Chapter Three: Health Behaviors

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 • Taking measures to combat 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 • Age • 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 Modifying Poor Health Behaviors • Emotional factors may lead to unhealthy behaviors • Instability of health behaviors • Different factors control different health habits • Different factors may control the same health behavior for different people

10. Barriers to Modifying Poor Health Behaviors • Factors controlling a health behavior change: • Over the history of the behavior • Across a person’s lifetime

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 Problems • Efficient use of health promotion dollars • Diseases may be prevented altogether • Makes it easier to identify other risk factors • 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. Ethnic 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 • Informal networks of communication and language • Co-occurring risk factors in ethnic groups • Combined effects of low socioeconomic status and a biologic predisposition to particular illnesses

16. Attitude Change and Health Behavior Educational appeals • People change their health habits if they have good information about their habits Fear appeals • People change their behavior if they fear that a particular habit is hurting their health Message framing • Depends on: • Type of message • People’s own motivation

17. Health Belief Model • Factors influencing health behavior practices • Perceived health threat • Perceived threat reduction • Used to increase perceived risk and 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 • Interventions may not always provide the impetus to take action • Assume that behavior changes are guided by conscious motivation • Ignores the fact 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 • Changes in intentions lead to changes in behavior

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: Uses complementary methods to intervene in the modification of a target problem and its context • Self-monitoring: Understanding the dimensions of one’s poor health habit before change can begin

24. Cognitive-Behavioral Approaches to Health Behavior Change • Assesses the frequency of a target behavior and its consequences • Stages • Learning to discriminate the target behavior • Charting the behavior - Helps in identifying the discriminative stimulus

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 • Operant conditioning: Pairs a voluntary behavior with systematic consequences • Reinforcement and its schedule are important

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. Self-Control of Behavior • CBT emphasizes self-control • People learn to control the antecedents and consequences of the target behavior • Cognitive restructuring: Trains people to recognize and modify their internal monologues to promote health behavior change

28. Self-Control of Behavior • Self-reinforcement: Systematically rewarding oneself to increase or decrease the occurrence of a target behavior • Contingency contracting: Effective self-punishment in behavior modification • Behavioral assignments: Home practice activities that support the goals of a therapeutic intervention

29. Advantages of Behavioral Assignments Client becomes involved in the treatment process Client produces useful analysis in planning further interventions Client becomes committed to the treatment process Responsibility for behavior change is slowly shifted to the client Homework assignments increase client’s sense of self-control

30. Social Skills and Relaxation Training • Social skills training or assertiveness training: People are trained in methods that help them deal effectively with social anxiety • Relaxation training: Deep breathing and progressive muscle relaxation

31. Motivational Interviewing • Interviewer adopts a nonjudgmental, nonconfrontational, encouraging, and supportive style • Goal - To help clients express their positive or negative thoughts regarding the behavior

32. Relapse Prevention • Abstinence violation effect: Feeling of loss of control that results when a person has violated self-imposed rules • Reasons for relapse • Vigilance fades • Negative affect • Should be integrated into treatment programs from the outset

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

34. Relapse Prevention • Techniques • Asking people to identify the situations that may lead to relapse • Engaging participants in constructive self-talk • Lifestyle rebalancing: Promotes a healthy lifestyle and reduces the likelihood of relapse

35. 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

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

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

38. 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

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