Dimensions of the Social Environment: Behavioral

Overview

There has been increasing recognition that aspects of social, physical, and cultural context can affect health status in a community by facilitating or inhibiting behaviors that impact well–being (Macintyre and Ellaway and Cummins 2002). We focus on behavior areas that are among the nation's leading health indicators and that have been repeatedly cited as major determinants of premature morbidity and mortality—tobacco use, physical activity, diet/obesity, alcohol and illicit drug use, and violence (USDHHS 2000; McGinnis and Foege 1998; Wilson 1994).

For each of these behaviors, we examine specific characteristics of communities that might influence how they will be adopted by residents. In the case of tobacco use, these characteristics include current smoking rates, the presence of cessation and preventive education programs, workplace smoking restrictions, the cost and accessibility of cigarettes, and targeted advertising. In physical activity, we include reported activity levels, physical education requirements in schools, participation in local sports and recreational activities, and availability of exercise facilities in the workplace and in the community. We also consider indicators of sedentary activities such as television viewing patterns and video game sales and use. Regarding diet and obesity, we look at consumption patterns of healthy foods such as fruit and vegetables as well as high–fat and high–sugar foods. The quality, availability, and cost of a range of different foods is of interest, as is the availability of generally less nutritious "fast food" as indexed by the number of such establishments in the area. We also include nutrition in the schools, including the prevalence of subcontracting to vendors of non–nutritious items and the presence of nutrition education programs. In assessing alcohol and illicit drug use, we consider availability as indicated by the number of liquor stores, marketing laws, and the nature of public advertising. We also include drug and alcohol treatment service availability and the presence of syringe laws and exchange programs. Violence in the community is indicated by factors such as the availability of guns and the level of exposure to violence perceived by residents.

Within the psychosocial dimension, we include theorized aspects of social capital such as civic engagement via political participation, membership in voluntary organizations and unions, and charitable giving. Crime as a marker for social cohesion is assessed through expenditures on jails and incarceration rates. Collecting information on lawsuits and the presence and use of protective services was also suggested as an indicator of the level of trust in communities.

This table presents the components and indicators of the behavioral dimension. Five behavioral psychosocial components are identified:

1. Tobacco Use
2. Physical Activity
3. Diet/Obesity
4. Alcohol and Illicit Drug Use
5. Violence

Within each component, several indicators are identified, and for each indicator at least one data set is listed.

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Page last reviewed: January 7, 2008
Page last modified: January 7, 2008

Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion