FIGURE 3-1 The socioecologic model of levels of influence on behavior. Individual factors include biologic characteristics and personal history. Interpersonal factors include interactions with peers, intimate partners, and family. Community factors include schools, workplaces, and other organizations where social relationships can occur. Societal factors are social and cultural norms; health, economic, educational, and social policies; and religious and cultural belief systems (CDC, 2007).

FIGURE 3-1 The socioecologic model of levels of influence on behavior. Individual factors include biologic characteristics and personal history. Interpersonal factors include interactions with peers, intimate partners, and family. Community factors include schools, workplaces, and other organizations where social relationships can occur. Societal factors are social and cultural norms; health, economic, educational, and social policies; and religious and cultural belief systems (CDC, 2007).

prevent tobacco-use initiation and promote cessation would need to be implemented at the multiple outlined levels (IOM, 2001). Individually oriented interventions would be most effective when the environment in which people live and make choices is in synchrony with the knowledge and behaviors addressed in the programs. Environmental and policy changes will be most effective when they are combined with programs that motivate and educate people to respond to the changes (Kumanyika, 2007).

Progress made in tobacco control in the general population has been based on a socioecologic understanding of health and human behavior (Hovell et al., 2009; Martinez-Donate et al., 2008). The greatest changes in smoking prevalence have resulted from populationwide interventions: economic measures to reduce access to tobacco; laws and regulations restricting tobacco use, advertising, promotion, and sales of tobacco products; and multicomponent public-education campaigns (Fisher et al., 2004; Task Force on Community Preventive Services, 2005). Lessons from tobacco control illustrate a compounding effect due to the interaction of interventions at different levels; tobacco-control interventions at the population level have proved most effective when conducted in combination with individual-level interventions. For example, smoking restrictions in workplaces and other public places can increase smokers’ motivation to seek cessation services and to restrict smoking in their homes (Borland et al., 2006), which in turn may



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