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Cited by 195Cardiovascular Health and Risk FactorsHealth Promotion and Cardiovascular PreventionBehavioral Health and Interventions

Better Population Health Through Behavior Change in Adults: A Call to Action

Open access
Spring, Bonnie, Ockene, Judith K., Gidding, Samuel S., Mozaffarian, Dariush, Moore, Shirley, Rosal, Milagros C., Brown, Michael D., Vafiadis, Dorothea K. +3 more·2013·Circulation
DOI 10.1161/01.cir.0000435173.25936.e1PMC PMC4074536
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Abstract

The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a

AI snapshot

Written from the paper’s full text.

TL;DR

The AHA 2020 goals call for improving cardiovascular health of all Americans by 20% and reducing deaths from cardiovascular diseases and stroke by 20%, with new emphasis on preserving healthy behaviors and treating unhealthy behaviors alongside risk biomarkers. The statement argues that clinician-delivered behavior change counseling, healthcare system supports, and population-level strategies are needed to shift the population toward ideal cardiovascular health.

Key findings

  • Ideal cardiovascular health is rare, and adverse behaviors—poor-quality diet, physical inactivity, overweight/obesity, and smoking—are common and most prevalent among those with low socioeconomic status, little education, and limited access to health care. Eliminating these risk behaviors could prevent at least 80% of heart disease, stroke, and type 2 diabetes and 40% of cancers.
  • Prospective evidence links more ideal metrics to lower mortality: adults with ≥5 of 7 ideal metrics versus 0 had 78% lower all-cause mortality and 88% lower cardiovascular disease mortality over 5.8 years; in CARDIA, 60% of young adults who practiced all 5 healthy lifestyle behaviors had all ideal cardiovascular biomarkers in middle age, versus fewer than 5% of those who practiced none.
  • Behavior change is feasible: brief physician advice has modest but significant effects on smoking cessation, dietary quality, and physical activity; intensive behavioral treatment with multiple sessions lasting ≥10 minutes produces greater improvement. The 5 A’s framework is validated, but the last 3 A’s—agree, assist, arrange—are underused despite having the greatest impact.
  • Conjoint high-risk and population strategies are needed; a simulation model estimated that adding health promotion to expanded coverage and improved care could save 90% more lives and reduce costs by 30% in 10 years, and by 25 years save 140% more lives and reduce costs by 62%.

Methods

  • Design: American Heart Association call to action/scientific statement, not an empirical study; it synthesizes evidence from prospective cohorts, randomized trials, guidelines, and simulation models.
  • Data or sample: No new sample or primary data are reported; cited evidence includes Ford et al., Yang et al., ARIC, CARDIA, and Milstein et al.
  • Main analysis: Narrative synthesis and policy/practice recommendations, including the 5 A’s counseling algorithm and a proposed two-tiered stepped care model.

Limitations

  • The paper does not state formal limitations.
  • Evident from the text: it is a narrative call to action rather than a systematic review or meta-analysis, and it reports no primary data.
  • Evident from the text: it focuses primarily on adult behavior change, although it notes full implementation of the AHA goals requires a life-course approach beginning in childhood; it also identifies implementation barriers such as limited visit time, competing medical priorities, and insufficient financial incentives.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1161/01.cir.0000435173.25936.e1

Cites

Statistics

Nothing to recompute.

Claims the paper makes

0 of 141 cited sources checked · 0 supported · 0 flagged

  • Interpretationcitation
    § Better Population Health Through Behavior Change in Adults A Call to Action

    The major reasons for the loss of cardiovascular health from childhood through young adulthood are adverse health behaviors related to diet, physical activity, healthy weight maintenance, and smoking.

    “It is abundantly clear that cardiovascular health is being lost from childhood through young adulthood and that the major reasons are adverse health behaviors related to diet, physical activity, healthy weight maintenance, and smoking.8”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] Shay CM Ning H Allen NB Carnethon MR Chiuve SE Greenlund KJ Daviglus ML Lloyd-Jones DM Status of cardiovascular health in US adults: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2003–2008 Circulation 2012 125 45 56 22095826 PMC4077723 source

      Not checked in the free run.

