In 1990, the National High Blood Pressure Education Program (NHBPEP) issued a Request for Proposals for the Stroke Belt Initiative. State Health Departments located in states with age-adjusted stroke mortality rates in excess of 10 percent of the national average were encouraged to initiate projects that assessed high risk target audience needs and to identify opportunities for more effective delivery of medical and/or educational services to reduce the high rate of stroke mortality experienced in the southeastern United States. These states were Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia. In addition, the State of Florida was of interest because of differences in county age-adjusted stroke mortality rates--northern counties in the state experienced mortality rates as high or higher than rates in the Stroke Belt states, whereas southern counties exhibited rates closer to the national average, representing an excellent opportunity for a comparative study.