Minnesota Heart Health Program Research Articles

Association of Cardiovascular Disease Risk Factors With Sociodemographic Characteristics and Health Beliefs Among a Community-Based Sample of African American Adults in Minnesota

ObjectiveTo assess cardiovascular disease (CVD) and CVD risk factors and their association with sociodemographic characteristics and health beliefs among African American (AA) adults in Minnesota. MethodsA cross-sectional analysis was conducted of a community-based sample of AA adults enrolled in the Minnesota Heart Health Program Ask About Aspirin study from May 2019 to September 2019. Sociodemographic characteristics, health beliefs, and self-reported CVD and CVD risk factors were collected. Prevalence ratio (PR) estimates were calculated using Poisson regression modeling to assess the association between participants’ characteristics and age- and sex-adjusted CVD risk factors. ResultsThe sample included 644 individuals (64% [412] women) with a mean age of 61 years. Risk factors for CVD were common: hypertension (67% [434]), hyperlipidemia (47% [301]), diabetes (34% [219]), and current cigarette smoking (25% [163]); 19% (119) had CVD. Those with greater perceived CVD risk had a higher likelihood of prevalent hyperlipidemia (PR, 1.34; 95% CI, 1.14 to 1.57), diabetes (PR, 1.61; 95% CI, 1.30 to 1.98), and CVD (PR 1.61; 95% CI, 1.16 to 2.23) compared with those with lower perceived risk. Trust in health care provider was high (83% [535]) but was not associated with CVD or CVD risk factors. ConclusionIn this community sample of AAs in Minnesota, CVD risk factors were high, as was trust in health care providers. Those with greater CVD risk perceptions had higher CVD prevalence. Consideration of sociodemographic and psychosocial influences on CVD and CVD risk factors could inform development of effective cardiovascular health promotion interventions in the AA Minnesota community.

Use of a Geographic Information System to create treatment groups for group-randomized community trials: The Minnesota Heart Health Program

BackgroundGroup-randomized trials of communities often rely on the convenience of pre-existing administrative divisions, such as school district boundaries or census entities, to divide the study area into intervention and control sites. However, these boundaries may include substantial heterogeneity between regions, introducing unmeasured confounding variables. This challenge can be addressed by the creation of exchangeable intervention and control territories that are equally weighted by pertinent socio-demographic characteristics. The present study used territory design software as a novel approach to partitioning study areas for The Minnesota Heart Health Program’s “Ask about Aspirin” Initiative.MethodsTwenty-four territories were created to be similar in terms of age, sex, and educational attainment, as factors known to modify aspirin use. To promote ease of intervention administration, the shape and spread of the territories were controlled. Means of the variables used in balancing the territories were assessed as well as other factors that were not used in the balancing process.ResultsThe analysis demonstrated that demographic characteristics did not differ significantly between the intervention and control territories created by the territory design software.ConclusionsThe creation of exchangeable territories diminishes geographically based impact on outcomes following community interventions in group-randomized trials. The method used to identify comparable geographical units may be applied to a wide range of population-based health intervention trials.Trial registrationNational Institutes of Health (Clinical Trials.gov), Identifier: NCT02607917. Registered on 16 November 2015.

An Evidence-Based Review of Exercise and Metabolic Syndrome

An Evidence-Based Review of Exercise and Metabolic Syndrome

From Framingham to North Karelia to U.S. Community-Based Prevention Programs: Negotiating Research Agenda for Coronary Heart Disease in the Second Half of the 20th Century

