Many atherosclerosis risk factors relate closely to individual behavior. Individual behavior reflects personal choices for behavior as modified by a complex set of factors both in the immediate environment and in the cultural environment of the person. This proposal is for a research program with an intervention and a comparison city. The intervention city will have an opportunity for citizens to participate actively through a penetrating community organization effort based upon the normative systems model. This community activation effort for health culture change will be aided by media and by research development of new strategies for individual behavior change. It will work with and through all major groups and organizations within the community including schools, government, labor, industry, churches, etc. The effectiveness of the process itself will be evaluated carefully. Short-term, mid-term, and long-term evaluation will include measuring outcomes of individual program components, survey for changes in physiologic variables such as serum cholesterol, and ongoing surveillance of morbidity and mortality in the intervention and comparison cities. The overall objective is to produce a significant reduction in morbidity and mortality from coronary heart disease and stroke. Equally importantly, the program aims to induce a cultural change process which will persist long after funding for research and development has ceased.
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