Cardiovascular risk factor changes in the Kilkenny Health Project. A community health promotion programme. Community-based primary prevention of cardiovascular disease in Switzerland: methods and results of the National Research Program (NRP 1A). The effectiveness of a media-led intervention to reduce smoking among Vietnamese-American men. Results of the Dutch community project "Healthy Bergeyk". Neighbors for a smoke free north side: evaluation of a community organization approach to promoting smoking cessation among African Americans. Evaluation of a Dutch community-based smoking cessation intervention. The Finnmark Intervention Study. Better health for the fishery population in an Arctic village in North Norway. The Finnmark Intervention Study: is it possible to change CVD risk factors by community-based intervention in an Arctic village in crisis? Reducing the risk of cardiovascular disease: effects of a community-based campaign on knowledge and behavior. Helping women quit smoking: results of a community intervention program. The Dutch Heart Health Community Intervention 'Hartslag Limburg': effects on smoking behaviour. Shifting the distribution of risk: results of a community intervention in a Swedish programme for the prevention of cardiovascular disease. The community-based strategy to prevent coronary heart disease: conclusions from the ten years of the North Karelia project. Changes in adult cigarette smoking in the Minnesota Heart Health Program. The Otsego-Schoharie healthy heart program: prevention of cardiovascular disease in the rural US. A cost effective, community based heart health promotion project in England: prospective comparative study. The effect of a community-based cardiovascular disease prevention project in a Danish municipality. A trial of church-based smoking cessation interventions for rural African Americans. Community-based intervention: the Coronary Risk Factor Study (CORIS). Efficacy of an anti-tobacco community education program in India. Smoking cessation in Texas-Mexico border communities: a quasi-experimental panel study. Changes in adult cigarette smoking prevalence after 5 years of community health education: the Stanford Five-City Project. The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk. Evaluation of the Heart To Heart Project: lessons from a community-based chronic disease prevention project. Reduction of coronary heart disease risk factors in the German cardiovascular prevention study. Change in cardiovascular risk factors during a 10-year community intervention program. Effect of a community action program on adult quit smoking rates in rural australian towns: the CART project. The impact of a community-based heart disease prevention program in a low-income, inner-city neighborhood. Preventing cardiovascular disease through community-based risk reduction: the Bootheel Heart Health Project. Effects of the Heartbeat Wales programme over five years on behavioural risks for cardiovascular disease: quasi-experimental comparison of results from Wales and a matched reference area.
The Kilkenny Health Project was a community research and demonstration programme which aimed to reduce risk of cardiovascular disease in a county in the south-east of Ireland with a total population of approximately 70,000. The health promotion programme was carried out in Kilkenny from 1985 to 1992. Outcome evaluation was by means of population surveys of independent samples of men and women aged 35 to 64 years in Kilkenny (n approximately 800) and in the reference county (n approximately 600) in 1985/1986 and in 1990/1991. Survey methods for health behaviour questionnaires and risk factor measurements were similar to those of the WHO MONICA Project. Mean systolic blood pressure (SBP) declined significantly (P < 0.01) in men and women in both counties, from 144.0 by 5.4 mmHg and from 143.2 by 5.4 mmHg in men and from 139.5 by 7.7 mmHg and from 136.5 by 6.6 mmHg in women in the intervention and reference counties. The prevalence of hypertension declined from 23.1% by 2.8% and from 26.1% by 6.0% in men in the two counties. Prevalence declined from 24.1% by 6.2% (P < 0.05) in women in the intervention county but was unchanged, increasing by 0.5% from 17.5%, in women in the reference county. Mean serum total cholesterol declined from 6.04 mmol.l-1 by 0.09 mmol.l-1 and from 6.00 by 0.44 mmol.l-1 (P < 0.01) in men and from 6.01 by 0.36 (P < 0.01) and from 5.90 by 0.31 (P < 0.01) in women in the intervention and reference counties, respectively.(ABSTRACT TRUNCATED AT 250 WORDS) The National Research Program 1A on Primary Prevention of Cardiovascular Disease in Switzerland was designed to determine whether community health education can reduce cardiovascular risk factors in whole population groups. Two towns (12,000 inhabitants each) in the French-speaking and two (16,000 inhabitants each) in the German-speaking part of the country were selected for either intervention or comparison. Following baseline screening in 1977 (stratified random samples) and the community intervention program (1978-1980), a final assessment on the initial participants was made at the end of 1980. In intervention towns, 26.2% of the regular smokers quit during this period compared with 18.1% in the reference towns. In addition, a significant net increase in the proportion of hypertensive patients under effective control was observed. A reduction in cholesterol levels was noted in both the intervention and the reference towns, with no difference between them. However, cholesterol levels in a subgroup of women participating in program activities as compared with those not participating were significantly reduced. The program, with extensive involvement of a diversity of community groups, has enjoyed continued support, even after the end of the research experience, thus demonstrating the viability and acceptability of community-oriented preventive action. This study evaluated an anti-tobacco campaign targeting Vietnamese men in San Francisco, Calif.
