1. Integrating Health Promotion and Environmental Change Candice A. Myers, Ph.D. Childhood Obesity and Public Health Conference April 1, 2014

2. Learning objectives 1) Benefits of considering the environment 2) Synergy!! 3) Multilevel interventions (?) 4) Guidance Why Does the Environment Matter for Health Promotion Programs?

3. – 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/

4. Social Ecological Perspective: Levels of Influence Intrapersonal: Individual Interpersonal: Family Organizational/Institutional: Schools Community: Neighborhood Society: Policy, Law, Culture

5. 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?

6. Health Promotion Programs versus Environmental Programs Individual Appropriate Energy Intake (Diet) + Appropriate Energy Expenditure (Physical Activity) = Energy Balance Positive Health Outcomes Decreased risks for: Obesity Diabetes CVD Environmental Programs Favorable: Social Conditions Food Availability Physical Activity Resources Opportunity *necessary for positive change* Health Promotion Programs Adoption of healthy behaviors Agency *necessary for positive change*

7. … 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

8. 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?

9. 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

10. 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

11. Accumulation Daily step goal Outdoor exercise/play Behavioral strategies and pedometer (intrapersonal) Construction of new park with amenities (community)

12. Facilitation Daily step goal Construction of new park with amenities (community) Behavioral strategies and pedometer (intrapersonal) Outdoor play/exercise

13. 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

14. Learning objectives 1)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?

15. 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

16. Contact Information: Candice A. Myers, Ph.D. Pennington Biomedical Research Center candice.myers@pbrc.edu Thank You!