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In this trial involving black male barbershop patrons with uncontrolled hypertension, health promotion by barbers resulted in larger blood-pressure reduction when coupled with medication management in barbershops by specialty-trained pharmacists.

\"The all-encompassing Second Edition of Prevention Practice and Health Promotion: A Health Care Professional's Guide to Health, Fitness, and Wellness offers foundational knowledge to health care professionals implementing primary, secondary, and tertiary prevention to healthy, at-risk, and disabled populations. Dr. Catherine Thompson along with her contributors, all with diverse backgrounds in physical therapy, rehabilitation, and health care, present the interdisciplinary health care perspective of health, fitness, and wellness concepts that are critical for providing preventive care to healthy, impaired, and at-risk populations using the World Health Organization's International Classification of Functioning, Disability, and Health model as a guideline for assessment and management. Based upon the goals outlined in Healthy People 2020, Prevention Practice and Health Promotion, Second Edition also combines the vision of direct access for health care professionals with the goals of national health care to increase the quality of years of healthy life, as well as to eliminate health disparities between various populations. Recognizing the cost effectiveness of preventive care, health care professionals have an expanded role in health promotion and wellness, complementing evidence-based medical management of acute and chronic conditions. Some topics covered inside Prevention Practice and Health Promotion, Second Edition include an overview of screening across the lifespan; effective interventions to promote health, fitness, and wellness; and options for program development, including marketing and management strategies to address both individual and community needs\"-- Provided by publisher.

School environments affect health and academic outcomes. With increasing secondary school retention in low-income and middle-income countries, promoting quality school social environments could offer a scalable opportunity to improve adolescent health and wellbeing. We did a cluster-randomised trial to assess the effectiveness of a multi-component whole-school health promotion intervention (SEHER) with integrated economic and process evaluations in grade 9 students (aged 13–14 years) at government-run secondary schools in the Nalanda district of Bihar state, India. Schools were randomly assigned (1:1:1) to three groups: the SEHER intervention delivered by a lay counsellor (the SEHER Mitra [SM] group), the SEHER intervention delivered by a teacher (teacher as SEHER Mitra [TSM] group), and a control group in which only the standard government-run classroom-based life-skills Adolescence Education Program was implemented. The primary outcome was school climate measured with the Beyond Blue School Climate Questionnaire (BBSCQ). Students were assessed at the start of the academic year (June, 2015) and again 8 months later at the end of the academic year (March, 2016) via self-completed questionnaires. This study is registered with ClinicalTrials.gov, number NCT02484014. Of the 112 eligible schools in the Nalanda district, 75 were randomly selected to participate in the trial. We randomly assigned 25 schools to each of the three groups. One school subsequently dropped out of the TSM group, leaving 24 schools in this group. The baseline survey included a total of 13 035 participants, and the endpoint survey included 14 414 participants. Participants in the SM-delivered intervention schools had substantially higher school climate scores at endpoint survey than those in the control group (BBSCQ baseline-adjusted mean difference [aMD] 7·57 [95% CI 6·11–9·03]; effect size 1·88 [95% CI 1·44–2·32], p<0·0001) and the TSM-delivered intervention (aMD 7·57 [95% CI 6·06–9·08]; effect size 1·88 [95% CI 1·43–2·34], p<0·0001). There was no effect of the TSM-delivered intervention compared with control (aMD −0·009 [95% CI −1·53 to 1·51], effect size 0·00 [95% CI −0·45 to 0·44], p=0·99). Compared with the control group, participants in the SM-delivered intervention schools had moderate to large improvements in the secondary outcomes of depression (aMD −1·23 [95% CI −1·89 to −0·57]), bullying (aMD −0·91 [95% CI −1·15 to −0·66]), violence victimisation (odds ratio [OR] 0·62 [95% CI 0·46–0·84]), violence perpetration (OR 0·68 [95% CI 0·48–0·96]), attitude towards gender equity (aMD 0·41 [95% CI 0·21–0·61]), and knowledge of reproductive and sexual health (aMD 0·29 [95% CI 0·06–0·53]). Similar results for these secondary outcomes were noted for the comparison between SM-delivered intervention schools and TSM-delivered intervention schools (depression: aMD −1·23 [95% CI −1·91 to −0·55]; bullying: aMD −0·83 [95% CI −1·08 to −0·57]; violence victimisation: OR 0·49 [95% CI 0·35–0·67]; violence perpetration: OR 0·49 [95% CI 0·34–0·71]; attitude towards gender equity: aMD 0·23 [95% CI 0·02–0·44]; and knowledge of reproductive and sexual health: aMD 0·22 [95% CI −0·02 to 0·47]). However, no effects on these secondary outcomes were observed for the TSM-delivered intervention schools compared with the control group (depression: aMD −0·03 [95% CI −0·70 to 0·65]; bullying: aMD −0·08 [95% CI −0·34 to 0·18]; violence victimisation: OR 1·27 [95% CI 0·93–1·73]; violence perpetration: OR 1·37 [95% CI 0·95–1·95]; attitude towards gender equity: aMD 0·17 [95% CI −0·09 to 0·38]; and knowledge of reproductive and sexual health: aMD 0·06 [95% CI −0·18 to 0·32]). The multi-component whole-school SEHER health promotion intervention had substantial beneficial effects on school climate and health-related outcomes when delivered by lay counsellors, but no effects when delivered by teachers. Future research should focus on the evaluation of the scaling up of the SEHER intervention in diverse contexts and delivery agents. John D. and Catherine T. MacArthur Foundation, USA and the United Nations Population Fund India Office.

In a pragmatic trial involving smokers, financial incentives were more effective than free cessation aids; free cessation aids or e-cigarettes were no more effective than usual care. Cessation rates among smokers assigned to financial incentives were less than 3%.

Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention. Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575. 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (−0·58 [95% CI −0·86 to −0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]). This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification. Västerbotten County Council, the Swedish Research Council, the Heart and Lung Foundation, the Swedish Society of Medicine, and Carl Bennet Ltd, Sweden.

Background. Crowdsourcing, the process of shifting individual tasks to a large group, may enhance human immunodeficiency virus (HIV) testing interventions. We conducted a noninferiority, randomized controlled trial to compare first-time HIV testing rates among men who have sex with men (MSM) and transgender individuals who received a crowdsourced or a health marketing HIV test promotion video. Methods. Seven hundred twenty-one MSM and transgender participants (≥ 16 years old, never before tested for HIV) were recruited through 3 Chinese MSM Web portals and randomly assigned to 1 of 2 videos. The crowdsourced video was developed using an open contest and formal transparent judging while the evidence-based health marketing video was designed by experts. Study objectives were to measure HIV test uptake within 3 weeks of watching either HIV test promotion video and cost per new HIV test and diagnosis. Results. Overall, 624 of 721 (87%) participants from 31 provinces in 217 Chinese cities completed the study. HIV test uptake was similar between the crowdsourced arm (37% [114/307]) and the health marketing arm (35% [111/317]). The estimated difference between the interventions was 2.1% (95% confidence interval, −5.4% to 9.7%). Among those tested, 31% (69/225) reported a new HIV diagnosis. The crowdsourced intervention cost substantially less than the health marketing intervention per first-time HIV test (US$131 vs US$238 per person) and per new HIV diagnosis (US$415 vs US$799 per person). Conclusions. Our nationwide study demonstrates that crowdsourcing may be an effective tool for improving HIV testing messaging campaigns and could increase community engagement in health campaigns. Clinical Trials Registration. NCT02248558.