flora-maibach-maccoby the role of media across four levels of health promotion intervention

7/29/2019 FLORA-MAIBACH-MACCOBY the Role of Media Across Four Levels of Health Promotion Intervention

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u u 18 1018101pygh y l Rews ll rghs resere

THE ROLE OF MEDIA ACROSS

FOUR LVL O HALTH

PROMOTON INTRVNTON

Jun . Foa

Institute for Commicatio Research, Staford Ceter fo Research i Diseaserevention ford Uivsy chl Mc, Sanfd alfa

Ewa Maiac2

nsue Cmmncan eah tan Unvey an Caa5

Naan Maccoyan Cente eeah n Deae Preveo Sao Uversy School M to Co

An ssue of grea mpoance for publc heah oday s how o mounprgrm tht chnge behavior n order to mprove the helth of our populaon. thogh threat to the pc' heath come from varety o domns,

heah behavor s a prmay conce ecae of s large coniion omordty nd premure morly 6) Lfetyle ply mjor role incardiovculr deae, cncer IDS nd utnce nd alcohol buse

Publc healh profesonal have begun o explore he puposive se ofteevon nd other form of mas med as a men for shaping helthattitdes and ehavor ) Howeer the feasty of sng the ma medao nluence attude and ehavor h long been debated Much of he early

reearch on the e of cmmuntn cmpagn to nuence non-helth

' s tw auts tbut qu t t pt ts a a sbet

2T s ut ws su b Pb Ht S sttut Nt Rs Aw HL00 rm Nn Hr. Lug B Iu

06372//000$000

Annu.Re

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18 OR MBH MOB

elated attitdes and behavios onuded that amains wee laely in

etve . Som ontoa wok on mass-mediated healthcampaigns has bn iscoaging 2, 7) o ssimistic 2 8. On th

oth hand, oth a sach attt to dfin th conditions ndwhih ommnication campaigns wee scess 7) and eentstdies and eviews have spoted th se o mass media o heath attitdeand behavio hang 3 227 4)

In this chat w attmpt to vid som insight into th ss o th mdiao heath omotion W bgin b dscssing on means o statiing thmdia: mass vess taget mda W thn hihiht o oes o th mdiao hath pmotion W aso snt a amwok to oaniz th oas ootcomes o comhnsiv heath motion intevntion O amwok

enomasses o distinct leves o adience oganiation indvidas, newoks, oganizations, and commnitis o socit Th blk o this adiscsss th cnt and otntia ss o mia at ah o th o vs oain oganization

n this ae, th oas o hath omotion incd both th otcomes otimat intst ( morbidit motait an hath behavio) and thintmediat poesses knowede acqisition and ski dvopmnt.W xamin how th mdia innc both timat an intmiat otoms acss th o ves o adin oganization

M: M

The mass media ae enea onsideed to inde teevision, adio, newspaps, and magazins Th stngth o thes mdia o hath pmotion isthat th tn to rah r arg ains Thir knss howv is thatth ains ac b ass a a vs an ag niffntatAdin divsity is obematic in that, to b etive, mdia messaessho be designd spia o paia taet aiens seond tpeo media, g m namd o thei abiit to ah seciic tagetpopations Ths media incd nwstts bookts sh kits,vdeos, and omtrzd inomation sstms thogh thes mdia can bdeived to specii taet aincs, ths aowin o taio mssasign th hav a imit abiit to ah r nmbs o po.

The distntion between mass and taeted meda s pa atia n thateven the mass media an be sed to tagt adiencs to some dege. The seo th mass mia to tgt adincs is tmd nowsng Naowast

ing ntais scting mia channs and signing mia ontnt to mt thdmands o siic tagt gops Fo exam, naowasting thogh channe section is vin b th act that most maazns tagt hghind ain rs. to tision tarts siiab ain

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MEDIA AND HEALTH PROMOTION 13

grup urng ffrnt tm t n thrugh irnt prgrm ring.h uinc gmnt cn vry cnrbly in iz n finitin Frxmpl mn f ll g cn b rch uring th Supr Bwl whr

primrily lr wmn cn b rch uring wy gm hwh thr primry mth fr uinc trgting i thrugh mg

gn M plnnr u t but hr ntn uinc t tir mcntnt nfrtuntly th uinc t cllct by th m inutrylthugh mwht ifrntit (g gnrl Niln uinc t inclug gnr n rc lc th pcificity t fully gu th tlrng fhlth mg nwct ffctivly cmpign plnnr mut cllctuinc infrmtin byn wht i vibl m inutry urc

M

h mi cn b u h piy chng gnt r mn t upprthr uctin n clinicl rvic W itinguih fur rl f mi: mi uctr b mi uppr mi progrm promtrn mi upplmnt

Media a dato

n th firt rl mi uctr, th mi r th primry r l mnfr chivng hlth prmtin gl h Stnfr hr Cmmunty Stuy(CS prvi n xmpl f lngtrm (thr yr cmprhnivm prgrm t chv crivcur ri ructn ( h CS ctuly mpr tw irnt tp intvntin m mi ln n mmi upplmnt with intniv fctfc cunling h CS illutrt tht mi ln cn chiv chng n ri bhvr vr th hrtrm but tht th itin f fctfc intrctin nhnc lngtrmchng (22