  • Premisecitation

    Over 14.8 years of follow-up, Yang and colleagues observed a graded reduction in all-cause, cardiovascular disease, and ischemic heart disease mortality in conjunction with having greater numbers of metrics at ideal levels at baseline.

    “Similarly, over 14.8 years of follow-up, Yang and colleagues11 observed a graded reduction in all-cause, cardiovascular disease, and ischemic heart disease mortality in conjunction with having greater numbers of metrics at ideal levels at baseline”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Yang Q Cogswell ME Flanders WD Hong Y Zhang Z Loustalot F Gillespie C Merritt R Hu FB Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults JAMA 2012 307 1273 1283 22427615 PMC9004324 source

      Not checked in the free run.

  • Interpretationcitation
    § Better Population Health Through Behavior Change in Adults A Call to Action

    The high prevalence of poor-quality diet, physical inactivity, and overweight/obesity presages a worsening of the current distribution of health biomarkers.

    “However, the prevalence of ideal cardiovascular health is very low in the US population, and the prevalence of poor-quality diet, physical inactivity, and overweight/obesity is alarmingly high, presaging a worsening of the current distribution of health biomarkers.1–8”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [1] Lloyd-Jones DM Hong Y Labarthe D Mozaffarian D Appel LJ Van Horn L Greenlund K Daniels S Nichol G Tomaselli GF Arnett DK Fonarow GC Ho PM Lauer MS Masoudi FA Robertson RM Roger V Schwamm LH Sorlie P Yancy CW Rosamond WD on behalf of the American Heart Association Strategic Planning Task Force and Statistics Committee Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond Circulation 2010 121 586 613 20089546 source

      Not checked in the free run.

    • cites [2] Heidenreich PA Trogdon JG Khavjou OA Butler J Dracup K Ezekowitz MD Finkelstein EA Hong Y Johnston SC Khera A Lloyd-Jones DM Nelson SA Nichol G Orenstein D Wilson PW Woo YJ on behalf of the American Heart Association Advocacy Coordinating Committee Stroke Council Council on Cardiovascular Radiology and Intervention Council on Clinical Cardiology Council on Epidemiology and Prevention Council on Arteriosclerosis Thrombosis and Vascular Biology Council on Cardiopulmonary Critical Care Perioperative and Resuscitation Council on Cardiovascular Nursing Council on the Kidney in Cardiovascular Diseas source

      Not checked in the free run.

    • cites [3] Bambs C Kip KE Dinga A Mulukutla SR Aiyer AN Reis SE Low prevalence of “ideal cardiovascular health” in a community-based population: the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study Circulation 2011 123 850 857 21321154 PMC3061396 source

      Not checked in the free run.

    • cites [4] Folsom AR Yatsuya H Nettleton JA Lutsey PL Cushman M Rosamond WD ARIC Study Investigators Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence J Am Coll Cardiol 2011 57 1690 1696 21492767 PMC3093047 source

      Not checked in the free run.

    • cites [5] Ford ES Greenlund KJ Hong YL ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States Circulation 2012 125 987 995 22291126 PMC4556343 source

      Not checked in the free run.

    • cites [6] Roger VL Go AS Lloyd-Jones DM Adams RJ Berry JD Brown TM Carnethon MR Dai S de Simone G Ford ES Fox CS Fullerton HJ Gillespie C Greenlund KJ Hailpern SM Heit JA Ho PM Howard VJ Kissela BM Kittner SJ Lackland DT Lichtman JH Lisabeth LD Makuc DM Marcus GM Marelli A Matchar DB McDermott MM Meigs JB Moy CS Mozaffarian D Mussolino ME Nichol G Paynter NP Rosamond WD Sorlie PD Stafford RS Turan TN Turner MB Wong ND Wylie-Rosett J on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics--2011 update: a report from the Ameri source

      Not checked in the free run.

