The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk.

Abstract

OBJECTIVES. Whether community-wide education changed cardiovascular risk factors and disease risk in Pawtucket, RI, relative to a comparison community was assessed. METHODS. 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. RESULTS. 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. CONCLUSIONS. 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.

Effect of a community-based intervention on nutritional behaviour in a developing country setting: the Isfahan Healthy Heart Programme

“…The programme had a local design and an impact on dietary behaviours, the same as previous heart health promotion programmes (18)(19)(20)(21) . Compared with the North Karelia Project, which showed a reduction in SFA of 20 % in men and 24 % in women (22) , other programmes have shown lower population-wide changes (18)(19)(20)(21) . Joint analysis of the combined evaluation data of the Stanford Project, the Minnesota Heart Health Program and the Pawtucket Heart Health Program did not show any global acceptable impact on the main dietary variables, suggesting that statistical power was not an issue in the evaluation of the individual programmes (23) .…”

Randomized Trial of Reduced-Nicotine Standards for Cigarettes

“…These trials typically incorporate mass media strate gies into larger health education programs. Some, such as the Stanford Five-City Project (Farquhar et al 1990), the Minnesota Heart Health Program Luepker et al 1994), and the Pawtucket Heart Health Program (Elder et al 1986;Carleton et al 1995), have been aimed at modifying smoking, as well as other risk factors for cardiovascular disease. Final reports suggest that these trials have met with little success in promoting smoking cessation.…”

“…The Pawtucket Heart Health Program had little impact on smoking behavior; its first attempt at a smoking cessation program prompted only 11 smokers to quit (Elder et al 1986(Elder et al , 1987. The final results con firmed the lack of impact (Carleton et al 1995).…”

“…In the Pawtucket Heart Health Program, the impact of a communitywide program for reducing risks for cardiovascular disease in Pawtucket, Rhode Island, was compared with trends in a nearby matched community in southern Massachusetts (name withheld to honor a confidentiality agreement with the city gov ernment) (Carleton et al 1995). Pawtucket was selected as the intervention site from among a pool of nine potential northeastern New England cities; the comparison site had similar sociodemographic char acteristics.…”

A nutrition and exercise intervention program for controlling weight in Samoan communities in New Zealand

“…32 ± 36 The most positive result came from the Pawtucket Heart Health Program where the intervention city maintained a relatively stable BMI throughout the intervention while the comparison city saw a steady increase. 37 Secular trends in weight and weak intervention effects because of the limited numbers of people reached or because too many behaviour changes were targeted have been cited as explanations. 34 The increase in mean weight in our control community suggests that the obesity-promoting nature of the environment is also a likely explanation.…”