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Alcoholism represents a major social problem for the adult population in the United States not only in terms of consequent addictions and financial dependence due to loss of productivity and absenteeism, but also in enhancing neighborhood crime, traffic accidents due to drunk driving, incarceration rates of offenders, family-related violence, and social costs related to fetal alcohol syndrome (Black & Paltzer, 2013).
These authors acknowledge that the problem of excessive alcohol consumption among adults in the state of Wisconsin is deeply rooted, and has led to several public health challenges that require immediate intervention.
The indicators of excessive alcohol consumption in Wisconsin are many and varied. In 2011, for example, excessive alcohol consumption in this state “resulted in approximately 1529 deaths, 48,578 hospitalizations, 46,583 treatment admissions, 60,221 arrests, and 5,751 motor vehicle accidents” (Black & Paltzer, 2013, p. 1).
Additionally, as reported by these authors, Wisconsin has over the years reported high incidences of alcohol consumption and dependence among its adult population and pregnant women. Many of the victims reported in the mentioned statistics are 35 years or older, implying that these indicators are a true representation of how the problem of excessive alcohol consumption is affecting the adult population.
Social Determinants of Health
It can be argued that the two foremost social determinants of health impacting the issue of excessive alcohol consumption include lack of social support networks/social exclusion and stress.
Adults and the elderly are more likely to lack social and emotional support systems and become socially excluded from the community due to factors such as advancing age, death of a spouse or close friends, retirement, altered activity levels, comorbidity, relocation of family and friends, and family dissonance (Briggs, Magnus, Lassiter, Patterson, & Smith, 2011).
Similarly, it has been reported that adults and older people are likely to experience psychological distress due to varied life events, including retirement, menopause, children leaving home, assuming a caregiving role, and death of a spouse or partner (Sorrocco & Ferrell, 2006).
The selected social determinants of health impact the health-related risk behaviors of adults in terms of
- triggering withdrawn, isolated, impulsive or hypersensitive behaviors,
- enhancing sleep problems and malnutrition,
- reinforcing suicidal ideation,
- increasing the number of deaths arising from cardiovascular disease (Sorrocco & Ferrell, 2006).
Socio-Ecological Theory & Application
The significance of the socio-ecological model is grounded on the fact it is a highly adaptable tool that can be used by public health professionals and other stakeholders to not only identify prevailing health issues by revealing the diverse yet interrelated issues affecting human behavior across the five levels of the model (individual, interpersonal, organizational, community/environment, and society/public policy), but also to deal with these issues by customizing interventions to achieve optimal outcomes (Pearson, Vaughan, Vaughan, & FitzGerald, 2005).
Consequently, the socio-ecological model can be applied to identify the population and health-related issues that are directly associated with the two foremost social determinants of health mentioned above (lack of social support networks/social exclusion and stress), and also to enable public health officials and other professionals to develop customized interventions to deal with the issue of excessive alcohol consumption among adults.
The intervention proposed in this paper is for the state government to provide adequate funds that would be used to operate media campaigns targeted at the factors associated with the mentioned social determinants of health.
These factors include advancing age, death of a spouse/partner or close friends, retirement, altered activity levels, comorbidity, relocation of family and friends, family dissonance, menopause, children leaving home, and assuming a caregiving role for dependents (Briggs et al., 2011; Sorrocco & Ferrell, 2006).
Applying this intervention across all levels of the socio-ecological model is bound to contribute to positive health outcomes due to a number of factors, such as
- ability to provide public health officials and other stakeholders with a framework for understanding the complex interplay between the factors that are unique to different levels of the model,
- capacity to take a holistic approach in identifying and understanding the factors related to excessive consumption of alcohol among adults,
- capacity to ensure that factors in different levels of the model are successfully addressed using a holistic approach (McMurray, 2007).
The visual application of the socio-ecological model for the mentioned intervention is illustrated below.
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Table 1 Application of the Socio-ecological Model
|Society/public policy|| |
Figure 1 Application of the Socio-ecological Model
Stakeholders and Organizations
For the successful execution of the mentioned intervention, there is need to involve health professionals, public health officials, researchers, community leaders, media consultants, and policy makers. Health professionals, public health officials and researchers will provide rich contextual information on
- how adults should cope with the factors arising from the mentioned social determinants of health,
- how such factors should be dealt with across the five levels of the socio-ecological model (Bauer et al., 2003).
Community leaders will be involved in identifying the needs and challenges of adults at the community level, while media consultants will be involved in designing the pamphlets for delivery to the affected population and health messages to be aired using various communication channels (e.g., radio, TV).
State and local policy makers will be involved in debating and enacting legislation aimed at providing the legal basis for the media campaigns and funding.
Social support networks, community-based organizations (CBOs), faith-based organizations (FBOs), health institutions, different media organizations, funding agencies, and state- and local-wide governments will also be involved.
Social support networks, CBOs and FBOs will be used as reference organizations not only in distributing the pamphlets to the affected population, but also in providing avenues for the development of social networks, reorientation of social support organizations, and strengthening of community action (Bauer et al., 2003).
