Minnesota Heart Health Program

Background:

The MHHP community intervention trial began in 1980 to determine the effects of a 5-year community strategy of health promotion on the knowledge, behavior, risk levels and CVD rates in three educated communities versus three paired controls in the upper mid-west. These communities were matched on the basis of size, community type, and distance from the Minneapolis-St. Paul metropolitan area. Sampled cohorts and representative cross-sections of each community were assessed annually with standard measures. Interventions included screening and education of adults, professional education among the health professions, youth-parent programs in local schools, market and restaurant programs, community events and mass media, devised and administered through locally ‘owned’ boards and task forces. Approximately 400,000 persons from these 6 upper Midwest communities were involved.

Methods:

The intervention advocated hypertension prevention and control, heart healthy eating behaviors, nonsmoking, and regular physical activity. Interventions were carried out at the individual and community level in a wide range of intervention strategies. The program alerted people to health issues, informed them of effective behavioral alternatives for health promotion, provided incentives for new behaviors, and reinforcements to maintain new behaviors. Intervention activities were carried out for a 5-6 years.

Evaluation of the program was based on the results of annual cohort surveys as well as independent cross-sectional samples of the general adult population of the communities. Resting blood pressures, serum total cholesterol, cigarette smoking, height and weight, and extent of leisure time activity were measured in a standardized manner. Surveillance systems were established for the collection of morbidity and mortality data in residents between the ages of 30 and 74 years.

Results:

Based on a calculated exposure score, exposure was significantly higher in the education compared with the non-intervened comparison communities after 1 and 3 years but not after study years 5 and 6. Using data from the cross-sectional and cohort study samples, many of the intervention components proved effective with regard to favorably influencing coronary risk factors. However, given strong secular trends in health promotional activities and declining risk factors in the comparison communities, the overall program effects were modest in size and duration and statistically insignificant after 5 years in the community cross-section samples.

Strong favorable secular trends were occurring in the comparison communities which were not offset by the Minnesota Heart Health program intervention. These findings, in conjunction with the results of other community-based trials, highlight the difficulties in engaging a large enough proportion of the general population sufficiently to change the risk factor profiles of entire communities over and above larger trends. The fact, however, is that risk levels changed universally during the 1980s, and CVD rates declined steeply. The results of the three U.S. community trials (Stanford, Minnesota, and Pawtucket), compared to their contemporary, the apparently effective North Karelia Project, also suggest that such trials are best carried out in populations where risk and rates are high or highest and where the health promotion message has not penetrated, that is, where knowledge, sophistication, and rapid change in health behaviors have not arrived.

Strengths:

The results of the three U.S. community trials (Stanford, Minnesota, and Pawtucket), compared to their contemporary, the apparently effective North Karelia Project, also suggest that such trials are best carried out in populations where risk and rates are high or highest and where the health promotion message has not penetrated, that is, where knowledge, sophistication, and rapid change in health behaviors have not arrived. (HB)