Behavioral Contracting in an Urban Health Promotion Project

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Abstract
A health promotion project involving 223 participants was conducted by the Department of Family Medicine at Wayne State University in Detroit, Michigan. Participants were screenedforfive cardiovascular riskfactors: blood lipids, obesity, smoking, blood pressure and physical fitness; they were reassessed at six-month and two-year intervals. Following the initial screening, participants were asked to meet with the project health educator to sign one or more "behavioral contracts" to make behavior or life-style changes designed to improve risk factor status. Individual and group interventions were provided to all interested clients. Of the individuals screened, 179 of the 223 returned for at least one health counseling session. Contractors were most successful in improving exercise habits and making dietary changes to reduce cholesterol. These changes were reflected in improved treadmill performance and significant reductions in serum cholesterol. Smokers and the overweight showed poor success rates, few smokers were willing to sign a smoking cessation contract, and there was a high dropout ratefrom weightcontrol counseling.