Nell H. Gottlieb

Life Events, Social Network, Life-Style, and Health: An Analysis of the 1979 National Survey of Personal Health Practices and Consequences

The relationships among social structure, stress, social support, life-style health behavior, and health status are explored in this multivariate analysis of data from the National Survey of Personal Health Practices and Consequences. Path analyses showed social structural factors to influence life-style practices both directly and indirectly through social network and negative life events. For women, social network and life events had direct relationships to health related life-style practices, while age and income acted both directly and indirectly through social network and, for income, through life events. Education was also directly related to life-style. For men, social network and education had the only direct effects on health practices, and age and income had indirect effects through social network. We then examined the relative contri butions of the social network index elements, life events, and demographic variables to each of the life-style practices. These analyses confirmed the importance of gender, education, age, and income to predicting life-style behaviors. Negative life events were associated with smoking for both men and women, sleep for women only, and physical activity and alcohol use for men, which suggests sex-specific norms for coping with stress. For both sexes, church attendance and marriage were associated with favorable smoking and alcohol use, implicating cognitive social support or social control as a mediator of health promotion. Finally, analyses for each gender using health status as the outcome variable indicated that age, income, education, and life events affected health directly, while the effects of church attendance and marriage were likely mediated through smoking and alcohol behaviors.

Sociocultural correlates of childhood sporting activities: Their implications for heart health

The relative contribution of sex, ethnicity, social class, parental exercise and heart health knowledge to the variability of sporting activities reported by Texas 7th and 8th grade students in 1980 was examined to study the cultural patterns of exercise that might relate to future risk for heart disease. Girls were more likely than boys to participate in activities with high aerobic potential. Relative to Mexican-Americans and Blacks, Anglos were more likely to engage in individual, non-competitive, aerobic-type activities. Multivariate analysis showed heart knowledge, parental exercise, sex, fathers occupation and ethnicity to be significantly related to the overall frequency of exercise. Parental exercise had a stronger influence on the frequency of exercise among girls than boys. These findings suggest possible cultural mechanisms in the epidemiology of heart disease.

A taxonomy of behaviour change methods: an Intervention Mapping approach

ABSTRACT In this paper, we introduce the Intervention Mapping (IM) taxonomy of behaviour change methods and its potential to be developed into a coding taxonomy. That is, although IM and its taxonomy of behaviour change methods are not in fact new, because IM was originally developed as a tool for intervention development, this potential was not immediately apparent. Second, in explaining the IM taxonomy and defining the relevant constructs, we call attention to the existence of parameters for effectiveness of methods, and explicate the related distinction between theory-based methods and practical applications and the probability that poor translation of methods may lead to erroneous conclusions as to method-effectiveness. Third, we recommend a minimal set of intervention characteristics that may be reported when intervention descriptions and evaluations are published. Specifying these characteristics can greatly enhance the quality of our meta-analyses and other literature syntheses. In conclusion, the dynamics of behaviour change are such that any taxonomy of methods of behaviour change needs to acknowledge the importance of, and provide instruments for dealing with, three conditions for effectiveness for behaviour change methods. For a behaviour change method to be effective: (1) it must target a determinant that predicts behaviour; (2) it must be able to change that determinant; (3) it must be translated into a practical application in a way that preserves the parameters for effectiveness and fits with the target population, culture, and context. Thus, taxonomies of methods of behaviour change must distinguish the specific determinants that are targeted, practical, specific applications, and the theory-based methods they embody. In addition, taxonomies should acknowledge that the lists of behaviour change methods will be used by, and should be used by, intervention developers. Ideally, the taxonomy should be readily usable for this goal; but alternatively, it should be clear how the information in the taxonomy can be used in practice. The IM taxonomy satisfies these requirements, and it would be beneficial if other taxonomies would be extended to also meet these needs.

