Community-based Cardiovascular Disease Prevention Program Research Articles

Participation in the Cardiovascular Health Awareness Program (CHAP) by older adults residing in social housing in Quebec: Social network analysis

BackgroundThe Cardiovascular Health Awareness Program (CHAP) is as a community-based cardiovascular disease prevention program recently adapted to target older adults living in 14 social housing buildings in Ontario (7) and Quebec (7). Social network analysis (SNA) has been used successfully to assess and strengthen participation in health promotion programs. We applied SNA methods to investigate whether interpersonal relationships among residents within buildings influenced their participation in CHAP.MethodsOur aim was to examine relational dynamics in two social housing buildings in Quebec with low and high CHAP attendance rates, respectively. We used sociometric questionnaires and network analysis for the quantitative phase of the study, supplemented by a phase of qualitative interviews. All residents of both buildings were eligible for the sociometric questionnaire. Respondents for the qualitative interviews were purposively selected to represent the different attendance situations following the principle of content saturation.ResultsIn total, 69 residents participated in the study, 37 through sociometric questionnaires and 32 in qualitative interviews. Of the latter, 10 attended almost all CHAP sessions, 10 attended once, and 12 attended none. Results of the quantitative analysis phase identified well-known and appreciated local leaders. In Building 1, which had a high attendance rate (34.3%), there was a main leader (in-degree or ‘named by others’ frequency 23.2%) who had attended all CHAP sessions. In Building 2, which had a low attendance rate (23.9%), none of the leaders had attended CHAP sessions. Results of the qualitative analysis phase showed that residents who did not attend CHAP sessions (or other activities in the building) generally preferred to avoid conflicts, vindictiveness, and gossip and did not want to get involved in clans and politics within their building.ConclusionWe identified four potential strategies to increase attendance at CHAP sessions by residents of subsidized housing for older adults: strengthen confidentiality for those attending the sessions; use community peer networks to enhance recruitment; pair attendees to increase the likelihood of participation; and intervene through opinion leaders or bridging individuals.

Evaluation of a Community-Based Cardiovascular Prevention Program in Patients With Type 2 Diabetes.

An outcomes' evaluation of a community-based cardiovascular disease (CVD) prevention program in persons with newly diagnosed type 2 diabetes. A prospective, observational study. A community-setting in Ireland. Persons with newly diagnosed type 2 diabetes, aged 40 years or older, and 2 or more cardiovascular risk factors. A 16-week community-based, cardiovascular prevention program, with health promotion seminars, group exercise, and individual consultations, delivered by a multidisciplinary team. Medical, lifestyle, and well-being measures. Changes in categorical and continuous variables were analyzed using the paired exact test and the t test/Wilcoxin matched-pairs test, respectively. In total, 218 persons (134 men) participated, mean age was 59.8 (10.2) years. Completion rate was 75.2% (n = 164). The proportion achieving target glycosylated hemoglobin (HbA1c) increased from 53% at baseline to 75% (P < .001) at end of program. Systolic and diastolic blood pressures reduced by 8.8 mm Hg (95% CI: -11.2 to -6.4, P < .001) and 5.2 mm Hg (95% CI: -6.9 to -3.5, P < .001), respectively. Mean low-density lipoprotein cholesterol reduced from 2.45 to 2.05 mmol/L (P < .001). Significantly higher proportions met recommended targets in diet (6.9% vs 43.4%, P < .001) and physical activity (9.2% vs 56.6%, P < .001). Psychosocial measures significantly improved at end of program. The majority of improvements were sustained at 1 year. Participation in this CVD prevention program was associated with significant improvements in glycemia and CVD risk factors in newly diagnosed patients with type 2 diabetes.

Implementation of Modified Cardiovascular Health Awareness Program for Canadian Adults on a Waiting List for a Family Physician.

