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April 1993, Vol 147, No. 4 >
Article | April 1993

Compliance With Childhood Cholesterol Screening Among Members of a Prepaid Health Plan FREE

Ronald P. Bachman, MD; Edgar J. Schoen, MD; Ann Stembridge, MS; Elaina R. Jurecki, MS, RD; Robin S. Imagire, MS
[+] Author Affiliations

Accepted for publication December 12, 1992.

Reprint requests to Department of Pediatrics, Kaiser Permanente Medical Center, 280 W MacArthur Blvd, Oakland, CA 94611-5693 (Dr Bachman).


Am J Dis Child. 1993;147(4):382-385. doi:10.1001/archpedi.1993.02160280032013.
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• Objective.  —To assess compliance with cholesterol screening and intervention by children who were members of a prepaid health plan in which there was no financial barrier to intervention.

Research Design.  —Children with family histories of hypercholesterolemia, coronary heart disease, and stroke were advised to have a random cholesterol test. Those with total cholesterol levels of 4.80 mmol/L (185 mg/dL) or higher were asked to return for a fasting blood test; of this group, compliant subjects with low-density lipoprotein values of 3.25 mmol/L (125 mg/dL) or higher were offered a nutrition program.

Setting.  —Kaiser Permanente Medical Center, Oakland, Calif.

Subjects and Participants.  —The parents of 1160 children aged 2 to 18 years who had routine pediatric appointments at Kaiser Permanente Medical Center were asked to complete screening forms on family history.

Selection Procedures.  —Children with family histories of hypercholesterolemia, coronary heart disease, and stroke were advised to have a random cholesterol test. Subjects with total cholesterol levels of 4.80 mmol/L or higher were asked to return for a fasting test, and subjects with low-density lipoprotein levels of 3.25 mmol/L or higher were offered a nutrition program.

Interventions.  —Telephone call, letter, low-cholesterol diet, and nutrition program.

Main Outcome Measures.  —Of the 1160 subjects contacted, 529 (46%) had positive family histories. Of these subjects, random blood cholesterol levels were determined for 369 (70%); 160 (30%) did not comply. Ninety-three subjects had total cholesterol levels of 4.80 mmol/L or higher; of these, 35 (38%) did not comply with follow-up testing. Of the 58 compliant subjects, 25 (43%) had low-density lipoprotein values of 3.25 mmol/L or higher and were offered either a 3-week or a 6-week nutrition program. Only nine subjects (36%) enrolled; 16 (64%) did not comply.

Conclusions.  —Parents do not comply well with a childhood cholesterol screening program that involves two blood tests and moderately intensive educational intervention. Compliance is an important component of cholesterol screening and intervention.(AJDC. 1993;147:382-385)

