Promoting Health Intervention Strategies from Social and Behavioral Research (2000) / Chapter Skim
Currently Skimming:
Findings and Recommendations
Findings and Recommendations
Pages 6-32
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 6... ...
A compelling case can be made for focusing attention on ensuring that children get a strong start by providing, for example, appropriate early education, immunization, injury prevention, nutrition, and opportunities for physical activity. Opportunities for public health intervention do not end at childhood, evidence indicates that intervention efforts with adolescents, adults, and older adults can be successful if these efforts address major developmental tasks at each stage and address major sources of health risk at multiple levels.
|
From page 7... ...
These data illustrate the tremendous toll, in both economic and human costs, of poor health behaviors and suggest strongly that initiatives to develop and implement effective interventions to reduce risk behaviors are an important component of efforts to improve the nation's health and to lower health care costs. Further, as illustrated above, risk behaviors are closely linked to social and economic conditions, such as economic inequality, social norms, and other forces (Kaplan, Everson, and Lynch, Paper Contribution A)
|
From page 8... ...
Maintenance of health behavior change appears to be limited when behaviors promoted by school-based programs are inconsistent with larger community norms, so that healthy behavior change is not supported and reinforced after the program is completed. Another excellent example of the promise offered by multilevel interventions is tobacco control, reviewed in this volume by Warner (see Paper Contribution K)
|
From page 9... ...
The committee finds the evidence compelling that coordinated, multilevel interventions offer the greatest promise to address most public health needs. Recommendation 2: Rather than focusing interventions on a single or limited number of health determinants, interventions on social and behavioral factors should link multiple levels of influence (i.e., individual, interpersonal, institutional, community, and policy levels)
|
From page 10... ...
~ .... Interventions Directed at the Social Context The preceding discussion of multilevel interventions offers examples of the importance of attending to the social context in which people live and work in the development of health interventions.
|
From page 11... ...
Communities characterized by high poverty, low residential stability, and a high percentage of single-parent households often possess low levels of social capital, and are linked to poor individual health outcomes such as coronary risk factors and heart disease mortality, low birthweight, smoking, and other negative outcomes, even when individual attributes and behaviors are taken into account. Analyses of the Alameda County Health Study reveal, for example, that selfreported fair/poor health was 70% higher for residents of concentrated poverty areas than for residents of nonpoverty areas, independent of age, sex, income, education, smoking status, body mass index, and alcohol consumption (Sampson and Morenoff, Paper Contribution I)
|
From page 12... ...
Recommendation 3: Intervention strategies must attend to aspects of the social context that may hinder or promote efforts at behavioral change and health risk reduction. Modifying the social capital of communities and neighborhoods offers promise to enhance social contexts.
|
From page 13... ...
, understanding these disparities requires further research and intervention into psychosocial and physiologic pathways that translate disparities into poor health, and into the broader social, cultural, economic, and political processes that determine the nature and extent of disparities. Socioeconomic status, for example, is commonly thought to exert its effects on health through discrete risk factors such as individuals' coping skills, health knowledge, health behaviors, and access to healthenhancing resources.
|
From page 14... ...
Recommendation 4: Research consistently indicates that life circumstances associated with low socioeconomic status, gender, race and ethnic disadvantage, and other high-risk circumstances are strongly associated with a wide range of poor health outcomes. Policies that take account of and enhance positive health outcomes
|
From page 15... ...
In particular, racial/ethnic and socioeconomic disparities have not been reduced, suggesting strongly that overall rates of poor birth outcomes are less related to reductions in risk behaviors (e.g., smoking, adolescent childbearing) or improvements in prenatal health care in individuals, and are more likely the direct consequence of disparities between socioeconomic and racial/ethnic groups.
|
From page 16... ...
As with birth outcomes, socioeconomic status remains a key predictor of school readiness. Low socioeconomic status is associated with low cognitive test scores, behavioral problems, and a range of physical health indicators including growth stunting, low rates of childhood immunizations, high blood-lead levels, and other health outcomes.
|
From page 17... ...
