Application of Health Promotion Theories and Models for Environmental Health

1. Application of Health Promotion Theories and Models for Environmental Health Edith A. Parker, DrPH, MPH Grant T. Baldwin, PhD, MPH, CHES Barbara Israel, DrPH, MPH Maria A. Salinas Presented By: Richard Lau, MPH

2. Communities Action Against Asthma (CAAA) – Overview • Michigan Center for the Environment and Children’s Health (MCECH) • Subjects: 6-11th graders and families in Detroit, MI • 331 children and their families in total • Staggered start dates one year apart

3. Communities Action Against Asthma (CAAA) – Intervention • ≥12 visits/2 years by community environmental specialists (CEH) in the first year • Educated participants regarding reducing asthma triggers • Provided cleaning materials • Coordinated pest control services • Worked with neighborhood leaders to raise awareness and reduce neighborhood triggers

4. Ecological Level

5. Ecological Framework in CAAA • Ecological Framework – Interaction of individual with social and physical environment • Levels of Influence: intrapersonal, interpersonal, institutional, community, public policy • Focus on “leverage points” within each level • CAAA addresses physical environment as well as social environment • Targeted specific actions/changes at different levels

6. The Health Belief Model • Personal beliefs about health risks influence actions • Key Constructs: • Perceived susceptibility or risk, severity or risk, benefits of action, barriers to action, cues to action, and self-efficacy

7. The Health Belief Model in CAAA • Perceived susceptibility and severity: • Education about different asthma triggers and how severe they can be • Perceived benefits and barriers: • Education about the role of environmental irritants and how to reduce them • Cues to action and self efficacy: • Provided information about baseline irritants found in the home and gave small, regular goals on how to reduce them

8. Social Cognitive Theory • Continual interaction between person, behavior, and environment • Key Constructs: • Environment, outcome expectations/expectancies, self-efficacy, behavioral capability, methods of change (learning and reinforcement)

9. The Social Cognitive Theory in CAAA • Behavioral capability: • Provided instructions on how to clean and reduce asthma triggers • Observational learning: • Demonstrated how to clean and reduce asthma triggers • Environment: • Tenant’s right advocate to improve conditions in apartments and rented homes

10. Organizational Level

11. Interoganizational (IOR) Theory • Levels of collaboration within a organization: • Obligational network: • Communication and information exchange within a network • Promotional network: • Organizations contributing to larger coalition • Systematic network: • Larger goal that requires the coalition to work with others to achieve it

12. IOR Theory in CAAA • CAAA worked with community leaders and organizations to identify and reduce asthma triggers • Organized local groups and organizations into informal information sharing network regarding asthma

13. Community Level

14. Community Level Models in CAAA • Key Constructs in community level modeling: • Sense of community • Community identity and caring • Community empowerment • Social actions that promote community involvement • CAAA worked with local organizations and groups to create a sense of community around reducing asthma triggers

15. Policy Level

16. Agenda Building Theory in CAAA • Agenda Building Theory – match policy promoting activities to stage that the issue is at • Outside initiative • Idea comes from community • Inside initiative • Idea comes from government • Mobilization model • Government idea requires rallying community for support • CAAA has held community meetings and met with local officials about asthma related policies

17. Ecological Stress Process Model for Environmental Health Promotion

18. Adapting the Stress Process Model for Environmental Health • Stress Process Model focus on stressors that exceed capacity to adapt and place person at risk for diseases or conditions • Adapted to become the Ecological Stress Process Model for Environmental Health Promotion

19. Ecological Stress Process Model for Environmental Health Promotion • 5 categories of stressors: • Ambient environment • Continuous conditions in the environment • Major life events • Discrete events that disrupt daily life • Daily hassles • Ongoing minor events • Chronic strains • Challenges faced over time • Cataclysmic events • Sudden physical environmental disasters

20. Ecological Stress Process Model for Environmental Health Promotion2 • Responses to stressors: • Physiological response • Psychological response • Behavioral response • Change behavior to cope with stressor • Physical/structural response • Change environment to cope with stressor • Socioeconomic response • Change in financial situation in response to stressor • May be long term or short term

21. Ecological Stress Process Model for Environmental Health Promotion3 • Protective factors: • Psychological • Self-efficacy, knowledge/attitudes, etc • Behavioral • Personal skills, self-management, exercise, etc • Biophysical/genetic • Age, gender, genes, etc • Physical/structural • Availability of housing, medical care, etc

22. Ecological Stress Process Model for Environmental Health Promotion4 • Health outcomes mediated by: • Social condition variables • Social support, perceived control, etc. • Community social dynamics • Sense of community, etc

23. Ecological Stress Process Model for Environmental Health Promotion5 • Implications: • Physical and psychosocial stressors and protective factors at different levels, all interacting together • Tailored interventions based on where the stressors are • Stressors are tied to social and political issues

24. One last thing (if time permits)

25. Activity • Split into groups with at least one environmental health person in each groups • Discuss which theory is most applicable in the field of environmental health