Background: There is a consensus today that comprehensive public health activities including many actors are needed for impact on health compromising behaviors. However, few studies are available to document long term effects regarding youth. We identified three rural, demographically comparable communities dominated by nuclear middle class families. One of these communities demonstrated comprehensive public health activities directed towards adolescents' needs and life-styles for a duration of at least 15 years, while the other two had an outspoken ideology of relying only on national health promotion.
Methods: Local health planners and pediatricians performed in-depth interviews with key people and checked relevant reports to trace the local public health history and to assess conventional and unconventional activities regarding health promotion for adolescents in the three communities. The outcome of at least 15 years of different policy regarding health promotion was studied in 1991 through self-reports of 915 subjects, 13-16 years old, with a questionnaire distributed through schools with questions on health, health habits and health compromising behaviors. The study itself turned out to be an important intervention. The two "inactive" communities changed their policy and methods. For this reason a second survey was done in 1993 with 593 subjects 13-16 years in the "active" and in one of the "inactive" communities.
Results: The adolescents in the "active" community with a long duration of energetic and comprehensive public health activities consistently demonstrated better mental health, health habits and less risk behavior in contrast to the state in the two "inactive" communities. Two years of active work in the "inactive" communities marginally improved health there.
Conclusion: This study suggests that consistent and comprehensive public health activities might have reduced risk taking behavior and improved health and health habits during mid-adolescence.