A mr rcnt mpl f mi uctr initit by th prvt ctrin cllbrtin with th Ntnl Ccr ntitut (NC h hwn mrffct n hth utcm ( Durng 98 n 98 th Klgg Cmpvlp ntinl mi cmpign bth t pmt brn crl cnumptin n NC' Cncr nfrmtin Srvic tllfr numbr h cmpigncnit f vn 30cn tlviin cmmrcil public rltin mtril n crl b pcging h NC' rcmmntin t cnum hghfbr/wft t w prnnty ftur ch mnt f th cmpgn chiv trmnu pur cmmnut with Kllgg mul

timillin llr vriing bugt During th tw yr th numbr ppl climing t t high fibr t t ruc thir ri mr thnubl (frm 2 t % whil th wrn f fibr prvnttiv frcncr mr thn trp (frm t 3% Brn cr r n

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18 LOR MIBCH MCCOB

r nttd th r hr nrtn h m ndt tht th md n t tr ntdnt t hthbhior a w ctain bhir.

Mda a Supportr

Whn n md t tr, mdi n rnr d m, hth hn nr mntnn hn, r hthi on th bic and Athoh ift rnforcmnt i not a mdatcom that ha bn w intitd in hath romoton, it h bndmntd in othr ana md . For xm, azrd nd 3) rtd tht on f h mt wr ct tcmin w to ort th dnc xtn bi bt ndidt.

h rnfrmnt nd r fnctin f md mortnt fr nwth th rbm bhr r nd rnwd bhr ndtn. Inth tnr and Fi t Prct (FP) bi r nnoncmnt PA) wr rr d to r a da hn nd rtfntn hn fr th rd t d nd o nd rnfrmn frtho wh hd md hn Or din dt rd tht mn rdmr wr nd bot in with thr r tht th wrhtant to rinitiat a it attmt, and that man rcnt ttr wr arid

thir r wod nr o awa. n ordr to h tho who had itnd t nor tho who hd rd, w dod ri of PAttmn b o citzn wh hd it ccf ttr td btthr r, th dmnihn trnth th r, nd thr mchnm rcoin wth thm h PA wr mant t motiat rr to it ainnd t h rnt r mon rcnt tr b thn thm how tod wth r to mk.

Mda a Prootr

Whn md d t omt tn rrm th n madinc mmbr with hath bhaior chan rdct nd c, ndncor th adnc to c, writ, or artict n roram. h irh th mot ommon ro for th ma md n hth omotn andrbb th bt nwn b th bc. n nd o n td oth bhr t f mn cntt mnd how acnt fndt bt th nt. Prmtn ndd tid PA nwrd, nd fr dtrbtd throh h, ibrr, wr, nd hiin fi. Ptint mt ftn mntnd V th wa th fnd ot

abot th ontt.Anthr xm mtimdi ta wtr cd b rntion rm(9) in whh bth tn nd tt bi n wr d t riwrn bt th dnr t wtr d b nd t mt th

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MEDIA AND HEALH PROMOION 185

bon of f hmom fo ng w mp. Of h 70000 inil bcib 10000 hmom hi miv pon clly ill h ponil of m mi o pomo hlh

pomoion civ

M SupplmMi cn ply ppmny o by bing ing ino pogm hincl fcofc o oh fo of invnion In ly ) v of0 moing cion pogm h fon h m m cmpgn wonby ccf n chngng nowg n n om nnc moing hvio. Fho mm moing cionclinic h povi pin mil w mo civ hn ho h i

no n mmi clinic wih ocil ppo gop w mo c-v hn h o h oh mho.

n noh x of non Pk n cog (68,0 wok wih Finnih lviion ion o cy o p mliikfco lviion ov i monh Th how f hlh p n io gop of igh picipn who mp o chng hi hlhbhvo h how n n ccompnying woboo w pomo hvyon nion TV n hogh np n pomo vn moinnivly in Noh Kli hogh in opinion l n in chool

mk n woi. Rl w vy poiiv howing g ffc:ho who picip in h io chn h mo ho who wchmo po mo chng hn ho who wch n ho wholiv wihin h boni of Noh Kli hom of h Noh Klipoc) po mo chng hn ho n oh p of h cony Thl ppo h noion h m mi yl mo powfl c hn n conncon wh oh ppmny hh ffo n h c nongoing commniy wi i cion o.

o mmiz h ol h mi cn b n ni fom ofinvnon o c o o ppo liyl chng n complmnyinvnion o pomo o pplmn h ffc of oh hlh pomoonnvnion.

EVES OF AUDIENE ORGANIZATION

h m cn b mny v of nc ognzon W hvlc fo lvl of inc onizon o ic in il inivilnwo ognizionl n ocil vl O lcion of inc lvli n o fc h fc h hlh pomoion i conc wih mnyvl of infnc on hlh bhvio inclng nvl ocl nnvinmn v fco. h moion invnon cn b mon o

