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Erica Frank, MD, MPH; Marilyn A. Winkleby, PhD; Stephen P. Fortmann, MD; Beverly Rockhill, MA; John W. Farquhar, MD

JAMA. 1992;268(12):1566-1572.

Abstract
Objectives.
—To determine whether cholesterol-related knowledge and behavior and plasma cholesterol levels were stable until the inception of large-scale national interventions in the middle to late 1980s, whether they subsequently improved, and whether these levels varied by subgroups.

Design, Setting, and Participants.
—Data were collected from 4173 adults aged 25 through 74 years in the two control cities (San Luis Obispo and Modesto, Calif) of the Stanford Five-City Project. Five separate, community-based surveys were conducted in 1979-1980,1981-1982,1983-1984,1985-1986, and 1989-1990.

Results.
—Cholesterol-related knowledge and behavior and plasma cholesterol levels improved (P=.0001) in both cities after the early 1980s. Those who were more educated, female, older, or nonsmokers had significantly higher knowledge and behavior scores, and those who were younger, more educated, or normotensive had significantly lower plasma cholesterol levels.

Conclusion.
—Improvements in this population's cholesterol-related knowledge and behavior and plasma cholesterol levels began in 1985-1986, suggesting that the extensive cholesterol interventions that began in the middle 1980s in the United States created positive cholesterol-related changes at the community level.

(JAMA. 1992;268:1566-1572)

Author Affiliations
From the Stanford (Calif) Center for Research in Disease Prevention and the Department of Medicine, Stanford University School of Medicine.

Footnotes
Reprint requests to Stanford Center for Research in Disease Prevention, 1000 Welch Rd, Palo Alto, CA 94304-1885 (Dr Fortmann).

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