    • cites [7] Roger VL Go AS Lloyd-Jones DM Benjamin EJ Berry JD Borden WB Bravata DM Dai S Ford ES Fox CS Fullerton HJ Gillespie C Hailpern SM Heit JA Howard VJ Kissela BM Kittner SJ Lackland DT Lichtman JH Lisabeth LD Makuc DM Marcus GM Marelli A Matchar DB Moy CS Mozaffarian D Mussolino ME Nichol G Paynter NP Soliman EZ Sorlie PD Sotoodehnia N Turan TN Virani SS Wong ND Woo D Turner MB on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics--2012 update: a report from the American Heart Association [published correction appea source

      Not checked in the free run.

    • cites [8] Shay CM Ning H Allen NB Carnethon MR Chiuve SE Greenlund KJ Daviglus ML Lloyd-Jones DM Status of cardiovascular health in US adults: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2003–2008 Circulation 2012 125 45 56 22095826 PMC4077723 source

      Not checked in the free run.

  • Premisecitation

    Higher numbers of ideal health metrics were also associated with lower cancer mortality.

    “Higher numbers of ideal health metrics were also associated with lower cancer mortality.11”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Yang Q Cogswell ME Flanders WD Hong Y Zhang Z Loustalot F Gillespie C Merritt R Hu FB Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults JAMA 2012 307 1273 1283 22427615 PMC9004324 source

      Not checked in the free run.

  • Interpretationcitation

    Substantial proportions of deaths could be prevented or postponed with greater achievement of ideal cardiovascular health.

    “which suggests that substantial proportions of deaths could be prevented or postponed with greater achievement of ideal cardiovascular health.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Yang Q Cogswell ME Flanders WD Hong Y Zhang Z Loustalot F Gillespie C Merritt R Hu FB Trends in cardiovascular health metrics and associations with all-cause and CVD mortality among US adults JAMA 2012 307 1273 1283 22427615 PMC9004324 source

      Not checked in the free run.

  • May combine two claims. 17
  • Classified as probably not a substantial claim. 5

  • May combine two claims.

    Premisecitation

    Over 20 years of follow-up, adults in the Atherosclerosis Risk in Communities Study who had higher numbers of either health behaviors or biomarkers at ideal levels had dramatically lower cardiovascular disease event rates, and results were similar for blacks and whites.

    “Likewise, over 20 years of follow-up, adults in the Atherosclerosis Risk in Communities Study who had higher numbers of either health behaviors or biomarkers at ideal levels had dramatically lower cardiovascular disease event rates, and results were similar for blacks and whites.4”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] Folsom AR Yatsuya H Nettleton JA Lutsey PL Cushman M Rosamond WD ARIC Study Investigators Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence J Am Coll Cardiol 2011 57 1690 1696 21492767 PMC3093047 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation
    § Better Population Health Through Behavior Change in Adults A Call to Action

    The elimination of these health risk behaviors would make it possible to prevent at least 80% of heart disease, stroke, and type 2 diabetes mellitus, and even 40% of cancers.

    “The elimination of these health risk behaviors would make it possible to prevent at least 80% of heart disease, stroke, and type 2 diabetes mellitus, and even 40% of cancers.1,7,9,10”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [1] Lloyd-Jones DM Hong Y Labarthe D Mozaffarian D Appel LJ Van Horn L Greenlund K Daniels S Nichol G Tomaselli GF Arnett DK Fonarow GC Ho PM Lauer MS Masoudi FA Robertson RM Roger V Schwamm LH Sorlie P Yancy CW Rosamond WD on behalf of the American Heart Association Strategic Planning Task Force and Statistics Committee Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond Circulation 2010 121 586 613 20089546 source

      Not checked in the free run.

    • cites [7] Roger VL Go AS Lloyd-Jones DM Benjamin EJ Berry JD Borden WB Bravata DM Dai S Ford ES Fox CS Fullerton HJ Gillespie C Hailpern SM Heit JA Howard VJ Kissela BM Kittner SJ Lackland DT Lichtman JH Lisabeth LD Makuc DM Marcus GM Marelli A Matchar DB Moy CS Mozaffarian D Mussolino ME Nichol G Paynter NP Soliman EZ Sorlie PD Sotoodehnia N Turan TN Virani SS Wong ND Woo D Turner MB on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics--2012 update: a report from the American Heart Association [published correction appea source

      Not checked in the free run.