                The intervention included Vietnamese-language media, health education materials, and activities targeting physicians, youth, and businesses. Evaluation involved pretest and posttest cross-sectional telephone surveys and multiple logistic regression analyses designed to identify variables associated with smoking and quitting.
                At posttest, the odds of being a smoker were significantly lower (odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.68, 0.99), and the odds of being a quitter were significantly higher (OR = 1.65, 95% CI = 1.27, 2.15), in San Francisco than in a comparison community.
                Despite modest success, further efforts are needed to reduce smoking among Vietnamese-American men. This article reports on the results of a community health project that was implemented in the Dutch municipality of Bergeyk. The major goal was to reduce four cancer-related risk behaviors: smoking, high fat consumption, excessive alcohol use, and exposure to artificial sunlight. A control community received no new intervention. Intervention methods included mass media messages, self-help materials, small group activities, lectures, and structural activities. Community organization principles such as a social network approach, community participation, and intersectoral cooperation were applied in the project.
                Data were collected from both communities among cohort research samples on three occasions using telephone interviews.
                The results indicate a significant reduction in fat intake in the experimental community. No other significant behavioral effects were found. Further analysis among respondents in the experimental condition showed that those personally exposed to the project as indicated by familiarity with and discussion about the project, had a greater decrease in fat consumption between baseline survey and second post-test than those who were not. Also, the percentage of smokers who quit between baseline survey and second post-test was greater among those who knew about the project than among those who did not. Finally, discriminant analysis was used to further examine the determinants of project exposure. Community involvement, marital status, education, and sex were related to project exposure.
                It is concluded that with the time limitations of the project in mind, the findings are encouraging. This study evaluated a community organization approach that emphasized involvement of audiences in program planning and implementation in promoting nonsmoking among African American residents of low-income neighborhoods.
                The quasi-experimental design involved a 24-month intervention in 3 low-income, predominantly African American neighborhoods in St. Louis. Intervention neighborhoods were compared with comparable, untreated neighborhoods in Kansas City.
                The program was successful in engaging audience members in its governance and in instigating numerous and diverse neighborhood activities to promote nonsmoking. The prevalence of smoking declined from 34% to 27% in program neighborhoods but only from 34% to 33% in comparison neighborhoods. This difference was apparent within all demographically defined subsamples, indicating that observed changes were consistent and not attributable to confounding by demographic characteristics.
                A community organization approach emphasizing local authority for program decisions and involvement of informal networks may have an appreciable impact on smoking among residents of low-income, African American neighborhoods. Until 1990, smoking cessation interventions in the Netherlands were limited. The utility and effectiveness of community-based smoking cessation programs have not been examined.
                In a treatment city (Den Bosch) a multicomponent community-based smoking cessation intervention was implemented in which local mass media and general practitioners draw smokers' attention to a local quit line. Telephone counselors advised applicants on their choice between self-help and group treatment and optional telephone counseling. Another Dutch city (Apeldoorn) served as a control. Population samples of smokers (n = 547 and n = 546) were interviewed three times at approximately 7-month intervals. Self-help manual requesters (n = 84) and group participants (n = 83) were interviewed before and 6 months after treatment.
                Treatment modalities were successful; 13% of self-help manual requesters and 22% of group participants were abstinent after 6 months. On a population level the intervention resulted in significantly higher recall of self-help manual and group program in the treatment city. A modest intervention effect on prevalence of abstinence was found at the community level.
