176 Diabetes Spectrum Volume 15, Number 3, 2002 Shaping Environments for Reductions in Type 2 Diabetes Risk Behaviors: A Look at CVD and Cancer Interventions Stephania T. Miller, PhD; David G. Schlundt, PhD; James W. Pichert, PhD; and Nasar U. Ahmed, PhD Among the many efforts to reduce the burden of diabetes in the United States, one involves focusing on communities. Evidence from cardiovascular disease and cancer-related community intervention projects indicate that such efforts show promise in reducing behavioral risk factors, many of which are the same for diabetes. Such projects, therefore, may provide insight for diabetes educa- tors, researchers, and others who are interested in designing and implement- ing diabetes interventions within communities. The ongoing epidemic of chronic dis- eases, including obesity and type 2 diabetes, has clear environmental roots. 1–4 The poor dietary habits and sedentary lifestyles that contribute to such diseases are environmentally influenced, and they must change if health risks are to be reduced. 5–8 As a result, governmental officials recog- nize the need for promoting changes in the environment that, in turn, pro- mote changes in health outcomes. The Department of Health and Human Services, for example, recently compiled a guide, Healthy People in Healthy Communities (http://web. health.gov/healthypeople/publications), that describes ways in which commu- nities may address selected behavioral health risk factors. These strategies are based on the notion that individual communities are composed of various aspects of the total environment and that these elements affect behaviors such as eating and exercise. Altering these environmental factors might then improve health outcomes for the large population of people who are at risk or suffering from chronic illness. 1–8 In addition, behaviors related to health care access and health care uti- lization may influence the risk of developing chronic diseases. 9,10 These behaviors are also influenced by envi- ronmental factors in communities. 11–13 Many of the risk behaviors for type 2 diabetes (poor dietary habits, seden- tary lifestyle, smoking, and underuti- lization of preventive care services) are the same as for other chronic illnesses such as cardiovascular disease (CVD) and cancer. Herein lies an opportunity for the diabetes community to consid- er examples of CVD and cancer inter- vention programs that have focused on affecting environments for changes in these behaviors. This article summarizes insights gleaned from the CVD and cancer research communities on how envi- ronments can be affected to reduce risk behaviors. Its specific objectives are to 1) define the many environ- ments that make up a community, 2) give examples of community CVD and cancer intervention programs that have integrated different levels of the environment for changes in risk behaviors, and 3) suggest implications for diabetes professionals. WHAT WE MEAN BY “ENVIRONMENT” Before reviewing how CVD and can- cer intervention programs have addressed behavioral risk factors, we must first define what is meant by “environment.” How we conceptual- ize the environment will affect research and intervention methodologies. Webster’s New World Dictionary defines “environment” as “something that surrounds—surroundings; all the conditions, circumstances, and influ- In Brief Downloaded from http://diabetesjournals.org/spectrum/article-pdf/15/3/176/557774/0176.pdf by guest on 14 November 2022