Background and Purpose. Health promotion programs are increasingly important components of health care in an era of predominantly chronic illness preceded by identified health risk behaviors. We report a large and relatively long experience with a low-cost intervention delivered through the mail and using sequential time-oriented risk appraisal and personalized recommendations, each six months, together with self-management materials. Methods. We performed a prospective, longitudinal, observational study of 103,937 consecutive program participants observed for at least six months and up to 30 months. The primary study endpoint is overall health risk score, with secondary analysis of individual risk behaviors. A concurrent comparison group utilizes the initial scores of new participants by calendar time over the study period. Results. Strong overall positive effects were observed, with improvement in computed health risk scores over 18 months of 14.7% (p < .0001) in those 65 and over and 18.4% (p < .0001) in those under 65. At 30 months, improvement was 18.8% (p < .0001) and 25.7% (p < .0001), respectively. There was improvement in self-report scores for all targeted health risk behaviors, except for pounds over ideal weight, including smoking; dietary fat, salt, and fiber; alcohol; exercise; cholesterol; and reported stress. There was progressive improvement approximating 5% each six-month period. Results were consistent across age groups 16–35, 36–50, 51–65, and over 65 and over different educational level. Results could not be accounted for by sequential changes in initial health habits of participants over time. Discussion. Low-cost health promotion programs may be practically applied to large populations with positive effects which continue to improve with time in program. Changes in senior populations are as great as in younger persons. Effects in those in lower socioeconomic classes appear as great as those in higher classes.
Systematic review of resilience-enhancing, universal, primary school-based mental health promotion programs
