Synthesis of findings and issues from community prevention trials

PURPOSE: Lessons from three decades of community prevention trials are discussed to provide directions for the future of community health promotion efforts. METHODS: The rationale for and characteristics of community prevention trials for cardiovascular disease (CVD) risk reduction are presented. Published articles regarding the main effects and component studies of community prevention trials regarding CVD were reviewed. RESULTS: All early and most recent community prevention trials carried out in diverse populations demonstrated population-wide effects on CVD risk factors, particularly blood pressure levels and smoking prevalence. Moreover, subgroup component studies (e.g., schools, worksites, events) demonstrate the efficacy of many risk reduction strategies. These results support a dose-response relationship by evidence of stronger effects where adequate exposure to the intervention was achieved. CONCLUSIONS: Although much remains untested in theory and practice, data indicate that community-based efforts to reduce the risk of CVD can influence behavior. Additional research is needed to increase understanding of the optimal mix and sequencing of components of these programs. In addition, this review indicates the importance of incorporating strategies to influence environmental change. Recommendations for the future include research regarding evaluation methods and the interaction of environmental and educational strategies, as well as dissemination research and concurrent international technology transfer of the vast number of lessons learned and the many widely accepted practice principles of community-based interventions. (C) 1997 Elsevier Science Inc.