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Health Sciences
Health Sciences 2000A/B
Leichelle Little

Health Behaviour Change and Risk Motivation Health Behaviours Influenced by the social, cultural and physical environments in which we live and work Shaped by…? Early indicators of…? Can be classified into two broad categories: Risk Behaviours (Health Compromising) – Harm current or future health Smoking Junk food Alcohol consumption Positive Behaviours (Health-Enhancing) – Promote health and prevent disease Young adults, particularly men, are most likely to engage in health risk behaviours Why? Characteristics of Health Compromising Behaviours Window of vulnerability in adolescence Behaviours are tied to peer culture Image of these behaviours as ‘cool’ Behaviours, though dangerous, are pleasurable Behaviours develop gradually rather than being acquired ‘all at once’ Capturing Patterns of Behaviour in Canada “To capture patterns of behaviour in Canada, four indicators are present: two health risk behaviours, and two associated with disease prevention” – Stats Canada Current smoking Heavy drinking Leisure-time physical activity Fruit and vegetable consumption Behaviour Change Models The Health Belief Model The Theory of ReasonedAction/Planned Behaviour Social Cognitive Theory The Transtheoretical Model The Health Belief Model Use: It was originally conceived by social psychologists in the public health arena in an attempt to understand the “widespread failure of people to accept disease preventives or screening tests for the early detection of asymptomatic disease” Predicting who would utilize screening tests and/or vaccinations Used for intervening with health screening, illness, sick role, and precautionary behaviours Concept Definition Application Perceived Susceptibility One’s opinion of chances of Define population(s) at risk, risk getting a condition levels; personalize risk behaviour based on a person’s features or behaviour; heighten perceived susceptibility if too low Perceived Severity One’s opinion of how serious a Specify consequences of the condition and its consequences risk and the condition are Perceived Benefits One’s belief in the efficacy of Define action to take; how, the advised action to reduce risk where, when; clarify the or seriousness of impact positive effects to be expected Perceived Barriers One’s opinion of the tangible Identify and reduce barriers and psychological costs of the through reassurance, incentives, advised action assistance Cues toAction Strategies to activate Provide how-to information, “readiness” promote awareness, reminders Self-Efficacy Confidence in one’s ability to Provide training, guidance in take action performing action The Theory of ReasonedAction/Planned Behaviour Use: Applied to many diverse health-related behaviours including: weight loss, smoking, alcohol abuse, HIV risk behaviours, and mammography screening Amodified version of TRAincludes the addition of…? And is referred to as the Theory of Planned Behaviour (TPB) Constructs Description Behavioural Intention Perceived likelihood of performing the behaviour Attitudes The product of the behavioural belief multiplied by the evaluation of it Behavioural Belief Evaluation of the likelihood that performance of the behaviour is associated with certain outcomes Evaluation of B.B. How good or how bad those outcomes would be Subjective Norm The product of the normative belief multiplied by the motivation to comply Normative Belief Perception of how much each personal contact approves or disapproves of the behaviour Motivation to Comply Motivation to do what each personal contact person wants Perceived Behavioural The product of the control belief multiplied by the perceived power Control Control Belief Perceived likelihood of each facilitating or constraining condition occurring Perceived Power Perceived effect of each condition in making the performance of the behaviour easier or more difficult Social Cognitive Theory Use: Applied to prevention, health promotion, and modification of unhealthy lifestyles for many different risk behaviours Reciprocal determinism: There is a continuous, dynamic interaction between the individual, environment and behaviour Constructs Description Environmental Factors outside the person Situation One’s perception of the environment Behavioural Capability One’s knowledge and skills to perform a behaviour Expectations One’s anticipation of the outcomes of a behaviour Expectancies How good or bad one evaluates the outcomes to be Self-control Regulation of one’s own behaviour Observational Learning Acquiring a new behaviour by watching someone else perform it and observing the outcomes – a.k.a. modeling Reinforcements Responses to a person’s behaviour that affect how likely it is that the behaviour will reoccur Self-efficacy One’s confidence in one’s own ability to perform a behaviour Emotional Coping Responses Strategies used by someone to deal with emotionally challenging thoughts, events, or experiences Reciprocal Determinism Dynamic interaction of the person, the behaviour, and his/her environment The Transtheoretical Model Use: Applied to wide range of health behaviours, such as smoking cessation, exercise adoption, sun protection, dietary fat reduction, condom use, adherence to mammography screening, medication adherence, stress management, substance abuse… Describes behaviour change as a process, as opposed to an event Breaking change process into stages – studying which variables are most strongly associated with progress through the stages Constructs Description Stages of Change Precontemplation No intention to take