Diehr P, Koepsell T, Cheadle A, Psaty B M, Wagner E, Curry S
Department of Biostatistics, University of Washington, Seattle 98195.
J Clin Epidemiol. 1993 Oct;46(10):1141-9. doi: 10.1016/0895-4356(93)90113-f.
Communities differ in the prevalence of various health behaviors, but it is not known to what extent these differences are due to "different types" of people living in them. We used data from the evaluation of the Henry J Kaiser Family Foundation Community Health Promotion Grant Program to study individual-level and community-level variation in health behaviors for 15 communities. Our results show (1) there was significant variation among these communities in prevalences of smoking, consumption of alcohol and dietary fat, and use of seatbelts; (2) these differences persisted after control for demographic, health status, and other health behavioral characteristics of the people in the communities; (3) the community effect on a particular person's behavior, as represented by R2, was very small (less than 1%); and (4) the adjusted differences in prevalences among communities were potentially large (for example, a 7 percentage point difference in the probability of smoking). Unique features of communities may influence health behaviors. These findings affirm the potential importance of contextual effects on individual health behavior and thus support the theory that changing the community environment may offer effective ways to change individual health behavior.
不同社区各种健康行为的流行程度存在差异，但尚不清楚这些差异在多大程度上是由于生活在其中的“不同类型”的人所致。我们利用亨利·J·凯泽家庭基金会社区健康促进资助项目评估中的数据，研究了15个社区健康行为在个体层面和社区层面的差异。我们的结果显示：（1）这些社区在吸烟、饮酒、膳食脂肪摄入以及使用安全带的流行程度方面存在显著差异；（2）在对社区中人群的人口统计学特征、健康状况和其他健康行为特征进行控制后，这些差异依然存在；（3）以R2表示的社区对特定个体行为的影响非常小（小于1%）；（4）社区间流行程度的调整差异可能很大（例如，吸烟概率相差7个百分点）。社区的独特特征可能会影响健康行为。这些发现证实了背景因素对个体健康行为潜在的重要性，从而支持了这样一种理论，即改变社区环境可能提供改变个体健康行为的有效方法。