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186 FLR MIBCH & MCCOB

inrvn on ch of hs lvls of udinc ornizion. o d osrrch h bn confind o individul lvl inrvnion nrvnion onhighr lvls h i group orgnizion nd communii or counri

hv lo bn dvlopd lhough usully wih gols d nd surd h ndvidul lvl

h drh of hlh prooion rrch highr lvls of inrvnionlii our ponil for boh undrnding hlh bhvior nd invning oni i our if h invnion srgis houd incud individu ndhighr lvls of udinc orgnizion including prsonl nwor ornizion nd couniis 2 2). Mulilvl inrvnions whn usdin n ingrd fhion cn uppor bnficil chng boh nd croch lvl Bridin h p bwn icro lvl inrvnions individully

ond nd cro lvl nvnons soclly orind s on of hgr chlngs fcing hlh promoion Siulnou inrvniono mulil lvls i ndd o h h srngh of bo mico ndcro pprochs oprhnsiv inrvnions r hos h cobin hsicro nd cro pprochs

h hr nionlly fundd comuniy donsrion ris for rducionof crdiovculr dis YD) ch illurions of coprhnsivpproch o hlh promoion inrvnion. h Minno Hr HlhPogrm 0 h Pw r lh Prgrm (, nd h Snfordr Diss rvnion ogrm 21 30) s wll s rlir comuniysudis nford C (22 4 nd h Norh rli roc 6), llinrvn h individul nwor orniionl nd comuniy lvls

n h following scion w discu h four lvl of udinc orgniz-ion nd nlyz h currn nd ponil u of mdi ch lvl

TH NDVDUA V

h hlhrld oucoms of ulim inrs h individl lvl hlh bhviors physicl indicors nd hlh sus. h ucos ofinrmdi inrs r ho ncdn o hl bhvior h includwrnss nowldg iud lficcy nd ill for bhviorchng.

W discus sprly numbr of individul lvl ouco in ordr oundrsnd h ponil of mdi lhough rrly would ny on of houcom b ondd lon Mo ofn fo xmpl wss nowld iud nd bhvior r combind ino suncd nd horiclly

drivd ffor o chiv chngwrAlhouh wrnss of hlh probl is h os bsic individul lvlouco for hlh prooion nd ncssry p for duconl pru

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MED ND HELTH PROMOON 18

in ccur (5) i i n we evepe heh ncep. niviu nbe iffeeniy we f heh pbem n f uin he pobemn hey cn be wre f he heh pbem f pepe in gener wihu

hwing wrene f heir wn heh prbem Furhemre wenecn vry in i rein piur cin F innce in he Snfr Fwe fun h m mer were wre h ming i ee cncermny fewer wee wre h ming i ee civcur iee ni fewe new f ein po ffee in he mmuniy.

he biiy genere wrene mng rge number f pepe icniere ne f he rengh f m mei (53), hugh mny mei-be inervenin hve fie in hi eg 27). F uiene wene ccu he uience mu be expe infrmin i.e he inervenin)

hey mu en i n hey mu remembe i (26, Cmpign hfi ie wene geney n hieve he neey peniinh i mege re ie iribue h he rge uience iexpe equey r mege re n cnruce cpure enin npreen infrmin cery. n gener enin uience rgeing me-ge pcemen n mege eign e n frmive reerch n ui-ene inere cn hep enure he generin f wrene

Kwlg

nveying impe infrmin rge number f iniviu i nherengh f he m mei nwege gin i n impn ucme heexen h i e eibe iue h i i necery cniin frubequen heh behvir h f hee cniin e nwn be e inei im. mmuniinpeuin me pi h iuechnge i cningen n nwege gin (50. Knwege hweve i n inge min. here e vriey f cgniive n ffecive cmpnen nwege 40 n ieren ype f eing my iffereniy efecubequen chnge Aiiny he ype f infrmin peene n heiuin in which he infrmin i preene ech inuence wh pepee n hw hey ppy i (). Auiene invvemen i n impnfcr. Knwege cn infuence he iue n behvi f pepe h ehighy invve wih heh iue bu my fi ffec pepe wih w iueinvvemen 14 ummrze eve f nwege (rec cmpreheninnyi n ynhei uience infrmin nee n uience invvemen re cery imprn he nwege efiniin pce

niein f mei hnne n mege fm wihin hnnee.g SA r peci prgrm n eeviin cr cumn innewpper re pricury imprn f nwege gin eeviin PSAe genery ny 0 ecn ng imiing he peenin cmpexnfrin. A mre efficien ue f SA n he mei my be timute infrin eeing (32) n he F prec we evepe SA

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188 FLORA MAIBACH & MACCOBY

promon h u of prn fhp . Anohr xmp h urh u of on mum o pomo h u of noh mo nfomvmum Ko' u of bn c box o pomo h NCI Cnc

Informon Srvc

Aus

cu of o ovr coon bn u n bhvo mnyf h u my no py n mpon o n chvn hh bhvochn Appropr u my no b ufcn o chv bhvorchn bcu of nonun brr o hhfu con o xmpvn h pov u or conrcpv u nr my no uconcpv f hy r coy f cnc no y ccb f

mn no n confnc or f hy r cn n bhvo hhch o no conom u Hh u cn nunc boh hhnfomon n n hh bhvor (23); hovr bhvopcfcu r mor prcv of hh bhvor hn nr hh u24).

h m cn b fcv n chnn hh u pcy hnuppmn by fcofc nucon (54) o hhy nvov uncu chn cn u fom n bou hh h n h cn o coponn hh bhvor chn 14 71) Au cn o b obvony hrouh m pory n u bop f h n b r n pfb o pvou hu 7)

Ahouh u my no b uffcn o chn bhvo bcu ofoh obc o hhfu con hy pb n o conbu obhvor chn (14 24)

