Scope and Target Population:
This guideline, Primary Prevention of Chronic Disease Risk Factors, outlines the existing evidence for the effectiveness of strategies and programs designed to help adult patients successfully make essential changes to achieve healthier lifestyles (increased physical activity, improved nutrition, decreased tobacco use and exposure, decreased hazardous and harmful drinking/alcohol use). It also outlines how these programs might be integrated into preventive services in health care systems, which traditionally have focused on early detection of disease or treatment of risk factors rather than preventing the onset of risk factors.

Nearly all individuals would derive measurable benefits from healthier lifestyles; even small improvements across a large portion of the population would have a greater impact than focusing on a small portion of the population that is at the upper end of the risk distribution. Therefore, the target population for this guideline includes all adults (age 18 and older) in the community, irrespective of their utilization of the health care system. Although this guideline focuses on adults, adolescents and children may benefit from many of the components or recommendations in this guideline.

Clinical Highlights and Recommendations:

• Four lifestyle behaviors – adequate physical activity, a diet that emphasizes fruits and vegetables, abstinence from tobacco and avoidance of tobacco smoke, and avoidance of hazardous and harmful drinking – are associated with a decade or more of increased life expectancy. Individuals who adopt this lifestyle in middle age have total mortality rates that are 40% lower than those who do not adopt.
  
• Medical groups cannot be given the sole responsibility for effecting lifestyle changes. There is a growing recognition and understanding of the role that community networks, physical and social environments, and public policy all play in fostering healthier lifestyles.
  
• A broad approach is necessary to achieve and support healthier behaviors in individuals. It requires individual change, health care system redesign, as well as community, employer and payer support.
  
• Health risk assessments are most effective when combined with interventions aimed at risk reduction and support.
  
• Collaborative decision-making and brief, combined interventions are effective in helping motivate and engage patients in healthier lifestyles.

Priority Aims:

1. Establish a relationship with employers to promote the implementation of an annual health risk assessment for employees.
   
2. Increase the percentage of adult patients with an up-to-date (within the last year) health risk assessment.
   
3. Increase the number of adult patients with documentation in their medical record, indicating that education around healthier lifestyle was provided.
   
4. Increase the number of adult patients with documentation in their medical record indicating they self-reported follow-through with recommended interventions in the area of physical activity, nutrition, tobacco use, hazardous and harmful drinking/alcohol use.
   
5. Develop relationships within the community that foster education and resources around healthier lifestyle (in order to prevent chronic disease risk factors).