The evidence base for the prevention of type 2 diabetes mellitus (T2DM) has progressed rapidly from efficacy trials to real-world translational studies and practical implementation trials over the ...last 15 years. However, evidence for the effective implementation and translation of diabetes programs and their population impact needs to be established in ways that are different from measuring program effectiveness. We report the findings of a systematic review that focuses on identifying the critical success factors for implementing diabetes prevention programs in real-world settings.
A systematic review of programs aimed at diabetes prevention was undertaken in order to evaluate their outcomes using the penetration, implementation, participation, and effectiveness (PIPE) impact metric. A search for relevant articles was carried out using PubMed (March 2015) and Web of Science, MEDLINE, CENTRAL, and EMBASE. A quality coding system was developed and included studies were rated independently by three researchers.
Thirty eight studies were included in the review. Almost all (92 %) provided details on participation; however, only 18 % reported the coverage of their target population (penetration). Program intensity or implementation-as measured by frequency of contacts during first year and intervention duration-was identified in all of the reported studies, and 84 % of the studies also reported implementation fidelity; however, only 18 % of studies employed quality assurance measures to assess the extent to which the program was delivered as planned. Sixteen and 26 % of studies reported 'highly' or 'moderately' positive changes (effectiveness) respectively, based on weight loss. Six (16 %) studies reported 'high' diabetes risk reduction but 'low' to 'moderate' weight loss only.
Our findings identify that program intensity plays a major role in weight loss outcomes. However, programs that have high uptake-both in terms of good coverage of invitees and their willingness to accept the invitation-can still have considerable impact in lowering diabetes risk in a population, even with a low intensity intervention that only leads to low or moderate weight loss. From a public health perspective, this is an important finding, especially for resource constrained settings. More use of the PIPE framework components will facilitate increased uptake of T2DM prevention programs around the world.
The purpose of this article is to highlight approaches to increase movement, physical activity (PA), and cardiorespiratory fitness, and reduce sedentary behavior (SB) in the context of the workplace. ...A deliberate strategy that will enable the successful promotion of movement at the workplace includes a business plan and rationale, an organizing framework, prioritization of interventions that are known to generate outcomes, and alignment of programmatic solutions with strong program design principles. Recommended principles of design include leadership, relevance, partnership, comprehensiveness, implementation, engagement, communications, being data-driven, and compliance. Specific evidence-based intervention examples are presented in the context of a socio-ecological framework including the individual, group, communications environment, physical environment, and policy domains. Increased movement at the workplace, as a result of promoting PA and reducing SB, generates important health outcomes across physical, mental, social, and economic domains and these benefits extend across the individual and organizational levels.
Physical inactivity and obesity crises persist in the United States despite substantial mitigation efforts. The primary goal of this analysis is to determine whether the geographic concentration of ...religious institutions overlaps with geographic patterns for physical inactivity and obesity prevalence.
We obtained 2021 county-level, age-adjusted physical inactivity (“no leisure time physical activity”) and obesity prevalence from the 2023 Centers for Disease Control and Prevention PLACES database. Data on number of congregations per 100,000 individuals and adherents as a percentage of the population were obtained from the 2020 US Religion Census. The American Nations regional cultures model was obtained from the Nationhood Lab.
On a national level, all correlations were statistically significant between health factors and religious infrastructure—higher physical inactivity and obesity were related to more congregations per 100,000 population on a county level. The strength of correlations between congregations per 100,000 county population and both physical inactivity and obesity prevalence was greatest in the American Nations model's Deep South and Tidewater regions.
Approaches to addressing the pandemics of unhealthy lifestyle-related health factors of physical inactivity and obesity in the United States have, in large part, been unsuccessful. Church-based healthy lifestyle programs, particularly in areas where a high concentration of congregations align with high physical inactivity and obesity, may offer a novel and effective approach to addressing this issue.
In the United States, ongoing efforts to increase individual- and population-level physical activity have made little to no progress over the past decade in reducing the percentage of individuals who ...report no leisure-time physical activity. The purpose of the current study is to further assess the relationship between social vulnerability and the prevalence of physical inactivity at the county level.
We merged county-level data on physical inactivity prevalence, the Social Vulnerability Index (SVI), and the American Nations regional cultures schematic.
Physical inactivity significantly correlated (P < .001) with the overall SVI score and all subtheme scores to varying levels of strength. Clear and statistically significant heterogeneity in the SVI scores was apparent across distinct regions using the American Nations model, consistent with previously demonstrated patterns of physical inactivity prevalence.
