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Preventing health problems at the community level and evaluating the effectiveness of community-based prevention present a considerable challenge in behavioral science research. The best known community-based prevention trials to date include those undertaken to reduce cardiovascular disease (CVD) and cancer. Health professionals now have accumulated over 20 years of experience in community programs to prevent chronic diseases. Some studies successfully reduced risk factors in high-risk subsets of the population and were carried out in clinical settings or in work sites (Benfari 1981). Other studies, directed at entire populations in communities, used comprehensive approaches combining community organizations and multichannel health education (Carlaw et al. 1984; Farquhar et al. 1990; Puska et al. 1985).’

Evaluating Efforts To Reduce Community-Level Problems Through Structural Rather Than Individual Change