The Benefits of 4-Sided Behavioral Modification Strategy on Cardiovascular Risk Factors in the National Alliance for Tobacco Free Networks, Thailand


  • Amporn Krobthong Thai Physicians Alliance Against Tobacco, Bangkok, Thailand & Faculty of Medicine, BangkokThonburi University, Bangkok, Thailand
  • Sakda Arj-Ong Vallibhakara 1 Faculty of Medicine, BangkokThonburi University, Bangkok, Thailand & 2 Child Safety Promotion and Injury Prevention Research Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
  • Suthat Rungruanghiranya Faculty of Medicine, Srinakharinwirot University, Thailand
  • Suwanee Raktham Thai Physicians Alliance Against Tobacco, Bangkok, Thailand
  • Rattiyaporn Thongyourn Thai Physicians Alliance Against Tobacco, Bangkok, Thailand & Developmental Psychology, Faculty of Humanities, Srinakharinwirot University
  • Komgrib Pukrittayakamee Thai Physicians Alliance Against Tobacco, Bangkok, Thailand


NCDs, Behavioral  Modifications, Risk modification, Cardiovascular risk, Change4Health


Background: Non-communicable diseases (NCDs) are the critical cause of morbidity and mortality in Thailand. Medical treatment and lifestyle modifications are indicated to control the disease. However, the efficacy of lifestyle modification programs is still not clearly revealed. Objective: To estimate and report on the effectiveness of health-risk behavior modification programs, called the "Change 4 Health" Strategy, on health outcomes in the National Alliance for Tobacco Free, Thailand.

Methods and Materials: "Change 4 Health" programs use mnemonics to change four bad habits: A-Avoiding Alcohol, B-Body Movement, C-Cessation, and D-Diet. Results aimed to retrieve the summary and secondary data from the database. Thailand's National Alliance for Tobacco Free (THPAAT) offers basic, easy-to-follow behavior workshops. We reviewed 1,815 quality records and qualitative data from 20 Bangkok primary care units. Changes in health risk behaviors were tracked 1 and 3 months after "Change4Health" was implemented. Changes in cardiovascular risk factors, alcohol intake, smoking cessation, exercise, and eating behaviors and diets were statistically significant at a p-value of 0.05.

Results: THPAAT's "Change 4 Health" technique helped populations quit smoking, improve their dietary habits, exercise more, and reduce alcohol consumption by 45%, 47.8%, 11.8%, and 15.8%, respectively. One-third (31.3%) reported weight loss. Nearly one-fifth (16.3%) reduced their waist circumference. These effects were linked to eating and smoking (p-value <0.01). Smoking cessation and exercise reduced blood pressure monitoring by 15.3%. Dextrostix found that glucose levels improved by 55.2%, which was strongly linked to eating behavior. One-third of LDL values dropped after eating and smoking cessation (p-value <0.01). Reducing alcohol consumption improved health indicators (body weight, waist circumference, blood pressure, blood sugar, and LDL) by 15.85% (p-values >0.05).

Conclusion: A health-risk behavior modification program called Change 4 Health (Avoid Alcohol, B-Body movement, C-Cessation, D-Diet) improved health indexes among participants. However, smoking cessation and diet changes appeared to be the most effective way to change physical parameters, including body weight, Waist circumferences, and have some effect on blood sugar and lipid level.


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How to Cite

Krobthong A, Vallibhakara SA-O, Rungruanghiranya S, Raktham S, Thongyourn R, Pukrittayakamee K. The Benefits of 4-Sided Behavioral Modification Strategy on Cardiovascular Risk Factors in the National Alliance for Tobacco Free Networks, Thailand. J. Med. Glob. [Internet]. 2022 Sep. 20 [cited 2023 Dec. 10];1(2):93-8. Available from:



Original Article