ABSTRACT
During the late 1970s and early 1980s, three large community car diovascular disease intervention studies were conducted to evaluate the effectiveness of comprehensive, community-wide health education on reducing the risks associated with cardiovascular disease, i.e., high dietary fat, hypertension, cigarette smoking, obesity, and sedentary lifestyle. The studies involved 12 cities, six of which received a 5-to 8-year multifactorial risk reduction program, in three distinct geo graphic regions of the United States. These studies consisted of the Stanford Five-City Project in California, the Minnesota Heart Health Program in the Minneapolis-St. Paul metropolitan areas, and the Paw tucket Heart Health Program in Rhode Island (Winkleby, Feldman, & Murray, 1997). These studies produced a wealth of knowledge about health behaviors, and many of the short-term targeted interventions within the larger studies were found effective. Long-term presumed effectiveness, however, was not seen. The recommendation was that more attention must be paid to finding ways to reach people who have resisted previous programs and messages, or subgroups that these studies were unable to reach. All three studies consisted predominant ly of Caucasian, non-Hispanic participants (83% to 97%, n = 5,792), aged 25 to 64 years, with almost equal numbers of men and women. The principal ethnic minority group was Hispanic (6% to 10%). Afri can-Americans represented 0.1% to 2.7% of the three combined sam ples. There is an overwhelming need to target, assess, and develop focused health-promotion interventions for women, ethnic minorities, older persons, and low socioeconomic persons, who continue to bear a
disproportionate burden of morbidity and mortality (Krieger, Rowley, Herman, Avery, & Phillips, 1993; Nickens, 1995; Palank, 1991).
