Minnesota Heart Health Program

This study has been completed.
Sponsor:
Information provided by:
National Heart, Lung, and Blood Institute (NHLBI)
ClinicalTrials.gov Identifier:
NCT00005150
First received: May 25, 2000
Last updated: June 23, 2005
Last verified: May 2000
  Purpose

To conduct a large-scale community-based demonstration and education research project designed to evaluate the effectiveness of multiple educational strategies on risk factor reduction and the primary prevention of population-wide cardiovascular diseases in three intervention communities compared with three control communities. The program was evaluated by cross-sectional surveys, a longitudinal survey, and morbidity and mortality surveillance.


Condition
Cardiovascular Diseases
Heart Diseases
Cerebrovascular Accident
Myocardial Infarction
Hypertension
Coronary Disease

Study Type: Observational

Resource links provided by NLM:


Further study details as provided by National Heart, Lung, and Blood Institute (NHLBI):

Study Start Date: July 1980
Estimated Study Completion Date: June 1993
  Hide Detailed Description

Detailed Description:

BACKGROUND:

The rationale for prevention derives from the mass nature of adult cardiovascular diseases in affluent societies, the insidious development of the underlying processes, particularly hypertension and atherosclerosis, the high immediate out-of hospital mortality of coronary disease and stroke, and the long-term excessive risk after survival of an initial episode.

The potential for a preventive approach in cardiovascular diseases was based on the large differences in disease rates found between populations and the strong associations between individual risk factor levels and disease rates within high risk cultures. The congruence of these population observations with clinical evidence and with plausible mechanisms of cause, strengthened inference of their causal importance. Further, the safety and feasibility were well established of modifying individuals' cardiovascular risk characteristics and changing personal health behavior through medical and educational strategies. Finally, the dynamic nature of the changes in vital statistics on deaths reported from hypertension, stroke, and coronary heart disease (CHD) in many nations, at the rate of one to two percent a year and greater, both upward and downward, indicated their preventability, though none of these trends was adequately explained when the study began in 1980.

The rationale for a population or community-wide strategy, as in the Minnesota Heart Health Program, contrasted to a high-risk individual, medical approach, was based on all the above considerations, plus the demonstration that entire populations were at excess risk relative to others. Focusing solely on the portion of higher risk people among high risk cultures appeared to be a necessary medical part of a community-wide prevention approach, but it was insufficient and inefficient as a sole or major public health strategy. This was mainly because the bulk of attributable (excess) cases of cardiovascular disease came from the large central part of the population distribution of risk, not the tail. The socially learned behaviors which lead to the precursors of cardiovascular disease were also mass phenomena, requiring a population strategy of prevention and health promotion. Finally, concentration of preventive effort only among the high risk or only on adults tended to ignore the mass emergence of youth into early adulthood bearing the physical characteristics of excess risk and already having well-developed unhealthy behaviors. Therefore, a rational and effective public health strategy would appear to be one directed toward all ages and segments of the community, over a sustained period, with the ultimate objective to prevent elevated risk and risky behaviors in the first place.

DESIGN NARRATIVE:

Three pairs of communities were selected, each pair with one education and one control community. Communities were matched on size and distance from Minneapolis-St. Paul and pairs were similar in median income, education, health care, and media resources. The first pair, Mankato and Winona, were small agricultural communities of approximately 40,000 in population in 1980. The second pair, Fargo, North Dakota and Moorhead, Minnesota paired with Sioux Falls, South Dakota, were medium-sized urban centers of approximately 100,000 in population. Bloomington and Roseville, Minnesota were suburban centers in the Twin Cities metropolitan area with a population of approximately 80,000.

The education program began in Mankato in 1981 after two baseline surveys, in Fargo-Moorhead in 1982 after three baseline surveys, and in Bloomington in 1983 after four baseline surveys. Education activities continued in the three communities for five years concluding in the staged manner in which they began. Targeted risk factors included blood pressure, exercise habits, smoking, and blood cholesterol levels. Health messages were communicated by involvement of community leaders and organizations, media education, population-based risk factor screening and education, adult education classes, youth and parent education disseminated in schools, health professional's educa0tion, and community-wide risk factor education campaigns.

The effectiveness of the program was evaluated by annual population survey samples of cross-sections or cohorts and by morbidity and mortality surveillance. The annual risk factor survey measured community and individual change in risk factors and related behaviors in 25-74 year old persons living in each of the six sites. Annual surveys included between 300-500 persons and were population-based, random, neighborhood cluster samples of each town. Selected households were invited to participate. A home interview was conducted to collect data on health beliefs, attitudes, and behaviors, medical history, health message exposure, and demographic characterization. After the home interview, participants had additional risk factor measurements at a survey center. Data were collected on height, weight, blood pressure, serum total and HDL cholesterol, and serum thiocyanate. In each community, a 50 percent sample of subjects was assessed for dietary habits and the other 50 percent for physical activity.