IntroductionThe Cardiovascular Health Awareness Program (CHAP) was originally developed and evaluated as a community-based cardiovascular diseases (CVD) prevention program in communities where access to family physicians was not a significant issue. Many Canadians now face sub-optimal access to a regular source of primary care. Centralized waiting lists and prioritization based on urgency of medical need were created to address this problem. We aimed to assess the acceptability, CVD risk profile, and potential benefits of offering a modified version of CHAP to adults on the waiting list.MethodsThe implementation was conducted in Laval (Canada) between March and June 2016, targeting individuals 40 years of age or older who were registered on the waiting list (GACO) and had a priority code of 3. Participants were invited through a personalized letter to attend sessions in community health centers. During the sessions, participants completed CVD risk profiles, risk of type 2 diabetes questionnaire (CANRISK); had their blood pressure, height and weight as well as waist circumference measured. They also received targeted healthy lifestyle and patient education materials and were referred to local programs including a medical follow-up, when required.ResultsA total of 1976 invitation letters were sent resulting in 281 (14.2%) participants. The average age of attendees was 58.1 (SD = 8.2) and a majority were female (58%, n = 163). A third of participants (34.2%, n = 96) had BP ≥140/90 and 11.4% (n = 32) were classified as having a very high risk for developing diabetes. Almost half (41.6%, n = 117) of participants were referred either to health promotion programs offered by local health authorities, to family physicians (4.6%, n = 13) or emergency departments (1.8%, n = 5) for short-term medical assistance.ConclusionDespite low participation rate, many adults on a waiting list had elevated risk for CVD and would greatly benefit from having a regular source of primary care.

Process Evaluation of Strong Hearts, Healthy Communities: A Rural Community-Based Cardiovascular Disease Prevention Program

ObjectiveTo evaluate the implementation of a community-based cardiovascular disease prevention program for rural women: Strong Hearts, Healthy Communities (SHHC). DesignMixed-methods process evaluation. Setting/ParticipantsA total of 101 women from 8 rural towns were enrolled in the SHHC program; 93 were enrolled as controls. Eligible participants were aged ≥40 years, sedentary, and overweight or obese. Local health educators (n = 15) served as program leaders within each town. Outcome MeasuresReach, fidelity, dose delivered, dose received, and program satisfaction were assessed using after-class surveys, participant satisfaction surveys, interviews with program leaders, and participant focus groups. AnalysisDescriptive statistics, chi-square tests of independence, and thematic analysis were employed. ResultsIntervention sites reported high levels of fidelity (82%) and dose delivered (84%). Overall reach was 2.6% and program classes were rated as effective (3.9/5). Participants were satisfied with their experience and reported benefits such as camaraderie and awareness of healthy eating and exercise strategies. Common recommendations included increasing class time and enhancing group discussion. Conclusions and ImplicationsImplementation was good in terms of fidelity, dose delivered, and satisfaction, although low reach. Findings from this research have informed a second round of implementation and evaluation of the SHHC program in rural communities.

P81 - Process Evaluation of a Rural Community-Based Cardiovascular Disease Prevention Program: Strong Hearts, Healthy Communities

