Medical Articles Medical Emergency

ECOLOGICAL MODELS of Health Behavior and Health Promotion

Health Behavior and Health Promotion
Brief Description: Ecological Models are comprehensive health promotion models that are multifaceted, concerned with environmental change, behavior, and policy that help individuals make healthy choices in their daily lives. The defining feature of an ecological model is that it takes into account the physical environment and its relationship to people at individual, interpersonal, organizational and community levels. The philosophical underpinning is the concept that behavior does not occur within a vacuum.
Characteristics/Key Terms:
· Multiple dimensions of influence on behaviors Interpersonal factors, social and cultural environments, and physical environments can influence health behaviors
· Interaction of influences across dimensions. To be useful in designing studies and interventions, the model should predict how the categories of behavior determinants interact.
· Multiple levels of environmental influences. Natural environments: weather, geography climate. Constructed environments: homes worksites, local communities
· Environments directly influence behaviors. Environment: space outside the individual. Ecology: interrelations between organisms and their environments
Working Definition of Ecological Models:
· Behaviors are influenced by intrapersonal, social, cultural, and physical environment variables
· Variables are likely to interact
· Need to address variables at multiple levels to understand and change health behaviors
· Levels of Influence: Individual, Interpersonal, Organizational, Community, and Public Policy.Ecological Programming for Communitywide Alcohol Use
Prevention Program during Early Adolescence
School programming focusing on social influences, such as peer resistance training or attempts to chance perceived norms in the individual.
Peer leadership programs in which adult volunteers facilitated T.E.E.N.S. groups, focusing on using group activities that plan alcohol free activities for seventh graders.
Parental involvement obtained by mailing program booklets directly to the parents. Booklets included activities for parents to do with their 7th graders.
Passage of five alcohol related ordinances and three resolutions.
Purpose: Ecological Models address multiple levels of behavior influence, leading to a more comprehensive approach to health promotion. Many of the predominant theories or models of behavior focus on one dimension of health promotion, such as knowledge attitudes, or skills. These one dimensional approaches do not necessarily result in desired behavioral change. Ecological models provide a mechanism for linking health promotion and health protection emphasizing a shared framework for change targeted at individual behaviors and the environment. This may lead to improved program effectiveness.
Development: Roots in Public Health and Psychology
· Public Health
As early as mid 1800’s, ecological factors such as poverty and social class were studied in relation to health/disease, i.e., typhus epidemic.
Host-agent-environment model is basic for analysis of infectious disease.
· Psychology
B. F. Skinner (1953): Considered an early and influential forerunner to ecological
ECOLOGICAL MODELS of Health Behavior and Health Promotion

models. Antecedents and consequences in observable environment control behavior.

