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 pr omotion efforts.METHODS: The rationale for and characteristics of comm unity prevention trials for cardiovascular disease (CVD) risk reductio n are presented. Published articles regarding the main effects and com ponent studies of community prevention trials regarding CVD were revie wed. RESULTS: All early and most recent community prevention trials ca rried out in diverse populations demonstrated population-wide effects on CVD risk factors, particularly blood pressure levels and smoking pr evalence. Moreover, subgroup component studies (e.g., schools, worksit es, events) demonstrate the efficacy of many risk reduction strategies . These results support a dose-response relationship by evidence of st ronger effects where adequate exposure to the intervention was achieve d. 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 unde rstanding of the optimal mix and sequencing of components of these pro grams. In addition, this review indicates the importance of incorporat ing strategies to influence environmental change. Recommendations for the future include research regarding evaluation methods and the inter action of environmental and educational strategies, as well as dissemi nation research and concurrent international technology transfer of th e vast number of lessons learned and the many widely accepted practice principles of community-based interventions. (C) 1997 Elsevier Scienc e Inc.