Background (Background, Rationale, Prior Research, and/or Theory): Rural women have a higher prevalence of cardiovascular disease (CVD) and behavioral risk factors than their urban counterparts. Although existing CVD prevention programs have shown promise in changing women's lifestyle behaviors, few programs have specifically targeted rural populations nor have they included social and environmental foci. Objective: To evaluate the implementation of a multilevel community-based CVD prevention program for rural women grounded in the socioecological framework. Study Design, Setting, Participants, Intervention: Process evaluation of a 6-month community-randomized intervention trial: Strong Hearts, Healthy Communities (SHHC). A total of 101 women from eight rural towns were enrolled in the SHHC intervention program. Eligible participants were 40 years or older, sedentary, and overweight or obese. The 48-class program included strength training, aerobic exercise, nutrition education, and civic engagement activities. Outcome Measures and Analysis: Program leaders completed after-class surveys to assess fidelity, dose delivered, and attendance. Program satisfaction and participation benefits were assessed through post-intervention surveys, leader interviews, and participant focus groups. Quantitative survey data were summarized using SAS v.9.4 and Microsoft Excel. Qualitative data were examined thematically using NVivo 11. Results: Most sites reported high levels of adherence to the SHHC curriculum (average fidelity: 82%, average dose delivered: 84%). On average, participants attended 67% of the 48 classes, but this varied by site from 53% to 81%. The majority of participants were satisfied with their experience and reported several benefits. Positive aspects of the program included group camaraderie, social support, and awareness building. Insufficient lesson time was the most common struggle reported. Recommendations included extending class length, expanding exercise variety, and enhancing discussion. Conclusions and Implications: SHHC was well-received and deemed an acceptable approach by rural women enrolled in this CVD prevention program. Findings from this evaluation will inform program development and implementation for at-risk, underserved rural women and guide modification strategies for future dissemination. Funding: National Heart, Lung and Blood Institute (R01 HL120702).

Effects of a South Korean Community-Based Cardiovascular Disease Prevention Program for Low-Income Elderly with Hypertension

ABSTRACTThis study identified the effects of a community-based cardiovascular disease prevention program (CVD-PP) on health behavior and modifiable cardiovascular risk factors in low-income Korean elderly with hypertension. Eighty-eight individuals completed the 3-month self-efficacy-enhancing interventions in which the control group received standard care. In the intervention group, there were statistically significant improvements in self-efficacy (t = 2.519, p = 0.016) and health behavior (t = 3.453, p = 0.001), and significant differences in diastolic blood pressure (t = –2.518, p = 0.018) between the two groups. This CVD-PP administered by visiting nurses may be effective in improving self-efficacy and health behavior and in reducing modifiable cardiovascular risk factors.

40-Year CHD Mortality Trends and the Role ofRisk Factors in Mortality Decline: The North Karelia Project Experience.

In the 1960s and early 1970s, coronary heart disease (CHD) mortality in Finland was the highest in the world, and within Finland, mortality was particularly high in the eastern part of the country. The North Karelia Project, the first large community-based cardiovascular diseases prevention program was established in 1972 to reduce the extremely high CHD mortality through behavioral change and reduction of the main cardiovascular disease risk factors among the whole population of North Karelia, the easternmost province of Finland. During the 40-year period from 1972 to 2012, smoking prevalence, serum total cholesterol, and systolic blood pressure declined markedly, except a small increase in serum cholesterol levels between 2007 and 2012. From the early 1970s to 2012, CHD mortality decreased by 82% (from 643 to 118 per 100,000) among working-age (35 to 64 years) men. Among working-age women, the decline was 84% (from 114 to 17 per 100,000). During the first 10 years, changes in these 3 target risk factors explained nearly all of the observed mortality reduction. Since the mid-1980s, the observed reduction in mortality has been larger than the predicted reduction. In the early 1970s, premature CHD mortality (35 to 74 years) was about 37% higher among Eastern Finnish men and 23% higher among Eastern Finnish women, compared with men and women in Southwestern Finland. During the last 40 years, premature CHD mortality declined markedly in both areas, but the decline was larger in Eastern Finland and the mortality gap between the two areas nearly disappeared.

Strong Hearts, healthy communities: a rural community-based cardiovascular disease prevention program.

