At the Gateway: Action at Critical Moments Starts a Lifetime of Healthy Behavior

Doug Storey

Doug Storey

The social science literature has long recognized a connection between the use of “gateway” drugs and the later abuse of other more harmful substances. But is there such a thing as a positive gateway when individuals or families might be particularly receptive to health information and motivated to make positive behavior changes? Can particular actions taken at a critical “gateway moments” such as marriage, first pregnancy, or birth lead to a lifetime of protective health behaviors?

To investigate, Douglas Storey, PhD, director for Communication Science and Research, Johns Hopkins Bloomberg School of Public Health Center for Communication Programs, worked with colleagues to examine the evidence from three datasets: the Egypt Minya Village Health surveys between 2004-2008, the Nigeria Urban Reproductive Health Initiative baseline survey (2011) and the Nigeria Demographic and Health Survey (2008). The team analyzed the association between six gateway behaviors and various other antenatal, neonatal, postpartum, intrapartum and early childhood behaviors to determine which gateway moments had the greatest influence on subsequent health behaviors.

In a presentation November 15 at the International Conference on Family Planning, Storey reported that behaviors associated with the greatest number of other subsequent health behaviors were those that occur earliest in the family health lifecycle: interpersonal communication with one’s spouse about health; and receiving four or more proactive antenatal care visits that help women and couples anticipate the future health challenges they face.

The findings suggest that by promoting these two gateway behaviors at the critical gateway moment of pregnancy, programs can catalyze subsequent positive family health behaviors, thereby making more efficient use of health program resources. A new operations research study in Nigeria is currently testing this gateway approach under field conditions.—Kim Martin