Background. This article proposes a conceptual framework for addressing social contextual factors in cancer prevention interventions, and describes work that operationalizes this model in interventions for working class, multiethnic populations. Methods. The Harvard Cancer Prevention Program Project includes three studies: (1) an intervention study in 25 small businesses; (2) an intervention study in 10 health centers; and (3) a computer simulation modeling project that translates risk factor modifications into gains in life expectancy and number of cancers averted. The conceptual framework guiding this work articulates pathways by which social context may influence health behaviors, and is used to frame the interventions and guide evaluation design. Results. Social contextual factors cut across multiple levels of influence, and include individual factors (e.g., material circumstances, psychosocial factors), interpersonal factors (e.g., social ties, roles/responsibilities, social norms), organizational factors (e.g., work organization, access to health care), and neighborhood/community factors (e.g., safety, access to grocery stores). Social context is shaped by sociodemographic characteristics (e.g., social class, race/ethnicity, gender, age, language) that impact day-to-day realities. Conclusions. By illuminating the pathways by which social contextual factors influence health behaviors, it will be possible to enhance the effectiveness of interventions aimed at reducing social inequalities in risk behaviors.
Bibliographical noteFunding Information:
This work was made possible by a grant from the National Cancer Institute (Grant PO1 CA 75308) and by the Liberty Mutual Insurance Company. The authors thank the numerous staff members contributing to this study, including Jennifer Dacey Allen, Joyce Cheatham, Graham Colditz, Martha Fay, Robert Fletcher, Paula Goldman, Elizabeth Gonzalez-Roberts, Caitlin Gutheil, Rebecca Hannigan, Elizabeth Harden, Laura Jay, Kerry Kokkinogenis, Nancy Kreiger, Mrinmoyi Kulkami, Ruth Lederman, Nancy Lightman, Lorraine Wallace, Jane Weeks, Milton Weintstein, and Richard Youngstrom. This work would not have been possible without the participation of the small businesses and health centers. We also appreciate the comments of two anonymous reviewers on an earlier version of the manuscript.
Copyright 2017 Elsevier B.V., All rights reserved.
- Cancer prevention
- Health disparities
- Health inequalities
- Health promotion
- Physical activity