action within the next 6 months Contemplation Intends to take action within the next 6 months Preparation Intends to take action within the next 30 days and has taken some behavioral steps in this direction Action Has changed overt behaviour for less than 6 months Maintenance Has changed overt behaviour for more than 6 months Decisional Balance Pros The benefits of changing Cons The costs of changing Self-efficacy Confidence Confidence that one can engage in the healthy behaviour across different challenging situations Temptation Temptation to engage in the unhealthy behaviour across different challenging situations Process of Change Consciousness Raising Finding and learning new facts, ideas, and tips that support the healthy behaviour change Dramatic Relief Experiencing the negative emotions (fear, anxiety, worry) that go along with unhealthy behavioral risks Self-reevaluation Realizing that the behaviour change is an important part of one’s identity as a person Environmental Reevaluation Realizing the negative impact of the unhealthy behaviour, or the positive impact of the healthy behaviour, on one’s proximal social and/or physical environment Self-liberation Making a firm commitment to change Helping Relationships Seeking and using social support for the healthy behaviour change Counterconditioning Substitution of the healthier alternative behaviours and/or cognitions for the unhealthy behaviour Reinforcement Management Increasing the rewards for the positive behaviour change and/or decreasing the rewards of the unhealthy behaviour Stimulus Control Removing reminders or cues to engage in the unhealthy behaviour and/or adding cues or reminders to engage in the healthy behaviour Social Liberation Realizing that social norms are changing in the direction of supporting the healthy behaviour change Summary Definitions Health Belief Model Health behaviours are explained by our health beliefs and attitudes TRA/PB Behavioral intention, attitude, subjective norm and behavioral control influence behaviour change Social Cognitive Theory Dynamic interaction between the individual, environment, and behaviour TTM Individuals do not change their behaviour all at once; instead they change it incrementally in change Motivation Reinforcement plays a significant role in self-efficacy Individuals are motivated to perform behaviours through…? Intrinsic versus Extrinsic When motivation is internalized can act as a stronger motivator Self-Efficacy The importance of self-efficacy for behaviour change has been widely recognized and is relevant to the behaviour change process Individuals will tend to pursue tasks that they believe they can accomplish and avoid Increases with successful completion of tasks Decrease with failure Several factors influence an individual’s self-efficacy, including Persuasion by others Observing others’behaviour (modeling) Previous experience with performing the behaviour (mastery) Direct psychological feedback (but also learning how to control these feelings – minimize stress, etc.) Monitoring New technologies have revolutionized our ability to monitor people’s behaviour and the ability of people to monitor their own behaviour in real time Bad Habits Health Habits = Firmly established health-related behaviours Many health compromising behaviours are habitual, and several are addictive, making them very difficult habits to break Person may become physically or psychologically dependent on behaviour/substance over a period of time Attitudinal approaches don’t explain long-term behaviour change very well Physical dependence: body has adjusted to the substance and incorporates its use into normal functioning Relapse The frequency of relapse remains a major issue in the treatment of addictive behaviours Can be influenced by situations: Social (e.g. social drinking and exposure to smoking) Relaxation Work Emotional upset (calming effect) Decision Making and Risk Perception Health care professionals must deal with expected or known perceptions that may disagree with their technical understanding These perceptions are still real to the person who holds them and must be respected as that individual’s reality Risk Perception and Skin Cancer Individuals at an increased risk (due to family history or skin cancer) increased screening but did not agree that they were at an increased risk Purposefully disagreed with the information provided External motivation enough? Screening: (Dermatologist exam for moles or discoloration) Nutrition & Health Demystifying a Healthy Diet Diet, Weight, and Health: Confused only if you want to be! Eat more naturally low-fat foods (vegetables, fruits, beans, lentils, whole grains, and lean meats) Carbohydrates, grains and gluten are not the enemy! Calories are not made equally Too many calories = weight gain New Brazilian Eating Guidelines Prepare meals from staple and fresh foods Use oils, fats, sugar and salt in moderation Limit consumption of ready-to-consume food and drink products Eat regular meals, paying attention, and in appropriate environments Eat in company whenever possible Buy food at places that offer varieties of fresh foods. Avoid those that mainly sell products ready for consumption Develop, practice, share and enjoy your skills in food preparation and cooking Plan your time to give meals and eating proper time and space When you eat out, choose restaurants that serve freshly made dishes and meals. Avoid fast food chains Be critical of the commercial advertisement of food products Satiety is the time that lasts between the end of your meal and the next meal you eat Importance of Cooking Skills Nutrition & Health How a