The Evolution of the Steps Program, 2003-2010: Transforming the Federal Public Health Practice of Chronic Disease Prevention

Abstract

The Steps program, formerly known as Steps to a HealthierUS, was the first Centers for Disease Control and Prevention (CDC) program to support a community-based, integrated approach to chronic disease prevention. Steps interventions addressed both diseases and risk factors, focusing on the 3 leading causes of preventable deaths in the United States — tobacco use, poor nutrition, and physical inactivity — and the associated chronic conditions of asthma, diabetes, and obesity. When Steps shifted from interventions focused on individual health-risk behaviors to the implementation of policy, systems, and environmental changes, the program became an integral part of changing the way CDC addressed chronic disease prevention. In this article, we describe the shift in intervention strategies that occurred among Steps communities, the model that was developed as Steps evolved, common interventions implemented before and after the shift in approach, challenges experienced by Steps communities, and CDC programs that were modeled after Steps.

Promoting Physical Activity Among Native American Youth: a Systematic Review of the Methodology and Current Evidence of Physical Activity Interventions and Community-wide Initiatives

“…Specifically, initiatives examined multiple study regions 49–51 or a tribal community or communities in Alaska 52 , California 53,54 , New Mexico 13,55 , North Carolina 17 , Oklahoma 56–58 , or Washington 59 .…”

“…Various culturally competent approaches were discussed including using digital storytelling 53 , a modified Talking Circle 17 , and a workshop series integrating Indigenous evaluation methods 50 . Only one initiative had some form of non-Native comparison group 49 but more than a third (n=5; 38%) included more than one tribe 17,49–51,54 .…”

Policy Approaches to Advancing Health Equity

“…This task is often described as "policy, systems, and environment change," an approach that expands the focus beyond health behaviors and clinical services. 17 Associations between community and societal contexts and individual and family health status are generally understood within the field of public health, and the commonly used socioecological model 18 has been an important tool for communicating these relationships. For example, resources such as the CDC Practitioner's Guide for Advancing Health Equity focus on specific policies used by communities, in combination with other interventions that can be effective in reducing disparities.…”

Media Outlet and Consumer Reactions to Promotional Activities of the Choose Health LA Restaurants Program in Los Angeles County

“…Despite growing recognition that coupling environmental and individually focused strategies can work synergistically, [10][11][12][13] best practices for integrating these strategies remain unknown. While previous studies have examined interventions to modify the retail food environment, including efforts to increase consumer demand, most studies have typically focused on a limited set of promotional components (eg, point-ofpurchase signage).…”