Trends in cardiovascular disease risk factors by educational level: the Stanford Five-City Project

Prev Med. 1992 Sep;21(5):592-601. doi: 10.1016/0091-7435(92)90067-r.


Background: Trends in blood pressure, smoking, and cholesterol were examined from 1979-1980 through 1985-1986 in four cities in California by level of education (< high school, high school graduate, some college, college or postgraduate).

Methods: Four biennial cross-sectional surveys (n = 6,580) were conducted in two treatment and two control cities to evaluate a 6-year community health education intervention, conducted as part of the Stanford Five-City Project.

Results: Over the 8-year study period, men and women ages 25-74 from each educational group in the treatment cities showed significant declines in smoking prevalence and levels of blood pressure and cholesterol (with the exception of cholesterol in women). In general, declines in the least educated group (< high school) were stronger than declines in the most educated group (college or postgraduate). Similar declines occurred in each educational group in control cities.

Conclusions: These results illustrate that persons from all educational levels can modify their risk for CVD and are of particular importance because of the higher prevalence of CVD risk factors among those with less education. The similarity of time trends in treatment as well as control cities suggests that the broad-based, multisource health education efforts in the United States are succeeding across the educational spectrum.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Blood Pressure / physiology
  • California / epidemiology
  • Cardiovascular Diseases / epidemiology*
  • Cholesterol / blood
  • Cohort Studies
  • Cross-Sectional Studies
  • Educational Status*
  • Female
  • Health Education
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Regression Analysis
  • Risk Factors
  • Smoking / epidemiology


  • Cholesterol