Media Advocacy: A Case Study of Philip Sokolof's Cholesterol Awareness Campaigns

According to statistics released by the National Institutes of Health (NIH), approximately 500,000 Americans die each year from coronary heart disease (NIH 1990b). Although coronary heart disease (CHD) is a complex, multifaceted health problem, attention has focused in recent years on dietary cholesterol and saturated fats as factors contributing to elevated blood cholesterol levels. Elevated blood cholesterol, specifically LDL (low density lipoprotein) cholesterol, can lead to arteriosclerosis (a narrowing of the arteries that slows or blocks the flow of blood) and greatly increases the risk of heart attack. In many instances blood cholesterol levels can be lowered through diet and exercise, and the risk of CHD can be reduced. Cholesterol is only one causal factor underlying CHD. Other CHD risk factors include genetic predisposition, obesity, high blood pressure, diabetes, and smoking. Although only one factor, cholesterol is, however, an important factor. A person with a blood cholesterol level of 240 mg/dL (milligrams per deciliter) has a risk of CHD more than double that of an individual whose cholesterol is 200 mg/dL (NIH 1990a). Public awareness of the health risks associated with high cholesterol levels has grown significantly. A recent study found the percentage of Americans who were informed that their blood cholesterol level was too high increased from 11 to 20 percent between 1987 and 1990, and the number of people tested during the same period increased by 25 percent ("Cholesterol Awareness Is Up" 1991). And, as awareness has increased, Americans have changed their diets. As recently as 1986, 23 percent of the adults surveyed in a national probability sample (N = 4,000) reported they had made dietary changes specifically to lower blood cholesterol levels (Schucker et al. 1987). Three dietary habits commonly contribute to elevated blood cholesterol levels (NIH 1989a). First are diets with high levels of saturated fatty acids which can elevate LDL cholesterol levels. These are found in both animal fats (e.g., butterfat) and plant oils. Many tropical oils (e.g., palm, palm kernel, and coconut oils) contain particularly high concentrations of saturated fatty acids. Fortunately, tropical oils are a minor component of the U.S. food supply (Willett and Sacks 1991). Second are diets with relatively high levels of cholesterol. Dietary cholesterol is present only in foods and byproducts of animal origin. Third are high calorie diets that exceed normal body requirements and contribute to obesity. Accordingly, health experts have provided relatively consistent dietary guidelines for reducing blood cholesterol levels (NIH 1989b). Specific recommendations normally include lowering the intake of saturated fats and dietary cholesterol, increasing the relative proportion of foods high in complex carbohydrates, and reducing total caloric intake for overweight persons. Although many Americans have responded to the threat posed by elevated blood cholesterol levels, problems remain. The average blood cholesterol level for adult Americans is approximately 210 mg/dL, and about 55 percent of the adult population have cholesterol levels of 255 mg/dL or higher (NIH 1990b). The National Center for Health Statistics (1986) estimated that 27.4 million adult Americans have cholesterol levels that put them at high risk of CHD, and another 19.6 million adults can be placed in the "moderate risk" category. Concern has also been expressed over elevated cholesterol levels in children. A study in New York determined that approximately 80 percent of the nine-year-old children surveyed were ingesting too much saturated fat and 60 percent were consuming excessive amounts of dietary cholesterol ("High Cholesterol in Children" 1989). Many researchers now feel that high cholesterol levels in childhood contribute to increased risk of heart disease and hypertension in adulthood. Contemporary lifestyles often discourage sound dietary behavior. …