BackgroundCardiovascular disease is the leading cause of death in the United States and places substantial burden on the health care system. Rural populations, especially women, have considerably higher rates of cardiovascular disease, influenced by poverty, environmental factors, access to health care, and social and cultural attitudes and norms.Methods/DesignThis community-based study will be a two-arm randomized controlled efficacy trial comparing a multi-level, community program (Strong Hearts, Healthy Communities) with a minimal intervention control program (Strong Hearts, Healthy Women). Strong Hearts, Healthy Communities was developed by integrating content from three evidence-based programs and was informed by extensive formative research (e.g. community assessments, focus groups, and key informant interviews). Classes will meet twice weekly for one hour for 24 weeks and focus on individual-level skill building and behavior change; social and civic engagement are also core programmatic elements. Strong Hearts, Healthy Women will meet monthly for hour-long sessions over the 24 weeks covering similar content in a general, condensed format. Overweight, sedentary women 40 years of age and older from rural, medically underserved communities (12 in Montana and 4 in New York) will be recruited; sites, pair-matched based on rurality, will be randomized to full or minimal intervention. Data will be collected at baseline, midpoint, intervention completion, and six-month, one-year, and eighteen months post-intervention. The primary outcome is change in body weight; secondary outcomes include physiologic, anthropometric, behavioral, and psychosocial variables. In the full intervention, engagement of participants’ friends and family members in partnered activities and community events is an intervention target, hypothesizing that there will be a reciprocal influence of physical activity and diet behavior between participants and their social network. Family members and/or friends will be invited to complete baseline and follow-up questionnaires about their health behaviors and environment, height and weight, and attitudes and beliefs.DiscussionStrong Hearts, Healthy Communities aims to reduce cardiovascular disease morbidity and mortality, improve quality of life, and reduce cardiovascular disease-related health care burden in underserved rural communities. If successful, the long-term goal is for the program to be nationally disseminated, providing a feasible model to reduce cardiovascular disease in rural settings.Trial registrationClinicalTrials.gov Identifier: NCT02499731 Registered on July 1, 2015.

Effect of 5-Year Community Intervention Hartslag Limburg on Cardiovascular Risk Factors

A widely advocated strategy in public health is community-based health promotion. The aim of this study was to investigate the net effect of a cardiovascular disease prevention program (Hartslag Limburg) on cardiovascular risk factors after 5 years of intervention. Cohort study comparing 5-year mean change in risk factors between the intervention and reference area. The statistical analyses for the study were performed in 2005. In 1998, 3000 subjects (aged 25 to 70) from the intervention area and 895 subjects from a reference area participated in the baseline measurement. Of these, 2414 intervention subjects and 758 reference subjects completed the follow-up measurement in 2003. Hartslag Limburg is an integrative community-based cardiovascular disease prevention program promoting a healthy lifestyle. Body mass index (BMI), waist circumference, blood pressure, serum glucose (nonfasting), and serum total and high-density lipoprotein (HDL) cholesterol. During the 5-year follow-up, risk factors changed unfavorably in the reference group, whereas changes were less pronounced or absent in the intervention group. The adjusted difference in mean change in risk factors between intervention and reference group was significant (p<0.05) for BMI: -0.36 kg/m(2) in men and -0.25 kg/m(2) in women; waist circumference -2.9 cm in men and -2.1 cm in women; systolic blood pressure: -7.8 mmHg in men and -5.5 mmHg in women; total cholesterol 0.11 mmol/L in women and finally serum glucose -0.23 mmol/L in women. Hartslag Limburg succeeded in reducing-and in some cases, preventing-age- and time-related increase in BMI, waist circumference, blood pressure, and, in women, nonfasting glucose concentration.

The impact of a community-based heart disease prevention program in a low-income, inner-city neighborhood.

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.

Shifting the distribution of risk: results of a community intervention in a Swedish programme for the prevention of cardiovascular disease.

STUDY OBJECTIVE: 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...

