Integrating Health Promotion and

Environmental ChangeCandice A. Myers, Ph.D.

Childhood Obesity and Public Health Conference April 1, 2014

Learning objectives

1) Benefits of considering the environment

2) Synergy!!

3) Multilevel interventions (?)

4) Guidance

Why Does the Environment Matter for Health Promotion Programs?

– Target individuals– Utilize education or behavior modification – Increase physical activity or improve diet

and nutrition

Health Promotion Programs

http://www.nfl.com/play60

http://www.choosemyplate.gov/

Social Ecological Perspective: Levels of Influence

Intrapersonal: Individual

Interpersonal: Family

Organizational/Institutional: Schools

Community: Neighborhood

Society: Policy, Law, Culture

“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

Why Does the Environment Matter for Health Promotion Programs?

Health Promotion Programs versus Environmental Programs

Individual

Appropriate Energy Intake (Diet)

+Appropriate Energy Expenditure

(Physical Activity)=

Energy Balance

Positive Health OutcomesDecreased risks for:

ObesityDiabetes

CVD

Environmental ProgramsFavorable:

Social ConditionsFood Availability

Physical Activity Resources‘Opportunity’

*necessary for positive change*

Health Promotion ProgramsAdoption of healthy behaviors

‘Agency’*necessary for positive change*

“… 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!!

Multilevel Interventions

• 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

How?

• 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

Health Promotion AND Environmental Change

• Outcome = Daily step goal• Target = Outdoor play/exercise• Program = Behavioral strategies via text

messages and pedometer for monitoring steps• Environment = Creating neighborhood park

access

Example of Multilevel Strategies

Accumulation

Daily step goalOutdoor

exercise/play

Behavioral strategies and pedometer

(intrapersonal)

Construction of new park with amenities(community)

Facilitation

Daily step goal

Construction of new park with amenities

(community)

Behavioral strategies and pedometer(intrapersonal)

Outdoor play/exercise

• 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

Issues

Learning objectives1) 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!!

Why Does the Environment Matter for Health Promotion Programs?

• 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?

Concluding Thoughts

Contact Information:Candice A. Myers, Ph.D.

Pennington Biomedical Research Centercandice.myers@pbrc.edu

Thank You!