In the United States in 1948, the newly formed National Heart Institute (NHI) responded to what its data showed as a rising tide of coronary heart disease (CHD) by underwriting new approaches to the elucidation of chronic disorders. In the process, it funded the application of epidemiology, previously almost exclusively concerned with communicable disease, to study CHD. With federal encouragement, CHD epidemiologists enriched research designs, helped develop the randomized controlled trial, and played a pioneering role in chronic disease prevention at the individual and population levels. While government funding was critical to the evolution of this rich scientific work, a vibrant epidemiological imagination was able to capitalize on decades of national political commitment to chronic disease research. Epidemiologists developed longitudinal studies meant to determine the relationship between well-measured clinical variables and subsequent CHD events. Here, consistent associations within and across populations, eventually reinforced by analyses of pooled data from multiple cohort investigations, demonstrated the existence of well-founded risk factors, but left open the question of causal inference based on observed relationships. After substantial ambivalence, the U.S. government, under pressure from epidemiologists, committed to an agenda of clinical trials to test that proposition. In addition, the results of the cohort studies elicited a demand by epidemiologists for a broader, population-wide approach, testing whether community-level models of risk factor modification through broad cultural change would demonstrate a reduction in the probability of disability and premature death from heart attack. To tell the story of the community studies and to analyze outcomes, we focus on the Minnesota Heart Health Program and the Finnish North Karelia Project. From the North Karelia experience, we find that health promotion campaigns in communities at very high risk of disease, where the population lives in traditional patterns and considerable poverty and is also unsophisticated in health knowledge and behaviors, are more likely to achieve major and measurable population effects. We argue that as chronic disease rates rise globally, and CHD rates increase in lower- and middle-income nations, as they have over the past several decades, population-level prevention interventions have become particularly relevant. But it remains to be seen whether the international community, prodded by its member states, can successfully reproduce the urgency and agenda-setting that sparked the successful epidemiologic and public health interventions in the affluent countries in the decades after World War II.

Quit and Win contests for smoking cessation

Quit and Win contests were developed in the 1980s by the Minnesota Heart Health Program, and have been widely used since then as a population-based smoking cessation intervention at local, national and international level. Since 1994 an international contest has been held every two years in as many as 80 countries (2002). To determine whether quit and win contests can deliver higher long-term quit rates than baseline community quit rates.To assess the impact of such programmes, we considered both the quit rates achieved by participants, and the population impact, which takes into account the proportion of the target population entering the contest. We searched the Cochrane Tobacco Addiction Group Specialized Register, with additional searches of MEDLINE, EMBASE, CINAHL, PsycINFO and Google Scholar. Search terms included competition*, quit and win, quit to win, contest*, prize*. Most recent search date was November 2007. We considered randomized controlled trials, allocating individuals or communities to experimental or control conditions. We also considered controlled studies with baseline and post-intervention measures. Data were extracted by one author and checked by the second. We contacted study authors for additional data where necessary. The main outcome measure was abstinence from smoking for at least six months from the start of the intervention. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. We decided against performing a meta-analysis, because of the heterogeneity of the included studies, and the small number of scientifically valid studies. Five studies met our inclusion criteria. Three demonstrated significantly higher quit rates (8% to 20%) for the quit and win group than for the control group at the 12-month assessment. However, the population impact measure, where available, suggests that the effect of contests on community prevalence of smoking is small, with fewer than one in 500 smokers quitting because of the contest. Levels of deception, where they could be quantified, were high. Although surveys suggest that international quit and win contests may be effective, especially in developing countries, the lack of controlled studies precludes any firm conclusions from this review. Quit and win contests at local and regional level appear to deliver quit rates above baseline community rates, although the population impact of the contests seems to be relatively low. Contests may be subject to levels of deception which could compromise the validity of the intervention. International contests may prove to be an effective mechanism, particularly in developing countries, but a lack of well-designed comparative studies precludes any firm conclusions.

Is reporting on interventions a weak link in understanding how and why they work? A preliminary exploration using community heart health exemplars.

BackgroundThe persistent gap between research and practice compromises the impact of multi-level and multi-strategy community health interventions. Part of the problem is a limited understanding of how and why interventions produce change in population health outcomes. Systematic investigation of these intervention processes across studies requires sufficient reporting about interventions. Guided by a set of best processes related to the design, implementation, and evaluation of community health interventions, this article presents preliminary findings of intervention reporting in the published literature using community heart health exemplars as case examples.MethodsThe process to assess intervention reporting involved three steps: selection of a sample of community health intervention studies and their publications; development of a data extraction tool; and data extraction from the publications. Publications from three well-resourced community heart health exemplars were included in the study: the North Karelia Project, the Minnesota Heart Health Program, and Heartbeat Wales.ResultsResults are organized according to six themes that reflect best intervention processes: integrating theory, creating synergy, achieving adequate implementation, creating enabling structures and conditions, modifying interventions during implementation, and facilitating sustainability. In the publications for the three heart health programs, reporting on the intervention processes was variable across studies and across processes.ConclusionStudy findings suggest that limited reporting on intervention processes is a weak link in research on multiple intervention programs in community health. While it would be premature to generalize these results to other programs, important next steps will be to develop a standard tool to guide systematic reporting of multiple intervention programs, and to explore reasons for limited reporting on intervention processes. It is our contention that a shift to more inclusive reporting of intervention processes would help lead to a better understanding of successful or unsuccessful features of multi-strategy and multi-level interventions, and thereby improve the potential for effective practice and outcomes.

