1. Introduction: The Links Between Health and Behavior
Chapter 1
Edberg, M. C. (2015). Essentials of Health Behavior: Social and Behavioral Theory in Public Health. (2nd ed.). R. Riegelman (Ed.). Burlington, MA: Jones and Bartlett Learning

2. Introduction How do you define: Health Social and Behavioral Sciences
Health Behavior

3. WHO definition of Health
World Health Organization
Health is a state on complete physical, mental, and social well-being and not merely the absence of disease or infirmity
Reference: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, June, 1946)
This is a biopsychosocial approach to health
The World Health Organization (WHO) is the most widely recognized specialized international governmental health organization of the United Nations concerned with international public health. Our primary role is to direct and coordinate international health within the United Nations’ system. They support countries to attain their health objectives and support their national health policies and strategies. Areas of focus: Promoting health through the life-course Non-communicable diseases Communicable diseases Corporate services Preparedness, surveillance and response.
The biopsychosocial model (abbreviated "BPS") is a general model or approach stating that biological, psychological (which entails thoughts, emotions, and behaviors), and social (socio-economical, socio-environmental, and cultural) factors, all play a significant role in human functioning in the context of disease or illness. It posits that, health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms.

4. Social and Behavioral Sciences
Defining social and behavioral –
Social
Cultural (race, ethnicity, gender), economics, demographic (age, geography) and social contexts (group dynamics)
Refers to interactions of organisms and other organisms, their collective co- existence, & voluntary or involuntary interaction
Reference: Sydnor, 2012
Behavioral
Actions that derive from cognition (thinking), emotion (feeling), temperament (predispositions), and motivation
Reference: Report – Social Science Research at NIH

5. Health Behavior What influences health behavior? Motives
Causal and contributing factors
Contexts
Cues
Other issues related to why people do what they do

6. Sam Brushing his teeth Influences Health purposes
To look like a male icon (cultural factor)
To stand out from the crowd & be as attractive as possible to a person of the opposite sex, & a special person at that (related to #2, with a little biology thrown in)
Habit
Not wanting bad breath
Family/personal income, status, insurance coverage (concerned about maintaining health because dentist is out of reach, no money to pay, therefore overly concerned with preventing health issues)
Influence from parents

7. Health Behavior
Field of study and practice concerning the complex nature of health behavior
The goal is to implement programs and interventions that seek to promote change in behavior to improve the health of the public or a segment of the public.
Relies on a body of knowledge about what motivates and influences human behavior

8. Programs and Interventions
Campaigns to stop smoking
Warnings on advertisements and cigarette packaging
Lawsuits against tobacco companies
TV ads and school programs warning young people about drug and alcohol use, or about drinking and driving (MADD, Say no)
Public campaigns, billboard ads, metro and bus ads, internet pop-ups
Public campaigns, including billboard ads, metro and bus ads, internet pop-ups, and TV ads, about the risks of transmitting HIV and the benefits of HIV testing (Greater than Aids)
Public campaigns about cardiovascular health and diet, low-carb diets, or low- cholesterol food choices (Let’s move – Michelle Obama)

9. Tobacco Use
Tobacco use remains the single largest preventable cause of morbidity (disease) and mortality (death)
Cigarette smoking kills more than 480,000 Americans each year
20 million American deaths since 1964
Tobacco use, smoking, and second hand smoking are linked to:
Lung cancer, diabetes, stroke, blindness, cataracts, ectopic pregnancies, coronary heart disease, pneumonia, erectile dysfunction, decreased immune function, arthritis, asthma, tuberculosis, chronic obstructive pulmonary disease, and other respiratory issues
Reference: CDC
Reference: Surgeon General’s Report

10. Smoking Campaigns Warnings on advertisements cigarette packaging
lawsuits against tobacco companies
Smoking Prevalence in the United States
42.4% in 1965 vs. 17.8% in 2013
Reference: CDC

11. Smoking Campaigns

12. The Public Health Question
Why do people behave in healthy or unhealthy ways?
Why do people do what they do?
What influences or motivates behavior or health behavior?
Are there factors at play:
Culture
Socioeconomic circumstances
Environmental conditions
Public policies and regulations
Factors outside of our control
Have to think about what motivates or influences behavior or health behavior – Reference Sam
Behavior that is often categorized as health behavior is not necessarily motivated or influenced by concerns about health. It may be, in some cases or it may be health concerns mixed together with other concerns or it may not be concerned with health at all. It may be based on ideas about being healthy that are different from the standards of health common to Western medicine.