S-E

A pron bf n hh by o nc bhvor uccfuy rmffccy n mporn mn nunc on h non n mnnnc of hh bhvo (6 84). Mbch (56) monr h f-ffccy o n mpon ouco for hh nfomon cmpn.xpou o h hh cmpn hon nfcny o nc f-ccy n fccy hon nfcny o ncr ncmn ofh r hh bhvor Bhvor chn r n nrc ru of hcmpn bu rc u of cmpn fccy nhncmn.

h m cn b u o mu h vopmn of fccy n

numb of y. h ncu mon h bhvor of n chnh ncy for ncn hh bhvor ncourn mp nrmbhvor uch o ov bhvo n rucn yfunconrou oc h h ncmn of hh bhvor fffccy unuz n nmry bhvo chn o

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Skills

MEA AND EALT PROMOTION 89

h uu namn man a hah ha qu am gn a an haa . F am a

mdan qu gn n ngn hahu n an a u pr am pu aunhahy an bhaira i r hahu prparain iaing hr ha bn nnia n ring i i anng n hha hang (5) hugh uh anng uuay cnu nrpna in na uaina ng ranng ah hamna ha mp an aqu hugh ma aa(0

Ahugh raiy un iin ha bn u uuy ah

mng an an h hah ha (7 68 0) h m r ma n aqun an hang hw ma a ampmn aa inn nrun 4

BhavrBhair hang i gnray hugh b bh h um uiman a h iniiua an h u a ng i annhang a ang h aa h u mng annga nmn nrmn an ngng a a aing

ha hang ). ha hang m m a nnnr h ann bhair uh a ga ng prma ga aniay (7. A urrny m h ma mia an ma imi in h gr whih hy maningu aia m hann ha r am a an a nmn n hng p. Hw a u h ma ma ha nuuy i inun h bhaira ann

A iu ab h Sanr S an amp uu u h mia bing abu bhair hang Bh ma an an up

pmn ma ru in bhair hang h urhr iuaha ma an a ab mua hang n mp hawha mr mp hab rn bha a mr nun wh h nan ma an aa nrnn a(5) riw mng an r uppr h w.

Our abi inun hah bhair hrugh h mia i urrnm b h a u unanng hw hang hah bhaur unanng hw rana nwn hara prnp n maampagn an u m u an unranng inrnn a highr aun ganan y argng haa ann a w ahah bhair ampagn pannr nhan hi abii prou bhara hang

n a mphni inrnin r mbining inria an uima

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90 FORA, MAIBACH MACCOB

outcome objectves, meda can assume many oles; educator, complementrenforcer, and promoter The roles selected should be based on audenceaalyss and terveton oals

pproprately developed medabased nteventons have the potental totransmt nfomaton, ater some atttues, teach sklls, enhance effcacy, andproduce shfts some behavors. Iterpersonal supplementato and evromental chane can also help to pomote loner term behavora chaes

WK

eor and Health

haacterstcs of socal networks have been shown to have a pofound mpact

o health. The rate of teracto for ndvduals wth a network has beenshown to have a drect consequence on health status (55) Ben aed,havn frequent contact wth close frends or relatves belonn to a churchand partcpatn n nformal or fomal roups have each been shown to lowermortalty ndependently (9 79) Intmate relatonshps (e mrrae) seemto have the stronest beefcal effec on physcal and mental health, andsome sudes have suested ha he uay o he reaoshps may aso e acosderato.

he mechansms throuh whch socal suppor acts to enhance health are

not fully understood One mechansm s thouht to be the encouraement ofbetter health practces A varety of health and preventve behavors have beenshow to be related to socal tes Socally solated ndvduals eae lessfrequently n preventve behavors such as mmunzatons medcal and dentalscreen and checkups, and seat belt use (6, 4) Socal relatons havebeen shown to afect postvely several mportant health practces ncludnabstnence fom smokn, eercsn mantann a desrable weht, andsleepn 7-8 hours per nht (), ad ndvduals n actve networks alsoconsume less health ca and exhbt more adaptve help sek behavors

(52) The mplcatons for health promoto are relatvely clear tervetoswthn, and on, socal networks hold reat potetal for mproved healthoutcomes. However, because of our curenly lmed undesad of ework fucton, teveto eor ae ot wthout drawbacks For example, Lchtensten and colleaues () found that smokn relapse amonoe pater a buddy system also made successful cessato for the otherprer less lkely

etwor Leel Indiator

Networks can be descrbd n terms of two types of varables structural andnteractonal (59). The structural varables n a network descrbe the socalsystem and how people are lnked toether wthn t Interactonal varables

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MIA AN HALTH ROMOTION

drib nt wh i inkd t whm, but rathr th quaiti f th inka.Ent and mr mpt diuin f ntwrk r aaiab whr6, 776

eork Srucure

trutura aiab inun th w f hath infrmatin and mmuniatin within a ntwrk, and mdia ampain pannr an ha thdynami Th twtp md f bradat infrmatin pit that th tataudin i inund n tw way rahin audin mmr irty andrahn pnn adr and thr ntwrk nfunta wh wud n tuprpaat th infrmatin intprnay 77 A m abrat md thNtp fw md, ni th fat that many pp d nt ntatpinin adr, that thr i n ar dihtmy btwn adr and fwr and that lad ar infund by thr 35. Infrmatin nd inunw thru many ay pint, frm hann t hann, and thruh amp patt f ntrpna ntwrk