                Treatment modalities were effective within their participants, but the intervention effectiveness on a community level was limited. No significant difference was found between quit rates after 14 months (7% in treatment city and 9% in control city). Several system failures could be identified. However, probably the intervention effect was seriously confounded by two national governmental publicity campaigns introducing and reinforcing a mandatory smoking ban and a series of national campaigns initiated by the united Dutch tobacco producers opposing the ban. To evaluate the lifestyle and cardiovascular risk factor changes after 6 years of intervention in the North Cape community.
                Longitudinal cohort study with a quasi-experimental design with one intervention and three control communities selected from the same coastal area with a baseline screening (1987), 6-year intervention, and re-screening (1993).
                Fishing communities on the coast of Finnmark in the Norwegian Arctic area.
                1685 (70%) of the invited in both screenings, aged between 20 and 62 years in 1987.
                Community-intervention based on empowerment and cooperation between voluntary organisations and local health services.
                Change in cardiovascular risk factors.
                Compared to the control communities, the main findings in North Cape were among men: 21.3% less drinking boiled coffee (p < 0.05), 10.5% more drinking low fat milk (p < 0.01), 0.3 mmol/l reduction in cholesterol (p < 0.01) and 0.2 kg/m2 reduction in BMI (p < 0.001). Among women, there were 5.9% fewer smokers (p < 0.01), 21% less drinking boiled coffee (p < 0.05), 1 kg/m2 less increase in BMI (p < 0.001) and 0.5 less increase in MI risk score (p < 0.05).
                Small close-knit communities are suitable for community-based interventions where it is easier to obtain close interaction between health service, voluntary organisations and the public at large. Owing to high cardiovascular mortality, the Norwegian Government introduced the programme "Health and Inequalities in Finnmark" in 1988. One of the projects in this programme was aimed at changing cardiovascular risk factors through community-based intervention in a fishing community in the Norwegian Arctic.
                The intervention community Båtsfjord and the three control communities were selected from the same coastal area. The intervention was based on a quasi-experimental design, and evaluated by population surveys before (1987) and after (1993) the invention. The attending cohort was analysed. The intervention method was based on empowerment and cooperation between different organizations, and the primary healthcare system.
                From 1987 - 93, the male cohort in Båtsfjord had a more favourable development when compared with changes in the control communities regarding the 8.6% increase in physical activity (p = 0.047), the reduction in systolic blood pressure by 0.01 mmHg (p = 0.002), and the reduction in diastolic blood pressure by 2.1 mmHg (p < 0.001). The female cohort in Båtsfjord had a more favourable development when compared with changes in the control communities regarding the 11.2% increase in use of low-fat milk (p = 0.046), the increase in systolic blood pressure by 2.1 mmHg (p = 0.024), and the reduction in diastolic blood pressure by 2.1 mmHg (p < 0.001).
                Despite a difficult economic situation for the Arctic coastal communities, the study found it possible for voluntary organizations, local public administration, and local health personnel to promote change in lifestyle and blood pressure using a community intervention approach. In 1972 the Stanford Heart Disease Prevention Program launched a three-community field study. A multimedia campaign was conducted for two years in two California communities (Watsonville and Gilroy), in one of which (Watsonville) it was supplemented by an intensive-instruction program with high-risk subjects. A third community (Tracy) was used as a control. The campaigns were designed to increase participants' knowledge of the risk factors for cardiovascular disease, to change such risk-producing behavior as cigarette smoking, and to decrease the participants' dietary intake of calories, salt, sugar, saturated fat, and cholesterol. Results of a sample survey indicate that substantial gains in knowledge, in behavioral modification, and in the estimated risk of cardiovascular disease can be produced by both methods of intervention. The intensive-instruction program, when combined with the mass-medica campaign, emerged as the most effective for those participants who were initially evaluated to be at high risk. The results after two years of intervention are reported for effects on knowledge and behavioral change for the total participant samples and for the high-risk subsamples in each of the three communities. This intervention was implemented to reduce the prevalence of cigarette smoking among women.
                We used community organization approaches to create coalitions and task forces to develop and implement a multicomponent intervention in 2 counties in Vermont and New Hampshire, with a special focus on providing support to help women quit smoking. Evaluation was by pre-intervention and post-intervention random-digit-dialed telephone surveys in the intervention counties and the 2 matched comparison counties.