    • cites [9] Institute of Medicine Committee on Quality of Health Care in America Crossing the Quality Chasm: A New Health System for the 21st Century 2001 National Academy Press Washington, DC

      Not checked in the free run.

    • cites [10] Ezzati M Lopez AD Rodgers A Murray CJL Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors 2004 World Health Organization Geneva, Switzerland

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ford and colleagues observed that adults who had ≥5 of the 7 metrics at ideal levels, compared with 0 metrics, were at 78% lower risk for all-cause mortality and 88% lower risk for cardiovascular disease mortality over 5.8 years of follow-up.

    “Ford and colleagues5 observed that adults who had ≥5 of the 7 metrics at ideal levels, compared with 0 metrics, were at 78% lower risk for all-cause mortality and 88% lower risk for cardiovascular disease mortality over 5.8 years of follow-up.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Ford ES Greenlund KJ Hong YL ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States Circulation 2012 125 987 995 22291126 PMC4556343 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Better Population Health Through Behavior Change in Adults A Call to Action

    Direct annual cardiovascular disease-related costs are projected to triple from $272 billion in 2010 to $818 billion in 2030.

    “with direct annual cardiovascular disease–related costs projected to triple, from $272 billion in 2010 to $818 billion in 2030,2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Heidenreich PA Trogdon JG Khavjou OA Butler J Dracup K Ezekowitz MD Finkelstein EA Hong Y Johnston SC Khera A Lloyd-Jones DM Nelson SA Nichol G Orenstein D Wilson PW Woo YJ on behalf of the American Heart Association Advocacy Coordinating Committee Stroke Council Council on Cardiovascular Radiology and Intervention Council on Clinical Cardiology Council on Epidemiology and Prevention Council on Arteriosclerosis Thrombosis and Vascular Biology Council on Cardiopulmonary Critical Care Perioperative and Resuscitation Council on Cardiovascular Nursing Council on the Kidney in Cardiovascular Diseas source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Better Population Health Through Behavior Change in Adults A Call to Action

    The prevalence of poor-quality diet, physical inactivity, and overweight/obesity is alarmingly high in the US population.

    “However, the prevalence of ideal cardiovascular health is very low in the US population, and the prevalence of poor-quality diet, physical inactivity, and overweight/obesity is alarmingly high, presaging a worsening of the current distribution of health biomarkers.1–8”
    Quote in the paperSubstantial claim0 of 8 sources checked
    • cites [1] Lloyd-Jones DM Hong Y Labarthe D Mozaffarian D Appel LJ Van Horn L Greenlund K Daniels S Nichol G Tomaselli GF Arnett DK Fonarow GC Ho PM Lauer MS Masoudi FA Robertson RM Roger V Schwamm LH Sorlie P Yancy CW Rosamond WD on behalf of the American Heart Association Strategic Planning Task Force and Statistics Committee Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond Circulation 2010 121 586 613 20089546 source

      Not checked in the free run.

    • cites [2] Heidenreich PA Trogdon JG Khavjou OA Butler J Dracup K Ezekowitz MD Finkelstein EA Hong Y Johnston SC Khera A Lloyd-Jones DM Nelson SA Nichol G Orenstein D Wilson PW Woo YJ on behalf of the American Heart Association Advocacy Coordinating Committee Stroke Council Council on Cardiovascular Radiology and Intervention Council on Clinical Cardiology Council on Epidemiology and Prevention Council on Arteriosclerosis Thrombosis and Vascular Biology Council on Cardiopulmonary Critical Care Perioperative and Resuscitation Council on Cardiovascular Nursing Council on the Kidney in Cardiovascular Diseas source

      Not checked in the free run.

    • cites [3] Bambs C Kip KE Dinga A Mulukutla SR Aiyer AN Reis SE Low prevalence of “ideal cardiovascular health” in a community-based population: the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study Circulation 2011 123 850 857 21321154 PMC3061396 source

      Not checked in the free run.

