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 .
This systematic review identified and grade d the evidence for a range of population -based strategies to promote lifestyle change .
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 .
Residential self-selection bias in the estimation of built environment effects on physical activity between adolescence and young adulthood
Background Built environment research is dominated by cross-sectional design s , which are particularly vulnerable to residential self- selection bias result ing from health-related attitudes , neighborhood preferences , or other unmeasured characteristics related to both neighborhood choice and health-related outcomes . Methods We used cohort data from the National Longitudinal Study of Adolescent Health ( United States ; Wave I , 1994 - 95 ; Wave III , 2001 - 02 ; n = 12,701 ) and a time-varying geographic information system . Longitudinal relationships between moderate to vigorous physical activity ( MVPA ) bouts and built and socioeconomic environment measures ( l and cover diversity , pay and public physical activity facilities per 10,000 population , street connectivity , median household income , and crime rate ) from adolescence to young adulthood were estimated using r and om effects models ( biased by unmeasured confounders ) and fixed effects models ( within-person estimator , which adjusts for unmeasured confounders that are stable over time ) . Results R and om effects models yielded null associations except for negative crime-MVPA associations [ coefficient ( 95 % CI ) : -0.056 ( -0.083 , -0.029 ) in males , -0.061 ( -0.090 , -0.033 ) in females ] . After controlling for measured and time invariant unmeasured characteristics using within-person estimators , MVPA was higher with greater physical activity pay facilities in males [ coefficient ( 95 % CI ) : 0.024 ( 0.006 , 0.042 ) ] , and lower with higher crime rates in males [ coefficient ( 95 % CI ) : -0.107 ( -0.140 , -0.075 ) ] and females [ coefficient ( 95 % CI ) : -0.046 ( -0.083 , -0.009 ) ] . Other associations were null or in the counter-intuitive direction . Conclusions Comparison of within-person estimates to estimates unadjusted for unmeasured characteristics suggest that residential self- selection can bias associations toward the null , as opposed to its typical characterization as a positive confounder . Differential environment-MVPA associations by residential relocation suggest that studies examining changes following residential relocation may be vulnerable to selection bias . The authors discuss complexities of adjusting for residential self- selection and residential relocation , particularly during the adolescent to young adult transition
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 .
This systematic review identified and grade d the evidence for a range of population -based strategies to promote lifestyle change .
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 .