Settings as an Important Dimension in Health Education/Promotion Policy, Programs, and Research

Settings—community, worksite, schools, and healthcare sites—constitute an important dimension of health education/health promotion policy and programs and for research about program needs, feasibility, efficacy, and effectiveness. These settings vary in the extent of coverage of and relationships with their respective constituencies, valued outcomes, and quantity and quality of evidence about the effectiveness of setting-specific and cross-setting programs. Main sources of evidence for program efficacy and effectiveness are summarized, leading to the conclusion that strides have been made toward building a strong evidentiary base for health education/health promotion in these settings. Gaps in research exist, especially for diffusion of effective programs, new technologies, the influence of policy, relations between settings, and approaches to marginal and special subgroups. Recommendations are offered for cross-setting and within-setting research related to intervention.

The Ecological Approach in Health Promotion Programs: A Decade Later

Purpose. Present a 10-year update of the ecologic model of health promotion published by Richard et al. in the American Journal of Health Promotion in 1996. Approach. We adapted and simplified the model by leaving out settings, focusing on levels, and incorporating interpersonal and individual levels and agents that are in control of environmental conditions. Setting. Health care facilities, schools, workplaces, living environments, and public environments were represented in program descriptions. Participants. Forty-three program coordinators responsible for 47 programs were interviewed in the United States and The Netherlands. Methods. A systematic interview protocol elicited general program descriptions and relevant aspects of the ecologic approach. Program aspects from written reports were coded by the authors into levels, interventions, targets, and strategies. Results. The programs had 234 strategies and 276 targets, with a mean of 2.15 levels. Twenty-seven distinct intervention strategies were identified, with the most common being modification of an organization to which the at-risk individuals belong, followed by policy and community changes. Conclusion. Our data fit the ecologic model and our adaptations and indicate that over the past decade health promotion practice may have changed to include more multilevel programs. Systematic analysis of program strategies within and across environmental levels allows better understanding of the social ecology of health-related behavior and potential leverage points for change.

Employee Involvement Management Practices, Work Stress, and Depression in Employees of a Human Services Residential Care Facility

This article tests a theoretically driven model of the relationship between work environment, specifically, management practices, and employee mental health, specifically depression. It draws on theoretical perspectives connecting work environment and stress, and on others linking stress and depression. It also examines sense of coherence as a possible mediator of the relationships among work environment, work stress, and depression. Results showed that perceived exposure to employee involvement management practices was related to perceived work stress, sense of coherence, and depression. A model was specified to assess potential causal relationships using LISREL. Results suggested that increased exposure to employee involvement practices was indirectly associated with lower levels of depression through both perceived work stress and sense of coherence. The implications of these findings for management practice are discussed.

A Review of the Health Impact of Smoking Control at the Workplace

Purpose. To summarize and provide a critical review of worksite health promotion program evaluations published between 1968 and 1994 that addressed the health impact of worksite smoking cessation programs and smoking policies. Methods. A comprehensive literature search conducted under the auspices of the Centers for Disease Control and Prevention identified 53 smoking cessation program evaluation reports, of which 41 covered worksite single-topic cessation programs. Nine additional reports were located through manual search of citations from published reports and reviews. These 50 reports covered 52 original data-based studies of cessation programs. The search produced 19 reports for tobacco policy evaluations, of which 12 addressed health impact. An additional 17 reports were located by the authors. These 29 reports covered 29 studies of policy impact. Summary of Important Findings. Smoking cessation group programs were found to be more effective than minimal treatment programs, although less intensive treatment, when combined with high participation rates, can influence the total population. Tobacco policies were found to reduce cigarette consumption at work and worksite environmental tobacco smoke (ETS) exposure. Conclusions. The literature is rated suggestive for group and incentive interventions; indicative for minimal interventions, competitions, and medical interventions; and acceptable for the testing of incremental effects. Because of the lack of experimental control, the smoking policy literature is rated as weak, although there is strong consistency in results for reduced cigarette consumption and decreased exposure to ETS at work.

