***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES This paper presents a prospect i ve examination of sociodemographic , psychosocial , and physiologic characteristics associated with positive change in cardiovascular disease risk factors during a 6-year multiple risk factor intervention study . METHODS Data are presented on 221 women and 190 men ( aged 25 through 74 years ) who participated in four cohort surveys ( 1979 through 1985 ) . A signal detection model was used to identify baseline variables that best divide the sample into subgroups on the basis of the probability of positive change in a composite risk factor score . RESULTS Sixty-nine percent of the respondents showed a positive change in risk factor score during the intervention . The subgroup with the highest proportion of positive changers ( 83 % ) was composed of older adults ( > 55 years ) with the highest perceived risk , highest health media use , and highest blood pressure and cholesterol levels . The subgroup with the lowest proportion of positive changers ( 42 % ) was the least educated , was the most likely to be Hispanic , and had the lowest health knowledge and self-efficacy scores . CONCLUSIONS The differing composition of subgroups who respond or do not respond to community cardiovascular disease interventions illustrates the need to develop specific interventions that target different age , socioeconomic , and cultural subgroups A comprehensive community based programme to control cardiovascular diseases was started in North Karelia , Finl and , in 1972 . Reductions in smoking , serum cholesterol concentrations , and blood pressure were among the central intermediate objectives . The effect of the programme during the 10 year period 1972 - 82 was evaluated by examining independent r and om population sample s at the outset ( 1972 ) and five ( 1977 ) and 10 ( 1982 ) years later both in the programme and in a matched reference area . Over 10 000 subjects were studied in 1972 and 1977 ( participation rate about 90 % ) and roughly 8000 subjects in 1982 ( participation rate about 80 % ) . Analyses were conducted of the estimated effect of the programme on the risk factor population means by comparing the baseline and five year and 10 year follow up results in the age range 30 - 59 years . The effect of the programme ( net reduction in North Karelia ) at 10 years among the middle aged male population was estimated to be a 28 % reduction in smoking ( p less than 0.001 ) , a 3 % reduction in mean serum cholesterol concentration ( p less than 0.001 ) , a 3 % fall in mean systolic blood pressure ( p less than 0.001 ) , and a 1 % fall in mean diastolic blood pressure ( p less than 0.05 ) . Among the female population the reductions were respectively , 14 % ( NS ) , 1 % ( NS ) , 5 % ( p less than 0.001 ) , and 2 % ( p less than 0.05 ) . During the first five years of the project ( 1972 - 7 ) the programme effectively reduced the population mean values of the major coronary risk factors . At 10 years the effects had persisted for serum cholesterol concentrations and blood pressure and were increased for smoking The National Research Program 1 A on " Primary Prevention of cardiovascular disease in Switzerl and ' was design ed to determine whether community health education can reduce cardiovascular risk factors in the population . Two communities ( 12,000 inhabitants each ) in the French speaking and two ( 16,000 inhabitants each ) in the German speaking part of the country were selected either for intervention or comparison . Following baseline screening in 1977 ( stratified r and om sample s ) and the community intervention program ( 1978 - 1980 ) , a final assessment on the initial participants was performed at the end of 1980 . Amongst the regular smokers , 26,2 % stopped during this period in the intervention communities whereas 18,1 % did so in the reference cities . 4,7 % of non-smokers began to smoke during the same period in the intervention communities whereas 7,8 % did so in the reference cities . Plasma thiocyanate measurement suggested reliable answers on smoking status . These results suggest that  community health education  may be effective in preventing harmful health consequence of smoking Abstract Objectives : To estimate the extent to which changes in the main coronary risk factors ( serum cholesterol concentration , blood pressure , and smoking ) explain the decline in mortality from ischaemic heart disease and to evaluate the relative importance of change in each of these risk factors . Design : Predicted changes in ischaemic heart disease mortality were calculated by a ligistic regression model using the risk factor levels assessed by cross sectional population surveys , in 1972 , 1977 , 1982 , 1987 , and 1992 . These predicted changes were compared with observed changes in mortality statistics . Setting : North Karelia and Kuopio provinces , Finl and . Subjects : 14 257 men and 14 786 women aged 30–59 r and omly selected from the national population register . Main outcome measures : Levels of the risk factors and predicted and observed changes in mortality