    • cites [4] Folsom AR Yatsuya H Nettleton JA Lutsey PL Cushman M Rosamond WD ARIC Study Investigators Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence J Am Coll Cardiol 2011 57 1690 1696 21492767 PMC3093047 source

      Not checked in the free run.

    • cites [5] Ford ES Greenlund KJ Hong YL ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States Circulation 2012 125 987 995 22291126 PMC4556343 source

      Not checked in the free run.

    • cites [6] Roger VL Go AS Lloyd-Jones DM Adams RJ Berry JD Brown TM Carnethon MR Dai S de Simone G Ford ES Fox CS Fullerton HJ Gillespie C Greenlund KJ Hailpern SM Heit JA Ho PM Howard VJ Kissela BM Kittner SJ Lackland DT Lichtman JH Lisabeth LD Makuc DM Marcus GM Marelli A Matchar DB McDermott MM Meigs JB Moy CS Mozaffarian D Mussolino ME Nichol G Paynter NP Rosamond WD Sorlie PD Stafford RS Turan TN Turner MB Wong ND Wylie-Rosett J on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics--2011 update: a report from the Ameri source

      Not checked in the free run.

    • cites [7] Roger VL Go AS Lloyd-Jones DM Benjamin EJ Berry JD Borden WB Bravata DM Dai S Ford ES Fox CS Fullerton HJ Gillespie C Hailpern SM Heit JA Howard VJ Kissela BM Kittner SJ Lackland DT Lichtman JH Lisabeth LD Makuc DM Marcus GM Marelli A Matchar DB Moy CS Mozaffarian D Mussolino ME Nichol G Paynter NP Soliman EZ Sorlie PD Sotoodehnia N Turan TN Virani SS Wong ND Woo D Turner MB on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics--2012 update: a report from the American Heart Association [published correction appea source

      Not checked in the free run.

    • cites [8] Shay CM Ning H Allen NB Carnethon MR Chiuve SE Greenlund KJ Daviglus ML Lloyd-Jones DM Status of cardiovascular health in US adults: prevalence estimates from the National Health and Nutrition Examination Surveys (NHANES) 2003–2008 Circulation 2012 125 45 56 22095826 PMC4077723 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    High-risk patients need both medical and intensive behavioral treatments that initially add cost but keep patients from progressing to a state that requires more expensive medical treatments or hospitalization.

    “In sum, high-risk patients need both medical and intensive behavioral treatments that initially add cost but keep patients from progressing to a state that requires more expensive medical treatments or hospitalization.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Shifting the population toward healthier behaviors will require time and systems support at the institutional, financial, and policy levels.

    “Shifting the population toward healthier behaviors will require time and systems support at the institutional, financial, and policy levels.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a dynamic simulation model of the US health system, when added to a simulated scenario that included expanded coverage and improved care, health promotion could save 90% more lives and reduce costs by 30% in 10 years; by 25 years, it could save 140% more lives and reduce costs by 62%.

    “The model showed that when added to a simulated scenario that included expanded coverage and improved care, health promotion could save 90% more lives and reduce costs by 30% in 10 years. That same investment could, by 25 years, save 140% more lives and reduce costs by 62%.35”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] Milstein B Homer J Briss P Burton D Pechacek T Why behavioral and environmental interventions are needed to improve health at lower cost Health Aff (Millwood) 2011 30 823 832 21555468 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Promotion of healthier behavior to those in lower-risk categories through less intensive behavioral intervention and environmental change takes longer to produce a benefit but gradually slows the growth in chronic disease prevalence and lowers costs by reducing the demand for expensive care.

    “The promotion of healthier behavior to those in the lower-risk categories through less intensive behavioral intervention and environmental change takes longer to produce a benefit but gradually slows the growth in chronic disease prevalence and lowers costs by reducing the demand for expensive care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Findings confirm modest but significant impacts of brief physician advice or intervention on smoking cessation, improved dietary quality, and increased physical activity.