Intprna infun within th ntwrk i nidrd mr ftithan mdiatd ma in brinin abut hih rdr indiidua t, uh a attitud and bhair han y narwatin hath in-rmatn . thruh maain, nwttr, an trni mai, am-

pa pannr a tart mar, mr pifia tart audin thatinud ntwrk inuntia uh a pinin adr and atkpr indiidua w ntr a t infrmatin, d, r ri In thifahin, th trutur f ia ntwrk, that i, th prn f inuntiawh an b tartd ia th mia bm a iab man f nfun frhath inrmatin ampain

Anthr anu fr hath prmtin i t dp th trtura apt fia ntwrk Th th ara pjt ha ytatiay buit a adr fay hath pinin ar t prpaat th t f it th mmunity

intrntin 62 h tanfrd hwd that pinin adrhipmrd frm th hih rik paiipant wh wr pd t bth mdatdand intprna ntntn A th mantud f nput t ptipantinrad frm ma mdia ny t ma mdia pu rnin pu hanant ntat did thir numr f hath nratin and th numbr fadditina pp with whm thy diud hath iu Th u f mamdia t dp r prmt fti pinin adrhip hud b furthrprd

tr ntractnPmtin han in mmuniatin bhair within ia ntwrk may banth impant funtin f ma mia. Whi th quaity f ratinhipn hath tm ha nt bn w rarhd pua and pr uppt


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2 FLRA MAIBACH & MACCB

hae been shown to be potant eleets in health behaor chane andaintenance (2 2 6) Both the nuber o suppoe nteractions andthe inds o suppotie inteactions ay be ipoant networ leel tarets

Media stratees and essaes can be deeloped that attept to nolealy ebes riends cowoes and ohes in coon discouse abouthealth issues hanes n these councaton behaors ay n tu inuence indidual health behaor

Newor ee nteenon is a arey uneplored possbiliy or heathpootion hile ost theoies o behaio acnowlede the ole o socialinuences thee ae ew theoies to uide our thinin about netwo leelinluences It is clear howeer that the health stats and behaior o thenddual are at least patly a unction o the socal networs o which theyare ebers.

THE OANIZATIONA EVE

Oganizaion and Halh

Delern health proras in oranizational setins has becoe an n-creasinly popular stratey The benets o usin worstes schools praryhealth cae settins supearets and othe etail ood outlets as inteventiontarets ae any By usin oaniatons as channels o deliein healthproras health educators can: reach dened taret audences b tailointerentions to speciic contexts c ultply their eorts by utilizin exit-n oranzatonal resouces (e socal suppor instrctonal eperiseacilites), nuence oranizatonal structure n ways that wll supportindidual leel behaio chane and e) inluence oanizations to becoeheahu odes o othe couny instituions

ealth nteentons wthin oanatons requently utlze low cost, s-ply produced print edia such as eos newsleters and bochures hese

eda are hhly tareted to specc audences and talored to the contet(e. bochue on eecises to do at your des) hese eda are oensuppleented with acetoace nteractons, both orally (as in a lectureclass o deonstation) and inoally (as when eployees dscuss thewosite newslette wth a health opinon leade) Mass eda hae been lesscoonly used to brn abot oranatonal chane he a edahoweer ay stiulate oranzatons to adopt nteventons by diusininoraton about health prootion proras. Adopton s urhe renorcedby edia attention to these inteentions which is seen as exceen pubic

relations with the county at lareTypicaly inteventions delieed throuh oanations taet and easure indidual chane Recently howee soe eseach has tareted andeasured both oranzatonal and ndidual leel chane (2 8) n one o

Annu.Re



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IA AND A PIN 193

hese sues anana a sen pub spays f up ahevemens use f he anan newee an neu men weeuse enhane eneaan an manenane f fesye hane These

muee es n ny nease u unesann bh nvuas ananans bu as u unesann f he eanshps beween he w

Organizational Indcators

s anans an seve as hannes huh whh eah nvuashey an as be aes f han Oanana umes whe esssue han nvua ues ae hse ha eae heahfu e heahprmn ranans Ou nen a heahu anan s neha exhbs haaess ha ae huh be nuve he heah f

bh hse nvuas n he anan e emyees) an hse nvuas nean wh he anan e ens usme) T heeen ha anana haaess ae nwn nbue he beemen f heah a he nvua ev he assessmen s a va measue fheahfuness f he anan Usn hs anae a Jaksn &Maby 29) an me eeny Fa Faquha28 have ppse a se fwkse eve heah nas The fwn s f sx anana evenas an exansn f he eae famewk by a an eaues9) naes bh hysa an aeae nas

Iormation Environment

An anans nfman envnmen s efne as he sum f hemmunan hannes ha an nvey nman he ananmembes an ens mass mea aee mea an neesnammunan whn an anan nsue s nfrman envrnmen The nfan envnen whn an anan s an mpanna f anana heahuness Heah nman whn he anana envnmen an have mupe nuenes n he anan anhe nvua These nue a) exen an aena sen ee pmeheah ssues n he anana aena b nfmn nvuas whnhe envnmen smuan aana eve ees suh as sussn an nr hanes an nn nvua behav hane 2.Reevan nman nas ne n ny quany an quay fnrman bu as vsby an eve mn

