Lifestyle Factors of a Five-Year Community-Intervention Program

Background

Community-based health promotion is a widely advocated strategy in public health to favorably alter lifestyle. The aim of this study was to investigate the net effect of a cardiovascular disease–prevention program (Hartslag Limburg) on lifestyle factors after 5 years of intervention (1998–2003).

Methods

In a cohort study, 5-year mean changes in lifestyle factors (energy intake; fat intake; time spent on leisure-time physical activity; walking, bicycling, and sports; and smoking behavior) between subjects from the intervention area (n=2356) and the control area (n=758) were compared for men and women and for those with a low (less than intermediate secondary education) and a moderate (intermediate vocational or higher secondary education) or high (higher vocational education or university) educational level. Adjustments were made for age and the mean of the individual pre- and post-intervention measurement of the variable under study. When stratifying for gender, adjustments were made for educational level, and vice versa.

Results

In general, lifestyle factors changed unfavorably in the control group, whereas changes were less pronounced or absent in the intervention group. The adjusted difference in mean change in lifestyle factors between the intervention group and the control group was significant (p≤0.05) for energy intake (−0.2 megajoule per day among both women and those with a low educational level); fat intake (−2.5 grams per day [g/d] among women and −3 g/d among those with a low educational level); time spent walking (+2.2 hours per week [hrs/wk] among women and +2.3 hrs/wk among those with a low educational level); time spent on total leisure-time physical activity (+2.1 hrs/wk among women); and time spent bicycling (+0.6 hrs/wk among those with a low educational level).

Conclusions

The community intervention Hartslag Limburg succeeded in preventing age- and time-related unfavorable changes in energy intake, fat consumption, walking, and bicycling, particularly among women and those with low SES.

Introduction

Cardiovascular diseases (CVD) are a major cause of disability and ill health, and the associated social and economic costs are high.¹ Extensive international research2, 3, 4 has shown that the majority of CVD risk factors are related to lifestyle. A widely advocated strategy in public health to favorably alter lifestyle is community-based health promotion.

In the Netherlands, some—but not all—community interventions have been shown to be successful, at least to a certain extent.5, 6, 7, 8 Merzel and D'Afflitti⁹ identified several reasons for the generally modest effects found in studies evaluating community-based prevention trials. One of the reasons is concurrent secular trends. It is the authors' understanding that these secular trends can also be found in age- and time-related changes—for example, in physical activity and blood pressure. Therefore, when targeting such risk factors with an intervention over a longer period of time, researchers must be aware of the challenges of overcoming these age-related secular trends before finding a net effect of the particular intervention.

In 1998, the Hartslag Limburg community intervention (hereafter, Hartslag Limburg) started in the Maastricht region of the province of Limburg in the Netherlands, which is one of the regions in the Netherlands that shows death rates from cardiovascular diseases above the country's average. Recently, the effects of Hartslag Limburg were published regarding biomedical risk factors for cardiovascular diseases.¹⁰ The aim of the present study was to investigate the effect of Hartslag Limburg on lifestyle factors after 5 years of intervention (1998–2003). Mean changes in diet, physical activity, and smoking among men and women in the intervention region were compared to mean changes among men and women in a control region. In addition, analyses stratified by educational level were conducted.