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Walsh S, Brain J, Mukadam N, Anderson R, Greene L, Govia I, Kuhn I, Anstey KJ, Knapp M, Stephan BCM, Brayne C. A systematic review of the cost-effectiveness of community and population interventions to reduce the modifiable risk factors for dementia. Maturitas 2022; 166:104-116. [PMID: 36150253 DOI: 10.1016/j.maturitas.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/03/2022] [Accepted: 09/04/2022] [Indexed: 10/14/2022]
Abstract
Dementia is a leading global cause of morbidity and mortality. Evidence suggests that tackling modifiable lifecourse risk factors could prevent or delay a significant proportion of cases. Population- and community-based approaches change societal conditions such that everyone across a given community is more likely to live more healthily. We systematically reviewed economic studies of population- and community-based interventions to reduce modifiable lifecourse risk factors for dementia. We searched Medline, EMBASE, Web of Science, CINAHL, PsycInfo, Scopus, Econlit, ERIC, the British Education Index, and Google, on 03/03/2022. We included cost-effectiveness, cost-benefit, and cost-utility studies, provided that the direct outcome of the intervention was a modifiable risk factor for dementia, and was measured empirically. Quality appraisal was completed using the Consensus on Health Economic Criteria checklist. A narrative synthesis was performed. We included 45 studies, from 22,749 records identified. Included studies targeted smoking (n = 15), education (n = 10), physical inactivity (n = 9), obesity (n = 5), air pollution (n = 2), traumatic brain injury (n = 1), and multiple risk factors (n = 3). Intervention designs included changing the physical/food environment (n = 13), mass media programmes (n = 11), reducing financial barriers or increasing resources (n = 10), whole-community approaches (n = 6), and legislative change (n = 3). Overall, interventions were highly cost-effective and/or cost-saving, particularly those targeting smoking, educational attainment, and physical inactivity. Effects were observed in high- (e.g. USA and UK) and low- and middle-income (e.g. Mexico, Tanzania, Thailand) countries. Further research into the direct effects of targeting these risk factors on future dementia prevalence will have important economic, social and policy implications.
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Affiliation(s)
- Sebastian Walsh
- Cambridge Public Health, University of Public Health, Robinson Way, Cambridge CB2 0SR, United Kingdom of Great Britain and Northern Ireland.
| | - Jacob Brain
- Institute of Mental Health, Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, United Kingdom of Great Britain and Northern Ireland
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, Maple House, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland
| | - Robert Anderson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, United Kingdom of Great Britain and Northern Ireland
| | - Leanne Greene
- College of Medicine and Health, University of Exeter, Exeter EX1 2HZ, United Kingdom of Great Britain and Northern Ireland
| | - Ishtar Govia
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Isla Kuhn
- University of Cambridge Medical School Library, School of Clinical Medicine, Cambridge CB2 0SP, United Kingdom of Great Britain and Northern Ireland
| | - Kaarin J Anstey
- UNSW Ageing Futures Institute, University of New South Wales, Kensington, Sydney 2033, Australia; Neuroscience Research Australia, 139 Barker Street, Randwick, NSW 2031, Australia
| | - Martin Knapp
- London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom of Great Britain and Northern Ireland
| | - Blossom C M Stephan
- Institute of Mental Health, Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, United Kingdom of Great Britain and Northern Ireland
| | - Carol Brayne
- Cambridge Public Health, University of Public Health, Robinson Way, Cambridge CB2 0SR, United Kingdom of Great Britain and Northern Ireland
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Giacinto JJ, Fricker GA, Ritter M, Yost J, Doremus J. Urban forest biodiversity and cardiovascular disease: Potential health benefits from California's street trees. PLoS One 2021; 16:e0254973. [PMID: 34731162 PMCID: PMC8565780 DOI: 10.1371/journal.pone.0254973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/08/2021] [Indexed: 01/14/2023] Open
Abstract
Enhanced immune functioning in response to biodiversity may explain potential health benefits from exposure to green space. Using unique data on urban forest biodiversity at the zip code level for California measured from 2014 to 2019 we test whether greater diversity of street trees is associated with reduced death from cardiovascular disease. We find that urban forests with greater biodiversity measured via the Shannon Index at the genus level are associated with a lower mortality rate for heart disease and stroke. Our estimates imply that increasing the Shannon Index by one standard deviation (0.64) is associated with a decrease in the mortality rate of 21.4 per 100,000 individuals for heart disease or 13% and 7.7 per 100,000 individuals for stroke or 16%. Our estimates remain robust across several sensitivity checks. A policy simulation for tree planting in Los Angeles based on our estimates suggests that if these relationships were causal, investment in planting for a more biodiverse set of street trees would be a cost-effective way to reduce mortality related to cardiovascular disease in urban areas.