                In the intervention counties, compared with the comparison counties, the odds of a woman being a smoker after 4 years of program activities were 0.88 (95% confidence interval = 0.78, 1.00) (P = .02, 1-tailed); women smokers' perceptions of community norms about women smoking were significantly more negative (P = .002, 1-tailed); and the quit rate in the past 5 years was significantly greater (25.4% vs 21.4%; P = .02, 1-tailed). Quit rates were significantly higher in the intervention counties among younger women (aged 18 to 44 years); among women with household annual incomes of $25,000 or less; and among heavier smokers (those who smoked 25 or more cigarettes daily).
                In these rural counties, community participation in planning and implementing interventions was accompanied by favorable changes in women's smoking behavior. A pretest-posttest control group design with two posttests was used to evaluate the effects of a regional Dutch Heart Health Community Intervention on smoking behaviour and its determinants. At baseline, a cohort research population of 1,200 smokers was recruited in the intervention region and in a control region. Data was gathered by means of short structured telephone interviews.
                No significant differences were found between the intervention region and the control region on smoking behaviour and its determinants.
                It is concluded that the regional intervention was unable to exceed secular trends in smoking cessation. To examine the impact of a systematic risk factor screening and counselling carried out by family physicians and family nurses within the larger framework of a community intervention programme for the prevention of cardiovascular disease (CVD).
                Quasi-experimental study comparing trends in an intervention area with those in a reference area.
                A Northern Sweden municipality (5500 inhabitants) constituted the intervention area while the Northern Sweden region (510,000 inhabitants) served as the reference area.
                All 30, 40, 50, and 60 year old inhabitants were invited each year from 1985 to 1992. Among 2046 eligible 1893 participated (92.5%), which formed eight independent cross sections. One cross section, 1986, was re-surveyed forming a panel.
                In the cross sections, mean total cholesterol was reduced from 7.09 to 6.27 mmol/l for men (p < 0.001) and from 7.13 to 5.89 mmol/l for women (p < 0.001) and mean systolic blood pressure from 132.2 to 123.7 mm Hg for men (p < 0.05) and from 129.2 to 122.0 mm Hg for women (p < 0.001) during the eight years. Body mass index (BMI) increased from 25.6 to 26.2 for men (p < 0.05) and from 25.0 to 25.5 for women (NS). A corresponding reduction in cholesterol and blood pressure (for women) occurred in the panel, while BMI was unchanged. The risk for CVD, using the Framingham equation, was estimated to be reduced overall by 19% (p = 0.0021) when comparing early cross sections (1985/86) with the later cross sections (1990/91).
                It was concluded that a long term community based CVD prevention programme that combines population and individual strategies can substantially promote a health shift in CVD risk in a high risk rural population. The individual attention and evaluation provided by the health provider survey seem to accelerate, but not increase the amount of, risk reduction. nan The Minnesota Heart Health Program was a research and demonstration project designed to reduce risk factors for heart disease in whole communities. This paper describes smoking-specific interventions and outcomes.
                Three pairs of matched communities were included in the study. After baseline surveys, one community in each pair received a 5-year education program, while both cross-sectional and cohort surveys continued in all sites. Adult education programs for smoking cessation included Quit and Win contests, classes, self-help materials, telephone support, and home correspondence programs.
                Encouraging short-term results were obtained for several adult education programs. Overall long-term outcomes were mixed, with evidence of an intervention effect only for women in cross-sectional survey data. Unexpectedly strong secular declines in smoking prevalence were observed in comparison communities.
                The findings suggest that community education may be unlikely to exceed dramatic secular reductions in smoking prevalence. The success of several key interventions and the incorporation of Minnesota Heart Health Program interventions by education communities are encouraging, however. To describe a rural, hospital-based public health intervention program and to evaluate its effectiveness in cardiovascular disease (CVD) risk reduction using cross-sectional studies and a panel study.
                A rural population of 158,000 located in New York state comprised the intervention population. A similar but separate population was used for reference. A multifaceted, multimedia 5-year program provided health promotion and education initiatives to increase physical activity, decrease smoking, improve nutrition, and identify hypercholesterolemia and hypertension. To evaluate the effectiveness of the intervention, surveys were conducted at baseline in 1989 (cross-sectional) and at follow-up in 1994-95 (cross-sectional and panel). For cross-sectional studies, a random sample of adults was obtained using a three-stage cluster design. Self-reported and objective risk factor measurements were obtained. Comparison of pre- to post- changes in intervention versus reference populations was done using 2 x 2 randomized block ANOVA, 2 x 2 mixed ANOVA. and extension of the McNemar test.
