The Stanford Five-City Project is an ongoing 13-year study involving two intervention and three control communities that began in 1978 as an outgrowth of the Three-Community Study. Although the primary goal of the Five-City Project is to reduce the risk of CVD, other important subsidiary goals include an analysis of the program's cost-effectiveness, development of educational and community organization methods, transfer of control to community organizations, and measurement of morbidity and mortality. Interim results of the project show a promising reduction in risk factors. The next step should be to learn how to replicate these results in disorders other than CVD.

The lessons learned from these studies can be summarized as follows:

Theory should be used as a basis for an national drug abuse helpline planning, implementation, and evaluation; in addition, drawing from several disciplines may increase the strength of the theoretical framework that eventually results.

A comprehensive, integrated program to help drug addicts is needed when the target of the intervention is an entire population rather than high-risk individuals alone.

Formative and process evaluation is required. In the Stanford studies, such evaluation included needs analysis, pretesting of educational programs, and analysis of the implementation process following the introduction of the programs into the community.

An extensive evaluation of outcome is essential and must be conducted using validated measures of the occurrence of risk-related behaviors and behavior change. These evaluations should include three levels of analysis: the individual, organizations, and the community.

There have also been successful campaigns in several other health-related areas. For example, a campaign to promote seat belt use indicated that legislation combined with work site-based incentives and education could promote some types of behavior change. A cancer prevention program sponsored by the National Cancer Institute in collaboration with the Kellogg Company provoked a demonstrable interest in dietary change. Some smoking prevention and cessation programs have achieved a degree of success. In addition, there have been several school-based programs that have apparently reduced adolescent pregnancies. The guiding principles offered by these campaigns, which may be applicable to programs to prevent alcohol problems, include the necessity to establish multiple outcome objectives and to design programs to meet the needs of the target population. Furthermore, these programs show that a potential exists for a beneficial, synergistic effect when several approaches are combined-for example, in the case of seat belt use, both legislation and education.

The growing evidence of success in these other fields makes it probable that the prevention of some alcohol problems can be effected through the use of similar methods. The generalization of principles from these efforts should be a carefully planned endeavor involving formative evaluation, pilot testing, behavioral analysis, and the critical review of research. In addition, the methodological issues noted below must be addressed.

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