Reducing health inequalities is a policy priority in many developed countries. Little is known about effective strategies to reduce inequalities in obesity and its underlying behaviors. The goal of the study was to investigate differential effectiveness of interventions aimed at obesity prevention, the promotion of physical activity or a healthy diet by SES.Subgroup analyses in 2010 and 2011 of 26 Dutch studies funded by The Netherlands Organization for Health Research and Development after 1990 (n=17) or identified by expert contact (n=9). Methodologic quality and differential effects were synthesized in harvest plots, subdivided by setting, age group, intensity, and time to follow-up.Seven lifestyle interventions were rated more effective and four less effective in groups with high SES; for 15 studies no differential effects could be demonstrated. One study in the healthcare setting showed comparable effects in both socioeconomic groups. The only mass media campaign provided modest evidence for higher effectiveness among those with high SES. Individually tailored and workplace interventions were either more effective in higher-SES groups (n=4) or no differential effects were demonstrated (n=9). School-based studies (n=7) showed mixed results. Two of six community studies provided evidence for better effectiveness in lower-SES groups; none were more effective in higher-SES groups. One high-intensity community-based study provided best evidence for higher effectiveness in low-SES groups.Although for the majority of interventions aimed at obesity prevention, the promotion of physical activity, or a healthy diet, no differential effectiveness could be demonstrated, interventions may widen as well as reduce socioeconomic inequalities in these outcomes. Equity-specific subgroup analyses contribute to needed knowledge about what may work to reduce socioeconomic inequalities in obesity and underlying health behaviors.

Given the health benefits of walking, there is interest in understanding how physical environments favor walking. Although GIS-derived measures of land-use mix, street connectivity, and residential density are commonly combined into indices to assess how conducive neighborhoods are to walking, field validation of these measures is limited.To assess the relationship between audit- and GIS-derived measures of overall neighborhood walkability and between objective (audit- and GIS-derived) and participant-reported measures of walkability.Walkability assessments were conducted in 2009. Street-level audits were conducted using a modified version of the Pedestrian Environmental Data Scan. GIS analyses were used to derive land-use mix, street connectivity, and residential density. Participant perceptions were assessed using a self-administered questionnaire. Audit, GIS, and participant-reported indices of walkability were calculated. Spearman correlation coefficients were used to assess the relationships between measures. All analyses were conducted in 2012.The correlation between audit- and GIS-derived measures of overall walkability was high (R=0.7 [95% CI=0.6, 0.8]); the correlations between objective (audit and GIS-derived) and participant-reported measures were low (R=0.2 [95% CI=0.06, 0.3]; R=0.2 [95% CI=0.04, 0.3], respectively). For comparable audit and participant-reported items, correlations were higher for items that appeared more objective (e.g., sidewalk presence, R=0.4 [95% CI=0.3, 0.5], versus safety, R=0.1 [95% CI=0.003, 0.3]).The GIS-derived measure of walkability correlated well with the in-field audit, suggesting that it is reasonable to use GIS-derived measures in place of more labor-intensive audits. Interestingly, neither audit- nor GIS-derived measures correlated well with participants' perceptions of walkability.

Exposure to ultraviolet radiation from indoor tanning devices (tanning beds, booths, and sun lamps) or from the sun contributes to the risk of skin cancer, including melanoma, which is the type of skin cancer responsible for most deaths. Indoor tanning is common among certain groups, especially among older adolescents and young adults, adolescent girls and young women, and non-Hispanic whites. Increased understanding of the health risks associated with indoor tanning has led to many efforts to reduce use. Most environmental and systems efforts in the U.S. (e.g., age limits or requiring parental consent/accompaniment) have occurred at the state level. At the national level, the U.S. Food and Drug Administration and the Federal Trade Commission regulate indoor tanning devices and advertising, respectively. The current paper provides a brief review of (1) the evidence on indoor tanning as a risk factor for skin cancer; (2) factors that may influence use of indoor tanning devices at the population level; and (3) various environmental and systems options available for consideration when developing strategies to reduce indoor tanning. This information provides the context and background for the companion paper in this issue of the American Journal of Preventive Medicine, which summarizes highlights from an informal expert meeting convened by the CDC in August 2012 to identify opportunities to prevent skin cancer by reducing use of indoor tanning devices.

