Addressing Behavioral Risk Factors

| December 21, 2015

•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
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
• 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

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