A community program for the control of cardiovascular risk factors

Abramson, J. H.; Hopp, C; Gofin, Jaime; Gofin, Rosa; Makler, Amnon; Habib, Jack; Ronen, Itamar

doi:10.1007/bf01321566

Cited by 18 publications

(25 citation statements)

References 9 publications

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“…There were 33 studies 43,152,[154][155][156][157][158] of individual-level interventions (12 treatment, 132,133,135,136,138,141,142,147-150,155 21 prevention 43,[127][128][129][130][131]134,137,139,140,[143][144][145][146]152,154,[156][157][158] ); 60 studies 65,66,103,153,[159][160][161][162][163][164][165][166][167][168][169][170][171][172][173][174][175][176]225,230,231 of communitylevel interventions (32 treatment, 153,159,160,164,…”

Section: Studies Included In the Reviewmentioning

confidence: 99%

“…Thirty-three 43,152,[154][155][156][157][158] individual-level studies were identified that met the review inclusion criteria. Because of heterogeneity in terms of study design and main outcomes, it was possible to conduct meta-analysis for only a small subset of studies in this category (n = 4 133,135,136,152 for weight change and n = 4 132,135,149,152 for BMI change, all targeted interventions).…”

Section: Overviewmentioning

confidence: 99%

“…Most of the studies (n = 21 43,[127][128][129][130][131]134,137,139,140,[143][144][145][146]152,154,[156][157][158] ) were prevention-type studies (they included participants regardless of their weight status). The other 12 studies 132,133,135,136,138,141,142,[147][148][149][150]155 were treatment studies in participants who were already overweight or obese.…”

Section: Overviewmentioning

confidence: 99%

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How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? Two systematic reviews

Bambra

Hillier

Cairns

et al. 2015

Public Health Research

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BackgroundTackling obesity is one of the major contemporary public health policy challenges and is vital in terms of addressing health inequalities.ObjectivesTo systematically review the effectiveness of interventions (individual, community and societal) in reducing socioeconomic inequalities in obesity among (1) children aged 0–18 years (including prenatal) and (2) adults aged ≥18 years, in any setting, in any country, and (3) to establish how such interventions are organised, implemented and delivered.Data sourcesNine electronic databases including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and NHS Economic Evaluation Database were searched from database start date to 10 October 2011 (child review) and to 11 October 2012 (adult review). We did not exclude papers on the basis of language, country or publication date. We supplemented these searches with website and grey literature searches.Review methodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Experimental studies and observational studies with a duration of at least 12 weeks were included. The reviews considered strategies that might reduce existing inequalities in the prevalence of obesity [i.e. effective targeted interventions or universal interventions that work more effectively in low socioeconomic status (SES) groups] as well as those interventions that might prevent the development of inequalities in obesity (i.e. universal interventions that work equally along the SES gradient). Interventions that involved drugs or surgery and laboratory-based studies were excluded from the reviews. The initial screening of titles and abstracts was conducted by one reviewer with a random 10% of the sample checked by a second reviewer. Data extraction was conducted by one reviewer and independently checked by a second reviewer. The methodological quality of the included studies was appraised independently by two reviewers. Meta-analysis and narrative synthesis were conducted focusing on the ‘best-available’ evidence for each intervention type (defined in terms of study design and quality).ResultsOf 56,967 papers of inequalities in obesity in children, 76 studies (85 papers) were included, and of 70,730 papers of inequalities in obesity in adults, 103 studies (103 papers) were included. These studies suggested that interventions that aim to prevent, reduce or manage obesity do not increase inequalities. For children, there was most evidence of effectiveness for targeted school-delivered, environmental and empowerment interventions. For adults, there was most evidence of effectiveness for primary care-delivered tailored weight loss and community-based weight loss interventions, at least in the short term among low-income women. There were few studies of appropriate design that could be included on societal-level interventions, a clear limitation of the evidence base found.LimitationsThe reviews located few evaluations of societal-level interventions and this was probably because they included only experimental study designs. The quality assessment tool, although described as a tool for public health interventions, seemed to favour those that followed a more clinical model. The implementation tool was practical but enabled only a brief summary of implementation factors to be made. Most of the studies synthesised in the reviews were from outside the UK and related to women.ConclusionsThe reviews have found some evidence of interventions with the potential to reduce SES inequalities in obesity and that obesity management interventions do not increase health inequalities. More experimental studies of the effectiveness and cost-effectiveness of interventions (particularly at the societal level) to reduce inequalities in obesity, particularly among adolescents and adult men in the UK, are needed.Study registrationThe studies are registered as PROSPERO CRD42011001740 and CRD42013003612.FundingThe National Institute for Health Research Public Health Research programme.