from ischaemic heart disease . Results — The observed changes in the risk factors in the population from 1972 to 1992 predicted a decline in mortality from ischaemic heart disease of 44 % ( 95 % confidence interval 37 % to 50 % ) in men and 49 % ( 37 % to 59 % ) in women . The observed decline was 55 % ( 51 % to 58 % ) and 68 % ( 61 to 74 ) respectively . Conclusion : An assessment of the data on the risk factors for ischaemic heart disease and mortality suggests that most of the decline in mortality from ischaemic heart disease can be explained by changes in the three main coronary risk factors BACKGROUND This article provides a descriptive overview of the implementation process of the Heart , Body , and Soul program . The program objective was to test strategies to reduce the prevalence of cigarette smoking among urban African Americans in East Baltimore . METHOD This study constitutes a prospect i ve r and omized trial among inner-city African Americans design ed to improve quit rates among church attenders . A r and om-digit-dialing survey was conducted to establish baseline levels of self-reported cigarette smoking , examine attendant attitudes , and determine the presence of known cardiovascular risk factors among community residents of the catchment area . A similar survey was conducted among churchgoers to establish a baseline . Twenty-two churches were recruited and r and omly assigned to either intensive or minimal ( self-help ) intervention strategies . Baseline health screenings were held in all participating churches . Innovative culturally specific smoking cessation strategies mediated through lay volunteers from participating churches were implemented in the intensive intervention churches . RESULTS Pastors of all churches were directly involved in all aspects of the planning and implementation process . A total of 29 volunteer lay smoking-cessation specialists were trained and successfully implemented the intensive interventions in churches . An additional 272 church members were trained to conduct their church 's health screenings . CONCLUSION The essential component of this successful implementation process were building trust and acceptance and providing the technical support to encourage smoking-cessation strategies . This description of the project is presented to assist others involved in church-based trials in urban African American communities The Belgian Heart Disease Prevention Project is a controlled , multifactorial prevention trial involving 19,390 males aged 40–59 years employed by 30 Belgian industries . These industries were paired and r and omized into a control or intervention unit . In each intervention factory , the subjects from the two highest deciles of a coronary risk-score distribution curve were given individual advice twice a year . A health education campaign was also organized in each intervention factory . In the control group , 10 % of r and omly chosen subjects had the same baseline examination as the whole of the intervention group . After 2 years , high-risk subjects and r and om sample s of the control and intervention group were compared regarding the coronary risk profile by means of a multiple logistic function ( MLF ) . In the intervention high-risk group , the MLF showed a decrease of 20 % , and in the control group there was an increment of 12.5 % ( p < 0.001 ) . Comparing the r and om sample s an increment of 25 % was found in the control group vs a drop of 2.26 in the intervention group ( p < 0.001 ) . The coronary risk profile can be altered in a middle-aged male working population through mass media health education supplemented by face-to-face counseling in high-risk subjects Purpose . To present an evaluation of a 5-year , community-based , chronic disease prevention project managed by a state health department to determine whether the department could replicate similar previous projects that had received more funding and other re sources . Design . The evaluation used a matched comparison design and a review of archive and interview data . Setting . Florence , South Carolina ( population : 56,240 ) . Subjects . A r and om sample of 1642 persons in Florence ( and 1551 in the comparison ) who responded to a risk factor question naire and underwent a physical assessment ; 70 . 7 % of baseline subjects participated in the postintervention . Forty key persons were interviewed concerning project effectiveness . Interventions by Project . Walk-a-thons , a speakers ' bureau , media messages , restaurant food labeling , and cooking seminars .  More than 31,000 participants were involved in 585 activities . Measures . Question naires focused on hypertension , obesity , high cholesterol , smoking , and exercise . Physical assessment s determined lipid , lipoprotein , apolipoprotein , and blood pressure levels . Analysis of covariance was used for baseline and postintervention comparisons . Content analysis was used on archive and interview data . Results . The project had a slightly favorable intervention effect on cholesterol and smoking , but failed to have an effect on other risk factors for cardiovascular disease . The project influenced community awareness , enlisted influential community members , and fostered linkages among local health services . Conclusions . Health departments can be instrumental in community risk reduction programming ; however , they may not replicate projects having greater re sources Few studies have prospect ively examined the characteristics associated with worksite adoption of tobacco-control initiatives .  