American College Of Preventive Medicine Research Articles

ACPM Position Statement: Air Pollution and Environmental Justice

The American Lung Association's “State of the Air” 2023 report reveals almost 36% of Americans live with unhealthy levels of air pollution. Studies link air pollution with acute respiratory symptoms and exacerbation of respiratory and cardiovascular diseases. Differential air pollution exposures between white and non-white communities are significant components of environmental injustices. Even during the COVID-19 lockdown, when the United States experienced significant decreases in polluting activities, these differences persisted. The American College of Preventive Medicine's Science and Translation Committee conducted a nonsystematic literature review to explore initiatives addressing air pollution as a key component of environmental justice, the state of the science regarding health impacts, and evidence supporting mitigations to reduce those impacts. We recommend advocacy for cleaner energy sources and increasing green space; and increasing research, surveillance, and education and training on linkages between air pollutants and health. We recommend preventive medicine physicians raise awareness about increased risks of cardiovascular disease, cancer, asthma, and reduced lung function with air pollution exposure. Preventive medicine physicians may also educate patients and other practitioners about exposures, and how “conventional” disease prevention strategies may have unintended consequences; and influence healthcare leaders to improve efficiency and reduce emissions. We also recommend physicians utilize social determinants of health (SDOH) Z-Codes to capture environmental factors. Private payers should incorporate pollution exposure data into SDOH risk-adjustments for Medicare Advantage programs. Medicaid agencies should develop provider recommendations for pediatric populations, and states should finance in-home interventions for asthma.

Recommendations for Population-Based Applications of the Adverse Childhood Experiences Study: Position Statement by the American College of Preventive Medicine

Childhood adversity profoundly influences health, well-being, and longevity. Prevention and interventions to mitigate its harmful effects are essential. The American College of Preventive Medicine reviewed the research literature and other professional and governmental statements about adverse childhood experiences to support the development of evidence-based and population-focused recommendations about prevention, screening, and mitigation interventions for childhood adversity. We performed an umbrella review to find, assess and synthesize the evidence from systematic reviews focused on 3 key questions: the prevention or mitigation of the effects of adverse childhood experiences; the association of screening for adverse childhood experiences with various benefits, including health outcomes; and the effectiveness and harms of interventions in individuals with elevated adverse childhood experience scores. Adverse childhood experience‒related recommendations from 6 professional and governmental organizations were also reviewed. On the basis of these reviews, the American College of Preventive Medicine developed a position statement through consensus. A total of 8 systematic reviews, including 260 studies in total, were identified and combined with adverse childhood experiences‒related recommendations from 6 professional organizations to support the American College of Preventive Medicine recommendations. The American College of Preventive Medicine offers 7 adverse childhood experiences‒related recommendations focused on screening, education/training, policy/practice, and research: 2 are evidence-based, and 5 are based on expert opinion. Notably, regarding secondary prevention of adverse childhood experiences, the American College of Preventive Medicine endorses population-level surveillance and research around childhood adversity but not adverse childhood experience screening in individual clinical encounters. Despite limitations in the heterogeneity and quality of the published systematic reviews, the extant literature supports the American College of Preventive Medicine recommendations. Interventions to enhance protective factors and prevent and mitigate the consequences of adverse childhood experiences and other childhood adversity are promising and require further implementation and research.

American College of Preventive Medicine: Addressing the Opioid Epidemic Through a Prevention Framework

The opioid epidemic has resulted in significant morbidity and mortality in the U.S. Health systems, policymakers, payers, and public health have enacted numerous strategies to reduce the harms of opioids, including opioid use disorder (OUD). Much of this implementation has occurred before the development of OUD‒related comparative effectiveness evidence, which would enable an understanding of the benefits and harms of different approaches. This article from the American College of Preventive Medicine (ACPM) uses a prevention framework to identify the current approaches and make recommendations for addressing the opioid epidemic, encompassing strategies across a primordial, primary, secondary, and tertiary prevention approach. Key primordial prevention strategies include addressing social determinants of health and reducing adverse childhood events. Key primary prevention strategies include supporting the implementation of evidence-based prescribing guidelines, expanding school-based prevention programs, and improving access to behavioral health supports. Key secondary prevention strategies include expanding access to evidence-based medications for opioid use disorder, especially for high-risk populations, including pregnant women, hospitalized patients, and people transitioning out of carceral settings. Key tertiary prevention strategies include the expansion of harm reduction services, including expanding naloxone availability and syringe exchange programs. The ACPM Opioid Workgroup also identifies opportunities for de-implementation, in which historical and current practices may be ineffective or causing harm. De-implementation strategies include reducing inappropriate opioid prescribing; avoiding mandatory one-size-fits-all policies; eliminating barriers to medications for OUD, debunking the myth of detoxification as a primary solo treatment for opioid use disorder; and destigmatizing care practices and policies to better treat people with OUD.