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Section: Studies Included In the Reviewmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%

Section: Overviewmentioning

confidence: 99%

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How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? Two systematic reviews

Bambra

Hillier

Cairns

et al. 2015

Public Health Research

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“…Tidlig på 1970-tallet ble det gjennomført flere store intervensjonsstudier med primaerforebyggende hensikt, for eksempel Nord-Karelen prosjektet i Finland [47], CHAD-prosjektet i Israel [1] samt Stanford Three Community Project [14] og Franklin Community CVD Health Program I USA [48]. Studiene forsøkte å påvirke kostvaner, røykevaner og kroppsvekt samt risikofaktorer som hyperkolesterolemi og hypertensjon gjennom atferdsendringer i befolkningen, men resultatene har vaert varierende.…”

Section: Tiltak På Befolkningsnivåunclassified

Sør-Trøndelag Aktivitets-Relaterte Tiltak (START) – Samhandling for bedre helse

Rehn¹,

Rognmo²,

Ingebrigtsen³

et al. 2011

Nor J Epidemiol

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Korrespondanse: Tommy Aune Rehn, tommyrehn@yahoo.no SAMMENDRAGHøy forekomst av kroniske sykdommer og stigende helseutgifter representerer i lys av den kommende eldrebølgen en stor samfunnsøkonomisk utfordring. Den negative helseutviklingen er i ferd med å bli et nasjonalt problem og må få konsekvenser for fremtidig norsk helsepolitikk. Fysisk inaktivitet er en livsstilsfaktor som er sterkt assosiert med lavt nivå av kondisjon, total dødelighet og død av hjerte-og karsykdom. Studier viser at selv en liten bedring i kondisjon forventes å gi betydelig økt forventet levealder og at individer som har et bra kondisjonsnivå har opptil 15 flere leveår med god helse hvor de er selvhjulpne. Økt fysisk aktivitet har en gunstig effekt på alle risikofaktorer for kronisk sykdom og tidlig død, og vi mener derfor at man bør legge til rette for å øke det generelle fysiske aktivitetsnivået i befolkningen og bedre kunnskapen om fysisk aktivitet. Økt fysisk aktivitet vil forventes å bedre folkehelsen ved å redusere sykdomsforekomst, medisinbruk og dødelighet samt øke arbeidsevnen i populasjonen, noe som igjen vil redusere de samfunnsøkonomiske utgiftene. For å lykkes med dette, har vi tatt initiativ til prosjektet "Sør-Trøndelag Aktivitets-Relaterte Tiltak" (START), som er tenkt å vaere en koordinert populasjonsbasert samhandling for bedre helse gjennom økt fysisk aktivitet rettet mot alle lag i befolkningen, fra krybbe til grav. Målet er at START skal danne grunnlag for nasjonal implementering av tiltak slik at vi oppnår en helsepolitisk baerekraftig utvikling i årene som kommer. Denne artikkelen beskriver START og bakgrunnen for prosjektet. ENGLISH SUMMARYHigh incidence of chronic diseases and rising health expenditure represents in light of the increasing proportion of elderly in our society a development that cannot be considered sustainable in the long run. The negative health trend is becoming a national problem and should have consequences for future Norwegian health policy. Physical inactivity is among the lifestyle factors most strongly associated with a low level of exercise capacity, all-cause mortality and death from cardiovascular disease. Studies show that even a small improvement in exercise capacity offers significantly increased life expectancy and that individuals who have a good fitness level have up to 15 more years of life with good health where they are self-reliant. Increased physical activity has a beneficial effect on all risk factors for chronic disease and premature death. We believe that the overall physical activity levels in the population needs to be increased and knowledge about physical activity should be improved. Increased physical activity will improve public health by reducing disease incidence, medical use and mortality as well as increasing working capacity in the population, which in turn will reduce the socioeconomic costs. To succeed with this, we have initiated the project "Sør-Trøndelag Activity-Related Trial (START), which is a coordinated population-based interaction for improved healt...

