A Compendium of Proven Community-Based Prevention Programs

The Trust for America’s Health (TFAH) and New York Academy of Medicine (NYAM) released A Compendium of Proven Community-Based Prevention Programs, which highlights 79 evidence-based disease and injury prevention programs that have saved lives and improved health.

“Over the past 50 years, healthcare costs have risen drastically—accounting for 18 percent of the Gross Domestic Product,” said Jo Ivey Boufford, MD, president of The New York Academy of Medicine.  “Some of the costliest chronic conditions have been the drivers of these costs—yet a significant number of these illnesses and injuries could have been prevented. Quite simply, disease and injury prevention programs are the key to reversing spiraling costs and safeguarding the future health and wealth of the nation.”

The Compendium notes that, since 2008, the number of effective community-based programs and interventions has grown exponentially and the report identifies specific programs—that can be taken to scale—which prevent disease and create a healthier population.

“The Compendium highlights the growing number and range of successful, evidence-based approaches to prevention,” said Jeffrey Levi, PhD, executive director of TFAH. “These efforts demonstrate that making healthy choices easier for people in their daily lives pays off in terms of improving health and lowering health care costs. This report documents how these programs can and do work – but we need to invest more if we’re going to bring them to scale and improve the nation’s health.”

The Compendium is a follow-up to a 2009 report released by TFAH and NYAM, which followed a 2008 TFAH study that found that an investment of $10 per person per year in proven evidenced-based community prevention programs that increase physical activity, improve nutrition and prevent smoking and other tobacco use could save the country more than $16 billion annually within five years—a return of $5.60 for every $1.

The report was supported by grants from The Kresge Foundation and the Robert Wood Johnson Foundation.

In conjunction with releasing the Compendium, TFAH also published several stories in the story bank of Prevention and Public Health Stories in the states, which highlight what is working in communities to make the healthy choice the easy choice.

The Compendium includes examples of programs that increase physical activity, reduce asthma, sexually transmitted infections and tobacco and alcohol use, and prevent violence and injury including:

Physical Activity:

• The Partnership for an Active Community Environment (PACE) steering committee in New Orleans, Louisiana installed a six-block walking path and school playground in a low-income Black neighborhood. The proportion of residents who were active increased significantly in the neighborhood with the path and playground, where 41 percent of those engaging in physical activity were moderately or vigorously active, compared to 24 to 38 percent of residents in similar neighborhoods without the path. The report notes that PACE is an effective intervention that demonstrates how changes to the built environment may increase neighborhood physical activity.
• North Carolina’s State Health Plan for Teachers and State Employees made the Eat Smart, Move More, Weight Less (ESMMWL) available to their members to better manage weight and reduce associated health care costs. The percentage of participants with a BMI less than 30 kg/m² increased from 40 percent to 45 percent and those with a normal blood pressure increased from 23 percent to 32.5 percent.
• Shape Up Somerville, a comprehensive effort to prevent obesity in high-risk first through third grade students in Somerville, Massachusetts, included improved nutrition in schools, a school health curriculum, an after-school curriculum, parent and community outreach, collaboration with community restaurants, school nurse education, and a safe routes to school program. After one year, on average the program reduced one pound of weight gain over eight months for an 8-year-old child. On a population level, this reduction in weight gain would translate into large numbers of children moving out of the overweight category and reducing their risk for chronic disease.
• The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program provides low-income uninsured women aged 40 to 64 with chronic disease risk factor screenings, lifestyle interventions and referral services. Over the course of a year, WISEWOMAN participants improved their 10-year risk of coronary heart disease by 8.7 percent, and there were significant reductions in the percent of participants who smoked and had high blood pressure and high cholesterol.

Asthma:

• School bus emissions collect within passenger cabins, pollute the environment and contribute disproportionately to air quality. The Washington State Clean School Bus Program found that school bus retrofits could result in reductions of bronchitis, asthma and pneumonia, with conservative benefit–cost ratios between 7:1 and 16:1.
• Urban, low-income patients with asthma from four zip codes were identified through logs of Emergency Department (ED) visits or hospitalizations, and offered enhanced care including nurse case management and home visits. The program provided services to 283 children with 39.6 percent Black, 52.3 percent Latino, 72.7 percent using Medicaid, and 70.8 percent with a household income of less than $25,000. Twelve-month data show a significant decrease in any asthma ED visits and hospitalizations, and any days of limitation of physical activity, patient missed school, and parent missed work. There was a significant reduction in hospital costs compared with the comparison community, and a return on investment of $1.46.

Violence and Injury Prevention:

• The federal Safe Routes to School (SRTS) program allocated funds for state departments of transportation to build sidewalks, bicycle lanes, and safe crossings, improve signage, and make other improvements that allow children to travel more safely to school.  In New York City, from 2001-2010, annual pedestrian injury rates per 10,000 population were calculated for different age groups and for census tracts with and without SRTS interventions during school-travel hours. The annual rate of school-aged pedestrian injury during school-travel hours decreased 44 percent in census tracts with SRTS interventions.
• Tennessee implemented an extensive statewide sobriety checkpoint program (Checkpoint Tennessee). The volume of checkpoints increased from about 15 in the preceding year to nearly 900 in the program year. The checkpoint activity was publicized extensively. The program resulted in a 20.4 percent reduction in alcohol related crashes extending at least 21 months after conclusion of the formal program, preventing nine fatal alcohol-related crashes per month.

Sexually Transmitted Infections and AIDS:

• A social marketing campaign conducted in Louisiana made over 33 million condoms freely available in over 1,000 public and commercial sites. Surveys among 275,000 Blacks showed that condom use increased by 30 percent and the program was estimated to prevent 170 HIV infections and save 1,909 quality-adjusted life years.

Tobacco Use:

• A cost-benefit analysis approach was used to estimate the return on investment for the tobacco cessation program implemented by the state of Massachusetts. Administrative data indicated that program costs were about $183 per program participant (in 2010 dollars). The study also estimated inpatient savings per participant of $571, meaning every $1 in program costs was associated with $3.12 in medical savings, for a $2.12 return on investment to the Medicaid program for every dollar spent.

Alcohol Use:

• A study examined the effects of changes to Washington State’s ignition interlock laws.  In June 2004, the interlock order requirement extended to first-time offenders with blood alcohol concentrations (BACs) below 0.15 percent.  Mandating interlock orders for all first DUI convictions was associated with reductions in recidivism, even with low interlock use rates, and reductions in crashes.  Recidivism among first simple DUI offenders declined by an estimated 12 percent.  Among all first-time offenders, it decreased by an estimated 11 percent. The 2004 law change was associated with an 8.3 percent reduction in single-vehicle late-night crash risk.

The report includes an extensive literature review, conducted by NYAM, of peer reviewed studies that evaluated the effectiveness of community-based prevention programs designed to reduce tobacco use, injuries, asthma, alcohol abuse and sexually-transmitted infections, increase physical activity and improve eating habits.