    “Findings confirm modest but significant impacts of brief physician advice or intervention on smoking cessation, improved dietary quality, and increased physical activity.14,15,19,22–27”
    Quote in the paperSubstantial claim0 of 9 sources checked
    • cites [14] Goldstein MG Whitlock EP DePue J Planning Committee of the Addressing Multiple Behavioral Risk Factors in Primary Care Project. Multiple behavioral risk factor interventions in primary care: summary of research evidence Am J Prev Med 2004 27 suppl 61 79 15275675 source

      Not checked in the free run.

    • cites [15] Rees K Dyakova M Ward K Thorogood M Brunner E Dietary advice for reducing cardiovascular risk (review) The Cochrane Library 28 3 2013 3 CD002128 23543514

      Not checked in the free run.

    • cites [19] US Preventive Services Task Force Web site Accessed February 12, 2012 Topic page Behavioral counseling in primary care to promote a healthy diet in adults at increased risk for cardiovascular disease 2003 http://www.uspreventiveservicestask-force.org/uspstf/uspsdiet.htm

      Not checked in the free run.

    • cites [22] Artinian NT Fletcher GF Mozaffarian D Kris-Etherton P Van Horn L Lichtenstein AH Kumanyika S Kraus WE Fleg JL Redeker NS Meininger JC Banks J Stuart-Shor EM Fletcher BJ Miller TD Hughes S Braun LT Kopin LA Berra K Hayman LL Ewing LJ Ades PA Durstine JL Houston-Miller N Burke LE on behalf of the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults a scientific statement from the American Heart Association Circulation 2010 122 406 441 206 source

      Not checked in the free run.

    • cites [23] Burke LE Styn MA Sereika SM Conroy MB Ye L Glanz K Sevick MA Ewing LJ Using mHealth technology to enhance self-monitoring for weight loss: a randomized trial Am J Prev Med 2012 43 20 26 22704741 PMC3563396 source

      Not checked in the free run.

    • cites [24] Ockene JK Kristeller J Pbert L Hebert JR Luippold R Goldberg RJ Landon J Kalan K The Physician-Delivered Smoking Intervention Project: can short-term interventions produce long-term effects for a general outpatient population? Health Psychol 1994 13 278 281 8055863 source

      Not checked in the free run.

    • cites [25] Ockene JK Kristeller J Goldberg RJ Amick TL Pekow PS Hosmer D Quirk M Kalan K Increasing the efficacy of physician-delivered smoking intervention: a randomized clinical trial J Gen Intern Med 1991 6 1 8 1999742 source

      Not checked in the free run.

    • cites [26] US Preventive Services Task Force The Guide to Clinical Preventive Services, 2012: Recommendations of the U.S. Preventive Services Task Force 2011 Agency for Healthcare Research and Quality Rockville, MD AHRQ publication No. 12-05154 23285491

      Not checked in the free run.

    • cites [27] National Diabetes Prevention Program Accessed September 13, 2012 Centers for Disease Control and Prevention Web site http://www.cdc.gov/diabetes/prevention/

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    For both obesity and smoking, a majority of providers now perform the first 2 A's: Assess the risk behavior and advise behavior change.

    “However, progress has been made, and for both obesity and smoking, a majority of providers now perform the first 2 A’s: Assess the risk behavior and advise behavior change.46–48”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [46] Jay M Gillespie C Schlair S Sherman S Kalet A Physicians’ use of the 5As in counseling obese patients: is the quality of counseling associated with patients’ motivation and intention to lose weight? BMC Health Serv Res 2010 10 159 20534160 PMC2903583 source

      Not checked in the free run.

    • cites [47] Alexander SC Cox ME Boling Turer CL Lyna P Østbye T Tulsky JA Dolor RJ Pollak KI Do the five A’s work when physicians counsel about weight loss? Fam Med 2011 43 179 184 21380950 PMC3367376

      Not checked in the free run.

    • cites [48] Unrod M Smith M Spring B DePue J Redd W Winkel G Randomized controlled trial of a computer-tailored intervention to increase smoking cessation counseling by primary care physicians J Gen Intern Med 2007 22 478 484 17372796 PMC1829425 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Limited visit time, competing medical priorities, and insufficient financial incentives for health promotion all create barriers to behavioral counseling.