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Affiliation(s)
- John J. Giacinto
- Economics, California Polytechnic State University, San Luis Obispo, CA, United States of America
| | - G. Andrew Fricker
- Social Sciences, California Polytechnic State University, San Luis Obispo, CA, United States of America
| | - Matthew Ritter
- Biological Sciences, California Polytechnic State University, San Luis Obispo, CA, United States of America
| | - Jenn Yost
- Biological Sciences, California Polytechnic State University, San Luis Obispo, CA, United States of America
| | - Jacqueline Doremus
- Economics, California Polytechnic State University, San Luis Obispo, CA, United States of America
- * E-mail:
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Abildso CG, Haas V, Daily SM, Bias TK. Field Test of a Passive Infrared Camera for Measuring Trail-Based Physical Activity. Front Public Health 2021; 9:584740. [PMID: 33816412 PMCID: PMC8009981 DOI: 10.3389/fpubh.2021.584740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/22/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Trails are ubiquitous and far-reaching, but research on the impact trails have on physical activity is limited by the lack of resource-efficient, accurate, and practical systematic observation tools. Commonly used infrared trail sensors count trail use and may broadly differentiate activity (i.e., bicyclist vs. pedestrian), but cannot detect nuances needed for outcomes research such as frequency, intensity, time, and type of activity. Motion-activated passive infrared cameras (PICs), used in ecological research and visitor management in wildlife areas, have potential applicability as a systematic observation data collection tool. Materials and Methods: We conducted a 7-month field test of a PIC as a systematic observation data collection tool on a hiking trail, using photos to identify each trail user's physical activity type, age, sex, and other characteristics. We also tallied hourly trail use counts from the photos, using Bland-Altman plots, paired t-tests, Concordance Correlation Coefficient, Kendall's Tau-b, and a novel inter-counter reliability measure to test concordance against concurrent hourly counts from an infrared sensor. Results: The field test proved informative, providing photos of 2,447 human users of the trail over 4,974 h of data collection. Nearly all of the users were walkers (94.0%) and most were male (69.2%). More of the males used the trail alone (44.8%) than did females (29.8%). Concordance was strong between instruments (p < 0.01), though biased (p < 0.01). Inter-counter reliability was 91.1% during the field study, but only 36.2% when excluding the hours with no detectable trail use on either device. Bland-Altman plots highlighted the tendency for the infrared sensor to provide higher counts, especially for the subsample of hours that had counts >0 on either device (14.0%; 694 h). Discussion: The study's findings highlight the benefits of using PICs to track trail user characteristics despite the needs to further refine best practices for image coding, camera location, and settings. More widespread field use is limited by the extensive amount of time required to code photos and the need to validate the PICs as a trail use counter. The future potential of PICs as a trail-specific PA research and management tool is discussed.
