文章基本信息

标题：The Influence of Social Context on Changes in Fruit and Vegetable Consumption: Results of the Healthy Directions Studies
本地全文：下载
作者：Glorian Sorensen ; Anne M. Stoddard ; Tamara Dubowitz 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2007
卷号：97
期号：7
页码：1216-1227
DOI：10.2105/AJPH.2006.088120
语种：English
出版社：American Public Health Association
摘要：As part of the Harvard Cancer Prevention Program Project, we used a social contextual model of health behavior change to test an intervention targeting multiple risk-related behaviors in working-class, multiethnic populations. We examined the relationships between the social contextual factors in our conceptual model and changes in fruit and vegetable consumption from baseline to completion of intervention in health centers and small business studies. We analyzed change in fruit and vegetable consumption, measured at baseline and final assessments by self-report, in 2 randomized controlled prevention trials: 1 in small businesses (n = 974) and 1 in health centers (n = 1954). Stronger social networks, social norms that were more supportive, food sufficiency, and less household crowding were associated with greater change in fruit and vegetable intake. We also observed differences between our intervention sites. Social context can play an important role in promoting changes in fruit and vegetable consumption. The social epidemiology literature has consistently demonstrated that regardless of how it is measured, lower socioeconomic position is associated with poorer health outcomes. 1 ^– 4 Disparities in health outcomes by race/ethnicity have also been observed. 5 Socioeconomic position and race/ethnicity shape many health behaviors, such as dietary patterns, physical activity, and tobacco and alcohol consumption. Fruit and vegetable consumption, for example, increases with education level and income, 6 ^, 7 is higher among individuals in white-collar rather than blue-collar occupations, 8 and differs by race/ethnicity. 9 These disparities are important because increased consumption of fruits and vegetables has been shown to reduce risk of chronic conditions, including type 2 diabetes, heart disease, stroke, and obesity, 10 ^– 17 all of which disproportionately contribute to increased morbidity and mortality in lower socioeconomic groups. Strategies to influence less-healthful behaviors among lower socioeconomic populations have been initiated by others. 18 ^– 21 As part of the Harvard Cancer Prevention Program Project, we developed a common behavioral intervention model, “Healthy Directions,” that targeted multiple risk-related behaviors 22 ; we tested the model in 2 randomized trials, 1 conducted through small businesses 23 ^, 24 and the other through health centers. 25 We designed this behavioral intervention specifically for working-class, multi-ethnic populations. The intervention tested in these studies operationalized a conceptual framework based on social context 22 that delineated pathways through which population characteristics (e.g., income, 26 ^, 27 race/ethnicity, 5 and acculturation 28 ^– 31 ) might be related to and influence health behaviors. By explicating these pathways, we were able to design and test interventions that attended to the social context of participants’ lives and were therefore meaningful and relevant to the intended audiences. The interventions in both studies were designed to change selected social context factors that influenced behavior and were amenable to change (e.g., social norms) and to be responsive to factors that were important determinants of behavior but that could not be altered by the intervention (e.g., material circumstances such as access to a car). 22 ^, 32 Overall, we found that these interventions were efficacious in changing the targeted health behaviors. In the Cancer Prevention in Health Centers Study (hereafter health centers study), participants in the intervention health centers made significantly greater improvements than did those in the control group in 3 of the 4 targeted risk behaviors: fruit and vegetable consumption, red meat consumption, and multivitamin use. 33 In the Cancer Prevention in Small Business Study (hereafter small business study), workers in intervention sites made significantly greater improvements than did those in control sites in the use of multi-vitamins and in physical activity. Although there was no significant intervention effect for the overall sample regarding fruit and vegetable consumption, we found a statistically significant interaction between the intervention and job status: the effects of the intervention were larger among nonmanagers than among managers. 34 This finding was promising because our intervention was specifically targeted to working-class men and women. We present the first analyses from the Harvard Cancer Prevention Program Project to examine the relationships of the social contextual model to change in 1 of our outcomes. We examined the relationships between the social contextual factors in our conceptual model and changes in fruit and vegetable consumption from baseline to completion of intervention in both the health centers study and small business study. We also examined the extent to which these relationships might be influenced by the interventions.