Morbidity and mortality data on myocardial infarction and stroke were collected and analyzed for the Minnesota Heart Health Program areas and mortality data for all of Minnesota, North Dakota, and South Dakota. Computer classification algorithms were developed jointly with the Pawtucket Heart Health Program and the Stanford Five-City Multifactor Risk Reduction Program to allow pooling of data of the three studies. All hospitalized cases of myocardial infarction and stroke were investigated and cause of death was validated for cardiovascular disease deaths occurring out-of-hospital. Deaths occurring throughout Minnesota, North and South Dakota were catalogued. Hospital disease surveillance was carried out with the cooperation of 34 area hospitals. Mortality was ascertained by death certificate counts and from tapes supplied by the three State Health Departments. Morbidity and mortality data were compared between pooled education versus pooled comparison communities and mortality data were compared between these and the remaining areas of the three states.

  Eligibility

Genders Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

No eligibility criteria

  Contacts and Locations
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No Contacts or Locations Provided
  More Information

Publications:
Murray DM, Perry CL, Davis MA: Cardiovascular Risk Reduction in Children. Education and Treatment of Children, 10(1):48-57, 1987
Perry CL, Crockett SJ, Pirie P: Influencing Parental Health Behavior: Implications of Community Assessments. Health Educ, 18:5, 1987
Perry CL, Klepp KI, Halper A, Dudovitz B, Golden D, Griffin G, Smyth M: Promoting Healthy Eating and Physical Activity Patterns Among Adolescents: A Pilot Study of 'Slice of Life' Health Educ Research, 2(2):93-103, 1987
Jeffery RW: Behavioral Treatment of Obesity. Ann Behav Med, 9(1):20-24, 1987
Jeffery RW, Forster JL: Obesity as a Public Health Problem, Chapter 11. In: Johnson WG (Ed), Advances in Eating Disorders, Vol. I: Treating and Preventing Obesity. Greenwich, CT: Jai Press, Inc., pp 253-271, 1987
Blackburn H: The Public Health View of Diet and Mass Hyperlipidemia. Part I, Part II. Cardiovas Rev Rep, 1:361-369, 433-442, 1980
Blackburn H, Gillum RF: Heart Disease. In: Public Health and Preventive Medicine, 11th Edition, Last JM (Ed), Appleton-Century-Crofts, New York, pp 1168-1201, 1980
Pechacek TF: Strategies for the Modification of Smoking Behavior: A Synoptic Review. Behavioral Medicine Update, 1:16-18, 1980
Pechacek TF, McAlister A: Strategies for the Modification of Smoking Behavior: Treatment and Prevention. In: A Comprehensive Handbook of Behavioral Medicine, Ferguson J, Taylor B (Eds), Spectrum Publications, New York, pp 257-298, 1980
Prineas RJ, Gillum RF, Blackburn H: Possibilities for Primary Prevention of Hypertension. In: Childhood Prevention of Atherosclerosis and Hypertension, Lauer RM, Shekelle RB (Eds), Raven Press, New York, pp 357-366, 1980
Blackburn H: A Public Health Approach to Diet, Risk Factors and Coronary Heart Disease. In: Hyperlipidemia (A Cornell Postgraduate Course), Scheidt S (Ed), MedCom Inc., New York, pp 27-35, 1981
Blackburn H: Primary Prevention of Coronary Heart Disease. In: Clinical Medicine, Spittell J Jr. (Ed), Harper & Row, Philadelphia, pp 1-23, 1981
Blackburn H (Rapporteur): Prevention of Coronary Heart Disease. Report of a WHO Expert Committee. Technical Report Series #678. World Health Organization, Geneva, 1982
Coates TJ, Petersen A, Perry C (Eds): Promoting Adolescent Health: A Dialog on Research and Practice. Academic Press, New York, 1982
Gatewood L: Evaluation of Prognostic Indices After Acute MI. Proceedings of Scientific Meeting on Ischemic Heart Disease, Specialized Centers of Research, NHLBI, Bethesda, MD, May 1982
Leon A, Blackburn H: Physical Activity and Hypertension. In: Hypertension. Cardiology I, Sleight P, Freis E (Eds), Butterworths, London, pp 14-36, 1982
Perry C: Adolescent Health: An Education-Ecological Perspective. In: Promoting Adolescent Health: A Dialog on Research and Practice. Coates T, Petersen A, Perry C (Eds), Academic Press, New York, pp 73-86, 1982
Blackburn H: Determinants of Individual and Population Blood Lipoprotein Levels: Nutritional-Genetic Interactions. In: Genetic Factors in Nutrition, Velasquez A, Gourges H (Eds), Academic Press, New York, 1983
Blackburn H: Physical Activity and Coronary Heart Disease: A Brief Update and Population View. Parts I, II. J Cardiac Rehab, 3:101-111, 171-174, 1983