Abstract 15858: Efficacy of Hypertension Self-management Classes Among Low-Income Patients of a Federally Qualified Health Center

Introduction: Racial and socioeconomic disparities in hypertension prevalence and treatment have been observed over numerous decades. There is opportunity to close racial disparities by focusing resources on patient education, skill-building, and self-management. Methods: A hypertension-reduction program was established between an academic-affiliated FQHC in the southeast, the American Heart Association, the Centers for Disease Control, and the American College of Preventive Medicine using a multidisciplinary outreach model in the community setting. Participants included 265 high-risk patients from the FQHC with severe hypertension (>160/90 mm HG). Program activities included a weekly class where participants learned about hypertension, were trained to take their blood pressure (BP), and received cuffs to use at home. A prospective pre-post cohort design was used to evaluate this portion of the program. Participants’ attendance at the self-management classes was tracked along with BP measurements at every class attended. Results: Over the program’s first 6 months, 93 of the 265 recruited participants attended at least one of 28 BP management classes. The 29 participants who attended multiple classes achieved an average 19 mm HG reduction in systolic BP ( p =0.004) and an average 14 mm HG reduction in diastolic BP ( p =0.002). Patients who were Black were significantly more likely to attend multiple classes than patients who were Hispanic ( p =0.004). Also, patients who were self-monitoring their BP prior to class attendance were significantly more likely to attend multiple classes than those who were not previously self-monitoring ( p =0.014). Multiple class attendance was also associated with higher baseline BP ( p =0.038 for systolic and p =0.018 for diastolic). Conclusions: Implementation of blood pressure self-management classes showed success in reducing hypertension among many of the high-risk participants. Hispanic patients were much less likely to attend multiple classes, underscoring the need for culturally and linguistically appropriate class content. The low proportion of Hispanic patients previously monitoring their BP points to an opportunity to improve patient awareness about hypertension among Hispanic populations generally.

Intimate Partner Violence Screening and Intervention: The American College of Preventive Medicine Position Statement

The purpose of this paper is to produce a position statement on intimate partner violence (IPV), a major sociomedical problem with recently updated evidence, systematic reviews, and U.S. Preventive Services Task Force guidelines. This position statement is a nonsystematic, rapid literature review on IPV incidence and prevalence, health consequences, diagnosis and intervention, domestic violence laws, current screening recommendations, barriers to screening, and interventions, focusing on women of childbearing age (15-45 years). The American College of Preventive Medicine (ACPM) recommends an integrated system of care approach to IPV for screening, identification, intervention, and ongoing clinical support. ACPM only recommends screening that is linked to ongoing clinical support for those at risk. ACPM recommends greater training of clinicians in IPV screening and interventions and offers health systems and research recommendations.

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Including Lifestyle Medicine in Medical Education: Rationale for American College of Preventive Medicine/American Medical Association Resolution 959

Introduced by the American College of Preventive Medicine and released by the American Medical Association House of Delegates in 2017, Resolution 959 (I-17) supports policies and mechanisms that incentivize and/or provide funding for the inclusion of lifestyle medicine education and social determinants of health in undergraduate, graduate and continuing medical education. Resolution 959 was passed to help address the current healthcare costs of lifestyle-related, noncommunicable chronic diseases that exert a devastating economic burden on the U.S. healthcare system. Approximately 86% of $2.9 trillion is spent annually on obesity, cardiovascular disease, type 2 diabetes, and some cancers, with very poor return on investment for health outcomes. Lifestyle medicine provides an evidence-based solution to the noncommunicable chronic disease epidemic; however, medical education in lifestyle medicine is minimal to nonexistent. This paper provides the case for healthcare innovation to include lifestyle medicine in the prevention and treatment of noncommunicable chronic diseases. Our medical education system recommendation is to provide lifestyle medicine training for prevention and treatment of noncommunicable chronic diseases. Exemplar lifestyle medicine schools are showcased and guidance for reform is highlighted that can be used to aid lifestyle medicine integration across the medical school education continuum. With a transformation of curriculum and development of new policies to support a focus on lifestyle medicine education in medical education across the continuum, a new healthcare model could be successful against noncommunicable chronic diseases and U.S. citizen wellness could become a reality.