On a national level, physical inactivity prevalence is unacceptably high and has not appreciably improved over the past decade. Within the United States, high levels of social vulnerability and physical inactivity are concentrated within specific geographic regions that need tailored solutions to resolve health disparities.
COVID-19 has severely impacted population health and well-being globally. Acknowledging that COVID-19 will not be the world's last pandemic, improving healthy living factors (i.e., physical activity, ...healthful nutrition, healthy weight), which are important in mitigating negative outcomes of future infectious disease pandemics, should be prioritized. Although well-documented, promoting healthy living factors remains challenged by a lack of scalability and sustainability due, in part, to a mismatch between intervention focus on individual behavior change as opposed to recognizing complex and multifactorial causes that prevent people from living healthy lifestyles and maintaining them long-term (such as political will, economic benefits, urban planning, etc.). To recognize this complexity in promoting healthy living, we propose the application of systems science methods for the creation of a comprehensive causal systems map of healthy living factors in the context of COVID-19 to inform future pandemic preparedness. Generating such a map would benefit researchers, practitioners, and policy makers in multi-sector collaborative efforts to improve public health preparedness in the context of future pandemics in a scalable, sustainable, and equitable manner. This effort should be facilitated by a trusted and widely respected governing body with global reach.
Prolonged sitting time is a health risk. We describe a practice-based study designed to reduce prolonged sitting time and improve selected health factors among workers with sedentary jobs.
We ...conducted our study during March-May 2011 in Minneapolis, Minnesota, among employees with sedentary jobs.
Project implementation occurred over 7 weeks with a baseline period of 1 week (period 1), an intervention period of 4 weeks (period 2), and a postintervention period of 2 weeks (period 3). The intervention group (n = 24) received a sit-stand device during period 2 designed to fit their workstation, and the comparison group (n = 10) did not. We used experience-sampling methods to monitor sitting behavior at work during the 7 weeks of the project. We estimated change scores in sitting time, health risk factors, mood states, and several office behaviors on the basis of survey responses.
The Take-a-Stand Project reduced time spent sitting by 224% (66 minutes per day), reduced upper back and neck pain by 54%, and improved mood states. Furthermore, the removal of the device largely negated all observed improvements within 2 weeks.
Our findings suggest that using a sit-stand device at work can reduce sitting time and generate other health benefits for workers.
According to the World Health Organization, 30 countries currently have a life expectancy of ≥80 years: the United States (U.S.) is not among this group of countries. The current analysis assesses ...the ability of key lifestyle behaviors and characteristics to predict a life expectancy of ≥80 years. Only 577 (19%) of the 3066 U.S. Counties assessed had a life expectancy ≥80 years. These counties had significantly higher life expectancy (81 ± 3 vs. 76 ± 2 years) and lower percent of the population who are physically inactive (20.7 ± 3.9 vs. 27.0 ± 4.7%), actively smoke (15.9 ± 3.1 vs. 21.1 ± 3.6%), obese (31.7 ± 4.7 vs. 37.3 ± 3.9%) and have limited access to healthy food (7.1 ± 6.8 vs. 8.4 ± 6.6%) (all p < 0.001). Binary logistic regression revealed percent adults who currently smoke, percent obese, percent physically inactive, and percent with limited access to healthy food were all significant univariate predictors of </≥80 years life expectancy (p < 0.001) and retained in the multivariate regression (p < 0.05). A better understanding of the driving forces that increase healthy living behaviors should be a primary goal in the effort to increase U.S. life expectancy: an individualized approach recognizing unique regional cultures may significantly improve adoption and maintenance of desirable health behaviors and outcomes.
OBJECTIVE:To describe integrated worker health protection and promotion (IWHPP) program characteristics, to discuss the rationale for the integration of occupational safety and health and worksite ...health promotion programs, and to summarize what is known about the impact of these programs on health and economic outcomes.
METHODS:A descriptive assessment of the current state of the IWHPP field and a review of studies on the effectiveness of IWHPP programs on health and economic outcomes were undertaken.
RESULTS:Sufficient evidence of effectiveness was found for IWHPP programs when health outcomes were considered. Impact on productivity-related outcomes is considered promising, but inconclusive, whereas insufficient evidence was found for health care expenditures.
CONCLUSIONS:Existing evidence supports an integrated approach in terms of health outcomes but will benefit significantly from research designed to support the business case for employers of various company sizes and industry types.
PDF
