John R. Finnegan

Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program.

OBJECTIVES The Minnesota Heart Health Program is a 13-year research and demonstration project to reduce morbidity and mortality from coronary heart disease in whole communities. METHODS Three pairs of communities were matched on size and type; each pair had one education site and one comparison site. After baseline surveys, a 5- to 6-year program of mass media, community organization, and direct education for risk reduction was begun in the education communities, whereas surveys continued in all sites. RESULTS Many intervention components proved effective in targeted groups. However, against a background of strong secular trends of increasing health promotion and declining risk factors, the overall program effects were modest in size and duration and generally within chance levels. CONCLUSIONS These findings suggest that even such an intense program may not be able to generate enough additional exposure to risk reduction messages and activities in a large enough fraction of the population to accelerate the remarkably favorable secular trends in health promotion activities and in most coronary heart disease risk factors present in the study communities.

Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence.

OBJECTIVES Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach. METHODS Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors. RESULTS At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline. CONCLUSIONS The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use.

Community-wide prevention of cardiovascular disease: Education strategies of the Minnesota Heart Health Program

The Minnesota Heart Health Program (MHHP) is a research and demonstration project of population-wide primary prevention of cardiovascular disease. Study goals are to achieve reductions in cardiovascular disease risk factors and morbidity and mortality in three education communities compared with three reference communities. The program in the first of the three intervention communities, Mankato, has been operating for 3 of the planned 5 years. Early objectives of the program have been achieved based on data obtained from population-based random samples surveyed in education and comparison communities. After 2 years of participation, Mankato was significantly more exposed to activities promoting cardiovascular disease prevention. In this town of 38,000 inhabitants, 190 community leaders were directly involved as program volunteers, 14,103 residents (over 60% of adults) attended a screening education center, 2,094 attended MHHP health education classes, 42 of 65 physicians and 728 other health professionals participated in continuing education programs offered by MHHP, and distribution of printed media averaged 12.2 pieces per household. These combined educational strategies have resulted in widespread awareness of MHHP and participation by the majority of the Mankato adult population in its education activities.

Social Capital and Health: Civic Engagement, Community Size, and Recall of Health Messages

OBJECTIVES We explored the effects of community integration and pluralism on recall of cardiovascular disease health information messages. METHODS With 1980-1983 data from the Minnesota Heart Health Program, we examined whether ties to community groups were associated with recall of health messages, and whether this relation was modified by size and degree of differentiation of the community. RESULTS A higher level of civic engagement through ties to community groups was associated with better recall of health messages. Ties to community groups independently contributed to better message recall even after control for gender, education, and other variables. The moderating role of community size was non-significant but intriguing. CONCLUSIONS Community group membership could increase exposure to health messages, providing a critical pathway for social capital to influence health promotion and, thus, public health outcomes.

Project Northland High School Interventions: Community Action to Reduce Adolescent Alcohol Use

Project Northland is a randomized community trial initially implemented in 24 school districts and communities in northeastern Minnesota, with goals of delaying onset and reducing adolescent alcohol use using community-wide, multiyear, multiple interventions. The study targets the Class of 1998 from the 6th to 12th grades (1991-1998). The early adolescent phase of Project Northland has been completed, and reductions in the prevalence of alcohol use at the end of 8th grade were achieved. Phase II of Project Northland, targeting 11th- and 12th-grade students, uses five major strategies: (1) direct action community organizing methods to encourage citizens to reduce underage access to alcohol, (2) youth development involving high school students in youth action teams, (3) print media to support community organizing and youth action initiatives and communicate healthy norms about underage drinking (e.g., providing alcohol to minors is unacceptable), (4) parent education and involvement, and (5) a classroom-based curriculum for 11th-grade students. This article describes the background, design, implementation, and process measures of the intervention strategies for Phase II of Project Northland.

Women's Ischemic Syndrome Evaluation: current status and future research directions: report of the National Heart, Lung and Blood Institute workshop: October 2-4, 2002: Section 3: diagnosis and treatment of acute cardiac ischemia: gender issues.