Social Capital and Health: Civic Engagement, Community Size, and Recall of Health Messages

We explored the effects of community integration and pluralism on recall of cardiovascular disease health information messages. With 1980-1983 data from the Minnesota Heart Health Program, we examined whether ties to community groups were associated with recall of health messages, and whether this relation was modified by size and degree of differentiation of the community. A higher level of civic engagement through ties to community groups was associated with better recall of health messages. Ties to community groups independently contributed to better message recall even after control for gender, education, and other variables. The moderating role of community size was non-significant but intriguing. Community group membership could increase exposure to health messages, providing a critical pathway for social capital to influence health promotion and, thus, public health outcomes.

The Influence of Race on the Relationship Among Perceived Exercise Behavior and Various Exercise Associated Psychological Factors

2059 PURPOSE: The purpose of this study was to examine the influence of race on the relationship among social physique anxiety, self-presentation protection, physical self-efficacy, and perceived exercise behavior among college students. METHODS: A convenience sample of undergraduate students (n = 328, age 18–30 yrs) from three medium-sized midwestern universities completed the Self-Presentation in Exercise Questionnaire (SPEQ), Social Physique Anxiety Scale (SPAS), Physical Self-Efficacy Scale (PSES), and a Minnesota Heart Health Program Physical Activity Questionnaire. Participants included 130 Caucasians (39.6%), 130 African-Americans (39.6%), 35 Hispanic Americans (10.7%), and 33 Asian Americans (10.1%). Data were partitioned by racial group and correlations between each of the variables were calculated. RESULTS: Analysis revealed significant differences (p<0.05) in correlations of exercise behavior with SPAS between African Americans (r = −.24) and Caucasians (r = .17), with perceived physical ability between African Americans (r = .50) and Caucasians (r = .08), and with physical self-presentational confidence between African Americans (r = .29) and Caucasians (r = −.07). A 4 × 5 (race × psychological factor) MANOVA and follow-up univariate analyses indicated that Hispanic Americans were significantly different from African Americans and Caucasians for impression motivation and that African Americans were significantly different from Asian Americans and Caucasians for SPA and PSPC, respectively. CONCLUSIONS: These results suggest that race may play a pivotal role in determining the exercise frequency, duration, and intensity of different racial groups.

The Influence of Race on the Relationship Among Perceived Exercise Behavior and Various Exercise Associated Psychological Factors

2059 PURPOSE: The purpose of this study was to examine the influence of race on the relationship among social physique anxiety, self-presentation protection, physical self-efficacy, and perceived exercise behavior among college students. METHODS: A convenience sample of undergraduate students (n = 328, age 18–30 yrs) from three medium-sized midwestern universities completed the Self-Presentation in Exercise Questionnaire (SPEQ), Social Physique Anxiety Scale (SPAS), Physical Self-Efficacy Scale (PSES), and a Minnesota Heart Health Program Physical Activity Questionnaire. Participants included 130 Caucasians (39.6%), 130 African-Americans (39.6%), 35 Hispanic Americans (10.7%), and 33 Asian Americans (10.1%). Data were partitioned by racial group and correlations between each of the variables were calculated. RESULTS: Analysis revealed significant differences (p<0.05) in correlations of exercise behavior with SPAS between African Americans (r = −.24) and Caucasians (r = .17), with perceived physical ability between African Americans (r = .50) and Caucasians (r = .08), and with physical self-presentational confidence between African Americans (r = .29) and Caucasians (r = −.07). A 4 × 5 (race × psychological factor) MANOVA and follow-up univariate analyses indicated that Hispanic Americans were significantly different from African Americans and Caucasians for impression motivation and that African Americans were significantly different from Asian Americans and Caucasians for SPA and PSPC, respectively. CONCLUSIONS: These results suggest that race may play a pivotal role in determining the exercise frequency, duration, and intensity of different racial groups.