    “Limited visit time, competing medical priorities, and insufficient financial incentives for health promotion all create barriers.45”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [45] Chase EC McMenamin SB Halpin HA Medicaid provider delivery of the 5A’s for smoking cessation counseling Nicotine Tob Res 2007 9 1095 1101 17978983 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many providers say they omit the last 3 A's because they perceive them as time consuming and feel they lack the needed counseling skills.

    “Many providers say they omit the last 3 A’s because they perceive them as time consuming and feel they lack the needed counseling skills.52,53”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [52] Forman-Hoffman V Little A Wahls T Barriers to obesity management: a pilot study of primary care clinicians BMC Fam Pract 2006 7 35 16756673 PMC1525170 source

      Not checked in the free run.

    • cites [53] Ruelaz AR Diefenbach P Simon B Lanto A Arterburn D Shekelle PG Perceived barriers to weight management in primary care: perspectives of patients and providers J Gen Intern Med 2007 22 518 522 17372803 PMC1829430 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Motivational interviewing, originally developed to treat alcohol abuse, is a specific form of patient-centered counseling that has also been applied successfully to foster health behavior changes.

    “Motivational interviewing, originally developed to treat alcohol abuse, is a specific form of patient-centered counseling that has also been applied successfully to foster health behavior changes.54–57”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [54] Epstein RM Franks P Fiscella K Shields CG Meldrum SC Kravitz RL Duberstein PR Measuring patient-centered communication in patient-physician consultations: theoretical and practical issues Soc Sci Med 2005 61 1516 1528 16005784 source

      Not checked in the free run.

    • cites [55] Rollnick S Mason P Butler C Health Behavior Change: A Guide for Practitioners 1999 Churchill Livingstone New York, NY

      Not checked in the free run.

    • cites [56] Rubak S Sandbaek A Lauritzen T Christensen B Motivational interviewing: a systematic review and meta-analysis Br J Gen Pract 2005 55 305 312 15826439 PMC1463134

      Not checked in the free run.

    • cites [57] Tulloch H Fortier M Hogg W Physical activity counseling in primary care: who has and who should be counseling? Patient Educ Couns 2006 64 6 20 16472959 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationnone given

    Both individual clinical and population-level strategies need to be implemented synergistically to reduce the high prevalence of these risk behaviors in the population.

    “Both individual clinical and population-level strategies need to be implemented synergistically to reduce the high prevalence of these risk behaviors in the population (Table 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Tobacco quit lines, YMCA-based Diabetes Prevention Program treatment, and peer educator-led Diabetes Prevention Program treatment are all examples of effective programs that were originally developed by behavior change professionals and then effectively implemented in the community.

    “Tobacco quit lines,74 YMCA-based Diabetes Prevention Program treatment,60 and peer educator–led Diabetes Prevention Program treatment59 are all examples of effective programs that were originally developed by behavior change professionals and then effectively implemented in the community.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [74] Borland R Segan CJ The potential of quitlines to increase smoking cessation Drug Alcohol Rev 2006 25 73 78 16492579 source

      Not checked in the free run.

    • cites [60] Ackermann RT Finch EA Brizendine E Zhou HH Marrero DG Translating the Diabetes Prevention Program into the community: the DEPLOY pilot study Am J Prev Med 2008 35 357 363 18779029 PMC2610485 source

      Not checked in the free run.

    • cites [59] Katula JA Vitolins MZ Rosenberger EL Blackwell CS Morgan TM Lawlor MS Goff DC Jr One-year results of a community-based translation of the Diabetes Prevention Program: Healthy-Living Partnerships to Prevent Diabetes (HELP PD) Project [published correction appears in Diabetes Care. 2012;35:455] Diabetes Care 2011 34 1451 1457 21593290 PMC3120203 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Weight loss and weight loss maintenance, physical activity, diet quality, and smoking cessation outcomes all improve with added treatment sessions, and smoking cessation improves further with the addition of medications to assist in quitting.

    “Weight loss and weight loss maintenance, physical activity, diet quality, and smoking cessation outcomes all improve with added treatment sessions, and smoking cessation improves further with the addition of medications to assist in quitting.21,22”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [21] Tobacco Use and Dependence Guideline Panel Treating Tobacco Use and Dependence: 2008 Update 2008 US Department of Health and Human Services Rockville, MD Public Health Service

      Not checked in the free run.

