Cohen D A, Scribner R A, Farley T A
Department of Public Health and Preventive Medicine, Louisiana State University Medical Center, New Orleans, Louisiana, USA.
Prev Med. 2000 Feb;30(2):146-54. doi: 10.1006/pmed.1999.0609.
Behavior is influenced by individual-level attributes as well as by the conditions under which people live. Altering policies, practices, and the conditions of life can directly and indirectly influence individual behavior. This paper builds on existing ecological theories of health behavior by specifying structural mechanisms by which population-level factors effect change in individual health behaviors.
This paper moves ecological theory from model building to a pragmatic characterization of structural interventions. We examined social and environmental factors beyond individual control and mechanisms as to how they influence behavior.
Four categories of structural factors are identified: (1) availability of protective or harmful consumer products, (2) physical structures (or physical characteristics of products), (3) social structures and policies, and (4) media and cultural messages. The first three can directly influence individuals through facilitating or constraining behavior. The fourth, media, operates by changing individual-level attitudes, beliefs, and cognitions, as well as group norms.
Interventions that target the four identified structural factors are a means to provide conditions that not only reduce high-risk behavior but also prevent the adoption of high-risk behaviors. Structural interventions are important and underutilized approaches for improving our nation's health.
行为受到个体层面的属性以及人们生活环境的影响。改变政策、做法和生活条件能够直接或间接地影响个体行为。本文通过明确群体层面因素影响个体健康行为变化的结构机制，在现有的健康行为生态理论基础上展开论述。
本文将生态理论从模型构建推进到对结构性干预措施的务实描述。我们研究了个体无法控制的社会和环境因素及其影响行为的机制。
确定了四类结构因素：（1）防护性或有害消费品的可得性，（2）物理结构（或产品的物理特性），（3）社会结构和政策，以及（4）媒体和文化信息。前三项可通过促进或限制行为直接影响个体。第四项，即媒体，通过改变个体层面的态度、信念和认知以及群体规范来发挥作用。
针对所确定的四类结构因素的干预措施是一种手段，可为不仅减少高风险行为而且预防高风险行为的采纳提供条件。结构性干预措施是改善我国健康状况的重要且未得到充分利用的方法。
