AMERICAN JOURNAL OF PUBLIC HEALTH
EDITOR’S CHOICE Innovations to Improve Population Health and Address Chronic Disease New technologies are helping individuals improve their health by providing real-time feedback that engages and motivates. These technologies also offer additional potential opportunities for teaching users about nutrition, exercise, health risks and healthy habits. In this issue of the Journal, we look specifically at how these efforts and innovations can transform underserved communities. When integrated into the lifestyles of millions of individuals, technology has the potential to improve overall population health in the United States as well as the health of high-risk populations and those disproportionately affected by chronic disease. Smartphones and related devices are the key platform for mobile health (mHealth) technologies. Encouragingly, these devices are prevalent among low-income and minority groups. Mobile phones with text messaging (SMS) are ubiquitous, which has prompted the Institute for eHealth Equity, an Aetna Foundation grantee, to study how to use this communications method for encouraging healthy behavior changes. The Institute’s Text4Wellness program enrolled African American women aged 19 to 55 years in a two-way text messaging campaign managed by the women’s local health ministers. The campaign delivers actionable exercise, wellness, disease prevention and lifestyle messaging uniquely tailored to the local African American faith community. People adopt healthier behaviors more readily if they have a clear picture of their current health status and risks and an enabling environment for behavior change. To test this assumption at the population level, Dartmouth College (Hanover, NH), with Aetna Foundation support, is deploying an electronic health risk assessment to measure the baseline health status of a community in the Upper Connecticut River Valley. The project is testing ways to encourage community members to take the assessment, and will share results with community stakeholders so they can help shape evidence-based health interventions. To test this same assumption, the Washington University School of Medicine (St. Louis, MO) in
2012 launched an evidence-based tablet app, Zuum, which taps into the university’s Your Disease Risk suite of health risk assessment tools that assist with lifestyle modifications. App users complete a brief survey, are presented with a summary of their healthy habits alongside those they have the power to improve, and receive weekly text messages tailored to their risk results and behaviors. With Aetna Foundation support, Washington University is working with Federally Qualified Health Centers to launch a pilot that will assess the feasibility of integrating Zuum into clinical care settings in urban St. Louis and rural Illinois, communities that serve largely lowincome, underinsured populations. Smartphone apps present a multitude of new methods for reducing chronic disease risk among vulnerable populations by providing users with opportunities to improve diet and nutrition. Technological innovations hold real potential to significantly impact chronic disease prevention; however, technology also can play a role in the management of chronic disease by patients and providers. To ensure that patients use these new technologies effectively, we must integrate them into clinical practices and offer patients guidance in choosing the mobile apps best suited to their needs. When combined with sound policy strategies, scalable, emerging technologies can be powerful allies for improving population health. The Aetna Foundation is proud to be exploring these new opportunities through partnerships, funding and collaborations like the ones featured in this issue of the American Journal of Public Health. j
December 2014, Vol 104, No. 12 | American Journal of Public Health
Garth Graham, MD, MPH Guest Editor, Aetna Foundation Alyse Sabina, MPH Guest Editor, Aetna Foundation Gillian Barclay, DDS, DrPH Guest Editor, Aetna Foundation doi:10.2105/AJPH.2014.302335
EDITOR-IN-CHIEF ASSISTANT EDITOR DEPUTY EDITOR FEATURE EDITOR IMAGE EDITOR ASSOCIATE EDITORS
Mary E. Northridge, PhD, MPH Ariel P. Greenblatt, DMD, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Hortensia Amaro, PhD Mary T. Bassett, MD, MPH Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Ferney-Voltaire, France) DEPARTMENT EDITORS Roy Grant, MA Government, Law, and Public Health Practice Public Health Policy Briefs Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Mark A. Rothstein, JD Public Health Ethics Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2015), Chair Chinua Akukwe, MD, MPH (2015) Caroline Bergeron, MSc (2016) Eric R. Buhi, PhD (2016) Keith Elder, PhD, MPH (2016) Thomas Greenfield, PhD (2015) Jeffrey Hallam, PhD (2014) Dio Kavalieratos, PhD (2016) Maureen Lichtveld, MD, MPH (2015) Justin B. Moore, PhD (2016) Samuel L. Posner, PhD (2015) Joan Reede, MD, MPH (2014) Helena Temkin-Greener, PhD, MPH (2014) David H. Wegman, MD, MSc (2014) Ruth Zambrana, PhD (2016) STAFF Georges C. Benjamin, MD Executive Director/Publisher Ashell Alston, Interim Publications Director Brian Selzer, Interim Deputy Publications Director Morgan Richardson, Production Coordinator Michael Henry, Associate Production Editor (Sr) Aisha Jamil, Associate Production Editor (Jr) Mazin Abdelgader, Graphic Designer Vivian Tinsley, Subscriptions Manager FREELANCE STAFF Kelly Burch, Greg Edmondson, John Lane, Gary Norton, Michelle Quirk, Alisa Riccardi, Trish Weisman, Eileen Wolfberg, Copyeditors Nestor Ashbery, Sarah Cook, Marci McGrath, Chris Smith, Proofreaders Vanessa Sifford, Graphic Designer
Editor's Choice | 2245
