The health promotion field is often criticized for focusing on lifestyle change while ignoring contextual forces that influence health. Social ecological models recognize individuals as embedded within larger social systems and describe the interactive characteristics of individuals and environments that underlie health outcomes (Sallis, Owen, & Fisher, 2008;Stokols, 1992). More than 20 years ago, an issue of this journal was dedicated to the exploration of an ecological model for health promotion. Building on the work of Urie Brofenbrenner (1977), who had previously articulated a multilevel framework, McLeroy, Bibeau, Steckler, and Glanz (1988) offered five levels of influence specific to health behavior: intrapersonal factors, interpersonal processes and primary groups, institutional factors, community factors, and public policy.In addition to articulating level-specific influences on health behavior, the authors described possible intervention strategies at each level of influence (McLeroy et al., 1988). What is particularly important, they argued, is to conceptualize model levels as more than just settings for interventions. Specific individual and environmental changes sought by a program help identify the level of intervention. For example, the authors suggest that intrapersonal level interventions aim to change the knowledge, beliefs, and skills of individuals. Interpersonal-level and institutional-level interventions, by contrast, are designed to create change in social relationships and organizational environments. The authors propose that changes in communities derive from partnerships with agencies, churches, neighborhoods, and other mediating structures; the objective of community-focused interventions is usually to increase health services or empower disadvantaged groups. Finally, implementing public policies with health behavior implications or facilitating citizen advocacy are frequent targets of interventions at the public policy level.Ecological models assume not only that multiple levels of influence exist but also that these levels are interactive and reinforcing. Stokols (1992Stokols ( , 1996 argues that the social, physical, and cultural aspects of an environment have a cumulative effect on health. He further contends that the environment itself is multilayered, since institutions and neighborhoods are embedded in larger social and economic structures, and that the environmental context may influence the health of individual people differently, depending on their unique beliefs and practices. Creating sustainable health improvements, therefore, is most effective when all of these factors are targeted simultaneously. Stokols (1996), however, notes that influencing all aspects of the environment Abstract Social ecological models that describe the interactive characteristics of individuals and environments that underlie health outcomes have long been recommended to guide public health practice. The extent to which such recommendations have been applied in health promotion interventions, however...

Efforts to change policies and the environments in which people live, work, and play have gained increasing attention over the past several decades. Yet health promotion frameworks that illustrate the complex processes that produce health-enhancing structural changes are limited. Building on the experiences of health educators, community activists, and community-based researchers described in this supplement and elsewhere, as well as several political, social, and behavioral science theories, we propose a new framework to organize our thinking about producing policy, environmental, and other structural changes. We build on the social ecological model, a framework widely employed in public health research and practice, by turning it inside out, placing health-related and other social policies and environments at the center, and conceptualizing the ways in which individuals, their social networks, and organized groups produce a community context that fosters healthy policy and environmental development. We conclude by describing how health promotion practitioners and researchers can foster structural change by (1) conveying the health and social relevance of policy and environmental change initiatives, (2) building partnerships to support them, and (3) promoting more equitable distributions of the resources necessary for people to meet their daily needs, control their lives, and freely participate in the public sphere.

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Objective Neighborhood socioeconomic and racial/ethnic disparities exist in the amount and type of tobacco marketing at retail, but most studies are limited to a single city or state, and few have examined flavored little cigars. Our purpose is to describe tobacco product availability, marketing, and promotions in a national sample of retail stores and to examine associations with neighborhood characteristics. Methods At a national sample of 2,230 tobacco retailers in the contiguous US, we collected in-person store audit data on: Availability of products (e.g., flavored cigars), quantity of interior and exterior tobacco marketing, presence of price promotions, and marketing with youth appeal. Observational data were matched to census tract demographics. Results Over 95% of stores displayed tobacco marketing; the average store featured 29.5 marketing materials. 75.1% of stores displayed at least one tobacco product price promotion, including 87.2% of gas/convenience stores and 85.5% of pharmacies. 16.8% of stores featured marketing below three feet, and 81.3% of stores sold flavored cigars, both of which appeal to youth. Stores in neighborhoods with the highest (vs. lowest) concentration of African-American residents had more than two times greater odds of displaying a price promotion (OR=2.1) and selling flavored cigars (OR=2.6). Price promotions were also more common in stores located in neighborhoods with more residents under age 18. Conclusions and relevance Tobacco companies use retail marketing extensively to promote their products to current customers and youth, with disproportionate targeting of African Americans. Local, state, and federal policies are needed to counteract this unhealthy retail environment.

We evaluate race/ethnicity and nativity-based disparities in three different types of intimate partner violence (IPV), and examine how economic hardship, maternal economic dependency, maternal gender beliefs, and neighborhood disadvantage influence these disparities. Using nationally representative data from urban mothers of young children who are living with their intimate partners (N=1,886), we estimate a series of unadjusted and adjusted logit models on mother’s reports of physical assault, emotional abuse, and coercion. When their children were age three, more than one in five mothers were living with a partner who abused them. The prevalence of any IPV was highest among Hispanic (26%) and foreign-born (35%) mothers. Economic hardship, economic dependency on a romantic partner, and traditional gender beliefs each increased women’s risk for exposure to one or more types of IPV, whereas neighborhood conditions were not significantly related to IPV in adjusted models. These factors also explained most of the race/ethnic and nativity disparities in IPV. Policies and programs that reduce economic hardship among women with young children, promote women’s economic independence, and foster gender equity in romantic partnerships can potentially reduce multiple forms of IPV.