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Integrating Health Promotion and Environmental Change

Integrating Health Promotion and Environmental Change. Candice A. Myers, Ph.D. Childhood Obesity and Public Health Conference April 1, 2014. Why Does the Environment Matter for Health Promotion Programs?. Learning objectives 1) Benefits of considering the environment 2) Synergy!!

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Integrating Health Promotion and Environmental Change

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  1. Integrating Health Promotion and Environmental Change Candice A. Myers, Ph.D. Childhood Obesity and Public Health Conference April 1, 2014

  2. Why Does the Environment Matter for Health Promotion Programs? Learning objectives 1) Benefits of considering the environment 2) Synergy!! 3) Multilevel interventions (?) 4) Guidance

  3. Health Promotion Programs • Target individuals • Utilize education or behavior modification • Increase physical activity or improve diet and nutrition http://www.nfl.com/play60 http://www.choosemyplate.gov/

  4. Social Ecological Perspective: Levels of Influence Society: Policy, Law, Culture Community: Neighborhood Organizational/Institutional: Schools Interpersonal: Family Intrapersonal: Individual

  5. Why Does the Environment Matter for Health Promotion Programs? “interventions designed solely to promote positive attitudes and increase health knowledge are insufficient to achieve long-term or sustainable behavior change… effective community interventions must include environmental solutions as key components if children and families are going to adopt healthy lifestyles. We cannot expect adults or kids to get regular physical activity or maintain a nutritious diet if they do not have convenient access to safe places to be active and affordable healthy foods.” - Bazzarre 2009, p.S1

  6. Health Promotion Programs versus Environmental Programs Individual Appropriate Energy Intake (Diet) + Appropriate Energy Expenditure (Physical Activity) = Energy Balance Health Promotion Programs Adoption of healthy behaviors ‘Agency’ *necessary for positive change* Environmental Programs Favorable: Social Conditions Food Availability Physical Activity Resources ‘Opportunity’ *necessary for positive change* Positive Health Outcomes Decreased risks for: Obesity Diabetes CVD

  7. Multilevel Interventions “… interventions that target determinants at multiple levels and mutually reinforce each other are likely to produce larger and longer lasting effects than interventions that target determinants at only one level.” - Weiner et al. 2010; pp. 34 • Simultaneously targeting environmental and individual factors can more effectively achieve desired outcome: getting kids healthy!!

  8. How? • The combination of environmental and behavioral interventions must work together in complementary and synergistic ways • This is key to designing an effective multilevel intervention • Practical guidance for designing/implementing multilevel interventions

  9. Health Promotion AND Environmental Change • Environmental interventions can enhance the outcome of programs targeting individuals • Accumulation: changes in the environment reinforce the program • Each makes a discrete contribution, and the overall effect of both is cumulative • Effect of each intervention is not conditional on the other • Facilitation: success of the program is conditional on environmental intervention • Environmental intervention removes barriers or facilitates the effects of the program • The effect of the program is conditional on environmental change

  10. Example of Multilevel Strategies • Outcome = Daily step goal • Target = Outdoor play/exercise • Program = Behavioral strategies via text messages and pedometer for monitoring steps • Environment = Creating neighborhood park access

  11. Accumulation Construction of new park with amenities (community) Outdoor exercise/play Daily step goal Behavioral strategies and pedometer (intrapersonal)

  12. Facilitation Behavioral strategies and pedometer (intrapersonal) Outdoor play/exercise Daily step goal Construction of new park with amenities (community)

  13. Issues • While environmental considerations are important, the complicated nature of planning, funding, and implementing multilevel interventions cannot be overlooked • Synergy between intervention levels should be prioritized in planning, not simply ‘a given’ • Funding and associated financial costs are increased with multilevel interventions • Implementation requires building new community partnerships • Multidisciplinary teams

  14. Why Does the Environment Matter for Health Promotion Programs? Learning objectives • Benefits of thinking about the environment • Supportive vs. non-supportive for healthy behaviors 2) Synergy!! • Interventions should include both environmental opportunity and personal agency 3) Multilevel interventions • Create opportunity for agency to take place 4) Guidance • Two examples of multilevel intervention strategies • Not exhaustive!!

  15. Concluding Thoughts • Targeting behavior change in kids is necessary for improving health, both short- and long-term, but this approach is not sufficient • Supportive environments are also necessary • What is the cost, both financially and time-wise, of continuing to implement programs without creating supportive changes in the environment?

  16. Thank You! Contact Information: Candice A. Myers, Ph.D. Pennington Biomedical Research Center candice.myers@pbrc.edu

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