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Chapter 3

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University of British Columbia
PSYC 314
Frances Chen

Chapter 3: Health Behaviours: Health promotion: good health & wellness is a personal and collective achievement World Health Organization definition: process of enabling people to increase control of health and improve their health Individual level: develop program of good health habits early in life and carry them through to adulthood and old age Medical practitioner level: teach people how to achieve their healthy lifestyle and help people who are at risk for particular health problems to learn behaviours which offset or monitor these risks Psychologist level: develop interventions to help people practice healthy behaviours and change poor ones Community & National policy maker level: emphasize good health, make info available to help people develop & maintain healthy lifestyles. Make resources, conditions and facilities available which can help people change poor health habits Lalonde Report (1974): suggested the need for a health promotion approach to keeping Canadians healthy. Role of Behavioural factors in disease & disorder: • prevalence of acute infectious diseases such as TB, flu, measles & polio declined because of innovations & changes in public health standards. improvement of waste control & sewage. • increase in “preventable” disorders including lung cancer, cardiovascular disease, alcohol & other druge abuse & vehicular accidents • nearly half the deaths in Canada are caused by modifiable behaviours. Ex: smoking, poor diet and physical inactivity as the leading social/behavioural risk factor. SUCCESSFUL MODIFICATION OF HEALTH BEHAVIOURS: 1. reduce deaths due to lifestyle related diseases 2. delay death, increasing individual longevity and general life expectancy of the population 3. practice of good health behaviours may expand the # of years during which a person may enjoy life free from complications of chronic disease What are Health Behaviours? − behaviours undertaken by people to enhance or maintain their health Health habit: health related behaviour that is firmly established and often performed automatically without awareness. These habits develop in childhood and begin to stabilize around age 11 or 12. Illustration of the importance of good health habits in maintaining good health provided by a classic study of people living inAlameda County, California (Belloc & Breslow, 1972) SEVEN IMPORTANT GOOD HEALTH HABITS: 1. sleeping 7-8 hrs/night 2. not smoking 3. breakfast each day 4. no more than 1 or 2 alcoholic drinks/day 5. regular exercise 6. not eating between meals 7. no more than 10% overweight • researchers found that the more good health habits people practiced, the fewer illnesses they had, the better they felt and less disabled they had been. • 9-12 years later mortality rates where dramatically lower for people practicing the 7 health habits. • men following these practices had a mortality rate only 28% that of the men following 0-3 of the health practices • women following the 7 health habits had mortality rate 43% that of women following 0-3 of the health habits PRIMARY PREVENTION: instilling good health habits & changing poor ones − TWO GENERAL STRATEGIES: 1. employ behaviour-change methods to get people to alter their problematic health behaviours (programs to lose weight) 2. keep people from developing poor habits in the first place (smoking prevention) WHAT FACTORS INFLUENCE THE PRACTICE OF HEALTH BEHAVIOURS: 1. Socioeconomic factors SES 2. age 3. gender 4. values 5. personal control 6. social influence 7. personal goals 8. perceived symptoms 9. access to health care services 10. place/environment 11. cognitive factors Barriers to modifying poor health behaviours: • once bad habits are engrained people are not highly motivated to change them • instability of health behaviours: health habits are UNSTABLE over time. Ex: a person may stop smoking for a year but take it up again during a period of high stress • dieter may lose 50 lbs only to regain them a few years later 1. health habits are controlled by different factors. Ex, smoking related to stress, whereas exercise may depend on ease of access to sports facilties 2. different factors may control the same health behaviour for different people. Ex, one person's overeating may be social and she may primarily eat more in the presence of other people. In contrast, another individuals overeating may depend on levels of tension and may overeat only when under stress. 3. Factors controlling health behaviours may change over the history of the behaviour, initial instigating factors may no longer be significant & new maintaining factors may develop to replace them 4. factors controlling the health behaviour may change across a person's lifetime-regular exercise occurs in childhood because it is built into the school curriculum but in adulthood this automatic habit must be practiced consciously 5. health behaviour patterns, their developmental course & the factors that change them across a lifetime will vary substantially between individuals Intervening w/ children & adolescents Socialization: influence of parents & role models Using the Teachable moment: certain times are better than others for teaching particular health practices: • early childhood • built into healthcare delivery system • pregnancy • newly diagnosed adults Closing the window of vulnerability: junior high school- important time for the development of several health related habits as food choices, snacking, dieting all begin to crystallize around this time. Window of vulnerability for smoking and drug use that occurs in junior high school when students are first exposed to these habits among their peers and older siblings. Interventions through the schools may help students avoid the temptations that lead to these health-compromising behaviours. INTERVENTIONS WITH AT-RISK PEOPLE: • children and adolescents – 2 vulnerable populations which health promotion efforts have been directed. • those who are at risk for particular health problems are also a vulnerable population. Ex, obese parents' offspring and daughters of women who have had breast cancer BENEFITS OF FOCUSING ONAT-RISK PEOPLE: − early identification of at risk people may prevent or eliminate poor health habits − working w/ at risk populations represeents an efficient and effective use of health promotion dollars – target those people whom the risk factor is relevant − focus on at-risk populations makes it easier to identify other risk-factos that may interact w/ the targetted factor in producing an undesirable outcome – other factors that contribute to development of an illness may be identified PROBLEMS OF FOCUSING ON RISK: − people do not always perceive their risk correctly, unrealistically optimistic about their vulnerability to health risks − people tend to view their poor health behaviours as widely shared but their healthy behaviours as more distinctive. Ex, when ppl perceive that others are engaging in the same unhealthy practice they may perceive a lower risk to their health − testing positive for a risk factor leads ppl into needlessly hypervigilant and restrictive behaviour − people may become defensive and minimize the significance of their risk factor and avoid using appropriate services or monitoring their condition Ethical issues: − psychological disturbance may be created in exchange for instilling risk-reduction behaviour. − People predisposed to depression may react especially badly to the prospect or results of genetic testing for health disorders − effective interventions may be unclear or no successful intervention for genetically based risk factors. Ex, Alcoholism is believed to have a genetic component and how and when one should intervene is not yet clear − emphasizing risks that are inherited can raise complicated issues of family dynamics. Blame, shame, disagreement, problems etc. Health promotion and the elderly: active aging: “the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age” (W.H.O.,2002) − exercise, keeping active -reduces risk of mortality − control of alchohol consumption. Elderly ppl may develop drinking problems
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