BackgroundPublic health programs can only deliver benefits if they are able to sustain activities over time. There is a broad literature on program sustainability in public health, but it is fragmented and there is a lack of consensus on core constructs. The purpose of this paper is to present a new conceptual framework for program sustainability in public health.MethodsThis developmental study uses a comprehensive literature review, input from an expert panel, and the results of concept-mapping to identify the core domains of a conceptual framework for public health program capacity for sustainability. The concept-mapping process included three types of participants (scientists, funders, and practitioners) from several public health areas (e.g., tobacco control, heart disease and stroke, physical activity and nutrition, and injury prevention).ResultsThe literature review identified 85 relevant studies focusing on program sustainability in public health. Most of the papers described empirical studies of prevention-oriented programs aimed at the community level. The concept-mapping process identified nine core domains that affect a program’s capacity for sustainability: Political Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Public Health Impacts, and Strategic Planning. Concept-mapping participants further identified 93 items across these domains that have strong face validity—89% of the individual items composing the framework had specific support in the sustainability literature.ConclusionsThe sustainability framework presented here suggests that a number of selected factors may be related to a program’s ability to sustain its activities and benefits over time. These factors have been discussed in the literature, but this framework synthesizes and combines the factors and suggests how they may be interrelated with one another. The framework presents domains for public health decision makers to consider when developing and implementing prevention and intervention programs. The sustainability framework will be useful for public health decision makers, program managers, program evaluators, and dissemination and implementation researchers.

Social isolation is a significant public health problem among many older adults; however, most of the empirical knowledge about isolation derives from community-based samples. There has been less attention given to isolation in senior housing communities. The objectives of this pilot study were to test two methods to identify socially isolated residents in low-income senior housing and compare findings about the extent of isolation from these two methods. The first method, self-report by residents, included 47 out of 135 residents who completed in-person interviews. To determine self-report isolation, residents completed the Lubben Social Network Scale 6 (LSNS-6). The second method involved a staff member who reported the extent of isolation on all 135 residents via an online survey. Results indicated that 26% of residents who were interviewed were deemed socially isolated by the LSNS-6. Staff members rated 12% of residents as having some or a lot of isolation. In comparing the two methods, staff members rated 2% of interviewed residents as having a lot of isolation. The combination of self-report and staff report could be more informative than just self-report alone, particularly when participation rates are low. However, researchers should be aware of the potential discrepancy between these two methods.

Although maintaining engagement in activities has a positive influence on our health and wellbeing as we age, many programs that serve older adults struggle with getting participation in the programs they offer. This study sought to explore activity disengagement among older adults in a senior housing community and identify the challenges and opportunities for reengagement with the aim of informing future intervention development and testing. Fifty-one adults over the age of 60 participated in structured interviews. Findings highlighted that many older adults have activities patterns that are not optimal for health. Many reasons given for disengaging in activities (e.g., no opportunity) were surprising given that participants lived in a setting where a variety of programs were offered. Programs need to more purposively address social challenges to participating in activities and consider a more person-centered approach when developing interventions for the older adults they serve.

More than 60% of Bosnian refugees in the United States may be current smokers. Examining health beliefs can provide insight into smoking behaviors in this community. Four hundred ninety-nine Bosnians were interviewed about health beliefs and personal health risks related to smoking. ANOVA was used to compare current, former, and never smokers. General health beliefs were significantly different by smoking status with medium effect sizes (P < .001; η(2) = 0.04-0.06); current smokers were less likely to agree that smokers live shorter lives and that smokers are more likely to get heart disease. Significant differences with large effect sizes (P < .001; η(2) = 0.11-0.29) were found in perception of personal risk of lung cancer and heart disease among current, former, and never smokers. Current smokers perceived their own health risks as less severe than those of other smokers. High smoking rates and smokers' optimism related to health indicate that culturally tailored educational and cessation interventions are needed for Bosnian refugee communities.

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