COST-EFFECTIVENESS OF MINIMAL CONTACT EDUCATION STRATEGIES FOR CHOLESTEROL CHANGE Objectives: To compare the effectiveness and cost effectiveness of minimal contact nutrition interventions that varied in intensity on lower- ing total blood cholesterol (BC) levels. Design: A randomized trial in which public, work, religious, and medical sites were ran- domly assigned to one of six minimal-contact nutrition interventions for lowering total BC. Setting: 36 public, work, religious, and med- ical sites in southern New England (total sites5144). Participants: The number of eligible partici- pants at baseline was 10,144, which included 1425 Hispanics, who were over-recruited for this study. Intervention: One of six brief interventions was provided to participants: 1) feedback tip sheet only; 2) tip sheet plus Rate Your Plate (RYP); 3) tip sheet, RYP, plus Let’s Eat Kit (LEK); 4) all written materials plus CD audio in- tervention (AUD); 5) all written materials plus counseling from a trained lay person (LAY-C); and 6) all written materials plus counseling by a nutritionist (NUT-C). The educational mate- rials were adapted to be culturally and linguistically appropriate for a Hispanic audi- ence, and the counselors for the Hispanic participants were bilingual. Measures: Total blood cholesterol levels were measured using fingerstick methods at base- line, 3 months, and 12 months after the intervention. Results: Blood cholesterol (BC) was signifi- cantly reduced from baseline to 12-month follow-up among most experimental groups. Only LAY-C and NUT-C conditions demon- strated significant BC reductions at three months. The BC change in the NUT-C group was statistically different from the feedback- only condition at three months only. At three- month followup, BC was reduced 1.6% for the total sample, 2.8% for participants with bor- derline-high BC levels, and 3.4% for partici- pants with high BC. Generally, the two conditions receiving counseling resulted in the largest percentage changes in BC levels. When examining BC change data by ethnicity, Hispanic participants in the audio condition achieved the largest overall 12-month change (4%). Generally, total costs increased as the intensity of the experimental condition in- creased. When comparing 3-month and 12- month cost effectiveness, LAY-C and NUT-C Kim M. Gans, PhD, MPH, LDN; Gary J. Burkholder Jr, PhD; Patricia M. Risica, DrPH, RD; Brooke Harrow, PhD; Thomas M. Lasater, PhD INTRODUCTION Cardiovascular disease (CVD) is the leading cause of death in the United States and cost the United States an estimated $329 billion dollars in 2002. 1 The relationship between high blood cholesterol (BC) and CVD is estab- lished, 2–5 and approximately half of US adults have elevated levels (.5.2 mmol/ L or $200 mg/dL), 6,7 although total BC levels have been decreasing. 6–8 A 1% reduction in total BC has a corre- sponding 2%–3% reduction in risk for coronary heart disease. 9–12 Addressing the BC problem should include population-based strategies that incorporate changes in diet. 9,13–16 Di- etary change has a significant effect on BC levels 17 as well as other CVD risk factors. 9,18,19 A number of nutrition education interventions have been tested for lowering BC levels, and in general, more intensive interventions have had a greater effect. 20–31 Unfortunately, many of these interventions would be too resource intensive and expensive to implement widely on a population basis. Design limitations of previous in- tervention studies preclude useful in- terpretation and extrapolation to com- munity practice. Some studies involved only limited segments of the communi- ty (mainly White participants and/or those at high risk), had small sample sizes, and/or had contamination issues because of individual-level randomiza- tion designs. 32 Furthermore, many stud- ies that have used multiple-component interventions were not designed to identify which component(s) or com- binations of the intervention were most effective. Thus, additional research is needed to evaluate the cost-effective- ness of alternative modes of interven- tion delivery to determine which in- tervention components hold the most promise for public health. 33–35 The objectives of this study were to evaluate the relative effectiveness of a variety of minimal contact nutrition education interventions on lowering BC levels and to examine the cost-effectiveness of each type of intervention in a large, multisite study with a diverse group of participants. METHODS General Design The Minimal Contact Education for BC Change (MC) project, an NHLBI- funded study, was conducted from July From the Institute for Community Health Promotion, Brown University, Prov- idence, Rhode Island (KG, PR, TL) and the University of Massachusetts, Boston, Mas- sachusetts (BH). Please address correspondence and reprint requests to Kim Gans, PhD; Brown University; Institute for Community Health Promotion; 1 Hoppin St. Coro-4W; Provi- dence RI 02903; 401-793-8318; 401-793- 8314 (fax); kim_gans@brown.edu were approximately the same, whereas LEK and AUD conditions tended to become more expensive than the other interventions. Conclusions: Brief nutrition counseling is an effective component of BC reduction pro- grams. Culturally tailoring programs can result in substantial reductions in BC among Hispan- ic participants. Overall, even the most expen- sive intervention was fairly inexpensive com- pared to other, more intensive clinical interventions. (Ethn Dis. 2006;16:443–451) Key Words: Cholesterol, Cost Effectiveness, Minimal Contact Intervention, Nutrition Edu- cation, Randomized Trial Ethnicity & Disease, Volume 16, Spring 2006 443