Electronic Nicotine Delivery Systems or E-cigarettes: American College of Preventive Medicine's Practice Statement

E-cigarettes or or electronic nicotine delivery systems (ENDS) have rapidly gained popularity in the U.S. Controversy exists about the safety and efficacy of ENDS. The American College of Preventive Medicine's Prevention Practice Committee undertook a consensus-based evidence review process to develop a practice statement for the American College of Preventive Medicine. A rapid review of the literature was performed through June 2017 to identify efficacy, patient-oriented harms, and the impact on population health. On an individual level, limited evidence suggests that ENDS may be effective at reducing cigarette use among adult smokers intending to quit. There is insufficient evidence addressing potential long-term harms of ENDS, and limited evidence is available about short-term harms of ENDS and the impact of secondhand exposure. Although ENDS appear safer than combustible cigarettes, they are not without risk. Among youth there is no known benefit and significant concern for harm. On a population level, there may be significant harms associated with ENDS, particularly among youth nonsmokers. The long-term balance of potential benefits versus harms from the individual and population perspectives are unclear. The American College of Preventive Medicine developed practice recommendations that include encouraging screening for ENDS use, strategies to prevent the initiation of ENDS use in nonsmokers, particularly in youth, adoption of a harm reduction model for smokers intending to quit in those who refuse or fail to quit with evidence-based smoking-cessation methods, recommendations on policy and regulatory strategies to decrease public use of ENDS and regulation of their components, and future research needs.

CENTERS FOR DISEASE CONTROL AND PREVENTION’S HEALTHY BRAIN INITIATIVE: A PUBLIC HEALTH APPROACH TO COGNITIVE HEALTH

Cognitive health, a crucial component of healthy aging, is a recently recognized public health issue. CDC, through its Healthy Brain Initiative, is working to advance cognitive aging as a vital, integral component of public health practice, in an effort to keep older Americans healthy and independent as long as possible. The Healthy Brain Initiative creates and supports partnerships, collects and reports data, increases awareness of cognitive aging, through utilization of its flagship publication, The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2018–2023. The Road Map outlines 25-items within its Action Agenda that identify how state and local public health agencies and their partners can promote brain health, address cognitive impairment for persons living in the community, and address the needs of caregivers to persons with a cognitive impairment. Because dementia, including Alzheimer’s disease, doesn’t have a cure, identifying and reducing risks are the best public health approaches for maintaining health and independence. The session will emphasize activities of partners implementing Road Map action items: The Alzheimer’s Association, a national organization providing assistance to state public health agencies; activities of CDC’s Healthy Brain Research Network which is a thematic network of the CDC Prevention Research Centers Program; and The Balm in Gilead’s efforts to increase awareness of cognition-related issues in African-American healthcare professionals and faith-based organizations; American College of Preventive Medicine will highlighted a new collaborative continuing education module for physicians; and the discussant will describe the HBI from a historical perspective and impact.

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.

Medical Training to Achieve Competency in Lifestyle Counseling: An Essential Foundation for Prevention and Treatment of Cardiovascular Diseases and Other Chronic Medical Conditions: A Scientific Statement From the American Heart Association.

A healthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight.1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation.2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health. Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling.3 Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year. Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians.4,5 However, data further indicate that lifestyle counseling does not routinely occur in physicians’ offices, thereby representing a lost opportunity. Physicians report that they perform lifestyle counseling during ≈34% of clinic visits.4 Patients, in turn, report an even lower frequency of physician lifestyle counseling. For example, obese patients reported receiving physical activity and …

Choosing Wisely® in Preventive Medicine: The American College of Preventive Medicine's Top 5 List of Recommendations.

The Choosing Wisely(®) initiative is a national campaign led by the American Board of Internal Medicine Foundation, focused on quality improvement and advancing a dialogue on avoiding wasteful or unnecessary medical tests, procedures, and treatments. The American College of Preventive Medicine (ACPM) Prevention Practice Committee is an active participant in the Choosing Wisely project. The committee created the ACPM Choosing Wisely Task Force to lead the development of ACPM's recommendations with the intention of facilitating wise decisions about the appropriate use of preventive care. After utilizing an iterative process that involved reviewing evidence-based literature, the ACPM Choosing Wisely Task Force developed five recommendations targeted toward overused services within the field of preventive medicine. These include: (1) don't take a multivitamin, vitamin E, or beta carotene to prevent cardiovascular disease or cancer; (2) don't routinely perform prostate-specific antigen-based screening for prostate cancer; (3) don't use whole-body scans for early tumor detection in asymptomatic patients; (4) don't use expensive medications when an equally effective and lower-cost medication is available; and (5) don't perform screening for cervical cancer in low-risk women aged 65 years or older and in women who have had a total hysterectomy for benign disease. The Task Force also reviewed some of the barriers to implementing these recommendations, taking into account the interplay between system and environmental characteristics, and identified specific strategies necessary for timely utilization of these recommendations.