return to cooking for ourselves could solve the obesity crisis Important to know where food comes from Able to control what goes into your food More time in the kitchen = less time sitting Makes us aware/think of what we’re eating Cooking skills ≠ Healthy eating When you boil something, you lose nutrients Aim for steaming or roasting as an alternative Back to Basics – Energy Needs Important to consume the right amount of calories: Stable weight = likely consuming proper amount of calories Back to Basics – Macronutrients Important to consume the right proportions of macronutrients: Carbohydrates: 45 – 65% of calories Added sugars < 25% Fiber 25g (women), 38g (men) Proteins: 10 – 35% of calories Fats: 20 – 35% of calories < 10% saturated and trans fats Nutrition & Health Micronutrients  Vitamins and minerals Back to Basics – Food Guide Important to eat a variety of foods everyday: Vegetable and Fruit Grain products Milk and Alternatives Meat and Alternatives Aim to eat darker fruits and vegetables Green and orange vegetables are highly concentrated in specific nutrients Make the Smart Choice! Chocolate Aim for dark chocolate (the higher the percentage of cocoa, the lower the amount of sugar) More Bang forYour Buck! Nutrition & Health **Food labels are important! Food Labels Nutrition facts and table Amount of food Choose less: sugar, fat, sodium Choose more: fiber, vitamins & minerals, protein Ingredient list Nutrition & Health Food Label Tips Granola bars (per bar): Fat: less than 5g Fiber: more than 2g Sugar: less than 8g & not first ingredient Breakfast cereals (per 30g portion): Fiber: more than 5g Sugar: less than 10g * Watch fat content of granola-type cereals Back to Basics – Ideal Plate Important to eat the proper amounts of foods everyday: Nutrition & Health Back to Basics – Ideal Snack Important to eat snacks containing a source of protein: Fresh fruit or dry cereal with nuts Handful of trail mix Veggie sticks with hummus Whose-wheat crackers and cheese Whole-wheat bread and nut butter Greek yogurt with oats/granola Cottage cheese with berries Smoothie Back to Basics – Energy Density Energy density is the amount of calories that we have in a specific volume of food WhatAbout Nuts? Research suggests nuts have many health benefits Limited impact on body weight High satiety effect Reduction in dietary compensation Very energy-dense (aim for 30 – 50g or a small handful per day) 20 almonds, 15 cashews, 10 whole walnuts Nutrition & Health Food as Fuel Energy in = calories Calories: Carbohydrate (4kcal/g) Protein (4 kcal/g) 3 macronutrients Fat (9 kgal/g) Alcohol  7 calories per gram Burning Fuel Energy out: Which macronutrient has the most thermogenic effect?  Protein, then carbs, then fats Fats and carbs provide us with our majority of energy Substrate Oxidation In healthy individuals, metabolism adapts quickly to oxidize fats & carbohydrates for energy Respiratory exchange ratio (ratio of CO2 produced to O2 consumed): 1.0 = 100% carbohydrate 0.7 = 100% fat Nutrition & Health How to measure our respiratory exchange ratio  measure breathing gases (subjects wear masks and a machine measures gases) At rest, we will burn fats Resting respiratory exchange ratio is 0.8 The more carbs you eat, the more insulin you’ll secrete Insulin drives carbohydrate oxidation Glycemic Index Nutrition & Health When blood glucose level drops, you’ll start to feel hungry or weak On a daily basis, you’re aiming for low GI foods Carbohydrates & Fats Consumption of carbohydrates = reduce need to use fat as fuel (insulin) Carbohydrate intake = important factor in determining how much of the fat consumed will be retained High-fat, low-carb diet = delay in gastric emptying & intestinal absorption; less insulin, more fat oxidation Nutrition & Health Energy Balance Weight gain (positive energy balance) = energy in > energy out Weight loss (negative energy balance) = energy in < energy out Weight Gain Many dietary factors: Sugar-rich drinks Refined carbohydrates poor in fiber and whole-grains and high in fat Low protein to carbohydrate ratio Fat Intake Without energy restriction, reducing fat intake tends to lead to weight loss and improvements in blood pressure, blood lipids (cholesterol, triglycerides), fasting plasma glucose and may prevent type 2 diabetes However, people who are insulin resistant may lose more weight on a low carbohydrate diet, and have a harder time losing weight on a low fat (and high carbohydrate) diet Type of fat matters! Vegetable > animal Unsaturated (oils) > saturated (solid) Omega-3 (DHAand EPA): Fish > plant* *Plant-based omega-3 (ALA) conversion to DHAand EPAis very limited Mediterranean Diet Plant-based diet, olive oil main source of fats Protection against mortality, the occurrence of cardiovascular diseases, and major chronic degenerative disease Reduced risk of metabolic syndrome: Waist circumference Blood lipids (HDL, triglycerides) Blood pressure Glucose metabolism Nutrition & Health Added Sugars Excess sugar can triple risk of dying of heart disease: report > 25% calories from added sugars = 3x risk for CVD 10 – 25% calories from sugar = 30% WHO recommends < 10% added sugars What are some foods high in sugar we may need to limit or promote less? Sport drinks, chocolate milk, fruit juices Is Fructose to Blame? In high-fructose corn syrup and sucrose (white sugar). Also found in fruits Food availability data from 1970 – 2009: Availability of fructose has remained the same Overall increase in energy intake, from increased availability of foods containing glucose (starch) and fat Is SugarAddictive? Study
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