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Gregory W. Heath, Ross C. Brownson, Judy Kruger, Rebecca Miles, Kenneth E. Powell, Leigh T. Ramsey and the Task Force on Community Preventive Services

Background:

Although a number of environmental and policy interventions to promote physical activity are being widely used, there is sparse systematic information on the most effective approaches to guide population-wide interventions.

Methods:

We reviewed studies that addressed the following environmental and policy strategies to promote physical activity: community-scale urban design and land use policies and practices to increase physical activity; street-scale urban design and land use policies to increase physical activity; and transportation and travel policies and practices. These systematic reviews were based on the methods of the independent Task Force on Community Preventive Services. Exposure variables were classified according to the types of infrastructures/policies present in each study. Measures of physical activity behavior were used to assess effectiveness.

Results:

Two interventions were effective in promoting physical activity (community-scale and street-scale urban design and land use policies and practices). Additional information about applicability, other effects, and barriers to implementation are provided for these interventions. Evidence is insufficient to assess transportation policy and practices to promote physical activity.

Conclusions:

Because community- and street-scale urban design and land-use policies and practices met the Community Guide criteria for being effective physical activity interventions, implementing these policies and practices at the community-level should be a priority of public health practitioners and community decision makers.

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Rebecca L. Vivrette, Laurence Z. Rubenstein, Jennifer L. Martin, Karen R. Josephson and B. Josea Kramer

Objective:

To determine seniors’ beliefs about falls and design a fall-risk self-assessment and educational materials to promote early identification of evidence-based fall risks and encourage prevention behaviors.

Methods:

Focus groups with community-dwelling seniors, conducted in two phases to identify perceptions about fall risks and risk reduction and to assess face validity of the fall-risk self-assessment and acceptability of educational materials.

Results:

Lay perception of fall risks was in general concordance with evidence-based research. Maintaining independence and positive tone were perceived as key motivators for fall prevention. Seniors intended to use information in the educational tool to stimulate discussions about falls with health care providers.

Implications:

An evidence-based, educational fall-risk self-assessment acceptable to older adults can build on existing lay knowledge about fall risks and perception that falls are a relevant problem and can educate seniors about their specific risks and how to minimize them.

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Pia Laukkanen, Markku Kauppinen and Eino Heikkinen

Identifying predictors of functional limitations among the elderly is essential for planning and implementing appropriate preventive services. The purpose of this prospective study was to examine baseline physical activity as a predictor of health and functional ability outcomes 5 years later in people age 75 and 80 years at baseline. A clear trend was observed: The more physically active subjects had better health and functional ability compared to their more sedentary counterparts. After controlling for the baseline status, the degree of physical activity did not predict future disability but still maintained its predictive role at the level of disease severity. It is suggested that the level of habitual physical activity is an important predictor of health and functional ability among elderly people. Presumably, however, there is a reciprocal causal relationship between physical activity and health in elderly people. Physical activity counseling should therefore be included in preventive health strategies for the elderly.

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Tina Lankford, Jana Wallace, David Brown, Jesus Soares, Jacqueline N. Epping and Fred Fridinger

Background:

Mass media campaigns are a necessary tool for public health practitioners to reach large populations and promote healthy behaviors. Most health scholars have concluded that mass media can significantly influence the health behaviors of populations; however the effects of such campaigns are typically modest and may require significant resources. A recent Community Preventive Services Task Force review on stand-alone mass media campaigns concluded there was insufficient evidence to determine their effectiveness in increasing physical activity, partly due to mixed methods and modest and inconsistent effects on levels of physical activity.

Methods:

A secondary analysis was performed on the campaigns evaluated in the Task Force review to determine use of campaign-building principles, channels, and levels of awareness and their impact on campaign outcomes. Each study was analyzed by 2 reviewers for inclusion of campaign building principles.

Results:

Campaigns that included 5 or more campaign principles were more likely to be successful in achieving physical activity outcomes.

Conclusion:

Campaign success is more likely if the campaign building principles (formative research, audience segmentation, message design, channel placement, process evaluation, and theory-based) are used as part of campaign design and planning.

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Gregory W. Heath

Background:

Regular physical activity has been demonstrated to protect against coronary heart disease, Type 2 diabetes mellitus, selected cancers, hypertension, obesity, and other chronic conditions. Therefore, the public health significance of promoting physical activity and preventing inactivity has become a well-established agenda for public health agencies at all levels.

