Wendel-Vos G C Wanda, Dutman Alice E, Verschuren W M Monique, Ronckers Emma T, Ament Andre, van Assema Patricia, van Ree Jan, Ruland Erik C, Schuit Albertine J
National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Am J Prev Med. 2009 Jul;37(1):50-6. doi: 10.1016/j.amepre.2009.03.015.
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).
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.
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<or=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).
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.
基于社区的健康促进是公共卫生领域广泛倡导的一种改善生活方式的策略。本研究旨在调查一项心血管疾病预防项目（哈特斯拉格林堡项目）在干预5年（1998 - 2003年）后对生活方式因素产生的净效应。
在一项队列研究中，比较了干预区（n = 2356）和对照区（n = 758）的男性和女性、低教育水平（低于中等教育程度）以及中等（中等职业或高中教育程度）或高教育水平（高等职业教育或大学教育程度）人群在生活方式因素（能量摄入、脂肪摄入、休闲时间体育活动时间、步行、骑自行车和运动以及吸烟行为）方面5年的平均变化。对年龄以及所研究变量干预前后个体测量值的均值进行了调整。在按性别分层时，对教育水平进行了调整，反之亦然。
总体而言，对照组的生活方式因素变化不利，而干预组的变化不那么明显或没有变化。干预组与对照组在生活方式因素平均变化方面的调整差异具有统计学意义（p≤0.05），具体表现为：能量摄入（女性和低教育水平人群均为每天 - 0.2兆焦耳）；脂肪摄入（女性为每天 - 2.5克，低教育水平人群为每天 - 3克）；步行时间（女性每周增加2.2小时，低教育水平人群每周增加2.3小时）；总休闲时间体育活动时间（女性每周增加2.1小时）；骑自行车时间（低教育水平人群每周增加0.6小时）。
哈特斯拉格林堡社区干预成功预防了能量摄入、脂肪消耗、步行和骑自行车方面与年龄和时间相关的不利变化，尤其是在女性和社会经济地位较低的人群中。
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