Literature Collection

In the United States, disparities in access to quality oral health care exist at every stage across the life course. The net result is a greater likelihood of poor oral health at every age for people who live in underserved and rural communities than for people who live in communities with better access to quality oral health care. Both universal and targeted interventions at multiple levels of influence across the life course and intergenerationally are needed to eliminate disparities in access to oral health care and end the disgrace of poor oral health as the US national symbol of social inequality. While community health centers hold promise for delivering patient-centered, value-based care, they experience challenges related to the oral health literacy of patients and organizations and to the building of sufficient capacity to meet the high demand for oral health care services. To address the training needs of the US dentistry workforce, the long-term goal of the New York University Langone Dental Medicine Postdoctoral Residency Programs is to improve oral health care access and delivery across the life course for people of all ages and intergenerationally. The short-term goal is to recruit and train dentists to lead patient-centered models of integrated care delivery at community health centers in underserved and rural communities of 30 US states, Puerto Rico, and the US Virgin Islands. This paper presents the capstone findings of a 5-year postdoctoral dental residency training project built upon a foundation of shared decision-making and motivational interviewing training for dental faculty and residents. Improving patient experience and patient-reported outcomes are critical in transforming dentistry from a fee-for-service to a value-based health care model. Scaling up promising interventions and addressing time and resource constraints in community health centers require the broad commitment of communities, organizations, patients and their families in demanding and realizing the US societal goal of oral health for all.

Objective: Diabetes is a defining disease of the 21st century because of its rising prevalence, association with obesity, and enormous health impact. Abundant evidence shows that lifestyle interventions can delay or prevent type 2 diabetes (T2D) in adults, offer relief, and sometimes achieve complete remission. Despite this empowering message, there are no clinical practice guidelines that focus primarily on lifestyle interventions as first-line management of prediabetes and T2D. Our objective, therefore, is to offer pragmatic, trustworthy, and evidence-based guidance for clinicians in using the 6 pillars of lifestyle medicine-nutrition, physical activity, stress management, sleep, social connectedness, avoidance of risky substances-for managing adults with T2D and in preventing T2D in adults with prediabetes or a history of gestational diabetes mellitus. Methods: We used well-established, peer-reviewed guideline methodology to develop evidence-based key action statements (recommendations) that facilitate quality improvement in clinical practice. The guideline development group included 20 members representing consumers, advanced practice nursing, cardiology, clinical pharmacology, behavioral medicine, endocrinology, family medicine, lifestyle medicine, nutrition and dietetics, health education, health and wellness coaching, sleep medicine, sports medicine, and obesity medicine. Recommendation strength was based on the aggregate evidence supporting a key action statement plus a comparison of associated benefits vs harms/costs. Multiple literature searches, conducted by an information specialist, identified 8 relevant guidelines, 118 relevant systematic reviews, and 112 randomized clinical trials. The guideline underwent extensive internal, external, and public review and comment prior to publication. Results: We developed 14 key action statements and associated evidence profiles, each with a distinct quality improvement goal in the context of lifestyle interventions for T2D. Strong recommendations were made regarding advocacy for lifestyle interventions; assessing baseline lifestyle habits; establishing priorities for lifestyle change; prescribing aerobic and muscle strength physical activity; reducing sedentary time; identifying sleep disorders; prescribing nutrition plans for prevention and treatment; promoting peer/familial support and social connections; counseling regarding tobacco, alcohol, and recreational drugs, and establishing a plan for continuity of care. Recommendations were made regarding identifying the need for psychological interventions and for adjusting (deprescribing) pharmacologic therapy. We include numerous tables and figures to facilitate implementation, a plain-language summary for consumers, and an executive summary for clinicians as separate publications. Conclusions: There is robust research evidence supporting the efficacy of lifestyle interventions in preventing, treating, and achieving remission of T2D in adults. Our multidisciplinary guideline development group successfully synthesized this evidence into 14 key action statements that can be used by clinicians and other healthcare professionals to improve quality of care for adults with, or at-risk for, T2D. Despite the research gaps and implementation challenges we highlight in the guideline we believe strongly that our recommendations have immediate relevance and can help raise awareness and shift the paradigm of T2D management towards optimal use of lifestyle interventions.

