No abstract

Scand J Public Health 2001; 29 (suppl 56): 21± 32Objectives: To describe a rural, hospital-based public health intervention program and to evaluate its eVectiveness in cardiovascular disease (CVD) risk reduction using cross-sectional studies and a panel study. Methods: 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 eVectiveness of the intervention, surveys were conducted at baseline in 1989 (crosssectional ) 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 Ö 2 randomized block ANOVA, 2 Ö 2 mixed ANOVA, and extension of the McNemar test. Results: Smoking prevalence declined (from 27.9 % to 17.6 % ) in the intervention population. Signi® cant 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 signi® cantly in both populations. Conclusions: 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.

No abstract

Scand J Public Health 2001; 29 (suppl 56): 46± 58Objectives: There is a need among healthcare providers to acquire more knowledge about small-scale and low budget community intervention programmes. This paper compares risk factor outcomes in Swedish and US intervention programmes for the prevention of cardiovascular disease (CVD). The aim was to explore how diVerent intervention programme pro® les aVect outcome. Methods: Using a quasi-experimental design, trends in risk factors and estimated CVD risk in two intervention areas (Norsjo È , Sweden and Otsego± Schoharie County, New York state) are compared with those in reference areas (Northern Sweden region and Herkimer County, New York state) using serial cross-sectional studies and panel studies. Results: The programmes were able to achieve signi® cant changes in CVD risk factors that the local communities recognized as major concerns: changing eating habits in the Swedish population and reducing smoking in the US population. For the Swedish cross-sectional follow-up study cholesterol reduction was 12 % , compared to 5 % in the reference population ( p for trend diVerences < 0.000). The signi® cantly higher estimated CVD risk (as assessed by risk scores) at baseline in the intervention population was below that of the Swedish reference population after 5 years of intervention. The Swedish panel study provided the same results. In the US, both the serial cross-sectional and panel studies showed a > 10 % decline in smoking prevalence in the intervention population, while it increased slightly in the reference population. When pooling the serial cross-sectional studies the estimated risk reduction (using the Framingham risk equation) was signi® cantly greater in the intervention populations compared to the reference populations. Conclusions: The overall pattern of risk reduction is consistent and suggests that the two diVerent models of rural county intervention can contribute to signi® cant risk reduction. The Swedish programme had its greatest eVect on reduction of serum cholesterol levels whereas the US programme had its greatest eVect on smoking prevention and cessation. These outcomes are consistent with programmatic emphases. Socially less privileged groups in these rural areas bene® ted as much or more from the interventions as those with greater social resources.

Scand J Public Health 2001; 29 (suppl 56): 40± 45Objectives: This paper aims to develop and describe a method for combining, comparing, and maximizing the statistical power of two longitudinal studies of risk factors for cardiovascular disease that did not have identical data collection methodologies. Methods: Subjects from a 1986 cross-sectional study (n = 180) were pair-matched with subjects of corresponding gender and age ( + 5 years) from a 1990 cross-sectional study. The methodology is described and results are calculated for various measures of cardiovascular risk or risk factors (e.g. cholesterol, Finnish Risk Score). Results: Box's test of equality and symmetry of covariance matrices gave chi-square values of 223.8 and 710.0 for two cardiovascular risk factors (cholesterol and cardiac risk score, respectively); these values were highly signi® cant ( p = 0.0001). For the North Karelia Risk Score, repeated measures ANOVA revealed a borderline signi® cant interaction for treatment by time ( p = 0.054 ) and a signi® cant interaction for treatment by time by country ( p = 0.035). These probabilities compared favorably with a randomized blocks model. Conclusions: Creation of a synthetic longitudinal control group resulted in a statistically valid ANOVA model that increased the statistical power of the study.