The role of behavioral change procedures in multifactorial coronary heart disease prevention programs.

Coronary risk factor screening and health education programs have constituted the mainstay of intervention in the large-scale community and clinic-based multifactorial CHD intervention trials which have been conducted in recent years. Community-based trials involving intervention along these lines have generally reported significant improvements in self-reported smoking patterns, slight improvements in blood pressure and serum lipid levels, and negligible changes in weight and physical fitness. The findings of controlled clinic-based trials involving nonbehavioral intervention have generally been only slightly more encouraging. Of note are the impressive findings of the Oslo Study (52), in which intervention involving brief personalized counseling and coronary risk factor assessment at 6-monthly intervals resulted in markedly greater improvements in mean serum cholesterol levels (13%) and the prevalence of smoking (15%) than was a case for the "no treatment" control group. The greater improvements in cigarette smoking were validated using serum thiocianate levels. The findings of both the North Karelia project and the MRFIT suggest behavioral intervention to be superior to traditional "exhortative" (i.e., screening; health education; medical counseling) procedures in achieving lasting improvements in the primary coronary risk factors (i.e., blood pressure, serum cholesterol, and cigarette smoking), but to be similarly ineffectual in changing the secondary risk factors (i.e., body weight, physical fitness). The issues of cost effectiveness, and the role of particular behavioral techniques in achieving lasting improvements in target coronary risk-related behaviors remain to be researched.