• Ecological Model of Four Domains of Active Living (Sallis, 2006)
    • Model is organized around four domains of physical activity
    • Some types of relevant influences are not tied to settings where the behavior takes place
    • Social and cultural environments operate at multiple levels
  • Social Ecological Model (Sorensen, 2003)
    • Uses a social ecological framework to conceptualize social contextual modifiers and mediators as cutting across multiple levels of influence
    • Framework considers:
      • Individual factors (income, debt)
      • Interpersonal factors (social ties, family roles)
      • Social norms
      • Organizational factors (job strain)
      • Neighborhood factors (safety, sidewalks)
      • Societal forces/social determinants (racism, discrimination)
      • Public policy
    • Operationalizing the Framework for Intervention Design: Examples from The Harvard Cancer Prevention Program Project
      • Objective: Develop and test behavioral interventions for multiple cancer risk factors in working-class and ethnically diverse groups, and estimate the impact of the degree of behavior change found in the intervention projects on decreased cancer rates and economic benefits on a population level.
      • Methods: Two intervention studies aimed to address social contextual factors in the design of behavioral interventions for cancer prevention. Sites included:
        • an intervention study in 25 small businesses
        • an intervention study in 10 health centers
      • Studies examined four risk-related behaviors: physical activity, red meat consumption, fruit and vegetable consumption, and multivitamin use.
      • Harvard Cancer Prevention Program Project interventions were designed to address social context in two ways:
        1. For social contextual factors defined as modifying conditions, investigators aimed to enhance the effectiveness of the interventions by a sensitivity to and understanding of the day-to-day realities of low-income, multiethnic populations.
          • Example: Physical activity intervention was not designed to increase the safety of participants' neighborhoods and thereby increase physical activity; rather, investigators acknowledged the barriers and addressed them by providing free gym passes, working with employers to provide walking paths, providing linkages to community resources, and creating opportunities for group exercise.
        2. Investigators identified as mediating mechanisms those social contextual factors that were amenable to change through the interventions, such as social support, social norms, and organizational environments.
          • Example: Worksite interventions provide ready access to social networks and organizational structures. Within the Harvard Cancer Prevention Project's small business study, interventions aimed to increase coworker social support for behavior change through activities such as group walking clubs and team competitions. Interventions also were undertaken with worksite management to promote a healthy and safe work environment.