                Smoking prevalence declined (from 27.9% to 17.6%) in the intervention population. Significant adverse trends were observed for high-density lipoprotein cholesterol and triglycerides. Systolic blood pressure was reduced while diastolic blood pressure remained stable. Body mass index increased significantly in both populations.
                This rural. 5-year CVD community intervention program decreased smoking. The risk reduction may be attributable to tailoring of a multifaceted approach (multiple risk factors, multiple messages, and multiple population subgroups) to a target rural population. The study period was too short to identify changes in CVD morbidity and mortality. To determine whether a community based coronary heart disease health promotion project, undertaken over four years, was associated with changes in the prevalence in adults of lifestyle risk factors known to affect the development of coronary heart disease, and to estimate whether such an approach was cost effective.
                Prospective, comparative study of the effects of a health promotion intervention on coronary heart disease lifestyle risk factors, assessed by postal questionnaire sent to a randomly chosen sample, both at baseline and after four years.
                Intervention and control populations of adults aged 18-64 in Rotherham, both from areas with a high incidence of coronary heart disease and similar socioeconomic composition.
                Changes in prevalence of lifestyle risk factors between the control and intervention communities from 1991 to 1995. The effect of the intervention on certain lifestyle behaviours was evaluated using multiple logistic regression to model the proportion with a particular behaviour in the study communities as a function of age (18-40 or 41-64 years), sex, the year of observation (1991 or 1995), and area (intervention of control).
                6.9% fewer people smoked and 8.7% more drank low fat milk in the intervention area, but no other statistically significant changes between the areas were detected. The estimated cost per life year gained was pounds 31.
                It is possible to have a cost effective impact on coronary heart disease lifestyle risk factors in a population of adults over four years using only modest resources. A community-based project for the prevention of cardiovascular diseases was undertaken in 1989 in a rural Danish municipality (Slangerup) with about 8000 inhabitants. Project goals were to draw attention to project activities and improve smoking, eating and exercise behaviours. The intervention was planned using the social learning theory, a communication-behaviour change model and community organisation principle. The strategy used for intervention involved both mass communication and active involvement of the local population in group activities. The objectives of the intervention were assessed by data obtained from representative cross-section surveys in intervention and a control area at baseline (1989) and one year later. More respondents in the intervention (82%) than control (67%) area were aware of local health projects. Ten % reported that they stopped smoking within the last year, 39% ate less fat, and 28% did more exercise, with no differences between intervention and control area. Several explanations are proposed for the limited effect of the project on behaviours. One possible explanation is that the project almost ended up being a pure mass media campaign which may increase awareness, but, as experience shows, may have limited influence on adoption of new behaviour. The Danish population around 1990 is very well informed and educated in this field due to earlier nationwide interventions. No further behavioural effects are obtainable with mass media campaigns. The Alliance of Black Churches Health Project was begun in an effort to address the health problems of the African-American residents of two rural Virginia counties. Smoking cessation was chosen as the principal target behavior in one county. Church coalitions were chosen as the principal organizations through which to implement the interventions.
                A smoking cessation program was designed that combined one-on-one counseling with self-help materials and community-wide activities. To provide these services, up to two smoking cessation counselors were trained from participating churches. To evaluate the impact, population-based cohorts of smokers were assembled in each county using a door-to-door survey. Respondents were recontacted after 18 months. Smoking cessation (1-month continuous abstinence), stages of change, and exposure to the interventions were assessed.
                The overall smoking prevalence at baseline was 25.8%. At follow-up, the smoking cessation rate in the intervention county was 9.6% and in the control county 5.4% (P = 0.18). Among those attending church once a month or more, the respective quit rates were 10.5% and 5.9% (P = 0.20). There was significantly more progress along the stages of change in the intervention than in the control county. There was also higher awareness of and contact with smoking cessation programs in the former compared with the latter.
