Community heart health programs: components, rationale, and strategies for effective interventions.

Large, well-funded, community heart health programs (CHHPs) have successfully focused on improving the cardiovascular health status of entire communities. CHHPs attempt to reduce the prevalence of risk factors associated with high rates of coronary heart disease mortality: high blood pressure, elevated serum cholesterol, smoking, overweight, and sedentary lifestyle. Program components include community organization, needs assessment, priority and evaluation, and program maintenance. Organizing the community, assessing needs and resources, and setting priorities generally occur concurrently, followed by implementing interventions. CHHP activities include social marketing, direct behavior-change efforts (including skills training, health education, and contingency management), screening (including counseling and referral), and policy and environmental change. Because State-sponsored efforts will seldom have the resources of federally-funded demonstration projects, they must pay particular attention to the "3 As" of community interventions: affordability, acceptability, and adequacy. Attention to these principles and the critical program components outlined in this paper facilitate the planning, development, implementation and evaluation of the next generation of CHHPs.