News and Notes

News and Notes

Prescribing a Healthy Lifestyle Polypill With High Therapeutic Efficacy in Many Shapes and Sizes.

The paradigm allowing for a lifestyle immersed in unhealthy behaviors to perpetuate to a point where a non-communicable disease (NCD) is eminent or manifests, and then initiating health care interventions, is deeply flawed, results in poor outcomes, and is unsustainable. This paradigm describes the current predominant healthcare model in many countries around the world and has resulted in the continual increase in unhealthy lifestyle patterns that have led to the global NCD epidemic. It is now broadly recognized that rapid integration of a new healthcare model, one heavily focused on primordial and primary NCD prevention, is needed. Being physically active, eating healthy and nutritious foods, not smoking and minimizing second-hand exposure, and maintaining an appropriate body weight are central to this new prevention model. Combined, these four characteristics can be viewed as the key ingredients for the "healthy lifestyle polypill". Recently, the American Heart Association (AHA), European Society of Cardiology (ESC), European Association for Cardiovascular Prevention and Rehabilitation (EACPR), and American College of Preventive Medicine (ACPM) came together to publish, in both the Mayo Clinic Proceedings and European Heart Journal, a policy statement entitled "Healthy Lifestyle Interventions to Combat Non-Communicable Disease: A Novel Non-Hierarchical Connectivity Model for Key Stakeholders". We hope the AHA-ESC-EACPR-ACPM healthy lifestyle policy statement prompts a massive increase in production of the healthy lifestyle polypill. Regulatory approval is not needed to start manufacturing and distributing this medication. The polypill can take many forms and have differing ingredients and dosages while still maintaining high therapeutic efficacy.

Preventive Medicine Training: The Case for Integrating Integrative Medicine.

This special issue of the American Journal of Preventive Medicine is devoted to preventive medicine residency program curricular innovations in the area of integrative medicine, implemented in the context of a Health Resources and Services Administration (HRSA) grant. Funds were awarded competitively to one coordinating center and a group of participating centers. The American College of Preventive Medicine (ACPM) received funding as the coordinating center and established the Integrative Medicine in Preventive Medicine Education program. A dozen preventive medicine residency programs were funded as participants. Project funds were made available through a Funding Opportunity Announcement by HRSA in 2012, inviting applicants to compete for the awards. The Announcement followed an extended period of discussion involving the ACPM, among others, about the need for just such an effort with both HRSA, and interested members of Congress, notably then Senator TomHarkin (D-Iowa). The case made was fairly straightforward. Preventive medicine residents are trained to prevent disease and promote health. Integrative medicine places a considerable emphasis on these same goals, on holistic models of care to facilitate them, and on lifestyle practices. The readership of this journal reliably requires no clarifying definition of preventive medicine. Integrative medicine may be rather less familiar, however. There are competing definitions in this area, and perennial dissatisfaction with the relevant nomenclature. Within the context of the project chronicled in this supplement, the operational definition of integrative medicine was informed by those of the National Academy of Medicine (formerly, IOM), the Academic Consortium for Integrative Medicine and Health (formerly, The Consortium of Academic Health Centers for Integrative Medicine), and the National Center for Complementary and Integrative Health (formerly, the

Integrative Medicine in Preventive Medicine Education: Competency and Curriculum Development for Preventive Medicine and Other Specialty Residency Programs.

