both blood pressure and overa ll mortality then tho se referred to their private physician for care. 3 This di fferential derived from differences in degree of control ac hi eved. Over the five-year period from en try into the study, diastolic blood pressure decreased from 1.01.1 mm Hg to 84.1 mrn Hg in pro toco l ca re and from 101.2 mm Hg to 89. 1 mm Hg in referred care. 4 Based on this and other studies it is reason- able to assume that those in w hom h ype rtension is de · t ecte d, whether or not they are on antihype rtensive medi- Journal of Occupational MedicinelVol. 24, No. 11INovember 1932 907 '-. -
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cation, can be brought '. lnder effecti ve control and that their morbidit y Jnd mortalit y, depending on age, sex, race and degree of hyp ertension, and other health ri s ks can be reduced over five years by 20 % to 50 % compared with untreated patient s, Hypertension is a prevalent problem in the work force. Based on studies at many places of work and in community blood pressure scref'ning programs, hypertension (uncon- trolled or controlled) is found in 15% 'CO 25% of those screened.
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  • Spring '12
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  • th e average, th ese programs, th ese program, al th prohssionals, th e work

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