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Affiliation(s)
| | - Vaike Haas
- West Virginia University Davis College of Agriculture, Natural Resources, and Design, Morgantown, WV, United States
| | - Shay M. Daily
- West Virginia University School of Public Health, Morgantown, WV, United States
- West Virginia University Office of Health Affairs, Morgantown, WV, United States
| | - Thomas K. Bias
- West Virginia University School of Public Health, Morgantown, WV, United States
- West Virginia University Office of Health Affairs, Morgantown, WV, United States
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Trailgazers: A Scoping Study of Footfall Sensors to Aid Tourist Trail Management in Ireland and Other Atlantic Areas of Europe. SENSORS 2021; 21:s21062038. [PMID: 33805794 PMCID: PMC7999918 DOI: 10.3390/s21062038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
This paper examines the current state of the art of commercially available outdoor footfall sensor technologies and defines individually tailored solutions for the walking trails involved in an ongoing research project. Effective implementation of footfall sensors can facilitate quantitative analysis of user patterns, inform maintenance schedules and assist in achieving management objectives, such as identifying future user trends like cyclo-tourism. This paper is informed by primary research conducted for the EU funded project TrailGazersBid (hereafter referred to as TrailGazers), led by Donegal County Council, and has Sligo County Council and Causeway Coast and Glens Council (NI) among the 10 project partners. The project involves three trails in Ireland and five other trails from Europe for comparison. It incorporates the footfall capture and management experiences of trail management within the EU Atlantic area and desk-based research on current footfall technologies and data capture strategies. We have examined 6 individual types of sensor and discuss the advantages and disadvantages of each. We provide key learnings and insights that can help to inform trail managers on sensor options, along with a decision-making tool based on the key factors of the power source and mounting method. The research findings can also be applied to other outdoor footfall monitoring scenarios.
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Modelling the impact of physical activity on public health: A review and critique. Health Policy 2020; 124:1155-1164. [DOI: 10.1016/j.healthpol.2020.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/14/2023]
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Abstract
Rural residents are less physically active than their urban counterparts and disproportionately affected by chronic diseases and conditions associated with insufficient activity. While the ecological model has been successful in promoting and translating active living research in urban settings, relatively little research has been conducted in rural settings. The resulting research gap prohibits a comprehensive understanding and application of solutions for active living in rural America. Therefore, the purpose of this article was to assess the evidence base for an ecological model of active living for rural populations and outline key scientific gaps that inhibit the development and application of solutions. Specifically, we reexamined the 4 domains conceptualized by the model and suggest that there is a dearth of research specific to rural communities across all areas of the framework. Considering the limited rural-specific efforts, we propose areas that need addressing to mobilize rural active living researchers and practitioners into action.
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Masters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health 2017; 71:827-834. [PMID: 28356325 PMCID: PMC5537512 DOI: 10.1136/jech-2016-208141] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/03/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions. METHODS We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries. RESULTS We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5. CONCLUSIONS This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.
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Affiliation(s)
- Rebecca Masters
- North Wales Local Public Health Team, Public Health Wales, Mold, Flintshire, UK
- Department of Public Health and Policy, University of Liverpool, UK
| | - Elspeth Anwar
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Halton Borough Council, Cheshire, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, UK
- Department of Public Health, Wirral Metropolitan Borough Council, Merseyside, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, UK
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Song Y, Preston J, Ogilvie D. New walking and cycling infrastructure and modal shift in the UK: A quasi-experimental panel study. TRANSPORTATION RESEARCH. PART A, POLICY AND PRACTICE 2017; 95:320-333. [PMID: 28163399 PMCID: PMC5270770 DOI: 10.1016/j.tra.2016.11.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Heavy dependency on car use leads to traffic congestion, pollution, and physical inactivity, which impose high direct and indirect costs on society. Promoting walking and cycling has been recognised as one of the means of mitigating such negative effects. Various approaches have been taken to enhance walking and cycling levels and to reduce the use of automobiles. This paper examines the effectiveness of infrastructure interventions in promoting walking and cycling for transport. Two related sets of panel data, covering elapsed time periods of one and two years, were analysed to track changes in travel behaviour following provision of new walking and cycling infrastructure so that modal shift from private car use to walking and cycling can be investigated. Two types of exposure measures were tested: distance from the infrastructure (a measure of potential usage), and actual usage of the infrastructure. Only the latter measure was statistically significantly associated with modal shift. This in turn suggested that infrastructure provision was not a sufficient condition for modal shift, but may have been a necessary condition. Along with the use of new infrastructure, the loss of employment, higher education, being male and being part of the ethnic majority were consistently found to be significantly and positively associated with modal shift towards walking and cycling. The findings of this study support the construction of walking and cycling routes, but also suggest that such infrastructure alone may not be enough to promote active travel.
