Health promotion in the city: A structured review of the literature on interventions to prevent heart disease, substance abuse, violence and HIV infection in us metropolitan areas, 1980-1995

To achieve its national public health goals, the US must improve the health of low-income urban populations. To contribute to this process, this study reviewed published reports of health promotion interventions designed to p revent heart disease, HN infection, substance abuse, and violence in US cit ies. The study's objectives were to describe the target populations, settin gs, and program characteristics of these interventions and to assess the ex tent to which these programs followed accepted principles for health promot ion. Investigators searched five computerized databases and references of s elected articles for articles published in peer-reviewed journals between 1 980 and 1995. Selected articles listed as a main goal primary prevention of one of four index conditions; were carried out within a US city; included sufficient information to characterize the intervention; and organized at l east 25% of its activities within a community setting. In general, programs reached a diverse population of low-income city residents in a variety of settings, employed multiple strategies, and recognized at least some of the principles of effective health promotion. Most programs reported a systema tic evaluation. However, many programs did not involve participants in plan ning, intervene to change underlying social causes, last more than a year, or tailor for the subpopulations they targeted, limiting their potential ef fectiveness. Few programs addressed the unique characteristics of urban com munities.