Methods:

A secondary search of the literature, focusing on existing evidence reviews, was conducted to identify effective or promising public health physical activity interventions. Further examination of published evidence-based programs also was carried out to supplement the known evidence base. Intervention strategies were selected using criteria prescribed by each of the systematic reviews to yield categories of intervention effectiveness.

Key recommendations:

The selected physical activity interventions conformed to the domains identified by The Guide to Community Preventive Services. Recommended evidenced-based strategies from within the domain of informational approaches include 2 exemplary community-wide campaigns; mass media campaigns, represented by VERB; and an emerging practice of delivery of short physical activity messages at key community sites. Exemplary representative behavioral/social interventions include social support through organized walking clubs/partners within communities. Exemplary environmental/policy approaches include creating/enhancing access to places for physical activity with informational outreach activities and the emerging strategy of community-wide policies and planning.

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Jay E. Maddock, Bill Reger-Nash, Katie Heinrich, Kevin M. Leyden and Thomas K. Bias

Background:

The U.S. Community Guide to Preventive Services strongly recommends changes in urban design, land use and accessibility to increase physical activity. To achieve these goals, policy change is often needed. This study assessed attitudes of decision makers in Hawaii to determine if physical activity related issues are among their priorities.

Methods:

State and county officials (n = 179) were mailed surveys. Respondents listed the three most important problems (open-ended) in Hawaii and rated the importance of 23 specified problems, of which six directly related to physical activity.

Results:

The survey was completed by 126 (70.4%) respondents. The most frequently mentioned categories for the open-ended questions were affordable housing, environment/sustainability, sprawl/traffic/population growth, and healthcare. Among the closed-ended physical activity related items, increasing traffic was ranked highest (43.9%) and fourth overall. Less than 12% of decision makers rated other physical activity issues as important.

Conclusions:

Future work is needed to increase the visibility and importance of physical activity related issues among policymakers.

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Larissa Roux, Mike Pratt, I-Min Lee, Terry Bazzarre and David Buchner

Background:

Community-based efforts to promote physical activity (PA) in adults have been found to be cost-effective in general, but it is unknown if this is true in middle-age specifically. Age group-specific economic evaluations could help inform the design and delivery of better and more tailored PA promotion.

Methods:

A Markov model was developed to estimate the cost-effectiveness (CE) of 7 exemplar community-level interventions to promote PA recommended by the Guide to Community Preventive Services, over a 20-year horizon. The CE of these interventions in 25- to 64-year-old adults was compared with their CE in middle-aged adults, aged 50 to 64 years. The robustness of the results was examined through sensitivity analyses.

Results:

Cost/QALY (quality-adjusted life year) of the evaluated interventions in 25- to 64-year-olds ranged from $42,456/QALY to $145,868/QALY. Interventions were more cost-effective in middle-aged adults, with CE ratios 38% to 47% lower than in 25- to 64-year-old adults. Sensitivity analyses showed greater than a 90% probability that the true CE of 4 of the 7 interventions was below $125,000/QALY in adults aged 50 to 64 years.

Conclusion:

The exemplar PA promotion interventions evaluated appeared to be especially cost-effective for middle-aged adults. Prioritizing such efforts to this age group is a good use of societal resources.

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Andrea Torres, Bethany Tennant, Isabela Ribeiro-Lucas, Alison Vaux-Bjerke, Katrina Piercy and Bonny Bloodgood

(USDA) Nutrition Evidence Library (NEL), 5 the Agency for Healthcare Research and Quality, 6 the Cochrane Collaboration, 7 the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine Systematic Review standards, 8 and the Guide to Community Preventive Services

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Xinling Xu, Orgul D. Ozturk, Margaret A. Turk and Suzanne W. McDermott

people with disability compared with people without disability. This finding has important preventive medicine implications as there are 2 existing grade B, US Preventive Services Task Force recommendations for the promotion of physical activity. Both recommendations advise counseling for healthy diet

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Kelly Cornett, Katherine Bray-Simons, Heather M. Devlin, Sunil Iyengar, Patricia Moore Shaffer and Janet E. Fulton

in place. Such efforts align with the Community Preventive Services Task Force (Task Force) recommendation for combined approaches that connect activity-friendly routes to everyday destinations. 2 An activity-friendly route is a direct and convenient connection with everyday destinations, offering