The North Karelia Youth Programs.

Two family-based and two community- and school-based studies have been done in the province of North Karelia in eastern Finland. In the two family-based studies it was possible to decrease serum cholesterol level among children by 15%, showing that to a great extent the extremely high blood cholesterol level among Finnish children can be explained mainly by the typical Finnish diet high in saturated fat. In the first North Karelia Youth Project it was possible to affect the onset of smoking among adolescents. Two years after the program, smoking was about 30% less common in the intervention school than in the reference schools. In the eighth-year follow up survey the effect of the teacher-delivered program was still seen. In the second North Karelia Youth Project it was possible to delay the onset of smoking during the seventh grade but no permanent effect was seen. Diet was changed more among the program school students than in the reference school. These studies, done during the last 10 years, show the cardiovascular risk factors can be reduced among children and adolescents. The next main question is how to use these findings in the normal school and health care system. We have started the National Healthy School Program in Finland to assess the extent to which these programs can be implemented on the national level.

Results of a one-year worksite and mass media based intervention on health behaviour and chronic disease risk factors.

The North Karelia Worksite Intervention Study was carried out to assess the effectiveness of worksite-based innovative intervention on chronic disease risk factors. The one-year intervention combined use of mass media, worksite opinion leaders, risk assessment and counselling and other health education measures. The study used eight medium sized intervention worksites (IW) and eight matched reference worksites (RW). Of the 715 workers 91% participated in the initial survey, and out of these 89% in the one-year follow-up survey. The proportion of current smokers changed from 39% to 30% (p less than 0.05) at the IWs while no change took place at the RWs (33%). The effect on smoking was confirmed by serum thiocyanate analyses. An additive score of the three main CHD risk factors changed from 3.1 to 2.7 at the IWs and from 3.2 to 3.0 at the RWs (p less than 0.05 for the net change). The results and experiences showed the feasibility of the intervention and significant, although modest, effects on risk factors and health behaviour, notably smoking.

Use of lay opinion leaders to promote diffusion of health innovations in a community programme: lessons learned from the North Karelia project.

PIP: This article describes the systematic use of lay opinion leaders in the North Karelia project, a comprehensive community-based preventive cardiovascular program in Finland. Over 800 lay opinion leaders were trained to promote the reduction of heart disease risk factors and, after approximately 4 years, a survey was conducted to assess the long-term feasibility and self-reported effects. 267 of the 399 active lay workers surveyed were women; their median age was 52 years. The median age of the men was 50. 86% of the lay workers were married, and the majority lived in large villages. On the average they were members of 4 different associations or organizations and had acted as lay health workers for an average of 4 years. About 10% of these workers stated that they had had coronary heart disease themselves, and hypertension had been diagnosed in 19%. Only 2% were current smokers. The different types of milk they consumed was 1 indicator of their dietary habits: 14% too no milk at all, 23% skim milk/butter milk, 27% "low-fat" milk, 13% "consumption" milk (fatty milk), and 23% "full milk" (directly from the farm). 78% said they used butter on their bread. According to the lay workers' findings, 15% responded "very positively" and 60% "positively" in discussions about health matters; only 1% were reported as negative. There was little difference between the answers given by male and female lay workers. Discussions about physical activity were said to be the easiest, all other topics being only relatively easy. Although changes in health behavior were important, these workers saw clearly the difficulties in influencing people to accomplish these changes. Altogether 36% of the lay workers reported that at least 1 person had stopped smoking in association with their efforts, and 3% reported that as many as 6 or more persons had stopped smoking. This means that over 500 persons had over this period of time been influenced by the program to stop smoking. About 15-25% of the lay workers tried to promote action to restrict smoking in local bars, worksites, and at local meeting places. In bars this was rarely successful but in the other places some change often followed. The overall community impact of this volunteer lay worker activity cannot be assessed with certainty, but the overall evaluation of the project interventions in North Karelia from 1972-82 showed a major impact on behaviors and risk factors related to cardiovascular disease, i.e., a 28% reduction in smoking when adjusted for simultaneous changes in a matched reference area and a significant reduction in coronary mortality rates in contrast to the rest of the country.^ieng