During 2012, the USDHHS’s Health Resources and Services Administration funded 12 accredited preventive medicine residencies to incorporate an evidence-based integrative medicine curriculum into their training programs. It also funded a national coordinating center at the American College of Preventive Medicine, known as the Integrative Medicine in Preventive Medicine Education (IMPriME) Center, to provide technical assistance to the 12 grantees. To help with this task, the IMPriME Center established a multidisciplinary steering committee, versed in integrative medicine, whose primary aim was to develop integrative medicine core competencies for incorporation into preventive medicine graduate medical education training. The competency development process was informed by central integrative medicine definitions and principles, preventive medicine’s dual role in clinical and population-based prevention, and the burgeoning evidence base of integrative medicine. The steering committee considered an interdisciplinary integrative medicine contextual framework guided by several themes related to workforce development and population health. A list of nine competencies, mapped to the six general domains of competence approved by the Accreditation Council of Graduate Medical Education, was operationalized through an iterative exercise with the 12 grantees in a process that included mapping each site’s competency and curriculum products to the core competencies. The competencies, along with central curricular components informed by grantees’ work presented elsewhere in this supplement, are outlined as a roadmap for residency programs aiming to incorporate integrative medicine content into their curricula. This set of competencies adds to the larger efforts of the IMPriME initiative to facilitate and enhance further curriculum development and implementation by not only the current grantees but other stakeholders in graduate medical education around integrative medicine training.

English

Self-care with over-the-counter (OTC) medicines have evolved from the “dark ages” of patent medicine manufacture and sale to a modem era of new drug development involving prescription-to-OTC switch. This evolution is largely due to the OTC review, which placed science at the cornerstone of safety, effectiveness, and labelling of non-prescription medicines. As selfcare with OTC drugs has evolved, the switching of drugs from prescription to non-prescription status has produced important benefits, creating more self-reliant consumers through novel self-care therapeutics, significant cost savings to the health care system, expanded markets for companies, enhanced science for regulatory decisions, a more consumer friendly label for all OTC agents, and a more consistent and predictable drug approval process. OTC drugs also known as Non-Prescription drugs are those medications which can be obtained without a Registered Medical Practitioner (RMP) and can be easily purchased in pharmacies, grocery stores, and convenience stores. According to American College of Preventive Medicine, they define OTC as “Drugs (Prescription and OTC drugs) are substances intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease”. The present study has been designed to investigate the benefits & risks, various classes and status of OTC medications in India.

Healthy lifestyle interventions to combat noncommunicable disease-a novel nonhierarchical connectivity model for key stakeholders: a policy statement from the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine.

Noncommunicable diseases (NCDs) have become the primary health concern for most countries around the world. Currently, more than 36 million people worldwide die from NCDs each year, accounting for 63% of annual global deaths; most are preventable. The global financial burden of NCDs is staggering, with an estimated 2010 global cost of $6.3 trillion (US dollars) that is projected to increase to $13 trillion by 2030. A number of NCDs share one or more common predisposing risk factors, all related to lifestyle to some degree: (1) cigarette smoking, (2) hypertension, (3) hyperglycemia, (4) dyslipidemia, (5) obesity, (6) physical inactivity, and (7) poor nutrition. In large part, prevention, control, or even reversal of the aforementioned modifiable risk factors are realized through leading a healthy lifestyle (HL). The challenge is how to initiate the global change, not toward increasing documentation of the scope of the problem but toward true action-creating, implementing, and sustaining HL initiatives that will result in positive, measurable changes in the previously defined poor health metrics. To achieve this task, a paradigm shift in how we approach NCD prevention and treatment is required. The goal of this American Heart Association/European Society of Cardiology/European Association for Cardiovascular Prevention and Rehabilitation/American College of Preventive Medicine policy statement is to define key stakeholders and highlight their connectivity with respect to HL initiatives. This policy encourages integrated action by all stakeholders to create the needed paradigm shift and achieve broad adoption of HL behaviors on a global scale.

Preventing texting while driving: a statement of the American College of Preventive Medicine.

The American College of Preventive Medicine (ACPM) is providing a set of recommendations designed to reduce the morbidity and mortality associated with distractions due to texting while driving. According to the National Highway Traffic Safety Administration, 12% of all fatal crashes involving at least one distracted driver are estimated to be related to cell phone use while driving. Given the combination of visual, manual, and cognitive distractions posed by texting, this is an issue of major public health concern for communities. Therefore, the ACPM feels it is timely to discuss this issue and provide the following recommendations: 1. Encourage state legislatures to develop and pass legislation banning texting while driving, while simultaneously implementing comprehensive and dedicated law enforcement strategies including penalties for these violations. Legislatures should establish a public awareness campaign regarding the dangers of texting while driving as an integral part of this legislation. 2. Promote further research into the design and evaluation of educational tools regarding texting while driving that can be incorporated into the issuance of driver’s licenses. 3. Provide primary care providers with the appropriate tools to educate patients of all ages. 4. Conduct additional studies investigating the risks associated with cell phone usage while driving, particularly texting, with motor vehicle crashes.

Moving On…

Moving On…