Twenty year smoking trends in a community-based cardiovascular diseases prevention programme. Results from the North Karelia Project

Objectives: to evaluate long-term changes associated with a community-based cardiovascular disease prevention programme on smoking. Methods: the North Karelia Project was started in 1972 to carry out a comprehensive community-based programme to reduce the exceptionally high rates of cardiovascular diseases (CVD) in North Karelia, an eastern province in Finland. Among the main intermediate objectives was the reduction of smoking rates, particularly among the male population. The programme was evaluated by standardized examinations of large representative cross-sectional population samples in 1972, 1977, 1982, 1987 and 1992 in North Karelia and in the Kuopio province, another province in eastern Finland, which was initially chosen as reference area for the first project period. Results: in men the percentage of current smokers decreased during the 20 years from 52 to 32% in North Karelia and from 50 to 37% in the initial reference area (p<0.05). Smoking declined faster in the first 10 years (from 1972 to 1982) than in the last 10 years. During the first 10 years the decline was more remarkable in North Karelia than in the reference area. The main reason for the decline in smoking during the first 10 years was smoking cessation and during the last 10 years the increase in the number of people who had never smoked regularly. Among women the proportion of smokers increased in both areas from approximately 10 to approximately 20%. This increase was greatest in the youngest age group. Conclusions: the community-based cardiovascular disease prevention programme was an effective way to reduce smoking in the general population in men and sustained decline could be achieved.

Determinants of willingness to pay taxes for a community-based prevention programme.

Prevention can reduce the risk of disease, but has other consequences as well. Willingness-to-pay (WTP) is one method to analyse these multi-dimensional consequences, if the stated WTP is assumed to be a function of all the expected positive and negative effects perceived. An interview study of a community-based cardiovascular disease prevention programme in northern Sweden shows that expectations regarding reduced mortality in the community and future savings in public health care spending increase the perceived value of the programme. Among personal benefits, decreased disease risk was not positively associated with WTP, while a low level of anxiety was.

The Washington Heights-Inwood Healthy Heart Program: a 6-year report from a disadvantaged urban setting.

This report summarizes 6 years of experience in a large community-based cardiovascular disease prevention program in a predominately minority, urban setting. The program seeks to reduce cardiovascular disease risk factors in an area of approximately 240,000 people in New York, NY; this population includes many Latino immigrants of low educational attainment and socioeconomic status. All program materials were in Spanish and English and at a low literacy level. Major elements that achieved high levels of reach and support were a marketing campaign promoting low-fat milk, exercise clubs, and a Spanish-language smoking cessation video. Program elements that did not meet expectations or were abandoned were school-based smoking prevention initiatives, cholesterol screening, and efforts to involve local physicians. At the end of 6 years, the program was transferred to a local community organization. Conclusions are that it is feasible to implement a complex cardiovascular disease prevention program in a socially disadvantaged urban community; that additional evaluation research is needed; that such programs can be transferred from an academic center to a community organization; and that such programs are unlikely to be sustained effectively without external resources.

The Washington Heights-Inwood Healthy Heart Program: A third generation community-based cardiovascular disease prevention program in a disadvantaged urban setting

The Washington Heights-Inwood Healthy Heart Program (WHIHHP) is part of the New York State Healthy Heart Program, which comprises eight community-based programs in different areas of the state. WHIHHP is directed at a population of approximately 200,000 people, predominantly Hispanic and of low socioeconomic status, living in northern Manhattan in New York City. The initial 3 years of experience are presented. Six potential barriers to diffusion of the community-based disease prevention model in disadvantaged inner city communities are discussed: (a) issues of scale and complexity; (b) adaptation of this model to a “community” without geopolitical boundaries or infrastructure; (c) linguistic and cultural diversity; (d) competing problems; (e) the role of evaluation; and (f) sustainability of the program in a poor community. Strategies for addressing obstacles to model adoption are also described, including program legitimization, building program infrastructure, setting realistic expectations, focusing on one risk factor at a time, defining target population segments, and emphasizing a small number of communication channels. Finally, research issues related to the diffusion of the community-based model are discussed, specifically: (a) Does the model work in disadvantaged urban settings? (b) What are the program effects on social class gradients for risk factors? (c) What are the barriers to program adoption in such settings? (d) What changes in the model will facilitate adoption in such settings? (e) What are the best methods for conducting formative evaluation in such programs? (f) What is the best way to select communities that may be ready to adopt the model? Our initial experience implementing this model in a disadvantaged urban setting supports the feasibility of model adoption. Unanswered questions about efficacy in such settings and regarding research issues related to model diffusion will require additional research investment.

