A Family-Based Approach to Cardiovascular Risk Reduction Education

  • Philip R. Nader
  • Tom Baranowski
Part of the NATO ASI Series book series (NSSA, volume 84)


Common sense dictates that the family command a central and continuing role in the shaping and modifying of many health-related attitudes, behaviors, and habits of individuals. The empirical evidence supports this contention. When cardiovascular health related factors are examined in a family context, a number of associations have been noted: blood pressure levels (Biron, Mongeau, and Bertrand, 1975), obesity (Garn, Cole, and Barley, 1976), eating habits and food preferences (Byran and Lowenberg, 1958), exercise (Perrier, 1979), smoking (Surgeon General, 1979), blood cholesterol levels (Garrison et al., 1979), use of alcohol (Tennant and Detels, 1976), and aspects of “coronary prone” behavior (Butensky et al., 1976). Recently, familial correlations of cardiovascular health knowledge and attitudes have also been documented (Flora et al., 1983). These findings suggest that a family-oriented approach should be considered as an important part of current community health education trials aimed to reduce cardiovascular risk (Fortmann et al., 1981; McAlister et al., 1982). Intervening with family units and capitalizing on family support systems may increase the likelihood of continued habit change (Brownell, Heckerman, and Westlake, 1978; Caplan et al., 1976; Duetscher, Epstein, and Kjelsberg, 1966; Hertzler, and Vaughan, 1979; Pratt, 1976).


