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Impact of a 3-year multi-centre community-based intervention on risk factors for chronic disease and obesity among free-living adults: the Healthy Alberta Communities study.

Lytvyak E, Olstad DL, Schopflocher DP, Plotnikoff RC, Storey KE, Nykiforuk CI, Raine KD - BMC Public Health (2016)

Bottom Line: Changes in parameters over time between groups were compared using meta-analysis.The net difference in change in outcomes (change in intervention communities minus change in comparison group) represented the effect of the intervention.Evaluating the success of community-based interventions based on their efficacy in changing individual-level clinical indicators may, however, underestimate their potential.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada.

ABSTRACT

Background: Healthy Alberta Communities (HAC) was a 3-year community-based intervention to reduce lifestyle-related risk factors for chronic disease and obesity at a population-level. The current paper examines changes in blood pressure (BP) and anthropometric indicators within HAC communities compared to secular trends.

Methods: Between 2006 and 2009, this community-academic partnership sought to create environments supportive of healthier dietary and physical activity behaviours within four diverse communities in Alberta, Canada. Height, weight, waist and hip circumference and BP were measured among 1554 and 1808 community residents at baseline (2006) and follow-up (2009), respectively. A comparison sample was drawn from a representative national survey. Samples were stratified by age and change between pre- and post-intervention was assessed using t-tests. Changes in parameters over time between groups were compared using meta-analysis. The net difference in change in outcomes (change in intervention communities minus change in comparison group) represented the effect of the intervention.

Results: Adjusted systolic (SBP) and diastolic (DBP) BP declined within most age groups in HAC communities from pre- to post-intervention. The net decline in SBP was 1 mmHg in 20-39 year olds (p = 0.006) and 2 mmHg in 40-59 year olds (p = 0.001), while the net decline in DBP was 3 mmHg in 20-39 year olds (p < 0.001), 2 mmHg in 40-59 year olds (p < 0.001) and 3 mmHg in 60-79 year olds (p < 0.001). The net increase in the proportion of individuals with normal BP was 5.9 % (p < 0.001), while the net decline in the proportion of individuals with stage 1 hypertension was 4.5 % (p < 0.001). BMI and body weight were unchanged. There was a significant net increase in waist and hip circumference among 20-39 year olds within intervention communities.

Conclusions: Findings suggest HAC succeeded in shifting the population distribution of BP in a leftward direction. By contrast, anthropometric parameters remained unchanged or worsened within intervention communities. Therefore, while improvements in some clinical risk factors can be achieved through relatively diffuse and shorter-term community-level environmental changes, improvements in others may require interventions of greater intensity and duration. Evaluating the success of community-based interventions based on their efficacy in changing individual-level clinical indicators may, however, underestimate their potential.

No MeSH data available.


Related in: MedlinePlus

Prevalence of stage 1 hypertension in intervention and comparison groups. Stage 1 hypertension was defined as systolic blood pressure 140–159 mmHg and/or diastolic blood pressure 90–99 mmHg [32]. ***p < 0.001 between follow-up and baseline in intervention communities. &&&p < 0.001 between follow-up and baseline changes in intervention and comparison groups. n/a = too unreliable to be published, data with a coefficient of variation >33.3 %, suppressed due to extreme sampling variability [11, 30]
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Fig4: Prevalence of stage 1 hypertension in intervention and comparison groups. Stage 1 hypertension was defined as systolic blood pressure 140–159 mmHg and/or diastolic blood pressure 90–99 mmHg [32]. ***p < 0.001 between follow-up and baseline in intervention communities. &&&p < 0.001 between follow-up and baseline changes in intervention and comparison groups. n/a = too unreliable to be published, data with a coefficient of variation >33.3 %, suppressed due to extreme sampling variability [11, 30]

Mentions: The proportion of individuals with normal BP increased significantly in intervention communities in all age groups except the 60–79 year old group (Fig. 3). No significant changes were observed within the comparison group. Changes within intervention communities were significantly greater than those in the comparison group overall (p = 0.029), and within the 18–39 (p < 0.001) and 40–59 year old (p < 0.001) age categories. A corresponding reduction in the proportion of individuals within intervention communities with stage 1 hypertension was also observed in all age groups except the 60–79 year old group (Fig. 4). By contrast, values in the comparison group were unchanged. The changes observed in intervention communities were significantly greater than those in the comparison group overall (p < 0.001), and for the 40–59 year old (p < 0.001) age categories. The outcome of these shifts was a net increase in the proportion of normotensive individuals of 4.0 % in the 18–39 year old group (p = 0.029), of 8.6 % in the 40–59 year old group (p < 0.001), and 5.9 % overall (p < 0.001), along with a net decrease in the proportion of stage 1 hypertensive individuals by 7.3 % among 40–59 year olds (p < 0.001) and 4.5 % overall (p < 0.001).Fig. 3


Impact of a 3-year multi-centre community-based intervention on risk factors for chronic disease and obesity among free-living adults: the Healthy Alberta Communities study.