As Perry notes, the way in which the environment "fits" the needs of adolescents is a critical determinant of adolescent health behavior. Social contexts that provide positive social norms, offer appropriate role models, set appropriate expectations, provide useful information, and provide social and neighborhood supports are strongly associated with positive health outcomes for adolescents.
|
From page 18... ...
The potential population-wide impact of programs targeting individuals is further limited because these efforts often fail to consider the social and environmental attributes that support poor individual health behaviors. The population effects of interventions to improve the health of adults can be enhanced when interventions address multiple levels of influence, including individual factors (e.g., health knowledge and attitudes, motivation for behavior change)
|
From page 19... ...
Social supports and social networks can also serve to reinforce prevention and smoking cessation messages. Recommendation 8: Community and work site interventions and evaluations are needed to promote behavioral change, prevent injuries, reduce exposure to occupational risks, and increase healthy environments.
|
From page 20... ...
Community senior centers and community-assisted housing are two examples of interventions that are especially promising for the frail elderly. Research Needs The committee's review of opportunities for intervention at specific developmental stages and "levers" for public health intervention yielded a great deal of information regarding promising intervention strategies.
|
From page 22... ...
For example, stress management-oriented interventions clearly alter a number of aspects of cardiovascular, immune, and endocrine function, some smaller studies provide encouraging results for the alteration of disease progression as well, particularly in the cardiovascular realm. Social and behavioral interventions may enhance health because they decrease psychological stress, improve mental health, alter chronic life strains, improve health behaviors, and/or enhance social support or social connectedness, indeed, the most successful interventions have positive benefits across this spectrum, rather than within any single sphere.
|
From page 23... ...
, and should address intergenerational risks. Recommendation 11: A substantial new research effort is needed to understand the pathways through which behavioral and social factors affect pregnancy outcomes, and to address the issues of women's health across the life span and across generations.
|
From page 24... ...
Recommendation 13: Research should identify sources of health strengths and resilience, as well as health risks, among individuals, families, and communities of low socioeconomic status and racial and ethnic minority groups. Research on Social Contexts and Social Capital Research is needed to identify ways in which social context influences health behaviors, environmental exposures, psychosocial responses, and health outcomes and mediates the influence of interventions.
|
From page 25... ...
Research that helps to elucidate these causal pathways may provide other important points for interventions. Recommendation 14: Research is needed to identify pathways through which social contexts directly and indirectly affect disease pathogenesis and outcomes.
|
From page 26... ...
As Emmons (Paper Contribution F) points out, community intervention trials are likely to observe smaller changes in individual health behaviors than are clinic-based interventions with motivated volunteers.
|
From page 27... ...
It is important to have explicit models of change and to predict in advance when results should be observed. Also, because multilevel interventions require assessments at multiple levels of influence and change for individuals, organizations, and communities methods for measuring change across time in these various settings are needed.
|
From page 28... ...
Cost-Effectiveness Analyses In the preceding sections, the committee has highlighted a number of promising approaches to public health intervention that draw upon important directions in behavioral and social science research. These interventions incorporate and integrate a range of approaches, spanning the continuum between traditional downstream approaches (i.e., interventions directed toward individuals to address health behaviors, attitudes, and/or knowledge)
|
From page 29... ...
Funding Full implementation of the above recommendations regarding intervention strategies and needed research requires significant changes in the manner in
|
From page 30... ...
This vast expenditure provides considerable leverage for motivating health professionals and patients to pursue behaviors that result in preventing illness and reducing disability. Payers for services, especially Medicare and Medicaid, have significant potential influence in encouraging widespread improvements in health behavior through the structure of their programs.
|
From page 31... ...
Warner (Paper Contribution K) shows that the most successful tobacco control programs are those that include a combination of elements, including higher prices on tobacco products, laws regarding indoor air quality and restricting the use of vending machines, the development of media messages, and the establishment of smoking cessation programs.
|
From page 32... ...
Because social and behavioral research demonstrates that several clinical entities have one or more risk factors in common, it is more useful to consider a new disease classification that unifies these different clinical entities based on the social and behavioral features they have in common. This is not a new idea.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.