school-based programs), while other elements associated with success are cultural or social factors (e.g., leadership, advocacy, scientific evidence). Althougth these social factors are less likely to be planned in the same way as formal interventions are, they can and should be cultivated and combined with more traditional intervention strategies This mix of formal interventions, typically provided by the medical and public health communities, coupled with social change strategies, typically stimulated by advocacy organizations and civil society, are most likely to result in successful and sustained health-related social change. Empirical data are lacking, but some could argue that the two types of interventions are inextricably linked, and either alone is unlikely to achieve success. If anything, anecdotal evidence suggests that social factors (those less likely to be initiated by the health community) are more likely to be associated with success in health-related social movements, if only serving to create a “tipping point” for social change (Gladwell, 2000).

AN ORGANIZING FRAMEWORK FOR PUBLIC HEALTH INTERVENTIONS

To learn from the lessons of other public health experiences and determine whether there is any utility or relevance for preventing childhood obesity, it is useful to have a conceptual framework to organize the experiences, principles, and strategies. In the 2000 Surgeon General’s Report, Reducing Tobacco Use, a framework was developed to categorize the different types of tobacco control interventions (DHHS, 2000). This framework reviewed the evidence within the following categories: educational, clinical, legal, economic, regulatory, and comprehensive. Although it was developed for tobacco control, this framework may be useful in categorizing interventions for other types of public health problems and has already been used to analyze similarities and differences between tobacco control and the prevention of obesity (Mercer et al., 2003). Analyzing strategies to prevent underage drinking, Komro and Toomey (2002) identified six different types of alcohol prevention strategies: school, extracurricular, family, policy, community, and multicomponent.

Drawing on and expanding the framework in the 2000 Surgeon General’s Report and from other sources, the next section reviews findings from a variety of public health campaigns, particularly efforts to reduce tobacco use, and other public health experiences that have commercial dimensions, or that have been politically sensitive (e.g., underage alcohol consumption, injury prevention). The following section reviews six categories of interventions that may have relevance for the prevention of childhood obesity. These categories are:



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