Exposure to ultraviolet radiation from indoor tanning device use is associated with an increased risk of skin cancer, including risk of malignant melanoma, and is an urgent public health problem. By reducing indoor tanning, future cases of skin cancer could be prevented, along with the associated morbidity, mortality, and healthcare costs. On August 20, 2012, the CDC hosted a meeting to discuss the current body of evidence on strategies to reduce indoor tanning as well as research gaps. Using the Action Model to Achieve Healthy People 2020 Overarching Goals as a framework, the current paper provides highlights on the topics that were discussed, including (1) the state of the evidence on strategies to reduce indoor tanning; (2) the tools necessary to effectively assess, monitor, and evaluate the short- and long-term impact of interventions designed to reduce indoor tanning; and (3) strategies to align efforts at the national, state, and local levels through transdisciplinary collaboration and coordination across multiple sectors. Although many challenges and barriers exist, a coordinated, multilevel, transdisciplinary approach has the potential to reduce indoor tanning and prevent future cases of skin cancer.

Providing optimal preventive services across the life span is integral to improving the nation's health. However, teaching future health professionals evidence-based prevention screening and counseling has notable limitations. Applying the U.S. Preventive Services Task Force (Task Force) preventive services recommendations is necessary but not sufficient to teach comprehensive and practical preventive services delivery. Certain important health topics have not yet been investigated by the Task Force; other Task Force health topics have insufficient evidence or nonspecific recommendations. The purpose of the current paper is to provide a strategy and develop a tool to educate future healthcare professionals in recommendations for prevention screening and counseling. Age-specific preventive history charts for children and adults were created using a total of 60 recommendations from the following sources (with number of recommendations shown): the Task Force (n=37); four primary care professional organizations (n=15); and a representative panel of experts (n=8). Using a systematic approach that incorporates other accredited organizations and inclusion criteria (as described) yielded a practical tool that is applicable in both educational and clinical settings.

Economic incentives to promote healthy behavior are becoming increasingly common and have been suggested as an approach to decreasing healthcare costs. Ethical concerns about programs with such incentives are that they may contribute to inequities, be coercive, interfere with therapeutic relationships, undermine personal responsibility for health, and decrease social solidarity. Additionally, they may be a source of stigma or discrimination, promote dependence, and be unfair for those already engaged in targeted health behaviors or those who cannot fulfill the incentivized behaviors. Incentive programs need to incorporate appropriate safeguards to monitor these risks and support fairness in offering economic incentives to promote healthy behavior.

To date, no reviews have investigated the evidence of tracking of physical activity and sedentary behavior specifically during early childhood (aged 0-5.9 years) or from early childhood to middle childhood (aged 6-12 years). It is important to review the evidence of tracking of these behaviors to determine their stability during the foundational early years of life.A literature search of studies was conducted in seven electronic databases (January 1980 to April 2012). Studies were compared on methodologic quality and evidence of tracking of physical activity or sedentary behavior. Tracking was defined as the stability (or relative ranking within a cohort) of behaviors, such as physical activity and sedentary behavior, over time.Eleven studies met the inclusion criteria. All studies reporting physical activity outcomes had high methodologic quality; 71% of studies reporting sedentary behavior outcomes had high methodologic quality. Of the tracking coefficients for physical activity, 4% were large, 60% were moderate, and 36% were small. Of the tracking coefficients for sedentary behavior, 33% were large, 50% were moderate, and 17% were small. Overall, there was evidence of moderate tracking of physical activity during early childhood, and from early childhood to middle childhood, and of moderate-to-large tracking of sedentary behavior during early childhood and from early childhood to middle childhood.This review highlights the importance of establishing recommended levels of physical activity and sedentary behavior during the early years of life. Based on this review, the following recommendations are made: (1) early childhood should be targeted as a critical time to promote healthy lifestyle behaviors through methodologically sound prevention studies; and (2) future tracking studies should assess a broad range of sedentary behaviors using objective measures.