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Affiliation(s)
- Yena Song
- Department of Geography, Chonnam National University, Gwangju 61186, South Korea
- Corresponding author.
| | - John Preston
- Transportation Research Group, Faculty of Engineering and the Environment, University of Southampton, Building 176, Bodlrewood, Southampton SO16 7QF, UK
| | - David Ogilvie
- Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UK
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Requia WJ, Roig HL, Adams MD, Zanobetti A, Koutrakis P. Mapping distance-decay of cardiorespiratory disease risk related to neighborhood environments. ENVIRONMENTAL RESEARCH 2016; 151:203-215. [PMID: 27497083 DOI: 10.1016/j.envres.2016.07.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 06/06/2023]
Abstract
Neighborhood characteristics affect an individual's quality of life. Although several studies have examined the relationship between neighborhood environments and human health, we are unaware of studies that have examined the distance-decay of this effect and then presented the risk results spatially. Our study is unique in that is explores the health effects in a less developed country compared to most studies that have focused on developed countries. The objective of our study is to quantify the distance-decay cardiorespiratory diseases risk related to 28 neighborhood aspects in the Federal District, Brazil and present this information spatially through risk maps of the region. Toward this end, we used a quantile regression model to estimate risk and GIS modeling techniques to create risk maps. Our analysis produced the following findings: i) a 2500 m increase in highway length was associated with a 46% increase in cardiorespiratory diseases; ii) 46,000 light vehicles in circulation (considering a buffer of ≤500 m from residences) was associated with 6 hospital admissions (95% CI: 2.6, 14.6) per cardiorespiratory diseases; iii) 74,000 m2 of commercial areas (buffer ≤1700 m) was associated with 12 hospital admissions (95% CI: 2.2, 20.8); iv) 1km2 increase in green areas intra urban was associated with less two hospital admissions, and; vi) those who live ≤500 m from the nearest point of wildfire are more likely to have cardiorespiratory diseases that those living >500 m. Our findings suggest that the approach used in this study can be an option to improve the public health policies.
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Affiliation(s)
- Weeberb J Requia
- McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
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Veerman JL, Zapata-Diomedi B, Gunn L, McCormack GR, Cobiac LJ, Mantilla Herrera AM, Giles-Corti B, Shiell A. Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study. BMJ Open 2016; 6:e011617. [PMID: 27650762 PMCID: PMC5051510 DOI: 10.1136/bmjopen-2016-011617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Studies consistently find that supportive neighbourhood built environments increase physical activity by encouraging walking and cycling. However, evidence on the cost-effectiveness of investing in built environment interventions as a means of promoting physical activity is lacking. In this study, we assess the cost-effectiveness of increasing sidewalk availability as one means of encouraging walking. METHODS Using data from the RESIDE study in Perth, Australia, we modelled the cost impact and change in health-adjusted life years (HALYs) of installing additional sidewalks in established neighbourhoods. Estimates of the relationship between sidewalk availability and walking were taken from a previous study. Multistate life table models were used to estimate HALYs associated with changes in walking frequency and duration. Sensitivity analyses were used to explore the impact of variations in population density, discount rates, sidewalk costs and the inclusion of unrelated healthcare costs in added life years. RESULTS Installing and maintaining an additional 10 km of sidewalk in an average neighbourhood with 19 000 adult residents was estimated to cost A$4.2 million over 30 years and gain 24 HALYs over the lifetime of an average neighbourhood adult resident population. The incremental cost-effectiveness ratio was A$176 000/HALY. However, sensitivity results indicated that increasing population densities improves cost-effectiveness. CONCLUSIONS In low-density cities such as in Australia, installing sidewalks in established neighbourhoods as a single intervention is unlikely to cost-effectively improve health. Sidewalks must be considered alongside other complementary elements of walkability, such as density, land use mix and street connectivity. Population density is particularly important because at higher densities, more residents are exposed and this improves the cost-effectiveness. Health gain is one of many benefits of enhancing neighbourhood walkability and future studies might consider a more comprehensive assessment of its social value (eg, social cohesion, safety and air quality).