The WISE workshop was convened to review results from the Women’s Ischemic Syndrome Evaluation (WISE) study and other studies of ischemic heart disease to examine the nature and scope of gender differences in both chronic and acute cardiac ischemia, in terms of clinical manifestations, detection, and treatment. This section addresses research needs in the diagnosis and treatment of acute coronary syndromes in women and in the effective implementation of these findings into the community. There is a substantial body of scientific literature about the presentation of acute cardiac ischemia (ACI) in women, including acute myocardial infarction (AMI) and unstable angina pectoris, which can lead to AMI. However, the diagnosis and treatment of ACI in women in the emergency department (ED) is not optimal, resulting in missed diagnoses and treatments and leading to excess mortality.1 Women present at older ages, in different social support environments, with more comorbidity, and with some differences in symptoms compared with men, and women are more likely to present with unstable angina pectoris than with AMI.2–8 Also, gender-specific clinical practices are not well understood or implemented.9–18 Particularly needed for improving health outcomes in women with ACI is a better understanding of how care for women with (and without) ACI can be effectively delivered in the wide range of care settings in this country. Thus, there is a clear need to supplement prior, excellent, disease-targeted “efficacy research” with “effectiveness research” that targets the development and testing of approaches that are broadly applicable to usual clinical practice settings.19,20 This next phase of research must avoid the incomplete inclusion of all patients with …

Motivation and the Knowledge Gap: Effects of a Campaign to Reduce Diet-Related Cancer Risk

The study described here examined whether knowledge gaps decrease when motivation to acquire information or the functionality of information is similar among more and less educated groups. Surveys at baseline and 12 months compared two groups with differing motivation to acquire cancer and diet information in a community that received a year-long health campaign. The more motivated group (higher on measures of salience, perceived cancer risk, and self-efficacy) was composed of those who self-selected to receive home-based learning, a campaign strategy. They were compared to general population samples. The study found that education-based differences in knowledge were evident even among members of the more motivated group. However, the effect of membership in this group raised knowledge levels higher than the general population irrespective of education level. The study suggested that group membership, information functionality, motivation, and education combined to affect knowledge, rather than motivation alone over-coming the effect of education.

Individual and neighborhood socioeconomic status effects on adolescent smoking: A multilevel cohort-sequential latent growth analysis

OBJECTIVES We examined the prospective effects of parental education (as a proxy for individual socioeconomic status [SES]) and neighborhood SES on adolescent smoking trajectories and whether the prospective effects of individual SES varied across neighborhood SES. METHODS The study included 3635 randomly recruited adolescents from 5 age cohorts (12-16 years) assessed semiannually for 3 years in the Minnesota Adolescent Community Cohort study. We employed a cohort-sequential latent growth model to examine smoking from age 12 to 18 years with predictors. RESULTS Lower individual SES predicted increased levels of smoking over time. Whereas neighborhood SES had no direct effect, the interaction between individual and neighborhood SES was significant. Among higher and lower neighborhood SES, lower individual SES predicted increased levels of smoking; however, the magnitude of association between lower individual SES and higher smoking levels was significantly greater for higher neighborhood SES. CONCLUSIONS We found evidence for differential effects of individual SES on adolescent smoking for higher and lower neighborhood SES. The group differences underscore social conditions as fundamental causes of disease and development of interventions and policies to address inequality in the resources.

REACT theory-based intervention to reduce treatment-seeking delay for acute myocardial infarction

Coronary heart disease (CHD) remains the leading cause of mortality in the U.S. Innovations in reperfusion therapies can potentially reduce CHD morbidity and mortality associated with acute myocardial infarction (AMI) when treatment is initiated within the first few hours of symptom onset. However, delay in seeking treatment for AMI is unacceptably lengthy, resulting in most patients being ineligible for reperfusion therapies. The Rapid Early Action for Coronary Treatment (REACT) Trial is a four-year, 20-community, randomized trial to design and test the effectiveness of a multi-component intervention to reduce patient delay for hospital care-seeking for AMI symptoms. This manuscript describes the development and content of the theoretically-based REACT intervention and summarizes: (1) the research literature used to inform the intervention; (2) the behavioral theories used to guide the development, implementation, and evaluation of the intervention; (3) the formative research undertaken to understand better decision-making processes as well as barriers and facilitators to seeking medical care as perceived by AMI patients, their families, and medical professionals; (4) the intervention design issues that were addressed; (5) the synthesis of data sources in developing the core message content; (6) the conceptualization for determining the intervention target audiences and associated intervention components and strategies, their integration with guiding theoretical approaches and implementation theories for the study, and a description of major intervention materials developed to implement the intervention; and (7) the focus of the outcome, impact, and process measurement based on the intervention components and theories on which they were developed.

Community Ties in a Rural Midwest Community and Use of Newspapers and Cable Television

This telephone survey of 377 persons in a Middle West community finds civic involvement related to local and regional newspaper subscription but not to cable TV subscription. The same is true of political involvement and active voting. Those living longest in the community and most committed to staying there were most likely to take the local paper, but this had little effect on taking local cable. Income was unrelated to cable subscription but was positively associated with local and regional newspaper subscription. There are a number of other findings, some substantiating findings of other community studies.