The relative influence of health beliefs, parental and peer behaviors and exercise program participation on smoking, alcohol use and physical activity

This research specifies a model for lifestyle health behavior which includes socialization, social environmental and cognitive influences on smoking, alcohol use and exercise. Survey respondents were participants in university conditioning classes, academic health classes and a community fitness program. Of the socialization influences, drinking by both parents was directly related to drinking by females and drinking by the mother to that of males. Physical activity level of the father was associated with the activity of both genders. Parental smoking was not related to that of the respondents. Income was positively correlated with alcohol consumption in both genders and with smoking among women. In the immediate environment, drinking and smoking by male and female friends were directly associated with that of both male and female respondents with congruent gender relationships being strongest. Exercise by male friends was positively associated with activity level for both genders, as was exercise by female friends for women only. For college students, program participation was related to lower alcohol consumption among men only and higher activity level for women only. It was not related to the likelihood of smoking. For cognitive factors, belief in the efficacy of lifestyle change was inversely related to alcohol consumption for both genders and to smoking for women. Susceptibility to heart disease was associated with a low exercise frequency and smoking, while generalized susceptibility was directly related to activity level and to smoking. Self control over health was positively related to activity level. With one exception, the peer modeling variables had the strongest relationships of any of the model elements in the multivariate analyses. Gender specificity for modeling of behavior was found for peers, but not for parents. These findings suggest that prevention programs incorporate strategies to maximize peer support for healthful behavior and to counteract the effects of unhealthful behavior modeled by peers. Interventions to increase beliefs in the efficacy of lifestyle change to reduce risk are appropriate to encourage behavior change. When the change is underway, discussion of lowered susceptibility as a function of program compliance should reinforce the new behavior.

The Relationship Between Hardiness, Supervisor Support, Group Cohesion, and Job Stress as Predictors of Job Satisfaction

Purpose. This study tested a conceptual model based on research supporting the relationship between the predictors of hardiness, supervisor support, and group cohesion and the criterions of job stress and job satisfaction and between the predictor of job stress and the criterion of job satisfaction. Design. The study employed a cross-sectional research design. Survey data were collected as part of the baseline measures assessed prior to an organizational hardiness intervention. Setting. Worksite of Dell Computer Corporation in Austin, Texas. Subjects. The subjects included 160 full-time Dell employees recruited from a convenience sample representing nine work groups (response rate = 90%). Measures. Hardiness was measured using the Dispositional Resilience Scale (DRS), job stress was measured using the Perceived Work Stress Scale (PWSS), and supervisor support, group cohesion, and job satisfaction were measured using a proprietary employee attitude survey. Results. In the proposed model, high hardiness, supervisor support, and group cohesion were related to lower levels of job stress, which in turn was related to higher levels of job satisfaction. The model also proposed direct paths from hardiness, supervisor support, and group cohesion to job satisfaction. Path analysis was used to examine the goodness of fit of the model. The proposed model was a good fit for the data (χ2[1, N = 160] = 1.85, p = .174) with the exception of the direct path between group cohesion and job satisfaction. Substantial portions of the variances in job stress (R2 = .19) and job satisfaction (R2 = .44) were accounted for by the predictors. Conclusion. Implications for targeted worksite health promotion efforts to lower job stress and enhance job satisfaction are discussed.

Ethnicity and lifestyle health risk: some possible mechanisms.

Lawrence W. Green, Dr. P.H., is Professor and Director at the Center for Health Promotion Research and Development at the University of Texas Health Science Center at Houston. Ethnic differences in health status and in behavioral risk are increasingly becoming a focus for public policy in the United States. 1-3 Each year minorities in the U.S. experience at least 60,000 excess deaths (deaths beyond the numbers they would have experienced if they had the same sex and age-adjusted rates as the white population). Heart disease is responsible for the most excess deaths cumulative to age 70 in these groups. 2,~ Behavioral risk factors, including smoking, alcohol use, obesity, and lack of exercise, contribute to this burden of illness.* Health promotion and disease prevention services have not been distributed equally across all population groups? Although there are some notable exceptions such as the Planned Approach to Community Health Projects funded by the Centers for Disease Control 6, health promotion has been a white middleclass phenomenon. Participants in these lifestyle behavior change programs typically are motivated individuals who are affluent enough to purchase the services or who work in companies which make them available as a benefit.