Effect of health education on dietary behavior: the Stanford Three Community Study

A 2-yr mass media cardiovascular health education program in two communities was followed by a 3rd, maintenance yr of reduced effort. In each community, a representative cohort reported its dietary behavior annually to an interviewer using a questionnaire which estimated daily consumption of cholesterol and fat. Relative weight and plasma cholesterol were also measured annually. Both men and women in the treatment towns reported reductions in dietary cholesterol (23 to 34%) and saturated fat (25 to 30%) which were significantly larger than those reported in a 3rd, control community. Relative weight was increased in the control community when compared to the treatment towns, perhaps as a result of the aging of the cohorts. Similar patterns were observed for plasma cholesterol changes. The 2-yr changes were maintained or increased during the 3rd, maintenance yr. The changes in individual values for plasma cholesterol showed low level correlations with dietary cholesterol and saturated fat, but the association with weight change was more important. These results suggest that mass media health education can achieve lasting changes in diet, obesity, and plasma cholesterol on a community level.