Table 2.
Multilevel Efforts to Improve CVH Across Social-Ecological Contexts
| Ecological level | Selected examples | Examples of key gaps and needed directions |
|---|---|---|
| Policies | ||
| Federal | FDA regulation of tobacco products Robust school nutrition standards and healthy school meals for all Active transportation infrastructure investment Ensuring affordable, equitable, adequate access to health insurance for all151 Public health infrastructure investment, data modernization, and surveillance systems upgrade152,153 |
Premarket approval of newer tobacco products154 Regulating synthetic nicotine155 Removing all characterizing flavors from all tobacco products156 Continued support for implementation and increasing sodium reduction, promotion of whole grains; developing an added sugars standard Ensuring that federal appropriations flow effectively to the state and local levels for biking, walking, and rolling, reaching all people equitably, particularly those in the most underserved and underinvested communities157 Preserving and building on the Affordable Care Act Optimizing value-based insurance design158,159 Continued federal investment of the data modernization and surveillance systems upgrade to ensure seamless integration across all levels of government and health systems Protecting and expanding the public health workforce |
| State | Tobacco end game strategies (eg, comprehensive smoke-free air laws, tobacco excise taxes, comprehensive coverage and access to tobacco cessation services, tobacco retail strategies, and removing all characterizing flavors from all tobacco products)138 Medicaid expansion and Medicaid coverage of extended postpartum coverage, self-measured BP, telehealth160–162 |
Effective coordination and engagement across public health, social justice, and equity partners Need for robust public and private investment in the tobacco end game, overcoming industry product innovation, targeted marketing, and positioning Housing, income, and transportation issues for the Medicaid population Ensuring that states can use all means at their disposal to offset costs of expansion163 and to increase access to services |
| Local | Sugar-sweetened beverage taxes164,165 Increasing access to early care and education166 | Combatting industry opposition and preemption efforts Significant commitment to funding for advocacy campaigns and ground softening efforts State preemption of local efforts Inadequate workforce compensation167,168 Disruption caused by the COVID-19 pandemic169 |
| Advocacy groups | AHA Voices for Healthy Kids grantees policy work | |
| Public health programs | ||
| Federal | Healthy People 2020 and 2030 Million Hearts WISEWOMAN NHLBI ENRICH/home visiting program partnership Head Start |
Tailored sociocultural messaging for diverse populations in partnership with relevant stakeholders |
| State/national | AHA’s Go Red for Women | Tailored sociocultural messaging for diverse populations in partnership with relevant stakeholders |
| Local | Mass media campaigns to promote healthy behaviors and risk factor control170,171 | |
| Institutions | ||
| Early childcare/education | Chicago Child-Parent Center Education Program Longitudinal Study172 | Broader implementation |
| Schools and colleges | AHA/NFL Play60 AHA/Clinton Foundation Alliance for a Healthier Generation AHA Kids Heart Challenge School-based tobacco prevention,171,173 PA promotion, sugar-sweetened beverage reduction |
Delineate specific intervention components most effective in promoting CVH and best approaches to implementation174 |
| Workplaces | AHA Workforce Well-Being Playbook and Corporate Recognition Program175 NIOSH Total Worker Health Centers of Excellence |
Implementation, particularly including workplaces more likely to employ individuals who may be socioeconomically impacted |
| Health care systems (eg, insurance/payers, hospitals, practitioners) | AHA Get With The Guidelines SPHERE176 | Broader implementation |
| Neighborhoods and communities | ||
| Community-serving programs | Strong Hearts, Healthy Communities intervention177,178 AHA SFRN-funded Hearts & Parks/Bull City Fit intervention179 CDC Prevention Research Centers |
Outreach to broader rural communities with geographic barriers to access |
| Private community settings | Faith-based interventions (FAITH trial, FAITH!) Barbershop interventions | Evaluation of design elements sufficient for large-scale dissemination and implementation in community settings and broad population health impact180 Expansion of rigorously tested CVH promotion interventions to other community venues (eg, hair salons,181 community centers) in partnership with civic organizations182 (eg, sororities, fraternities) |
| Neighborhood environments | Green space, corner store interventions183,184 | Development of methods to increase consumer demand and to foster sustainability of corner store interventions in various neighborhood/environmental contexts (eg, urban vs rural)185 Specific assessment of impacts of green space interventions on health equity and potential adverse effects (eg, gentrification and reduced access)186 |
| Virtual communities | Interactive, group social media interventions187 | Culturally responsive interventions to promote CVH |
| Families and individuals | ||
| Parents/children | AHA Simple Cooking With Heart for Kids AHA/Aramark Health for Life nutrition education curriculum INSIGHT intervention STRIP intervention |
|
| Adults | Health-partner intervention Mobile technology for stroke prevention |
|
AHA indicates American Heart Association; BP, blood pressure; CDC, Centers for Disease Control and Prevention; CVH, cardiovascular health; ENRICH, Early Intervention to Promote Cardiovascular Health of Mothers and Children; FAITH, Faith-Based Approaches in the Treatment of Hypertension; FAITH!, Fostering African-American Improvement in Total Health; FDA, US Food and Drug Administration; INSIGHT, Intervention Nurses Start Infants Growing on Healthy Trajectories; NFL, National Football League; NHLBI, National Heart, Lung, and Blood Institute; NIOSH, National Institute for Occupational Safety and Health; PA, physical activity; SFRN, Strategically-Focused Research Network; SPHERE, Stroke Prevention in Healthcare Delivery Environments; STRIP, Special Turku Coronary Risk Factor Intervention Project; and WISEWOMAN, Well-Integrated Screening and Evaluation for Women Across the Nation.