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Affiliation(s)
- J Lennert Veerman
- The University of Queensland, School of Public Health, Herston, Queensland, Australia
| | - Belen Zapata-Diomedi
- The University of Queensland, School of Public Health, Herston, Queensland, Australia
| | - Lucy Gunn
- McCaughey Centre, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Excellence in Intervention Prevention Science, Carlton South, Victoria, Australia
| | - Gavin R McCormack
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Linda J Cobiac
- The University of Queensland, School of Public Health, Herston, Queensland, Australia
- Nuffield Department of Population Health, The British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, University of Oxford, Oxford, UK
| | | | - Billie Giles-Corti
- McCaughey Centre, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alan Shiell
- Centre for Excellence in Intervention Prevention Science, Carlton South, Victoria, Australia
- Department of Public Health, The Australian Prevention Partnership Centre, La Trobe University, Melbourne, Victoria, Australia
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McKinnon RA, Siddiqi SM, Chaloupka FJ, Mancino L, Prasad K. Obesity-Related Policy/Environmental Interventions: A Systematic Review of Economic Analyses. Am J Prev Med 2016; 50:543-549. [PMID: 26707464 DOI: 10.1016/j.amepre.2015.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 10/12/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT Policy and environmental changes to support and encourage individual-level nutrition and physical activity behavior are underway in many parts of the U.S. and around the world at national, state, and local levels. Yet, to the authors' knowledge, no summary of the cost-benefit or cost-effectiveness studies of obesity-related policy/environmental interventions exists. EVIDENCE ACQUISITION The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines were followed to identify, screen, and describe the protocols used in this systematic review. In 2014, a unique search was conducted of titles and abstracts in MEDLINE, EconLit, SCOPUS, and Web of Science databases that were published from January 2002 through January 2014 in English-language, peer-reviewed journals. The search terms described obesity, physical activity, and diet in combination with economic evaluation. EVIDENCE SYNTHESIS In 2014 and 2015, the results were analyzed. A total of 27 studies met the inclusion criteria, of which 26 described separate interventions. Of the 27 included studies, eight focused on the community and built environment, seven assessed nutrition-related changes, nine reported on the school environment, and three evaluated social marketing and media interventions. The vast majority of included studies reported beneficial economic outcomes of the interventions. CONCLUSIONS Given the large and growing literature on the health and behavioral outcomes of policy and environmental interventions, the relatively low number of located cost-benefit and cost-effectiveness economic assessments appears to indicate a prime opportunity for the research community to address.
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Affiliation(s)
- Robin A McKinnon
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland.
