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Heart-Healthy and Stroke-Free: A Social Environment HandbookThis document is also available in Portable Document Format (PDF - 1.2M). Learn more about PDFs. Chapter Three: Social Environment—Heart-Healthy and Stroke-Free LivingIn a broad sense, the phrase “heart-healthy and stroke-free living” includes the entire content of this handbook. Our focus in this chapter will be on environmental changes that can encourage better nutrition, more physical activity, and smoking cessation. Specifically, we will focus on 1) food environments, 2) recreational environments, and 3) smoke-free environments. First, we briefly explain the importance of considering geographic scale while assessing heart-healthy and stroke-free living. We then briefly review the contribution of food environments, recreational environments, and smoke-free environments to creating heart-healthy and stroke-free communities. Second, we list important questions about heart-healthy and stroke-free living that you can investigate in your community. These questions are organized into three tables below. Next, we offer three sample worksheets to help you get started. The worksheets provide recommendations about practical methods, space for you to record your findings, and a summary table with space for you to record the assets, strengths, needs, and challenges your community faces. Finally, a sample community assessment of heart-healthy stroke-free living environments is included here. You will be able to see how we applied various practical methods to gather useful community information, and how we recorded and summarized the information we learned on the forms. Sample worksheets are below. Why Consider Geographic Scale?Geographic scale, in the context of health promotion, refers to the specific spaces in which human activities occur. Some common examples of scales include household, neighborhood, city, county, state, and nation. Small-scale environments include the household, school, workplace, and neighborhood. Intermediate-scale environments include towns, cities, and counties. Large-scale social environments include states, regions, nations, and global regions. The social environment influences human health at multiple geographic scales at the same time. Moreover, these multiple influences may be mutually contradictory. Therefore, it is very important to evaluate the influence of the social environment at multiple scales before planning and implementing new programs and policies. For example, a family may have created healthy food, recreation, and smoke-free environments at the level of their own household. Similar positive influences at the level of the neighborhood and city may also exist. But if, at the scale of the school or worksite, the social environmental influences on health are negative, the positive influences present at other scales will have reduced impact. Similarly, a regional or national marketing campaign to sell cigarettes or high-fat snack foods has the potential to diminish the positive influences of smaller-scale social environments. Physical Activity and Recreational EnvironmentsRegular moderate to vigorous physical activity can help prevent heart disease and stroke in several ways. First, inadequate physical activity is an independent risk factor for development of heart disease and stroke. Second, regular physical activity, combined with a heart-healthy diet, is very important in preventing overweight, obesity, high blood pressure, and diabetes. Third, for people who already suffer from high blood pressure, obesity, or diabetes, regular physical activity appears to lessen the negative health consequences of these conditions. Especially in the case of diabetes, regular physical activity can improve regulation of blood sugar and insulin and lessen the likelihood of common complications. Unfortunately, despite the overwhelming evidence of the health benefits of regular physical activity, the majority of adults in the United States do not get enough exercise. We use the term “recreational environments” to encompass a wide range of social environmental conditions that may create barriers or opportunities for physical activity in a particular community. Moreover, recreational environments exist at several different geographic scales. It is important to recognize and consider how these scales interact, because environmental influences at one scale may conflict with those at another. Refer to the table below for a detailed list of questions that you may consider asking about recreational environments in your local area. Smoke-Free EnvironmentsCigarette smoking has been scientifically well-established as an important risk factor for heart disease and stroke for many years. Cigarette smoke reduces the oxygen-carrying capacity of red blood cells and introduces numerous toxins and particulates into the bloodstream, which subsequently contribute to the development of atherosclerosis. In recent years, the public health community has achieved tremendous progress in reducing the prevalence of cigarette smoking in the United States. However, a large number of children and adolescents still begin smoking each year. Moreover, social class and ethnic disparities in cigarette use have become more pronounced. “Smoke-free environments” encompass a wide range of social environmental conditions that create opportunities for smoke-free living. These include cultural, familial, institutional, and commercial policies and practices related to cigarette production, acquisition, and consumption. Smoke-free environments exist at several different geographic scales. It is important to recognize and consider the ways in which these scales interact, because environmental influences at one scale may conflict with those at another. Refer to the table below for a detailed list of questions that you may consider asking about smoke-free environments in your local area. Food EnvironmentsA large body of scientific evidence supports the statement that a diet low in fat and sodium; moderate in calories, protein, and alcohol; high in fruits and vegetables, fiber, potassium, antioxidants, and other vitamins and minerals will help to prevent atherosclerosis, high blood pressure, and the development of heart disease and stroke. Despite this evidence, the majority of adults in the United States do not consume a heart-healthy diet every day. Numerous health education campaigns have been targeted to the public, yet the prevalence of obesity has continued to rise, and high blood pressure and high blood cholesterol continue to be significant public health problems. We use the term “food environments” to encompass a wide range of social environmental conditions that may create barriers or opportunities for healthy diets. Food environments include cultural, familial, institutional, and commercial policies and