The following intervention approaches, strategies from the Guide to Community Preventive Services and the Guide to Clinical Preventive Services (see Attachment B), and other evidence-based strategies, should be considered in designing community action plans.

(Also see School Health )

Alter the food environment by making healthy food the easy, less expensive, and desirable choice.

Increase the availability of fruits and vegetables by adding salad bars, fruits, and vegetables to school and worksite cafeterias, and by adding fruit to refrigerated vending machines.

Improve access to fruits and vegetables by encouraging the establishment of community and worksite locations for produce stands and sales.

Encourage schools and worksites to lower the price of fruits and vegetables to help promote their purchase.

Implement five A-Day programs.

Conduct community-wide media campaigns to promote healthy food choices.

Provide "point-of-decision" prompts and supermarket displays to encourage purchase of healthy food items.

Help to establish social support for making healthy nutritional choices.

Provide cooking demonstrations on how to prepare foods with less fat, fewer calories, and of appropriate portion size.

Encouraging restaurants to label heart-healthy menu items.

Implement hospital and maternity care practices based on the ten steps to successful breastfeeding.

Implement social marketing and media campaigns with positive breastfeeding campaigns.

Provide breastfeeding information and services to create a supportive environment for breastfeeding women in the workplace.

(Also see School Health.)

Implement programs that create enhanced access to places for physical activity (e.g., before-hours shopping malls open for walking, school gyms and fields for after school and weekend activities for persons of all ages).

Implement community physical activity programs and information outreach activities such as walk-to-school programs, walking and biking clubs.

Implement transportation and urban planning approaches designed to increase physical activity.

Implement programs to reduce television watching among children.

(Also see School Health.)

Reduce environmental tobacco smoke.

Conduct counter-advertising campaigns to reduce the attractiveness of tobacco use.

Implement reminder systems that prompt providers to ask patients about tobacco use and include encouragement to quit for persons who use tobacco.

Provide telephone support, with other interventions, for people who want to quit.

(Also see Tobacco and School Health.)

Improve quality of medical care by educating providers how to appropriately classify asthma severity, providing information on controller medications and spacer devices, influenza vaccine, asthma flow sheets, asthma care plans with patients/families, and helping providers develop more effective patient-provider communication approaches.

Improve self-care, and care by primary household caregiver through training in family-oriented asthma decision-making skills, monitoring and adherence.

Encourage at-risk individuals to seek family and/or mental health services to help families cope with their stress, remove barriers to effective asthma care, and develop a sense of empowerment/self-efficacy.

Reduce indoor allergen and/or ambient air pollution exposure through low cost and well studied measures (e.g. mattress covers, feather pillows, training in indoor environmental remediation, and reductions in diesel bus idling).

Educate health plans and providers regarding standards for preventive health care practices and how to fully implement them.

Diabetes:

Also see tobacco, nutrition, physical activity, and school health.

Conduct community-wide campaigns to implement a diabetes risk assessment questionnaire (e.g., American Diabetes Association’s Are You at Risk?) at multiple points of contact such as grocery stores, pharmacies, family planning clinics, senior centers, churches, and department stores, etc.

Conduct media campaigns promoting diabetes risk-assessment with the message to see a health care provider if the individual is at risk.

Promote diabetes literacy among the public.

Increase the likelihood that physicians develop treatment plans for diagnosed patients and follow accepted standards of care.

Provide and train health care professionals on office-based procedures for referrals, follow-up, and patient reminders.

Provide a process for referrals to community facilities for physical activity, nutrition education, and tobacco cessation.

Ensure participation of federally funded health centers in comprehensive diabetes plans.

Form diabetes support groups to improve self-management practices in people with diabetes and to support lifestyle changes.

Provide family and caretaker education for people with diabetes to support change/maintenance of behavior in patients with pre-diabetes and diabetes.

Support faith-based outreach services to offer their resources (e.g. transportation, meeting space, designated diabetes awareness activities) to the elderly, disabled, and socially isolated members of the community.

Provide training to school staff to respond to diabetes emergencies, assist in diabetes care/self-management, and provide education to other students regarding diabetes.

Develop community support groups for persons with diabetes.

(Also see Tobacco, Nutrition, Physical Activity, and School Health.)

Assist health care systems in using Body Mass Index (BMI) as a vital sign beginning at age two years and continuing through adulthood.

Train providers to use current recommendations in screening, assessing, and managing overweight children and adolescents.

Assist health care systems and providers in establishing effective, intensive, behavioral counseling for adult patients with known risk factors for diet-related chronic disease.

Implement lifestyle interventions for high-risk adults from the Diabetes Prevention Program Lifestyle Change Program.

(Also See Tobacco, Nutrition, Physical Activity, Diabetes, Asthma, and Obesity)

Implement a planned, sequential, K-12 curriculum that addresses the physical, mental, emotional, and social dimensions of health. Such a curriculum should be designed to motivate and assist students to maintain and improve their health, prevent disease, and reduce health-related risk behaviors. The curriculum should also provide

learning experiences through a variety of activity areas such as basic movement skills; physical fitness; rhythms and dance; games; team, dual, and individual sports; tumbling and gymnastics, and aquatics. Emphasize enjoyable participation in physical activities that are easily done throughout life. Give young people the skills and confidence they need to be physically active for a lifetime.

Provide nutrition services that provide access to a variety of nutritious and appealing meals that accommodate the health and nutrition needs of all students. Such nutrition services should reflect the U.S. Dietary Guidelines for Americans and other criteria to achieve nutrition integrity. Establish a school nutrition program that limits the availability of foods high in fat, sodium, and added sugars (such as soda, candy, and fried chips); discourages teachers from using food to discipline or reward students, and provides adequate time and space for students to eat meals in a pleasant, safe environment.

Provide health promotion opportunities for school staff to improve their health status through activities such as health assessments, health education and health-related fitness activities. These opportunities encourage school staff to pursue a healthy lifestyle that contributes to their improved health status and creates positive role modeling for students.

Provide a healthy school environment that includes both the physical and psychosocial climates and cultures of the school. Factors that influence the physical environment include the school building and the area surrounding it (e.g. tobacco-free policies, assessing indoor allergen agents, noise, and lighting). The psychosocial environment includes the physical, emotional, and social conditions that affect the well-being of students and staff.

Encourage parent/community involvement that integrates a school, parent, and community approach for enhancing the health and well-being of students through the involvement of school health advisory councils, coalitions, and broadly based constituencies for school health.

Expand and/or improve school health services and educational programs to address children with asthma. Improve the existing system of asthma care by school personnel (i.e. school nurses, teachers, coaches, etc.) through the introduction of standardized training curricula, treatment protocols, and streamlined communication mechanisms between school nurses, coaches/physical education teachers, parents, and medical providers.

Adopt classroom-based asthma education activities (e.g. Open Airways, You Can Control Asthma, Power Breathing, etc.)

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