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Individual LevelBy Sarah Maness

Learning Objectives

• Understand how the Individual Level plays a role in the following:– Social Ecological Model– Determinants of Health

• Discuss Individual Level Factors that can contribute to health outcomes

• Apply examples of health behaviors to the individual level

Outline

• Social Ecological Model

• Determinants of Health

• Individual Level Factors‐ Socio‐demographics‐ Psychosocial‐ Lifestyle‐ Psychological

• Health Outcomes Impacted by Individual Factors– Risky Sexual Behavior– Obesity

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INDIVIDUAL

INTERPERSONAL

COMMUNITY

ORGANIZATIONAL/INSTITUTIONAL

SOCIETAL/POLITICAL

Race/ethnicity

Age

Socio‐economic status (SES)

Gender

Family 

FriendsPeers

Healthcare Providers

Workplace

School

Neighborhood

Federal and State Laws

Policies

RegulationsSocietal Norms

Attitudes

Education

Physical Environment

Social Environment

Culture

Media

Organization Rules

HealthcareSystem

Broad level Culturee.g., Racism

Sex

Organizational Culture

Social Ecological Model

Determinants of Health

• “The conditions in which people are born, live, work and age” – WHO

– Shaped by money, power, resources

– Responsible for health inequities

– Comprised of internal and external factors

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Internal and External Factors

• Internal factors 

‐ Characteristics of the individual

‐ Inherited or learned

‐ May be physical, social, psychological, or behavioral

• External factors

– Characteristics of the community

– May be physical, social, economic

– Discuss these factors, included in other levels of the SEM, throughout the semester

Determinants of Health Disparities

Psychosocial ‐ compliance, coping

Lifestyle ‐ exercise, diet, alcohol, smoking, sexual behavior, illicit drug use

Health care

Sociodemographics ‐ age, race, ethnicity, education, income

Physical environment

Social environment

Healthdisparities

Psychological ‐ beliefs, attitudes,personality 

Contextual Individual‐level

Organizational,institutional

Economic resources

Societal, political

(External factors)  (Internal factors) 

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Socio‐demographics

• Age

• Race

• Ethnicity

• Education

• Income

• Gender

Psychosocial

• Coping

• Compliance

• Stress

• Depression

• Risk taking

• Social Support

Lifestyle

• Exercise

• Diet

• Alcohol use

• Smoking

• Sexual behavior

• Drug use

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Psychological

• Beliefs

• Attitudes

• Personality

Example: Sexual Risk Behaviors 

• Adolescent Sexual Risk Behaviors (CDC, 2012)

‐ Ever had sexual intercourse

‐ Frequency of sexual intercourse

‐ Condom or birth control use

‐ Number of sexual partners

• Adverse Outcomes (CDC, 2012)

– HIV

– STIs

– Pregnancy 

Socio‐DemographicsSexual Risk Behaviors

• Age 

– Half of 19 million new STDs each year among people aged 15‐24 (CDC, 2012)

• Race/Ethnicity

– African American and Latino youth more likely to experience teenage pregnancy (CDC, 2012)

• Gender

– Prevalence of sexual risk behaviors higher in males (Puente et al., 2011; Newman & Zimmerman, 2000)

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PsychosocialSexual Risk Behaviors

o Risk taking behaviors (Ratliff‐Crain et al., 1999)

– High number of partners

– Unprotected sex

• Perceived peer norms (Ratliff‐Crain et al., 1999)

– Perceptions of friends attitudes or behaviors regarding sexual risk taking

LifestyleSexual Risk Behaviors

o Alcohol use (Naimi et al., 2003; Weschler

et al., 1994)

– Binge drinking linked to risky sexual behavior

o Sexual behavior (CDC, 2012)

– Number of lifetime partners

– Frequency of intercourse

– Age of initiation 

PsychologicalSexual Risk Behaviors

• Knowledge

– Understanding of sexual health

– Transmission of STIs/HIV

• Beliefs and attitudes

– Perception of consequences

– Evaluation of consequences(Ratleff‐Crain et al., 1999)

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Applied Example: Obesity

Health Condition Overview

• What is obesity?

– An adult who has a Body Mass Index (BMI) of greater than 30

• What are some health risks associated with obesity?

– Coronary heart disease– Type 2 diabetes– Cancer– High blood pressure– Stroke– Sleep apnea and respiratory problems– Gynecological problems (CDC, 2012)

Applied Example: Obesity

It’s your turn!

Can you think of four individual level factors related to obesity?

Applied Example: Obesity

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Applied Example: Obesity

• Socio‐Demographic– Cultural dishes– Regional preferences– Age

• Psychosocial– Stress eating– Eating to cope

• Lifestyle– Fast food– Pre‐packaged frozen food

• Psychological

– Chronic disease

– “It won’t happen to me”

Also to consider outside of behavior…

• Biological 

– Medical conditions

– Genetic factors

– Metabolism

INDIVIDUAL

INTERPERSONAL

COMMUNITY

ORGANIZATIONAL/INSTITUTIONAL

SOCIETAL/POLITICAL

Race/ethnicity

Age

Socio‐economic status (SES)

Gender

Family 

FriendsPeers

Healthcare Providers

Workplace

School

Neighborhood

Federal and State Laws

Policies

RegulationsSocietal Norms

Attitudes

Education

Physical Environment

Social Environment

Culture

Media

Organization Rules

HealthcareSystem

Broad level Culturee.g., Racism

Sex

Organizational Culture

Social Ecological Model

References

• Centers for Disease Control and Prevention (2012). Sexual Risk Behavior: HIV, STD & Teen Pregnancy Prevention. http://www.cdc.gov/healthyyouth/sexualbehaviors/index.htm

• Centers for Disease Control and Prevention (2012). About Teen Pregnancy. http://www.cdc.gov/TeenPregnancy/AboutTeenPreg.htm

• Centers for Disease Control and Prevention (2012). Defining overweight and obesity. http://www.cdc.gov/obesity/adult/defining.html

• Naimi TS, Lipscomb LE, Brewer RD, Colley BG. Binge drinking in the preconception period and the risk of unintended pregnancy: Implications for women and their children. Pediatrics 2003;11(5):1136–1141.

• NIH, NHLBI Obesity Education Initiative. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Available online: http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf [PDF-1.25Mb]

• Puente, D., Zabaleta, E., Rodriguez-Blanco, T., Cabanas, M., Monteagudo, M., Pueyo, MJ., Jane, M., Mestre, N., Mercader, M. Bolibar, B. (2011). Gender differences in sexual risk behavior among adolescents in Catalonia, Spain. Gaceta Sanitaria 25(1): 13-9.

• U.S. Department of Health and Human Services. The Surgeon General's call to action to prevent and decrease overweight and obesity. [Rockville, MD]: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; [2001]. Available from: US GPO, Washington.

• Wechsler H, Davenport A, Dowdall G, Moeykens B, Castillo S. Health and behavioral consequences of binge drinking in college. JAMA 1994;272(21):1672–1677.