                Smoking cessation interventions for African Americans can be successfully implemented through a church coalition. The interventions were associated with significant progress along the stages of cessation. Although the quit rate was higher in the intervention community, the difference was not significant. The Coronary Risk Factor Study (CORIS) examined the feasibility and effectiveness of a multifactorial community intervention programme to reduce coronary heart disease (CHD) risk factor levels. Three Afrikaner communities were surveyed before and after a 4-year intervention in two of the communities, the third serving as a control (C). Intervention was primarily by small mass media (low-intensity intervention, LII) or by small mass media plus interpersonal intervention to high-risk individuals (high-intensity intervention, HII). After allowing for change in C, significant net reductions in blood pressure, smoking, and risk score were obtained in LII and HII alike. Though the total cholesterol (TC) fell by 10-12%, there was no net reduction in favour of the intervention communities. However, LII and HII resulted in significant increases in high-density lipoprotein cholesterol (HDL-C) levels and HDL-C/TC ratios in comparison to C. Overall, the LII community fared almost as well as the HII community, and high-risk individuals did not show a greater change in risk factors than others. We conclude that community-based intervention works, and that in these particular communities a media-based health education programme was more cost-effective than one which adds a greater degree of interpersonal intervention. In a study on 'Assessment of Efficacy of an Anti-Tobacco Community Education Program' on Kolar District of Karnataka, India, an experimental and two control areas were chosen based on comparable population, health, and socioeconomic parameters. The two main objectives were to prevent individuals from taking up the tobacco habit among those who currently did not smoke or chew tobacco, and to stop the tobacco habit in those who did smoke or chew tobacco. A baseline tobacco-habit survey of the population was followed by anti-tobacco education of the community in the experimental area only. Two years later, a repeat survey of the population was conducted, followed by a final survey after a further three years. Methods of health education of the community included screening of films, exhibits, and personal contact with a display of photographs of the harmful effects of tobacco. The results were evaluated through changes in prevalence rates, quitters' rates, and initiation rate. The final survey showed that in the experimental area, the decline in the prevalence rate in the combined sample compared with the baseline rates was 10.2 percent in males and 16.3 percent in females, with a corresponding quitter's rate of 26.5 percent in males and 36.7 percent in females. Among men, a higher proportion (30.2 percent) had given up chewing compared with smoking (20.4 percent). BACKGROUDd. Smoking-related disease and injury is prominent among the numerous health problems on the U.S.-Mexico border, but little is known about the methods that might help promote smoking cessation among the low-income populations in this region.
                Media campaigns were combined with different forms of intensive and community-wide interpersonal communication to encourage smoking cessation in a border U.S. city and in a Mexican city. Panels of moderate to heavy smokers were followed in four groups to allow quasi-experimental comparison of smoking cessation rates.
                Over a five-year study period smoking cessation rates of 17% (self-reported) and 8% (verified) were observed in panels in the program community (N = 160). In the comparison community (N = 135) corresponding rates of smoking cessation were 7% (self-reported) and 1.5% (verified). Within the program community, no differences were observed in smoking cessation among smokers exposed to a community-wide program and those assigned to receive personal counseling.
                Although the observed changes in smoking were unexpectedly small in the treatment and comparison groups, the approximately 8% effect size for the community-wide program was close to what was predicted. Results indicate that such programs may yield effects similar to those of more intensive approaches, but further research with greater statistical power will be necessary to confirm that point. To determine the effects of 5 years of community-wide cardiovascular health education on smoking prevalence and cessation, the authors analyzed data from the Stanford Five-City Project, an experimental field study with two treatment cities and two control cities. Representative samples of the population aged 12-74 years were drawn at baseline and every 2 years thereafter to obtain four independent cross-sectional surveys; participants aged 25-74 years are included in this paper (n approximately 440 per city per survey; total n = 6,981). The baseline sample was asked to return to three follow-up surveys, also 2 years apart, and those that did (n = 805) constitute the cohort survey sample. Self-reported cigarette smoking was confirmed by plasma thiocyanate and expired-air carbon monoxide levels. Smoking prevalence decreased over time in all cities, but in the cohort the decrease tended to be greater in treatment than in control cities (p = 0.10, two-tailed); the treatment-control difference was consistent over time (-1.51 percentage points/year in treatment vs. -0.78 percentage points/year in control, p = 0.007, two-tailed). In contrast, smoking prevalence in the independent samples declined similarly in treatment and control cities, changes were not linear, and rates varied within cities between times. Baseline smokers in both the cohort and the follow-up independent surveys were significantly more likely to quit in the treatment cities than in the control cities. Whether community-wide education changed cardiovascular risk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed.
