Lifestyle factors are important in the development of chronic diseases, such as heart disease, respiratory disease, and diabetes, and chronic disease risk can be reduced by changes in lifestyle behaviors linked to these conditions. The use of mass media and community-wide strategies targeting these behaviors has been extensively evaluated since the 1970s. This review summarizes some examples of interventions and their use of media conducted within the old communications landscape of the 1970s and 1980s and the key lessons learned from their design, implementation, and evaluation. We then consider the potential and evidence base for using contemporary technology applications and platforms-within the new communications landscape-to improve the prevention and management of lifestyle-related chronic diseases in the future. We discuss the implications and adaptation of lessons derived from the ways in which new technologies are being used in commercial and political contexts and their relevance for public health. Finally, we consider some recent examples of applying new technologies to public health issues and consider some of the challenges in this rapidly developing field.
COMMUNITY INTERVENTIONS CONDUCTED WITHIN THE OLD COMMUNICATIONS LANDSCAPESeminal epidemiological studies of the 1950s and 1960s (33, 38) demonstrated the influence of lifestyle-related factors in the development of chronic diseases, such as cancers and heart and respiratory diseases. The potential to ameliorate the risk and burden of lifestyle-related chronic disease using lifestyle-based behavior change strategies was soon realized and continues to this day (47). In developed countries, theory-based community interventions targeting lifestyle-related behavior risk factors commenced in the 1970s and have continued to the present day.
Community Studies in the 1970sThe North Karelia Project, Finland. In the early 1970s, Finland had one of the highest cardiovascular disease (CVD) mortality rates in the world. The North Karelia Project started in 1972 as a national pilot and demonstration program aimed at reducing population levels of wellestablished CVD risk factors and thus the incidence of CVD (73,103). This comprehensive, community-wide intervention program utilized multiple lifestyle change strategies, including use of the state-of-the-art mass media of that time-that is, radio, television, billboards, newspapers, magazine articles, pamphlets, and other printed materials-combined with environmental and legislative approaches. The project developed and evaluated a model that systematically addressed the steps leading to changes in social norms and community-wide behavior change. After the initial intervention phase (1972)(1973)(1974)(1975)(1976)(1977), the project findings and lessons were further adapted and more widely implemented to develop a comprehensive national heart health program in Finland.An evaluation involving population surveys and disease registers showed that the population risk factor levels in Finland were greatly redu...