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Community-Generated Recommendations Regarding the Urban Nutrition and Tobacco Environments: A Photo-Elicitation Study in Philadelphia

The ecological model specifies several levels of influence that are likely to determine tobacco use and healthful or unhealthful eating among youth and adults. These levels of influence are depicted as concentric circles, with the individual at the center and surrounding circles representing forces that apply pressure or force to the individual, thereby shaping health behaviors. The person at the center of the model must decide how and what she or he will eat and whether or not she or he will use tobacco. The circle surrounding the individual represents the interpersonal and household environments. Within that sphere, social interactions that occur within homes, families, or close peer groups may have an influence on the individual’s health behaviors. The next level of influence incorporates school and work environments, which can shape behavior by determining what foods and tobacco products are available, accessible, and normatively used and accepted (or not) within these environments where children and adults spend most of their time. Encompassing these lower levels of influence are neighborhood and community physical and social environments, which include commercial or retail establishments; parks, playgrounds, and streets; and the exchanges that occur in those settings. The outside circle features policy inputs on government programs or agencies, regulations, laws, and taxes.

Figure 1. The ecological model, adapted to reflect health influences on tobacco use and nutrition in both youth and adults.

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