Health institutions will be used to provide the much needed mental health care services to adults, while media organizations will be involved in ensuring the health messages get to the affected population through a multiplicity of communication channels.
The primary role of funding agencies is to avail the funds needed to implement the intervention, while that of state- and local-wide governments is to ensure that policies are put in place to support the intervention and hence facilitate successful implementation (McMurray, 2007).
Principals of Community-based Participatory Research
Community-based participatory research (CBPR) has been defined in the literature as “a collaborative approach to research that involves the equitable participation of those affected by an issue in the research process” (Kamanda et al., 2013, p. 1). In illuminating the principles, it is important to note that CBPR
- recognizes the community as a unit of identity,
- builds on strengths and resources within the community,
- enhances collaborative partnerships in all phases of the research,
- integrates knowledge and action for mutual benefit of all partners,
- promotes a co-learning and empowering process that addresses recognized social inequities,
- involves a cyclical and iterative process,
- addresses health from both positive and ecological standpoints,
- disseminates findings and knowledge gained to all partners, hence enhancing the understanding of a problem within the social, political, economic and cultural context of the community with the objective of taking action to improve the health and well-being of community members (Freudenberg & Tsui, 2014).
As demonstrated by Freudenberg and Tsui (2014), meaningful improvements in health for adults require modifying the social determinants of health that have been critical in reinforcing excessive alcohol consumption in this group of the population.
Consequently, in implementing the intervention of media campaigns, it is important to build on the strengths and resources within the community in identifying and dealing with the factors associated with the mentioned social determinants of health.
The community must be used as a reference point in disseminating media campaigns aimed at assisting adults to cope with the various factors associated with lack of support systems/social exclusion and stress. This calls for clarity in defining the roles of social support systems and other organizations found within the community, particularly in relation to the provision of socio-economic and emotional support to adults
Collaborative relationships and partnerships must be enhanced among the relevant stakeholders in an attempt to develop tailor-made media campaigns targeting the adults and how they can deal with the factors that lead them to abuse alcohol.
For example, public health officers, health care professionals and researchers from various universities across the state of Wisconsin should implement collaborative partnerships aimed at developing rich contextual health messages on how adults should cope with retirement, comorbidity, death of spouse or partner, and other health-related risk behaviors associated with social exclusion and stress (e.g., suicidal ideation, sleep problems and hypersensitive behaviors).
Available CBO’s, FBOs, community health institutions and media channels should be used to disseminate the pamphlets and health messages with the view to integrating knowledge and action for the mutual benefit of all partners (Kamanda et al., 2013).
According to the CBPR approach, the media campaigns should be implemented in a manner that enhances a co-learning and empowering process with the view to directly addressing the social determinants of health associated with excessive consumption of alcohol in adults (Kamanda et al., 2013).
Indeed, for the campaigns to succeed in addressing the health concerns of the population from both positive and ecological standpoints, they must have the capacity to provide adequate health information and also encourage adults to adapt well-researched personal and life skills.
Lastly, the pamphlets and health messages should be disseminated to the target group and all other partners engaged with the intervention not only to facilitate the learning process, but also to rally all stakeholders behind the case for change and the need for policy makers to allocate adequate resources to successfully implement the media campaigns (Freudenberg & Tsui, 2014).
Drawing from the above exposition, it is clear that the targeted intervention of rolling out media campaigns is likely to succeed in contributing to favorable health outcomes for adults due to a number of factors, namely
- inclusion of the social determinants of health in attempting to identify the factors that cause adults to become dependent on alcohol,
- employment of the socio-ecological model in developing tailor-made solutions for each of the factors across the five levels of the model,
- inclusion of all relevant stakeholders and partners in designing and implementing the intervention,
- assuming a holistic approach in dealing with health and ecological factors associated with excessive consumption of alcohol among adults.
Lastly, the proposed intervention informs, educates, and empowers people about the issue of excessive alcohol consumption among adults by ensuring the dissemination of rich contextual information on the health and ecological factors associated with this issue and how these factors can be successfully resolved. Here, pamphlets and health messages aired over the radio or TV are used to disseminate the information.
The proposed intervention also mobilizes community partnerships and action to identify and solve health problems by bringing together public health officials, health care professionals, researchers, media consultants, CBOs, FBOs, and health institutions in designing and disseminating the various media campaigns aimed at fighting excessive alcohol consumption among the adult population.
Bauer, G., Davies, J.K., Pelikan, J., Noack, H., Broesskamp, U., & Hill, C. (2003). Advancing a theoretical model for public health and health promotion indicator development: Proposal from the EUHPID consortium. European Journal of Public Health, 13(3), 107-113.
Black, P., & Paltzer, J. (2013). The burden of excessive alcohol use in Wisconsin. Web.
Briggs, W.P., Magnus, V.A., Lassiter, P., Patterson, A., & Smith, L. (2011). Substance use, misuse, and abuse among older adults: Implications for clinical mental health counselors. Journal of Mental Health Counseling, 33(2), 112-127.
Freudenberg, N., & Tsui, E. (2014). Evidence, power, and policy change in community-based participatory research. American Journal of Public Health, 104(1), 11-14.
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