Abstract
Among the different approaches to the study of cardiovascular disease prevention are community-based programs. This type of program concerns a whole community and the intervention takes advantage of the existing service structure and community organization. The evaluation assesses the feasibility, effects on risk factor and disease reduction, costs, process, and other consequences associated with the program. Several such programs have recently been launched in the United States and some other countries. The first major community-based control program was the North Karelia project in Finland, started in 1972 and recently evaluated for its first five-year period. This paper discusses the problems in evaluating community-based CVD control programs on the experiences obtained in the North Karelia project.
Similar content being viewed by others
References
Puska P, Tuomilehto J, Salonen J, Nissinen A, Virtamo J, Bjorkqvist S, Koskela K, Neittaanmaki L, Takalo T, Kottke T, Mäki J, Sipilä P, Varvikko P:The North Karelia Project. Evaluation of a Comprehensive Community Program for Control of Cardiovascular Diseases in North Karelia, Finland. World Health Organization, Regional Office for Europe, Copenhagen 1981.
Puska P, Tuomilehto J, Salonen J, Neittaanmäki L, Mäki J, Virtamo J, Nissinen A, Koskela K, Takalo T: Changes in coronary risk factors during comprehensive five-year community program to control cardiovascular diseases (North Karelia project).Br Med J 2:1173–1178, 1979.
McAlister A, Puska P, Salonen JT, Tuomilehto J, Koskela K: Theory and action for Health Promotion: Illustrations from the North Karelia Project.Am J Public Health 72:43–50, 1982.
Farquhar JW: The community-based model of lifestyle intervention trials.Am J Epidemiol 108:103–111, 1978.
Campbell DT, Stanley JC:Experimental and Quasi-experimental Designs for Research. Chicago, Rand McNally Co, 1963.
Keys A:Coronary heart disease in seven countries. Am Heart Asso Monograph No. 29, New York, 1970.
Puska P, Mustaniemi H: Incidence and presentation of myocardial infarction in North Karelia, Finland.Acta Med Scand 197:211–216, 1975.
Karvonen M, Keys A, Orma E, Fidanza F, Brozek J: Cigarette smoking, serum cholesterol, blood pressure and body fatness. Observations in Finland.Lancet i:492–494, 1959.
Rimpelä M: Trends in the smoking habits in Finland in 1949 and 1960-77.Sosiaalilääketieteellinen Aikakauslehti 15:108–120, 1978.
Valkonen T, Niemi ML: The development of male mortality by county and cause of death in Finland in 1961–75. Department of Sociology, University of Helsinki, Working Papers No. 10, 1980.
Glasunov I, Dowd J, Jaksic Z, Kesic G, Ray O, Steinberger C, Stromberg J, Vuletio S: Methodological aspects of the design and conduct of preventive trials in ischaemic heart disease.Int J Epidemio 2:137–143, 1973.
Puska P, Virtamo J. Tuomilehto J, Mäki J, Neittaanmäki L: Cardiovasvular risk factor changes in three-year follow-up of a cohort in connection with a community program (the North Karelia project).Acta Med Scand 204:381–388, 1978.
Farquhar JW, Wood PD, Breitrose H, Haskell WL, Meyer AJ, Maccoby N, Alexander JK, Brown BW Jr, McAlister Al, Nash JD: Community education for cardiovascular health.Lancet 1:1192–1195, 1977.
Salonen JT:Smoking and Dietary Fats in Relation to Estimated Risk of Myocardial Infarction Before and During a Preventive Community Program. Publications of the University of Kuopio, Community Health Series, Original Reports 1/1980.
World Health Organization:Myocardial Infarction Community Registers. Public Health in Europe 5. Copenhagen, WHO/EURO, 1976.
Hatano S, et al: Experience from a multicentre stroke register: A preliminary report. Bull WHO54: 541–553, 1976.
Hatano S, et al.: Observer variations in the diagnosis of stroke. WHO Collaborative study on the control of stroke in the community.Jpn Heart J 18:171–177, 1977.
Hjerman I: The randomized “Smoking-Lipid Trial” of the Oslo Study. Abstract. V International Symposium on Atherosclerosis. Houston 6.–9.11.1979.
Kuller LH: Prevention of cardiovascular disease and risk factor intervention trials.Circulation 61:26–30, 1980.
World Health Organization:Report of a Joint HQ/EURO Meeting on Comprehensive Cardiovascular Community Control Programs. Geneva, 24–26 November 1977.
Additional information
Pekka Puska and Aulikki Nissinen are with the Department of Epidemiology, National Public Health Institute, Mannerheimintie 166, SF-00280 Helsinki 28, Finland. Pekka Puska and Jukka T. Salonen are with the Research Institute of Community Health (North Karelia project), University of Kuopio, P.O. Box 138, SF-70101 Kuopio 10, Finland. Jaako Tuomilehto is with the World Health Organization Headquarters, Cardiovascular Unit, 1211 Geneva 27, Switzerland. Thomas E. Kottke is with the Laboratory of Physiological Hygiene, School of Public Health, University of Minnesota, Minneapolis, MN 55455, U.S.A. Communication concerning the manuscript should be addressed to Prof. Pekka Puska
Rights and permissions
About this article
Cite this article
Puska, P., Salonen, J.T., Tuomilehto, J. et al. Evaluating community-based preventive cardiovascular programs: Problems and experiences from the North Karelia project. J Community Health 9, 49–64 (1983). https://doi.org/10.1007/BF01318933
Issue Date:
DOI: https://doi.org/10.1007/BF01318933