Impact of Direct Mail as a Method to Recruit Smoking Mothers into a "Quit and Win" Contest

In the early 1980s the concept of a Quit and Win (Q&W) contest was developed in the Minnesota Heart Health Program (MHHP) as a population-based smoking cessation strategy. The Q&W model has since spread and been applied in many countries around the world. Different communication strategies have been applied for recruiting participants for Q&W. In the Q&W contest in 1995 in Stockholm County, Sweden, direct mail was used as the main recruitment strategy among daily smoking mothers with children aged 0-6 years. Two additional strategies were employed to recruit participants, that is, ads in a local newspaper and personal communication. The target group was estimated to be approximately 4,300 women. In total 5.5% of the target group was recruited, and of those, 4.3% were recruited by direct mail. After 12 months, 14.3% of the women were sustained smoke-free, and the corresponding percentage for those women who were recruited by direct mail was 15.5%. In comparison with several other Q&W contests employing other strategies, the direct-mail technique seems not only to have been successful in recruiting participants, but also in aiding remained sustained smoke-free women after 12 months. To optimize recruitment for Q&W contests, a combination of recruiting strategies should be applied.

Community Action for Health Promotion: A Review of Methods and Outcomes 1990-1995

Our objective was to explore the effectiveness of community action as a strategy for health promotion, through a critical review of five years of community action evaluation literature. Community action was defined as a health promotion, program that involved the community in implementation and control of the process of the program. Criteria for scientific evaluation of programs were proposed for sampling and control procedures, reliability and validity of instruments, analysis techniques, and specification of details of the intervention. A critical review of the literature, located by an on-line and related reference search, was undertaken for community action aimed at reducing cancer and cardiovascular disease, between January 1990 and May 1995. None of seven community action studies (17 articles) that examined cancer risk factors fulfilled all the criteria for rigorous scientific evaluation. The most methodologically adequate cancer study, the COMMIT intervention, had only a moderate degree of success in reducing community smoking rates. Similarly, none of the six studies (25 articles) on cardiovascular disease fulfilled all the criteria. The results for the most methodologically adequate study, the Minnesota Heart Health Program, were disappointing, with strong secular trends preventing adequate assessment of the intervention effect. The finding that none of the reviewed studies met all evaluation criteria was due to several factors, including political considerations, feasibility, and the continued evolution of the science of evaluation in health promotion. Some important questions are posed for researchers by the failure of methodologically superior projects, such as COMMIT, to show major gains in reducing health risk behaviors.

Joint analysis of three U.S. community intervention trials for reduction of cardiovascular disease risk

During the 1980s three comprehensive community-based heart disease prevention trials were conducted in the United States. The Stanford Five-City Project, Minnesota Heart Health Program, and Pawtucket Heart Health Program involved 12 cities; six received a 5–8 year multifactorial risk reduction program. This analysis pools data from the three studies to delineate the common intervention effects with greater sample size and power than could be attained by the single studies. Time trends were estimated for cigarette smoking, blood pressure, total cholesterol, body mass index, and coronary heart disease mortality risk in women and men aged 25–64 years. The joint estimates of intervention effect were in the expected direction in nine of 12 genderspecific comparisons; however, these were not statistically significant. The results illustrate the analytic challenges of evaluating community-based prevention trials and point to the smaller than expected net differences, rather than small sample size, as the reason for few statistically significant effects in the three U.S. prevention trials.

Can we achieve sustainable reductions in harm in local communities?

