Healthy Alberta Communities: Impact of a three-year community-based obesity and chronic disease prevention intervention Kim D. Raine a, ⁎, Ronald Plotnikoff a,1 , Donald Schopflocher a , Ellina Lytvyak a , Candace I.J. Nykiforuk a , Kate Storey a , Arto Ohinmaa a , Lisa Purdy b , Paul Veugelers a , T. Cameron Wild a a School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave., Edmonton, AB T6G 1C9, Canada b Department of Medical And Laboratory Sciences, University of Alberta, 5-412 ECHA, 11405 87 Ave., Edmonton, AB T6G 1C9, Canada abstract article info Available online 6 September 2013 Keywords: Obesity Chronic disease Prevention Public health Intervention studies Community networks Health promotion Objective. To assess the impact of a 3 year (2006–2009) community-based intervention for obesity and chronic disease prevention in four diverse “Healthy Alberta Communities” (HAC). Methods. Targeted intervention development incorporated the ANGELO conceptual framework to help com- munity stakeholders identify environmental determinants of obesity amenable to intervention. Several inter- related initiatives were implemented. To evaluate, we surveyed separate samples of adults in HAC communities before and after the interventions and compared responses to identical survey questions asked of adults living in Alberta in two waves of the Canadian Community Health Survey (CCHS). Results. The HAC sample included 4761 (2006) and 4733 (2009) people. The comparison sample included 9775 and 9784 respondents in 2005 and 2009–10 respectively. Self-reported body mass index showed no change, and neither were there significant changes in behaviors relative to secular trends. Most significant out- comes were relevant to social conditions, specifically sense of belonging to community in the intervention com- munities. Conclusion. Health outcome indicators at the community level may not be sufficiently sensitive to capture changes which, over a relatively short term, would only be expected to be incremental, given that interventions were directed primarily to creating environmental conditions supportive of changes in behavioral outcomes rather than toward health outcome change directly. © 2013 Elsevier Inc. All rights reserved. Introduction The impact of chronic diseases – including cardiovascular diseases, diabetes, and cancers – is steadily growing (World Health Organization, 2011b). The causes are well established, including unhealthy diet, physical inactivity, obesity, tobacco and alcohol use (World Health Organization, 2011b). The United Nations Global Assembly recognized “…the incidence and impacts of non-communicable diseases can be largely prevented or reduced with an approach that incorporates evidence-based, affordable, cost-effective, population-wide and multi- sectoral interventions” (United Nations General Assembly, 2011). In Canada, obesity has become a public health priority (Canadian Institute for Health Information, 2003; Public Health Agency of Canada, 2008). Twenty-year trends (1980–2008) of mean age– standardized body mass index (BMI) shows a persistent increase by 9.13% in men and 10.79% in women (World Health Organization, 2011a). The causes of obesity are multifaceted (Butland et al., 2007; The Public Health Agency of Canada and the Canadian Institute for Health Information, 2011). Human biology, growth and development early in life, eating and physical activity behaviors, and broader eco- nomic and social drivers all have a role to play (Butland et al., 2007; Kanoski, 2012). Thus, obesity does not have easy or obvious solutions. Currently, evidence is heavily biased towards causes rather than strate- gies for prevention. Controlled studies are few in number and limited in scope (Brown et al., 2007; National Institute for Health Clinical Excellence and National Collaborating Centre for Primary Care, 2006; Wareham, 2007). There is need for additional evidence in obesity pre- vention, especially (1) large-scale “pilot” or “demonstration” projects for obesity prevention and (2) population-based solutions, including studies of the built environment and diet/activity/obesity (Butland et al., 2007). Preventive Medicine 57 (2013) 955–962 ⁎ Corresponding author. E-mail addresses: kim.raine@ualberta.ca (K.D. Raine), ron.plotnikoff@newcastle.edu.au (R. Plotnikoff), don.schopflocher@ualberta.ca (D. Schopflocher), Ellina.lytvyak@ualberta.ca (E. Lytvyak), Candace.nykiforuk@ualberta.ca (C.I.J. Nykiforuk), Kate.storey@ualberta.ca (K. Storey), aohinmaa@ualberta.ca (A. Ohinmaa), Lisa.purdy@ualberta.ca (L. Purdy), Paul.veugelers@ualberta.ca (P. Veugelers), Cam.wild@ualberta.ca (T.C. Wild). 1 Present address: Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle Callaghan, NSW 2308, Australia. 0091-7435/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ypmed.2013.08.024 Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed