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.