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Preventing Chronic Disease: Public Health Research, Practice and Policy

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Emerging Infectious Diseases Journal


Volume 2: No. 2, April 2005

Retooling an Osteoporosis Prevention Program to Serve Low-Income Populations: A Practical Guide to Bone Health


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Denise Cyzman, Norma Bour, Rachel McLaury, Judith Lyles

Suggested citation for this article: Cyzman D, Bour N, McLaury R, Lyles J. Retooling an osteoporosis prevention program to serve low-income populations: A Practical Guide to Bone Health [abstract]. Prev Chronic Dis [serial online] 2005 Apr [date cited]. Available from: URL:


Track: Partnerships

We modified an existing osteoporosis prevention program to address the needs of low-income consumers in Michigan and conducted a pilot test to assess the program’s effectiveness.

Building on previously collected focus group data from consumers and educators, we surveyed eight educators with the Michigan State University Extension (MSUE) to help identify barriers encountered delivering an educational osteoporosis prevention program to low-income constituents. The educators recommended program content changes that placed more emphasis on practical information relating to food choices, nutrition, and physical activity. Registered dietitians and staff representing the Michigan Nutrition Network, United Dairy Industry, and the Michigan Department of Community Health developed new material. The resulting program, A Practical Guide to Bone Health, was designed as a 45-minute presentation available in either a flip-chart or PowerPoint format. The content emphasized physical activity, diet quality, and the importance of calcium and vitamin D. A shopping section guided consumers to better food choices. The program also encouraged change in diet and physical activities. A statewide steering committee reviewed the program before a final field test.

We conducted the program at four sites, one urban and three rural, selected by MSUE educators who reach low-income populations. Participants completed pre-tests and post-tests assessing basic knowledge and intent to change behavior. Educators documented program location, number of participants, and audience income level.

A total of 46 people participated in the program. Participants were primarily between the ages of 18 and 44 years (75%), white (93%), and female (79%); at three of four sites, participants were predominantly low-income. A total of 43 participants completed both the pre-test and the post-test (93%). Of those who did not have perfect scores on the knowledge pretest, 73% increased their scores following the session. Prior to the program, 28% reported inadequate calcium intake and 30% reported inadequate physical activity. At post-test, 50% of those with low calcium intake indicated intent to eat three or more servings of calcium-rich foods. Likewise, 62% of those with low activity levels reported intent to increase physical activity to at least 30 minutes three times a week. An additional 13% indicated intent to increase activity to 30 minutes five times a week.

Collaboration among public health practitioners resulted in an easy-to-use and effective osteoporosis prevention program directed toward the needs of low-income populations.

Corresponding Author: Denise R. Cyzman, MS, RD, Section Manager, Diabetes, Kidney, and Other Chronic Diseases, Michigan Department of Community Health, 3423 N Martin Luther King Blvd, PO Box 30195, Lansing, MI 48909. Telephone: 517-335-8369. E-mail:

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