Physcal Faclts

hysa aes ae a sen ae f anana eve naDeenn n he ye f anan apae faes an nue hse hysa avy e bke aks fness equmen) f heahy eane. heahu venn mahnes afeea he f seens) f

Annu.Re



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14 LORA MAIBACH & MACCOBY

eal screenin (e. auaed bd ressure cus r ea rs araisas, and dedcaed sace r er cun ea acve Muc e enran ennen, an ranzan ea ace e a cle ndca

n ranzana cen eal. Te a enabe nd u awde vare eal beavrs and acves a wuld erwse n bessible

Aces

Hea acve ncudn ae, creenn (eenn and cee,densrans (e. d asn, ru acves, and sur us are aird class anizaina leve ndcars. B e nuber and e e ea aciviies (e awareness versus beavir cane sud be enuer-

aed ncrease ur undersandn ranzanal eaulne.

Resources

esurces acaed ea as, suc as bude and esnne, areaner cass ranizaina indicars Oer nie exeie, indienus e ranzain and avalable r eal rn ers, s an addnaleasure

Coece fcac

ecve ecac, a rus belie n is abili slve s rbessuccessull, a be an ian ananal level ndcar 6, 7.Perceived cecve ecac wi inuence wa ee cse d as au, w uc er e u in i, ad ei sain wer wen ruer al rduce reul (6). Te re cnl e eber a rur ranzan eel e ave ver a cndn, e re lel e wil beabe ra cecve ecac

Polces

Heal lce are a nal and enall ran se f ranzanaleve eal varabes (82) Pces can encurae beavr (e rurainn, aciae beavr (e d labelin, reinrce beavr (ereduced insurance reus reulae beavr (e sin bans andsuercede ea bear (e. n a sae and clean ennen.Quani, e, and quai icies (e. enrceen, wrdin, andawaenes are iran aniana and individua ea

ese ndcar var in e deree wc e are nluenced b eedia (eer areed ineal eda r e exeal ass edia. Fr exae, e inain envirnen s diec nluenced b e nuber andes edia available e ebes e raniain Plicies a beindirec inuenced b e edia e. eees can read abu ea

Annu.Re



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MA AD HALH ROMOIO 15

polc n voc mk chns wh hr own orno orornzol lr my s r or h bou polc h cn mprovnvul hlh n publc rlon n mn hr mplmnn.

nvus whn n ornzon who m hhfu fsy chns cnus hlh formo o ohrs n voc chns whn h orn-on.

To ornzonl lv1 cors of hlh r hr s horcllyrvn nor s mprcly sbsh s ncors ohr lvs Nvrl mn hlh ponl l h ornznl ncor rmnnul nunc on nvul n nwors whn n l o hornzon (1 66 8) I on unrs of h rlonshpmon ornzon n nvu vl vrbs s ncssry or hss

h full pol of rvon lhouh ll nown bou hnunc o h m boh r n m on ornzn hponl m r

ocl nunc n h nl of conrn n humn hlh nbhvor. ocl cors such s normv bhvor lws polcs h phycl n ormon nvronmns py n mporn ro n hpn bln hlh con h ohr lvls of lyss. Ms m prcully mpon hs lvl bcus of hr nrl rol n crn orunn h ocl cor.

Sal Lvl ndars

ocl lvl hlh ncors clu rucurl or physcl vrbls such sh phycl nvronmn lw n publc polcy n non chnnl.Ms psycholocl vrbl compo of h collcv vlu nors

us opos o ocy mmbrs r so mpor socl lvlncor of hlh. Mo ocl lvl ncor cn b ppl o oclsubuns such s communs ss ros s wll s o h non s whol

nran nvrnn

h ornzonl lvl h socl fomon vronmn s prvv nunc on our collcv prnc. For nnc h mm our collcv n h wh w hn bou ocy 48)Throuh hr scon procss h m f whch ssus mpornn by hr lc fn whch us r upor pnn on o ss pvo hlh pomoo cn b lv o

Annu.Re



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16/21

FLORA MAACH MACCOY

or dmod from an ssu of communy mporanc. urhrmor h wayha h mda porray h ssu nfuncs how h pubc prcv ()

Mass mda campans ar a mans of nuncn h sn nformaon

nvromn. Th modn of unhahy bhavor and advrsn for unhahy producs ar prasv n our mda ) havora nocuaon( 72 and ohr mans of counradsn ) can b hhy ffcv nprprn audncs o rss h nsdous cs of hs unhahfu porrayas or amp a md amoun of car ounradvrsn conducd from o 0 undr h auspcs of h 's ass Docrnhad a profound c on curbn h owh of smon n hs counry 88Ths ffc was achvd dsp h ac ha car manufacurrs wrpurchasn $200 mon of vson dvsn pr yar durn hs prod.