Health Promotion And Disease Prevention Among Minorities

Commentary Health AffairsVol. 9, No. 2 Health Promotion And Disease Prevention Among MinoritiesHerbert W. Nickens AffiliationsVice-president for minority health at the Association of American Medical Colleges in Washington, D.C. Previously he served as director of the federal Office of Minority Health in the U.S. Public Health Service.PUBLISHED:Summer 1990No Accesshttps://doi.org/10.1377/hlthaff.9.2.133AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSHIV/AIDSPopulationsDiseasesMinority healthSocioeconomic statusMortalityHealth professionalsMortality ratesPrivate health insuranceCancer Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 19 History Published online 1 January 1990 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF downloadCited ByAchieving Dietary Sodium Recommendations and Atherosclerotic Cardiovascular Disease Prevention through Culinary Medicine Education26 November 2020 | Nutrients, Vol. 12, No. 12“Gamblefree Day,” A Community Project to Minimise Harm Caused by Gambling Disorder in New Zealand Chinese and Korean Communities: Formative Evaluation and Lessons Learnt24 October 2014 | Journal of Psychosocial Rehabilitation and Mental Health, Vol. 1, No. 2Evolutionary biology and anthropology suggest biome reconstitution as a necessary approach toward dealing with immune disorders19 April 2013 | Evolution, Medicine, and Public Health, Vol. 2013, No. 1A Meta-Analysis of Obesity Interventions Among U.S. Minority ChildrenJournal of Adolescent Health, Vol. 46, No. 4Cultural Proficiency, Research, and Evidence-based Practice: Implications for the Nurse PractitionerJournal of Pediatric Health Care, Vol. 23, No. 1P.O.W. (Protect Our Women): Results of a Breast Cancer Prevention Project Targeted to Older African-American WomenSocial Work in Health Care, Vol. 47, No. 1Journal of Clinical Oncology, Vol. 23, No. 34Ethnic Minority Older Adults Participating in Clinical Research25 November 2016 | Journal of Aging and Health, Vol. 16, No. 5_supplIncreasing the pool of academically oriented African-American medical and surgical oncologists18 December 2002 | Cancer, Vol. 97, No. S1The Relationships Among Racial Identity, Self-Esteem, Sociodemographics, and Health-Promoting Lifestyles1 July 2002 | Research and Theory for Nursing Practice, Vol. 16, No. 3Can Cultural Competency Reduce Racial and Ethnic Health Disparities? A Review and Conceptual Model15 December 2016 | Medical Care Research and Review, Vol. 57, No. 1_supplPreventing cigarette use in a bi-ethnic population: Results of the memphis smoking prevention programCognitive and Behavioral Practice, Vol. 6, No. 2Race, Class, and Violence: Research and Policy Implications1 April 1998 | International Journal of Health Services, Vol. 28, No. 2Exploring a Model of Symbolic Social Communication1 July 2016 | Journal of Health Psychology, Vol. 1, No. 3Reflections on the Minority Elderly in Healthcare15 June 2016 | Hospital Topics, Vol. 74, No. 3National cancer institute's ethnic and low literacy nutrition education projectJournal of Nutrition Education, Vol. 26, No. 2Human Immunodeficiency Virus (HIV) and the Health of African Americans23 December 2011 | Journal of Multicultural Counseling and Development, Vol. 21, No. 3Health, Recreation, and the Unemployed: An Interactive Model28 November 2016 | International Quarterly of Community Health Education, Vol. 13, No. 1The Washington Heights-Inwood Healthy Heart Program: A third generation community-based cardiovascular disease prevention program in a disadvantaged urban settingPreventive Medicine, Vol. 21, No. 2

Message dissemination for a community-based cardiovascular disease prevention programme (the North Karelia Project).