Lytvyak E, Olstad DL, Schopflocher DP, Plotnikoff RC, Storey KE, Nykiforuk CI, Raine KD - BMC Public Health (2016)

Prevalence of stage 1 hypertension in intervention and comparison groups. Stage 1 hypertension was defined as systolic blood pressure 140–159 mmHg and/or diastolic blood pressure 90–99 mmHg [32]. ***p < 0.001 between follow-up and baseline in intervention communities. &&&p < 0.001 between follow-up and baseline changes in intervention and comparison groups. n/a = too unreliable to be published, data with a coefficient of variation >33.3 %, suppressed due to extreme sampling variability [11, 30]
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4835846&req=5

Fig4: Prevalence of stage 1 hypertension in intervention and comparison groups. Stage 1 hypertension was defined as systolic blood pressure 140–159 mmHg and/or diastolic blood pressure 90–99 mmHg [32]. ***p < 0.001 between follow-up and baseline in intervention communities. &&&p < 0.001 between follow-up and baseline changes in intervention and comparison groups. n/a = too unreliable to be published, data with a coefficient of variation >33.3 %, suppressed due to extreme sampling variability [11, 30]
Mentions: The proportion of individuals with normal BP increased significantly in intervention communities in all age groups except the 60–79 year old group (Fig. 3). No significant changes were observed within the comparison group. Changes within intervention communities were significantly greater than those in the comparison group overall (p = 0.029), and within the 18–39 (p < 0.001) and 40–59 year old (p < 0.001) age categories. A corresponding reduction in the proportion of individuals within intervention communities with stage 1 hypertension was also observed in all age groups except the 60–79 year old group (Fig. 4). By contrast, values in the comparison group were unchanged. The changes observed in intervention communities were significantly greater than those in the comparison group overall (p < 0.001), and for the 40–59 year old (p < 0.001) age categories. The outcome of these shifts was a net increase in the proportion of normotensive individuals of 4.0 % in the 18–39 year old group (p = 0.029), of 8.6 % in the 40–59 year old group (p < 0.001), and 5.9 % overall (p < 0.001), along with a net decrease in the proportion of stage 1 hypertensive individuals by 7.3 % among 40–59 year olds (p < 0.001) and 4.5 % overall (p < 0.001).Fig. 3

Bottom Line: Changes in parameters over time between groups were compared using meta-analysis.The net difference in change in outcomes (change in intervention communities minus change in comparison group) represented the effect of the intervention.Evaluating the success of community-based interventions based on their efficacy in changing individual-level clinical indicators may, however, underestimate their potential.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada.

ABSTRACT

Background: Healthy Alberta Communities (HAC) was a 3-year community-based intervention to reduce lifestyle-related risk factors for chronic disease and obesity at a population-level. The current paper examines changes in blood pressure (BP) and anthropometric indicators within HAC communities compared to secular trends.

Methods: Between 2006 and 2009, this community-academic partnership sought to create environments supportive of healthier dietary and physical activity behaviours within four diverse communities in Alberta, Canada. Height, weight, waist and hip circumference and BP were measured among 1554 and 1808 community residents at baseline (2006) and follow-up (2009), respectively. A comparison sample was drawn from a representative national survey. Samples were stratified by age and change between pre- and post-intervention was assessed using t-tests. Changes in parameters over time between groups were compared using meta-analysis. The net difference in change in outcomes (change in intervention communities minus change in comparison group) represented the effect of the intervention.

Results: Adjusted systolic (SBP) and diastolic (DBP) BP declined within most age groups in HAC communities from pre- to post-intervention. The net decline in SBP was 1 mmHg in 20-39 year olds (p = 0.006) and 2 mmHg in 40-59 year olds (p = 0.001), while the net decline in DBP was 3 mmHg in 20-39 year olds (p < 0.001), 2 mmHg in 40-59 year olds (p < 0.001) and 3 mmHg in 60-79 year olds (p < 0.001). The net increase in the proportion of individuals with normal BP was 5.9 % (p < 0.001), while the net decline in the proportion of individuals with stage 1 hypertension was 4.5 % (p < 0.001). BMI and body weight were unchanged. There was a significant net increase in waist and hip circumference among 20-39 year olds within intervention communities.

Conclusions: Findings suggest HAC succeeded in shifting the population distribution of BP in a leftward direction. By contrast, anthropometric parameters remained unchanged or worsened within intervention communities. Therefore, while improvements in some clinical risk factors can be achieved through relatively diffuse and shorter-term community-level environmental changes, improvements in others may require interventions of greater intensity and duration. Evaluating the success of community-based interventions based on their efficacy in changing individual-level clinical indicators may, however, underestimate their potential.

No MeSH data available.


Related in: MedlinePlus