Kline FG: The Minnesota Heart Health Project: Field Intervention in American Communities. In: Att Forandra Levnadssatt: Rapport fran ett Symposium om Metoder att Forbattra Folkhalsan (In: To Change Lifestyles: Report From a Symposium on Methods to Improve Public Health). Arvidsson O (Ed), Riksbankens Jubileumsfond, Stockholm, 1983
Leon A, Blackburn H: Physical Inactivity. In: Prevention of Coronary Heart Disease, Kaplan NM, Stamler J (Ed), W.B. Saunders Co., New York, pp 86-97, 1983
Mullis R: Health Promotion Opportunities. Community Nutritionist, January-February, pp 11-12, 1983
Pechacek TF, Grimm RH: Cigarette Smoking and the Prevention of Coronary Disease: Principles for Effective Smoking Cessation Programs for Health Professionals. In: Physician's Guide to the Prevention of Coronary Heart Disease. Podell RN, Stewart MM (Eds), Addison-Wesley, Palo Alto, pp 34-77, 1983
Blackburn H, Luepker R, Kline FG, Bracht N, Carlaw R, Jacobs DR, Mittelmark M, Stauffer L, Taylor HL: The Minnesota Heart Health Program: A Research and Demonstration Project in Cardiovascular Disease Prevention. In: Behavioral Health: A Handbook for Health Enhancement and Disease Prevention, Matarazzo J et al (Eds), John Wiley & Sons, New York, 1984
Pechacek TF, Fox BH, Murray DM, Luepker RV: Review of Techniques for Measurement of Smoking. In: Behavioral Health: A Handbook of Health Enhancement and Disease Prevention. Matarazzo J, et al (Eds) John Wiley & Sons, New York, 1984
Blackburn H, Pechacek T: Smoking Cessation and the Minnesota Heart Health Program. In: Proceedings of the 5th World Conference on Smoking and Health, Nosbakken D (Ed), 1984
Mullis RM, Lansing D: Using Focus Groups to Plan Worksite Nutrition Programs. J Nutr Educ, Special Supplement, 18(2):32-33, 1986
Mullis RM, Perry CL, Pirie PL: A Model for Levels of Community Health Promotion. In: Coates AY and Frankle RT (Eds), Nutrition in the Community: The Art of Delivering Services, 2nd Edition. St. Louis: Times Mirror/Mosby College Publishing, 1986
Blackburn H: Atherosclerosis and Coronary Heart Disease. Strategy for Change: A Population Approach to Prevention. In: Fidge NH, Nestel PJ (Eds), Atherosclerosis VII. New York: Elsevier Science Publishers B.V., pp 15-17, 1986
Murray DM, Leupker RV, Grimm R, Blackburn H: Prevention and Treatment of Hypertension at a Community Level: The Minnesota Heart Health Program. In: Horan MJ, Shkvatsabaya IK (Eds), Hypertension: Psychophysiological, Biobehavioral, and Epidemiological Aspects. NIH Publication No. 86-2704, Washington, DC: U.S. Government Printing Office, pp 183-191, 1986
Luepker RV, Murray DM, Prineas RJ: Primary Prevention of Hypertension in Youth: A Population Approach. In: Horan MJ, Shkvatsabaya IK (Eds), Hypertension: Psychophysiological, Biobehavioral, and Epidemiological Aspects. NIH Publication No. 86-2704, Washington, DC: U.S. Government Printing Office, pp 211-226, 1986
Luepker RV: Coronary Heart Disease Risk Factor Reduction in the Elderly. Quality of Life and Cardiovascular Care, 2(4):159-175, 1986
Luepker RV: Prevention of Cigarette Smoking. In: Feldman DA, Stiffman AR (Eds), Advances in Adolescent Mental Health. Greenwich, CT: JAI Press, Inc, 1986
Blake SM, Jeffery RW, Finnegan JR, Crow RS, Pirie PL, Ringhofer KR, Fruetel JR, Caspersen CJ, Mittelmark MB: Process Evaluation of a Community-Based Physical Activity Campaign: The Minnesota Heart Health Program Experience. Health Educ Research, 2(2):115-121, 1987
Finnegan JR, Loken B, Howard-Pitney B: Using Direct Mail to Bridge 'Knowledge Gaps' in Communication About Health. J Direct Marketing, 1(Summer):3, 1987
Loken B, Pirie PL, Virnig K, Hinkle R, Salmon CT: The Use of 0-10 Scales in Telephone Surveys. J Market Res Society, 29(3):353-362, 1987
Mullis RM, Hunt MK, Foster M, Hachfeld L, Lansing D, Synder P, Pirie P: Environmental Support of Healthful Food Behavior: The Shop Smart For Your Heart Grocery Program. J Nutr Educ, 19(5):225-228, 1987

ClinicalTrials.gov Identifier: NCT00005150     History of Changes
Other Study ID Numbers: 1021
Study First Received: May 25, 2000
Last Updated: June 23, 2005
Health Authority: United States: Federal Government

Additional relevant MeSH terms:
Cardiovascular Diseases
Cerebral Infarction
Coronary Artery Disease
Coronary Disease
Heart Diseases
Hypertension
Infarction
Myocardial Infarction
Stroke
Arterial Occlusive Diseases
Arteriosclerosis
Brain Diseases
Brain Infarction
Brain Ischemia
Central Nervous System Diseases
Cerebrovascular Disorders
Ischemia
Myocardial Ischemia
Necrosis
Nervous System Diseases
Pathologic Processes
Vascular Diseases

ClinicalTrials.gov processed this record on October 23, 2014