Addressing Behavioral Risk Factors

Addressing Behavioral Risk Factors Order Description •Select one of the behavioral risk factors from the Healthy Population 2010 Objectives (listed in Table 7.1 on p. 128 of the course text) that is of interest to you. The risk factor I selected is Overweight and obeisity among children and adolescents Post a description of the behavioral risk factor you selected and how this factor is impacting your community or state. Using the Population-Based Intervention Model, suggest at least one intervention that could be put into place at each stage (downstream, midstream, and upstream) to ensure that a health prevention program addressing the behavioral risk factor would have a greater chance at succeeding. Justify why each intervention you identified would be effective. • Upstream efforts to create, or increase, access to safe, attractive, and convenient places for physical activity, along with informational outreach to change knowledge and attitudes about the benefits of and opportunities for physical activity Recommendations from the CDC's Community Guide to Increasing Physical Activity address transportation and land-use policies, ranging from zoning guidelines to improved federal, state, and community projects for walking and bicycling (2013e). Together, these guidelines have provided a strong, science-based blueprint for multisector efforts by professionals in public health, urban planning, transportation, parks and recreation, architecture, landscape design, public safety, and the mass media to close the gaps between recommended and actual physical activity levels for U.S. children and adults. Some upstream efforts come in the form of federal payments that can help communities create or improve access to healthy options. The Patient Protection and Affordable Care Act (ACA), passed in 2010, provides states and communities with a new stream of funds to promote healthy living by creating and improving multiple factorssuch as housing, education, child care, and food outlets-in ways that address health disparities, improve access to behavioral health services, and reduce and control behavioral risk factors. Other federal and state health-related policy changes have been influential in reducing childhood obesity, particularly among children from low-income families who participate in the Special Supplemental Nutrition Program for Women, Infants, and Children (better known as WIC). A 2008 overhaul of the WIC food package changed the mix of foods covered by the program, making more fruits and vegetables, skim and low-fat milk, and whole grain breads and cereals available to participants. Grocery stores and schools serving WIC children changed their inventories to meet the new standards, which benefitted not only WIC families but also entire communities. In 2013, evidence pointed to declining obesity rates among children from lowincome communities in 18 states and one U.S. territory (CDC, 2013c). Among U.S. cities, Philadelphia set itself apart by reporting a significant decrease in obesity between 2006 and 2010, particularly among schoolchildren in grades K through 12 and adolescents of color. These decreases emerged after the city instituted a decade-long, multipronged effort to combat obesity and influence health behavior. Over those 10 years, Philadelphia implemented the following: • Nutrition education to public school students whose families are eligible for the federal Supplemental Nutrition Assistance Program • Financial incentives to attract grocers to open stores in underserved areas • A school district-wide wellness policy • Improved nutritional offerings in schools, which included the removal of deep-fried foods, sodas, and sugar-sweetened beverages • Required calorie po stings at chain restaurants . With respect to high-risk populations and environments, systematic surveillance can increasingly monitor the prevalence of behavioral risk factors and related healthpromoting programs, resources, and policies. Such surveillance systems, which already exist for tobacco control and are rapidly developing for physical activity, establish a national baseline that makes it possible to assess the effects of specific interventions Chapter 7. Health and Behavior 135 • Smoking bans and restrictions to reduce exposure to environmental tobacco smoke • Tax and price increases and mass media campaigns to reduce the number of youth who start smoking and to promote cessation • Telephone quitline and mobile phone-based support, as well as a number of health care system interventions, also to increase cessation -8. Similar ecological models have been described and proposed for each of the other major behavioral risk factors discussed in this chapter-risky drinking, physical inactivity, dietary behavior change, and obesity. These are summarized on the CDC's Community Preventive Services Task Force Community Guide website (CDC, 2013b) and in the Task Force's 2013 Third Annual Report to Congress, presenting more than 200 evidence-based recommendations for promoting better health among community members. EXAMPLES FROM CHILDHOOD OBESITY PREVENTION A great sense of urgency surrounds the need to identify evidence-based full-court press strategies that can halt the nation's current obesity epidemic, especially among children (10M, 2010, 2012; White House Task Force, 2010). The dramatic rise in the prevalence of overweight and obesity among youth and adults over the past several decades is primarily due to environmental and economic changes affecting behavior on both sides of the energy balance equation; that is, the amount of energy (calories) used versus the amount consumed. The cumulative effects of technology-such as automobile-dependent transportation and more sedentary jobs-along with changes in lifestyles in typical suburban environments, which limit the places to which adults and children can walk, have reduced the amount of physical activity in everyday life. At the same time, increased access to low-cost, sugar-laden, and high-fat foods and beverages, increased exposure to marketing for these unhealthy products, larger portion sizes, increased restaurant use, an exodus of grocery stores and other sources of fresh fruits and vegetables from cities to suburbs, and the rising cost of fresh produce relative to soda and snack foods have all played a critical role in promoting excessive caloric intake, especially in low-income and racial!ethnic minority populations. Pervasive racial! ethnic disparities in access to safe places to walk, bike, and play have sparked several studies of socioeconomic differences in access to community sports areas, parks, swimming pools, beaches, and bike paths. Rapid progress is being made to understand the environmental and policy factors that affect physical activity and identify promising multilevel, broad-spectrum interventions to address the nation's obesity epidemic. The CDC's Community Preventive Services Task Force reviewed research on interventions and found evidence for recommendations spanning the full McKinlay model. These include the following: • Downstream health behavior change programs that increase social supports for physical activity and exercise (e.g., health care provider reminder systems plus provider education) • Midstream requirements for school physical education classes that increase the time students spend in moderate or vigorous physical activity and "point of decision" prompts on elevators and escalators that encourage people to use nearby stairs