Table 2. Participant-Generated Intervention Strategies to Promote Healthy Eating or Physical Activity, Classified Into Categories That Correspond to the Ecological Model, Philadelphia, 2012.

Theme	Participants’ Insights on Nutrition and Physical Activity
Individual level: Personal preferences and constraints drive choices and behaviors; knowledge is not necessarily translated into healthy behavior. (n = 11)	• Personal responsibility and accountability are essential.
	• Time constraints interfere with healthful food preparation.
	• Changing habits and ingrained preference for unhealthful foods is difficult.
Interpersonal level: Interactions, including those that occur within households, families, or peer groups, contribute to the learning and adoption of healthy or unhealthy behaviors. (n = 21)	• Parent–child interactions offer both positive and negative modeling of eating habits.
	• Family mealtimes can foster communication and set tone for healthful eating.
	• Ideally, school and home environments should reinforce messages about healthful eating; when messages are conflicting, then positive efforts in 1 setting may be undermined by negative forces in the other.
School and work level: Environments and policies at schools and workplaces have the potential to markedly influence health behaviors. (n = 29)	• Students and adults spend a substantial proportion of their time at school and work — so it is important to maximize healthy exposures and minimize unhealthy exposures there.
	• School cafeteria food is widely critiqued by students as both unhealthful and unpalatable.
	• Students and adults are intrigued by curricular innovations around food production and preparation (eg, urban gardening).
	• Money spent on junk food takes away money for healthful food.
Neighborhood and community level: Neighborhoods and communities need better access to healthful foods and amenities and less access to unhealthful ones; residents need to be encouraged to use existing programs and resources. (n = 35)	• Communities have to organize to demand access to more healthful food and less unhealthful food.
	• Simple solutions, like reviving play, can be good solutions.
	• “Food culture” has to change. Often healthful food options are not “sexy” and need to be made more appealing.
	• People will not go out of their way to be healthy; make it easy for them to make healthful choices.
	• Communities have a range of underused health-promoting resources now — like parks and exercise programs.
Policy input level: Government programs or agencies, regulations, laws, and taxes all can be used more effectively to promote health. (n = 20)	• Urban residents are often unaware of existing programs from which they could benefit, like Philly Bucks, which provides Supplemental Nutrition Assistance Program (SNAP) recipients a $2 voucher for every $5 spent at farmers’ markets.
	• Programs that introduce children to fresh, local foods can shape healthier preferences.
Multilevel: Interventions should target several levels concurrently. The participant insight at right combines interpersonal and school levels; other participants combined individual, community, and policy levels.	• “Half of their day is in school, half of their day is at home . . . and even if they get it from the schools, but it’s not enforced at home . . . all the work that the schools do will be thrown out the window. Or if the families are the really strong one, and they eat healthy, and they get to school and then they’re given chicken fingers . . . then it messes up the balance of wanting to live a healthier lifestyle. . . . At the end of the day it’s everybody that plays a huge part in whether this child is going to be healthier and be more conscious of what they’re eating.” (African American woman, 22 years old)