Table 2-6.

Summary of Evidence-Based Population Approaches for Improving Diet, Increasing Physical Activity, and Reducing Tobacco Use*

Diet
 Media and educationSustained, focused media and educational campaigns, using multiple modes, for increasing consumption of specific healthful foods or reducing consumption of specific less healthful foods or beverages, either alone (Class IIa; Level of Evidence B) or as part of multicomponent strategies (Class I; Level of Evidence B)§
On-site supermarket and grocery store educational programs to support the purchase of healthier foods (Class IIa; Level of Evidence B)
 Labeling and informationMandated nutrition facts panels or front-of-pack labels/icons as a means to influence industry behavior and product formulations (Class IIa; Level of Evidence B)
 Economic incentivesSubsidy strategies to lower prices of more healthful foods and beverages (Class I; Level of Evidence A)
Tax strategies to increase prices of less healthful foods and beverages (Class IIa; Level of Evidence B)
Changes in both agricultural subsidies and other related policies to create an infrastructure that facilitates production, transportation, and marketing of healthier foods, sustained over several decades (Class IIa; Level of Evidence B)
 SchoolsMulticomponent interventions focused on improving both diet and physical activity, including specialized educational curricula, trained teachers, supportive school policies, a formal PE program, healthy food and beverage options, and a parental/family component (Class I; Level of Evidence A)
School garden programs, including nutrition and gardening education and hands-on gardening experiences (Class IIa; Level of Evidence A)
Fresh fruit and vegetable programs that provide free fruits and vegetables to students during the school day (Class IIa; Level of Evidence A)
 WorkplacesComprehensive worksite wellness programs with nutrition, physical activity, and tobacco cessation/prevention components (Class IIa; Level of Evidence A)
Increased availability of healthier food/beverage options and/or strong nutrition standards for foods and beverages served, in combination with vending machine prompts, labels, or icons to make healthier choices (Class IIa; Level of Evidence B)
 Local environmentIncreased availability of supermarkets near homes (Class IIa; Level of Evidence B)
 Restrictions and mandatesRestrictions on television advertisements for less healthful foods or beverages advertised to children (Class I; Level of Evidence B)
Restrictions on advertising and marketing of less healthful foods or beverages near schools and public places frequented by youths (Class IIa; Level of Evidence B)
General nutrition standards for foods and beverages marketed and advertised to children in any fashion, including on-package promotion (Class IIa; Level of Evidence B)
Regulatory policies to reduce specific nutrients in foods (eg, trans fats, salt, certain fats) (Class I; Level of Evidence B)†§
Physical activity
 Labeling and informationPoint-of-decision prompts to encourage use of stairs (Class IIa; Level of Evidence A)
 Economic incentivesIncreased gasoline taxes to increase active transport/commuting (Class IIa; Level of Evidence B)
 SchoolsMulticomponent interventions focused on improving both diet and physical activity, including specialized educational curricula, trained teachers, supportive school policies, a formal PE program, serving of healthy food and beverage options, and a parental/family component (Class IIa; Level of Evidence A)
Increased availability and types of school playground spaces and equipment (Class I; Level of Evidence B)
Increased number of PE classes, revised PE curricula to increase time in at least moderate activity, and trained PE teachers at schools (Class IIa; Level of Evidence A/Class IIb; Level of Evidence A)
Regular classroom physical activity breaks during academic lessons (Class IIa; Level of Evidence A)§
 WorkplacesComprehensive worksite wellness programs with nutrition, physical activity, and tobacco cessation/prevention components (Class IIa; Level of Evidence A)
Structured worksite programs that encourage activity and also provide a set time for physical activity during work hours (Class IIa; Level of Evidence B)
Improving stairway access and appeal, potentially in combination with “skip-stop” elevators that skip some floors (Class IIa; Level of Evidence B)
Adding new or updating worksite fitness centers (Class IIa; Level of Evidence B)
 Local environmentImproved accessibility of recreation and exercise spaces and facilities (eg, building of parks and playgrounds, increasing operating hours, use of school facilities during nonschool hours) (Class IIa; Level of Evidence B)
Improved land-use design (eg, integration and interrelationships of residential, school, work, retail, and public spaces) (Class IIa; Level of Evidence B)
Improved sidewalk and street design to increase active commuting (walking or bicycling) to school by children (Class IIa; Level of Evidence B)
Improved traffic safety (Class IIa; Level of Evidence B)
Improved neighborhood aesthetics (to increase activity in adults) (Class IIa; Level of Evidence B)
Improved walkability, a composite indicator that incorporates aspects of land-use mix, street connectivity, pedestrian infrastructure, aesthetics, traffic safety, and/or crime safety (Class IIa; Level of Evidence B)
Smoking
 Media and educationSustained, focused media and educational campaigns to reduce smoking, either alone (Class IIa; Level of Evidence B) or as part of larger multicomponent population-level strategies (Class I; Level of Evidence A)
 Labeling and informationCigarette package warnings, especially those that are graphic and health related (Class I; Level of Evidence B)§
 Economic incentivesHigher taxes on tobacco products to reduce use and fund tobacco control programs (Class I; Level of Evidence A)§
 Schools and workplacesComprehensive worksite wellness programs with nutrition, physical activity, and tobacco cessation/prevention components (Class IIa; Level of Evidence A)
 Local environmentReduced density of retail tobacco outlets around homes and schools (Class I; Level of Evidence B)
Development of community telephone lines for cessation counseling and support services (Class I; Level of Evidence A)
 Restrictions and mandatesCommunity (city, state, or federal) restrictions on smoking in public places (Class I; Level of Evidence A)
Local workplace-specific restrictions on smoking (Class I; Level of Evidence A)§
Stronger enforcement of local school-specific restrictions on smoking (Class IIa; Level of Evidence B)
Local residence-specific restrictions on smoking (Class IIa; Level of Evidence B)§
Partial or complete restrictions on advertising and promotion of tobacco products (Class I; Level of Evidence B)
  • PE indicates physical education.

  • * The specific population interventions listed here are either a Class I or IIa recommendation with a Level of Evidence grade of either A or B.

  • At least some evidence from studies conducted in high-income Western regions and countries (eg, North America, Europe, Australia, New Zealand).

  • At least some evidence from studies conducted in high-income non-Western regions and countries (eg, Japan, Hong Kong, South Korea, Singapore).

  • § At least some evidence from studies conducted in low- or middle-income regions and countries (eg, Africa, China, Pakistan, India).

  • Based on cross-sectional studies only; only 2 longitudinal studies have been performed, with no significant relations seen.

  • Class IIa; Level of Evidence A for improving physical activity; Class IIb; Level of Evidence B for reducing adiposity.

  • Reprinted from Mozaffarian et al28 with permission. Copyright © 2012, American Heart Association, Inc.