Health promotion addresses issues from the simple (with well-known cause/effect links) to the highly complex (webs and loops of cause/effect with unpredictable, emergent properties). Yet there is no conceptual framework within its theory base to help identify approaches appropriate to the level of complexity. The default approach favours reductionism--the assumption that reducing a system to its parts will inform whole system behaviour. Such an approach can yield useful knowledge, yet is inadequate where issues have multiple interacting causes, such as social determinants of health. To address complex issues, there is a need for a conceptual framework that helps choose action that is appropriate to context. This paper presents the Cynefin Framework, informed by complexity science--the study of Complex Adaptive Systems (CAS). It introduces key CAS concepts and reviews the emergence and implications of 'complex' approaches within health promotion. It explains the framework and its use with examples from contemporary practice, and sets it within the context of related bodies of health promotion theory. The Cynefin Framework, especially when used as a sense-making tool, can help practitioners understand the complexity of issues, identify appropriate strategies and avoid the pitfalls of applying reductionist approaches to complex situations. The urgency to address critical issues such as climate change and the social determinants of health calls for us to engage with complexity science. The Cynefin Framework helps practitioners make the shift, and enables those already engaged in complex approaches to communicate the value and meaning of their work in a system that privileges reductionist approaches.

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Four hundred forty-two women and 341 men were surveyed at Panama City Beach, Florida, to assess the effects of gender, age, fraternity or sorority membership, and travel motivation on alcohol consumption and binge drinking during spring break. The mean number of drinks consumed the previous day was 18 for men and 10 for women; 91.7% of the men and 78.1% of the women had participated in a binge-drinking episode during the previous day. Respondents less than 21 years old consumed less alcohol and reported significantly lower frequencies of intoxication than those over 21. The men's reported levels of alcohol consumption, binge drinking, and intoxication to the point of sickness were significantly higher than the women's, but fraternity or sorority membership was not associated with higher levels of consumption. Students motivated to visit the specific destination because of its "party" reputation consumed significantly more alcohol than students who cited other reasons for going there.

The TFV program was a one-year intervention conducted during 2006 and 2007 in 18 preschools (matched with 13 control preschools). The study had a quasi-experimental design with pre- and postintervention evaluation of nutrition and physical activity variables as well as anthropometric measures. Details of the program's methodological aspects such as the recruitment process, intervention strategies and evaluation instruments are described.

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