During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.

An Ecological Perspective on Health Promotion Programs

Photovoice is a process by which people can identify, represent, and enhance their community through a specific photographic technique. As a practice based in the production of knowledge, photovoice has three main goals: (1) to enable people to record and reflect their community's strengths and concerns, (2) to promote critical dialogue and knowledge about important issues through large and small group discussion of photographs, and (3) to reach policymakers. Applying photovoice to public health promotion, the authors describe the methodology and analyze its value for participatory needs assessment. They discuss the development of the photovoice concept, advantages and disadvantages, key elements, participatory analysis, materials and resources, and implications for practice.

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Photovoice: Concept, Methodology, and Use for Participatory Needs Assessment:

Meanwhile, the authors' antidote to the American sicknessa quest for democratic community that draws on our diverse civic and religious traditionshas contributed to a vigorous scholarly and popular debate. Attention has been focused on forms of social organization, be it civil society, democratic communitarianism, or associative democracy, that can humanize the market and the administrative state. In their new Introduction the authors relate the argument of their book both to the current realities of American society and to the growing debate about the country's future. With this new edition one of the most influential books of recent times takes on a new immediacy.\

Habits of the Heart: Individualism and Commitment in American Life

▪ Abstract The thesis of this article is that multilevel interventions based on ecological models and targeting individuals, social environments, physical environments, and policies must be implemented to achieve population change in physical activity. A model is proposed that identifies potential environmental and policy influences on four domains of active living: recreation, transport, occupation, and household. Multilevel research and interventions require multiple disciplines to combine concepts and methods to create new transdisciplinary approaches. The contributions being made by a broad range of disciplines are summarized. Research to date supports a conclusion that there are multiple levels of influence on physical activity, and the active living domains are associated with different environmental variables. Continued research is needed to provide detailed findings that can inform improved designs of communities, transportation systems, and recreation facilities. Collaborations with policy resear...

https://www.annualreviews.org/doi/pdf/10.1146/annurev.publhealth.27.021405.102100

An ecological approach to creating active living communities.

Health promotion programs often lack a clearly specified theoretical foundation or are based on narrowly conceived conceptual models. For example, lifestyle modification programs typically emphasize individually focused behavior change strategies, while neglecting the environmental underpinnings of health and illness. This article compares three distinct, yet complementary, theoretical perspectives on health promotion: behavioral change, environmental enhancement, and social ecological models. Key strengths and limitations of each perspective are examined, and core principles of social ecological theory are used to derive practical guidelines for designing and evaluating community health promotion programs. Directions for future health promotion research are discussed, including studies examining the role of intermediaries (e.g., corporate decision-makers, legislators) in promoting the well-being of others, and those evaluating the duration and scope of intervention outcomes.

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Translating social ecological theory into guidelines for community health promotion.

The purpose of this study was to determine the reliability and validity of an instrument designed to assess the extent of alcohol and drug use. Factors in a school or community contributing to use ...

Assessing Drug and Alcohol Abuse: An Instrument for Planning and Evaluation.

Inadequate control of high systolic blood pressure in older adults has been largely attributable to poor control of overall hypertension (HTN). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines emphasize the importance of controlling isolated systolic HTN in older adults. The study examined demographics, self-reported health information, and clinical measures as predictors of uncontrolled HTN among individuals taking antihypertensive medications. The Community Initiative to Eliminate Stroke, a stroke risk factor screening and prevention project, collected data in two North Carolina counties. Statistical modeling of predictors included odds ratios (ORs) and logistic regression analyses. Of the 2663 participants, 43.5% and 22.8% had uncontrolled systolic and diastolic HTN, respectively. African Americans were more likely to have uncontrolled systolic (60%) or diastolic HTN (70.9%) compared with whites (40% and 29.1%, respectively). Participants 55 years and older were more likely to have uncontrolled systolic HTN compared with younger individuals. Regression analyses showed that race (OR, 1.239; P=.00), age (OR, 1.683; P=.00), and nonadherence with medications (OR, 2.593; P=.00) were significant predictors of uncontrolled systolic HTN. Future interventions should focus on improving management of isolated systolic HTN in older adults and African Americans to increase overall control of HTN.

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Predictors of Uncontrolled Hypertension in the Stroke Belt

BACKGROUND
Understanding the reasons for overweight and obesity is critical to addressing the obesity epidemic. Often the decision to lose weight is based as much on one’s self-perception of being overweight as on inherent health benefits.

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Factors Associated with Misperception of Weight in the Stroke Belt

Objectives: This study tested whether days on campus, financial access through a meal plan, and health consciousness were associated with number of meals that college students obtained from fast food restaurants. Participants and Methods: In April 2013, all students currently enrolled in a meal plan were invited to participate in an online survey ( N = 1,246). Students were asked to report the total number of meals eaten in the past week and where they obtained them. Results: Negative binomial regression was used, and it was found that the number of meals obtained from fast food restaurants was positively associated with financial access and negatively associated with health consciousness. An association between days on campus and the number of meals obtained from fast food restaurants was not found. Conclusions: Increasing levels of health consciousness and reducing access to fast food restaurants through flex plans may reduce college students’ consumption of fast food.

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Daniel L. Bibeau

Papers

An Ecological Perspective on Health Promotion Programs

Assessing Drug and Alcohol Abuse: An Instrument for Planning and Evaluation.

Predictors of Uncontrolled Hypertension in the Stroke Belt

Factors Associated with Misperception of Weight in the Stroke Belt

Factors Related to the Number of Fast Food Meals Obtained by College Meal Plan Students