Exercise Behavior Pretest Score Health Habit Extrinsic Reward Cardiovascular Risk Reduction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Amanat, E. Paradoxical treatment of adolescent resistance. Adolescence 14 (56) (1979) 851–861.PubMedGoogle Scholar
  2. Annest, J. L., Sing, C. F., Biron, P., and Mongeau, J. G. American Journal of Epidemiology 110 (1979) 479–491.PubMedGoogle Scholar
  3. Atkins, C. J., Kaplan, R. M., and Timms, R. M. Behavioral programs for exercise compliance in chronic obstructive pulmonary disease. San Diego, Calif., San Diego State University, (unpublished).Google Scholar
  4. Bandura, A. Social learning theory. Englewood Cliffs, N.J.: Prentice Hall, 1977.Google Scholar
  5. Bandura, A. Self efficacy: Toward a unifying theory of behavioral change. Psychological Review (1977) 191–209.Google Scholar
  6. Baranowski, T., Nader, P. R, Dunn, K., and Vanderpool, N. A. Family self-help: Promoting changes in health behavior. Journal of Communication (1982).Google Scholar
  7. Baranowski, T., Doria, J., and Evans, M. Scale for qualifying salt food consumption in large sample studies. (unpublished).Google Scholar
  8. Baranowski, T., Nader, P. R, and Vanderpool, N. Family health project: The facilitator’s handbook. Galveston: University of Texas Medical Branch, Department of Pediatrics, 1981.Google Scholar
  9. Benfari, R. C. The multiple risk factor intervention train (MRFIT), III. The model for intervention. Preventive Medicine 10 (1981) 426–442.PubMedCrossRefGoogle Scholar
  10. Biron, P., Mongeau, J. G., and Bertrand, D. Familiar aggregation of blood pressure in adopted and natural children. In: Paul O. (ed.) Epidemiology and control of hypertension. New York: Stratton, 1975.Google Scholar
  11. Brownell, L. D., Heckerman, C. L., and Westlake, R. J. The effect of couples training and partner cooperativeness in the behavioral treatment of obesity. Behavioral Research and Therapy 16 (1978) 323–333.CrossRefGoogle Scholar
  12. Butensky, A., Faralli, B., Heebner, D., and Waldron, I. Elements of the coronary prone behavior patterns in children and teenagers. Journal of Psychosomatic Research 20 (1976) 439–444.PubMedCrossRefGoogle Scholar
  13. Byran, M. S. and Lowenberg, M. E. The father’s influence of young children’s food preferences. Journal of the American Dietetic Association 34 (1958) 30–35.Google Scholar
  14. Caplan, R. D., Robinson, E. A. R., French, J. R. P., Jr., Caldwell, J. R., and Skinn, M. Adhering the medical regimens: Pilot experiments in patient education and social support. Ann Arbor: University of Michigan, Institute for Social Research, 1976.Google Scholar
  15. Coates, T. J., Jeffrey, R. W., and Slinkard, L. A. Heart healthy eating and exercise: Introducing and maintaining changes in health behaviors. American Journal of Public Health 71 (1981) 15–23.PubMedCrossRefGoogle Scholar
  16. DeRisi, W. J. and Butz, G. Writing behavioral contracts: A case simulation practice manual. Champaign, Ill.: Research Press, 1975.Google Scholar
  17. Duetscher, S., Epstein, F. H., and Kjelsberg, M. D. Familial aggregation of factors associated with coronary heart disease. Circulation 33 (1966) 911–924.Google Scholar
  18. Epstein, L. H., Wing, R. R., Koeske, R., Andraski, F., and Ossip, D. J. Child and parent weight loss in family-based behavior modification programs. Journal of Consulting and Clinical Psychology 49 (5) (1981) 674–685.PubMedCrossRefGoogle Scholar
  19. Farquhar, J., Principal Investigator: This measure was used with the permission of the Stanford Cardiovascular Risk Reduction Program at Stanford University.Google Scholar
  20. Flora, J. A., Williams, P. T., Solomon, D., Fortmann, S., and Farquhar, J. W. Familiar correlations of cardiovascular health knowledge and attitudes. Abstract 68, 23rd annual conference on cardiovascular disease epidemiology, March 3–5, Heart Association, No. 33, January, 1983, p. 36.Google Scholar
  21. Fortmann, S. P., Williams, P. T., Hulley, S. B., Haskell, W. L., and Farquhar, J. W. Effects of health education on dietary behavior: The Stanford three community study. American Journal of Clinical Nutrition 34 (1981) 2030–2038.PubMedGoogle Scholar
  22. Garn, S. M., Cole, P. R., and Barley, S. M. Effect of parental fatness levels on the fatness of biological and adoptive children. Ecology of Food Nutrition 6 (1976) 1–3.Google Scholar
  23. Garrison, R. J., Castelli, W. P., Feinleib, M., Kennel, W. B., Havlik, R., Padgett, S. J., and McNamara, P. M. The association of total cholesterol, triglycerides, and plasma lipoprotein cholesterol levels in first degree relatives and spouse-pairs. American Journal of Epidemiology 110 (3) (1979) 313.PubMedGoogle Scholar
  24. Heinzelman, F. and Bagley, R. W. Response to physical activity programs and their effects on health behavior. Public Health Report 85 (1970) 905–911.CrossRefGoogle Scholar
  25. Heppner, P. O. A review of the problem-solving literature and its relationship to the counseling process. Journal of Counseling Psychology 25 (5) (1978) 366–375.CrossRefGoogle Scholar
  26. Hertzler, A. A. and Vaughan, C. E. The relationship of family structure and interaction to nutrition. Journal of the American Dietetic Association 74 (1979) 23–27.PubMedGoogle Scholar
