Abstract
Health behaviors can prevent many diseases and alter the course of prevalent chronic illnesses. Thousands of studies have examined diverse health behaviors. Correlates of health behaviors have been extensively documented. Myriad interventions have been tested. Despite this extensive research, we have limited evidence regarding consistently effective interventions which change health behaviors to the extent that health outcomes are improved.
Most health behavior research has focused on intrapersonal or interpersonal influences on behavior. Social cognitive theories have been a predominant influence in health behavior research. Studies using these theories are based on assumptions about conscious and deliberate decision making and emphasize attitudes, self-efficacy, and cognitive mediators of behavior. Social cognitive theory as envisioned by Bandura recognized environmental influences, although most research has placed scant emphasis on environmental factors. Theories which address underlying mechanisms of environmental influence on health behavior need to be elaborated.
Environment includes macro- and community-level factors, including social, physical, legal, and policy factors that influence health behavior decisions. Environment is the context in which health behavior decisions are made. Examining environments is one aspect of studying upstream factors which contribute to the network of interrelated influences on health behaviors. We are pleased to publish a paper in this issue about parks and physical activity among Latina women (Munet-Vilaró, Chase, & Echeverria, 2018). We welcome future manuscripts addressing environments and health behaviors.
The role of environment in habit is important. Although some health behaviors are conscious and deliberate (e.g., vaccination), many are habitual (e.g., physical activity, diet). We need studies that examine environmental influences that both prompt and maintain habitual health behaviors.
Research addressing environmental influences on behavior has been promising, but mixed results have been reported. Research examining environmental influences on health behavior is complicated. Measures to address key constructs need further development. Challenges in disentangling objective and perceived environmental influences plague these studies. Multilevel longitudinal studies are essential. The selection bias created by individuals sorting into environments best suited for their desired lifestyles is challenging in nonexperimental studies. Multilevel analyses require statistical methods that account for both mediators and moderators in complex causal modeling.
Research which examines individual, family, social, and environmental influences on behavior will be necessary to meet public health goals. Examining the context of behavior will help us reframe the predominant, implicit model of health behaviors as a conscious, discretionary lifestyle choice toward a more complete understanding of complex behaviors in context. Addressing the multilevel influences on health behavior is essential to achieve significant health improvements.