The Otsego-Schoharie healthy heart program: prevention of cardiovascular disease in the rural US

Objectives: To describe a rural, hospital-based public health intervention program and to evaluate its effectiveness in cardiovascular disease (CVD) r isk reduction using cross-sectional studies and a panel study. Methods: A rural population of 158,000 located in New York state comprised the intervention population. A similar but separate population was used for reference. A multifaceted, multimedia 5-year program provided health promo tion and education initiatives to increase physical activity, decrease smok ing, improve nutrition. and identify hypercholesterolemia and hypertension. To evaluate the effectiveness of the intervention, surveys were conducted at baseline in 1989 (cross-sectional) and at follow-up in 1994-95 (cross-se ctional and panel). For cross-sectional studies. a random sample of adults was obtained using a three-stage cluster design. Self-reported and objectiv e risk factor measurements were obtained. Comparison of pre- to post- chang es in intervention versus reference populations was done using 2 x 2 random ized block ANOVA, 2 x 2 mixed ANOVA, and extension of the McNemar test. Results: Smoking prevalence declined (from 27.9% to 17.6%) in the intervent ion population. Significant adverse trends were observed for high-density l ipoprotein cholesterol and triglycerides. Systolic blood pressure was reduc ed while diastolic blood pressure remained stable. Body mass index increase d significantly in both populations, Conclusions: This rural. 5-year CVD community intervention program decrease d smoking. The risk reduction may be attributable to tailoring of a multifa ceted approach (multiple risk factors, multiple messages, and multiple popu lation subgroups) to a target rural population. The study period was too sh ort to identify changes in CVD morbidity and mortality.