· Ecological Psychology:
Kurt Lewin (1936): the study of the influence of the outside environment on the
person. Hypothesized that environments influenced behavior indirectly through effects
on psychological variables. Perceptions of the external environment were deemed
Roger Barker (1968): Developed the concept of behavior settings: the social and
physical situations in which behavior takes place. Believed environments directly affect
Urie Bronfenbrenner (1979): Described 3 levels of environmental factors:
microsystem, mesosystem, and exosystem.
· Health Promotion: Social Ecological Approach
Rudolph Moos (1970’s): Specified 4 sets of environmental factors relevant to health studies: physical settings, organizational, human aggregate (sociodemographic or sociocultural characteristics), and social climate.
Stokols (1992): Health Promotive Environment: Interventions must address environmental resources that may facilitate or hinder targeted health behavior changes.
Ecological Models and Health Promotion: While the theory of ecological models has evolved over a long period of time, the application for health promotion programming has been a recent development.
*Health People 2000: US National Health Plan includes objectives consistent with the ecological model of health promotion.
Ecological Models in Action:
Worksite Health Promotion
Smoking, drug, and alcohol restriction policies
Nutrition Programs
Food  Labeling
Nutrient labels on processed food packages, baked
Goods, and some fresh items
Roadway Improvements to Enhance Safety
Lighting, signs and signals
Adoption of Vehicle Safety Measures
Airbags, seatbelts, helmets, care seats.
Annotated Bibliography
Borland, R., Chapman, S., Owen, N., & Hill, D. (1990). Effects of workplace smoking bans on cigarette consumption. American Journal of Public Health, 80, 178-180.
This article is a study of the effects of smoking bans in the workplace on cigarette consumption. The study is based on an ecological model, in which individual behavior is changed by making changes in the environment. The article focuses on the effects of a ban on 391 smokers. Results show a reduction of cigarette consumption by more than 25%.
Brownson, R. C., Koffman, D. M., Novotny, T. E., Hughes, R. G., & Eriksen M. P. (1995). Environmental and policy interventions to control tobacco use and prevent cardiovascular disease. Health Education Quarterly, 22 (4), 478-498.
This article discusses the value of environmental and policy interventions to control tobacco use and prevent cardiovascular disease. Interventions include clean air acts, tobacco taxes to fund public health programs directed at smoking, and urging state and local health departments to collaborate with other entities. Interventions such as the clean air acts encourage change in individual behavior based on changes in the environment.
Stokols, D., Pelletier, K. R., & Fielding, J. E. (1996). The ecology of work and health: Research and policy directions for the promotion for employee health. Health Education Quarterly, 23 (2), 137-158.
This article, co-written by Dr. Stokols, one of the founders of the ecological model address new research and policy in the field of worksite health promotion. Three major themes in this article are: the influence of social and physical environments on occupational health, the effects of nonoccupational settings on employee well being, and issues in design and evaluation of worksite health. This research indicates that a change from individually oriented wellness programs toward more comprehensive programming.
Sorensen, G., Stoddard, A., Ockene, J. K., Hunt, M. K., & Youngstrom, R. (1996). Worker participation in an integrated health promotion/health protection program: Results from the WellWorks Project. Health Education Quarterly, 23 (2), 191-203.
The WellWorks intervention was a worksite health promotion intervention based on the ecological model. The intervention targeted worksite change at individual and environmental levels. Worker participation and worker perception of managerial change were measured in the study. Results showed that blue-collar workers were less likely than white-collar workers to report participating in the program. Results also indicated that blue-collar participation in exposure-related activities versus nutrition activities may increase worker participation in worksite health promotion programming. Finally, when workers were aware of managerial intervention, they were more likely to participate in smoking and nutrition programs.
Perry, C. L., Williams, C. L., Mortenson, S. V., Toomey, T. L., Komro, K. A., Anstime, P. S., McGovern, P.G., Finnegan, J. R., Forster, J. L., Wagenaar, A. C., & Wolfson, M. (1996). Project Northland: Outcomes of a community wide alcohol Use prevention program during aarly adolescence. American Journal of Public Health, 86, 956-965.
Project Northland was a community based alcohol use prevention program directed at reducing adolescent alcohol use. The program used social-behavioral programming in the schools, peer education, parental and community involvement and community task forces to reduce adolescent alcohol consumption. The project aimed at changing individual behavior and the environment (or accessibility) in regards to alcohol use. After three years, results indicated that prevalence and onset of alcohol use in targeted communities had decreased. These results indicate that multi-level alcohol interventions are effective in decreasing adolescent alcohol use.
Betancur, J. J. (1996). The settlement experience of Latinos in Chicago: segregation, speculation, and the ecology model. Social Forces, 74(4), 1299-1325.
This article utilizes the Ecological model to explain the process and characteristics of Latinos in Chicago. The analysis views different aspects of the Latin community in Chicagoand the process of settlement. In addition, the study observes the status and exclusion Latinos have face in the United States and how this has affected them. The article also offers a description of the Ecological model. Segregation of Latinos by discrimination and housing conditions is also included in the analysis. Finally, the article aims at offering a description of the impact that surroundings might have on a particular population.
Coulton, C. J. (1996). Measuring neighborhood context for young children in an urban area. (Special Issue: Ecological Assessment). American Journal of Community Psychology, 24(1), 5-33.
The article describes the effects that an urban environment might have on young children. The urban environment often presents a certain degree of neighborhood decline. Children in this type of surroundings typically develop certain patterns of risk behavior. The Ecological Model is applied to analyze the effects that the urban environment has had in these children. Furthermore, this article also presents a description of racial segregation and the consequences of it. Finally, the study describes the relationship among neighborhood characteristics and individual behavior.
Lesar, S. (1995). HIV infection in children: family stress, social support, and adaptation. (Families of Children and Adolescents with Special Needs). Exceptional Children, 62(3), 224-237.
This article presents the effects that caring for children with HIV has on family members. The results examined include family functioning, parenting stress, and social support of caregivers. The Ecological model is applied to analyze how the HIV infected children affect family functioning. Family stress and support are examined as well. Thus, the study presents how caring and relating to children with HIV affects behavior and coping of individuals.
Perkins, D. D.(1996). The ecology of empowerment: Predicting participation in community organizations. The Journal of Social Issues, 52(1), 85-111.
This article has a strong application of the Ecological Model and Public Health. The subject studied in this case is the empowerment of communities and grassroots organizations. The behavior observed on individual members of empowered communities is assessed carefully. Certain individuals and communities participate more that others. This last issue is examined in the study by applying the Ecological Model.
Szymanski, E. M. (1996). Career development of people with developmental disabilities: an ecological model. The Journal of Rehabilitation, 62(1), 48-56.
As the title of the article implies the study analyzes the career development and opportunities of individuals with developmental disabilities. The Ecological Model is applied to assess this phenomenon. For example, the fact that people with disabilities tend to have a higher rate of unemployment. The interesting aspect of this article is that it provides the reader with recommendations for interventions. This study could be used as source information for Health Education specialists working with disabled persons.
Written by: Sandra Reynolds and Janice Anderson, MPH students at the University of South Florida as part of PHC 6500: Foundations of Health Education, Fall 1997. Updated annotated bibliography by Arlene Calvo, Spring 1998. 
ECOLOGICAL MODELS of Health Behavior and Health Promotion