Th nformao nvronmn aso suppors h fcs of ohr socaorzaona nwor nd ndvdua v chn fors. or amphr has bn nav bacash n rspons o wors smon bansrpordy bcaus mda covra of s mpndn arrva prpard worrsfor h chans on bfor hy wr vr mpmnd 5).

b non

Pubc opnon pays an mporan ro n h sabshmn and mannancof pubc pocy and h aocaon of pubc rsourcs. Mass mda pay an

mporan ro n h shapn of pubc opnon mod of h pubc opnonprocss by Prc Robrs ) usras h mporanc of mass mda.Thy sus ha h mda sc fom h hu morass of pubc acvsha whch hy dm mos mporan and hy rpor on . y vru of hac ha hs paruar pub affar hav bn rpord o hy bom"nws. Th "nws acs o dfn wha h nrsd pubc consdrs o b"pubc affars. Posrs connuay assss communy nrs n varous"pubc aars and hrby hp form "pubc opnon. caus "pubcopnon s nwswohy h da po on an onon bass. n sus ha boh h nrsd pubc and pocans rvs hr prcpons ofboh "pubc affars and "pubc opnon on h bass of wha h mda havrpord. Pocans hn ac on hs prcpons and hrby cra mor"nws whh s rpod wh h c o uhr nuncn pubc prcpon furhr arousn po ars and furhr ncn h poca procss.aws and pocs ar nacd pubc nanc sysms ar shapd and pubcmons ar spn on soca prorams and pubc nfrasrucur as a rsu of h"pub opnon ha h mda hp o cra

b oTh aws pocs and aocaon of pubc rsourcs a a vs of ovmn can hav mporan mpacs on h hah of h pub "Sn axs sa

Annu.Re



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17/21

MDA AND HEAH PROMOION 17

aws ad ud r IS rsarc ad duca r u a wams c vm ua Rua may aya quay fud h acs f azas T mass mda aya ma r cuva uc accac ad sur fr vma ss (18 7

Puc ma camas, ms ay drc ma aroacs hav succssuy myd y razas ccd w h ucshah Ms as uk vs r fuc uc ad uc cy Suc uc uc cy ca vr-ad mra v s

Sal Nm

ca r ahr ma sca v ucm ha om- Mda uc has a sdus fc h rc dvduasand on noaiv bvo in h oa sysm ddua rcs sca ms ar fucd y mda h a h mda rs vw f rmav uds hvs ad cud vws (.dvdua ac s ucd y hs mdaad cs fsca ms (18 sca v, mav av mrs a asry frm h havra rs ha dcd mda

u usd w hah a mdfca mass mdad

fdack ad sca ms may a ma sca v v say F am h massmad ad vsd fdackav shw rduc y csum dramacay Gru vdac ard rhd ry us as sw rduccsum y 10 35% (65 0) vs fdack has as usd duc cmmuywd as csum y 5 0% (8

hical nionent

Pysca vms f cmmus scs ca a fc acmmm hah Evma dcars a fm h avaahah svcs, h safy f h scus w ccuy, ad h r vr-ms whc w v wk, ad sh Mda ucs hs hyscavms ar w udrsd y chas hs vrms caav rfud macs hah avaay hahy ds sur-maks, asssf vms, adf a

hu s kw au h mac mass mda scav dcas f hah a a da f vdc xss dmsa h

k w mass mda ad r sca v dcas Th a uc sca v ha dars w h mass mda smsa d w rsarch k sm f h sca v a

Annu.Re



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18/21

198 O MBCH MCCBY

ndcators to ndvdua behavor s sparse other lns e.. laws acltesare both drect and obvous

ONUSONWe have dscussed the roles o eda n halth prooton and analydaudences at our levels o oranzaton. We have derentated a the rsteve o councaton, whch s ade drectly to the ndvdua b the evelo councaton taretn networks such as the aly councatonhat aects oranzatons such as shools and worses ( and counatonbasd ntevnton wthn th county as a wo o snown about t uss and ets o da at the nddua and sota lels

o oranaton than at the network and oranatona levels.he eda see to hold the potental or proound nuences on heath atany levels o audene oranzaton owever te ed consttut onyone st o nterventon strates he pact o da both ass andnarrowas da an b ntnsd and tndd whn obnd wth othrors o nterenton Meda can b nluental at al levels o audenceoranaton As our understandn o ow to use te eda nreases so doesour understandn o uan eavor and socal systes

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MD ND HH PRMN 199

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9 ntmn R M. 988. Hw h mdaa wha pp hk nmapng appah Preented t Ann.Met Int Cmmun. A. Ne

Olen20 Frquhr W. Fl J A., Gd L.. Fortmn S. P. 985 IntegtedCmehenve elth Pomotn Pro-grm publihed Mngh pe-ped fr he Ker mily undtin

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e t . 1 977. Cmmunty edutin fcardioascua eah. L I 1 92952 . Fting, L 975 . Behvrl upp

for nion hnge In Cmmunanand Pub Opn d. R. O. Cln,pp. 429 N Yk Peg

2. Fhbin M., Aen 975. B,ud nnn, and Bha: n ndutn h and h.Rding, M AddinWely

5. ly R 987. Mmed ndmkng tn A tal rvim Pub Hah 775360

26. Fy, R. De, D Sleg RP 1 980. M medi n hth prm-tin An nly ung n xtended n-fomtonoeing mode Hahdu. Q. 7:1277

27. Fy, B. R Sbe L 1 983. he rle

f m md in prventng ubtnabue n Pvnng dsn uban bu: vn Sagsd. . Glynn, C. eufd , udfrp 5 Whngtn D NIDA Re.

