Residents of rural Franklin County, Maine who were enrolled in a sustained, community-wide education program targeting cardiovascular risk factors and behavior changes saw reductions in hospitalization and death rates over a 40 year period (1970 to 2010), compared with residents in the rest of the state, results of a study published in JAMA indicate.

Few comprehensive cardiovascular risk reduction programs, especially those in rural, low-income areas, have sustained community-wide interventions for more than 10 years. Not many programs have demonstrated improvements in known cardiovascular risk factors and reductions in illness and death, noted the study authors.

To study the health outcomes associated with a comprehensive cardiovascular risk reduction program in Franklin County, Maine, N. Burgess Record, MD, of Franklin Memorial Hospital in Farmington, Maine, and colleagues followed participants enrolled in the community-wide Franklin Cardiovascular Health Program (FCHP) in 1974.

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The programs educated the participants on hypertension, cholesterol, and smoking, as well as diet and physical activity. The current analysis included residents of Franklin County (n=22,444 in 1970), and used the preceding decade as a baseline and compared Franklin County with other Maine counties and state averages.

The FCHP screened about 50% of Franklin County adults in its first four years. Individuals with hypertension showed significant movement from detection to treatment and blood pressure control; the proportion in control increased from 18.3% to 43.0% from 1975 to 1978, an absolute increase of 24.7%.

After introducing cholesterol screening in 1986, FCHP reached 40% of county adults within five years, half of whom had elevated cholesterols. Over subsequent decades, cholesterol control had an absolute increase of 28.5%, from 0.4% to 28.9%, from 1986 to 2010.

Similarly, after initiation of multiple community smoking cessation projects, community-wide smoking quit rates improved significantly, from 48.5% to 69.5%, and became significantly higher than that for the rest of Maine; these differences later disappeared when Maine’s overall quit rate increased.

Franklin County hospitalizations per capita were less than expected for the period 1994 to 2006. The lower overall hospitalization rates were associated with $5,450,362 reductions in total in- and out-of-area hospital charges for Franklin County residents per year.

“Further studies are needed to assess the generalizability of such programs to other U.S. county populations, especially rural ones, and to other parts of the world.”


  1. Record NB et al. JAMA. 2015; doi: doi:10.1001/jama.2014.16969