    • cites [22] Artinian NT Fletcher GF Mozaffarian D Kris-Etherton P Van Horn L Lichtenstein AH Kumanyika S Kraus WE Fleg JL Redeker NS Meininger JC Banks J Stuart-Shor EM Fletcher BJ Miller TD Hughes S Braun LT Kopin LA Berra K Hayman LL Ewing LJ Ades PA Durstine JL Houston-Miller N Burke LE on behalf of the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults a scientific statement from the American Heart Association Circulation 2010 122 406 441 206 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    These measures were successful in increasing counseling, although effects on tobacco use are just beginning to be studied.

    “These measures were successful in increasing counseling,71 although effects on tobacco use are just beginning to be studied.72”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [71] Joint Commission report shows quality gains Healthcare Benchmarks Qual Improv 2007 14 52 54 17515015

      Not checked in the free run.

    • cites [72] Reeves GR Wang TY Reid KJ Alexander KP Decker C Ahmad H Spertus JA Peterson ED Dissociation between hospital performance of the smoking cessation counseling quality metric and cessation outcomes after myocardial infarction Arch Intern Med 2008 168 2111 2117 18955640 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Joint Commission on Accreditation of Healthcare Organizations first required smoking cessation counseling as a performance measure for pneumonia, heart failure, and myocardial infarction hospital admissions and then added smoking cessation counseling as a quality criterion for excellence.

    “Also, The Joint Commission on Accreditation of Healthcare Organizations first required smoking cessation counseling as a performance measure for pneumonia, heart failure, and myocardial infarction hospital admissions70 and then added smoking cessation counseling as a quality criterion for excellence.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [70] Balkstra CR Fields M Roesler L Meeting Joint Commission on Accreditation of Healthcare Organizations requirements for tobacco cessation: the St. Joseph’s/Candler Health System approach to success Crit Care Nurs Clin North Am 2006 18 105 111 xiii 16546013 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationcitation

    An effective healthcare system to improve cardiovascular health by fostering healthy lifestyle change may resemble a 2-tiered, stepped care model.

    “An effective healthcare system to improve cardiovascular health by fostering healthy lifestyle change may resemble a 2-tiered, stepped care model.81”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] Brown RL Configuring health care for systematic behavioral screening and intervention Popul Health Manag 2011 14 299 305 22074564 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Intervening to achieve sustained improvements in tobacco use, obesity, poor-quality diet, and physical inactivity is feasible and will improve patients' health.

    “Intervening to achieve sustained improvements in tobacco use, obesity, poor-quality diet, and physical inactivity is feasible and will improve patients’ health.”
    Quote in the paperNot a substantial claim
21 of 21

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References 94 · Cited by 195

Authors
Spring, B., Ockene, J. K., Gidding, S. S., Mozaffarian, D., Moore, S., Rosal, M. C., Brown, M. D., Vafiadis, D. K., Cohen, D. L., Burke, L. E., & Lloyd-Jones, D.
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-11-05
Volume
128
Issue
19
Pages
2169-2176
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/01.cir.0000435173.25936.e1
PMC
PMC4074536
OpenAlex
W2090797240
Semantic Scholar
97506744c56b27d2e226baa3f47cb86b2713f334
Cited by
195
References
94
Citations by year
2026: 9 · 2025: 10 · 2024: 7 · 2023: 9 · 2022: 9 · 2021: 12 · 2020: 60 · 2019: 10 · 2018: 9 · 2017: 16 · 2016: 12 · 2015: 13 · 2014: 19
FWCI
9.98
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
Funders
  • National Heart, Lung, and Blood Institute (R01HL075451)
  • National Institute of Diabetes and Digestive and Kidney Diseases (RC1DK087126, R01DK097364)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords
population health, behavior change, adults, cardiovascular health, health promotion
MeSH terms
Adult, Cardiology, Cardiovascular Diseases, Health Promotion, Humans, Risk Factors, Risk Reduction Behavior

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

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