Drug and Alcohol ReviewVolume 16, Issue 2 p. 109-111 Free Access Can we achieve sustainable reductions in harm in local communities? Robert Bush, Corresponding Author Robert BushCentre for Primary Health Care, Department of Social and Preventive Medicine, Graduate School of Medicine, Faculty of Health Sciences, The University of Queensland, Queensland 4102, AustraliaSearch for more papers by this author Robert Bush, Corresponding Author Robert BushCentre for Primary Health Care, Department of Social and Preventive Medicine, Graduate School of Medicine, Faculty of Health Sciences, The University of Queensland, Queensland 4102, AustraliaSearch for more papers by this author First published: 29 May 2009 https://doi.org/10.1080/09595239700186391Citations: 9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Nutbeam D., Harris E. Creating supportive environments for health: a case study from Australia in developing national goals and targets for healthy environments. Health Promot Ind 1995; 10: 51– 59. 2 Rissel C., Finnegan J., Bracht N. Evaluating quality and sustainability: issues and insights from the Minnesota Heart Health Program. Health Promot Intl 1995; 10: 199– 207. 3 Woelk G. Cultural and structural influences in the creation of participation in community health programs. Soc Sci Med 1992; 35: 419– 424. 4 World Development Report. Investing in health. New York: Oxford University Press, 1993. 5 Berkman L. The role of social relations in health promotion. Psychosom Med 1995; 57: 245– 254. 6 World Health Organization. Global strategy for health for all by the year 2000. Health For All Series, No. 3. Geneva: WHO, 1981. 7 World Health Organization. Primary health care concepts and challenges in a changing world: Alma-Ata Revisited. SHS paper, No. 7. Geneva: WHO, 1994. 8 Kickbusch I. Setting health outcomes. Keynote address to the Healthy People 2000 Consortium meeting: Building the Prevention Agenda for 2010. New York, November, 1996. 9 Baum, F. Community health services and managerialism. Aus J Prim Health—Interchange 2;4: 31– 41. 10 Hawe P., Noort M., King L., Jordens C. Multiplying health gains: the critical role of capacity-building within health promotion programs. Health Policy (in press). 11 Chavis D., Speer P., Resnick I., Zippay A. Building community capacity to address alcohol and drug abuse: getting to the heart of the problem. In B. Davis, A. Lurigo, D. Rosenbaum, eds. Drugs and the Community. Springfield: Charles C. Thomas, 1993. Citing Literature Volume16, Issue2June 1997Pages 109-111 ReferencesRelatedInformation

Phosphorus nuclear magnetic resonance spectroscopy: in vivo magnesium measurements in the skeletal muscle of normal subjects.

31P nuclear magnetic resonance spectroscopy was used to study the skeletal muscle of 33 normal males and 32 females. Free intracellular magnesium levels and the ratios of the phosphorus metabolites were determined. Males had significantly lower free magnesium levels (499.8 microM +/- 26.3 microM vs. 530.7 microM +/- 36.0 microM, P = 0.001, d.f. = 63, analysis of variance). The free magnesium level (rs = -0.5431, P = 0.001) and the phosphocreatin/Inorganic phosphate ratio in males (rs = -0.4102, P = 0.018), and the phosphocreatine/Inorganic phosphate ratio in females (rn = -0.4759, P = 0.009) fell with the increasing Minnesota Heart Health Program Questionnaire score.

The shape up challenge: a community-based worksite exercise competition.

To assess organizational and employee participation during three community-wide worksite exercise competitions in two communities. A one-group, posttest-only design was used. Lack of controls, exercise baseline, and the short-term nature of the interventions were limitations. The Minnesota Heart Health Program conducted annual exercise campaigns between 1982 and 1989 within three intervention communities to reduce behavioral risk for cardiovascular disease. The Shape Up Challenge was a worksite exercise competition designed, in conjunction with other campaign activities, to increase levels of physical activity. A total of 119 participating companies in two Minnesota communities, and 17,626 employees within these worksites, composed the subjects in this study. Eligible worksites were invited to participate in a month-long competition during which employees recorded minutes spent daily in aerobic activities. Incentives were established to promote intragroup cooperation and intergroup competition. Companies competed for awards that were based on average minutes of exercise per employee versus per participant. Numbers of companies recruited and participating, campaign activities, minutes of exercise, and costs were recorded on implementation logs. Companies completed surveys describing business type, number and sex of employees, existing health promotion programs, and perceived benefits of participation. Of the 365 companies invited to participate, 33% participated (range 15% to 50%). Participating companies were more likely than nonparticipating companies to offer other health promotion programs and perceived greater benefits from participation. Women and smaller companies had significantly greater participation rates than men and larger companies. Average employee participation rates ranged from as high as 84% in smaller organizations to as low as 16% as organization size increased. Community-based worksite exercise competitions appear to be a viable strategy for promoting employee exercise, particularly in smaller companies. Group-based contingencies applied in natural work units may facilitate employee participation. Further research is needed to assess the relative efficacy of this approach, compare alternative incentives, and identify strategies to enhance exercise maintenance after the intervention has ceased.

Design and analysis of community trials: lessons from the Minnesota Heart Health Program.

