1. Chapter Three: Health Behaviors

2. Chapter Outline An introduction to health behaviors
Health promotion: An overview
Changing health habits
Cognitive-behavioral approaches to health behavior change

3. Chapter Outline The transtheoretical model of behavior change
Changing health behaviors through social engineering
Venues for health-habit modification

4. Table 3.1 - Risk Factors for the Leading Causes of Death in the United States

5. Health Promotion
Idea that good health, or wellness, is a personal and collective achievement
Health behaviors: Undertaken by people to enhance or maintain their health
Health habit: Firmly established and performed automatically without awareness

6. Primary Prevention
Reduce risk factors for illness before it has a chance to develop
Strategies
Getting people to alter their problematic health behaviors
Keeping people from developing poor health habits in the first place

7. Factors Responsible for Practicing and Changing Health Behaviors
Demographic factors
Values
Personal control
Health locus of control scale: Measures the degree to which people perceive their health to be under personal control

8. Factors Responsible for Practicing and Changing Health Behaviors
Social influence
Personal goals and values
Perceived symptoms
Access to the health care delivery system
Knowledge and intelligence

9. Barriers to Change Emotional factors may lead to unhealthy behaviors
Behaviors hard to Predict
Different factors control different health habits in the same person (e.g, Vegan and a binge drinker)
Different factors may control the same health behavior for different people (Desire to look better – Diet/Exercise)

10. Barriers to Modifying Poor Health Behaviors
Factors controlling a health behavior change:
Over the history of the behavior : Binge Drinking

11. Intervening with Children and Adolescents
Socialization: Influence of parents as both teachers and role models
Teachable moment: Better times for modifying health practices
Window of vulnerability: Time when students are first exposed to bad habits
Not confined to childhood and adolescence
Precautions taken in adolescence may affect disease risk after age 45

12. Intervening with At-Risk People
Benefits
Efficient use of health promotion dollars
Diseases may be prevented altogether
Makes it easier to identify other risk factors
Problems
Risks are not perceived correctly
Testing positive for a risk factor leads people into a hypervigilant behavior

13. Ethical Issues in Intervening with At-Risk People
Choosing the right time to alert people
Instilling risk reduction behaviors may cause psychological stress
No effective intervention may be available for cases with genetic risk factors
Emphasizing risks that are inherited can raise complicated issues of family dynamics

14. Health Promotion Efforts for Older Adults
Maintain a healthy, balanced diet and an exercise regimen
Take steps to reduce accidents
Control alcohol consumption and eliminate smoking
Reduce inappropriate use of prescription drugs
Obtain vaccinations against influenza
Remain socially engaged

15. Culture and Gender Differences in Health Risks and Habits
Health promotion efforts should take the social norms of a group into account
Health practices in the community?
Co-occurring risk factors in ethnic groups
South Asian
Hispanic
African-American
Anglo-American
SES and Genetics: Compound Risk

16. Attitude Change and Health Behavior
People change their health habits if they have good information about their habits
Educational appeals:
People change their behavior if they fear that a particular habit is hurting their health
Fear appeals:
Depends on:
Clarity, Easy to Follow, Can identify with the messenger
People’s own motivation
Message framing

17. Health Belief Model Factors influencing health behavior practices
Perceived health threat
Perceived threat reduction
Perceived effectiveness of steps to modify health habits
Leaves out self-efficacy
Self-efficacy: One’s ability to control his or her practice of a particular behavior

18. Figure 3.2 - The Theory of Planned Behavior Applied to Adopting a Healthy Diet
(Sources: Ajzen & Fishbein, 1980; Ajzen & Madden, 1986)

19. Self-Determination Theory (SDT)
People are actively motivated to pursue their goals
Components fundamental to behavior change
Autonomous motivation
Perceived competence

20. Criticisms of Attitude Theories
Information of threat not always enough
Assume that behavior changes are guided by conscious motivation
Ignores that behavior changes occur automatically and are not subject to awareness

21. Implementation Intentions
Integrates conscious processing with automatic behavioral enactment
Control of goal-directed responses can be delegated to situational cues
Creating Routines, Behaviors tied to time, situation, reminders
Creation of automatic behaviors

22. Health Behavior Change and the Brain
Health behavior change in response to persuasive messages can occur outside of awareness
Change can be reflected in patterns of brain activation
Medial prefrontal cortex (mPFC)
Posterior cingulate cortex (pCC)

23. Cognitive-Behavioral Approaches to Health Behavior Change
Cognitive-behavior therapy: Addresses irrational beliefs and conditioned behaviors to understand roots of risky behaviors (i.e, smoking marijuana)
Self-monitoring: Awareness increases power of choice

24. Cognitive-Behavioral Approaches to Health Behavior Change
Assesses the frequency of a target behavior and its consequences (i.e, what occurs before the behavior and after the behavior)
Tasks for Patients: Homework
Learning to discriminate the target behavior (find the triggers)
Charting the behavior – Monitor trigger and response

25. Cognitive-Behavioral Approaches to Health Behavior Change
Classical conditioning: Pairing of an unconditioned reflex with a new stimulus
Produces a conditioned reflex
Heavily depends on the client’s willingness
TV->Food->Salivation/hunger
TV -> Hunger
Operant conditioning: Pairs a voluntary behavior with systematic consequences
Sedentary Behavior rewarded with Binge Eating

26. Cognitive-Behavioral Approaches to Health Behavior Change
Modeling: Learning that occurs from witnessing another person perform a behavior
Stimulus-control interventions:
Ridding the environment of discriminative stimuli that evoke the problem behavior
Creating new discriminative stimuli, signaling that a new response will be reinforced

27. Social Skills and Relaxation Training
Social skills training or assertiveness training: People are trained in methods that help them deal effectively with social anxiety
Loneliness a risk for poor health
Relaxation training: Deep breathing and progressive muscle relaxation

28. Relapse Prevention
Abstinence violation effect: Feeling of loss of control that results when a person has violated self-imposed rule to never drink.
Reasons for relapse?
Vigilance fades
Negative affect
Should be integrated into treatment programs from the outset

29. Figure 3.5 - A Cognitive-Behavioral Model of the Relapse Process
(Source: Larimer, Palmer, & Marlatt, 1999)

30. Relapse Prevention Techniques
Asking people to identify the situations that may lead to relapse
Plan for triggers to craving
Engaging participants in constructive self-talk
Healthy Lifestyle; Healthy Relationships

31. Advantages of CBT
A carefully selected set of techniques help deal with all aspects of a problem
Therapeutic plan can be tailored to each individual’s problem
Skills imparted by multimodal interventions help to modify several health habits simultaneously

32. Transtheoretical Model of Behavior Change
Analyzes the stages and processes people go through in bringing a change in behavior

33. Figure 3.6 - A Spiral Model of the Stages of Change
(Source: Prochaska et al., 1992)

34. Changing Health Behaviors through Social Engineering
Social engineering: Modifies the environment in ways that affect people’s ability to practice a health behavior
Venues for health habit modification
Private therapist’s office
Health practitioner’s office
Family
Self-help groups

35. Changing Health Behaviors through Social Engineering
Schools
Workplace interventions
Community-based interventions
Mass media
Cellular phones and landlines
Internet