REFERENCES

1 +
Dalen JE.  Detection and treatment of elevated blood cholesterol: what have we learned? Arch Intern Med . 1991;;151:25-28.
2 +
Shekelle RB, Shryock AM, Paul OS, et al.  Diet, serum cholesterol, and death from coronary heart disease: the Western Electric Study . N Engl J Med . 1981;;304:65-70.
3 +
Castelli WP.  Epidemiology of coronary heart disease: the Framingham Study . Am J Med . 1984;;76( (suppl 2A) ):4-12.
4 +
Stamler J, Wentworth D, Neaton JD.  Is the relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? findings in 356 222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT) . JAMA . 1986;;256:2823-2828.
5 +
Lipid Research Clinics Program.  The Lipid Research Clinics Coronary Primary Prevention Trial results, II: the relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA . 1984;;251:365-374.
6 +
Brown C, Albers JJ, Fisher LD, Schaefer SM, Lin J-T, Kaplan C.  Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B . N Engl J Med . 1990;;323:1289-1298.
7 +
Kane JP, Malloy MJ, Ports TA, Phillips NR, Diehl JC, Havel RJ.  Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens . JAMA . 1990;;264:3007-3012.
8 +
Newman TB, Browner WS, Hulley SB.  The case against childhood cholesterol screening . JAMA . 1990;;264:3039-3043.
9 +
Feldman W.  Routine cholesterol surveillance in childhood . Pediatrics . 1990;;86:150-151.
10 +
Staines A.  Another view of cholesterol screening . Pediatrics . 1990;;86: 327-328.
11 +
Dennison BA, Kikuchi DA, Srinivasan SR, Webber LS, Berenson GS.  Serum total cholesterol screening for the detection of elevated low-density lipoprotein in children and adolescents: the Bogalusa Heart Study . Pediatrics . 1990;;85:472-479.
12 +
Lauer RM, Clarke WR.  Use of cholesterol measurements in childhood for the prediction of adult hypercholesterolemia: the Muscatine Study . JAMA . 1990;;264:3034-3038.
13 +
Lifshitz F, Moses N.  Growth failure: a complication of dietary treatment of hypercholesterolemia . AJDC . 1989;;143:537-542.
14 +
Finberg L.  Dietary advice: responsibility for monitoring . AJDC . 1989;; 143:531.
15 +
Griffin TC, Christoffel KK, Binns HJ, McGuire PA.  Family history evaluation as a predictive screen for childhood hypercholesterolemia: Pediatric Practice Research Group . Pediatrics . 1989;;84:365-373.
16 +
Krieger N.  Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology . Am J Public Health . 1992;;82:703-710.
17 +
Committee on Nutrition.  Indications for cholesterol testing in children . Pediatrics . 1989;;83:141-142.
18 +
Eastman Kodak Co. Cholesterol Test Methodology . Rochester, NY: Eastman Kodak Co; 1986;. Publication MP2-35.
19 +
Eastman Kodak Co. Triglycerides Test Methodology . Rochester, NY: Eastman Kodak Co; 1989;. Publication MP2-19.
20 +
Kaiser Permanente Regional Laboratory. TPMG Inc Procedure: HDL Cholesterol . Oakland, Calif: Kaiser Permanente Medical Care Program; 1989;.
21 +
Pugliese MT, Weyman-Daum M, Moses N, Lifshitz F.  Parental health beliefs as a cause of nonorganic failure to thrive . Pediatrics . 1987;;80:175-182.
22 +
Nicklas TA, Webber LS, Koschak M, Berenson GS.  Nutrient adequacy of low fat intakes for children: the Bogalusa Heart Study . Pediatrics . 1992;;89:221-228.
23 +
Isles CG, Hole DJ, Gillis CR, Hawthorne VM, Lever AF.  Plasma cholesterol, coronary heart disease, and cancer in the Renfrew and Paisley survey . BMJ . 1989;;298:920-924.
24 +
Iso H, Jacobs DR Jr, Wentworth D, Neaton JD, Cohen JD.  Serum cholesterol levels and 6-year mortality from stroke in 350 977 men screened for the Multiple Risk Factor Intervention Trial . N Engl J Med . 1989;;320:904-910.
25 +
Muldoon MF, Manuck SB, Matthews KA.  Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials . BMJ . 1990;;301:309-314.
26 +
Hampton ML, Anderson J, Lavizzo BS, Bergman AB.  Sickle cell 'nondisease': a potentially serious public health problem . AJDC . 1974;;128:58-61.
27 +
Cayler CG, Lynn DB, Stein EM.  Effect of cardiac 'nondisease' on intellectual and perceptual motor development . BMJ . 1973;;35:543-547.
28 +
Bodegard G, Fyro K, Larsson A.  Psychological reactions in 102 families with a newborn who has a falsely positive screening test for congenital hypothyroidism . Acta Paediatr Scand Suppl . 1983;;304:3-21.
29 +
Newman TB, Browner WS, Hulley SB.  Childhood cholesterol screening: contraindicated . JAMA . 1992;;267:100-101.
30 +
Clarke WR, Lauer RM.  The predictive value of childhood cholesterol screening . JAMA . 1992;;267:101-102.
31 +
American Academy of Pediatrics.  National Cholesterol Education Program, II: report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents . Pediatrics . 1992;;89:515-584.
32 +
 National Cholesterol Education Program (NCEP): highlights of the Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents . Pediatrics . 1992;;89:495-501.
33 +
Burke GL, Sprafka JM, Folsom AR, Hahn LP, Leupker RV, Blackburn H.  Trends in serum cholesterol levels from 1980 to 1987: the Minnesota Heart Survey . N Engl J Med . 1991;;324:941-946.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Dalen JE.  Detection and treatment of elevated blood cholesterol: what have we learned? Arch Intern Med . 1991;;151:25-28.
