title: Outcomes of cardiovascular disease risk factor screening and referrals in a family planning clinic.
abstract: BACKGROUND
  Cardiovascular disease (CVD) screening in Title X settings can identify low-income women at risk of future chronic disease. This study examines follow-up related to newly identified CVD risk factors in a Title X setting.
  
  
  METHODS
  Female patients at a North Carolina Title X clinic were screened for CVD risk factors (n=462) and 167/462 (36.1%) were rescreened one year later. Clinical staff made protocol-driven referrals for women identified with newly diagnosed CVD risk factors. We used paired t-tests and chi square tests to compare screening and rescreening results (two-tailed, p<0.05).
  
  
  RESULTS
  Among 11 women in need of referrals for newly diagnosed hypertension or diabetes, 9 out of 11 (81.8%) were referred, and 2 of 11 (18.2%) completed referrals. Among hypertensive women who were rescreened (n=21), systolic blood pressure decreased (139 to 132 mmHg, p=0.001) and diastolic blood pressure decreased (90 to 83 mmHg, p=0.006). Hemoglobin A1c did not improve among rescreened diabetic women (n=5, p=0.640). Among women who reported smoking at enrollment, 129 of 148 (87.2%) received cessation counseling and 8 of 148 (5.4%) accepted tobacco quitline referrals. Among smokers, 53 out of 148 (35.8%) were rescreened and 11 of 53 (20.8%) reported nonsmoking at that time. Among 188 women identified as obese at enrollment, 22 (11.7%) scheduled nutrition appointments, but only one attended. Mean weight increased from 221 to 225 pounds (p 0<.05) among 70 out of 188 (37.2%) obese women who were rescreened.
  
  
  CONCLUSIONS
  The majority of women in need of referrals for CVD risk factors received them. Few women completed referrals. Future research should examine barriers and facilitators of referral care among low-income women.
authors.affiliation: 1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion , Centers for Disease Control and Prevention (CDC), Atlanta, Georgia .
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Robbins
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Keyserling
authors.forename: Stephanie
authors.initials: S
authors.lastname: Jilcott Pitts
authors.forename: John
authors.initials: J
authors.lastname: Morrow
authors.forename: Merry-K
authors.initials: MK
authors.lastname: Moos
authors.forename: Larry F
authors.initials: LF
authors.lastname: Johnston
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Farr
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000453:epidemiology; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008403:Mass Screening / Q000379:methods*; D009657:North Carolina / Q000453:epidemiology; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D011203:Poverty; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D000074606:Smoking Prevention