                Random-sample, cross-sectional surveys were done of people aged 18 through 64 years at baseline, during, and after education. Baseline cohorts were reexamined. Pawtucket citizens of all ages participated in multilevel education, screening, and counseling programs.
                The downward trend in smoking was slightly greater in the comparison city. Small, insignificant differences favored Pawtucket in blood cholesterol and blood pressure. In the cross-sectional surveys, body mass index increased significantly in the comparison community; a similar change was not seen in cohort surveys. Projected cardiovascular disease rates were significantly (16%) less in Pawtucket during the education program. This difference lessened to 8% posteducation.
                The hypothesis that projected cardiovascular disease risk can be altered by community-based education gains limited support from these data. Achieving cardiovascular risk reduction at the community level was feasible, but maintaining statistically significant differences between cities was not. Accelerating risk factor changes will likely require a sustained community effort with reinforcement from state, regional, and national policies and programs. To present an evaluation of a 5-year, community-based, chronic disease prevention project managed by a state health department to determine whether the department could replicate similar previous projects that had received more funding and other resources.
                The evaluation used a matched comparison design and a review of archive and interview data.
                Florence, South Carolina (population: 56,240).
                A random sample of 1642 persons in Florence (and 1551 in the comparison) who responded to a risk factor questionnaire and underwent a physical assessment; 70.7% of baseline subjects participated in the postintervention. Forty key persons were interviewed concerning project effectiveness. INTERVENTIONS BY PROJECT: Walk-a-thons, a speakers' bureau, media messages, restaurant food labeling, and cooking seminars. More than 31,000 participants were involved in 585 activities.
                Questionnaires focused on hypertension, obesity, high cholesterol, smoking, and exercise. Physical assessments determined lipid, lipoprotein, apolipoprotein, and blood pressure levels. Analysis of covariance was used for baseline and postintervention comparisons. Content analysis was used on archive and interview data.
                The project had a slightly favorable intervention effect on cholesterol and smoking, but failed to have an effect on other risk factors for cardiovascular disease. The project influenced community awareness, enlisted influential community members, and fostered linkages among local health services.
                Health departments can be instrumental in community risk reduction programming; however, they may not replicate projects having greater resources. In six regions of former West Germany, a community-oriented prevention program for coronary heart disease (CHD) was conducted over a 7-year period.
                In the intervention regions, CHD prevention activities were performed with special emphasis on healthy nutrition, increased physical activity, and reduction of smoking, hypertension, and hypercholesterolemia. The impact of these activities on CHD risk factor trends was observed in three independent samples of the intervention regions. Three independent representative samples of the total West German population were used as a reference. Linear regression models with interaction terms to represent the intervention effects were used to test for differences in risk factor trends.
                In the pooled intervention regions, a net reduction in mean values of systolic (-2.0%) and diastolic (-2.0%) blood pressure, total serum cholesterol (-1.8%), as well as the percentage of smokers (-6.7%) was observed compared with the nationwide trend. From the major CHD risk factors, only body mass index was not influenced in the intervention population.
                The community-oriented German Cardiovascular Prevention program can effectively be used to reduce CHD risk factors in a broad population. The study describes changes in cardiovascular risk factors during 10 years of a community intervention program conducted in a rural area in Central Italy. Two areas were involved, one for treatment and one for reference. In 1983-84, 739 men and 859 women in the treatment area and 942 men and 1045 women in the control area, aged 20-69 years, were screened; total and HDL cholesterol, systolic and diastolic blood pressure, fasting blood glucose, smoking habit, weight and height were measured. Between 1983 and 1993 several intervention activities based on community medicine were carried out in the treatment area. They were based on interaction with the local socio-sanitary institutions and school system in order to influence individual persons, small groups and entire community. Major effort was addressed to mass health education, nutrition education, antismoking-propaganda and detection and treatment of hypertension, diabetes and hyperlipidemia. This article describes one outcome of a randomized controlled trial of community action for cancer prevention. The aims of this article were to (a) explore the effectiveness of a community action program in decreasing community smoking rates in rural Australian towns and (b) describe the relationship between adult smoking quit and uptake rates and demographic variables.
