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Effects of Communitywide Education on Cardiovascular Disease Risk Factors: The Stanford Five-City Project
Abstract
To test whether communitywide health education can reduce stroke and coronary heart disease, we compared two treatment cities (N = 122 800) and two control cities (N = 197 500) for changes in knowledge of risk factors, blood pressure, plasma cholesterol level, smoking rate, body weight, and resting pulse rate. Treatment cities received a 5-year, low-cost, comprehensive program using social learning theory, a communication—behavior change model, community organization principles, and social marketing methods that resulted in about 26 hours of exposure to multichannel and multifactor education. Risk factors were assessed in representative cohort and cross-sectional surveys at baseline and in three later surveys. After 30 to 64 months of education, significant net reductions in community averages favoring treatment occurred in plasma cholesterol level (2%), blood pressure (4%), resting pulse rate (3%), and smoking rate (13%) of the cohort sample. These risk factor changes resulted in important decreases in composite total mortality risk scores (15%) and coronary heart disease risk scores (16%). Thus, such low-cost programs can have an impact on risk factors in broad population groups. (JAMA. 1990;264:359-365)
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“Community- and school-based long-term media and education campaigns have also been effective in improving dietary habits of adults, school-age children, and younger children,45–48 as well as reducing adiposity and cardiovascular risk factors in adults.49”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [49]
In the citing paper
“After 3 to 5 years of intervention, compared with controls, the intervention communities saw improvements in several cardiovascular risk factors, including lower blood cholesterol, blood pressure, resting heart rate, weight gain, and smoking prevalence.49”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [49]
In the citing paper
“These interventions produced mixed results, with benefits on risk factors seen in 1 study49 but without clear benefits in the other 2 studies, as compared with secular trends.61,62”
From Population Approaches to Improve Diet, Physical Activity, and Smoking Habits: A Scientific Statement From the American Heart Association (2012) · cites this paper as [49]
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Metadata
- Authors
- Farquhar, J. W.
- Corresponding author
- Farquhar, John W.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1990-07-18
- Volume
- 264
- Issue
- 3
- Pages
- 359
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W4301237366
- Cited by
- 448
- References
- 0
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 4 · 2020: 4 · 2019: 4 · 2018: 10 · 2017: 6 · 2016: 9 · 2015: 11 · 2014: 13 · 2013: 12 · 2012: 11
- FWCI
- 24.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL21906)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Public Health Policies and Education
- Keywords
- cardiovascular risk factors, stroke prevention, coronary heart disease prevention, social learning theory, social marketing, blood pressure, serum cholesterol, smoking prevalence, body weight, resting heart rate, mortality risk score, community-based intervention
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