EDITOR’S CHOICE Innovations to Improve Population Health and Address Chronic Disease New technologies are helping individuals improve their health by providing real-time feedback that engages and motivates. These technologies also offer additional potential opportunities for teaching users about nutrition, exercise, health risks and healthy habits. In this issue of the Journal, we look specifically at how these efforts and innovations can transform underserved communities. When integrated into the lifestyles of millions of individuals, technology has the potential to improve overall population health in the United States as well as the health of high-risk populations and those disproportionately affected by chronic disease. Smartphones and related devices are the key platform for mobile health (mHealth) technologies. Encouragingly, these devices are prevalent among low-income and minority groups. Mobile phones with text messaging (SMS) are ubiquitous, which has prompted the Institute for eHealth Equity, an Aetna Foundation grantee, to study how to use this communications method for encouraging healthy behavior changes. The Institute’s Text4Wellness program enrolled African American women aged 19 to 55 years in a two-way text messaging campaign managed by the women’s local health ministers. The campaign delivers actionable exercise, wellness, disease prevention and lifestyle messaging uniquely tailored to the local African American faith community. People adopt healthier behaviors more readily if they have a clear picture of their current health status and risks and an enabling environment for behavior change. To test this assumption at the population level, Dartmouth College (Hanover, NH), with Aetna Foundation support, is deploying an electronic health risk assessment to measure the baseline health status of a community in the Upper Connecticut River Valley. The project is testing ways to encourage community members to take the assessment, and will share results with community stakeholders so they can help shape evidence-based health interventions. To test this same assumption, the Washington University School of Medicine (St. Louis, MO) in
2012 launched an evidence-based tablet app, Zuum, which taps into the university’s Your Disease Risk suite of health risk assessment tools that assist with lifestyle modifications. App users complete a brief survey, are presented with a summary of their healthy habits alongside those they have the power to improve, and receive weekly text messages tailored to their risk results and behaviors. With Aetna Foundation support, Washington University is working with Federally Qualified Health Centers to launch a pilot that will assess the feasibility of integrating Zuum into clinical care settings in urban St. Louis and rural Illinois, communities that serve largely lowincome, underinsured populations. Smartphone apps present a multitude of new methods for reducing chronic disease risk among vulnerable populations by providing users with opportunities to improve diet and nutrition. Technological innovations hold real potential to significantly impact chronic disease prevention; however, technology also can play a role in the management of chronic disease by patients and providers. To ensure that patients use these new technologies effectively, we must integrate them into clinical practices and offer patients guidance in choosing the mobile apps best suited to their needs. When combined with sound policy strategies, scalable, emerging technologies can be powerful allies for improving population health. The Aetna Foundation is proud to be exploring these new opportunities through partnerships, funding and collaborations like the ones featured in this issue of the American Journal of Public Health. j
December 2014, Vol 104, No. 12 | American Journal of Public Health
Garth Graham, MD, MPH Guest Editor, Aetna Foundation Alyse Sabina, MPH Guest Editor, Aetna Foundation Gillian Barclay, DDS, DrPH Guest Editor, Aetna Foundation doi:10.2105/AJPH.2014.302335
EDITOR-IN-CHIEF ASSISTANT EDITOR DEPUTY EDITOR FEATURE EDITOR IMAGE EDITOR ASSOCIATE EDITORS
Mary E. Northridge, PhD, MPH Ariel P. Greenblatt, DMD, MPH Farzana Kapadia, PhD Gabriel N. Stover, MPA Aleisha Kropf Hortensia Amaro, PhD Mary T. Bassett, MD, MPH Michael R. Greenberg, PhD Sofia Gruskin, JD, MIA Said Ibrahim, MD, MPH Robert J. Kim-Farley, MD, MPH Stewart J. Landers, JD, MCP Stella M. Yu, ScD, MPH ASSOCIATE EDITOR FOR STATISTICS AND EVALUATION Roger Vaughan, DrPH, MS INTERNATIONAL ASSOCIATE EDITORS Kenneth Rochel de Camargo Jr, MD, PhD (Rio de Janeiro, Brazil) Daniel Tarantola, MD (Ferney-Voltaire, France) DEPARTMENT EDITORS Roy Grant, MA Government, Law, and Public Health Practice Public Health Policy Briefs Elizabeth Fee, PhD, and Theodore M. Brown, PhD Images of Health Public Health Then and Now Voices From the Past Mark A. Rothstein, JD Public Health Ethics Kenneth R. McLeroy, PhD, and Deborah Holtzman, PhD, MSW Framing Health Matters EDITORIAL BOARD Jeffrey R. Wilson, PhD, MS (2015), Chair Chinua Akukwe, MD, MPH (2015) Caroline Bergeron, MSc (2016) Eric R. Buhi, PhD (2016) Keith Elder, PhD, MPH (2016) Thomas Greenfield, PhD (2015) Jeffrey Hallam, PhD (2014) Dio Kavalieratos, PhD (2016) Maureen Lichtveld, MD, MPH (2015) Justin B. Moore, PhD (2016) Samuel L. Posner, PhD (2015) Joan Reede, MD, MPH (2014) Helena Temkin-Greener, PhD, MPH (2014) David H. Wegman, MD, MSc (2014) Ruth Zambrana, PhD (2016) STAFF Georges C. Benjamin, MD Executive Director/Publisher Ashell Alston, Interim Publications Director Brian Selzer, Interim Deputy Publications Director Morgan Richardson, Production Coordinator Michael Henry, Associate Production Editor (Sr) Aisha Jamil, Associate Production Editor (Jr) Mazin Abdelgader, Graphic Designer Vivian Tinsley, Subscriptions Manager FREELANCE STAFF Kelly Burch, Greg Edmondson, John Lane, Gary Norton, Michelle Quirk, Alisa Riccardi, Trish Weisman, Eileen Wolfberg, Copyeditors Nestor Ashbery, Sarah Cook, Marci McGrath, Chris Smith, Proofreaders Vanessa Sifford, Graphic Designer
Editor's Choice | 2245