                In 1992, 20 towns were selected for randomization. Community action involved formation of community committees and utilization of access point networks to initiate and maintain intervention strategies. At post-test, outcomes were proportion of "quitters" from a cohort of self-described smokers, proportion of "uptakers" from a cohort of self-described nonsmokers, and "net effect."
                Differences in quit rate, uptake rate, and net effect for intervention compared to control condition favored the intervention in all cases, although mainly nonsignificant. Significantly more male smokers quit in intervention towns than in control towns [7.0% (95% CI: 0.6, 13.5)].
                Given that CART utilized and improved upon strategies argued as effective in the literature, the limited success of the project in reducing adult smoking, considered in combination with COMMIT findings, suggests the need for further innovation in the field.
                Copyright American Health Foundation and Academic Press. This study evaluated the impact of a 4-year, community-based cardiovascular disease prevention program among adults aged 18 to 65 years living in St-Henri, a low-income, innercity neighborhood in Montreal, Quebec.
                Awareness of and participation in the program were monitored in 3 independent sample telephone surveys. Self-reported behaviors were compared in St-Henri and a nearby comparison community before and after program implementation in both a 3-year repeat independent sample survey and a 5-year longitudinal cohort telephone survey.
                Awareness of the program reached 37.4%, but participation was low (2%-3%). There were no secular declines in smoking or high-fat diet; physical inactivity increased in both communities. There were no statistically significant program effects detected in the independent sample surveys, although physical inactivity increased more in the comparison community than in St-Henri. In the longitudinal cohort sample, there was a small, statistically significant increase favoring St-Henri in frequency of cholesterol checkups.
                Despite careful adaptation of the program to the local social context, there were few community-wide program effects. However, several component interventions showed promise in terms of community penetration and impact. The purpose of this study was to determine whether a community-based risk reduction project affected behavioral risk factors for cardiovascular disease.
                Community-based activities (e.g., exercise groups, healthy cooking demonstrations, blood pressure and cholesterol screenings, and cardiovascular disease education) were conducted in six southeastern Missouri counties. Evaluation involved population-based, cross-sectional samples of adult residents of the state and the intervention region. Weighted prevalence estimates were calculated for self-reported physical inactivity, cigarette smoking, consumption of fruits and vegetables, overweight, and cholesterol screening.
                Physical inactivity decreased within the intervention region, that is, in communities where heart health coalitions were developed and among respondents who were aware of these coalitions. In addition, the prevalence rates for reports of cholesterol screening within the past 2 years were higher for respondents in areas with coalitions and among persons who were aware of the coalitions.
                Even with modest resources, community-based interventions show promise in reducing self-reported risk for cardiovascular disease within a relatively brief period. To assess the net 5 year effects of intervention of a community based demonstration project, the Heartbeat Wales programme, on modifiable behavioural risks for prevention of cardiovascular disease.
                Quasi-experimental design comparing results from two independent cross sectional population surveys conducted in 1985 and 1990 in Wales and a matched reference area in north east England.
                Random, stratified samples of people aged 18-64 years (18,538 in 1985 and 13,045 in 1990) in Wales and in north east England (1483 and 4534, respectively).
                A coordinated range of activities for heart health promotion in Wales entailing public education campaigns along with supportive policy and infrastructure change. In the reference area no additional community heart health promotion was planned, though considerable activity did take place, "contaminating" the reference area.
                Fifteen self reported behavioural indicators relating to dietary choice, smoking, frequency of exercise, and weight.
                Positive changes (for health) in behavioural outcomes were observed among the population in Wales, including a reduction in reported smoking prevalence and improvements in dietary choice. There was no net intervention effect for the programme over and above observed change in the reference area.
                No definite conclusions can be drawn concerning the efficacy of the programme in terms of behavioural outcomes. With hindsight, the difficulties of evaluating such a complex multifaceted intervention were underestimated. Further debate on the most appropriate methods for assessing the effectiveness of community based health promotion programmes is called for.
The failure of the largest and best conducted studies to detect an effect on prevalence of smoking is disappointing. A community approach will remain an important part of health promotion activities, but designers of future programmes will need to take account of this limited effect in determining the scale of projects and the resources devoted to them.