This review is based on a presentation at the 2024 Annual Meeting of the American College of Lifestyle Medicine (ACLM), which showcased ACLM's first clinical practice guideline on Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults. Our goal is to offer pragmatic implications of the guideline for everyday patient care, including case presentations showing how the guideline recommendations (key action statements) can be implemented. The target audience is any clinician or healthcare professional in a community or outpatient healthcare setting involved in managing non-pregnant adults with T2D, prediabetes or a history of gestational diabetes mellitus (GDM). Unique features of the ACLM guideline include placing lifestyle interventions as the foundation of T2D management and prevention, offering strategies for sustained behavior change, and emphasizing all six pillars of lifestyle medicine: plant-predominant nutrition, regular physical activity, restorative sleep, stress reduction, social connectedness, and avoiding risky substances. This review is not intended to substitute for the full guideline, which should be read before doing the recommended actions.

Mental health in the United States faces a mounting crisis, with rising prevalence, inadequate outcomes from pharmacologic treatments, and compounding social and environmental stressors. Traditional care models often neglect the biopsychosocial factors that shape psychological well-being, underscoring the need for a deeper integration of lifestyle medicine and behavioral health. Lifestyle interventions including nutrition, physical activity, sleep hygiene, stress resilience, social connection, and reduction of harmful substance use are biologically active treatments that influence neuroplasticity, inflammation, circadian rhythms, and emotional regulation. Framing these as first-line, rather than adjunctive, interventions repositions them at the center of mental healthcare. Behavioral health professionals are uniquely positioned to facilitate this shift through therapeutic alliance, motivational interviewing, psychoeducation, and interprofessional collaboration. Clinical integration requires systematic assessment of lifestyle domains, incorporation into psychotherapeutic modalities, and deployment within community and digital platforms to enhance access and adherence. Emerging fields such as lifestyle psychiatry, positive psychology, and community-based health models highlight the promise of synergistic care that addresses meaning, purpose, and connectedness. By embedding lifestyle medicine into behavioral health practice, clinicians can foster resilience, reduce disease burden, and expand the scope of preventive and therapeutic strategies, advancing whole-person care for individuals and communities.

INTRODUCTION: As Novel psychoactive substances (NPS) are conceived to mimic the effects of common illicit drugs, they represent a serious public health challenge due to the spike in intoxications and fatalities that have been linked to their use. This study aims to provide epidemiological data on NPS use in the USA, determining lifetime prevalence of use and defining demographic, socioeconomic, drug use patterns and mental health correlates. METHODS: This study uses secondary data from the US National Survey on Drug Use and Health (NSDUH), which is a large cross-sectional population-based survey carried out annually in the USA. We analysed data from 2007-14 (N = 307,935) using bivariate descriptive analysis and binary logistic regression to calculate prevalence and determine factors underlying NPS consumption. Adjusted odds ratios (OR) with 95% CI's were calculated for a set of selected independent variables. RESULTS AND DISCUSSION: Our analysis NSDUH from 2007-14 highlights an increase in NPS use among adults, especially among white young men aged 18 to 25. Although the level of education of NPS users was relatively higher as compared to non-users, NPS users seemed to have a less wealthy situation. However, socioeconomic vulnerability appeared to be less important than mental health issues as a correlate to NPS use. NPS users seem to have followed a pattern of polysubstance use throughout their life, which involves both traditional illicit drugs and classic synthetic drugs. As NPS use seemed to be more prevalent among people having mental health issues, the rise in their use may have a negative impact on population mental health outcomes. CONCLUSION: Further comparative research on trends in NPS use and potential public health responses would be instrumental for developing appropriate health interventions, including drug checking, education for users and training for healthcare professionals working both within emergency wards and in/outpatient addiction and mental health services.