Data were collected as part of the Community Intervention Trial ( COMMIT ) for Smoking Cessation , which conducted interventions in 11 communities . This smoking cessation intervention was based on community organization principles and delivered through multiple community channels , including worksites , health care providers , the media , and cessation re sources . This article reports results from telephone interviews of intervention community worksites having 50 or more employees , conducted at baseline and the end of the intervention period . Among worksites that responded to both baseline and final surveys , 83 % had not adopted a smoke-free policy at baseline , and 61 % did not offer any cessation aid or quitting re sources at baseline . By the final survey , 34 % of those with no smoking ban at baseline had become smoke-free , and 36 % of those offering no cessation assistance at baseline were offering cessation re sources at the follow-up . The prevalence of policy adoption was higher among worksites employing more female employees and offering other health-promotion activities ; manufacturing businesses were significantly less likely than businesses other than service and wholesale/retail businesses to adopt policies . Adoption of cessation programs was significantly more likely among worksites employing 100 to 249 workers , compared with those employing 50 to 99 workers ; those predominantly employing men ; those offering other types of health-promotion activities ; and those with a higher rate of turnover . These results provide important information about the characteristics of worksites likely to engage in tobacco-control efforts . Health educators and others may choose to target those worksites most ready for adoption of tobacco control policies and programs , as indicated by these findings Since 1985 a small-scale community-based cardiovascular disease ( CVD ) preventive programme has been in operation in an inl and municipality , Norsjö , in Northern Sweden . The aim of this study was to assess the development of the relationship between social position and CVD risk factors in repeated cross-sectional surveys ( 1985 - 1990 ) among all men and women aged 30 , 40 , 50 and 60 years in the study area , using an age-stratified r and om sample from the Northern Sweden MONICA Study of 1986 and 1990 as reference population . These multiple cross-sectional surveys comprised a self-administered question naire and a health examination . Of the study population 95 % ( n = 1499 ) and 80 % of those in the reference area ( n = 3208 ) participated . Subjects were classified with regard to demographic , structural and social characteristics in relation to CVD risk factors and self-reported health status . Time trends in classical risk factor occurrence were assessed in terms of age- and sex- adjusted odds ratios using Mantel-Haenszel procedures . When simultaneously adjusting for several potential confounders we used a logistic regression analysis . Initially , more than half of the study population , both males and females , had and elevated ( > or = 6.5 mmol/l ) serum cholesterol level . After adjustments had been made for age and social factors it was found that the relative risk of hypercholesterolaemia dropped substantially and significantly among both sexes during the 6 years of CVD intervention in the study area . However , the probability of being a smoker was significantly reduced only in highly educated groups . Among other risk factors no single statistically significant change over time could be found . In the reference area there were no changes over time for the selected CVD risk factors . People in the study area had a less favourable perception of their health than those in the reference area . Social differences were found when perceived good health was measured , especially in variables indicating emotional and social support . When sex , age and social factors had been accounted for there was not clear change over the years in perceived good health INTRODUCTION Our objectives were ( 1 ) to examine the 
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The two most rigorous studies showed limited evidence of an effect on prevalence .
In the US COMMIT study there was no differential decline in prevalence between intervention and control communities , and there was no significant difference in the quit rates of heavier smokers who were the target intervention group .
In the Australian CART study there was a significantly greater quit rate for men but not women .
REVIEW ER 'S CONCLUSIONS The failure of the largest and best conducted studies to detect an effect on prevalence of smoking is disappointing .