Circulation. 2012 Sep 18;126(12):1514-63. doi: 10.1161/CIR.0b013e318260a20b. Epub 2012 Aug 20.
BACKGROUND: Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established. METHODS AND RESULTS: For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies. CONCLUSIONS: This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.
背景:不良生活方式行为,包括饮食不合理、身体活动不足和使用烟草,是全球可预防疾病的主要原因。尽管风险人群的适度变化会显著改变健康结果,但改善生活方式的最佳人群方法尚未得到很好的确定。
方法和结果: 为此,美国心脏协会科学声明,写作小组系统地审查和评估了有效改善饮食习惯、增加身体活动和减少烟草使用的人群方法的当前科学证据。策略在 6 个广泛的领域中进行考虑:(1)媒体和教育运动;(2)标签和消费者信息;(3)税收、补贴和其他经济激励措施;(4)学校和工作场所方法;(5)当地环境变化;(6)直接限制和授权。写作小组还审查了医疗保健系统和监测系统对行为改变努力的潜在贡献。确定了一些具体的人群干预措施,这些干预措施获得了 I 级或 IIa 类推荐,且具有 A 级或 B 级证据,为一系列具体的基于证据的策略提供了依据,这些策略值得密切关注和优先实施。有效的干预措施包括在所有 6 个评估领域中都有具体的方法,以改善饮食、增加活动和减少烟草使用。写作小组还确定了这些领域中每个领域的几个具体干预措施,这些措施的当前证据较弱,以及其他不一致和证据差距,这表明需要进一步进行严格和跨学科的方法来评估人群计划和政策。
结论: 这项系统综述确定并评估了一系列促进生活方式改变的基于人群的策略的证据。这些发现为政策制定者、宣传团体、研究人员、临床医生、社区和其他利益相关者提供了一个框架,以了解和实施最有效的方法。需要新的战略举措和伙伴关系将这一证据转化为行动。
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