13. The Complex Social-Ecological Web

14. Social-Ecological Web
Proposes the idea that human behavior regarding health and other issues are influenced by a complex and sometimes random group of factors
Ecological Model
Focus on the multiplicity of influences on behavior
Assumptions
No single factor influences people’s behavior
A complex interaction between individuals and an environment is a process that influences behavior

15. Social Determinants Social Determinants of health
Societal conditions in which people are born, grow, live, work, and age that predispose health inequities
Reference: WHO
Social conditions include early years experiences, education, economic status, employment, and decent work, housing and environment, and effective systems of preventing and treating ill health

16. Health Inequity Health Inequities
“are avoidable inequalities in health between groups of people within countries and between countries. These inequities arise from inequalities within and between societies.”
Reference: WHO
“are differences in health that are not only unnecessary and avoidable but, in addition, are considered unfair and unjust.  Health inequities are rooted in social injustices that make some population groups more vulnerable to poor health than other groups.”
Reference:
Inequity – lack of fairness or justice, everyone does not have fair opportunities, thought to have more ethical valence than the term disparity
It implies that health should not be compromised or disadvantaged because of an individual or population group’s race, ethnicity, gender, income, sexual orientation, neighborhood or other social condition.

17. Health Disparities Health disparities:
are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”
Health disparities result from multiple factors, including
Poverty
Environmental threats
Inadequate access to health care
Individual and behavioral factors
Educational inequalities
Reference:
Health disparities, or health inequalities, are differences in the presence of disease, health outcomes, or access to health care between population groups.
Disparity = inequality

18. Health Disparities Healthy People 2020 defines a health disparity as:
“a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”
Reference:

19. Contributors to Behavior
Individual factors
Awareness and knowledge
Biophysical characteristics
Personal attitudes and motivations
Developmental stage
Behavior/habit socialization
Awareness and knowledge - About health risks, ways to prevent health problems – people living downstream from a factory that is polluting the waterway may suffer health consequences from eating fish or other animals contaminated by the pollutant, or from drinking contaminated water. They may be unaware of the risk of the pollutants or that they are at risk to begin with. Or they are heavily dependent on fishing for their livelihood
Biophysical characteristics – genetics, systemic vulnerabilities –
Developmental stage – adolescent, adult
Behavior/habit socialization – from parents or family

20. Contributors to Behavior
Social/cultural/group factors
Social/peer group lifestyle patterns
Cultural attitudes/beliefs (and their implications for health)
Culture defined as shared beliefs, attitudes, values, and behaviors (Flores, 2000). Refers to the “sum total of the attainment and learned behavior patterns of any specific period, race or people (Funk and Wagnalls Standard Desk Dictionary)
Level of social support
Social Support defined as “resources provided by other persons” (Cohen and Syme, 1985). Social support leads an individual to believe that he or she is cared for and loved, is esteemed and valued and belongs to a social network (Cobb, 1976). Types of support include emotional, instrumental or practical, negative interaction (Marmot & Wilkinson, 2006).
Religion
In every culture there are norms, or expected accepted practices, values, and beliefs that are the foundation for behavior. Like showering daily and using deodorant in American culture, vs other cultures who bathe less frequently. It is expected in mainstream American culture
Beliefs are intimately woven with culture, ones own perception of what is true, even if it agrees or disagrees with others.
Attitudes occurs when there are a series of beliefs
Values are what people hold in high regard, things that are important to them, such as friendship, education, integrity, family
Religion – values and beliefs are reflective of not only culture, but also of a religion. Religion can also influence health outcomes, example diet, Seventh Day Adventist

21. Contributors to Behavior
Socioeconomic and structural factors
Poverty
Education
Access to health care and prevention services/information
Social stressors such as civil strife, neighborhood violence, racial and other discrimination
Access to clean water

22. Socioeconomic Status (SES)
Social standing or class of an individual or group.
Based off of the total measure of a person’s work experience and of an individual’s or family’s economic and social position in relation to others” (Glanz, Rimer, Viswanath (eds.), 2008).
Indicators of SES
Income
Education
Occupation

23. Contributors to Behavior
Political Factors
Policies and funding for health promotion programs
Health insurance
Regulations that affect health risk
Health insurance – policies, cost, availability
Regulations – prohibiting sale of cigarettes to minors

24. Contributors to Behavior
Environmental factors
Presence of an environmental risk, such as air or water pollution
Disasters
Conditions for spread of an infectious disease

25. Contributors to Behavior
Factors operate together and can influence health behavior and health outcomes
Ecology
Describes a system of relationships
A system of interactions between organisms and in environment
The complex relationships among organisms in the system (niches)
The dependent relationship among members/components of the system, where if one part of the system is disturbed, other parts will be affected