| | - Sameer M Siddiqi
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Frank J Chaloupka
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Lisa Mancino
- U.S. Department of Agriculture, Economic Research Service, Washington, District of Columbia
| | - Kislaya Prasad
- Robert H. Smith School of Business, University of Maryland, College Park, Maryland
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Risk factors of acute and overuse musculoskeletal injuries among young conscripts: a population-based cohort study. BMC Musculoskelet Disord 2015; 16:104. [PMID: 25925549 PMCID: PMC4429711 DOI: 10.1186/s12891-015-0557-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Military service in Finland is compulsory for all male citizens and annually about 80% of 19-year-old men enter into the service. The elevated risk for many chronic diseases and loss of function among those who are inactive and unfit can be often detected already in youth. On the other hand, activity-induced injuries among young are true public health issue. The purpose of the present prospective cohort follow-up study was to evaluate predictive associations between acute or overuse injuries and their various intrinsic risk factors. METHODS Four successive cohorts of conscripts who formed a representative sample of Finnish young men were followed for 6 months. At the beginning of the service, the risk factors of injuries were measured and recorded and then the acute and overuse injuries treated at the garrison clinic were identified. Predictive associations between injuries and their risk factors were examined by multivariate Cox's proportional hazard models. RESULTS Of the 1411 participants, 27% sustained an acute injury and 51% suffered from overuse injury. Concerning acute injuries, highest risk for severe injuries were detected among conscripts with low fitness level in both the standing long-jump and push-up tests (hazard rate, HR=5.9; 95% CI: 1.6‒21.3). A history of good degree in school sports was not a protective factor against acute injuries. High waist circumference and, on the other hand, being underweight according to BMI increased the HR for overuse injuries. Brisk leisure time physical activity before military entry was a protective factor against overuse injuries. Poor result in Cooper's test was a warning signal of elevated risk of overuse injuries. CONCLUSION We confirmed previous findings that low level of physical fitness is predictor for musculoskeletal injuries during intensive physical training. The U-shaped relationship between body composition and overuse injuries was noticed indicating that both obesity and underweight are risk factors for overuse injuries. Persons with excellent sports skills according to their earlier degrees in school sports had similar HR for acute injuries than those with poorer degrees. This indicates that school-age sports skills and fitness do not carry far and therefore preventive programmes are needed to prevent activity-induced injuries.
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Heinrich KM, Lightner J, Oestman KB, Hughey SM, Kaczynski AT. Efforts of a Kansas foundation to increase physical activity and improve health by funding community trails, 2012. Prev Chronic Dis 2014; 11:E208. [PMID: 25427316 PMCID: PMC4248789 DOI: 10.5888/pcd11.140356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Trails are associated with increased physical activity; however, little is known about the process of building trails by various types of organizations. From 2005 through 2012 the Sunflower Foundation: Health Care for Kansans (Sunflower) funded multiple organizations to construct 70 trails of varying lengths and surfaces in municipalities, schools, and communities across Kansas. The purpose of this study was to assess the process of developing and implementing community trail projects across Kansas with funding from a public foundation. METHODS In 2012, we stratified funded organizations by type and conducted proportional random sampling to select 20 key informants from those organizations to participate in structured telephone interviews. Interviews were recorded and transcribed verbatim. Two researchers coded interview transcripts according to issues identified by participants. RESULTS Issues associated with trail-building identified as important were collaboration among groups, unexpected construction costs, champions for the project, and level of difficulty of construction. Participants indicated that trails facilitated physical activity. Trails were integrated into communities through events such as walking events and other promotional efforts; these efforts were thought to increase trail use. The perceived outcomes of building the trails included providing the community with a physical activity resource, inspiring the community to start additional trail projects, and increasing the physical activity of local residents. CONCLUSION Sunflower's funding was instrumental in developing trail projects to provide new physical activity resources across Kansas. Public health practitioners seeking to increase physical activity should seek funding from foundations that focus on health.
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Affiliation(s)
| | | | | | - S Morgan Hughey
- University of South Carolina, 915 Greene St, Room 519, Columbia, SC 29208. E-mail:
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Health Impact Assessment, Physical Activity and Federal Lands Trail Policy. HEALTH BEHAVIOR AND POLICY REVIEW 2014; 1:82-95. [PMID: 27213163 DOI: 10.14485/hbpr.1.1.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The objectives of this paper are to describe the application of Health Impact Assessment (HIA) to inform trail decisions affecting a rural, under-resourced community and propose the routine integration of HIAs to enhance NEPA environmental assessments and environmental impact statements for trail decisions on federal lands. METHODS Screening, scoping, assessment, recommendations, reporting, monitoring and evaluation are being used to examine the health impact of trail location and design. RESULTS HIA recommendations are being integrated into the public lands National Environmental Protection Act process for planning access to a new segment of the Continental Divide National Scenic Trail. Potential users from a nearby rural New Mexico community and a region of almost one million may benefit from this HIA-informed planning. CONCLUSIONS HIA can be integrated into the policy and decision-making process for trails on public lands.
