Elevated serum cholesterol is a risk factor for coronary heart disease (CHD) (1,2). From 1983 through 1990, the percentage of persons who had their cholesterol measured--a first step in reducing risk for CHD from serum cholesterol-increased nationwide (3). Changes in patterns had not been monitored specifically in rural areas, where access to medical care and other socioeconomic barriers may hinder receipt and use of cholesterol screening (4,5). To monitor trends in cholesterol awareness and other risk factors for cardiovascular disease among persons who live in rural and urban settings in Missouri, Washington University and the Missouri Department of Health (MDH) analyzed 1988-1991 Behavioral Risk Factor Surveillance System (BRFSS) data for Missouri (6).