Community trials remain the only design appropriate for the evaluation of lifestyle interventions that cannot be allocated to individuals. The Minnesota Heart Health Program, conducted in Minnesota and the Dakotas between 1980 and 1993, is one of the largest community trials ever conducted in the United States. That study suggests several lessons that should guide future community trials. Planners should 1) carefully assess the secular trends for their outcomes and be confident that they can demonstrate an intervention effect against those trends; 2) be confident that they have effective programs than can be delivered to a sufficiently large fraction of their target population; 3) avoid differences between study conditions in levels and trends for their outcomes through random allocation of a sufficient number of communities to each condition; 4) develop good estimates of community-level standard errors prior to launching future trials; and 5) take steps to ensure that power will be sufficient to test the hypotheses of interest.

Community Programs for Obesity Prevention: The Minnesota Heart Health Program

Community intervention strategies for obesity that were developed and evaluated in the Minnesota Heart Health Program (MHHP) are described. The MHHP was a 13-year research and demonstration project involving 6 communities that was designed to evaluate whether a sustained multicomponent education campaign could reduce population-wide risk factors for cardiovascular disease. MHHP weight control activities included adult education classes for weight control, exercise, and cholesterol reduction, a worksite weight control program, a home correspondence course for weight loss and a weight gain prevention program. In separate component evaluation studies each of the programs was shown to facilitate favorable changes in weight among individuals choosing to participate in them. Compared to more intensive interventions, weight changes produced by these methods were modest in magnitude, but the number of individuals participating in some of them was quite large. The overall effects of the MHHP program on population levels of obesity were disappointing. Over 7 years of intervention there was a strong upward trend in weight in all communities, independent of age, demographics, smoking habits, or other potential confounding variables. This trend was not different in communities receiving education than in comparison communities. Possible reasons for these results are discussed.

Alcohol and tobacco use in the Minnesota heart health program

Correlations between alcohol intake and cigarette smoking have been extensively documented. Prospective data on the relationship between smoking and alcohol remain quite limited. The Minnesota Heart Health Program (MHHP) collected such data as part of a 10-year research and demonstration project intended to reduce the prevalence of heart disease. The study involved six communities, three that received intervention and three, comparison. The current analyses focused upon baseline relationships and longitudinal changes in alcohol and tobacco use. Contrary to prediction, those who quit smoking were no more likely than continuing smokers to reduce alcohol intake. Furthermore, alcohol intake at baseline did not predict smoking status at follow-up. Gender differences were found in a number of comparisons. Further study is needed of changes in smoking and drinking patterns over time in the general population.

Gender Differences in the Class of 1989 Study: The School Component of the Minnesota Heart Health Program

Abstract The Class of 1989 Study is part of the Minnesota Heart Health Program (MHHP). Beginning in sixth grade (1983), seven annual waves of measurements were taken from students in one of the MHHP intervention communities and its matched pair (baseline n = 2,376). Self-reported data were collected at each time period describing a variety of health-related behaviors, including smoking, physical activity, and food preferences. With regard to the intervention hypotheses, significant positive differences between genders were observed on the physical activity and food preference variables. Significant gender by treatment interactions were observed on five of six follow-up periods for food preferences. The effects of the intervention on smoking by gender were less apparent. The results from the tracking analysis indicate there is evidence of early consolidation and tracking of physical activity, food preference, and smoking behaviors, but these results did not differ greatly by gender. These data suggest that...

Alcohol and marijuana use among adolescents: Long-term outcomes of the class of 1989 study

The Minnesota Heart Health Program (MHHP) is a population-wide research and demonstration project designed to reduce cardiovascular disease in three educated communities (1980-1993) compared to three matched reference communities. The Class of 1989 Study, a substudy of the MHHP, collected self-reported data in one educated and one matched reference community. All sixth graders enrolled in both communities were invited to participate in a baseline survey in 1983, and that grade cohort was surveyed annually throughout junior high and high school until 1989. Students received interventions designed to favorably influence their smoking, physical activity levels, and eating behavior each year from 1983 to 1987. As part of this five-year intervention, a program addressing smoking, alcohol use, drinking and driving behavior, and marijuana use was implemented during the school year of 1985-1986, when students were in ninth grade.Using the school as the unit of analysis, we found that students in the intervention community in 1986 reported fewer occasions on which they had been drinking alcohol in the past 30 days than did students in the reference community. Furthermore, students in the intervention community reported less problem drinking in the previous two weeks and less driving after drinking than did students in the reference community. These positive intervention effects were not maintained through twelfth grade.