The ecological model of health promotion and smoking behavior: Which domains significantly predict stage of change?

摘要

The present research--using the Ecological Model of Health Promotion as a guiding framework, cross-level research as the design, and the Ozark Heart Health Project as setting--examined the influence of individual and contextual variables on the smoking stage of change of individuals.;Despite remarkable decreases in the use of tobacco by individuals in the United States, the current prevalence of 25% has stabilized. Yet, cigarette smoking remains the leading cause of death and the single most preventable cause of premature mortality in the United States. Ecological frameworks have been suggested as a solution to the declining impact of intra-personally oriented intervention programs. These frameworks include the environment surrounding the individual as influential in health, without negating the power of intra-personal factors. The Ecological Model of Health Promotion (EMPH) was selected as the framework of choice.;The design of the research was cross-level, blocks of variables were included for each 'level' of the EMHP. In addition, two types of variables were found within most levels: those which were individual in nature--or self-response, and those which were contextual in nature--or at the zip code level. The sample included 700 ever smokers who lives in zip codes with population ;Four main research questions were explored: (1) is there a contextual effect on stage of change? (2) which variables are predictive of stage of change within level? (3) which levels as a whole predict stage of change? and (4) what is the additional amount of variance in stage of change explained by subsequent additions of levels?;No contextual effect for smoking stage of change was found in this data. The variables within level which were found to predict stage of change were, for the most part, supportive of prior level-specific research. All levels as a whole were found to be predictive of stage of change, supporting the notion of the EMPH that all levels are important in affecting smoking behavior change. When entered all together in subsequent blocks, specific levels added to the explained variance in smoking stage of change over and above the variance explained by the intra-personal level. This suggests that ecologic models are in fact new and innovative methods to re-establish the decline in slope of smoking cessation. Results are discussed in the context of implications for practice and further research.