The North Karelia Project was a community-based pilot programme in an Eastern Finnish community of 180,000 adults. During the intervention period from 1972 to 1977, the project successfully demonstrated that changing risk factors at the community level was feasible and could result in a significant reduction in disease rates. The North Karelia Project used mass media for dissemination of the message, but relied on face-to-face contact to persuade people to adopt the new lifestyles. Training seminars for professionals were a key programme component. On average, one seminar was conducted every two and a half weeks. Total project costs were only one per cent of the total health services costs for the county during the project. These findings suggest that community programmes can improve both subjective and objective cardiovascular health, and that the strategy of integrating funding into the project recruitment and commitment process is appropriate and may even be necessary for a successful community based heart disease prevention programme.

A decline in earning losses associated with a community-based cardiovascular disease prevention project.

Permanent and temporary disability pension award data and survey data were used to estimate the lower bound of earning losses related to cardiovascular disease during a community-based cardiovascular disease prevention program in Eastern Finland. Earning losses due to death totaled $39.94 million but were not affected by the project. Earning losses due to permanent disability totalled +29.01 million and were $4.25 million less than expected (p less than 0.025). Earning losses due to temporary disability were $10.91 million and were not affected by the project. Total earning losses attributable to cardiovascular disease during the project period were $79.86 million, and total decline in earning losses was +4.25 million. Project implementation costs were less than one per cent of total earning losses and were equal to approximately 17 per cent of the decline in these losses attributable to the project. The findings suggest that community-based heart disease prevention programs have the potential of more than paying for themselves through an associated decline in lost earnings.

Changes in smoking, serum cholesterol and blood pressure levels during a community-based cardiovascular disease prevention program--the North Karelia Project.

A comprehensive community-based program to control cardiovascular disease was carried out in North Karelia, Finland, in 1972--1977. Reductions in smoking, serum cholesterol and blood pressure (BP) levels were among the central intermediate objectives. The effect was evaluated by examining independent population samples at the outset and at the end, both in the program area and in a matched reference area. More than 10,000 subjects were studied each time (participation rate about 90%). This paper presents the analyses of the estimated effect of the program on the risk factor means by comparing the baseline and terminal situations among the population aged 30--59 years. The effect of the program among men was estimated to be a reduction of 13% in smoking, 4% in serum cholesterol and 3% in systolic and diastolic BP means. Among women, there was a net reduction of 5% in systolic BP and 4% in diastolic BP means. The net reductions in smoking (8%) and serum cholesterol (1%) among women were within sampling variation. It is concluded that the population means of the major coronary heart disease risk factors were reduced during the program more in the intervention area than in the reference area, and it seems likely that most of this difference was due to the program.

Change in health behaviour in relation to estimated coronary heart disease risk during a community-based cardiovascular disease prevention programme.

The relationship between change in one coronary heart disease risk factor and levels of other risk factors was investigated in independent pre-and post-intervention samples and in a cohort surveyed both before and after a community-based cardiovascular disease prevention programme. A risk score that did not include the factor being analysed for change was developed and used to estimate risk. In the independent samples generally neither change in smoking nor change in saturated fat intake was related to coronary heart disease risk estimated from other factors in either men or women. Only the intake of saturated fats reduced slightly more among the hypertensive than other men (p less than 0.05). In the cohort, only change in smoking by women was related to initial risk estimated from other factors (p less than 0.05). Since change in behaviour had no consistent relation to the preprogramme risk level, it was concluded that health behaviour change in the population was based on common lifestyle changes in th intervention community, and that either face-to-face counselling or new techniques of mass communication are needed to induce high-risk individuals to do more to change their risk-inducing behaviours.