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Do health benefits outweigh the costs of mass recreational programs? An economic analysis of four Ciclovía programs. J Urban Health 2012; 89:153-70. [PMID: 22170324 PMCID: PMC3284592 DOI: 10.1007/s11524-011-9628-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
One promising public health intervention for promoting physical activity is the Ciclovía program. The Ciclovía is a regular multisectorial community-based program in which streets are temporarily closed for motorized transport, allowing exclusive access to individuals for recreational activities and physical activity. The objective of this study was to conduct an analysis of the cost-benefit ratios of physical activity of the Ciclovía programs of Bogotá and Medellín in Colombia, Guadalajara in México, and San Francisco in the U.S.A. The data of the four programs were obtained from program directors and local surveys. The annual cost per capita of the programs was: U.S. $6.0 for Bogotá, U.S. $23.4 for Medellín, U.S. $6.5 for Guadalajara, and U.S. $70.5 for San Francisco. The cost-benefit ratio for health benefit from physical activity was 3.23-4.26 for Bogotá, 1.83 for Medellín, 1.02-1.23 for Guadalajara, and 2.32 for San Francisco. For the program of Bogotá, the cost-benefit ratio was more sensitive to the prevalence of physically active bicyclists; for Guadalajara, the cost-benefit ratio was more sensitive to user costs; and for the programs of Medellín and San Francisco, the cost-benefit ratios were more sensitive to operational costs. From a public health perspective for promoting physical activity, these Ciclovía programs are cost beneficial.
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Affiliation(s)
- Thomas A Pearson
- Rochester Prevention Research Center, Department of Community and Preventive Medicine, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA.
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Giles-Corti B, Foster S, Shilton T, Falconer R. The co-benefits for health of investing in active transportation. NSW PUBLIC HEALTH BULLETIN 2011; 21:122-7. [PMID: 20637168 DOI: 10.1071/nb10027] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Amid growing concerns about the impact of rising obesity and physical inactivity levels, climate change, population growth, increasing traffic congestion and declining oil supplies, multiple sectors are now promoting active transportation as an alternative to driving. This paper considers the health benefits and co-benefits of investing in active transportation, enabling comparison of policy options to optimise societal objectives aimed at creating healthy, socially and environmentally sustainable communities. Policies promoting the use of both energy-efficient motor vehicles and increased active transportation would almost double the impact on greenhouse gas emissions and would reduce disease burden by increasing physical activity. More co-benefit and economic analyses research is required to inform 'joined-up' policy solutions.
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Affiliation(s)
- Billie Giles-Corti
- Centre for the Built Environment and Health, School of Population Health, The University of Western Australia.
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Weintraub WS, Daniels SR, Burke LE, Franklin BA, Goff DC, Hayman LL, Lloyd-Jones D, Pandey DK, Sanchez EJ, Schram AP, Whitsel LP. Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Circulation 2011; 124:967-90. [PMID: 21788592 DOI: 10.1161/cir.0b013e3182285a81] [Citation(s) in RCA: 410] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The process of atherosclerosis may begin in youth and continue for decades, leading to both nonfatal and fatal cardiovascular events, including myocardial infarction, stroke, and sudden death. With primordial and primary prevention, cardiovascular disease is largely preventable. Clinical trial evidence has shown convincingly that pharmacological treatment of risk factors can prevent events. The data are less definitive but also highly suggestive that appropriate public policy and lifestyle interventions aimed at eliminating tobacco use, limiting salt consumption, encouraging physical exercise, and improving diet can prevent events. There has been concern about whether efforts aimed at primordial and primary prevention provide value (ie, whether such interventions are worth what we pay for them). Although questions about the value of therapeutics for acute disease may be addressed by cost-effectiveness analysis, the long time frames involved in evaluating preventive interventions make cost-effectiveness analysis difficult and necessarily flawed. Nonetheless, cost-effectiveness analyses reviewed in this policy statement largely suggest that public policy, community efforts, and pharmacological intervention are all likely to be cost-effective and often cost saving compared with common benchmarks. The high direct medical care and indirect costs of cardiovascular disease-approaching $450 billion a year in 2010 and projected to rise to over $1 trillion a year by 2030-make this a critical medical and societal issue. Prevention of cardiovascular disease will also provide great value in developing a healthier, more productive society.
