Cholesterol reduction in the workplace and in community settings.

Recent emphasis has been placed on the role of serum cholesterol in the development of cardiovascular disease and on reducing high serum cholesterol levels through a screening followed by a behavioral intervention. However, evidence about the effectiveness of this technique in reducing cholesterol has yet to be evaluated. A review of the biomedical and allied health literature was conducted to determine the effectiveness of reducing serum cholesterol levels in the general population through the use of a screening to identify those at risk followed by a behavioral intervention. Only worksite and community based studies published from 1980-89 were reviewed. Seven worksite and four community studies were identified. All studies used total serum cholesterol as the dependent variable while some included other physiological measures. The majority of studies used a multicomponent intervention involving dietary education, exercise, smoking cessation, or weight reduction components. The interventions tested lasted from 14 weeks to five years and varied from low intensity to high intensity. The methods of intervention ranged from face-to-face interaction to mail and telephone counseling. Although many of the studies reviewed contain methodological flaws, certain findings are evident. The studies show that cholesterol can be reduced through a screening followed by a behavioral intervention, the multicomponent program is the most effective intervention, and low intensive interventions are as equally effective as high intensive interventions. Program implications and future research directions are discussed.