practices for food production, acquisition, preparation, and consumption. Moreover, food environments exist at several different geographic scales. It is important to recognize and consider the ways these multiple scales may interact, because environmental influences at one scale may conflict with those at another. Refer to the table below for a detailed list of questions that you may consider asking about food environments in your local area. How to Use the WorksheetsWe have designed a series of three worksheets to help you investigate food environments, recreational environments, and smoke-free environments in your community. These worksheets will help you to prioritize healthy-living needs that are identified by community members. Sample worksheets with data for a hypothetical community are provided below. The blank worksheets in Chapter 10 may be freely photocopied and distributed. The first worksheet (see below) is the Planning Worksheet. Use this planning worksheet and the tables below to help choose the most important questions for your community. Write each question in the left-hand column. Then, focus on one or more geographic scales. Next, choose one or more practical methods. The second worksheet (see below) is the Results Worksheet, which you can use during and after your field work. Complete one Results Worksheet for each of the questions you identified on your Planning Worksheet. Write the question at the top of the worksheet. Then, for each practical method, record your findings under “Assets and Strengths” and “Needs and Challenges.” The third worksheet (see below) is the Summary Worksheet, which you can use to summarize your findings for food environments, recreational environments, and smoke-free environments. Identify the most important strengths and challenges from your Results Worksheets and record them here. Further Reading
Planning Worksheet for Heart-Healthy and Stroke-Free Living
|
Heart-Healthy and Stroke-Free Living Questions | Geographic Scale (circle all that apply) |
Practical Methods (circle all you plan to use) |
Notes |
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Question 1: Are healthy foods available in schools? |
Individual memory Household School Worksite Neighborhood Town or city Counties State Region |
Library research Internet search Newspapers Direct observations Windshield surveys Photography Videography Key informant interviews |
Check online and in local newspapers for school menus. |
Question 2: Are outdoor recreation facilities available? |
Individual memory Household School Worksite Neighborhood Town or city Counties State Region |
Library research Internet search Newspapers Direct observations Windshield surveys Photography Videography Key informant interviews |
Check to see where the recreational facilities are and try to determine how often they are actually used by the community. |
Question 3: What state laws and policies regulate tobacco advertising, sales, and use within the state? |
Individual memory Household School Worksite Neighborhood Town or city Counties State Region |
Library research Internet search Newspapers Direct observations Windshield surveys Photography Videography Key informant interviews |
Check on legislation passed at the state level. |
Complete one Results Worksheet for each of your questions. Write the question at the top of the worksheet. Then, for each practical method, record your findings under “Assets and Strengths” and “Needs and Challenges.” You can photocopy the blank Results Worksheet in Chapter 10.
SAMPLE
QUESTION: What laws and policies regulate tobacco advertising, sales, and use? | |||
---|---|---|---|
Practical Method (circle one) |
Geographic Scale (circle all that apply) |
Assets and Strengths | Needs and Challenges |
Library research Internet search Newspapers Direct observations Windshield surveys Photography Videography Key informant interviews |
Individual memory Household School Worksite Neighborhood Town or city Counties State Region |
Local police departments update retailers regarding state
controls on sale of tobacco. City council seeks ban on smoking for public health reasons. |
Certain establishments feel smoking ban is an
infringement on rights. Certain establishments are exempt from smoking ban. |
Library research Internet search Newspapers Direct observations Windshield surveys Photography Videography Key informant interviews |
Individual memory Household School Worksite Neighborhood Town or city Counties State Region |
Laws to prohibit advertising on billboards and city buses. Legislation to prevent access to tobacco by minors. |
Courts striking down legislation to regulate tobacco
as an addictive drug. Minors’ perception of tobacco use. |
Library research Internet search Newspapers Direct observations Windshield surveys Photography Videography Key informant interviews |
Individual memory Household School Worksite Neighborhood Town or city Counties State Region |
No smoking signs on some buildings. | Easy access by minors to tobacco products via retail
sales. Tobacco retail shops located near daycare centers and schools. |
Condense the findings recorded on your Results Worksheets to highlight the most important assets, strengths, needs, and challenges. Identify the most important geographic scales influencing heart-healthy living in your community. You can photocopy the blank Summary Worksheet in Chapter 10.
SAMPLE
Questions | Most Important Assets/Strengths | Most Important Needs/Challenges | Geographic Scales |
---|---|---|---|
Food Environments Are heart-healthy foods available in schools? Do grocery stores, specialty food stores, and restaurants offer heart-healthy foods? |
Free and reduced-cost lunches available at school. A variety of grocery stores in area. |
Struggle with soft drink giant and distribution rights at
schools. Lack of fresh produce at food stores. |
Individual memory Household School Worksite Neighborhood Town or city Counties State Region |
Recreational Environments Are there special physical activity events? Are exercise facilities available in schools and worksites? |
Annual walk-a-thon activities. Health and fitness fairs to raise awareness. |
School board plans to decrease PE programs within county. | Individual memory Household School Worksite Neighborhood Town or city Counties State Region |
Smoke-Free Environments Do local or city ordinances regulate use of cigarettes and other tobacco products in public and commercial locations? |
City council seeks ban on smoking in public places. | Some bars and restaurants are exempt from smoking ban. | Individual memory Household School Worksite Neighborhood Town or city Counties State Region |
Date last reviewed:
07/09/2007
Content source: Division for Heart Disease and Stroke
Prevention,
National Center for Chronic Disease Prevention and
Health Promotion
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