Monog 478 Fora J Faquhr, J W 1989vuatn of ok hth mo-tn pgram: Cont mthod, ndbetiv In ah Pm Wkpa, d. . E Feding. Boston:avd niv P

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31. emuth V S, mmnd, S. L.,Sten J. A. 988. lth dvetng:Prnto fo pot m. PubHah 78:5576

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33 Gttleb, N . Geen L W. 984 Life

evnts soal nwos f-sye andhth An nlyi f ernl helthprtie nd onequene . Hahdu Q. 1 905

34 ymn . . Shetley P B. 974.Sme ren hy Infrmtn Cmpgn Fl Pub Opn. Q 43

5 K 957. e wo-tp flow ommunitin An uptdt rrt n hypthei. Pub Op Q 21678

36 Kpln, B. ., Cel J., Gre, S. 977. S upot nd helth. d.a 154758(Sul)

37. King A. C. l, . A . tmnn, S.P . , Taylor, C B 1987. Smoks chaleng Immedte nd lngterm fndngof ommunty mkng eton on-tet. m J Pub Hah 77340

38. Klppe 960. h aCmmuna Nw : re Pss

39. Klthe M L 987. Pevention of te d bu eluton of mu-medi inury ntrl pgm m JPub Hah 77:1 19597

40. Kthl, D. R . , Bm . S . MiB B 964 axnm duana

bj Bk Dman.N Yk: Lngmn4. Lnge 97 . S netk,

health beef nd preventve hath be-hvir Hah S Bha 82460

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200 FLOR MIBCH MCCOB

4 Lu, R. , Kn, R , By, S , Wr, J . Ro, D 1980. Chnnelng heth: A revw of th vauaton of tevisd thcmpign. Hath du 75689

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4. fbvr, R. C , s, T M. Cron, R. A , Ptrson, 1987 Thoynd divy o hh pogmming inh ommuniy T Pu

h Pogm P Md. 16896 ichnin, E, Wss, S. M. itch

coc, , von . O'Conn A , 1 988 Ps of smongrps. Hath Psyho. 5(Supp.)2-0

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53 Mccoby, N Axnd 198 sof md n fsy progms In havoa M Changg Hathstys, d. P. Dvidson S Dvidson pp 351-7. N o n

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MEDI ND ET PROMOTON 20

ic onion csss R 60 p8-86

6 8 sa, clstr A Nmns,H ha Wiilo t aJ 98 A

teeson foa or naona eat pomotion: land's "Ks to HalthPulc Health ep 0226369

69 ska P. ssnn A mt Salonn . , oska t a 985The community-based strategy o pn coonay hat isas Conlsinsom h n yeas o he Noh Kaajc . Ann Rev ublc Hh 6479

0 sa Wio cAlsr Aoska moland A a98 annd s mass mia n

Natona ath omoto h sto Hea" TV pogra n 198 n nand. Can J Publ Health 7633642

Ra . 93 ang commnica-o and h hh o cts In NwModel for Commitio Rsrh, . Cla, p. 46 BryHls ag

2 Robes D F . , accob N. 93 Inoraion pocessn and persuasonCounaung bhaio Rf 26930

7Rsn

S A B B Wxom C W Eiswrh R , t

a 9 A conroll s of th c lision mssags n say ts. Am J ublc Hth :080

4 Rogs E , Agawaa-Roges, R96 Cuncatn n OrganzatnsNew Yok: The e ess

Rgs E ina D L 9 8 omunto Ntork Towrd New radigo Resech Ncw Yok:h ss

6 Rogrs , E , homa, . 9 unan Innvans A CrssCultul poch Nw Yok Th eress

Rogrs Soy D 98ommnication campagns R60 846

8 Rothsti, R N 980 son ac s o my asoin nsm-in Behv Th 68388

9 man T Kapan G A. nd-sen Cohen, R Gurank . 98

oca nw s an oalt amonth y n th ama ContSt Am J Epdol 26423

80 Seffed F D 9 6 Tocl sations th eing o comlseqna ass o onsaon anatc n Suden Rspns n P-gmmed Instruction. A Sypsu nExprmntl td o C d R-sponse Factors in Group and IndvdulLenn fm Inucn Med, ed A A Lusdane pp 32 Washington DC Na Aca c-Nal ResCoun #943

8 imonston B G arc G Oaa 988 mmnng

organzatona changs to omotheah e n phsa av atschool Heth Educ. Q 5 530

82 Soan R Gman, . c , Aegan, . 98 Invesng n Ely- Heth A Gud Efecve Helthromotio i h an ancsc: ossyBass

ta, A Hghs H G 90 Roton an datoa amaign h ncinnai an o te Unted J 55389400

84 rch V DVlls B Bc

Rsnsc 986 ThRo o slfca in aching halthhao chang Heth du Q339

8 Wal tt . 988 Ap 26 p 86 Waack L. 9 8 Mas ea ca

pagns Te ods agast ndng behao han Helth uc Q 8:200

8 alac L. Gr, adn P Bd, W 989 lcoh oaas onrm tim tvsn 9986 Subm

88 W, K E.

97Th ts o than-sokng capagn on cgaee con

supton Am. J ubl Hth 66450

89 W, . 98 Tlisin andhalh dcaon: a tnd Am Jubc Heh 7:42

90 Wint A Kasr HabrkoG 9 Th cts montary r-ats an dack on tcty consupton Envn Sst 63294

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