  27. Hoehn-Saric, R., Frank, J. D., Imber, S. D., Nash, E. H., Stone, A. R., and Battle, C. C. Systemic preparation of patients for psychotherapy — 1. Effects of therapy behavior and outcome. Journal of Psychiatric Research 2 (1966) 267–281.CrossRefGoogle Scholar
  28. Hopp, J. W. and Irwin, C. Nutrition and physical fitness education for families. A paper presented to the Nutrition/Food section, at the annual meeting of the American Public Health Association, Detroit, Mich., October, 1980.Google Scholar
  29. Isreal, A. C. and Saconne, A. J. Follow-up of effects of choice of mediator and target of reinforcement on weight loss. Behavior Therapy 10 (1979) 260–265.CrossRefGoogle Scholar
  30. Kanfer, F. H. Self management methods. In F. H. Kanfer and A. P. Goldstein (eds.) Helping people change. New York: Pergamon, 1975.Google Scholar
  31. Kannel, W. B. Prospects for prevention of atherosclerosis in the young. Australian and New Zealand Journal of Medicine 6 (1976) 410–419.PubMedCrossRefGoogle Scholar
  32. Kolonel, L. N. and Lee, J. Husband-wife correspondence in smoking, drinking, and dietary habits. American Journal of Clinical Nutrition 34 (1981) 99–104.PubMedGoogle Scholar
  33. Kornitzer, M., Dramaix, M., Kittel, F., and DeBacker, G. The Belgian heart disease prevention project. Changes in smoking habits after two years of intervention. Preventive Medicine 9 (1980) 496–503.PubMedCrossRefGoogle Scholar
  34. Langlie, J. D. Interrelationships among preventive health behaviors: A test of competing hypotheses. Public Health Reports 94 (1979) 216–225.PubMedGoogle Scholar
  35. Lewin, L. Forces behind food habits and methods of change. In: Report of the committee on food habits, Bulletin No. 108. Washington, D.C.: National Research Council, 1943. Pp. 55–64.Google Scholar
  36. Liu, K., Stamler, J., Dyer, A., McKeever, J., and McKeever, P. Statistical methods to assess and minimize the role of intraindividual variability in obscuring the relationship between dietary lipids and serum cholesterol. Journal of Chronic Disease 31 (1978) 399–418.CrossRefGoogle Scholar
  37. Liu, K., Cooper, R., and McKeever, J. Assessment of the association between habitual salt intake and high blood pressure: Methodological problems. American Journal of Epidemiology 110 (1979) 219–226.PubMedGoogle Scholar
  38. Martin, J. E. Exercise management: Shaping and maintaining physical fitness. Behavioral Medicine Advances 4 (1981) 1–15.Google Scholar
  39. McAlister, A., Puska, P., Salonen, J. T., Tuomilehto, J., and Koskela, K. Theory and action for health promotion: Illustrations from the North Karelia project. American Journal of Public Health 72 (1982) 43–50.PubMedCrossRefGoogle Scholar
  40. Mischel, W. Toward a cognitive social learning reconceptualization of personality. Psychological Review 80 (1973) 252–267.PubMedCrossRefGoogle Scholar
  41. Parcel, G. S. and Baranowski, T. Social learning theory and health education. Health Education 80 (1973) 252–267.Google Scholar
  42. Perrier, J. Fitness in America, the Perrier study, January 1979.Google Scholar
  43. Petitti, D. B., Friedman, G. D., and Kahn, W. Accuracy of information on smoking habits provided on self-administered research questionnaires. American Journal of Public Health 71 (3) (1981) 308–311.PubMedCrossRefGoogle Scholar
  44. Pratt, L. Family structure and effective health behavior: The energized family. Boston: Houghton Mifflin, 1976.Google Scholar
  45. Rosenthal, B., Allen, G. J., and Winter, C. Husband involvement in the behavioral treatment of overweight women: Initial effects and long-term follow-up. International Journal of Obesity (1980) 65–173.Google Scholar
  46. Surgeon General. DHEW: Smoking health report. Publication #79–50066, 1979.Google Scholar
  47. Tennant, F. S. and Detels, R. Relationship of alcohol, cigarette and drug abuse in adulthood with alcohol, cigarette and coffee consumption in childhood. Preventive Medicine 5 (1) (1976) 70–71.PubMedCrossRefGoogle Scholar
  48. Tobian, L., Jr. The relationship of salt to hypertension. American Journal of Clinical Nutrition 32 (12) (1979) 2739–2748.PubMedGoogle Scholar
  49. U.S. Bureau of the Census, Statistical abstracts of the United States, 1979, (199th edition) Washington, D.C.: U.S. Government Printing Office, 1979. Table 231, p. 145.Google Scholar
  50. Weltman, A., Matter, S., and Stamford, B. A. Caloric restriction and/or mild exercise: Effects on serum lipids and body composition. American Journal of Clinical Nutrition 33 (1980) 1002–1009.PubMedGoogle Scholar
  51. Wheeler, M. and Haider, S. Q. Buying and food preparation patterns of ghetto Blacks and Hispanics in Brooklyn. Journal of the American Dietetic Association 75 (5) (1979) 560–563.PubMedGoogle Scholar
  52. Williams, A. F. and Wechsler, H. Interrelationship of preventive actions in health and other areas. Health Services Report 87 (10) (1972) 969–976.CrossRefGoogle Scholar
  53. Winkelstein, W., Jr. Primary prevention of ischemic heart disease: Evaluation of community interventions. Annual Review of Public Health 2 (1981) 253–276.PubMedCrossRefGoogle Scholar
  54. Wood, P. D. and Klein, H. et al. Plasma lipoprotein concentration in middle aged runners. Circulation 50 (1974) 111–115.Google Scholar

Copyright information

© Plenum Press, New York 1985

Authors and Affiliations

  • Philip R. Nader
  • Tom Baranowski

There are no affiliations available

Personalised recommendations