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Chaufan C, Hong GH, Fox P. "Sin-food" taxes and sugar-sweetened beverages--the right policy for the wrong reasons? Am J Health Promot 2011; 25:87-90. [PMID: 21039287 DOI: 10.4278/ajhp.100223-cit-57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Claudia Chaufan
- Institute for Health and Aging, University of California San Francisco, San Francisco, CA 94118, USA.
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Fraser SD, Lock K. Cycling for transport and public health: a systematic review of the effect of the environment on cycling. Eur J Public Health 2010; 21:738-43. [DOI: 10.1093/eurpub/ckq145] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Peterson M, Chandlee M, Abraham A. Cost-effectiveness analysis of a statewide media campaign to promote adolescent physical activity. Health Promot Pract 2008; 9:426-33. [PMID: 18367641 DOI: 10.1177/1524839907313722] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A cost-effectiveness analysis of a statewide social marketing campaign was performed using a statewide surveillance survey distributed to 6th through 12th graders, media production and placement costs, and 2000 census data. Exposure to all three advertisements had the highest impact on both intent and behavior with 65.6% of the respondents considering becoming more active and 58.3% reporting becoming more active. Average cost of the entire campaign was $4.01 per person to see an ad, $7.35 per person to consider being more active, and $8.87 per person to actually become more active, with billboards yielding the most positive cost-effectiveness. Findings highlight market research as an essential part of social marketing campaigns and the importance of using multiple marketing modalities to enhance cost-effectiveness and impact.
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Librett JJ, Yore MM, Schmid TL. Characteristics of physical activity levels among trail users in a U.S. national sample. Am J Prev Med 2006; 31:399-405. [PMID: 17046411 DOI: 10.1016/j.amepre.2006.07.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2006] [Revised: 05/31/2006] [Accepted: 07/24/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Task Force on Community Preventive Services strongly recommends environmental interventions that include enhanced access to opportunities for physical activity, such as walking and cycling trails. Although accumulating evidence indicates that trails can be effective in increasing physical activity, little is known about trail users. METHODS Cross-sectional analysis of a national sample of 3717 adults from the HealthStyles and ConsumerStyles surveys using logistic regression to determine physical activity patterns and sociodemographic correlates related to trail use, and to identify support regarding trail development policies. RESULTS Almost 13% (12.7%) of the sample reported using trails at least once a month and 24.3% at least once a week. People who reported using trails at least once a week were twice as likely than people who reported rarely or never using trails to meet physical activity recommendations (odds ratio=2.3, 95% confidence interval=1.9-2.8). Nearly half (43.6%) of the non-trail users supported expanded public spaces for people to exercise, and 36.4% of the non-trail users reported that they would be willing to pay more taxes to build more parks and trails in their community. CONCLUSIONS Community trails facilitate physical activity, and almost half of frequent trail users report that access to trails and other green space is important in choosing a place to live. These results support the need for prospective research on whether newly built trails promote physical activity in previously inactive people.
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Affiliation(s)
- John J Librett
- Department of Parks, Recreation, and Tourism, College of Health, University of Utah, Salt Lake City, Utah 84112, USA.
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