2 +
Shekelle RB, Shryock AM, Paul OS, et al.  Diet, serum cholesterol, and death from coronary heart disease: the Western Electric Study . N Engl J Med . 1981;;304:65-70.
3 +
Castelli WP.  Epidemiology of coronary heart disease: the Framingham Study . Am J Med . 1984;;76( (suppl 2A) ):4-12.
4 +
Stamler J, Wentworth D, Neaton JD.  Is the relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? findings in 356 222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT) . JAMA . 1986;;256:2823-2828.
5 +
Lipid Research Clinics Program.  The Lipid Research Clinics Coronary Primary Prevention Trial results, II: the relationship of reduction in incidence of coronary heart disease to cholesterol lowering . JAMA . 1984;;251:365-374.
6 +
Brown C, Albers JJ, Fisher LD, Schaefer SM, Lin J-T, Kaplan C.  Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B . N Engl J Med . 1990;;323:1289-1298.
7 +
Kane JP, Malloy MJ, Ports TA, Phillips NR, Diehl JC, Havel RJ.  Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens . JAMA . 1990;;264:3007-3012.
8 +
Newman TB, Browner WS, Hulley SB.  The case against childhood cholesterol screening . JAMA . 1990;;264:3039-3043.
9 +
Feldman W.  Routine cholesterol surveillance in childhood . Pediatrics . 1990;;86:150-151.
10 +
Staines A.  Another view of cholesterol screening . Pediatrics . 1990;;86: 327-328.
11 +
Dennison BA, Kikuchi DA, Srinivasan SR, Webber LS, Berenson GS.  Serum total cholesterol screening for the detection of elevated low-density lipoprotein in children and adolescents: the Bogalusa Heart Study . Pediatrics . 1990;;85:472-479.
12 +
Lauer RM, Clarke WR.  Use of cholesterol measurements in childhood for the prediction of adult hypercholesterolemia: the Muscatine Study . JAMA . 1990;;264:3034-3038.
13 +
Lifshitz F, Moses N.  Growth failure: a complication of dietary treatment of hypercholesterolemia . AJDC . 1989;;143:537-542.
14 +
Finberg L.  Dietary advice: responsibility for monitoring . AJDC . 1989;; 143:531.
15 +
Griffin TC, Christoffel KK, Binns HJ, McGuire PA.  Family history evaluation as a predictive screen for childhood hypercholesterolemia: Pediatric Practice Research Group . Pediatrics . 1989;;84:365-373.
16 +
Krieger N.  Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology . Am J Public Health . 1992;;82:703-710.
17 +
Committee on Nutrition.  Indications for cholesterol testing in children . Pediatrics . 1989;;83:141-142.
18 +
Eastman Kodak Co. Cholesterol Test Methodology . Rochester, NY: Eastman Kodak Co; 1986;. Publication MP2-35.
19 +
Eastman Kodak Co. Triglycerides Test Methodology . Rochester, NY: Eastman Kodak Co; 1989;. Publication MP2-19.
20 +
Kaiser Permanente Regional Laboratory. TPMG Inc Procedure: HDL Cholesterol . Oakland, Calif: Kaiser Permanente Medical Care Program; 1989;.
21 +
Pugliese MT, Weyman-Daum M, Moses N, Lifshitz F.  Parental health beliefs as a cause of nonorganic failure to thrive . Pediatrics . 1987;;80:175-182.
22 +
Nicklas TA, Webber LS, Koschak M, Berenson GS.  Nutrient adequacy of low fat intakes for children: the Bogalusa Heart Study . Pediatrics . 1992;;89:221-228.
23 +
Isles CG, Hole DJ, Gillis CR, Hawthorne VM, Lever AF.  Plasma cholesterol, coronary heart disease, and cancer in the Renfrew and Paisley survey . BMJ . 1989;;298:920-924.
24 +
Iso H, Jacobs DR Jr, Wentworth D, Neaton JD, Cohen JD.  Serum cholesterol levels and 6-year mortality from stroke in 350 977 men screened for the Multiple Risk Factor Intervention Trial . N Engl J Med . 1989;;320:904-910.
25 +
Muldoon MF, Manuck SB, Matthews KA.  Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials . BMJ . 1990;;301:309-314.
26 +
Hampton ML, Anderson J, Lavizzo BS, Bergman AB.  Sickle cell 'nondisease': a potentially serious public health problem . AJDC . 1974;;128:58-61.
27 +
Cayler CG, Lynn DB, Stein EM.  Effect of cardiac 'nondisease' on intellectual and perceptual motor development . BMJ . 1973;;35:543-547.
28 +
Bodegard G, Fyro K, Larsson A.  Psychological reactions in 102 families with a newborn who has a falsely positive screening test for congenital hypothyroidism . Acta Paediatr Scand Suppl . 1983;;304:3-21.
29 +
Newman TB, Browner WS, Hulley SB.  Childhood cholesterol screening: contraindicated . JAMA . 1992;;267:100-101.
30 +
Clarke WR, Lauer RM.  The predictive value of childhood cholesterol screening . JAMA . 1992;;267:101-102.
31 +
American Academy of Pediatrics.  National Cholesterol Education Program, II: report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents . Pediatrics . 1992;;89:515-584.
32 +
 National Cholesterol Education Program (NCEP): highlights of the Report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents . Pediatrics . 1992;;89:495-501.
33 +
Burke GL, Sprafka JM, Folsom AR, Hahn LP, Leupker RV, Blackburn H.  Trends in serum cholesterol levels from 1980 to 1987: the Minnesota Heart Survey . N Engl J Med . 1991;;324:941-946.

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