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“…Much has been learned about conducting community-based health promotion trials since the first generation of community-based studies, which tended to assess individual behavioral change within the community without taking into account the special factors that influence the power of community designs (2,87,114). Improvements in subsequent generations of community-based designs came about when researchers started to pay attention to the unit of randomization (the community), the interaction among individuals in the same community (intraclass correlation), and the special analytic techniques required for community studies (29,36,37,55,84).…”

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confidence: 99%

Methodologic Advances and Ongoing Challenges in Designing Community-Based Health Promotion Programs

Thompson

Coronado

Snipes

et al. 2003

Annu. Rev. Public Health

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s Abstract Community intervention trials continue to attract researchers as potential ways to achieve widespread, long-term change in health behaviors. The first generations of community studies were somewhat unsophisticated in design and analysis, and their promise may have been overstated. As design and analysis issues were better defined, as secular trends caught up with the behaviors that researchers were trying to change, or as other unknown variables affected community studies, small effects of interventions were observed in community trials. Discussions were held in professional meetings and reported in the literature: Should community trials be discontinued? In general, the answer was a qualified no. In this paper, we briefly review some of the many advances made in community intervention trials, and address in more detail the challenges ahead. INTRODUCTIONMuch of the risk for chronic disease is behavioral and can be controlled. Many cancer factors, for example, are related to diet, smoking, and sexual behavior; these lifestyle behaviors account for up to 70 percent of all cancers (44, 70,110). Lifestyle behaviors are similarly important in the prevention of cardiovascular disease (CVD), much of which is attributed to the behavioral factors of diet, smoking, and uncontrolled hypertension (48, 56, 61). Other chronic diseases, including diabetes (13,100,133), arthritis (9, 92), and osteoporosis (3, 92), may be prevented by behavioral changes in diet and exercise. Numerous experimental studies designed to modify health-risk behaviors have been conducted. Success rates of such programs are generally determined in randomized trials, and the great bulk of such trials have focused on the individual, i.e., they rely on volunteers to participate in the experiment. Such trials may have an effect on the individual participants but have limited ability to achieve widespread, large-scale changes in the health-risk behaviors of the population as a whole.The past three decades have seen a change in the manner in which many lifestyle behaviors are viewed. Increasingly, smoking is perceived not as an individual problem, but as a public health problem, in need of policies to control where smoking is allowed (59, 77). Similarly, fluoride is added to water to reduce dental caries (72,96). Seat belt usage is required by law in many states (43, 62,119), as are helmets for motorcycle riders (8,90,97). Dietary habits also are no longer considered purely individual matters. The U.S. Food and Drug Administration and the United States Department of Agriculture have produced a report recommending reform in food and nutrition labeling (6,104,130).This approach to behavior is familiar to many public health and health-promotion researchers. The increasing focus on "the public" in health promotion is due, at least in part, to growing recognition that behavior is greatly influenced by the social environment in which people live. Local values, norms, and behavioral patterns have a significant effect on shaping an individual's attitudes a...

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A community program for the control of cardiovascular risk factors

Cited by 18 publications

References 9 publications

How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? Two systematic reviews

How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? Two systematic reviews

Sør-Trøndelag Aktivitets-Relaterte Tiltak (START) – Samhandling for bedre helse

Methodologic Advances and Ongoing Challenges in Designing Community-Based Health Promotion Programs

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