Health Behaviors and Primary Prevention

Transcription

1 Health Behaviors and Primary Prevention

2 Following up on Health Psychological Methods: Long-term longitudinal studies and daily process approaches Philosophy underlying health promotion Obesity as a current concern Key constructs: Health behaviors, health habits, primary prevention Today: Mechanism underlying health behavior change

3 Introduction to Health Behaviors: Intervening with Children/Adolescents Socialization influences early health habits Socialization The process by which people learn the norms, rules, and beliefs associated with their family and society Parents and social institutions are usually the major agents of socialization. Adolescents may ignore early training received by parents

4 Window of vulnerability Adolescents may ignore early training received by parents Adolescents are vulnerable to problematic health behaviors Poor diet Cigarette Smoking Alcohol and drug use Risky sexual behaviours Decreased activity/exercise levels

5 Media Campaigns Targeting Adolescents

6 Media Campaigns Targeting Adolescents

7 Teachable moment Certain times are better than others for teaching particular health practices Think, pair, share

8 Teachable moment Certain times are better than others for teaching particular health practices Examples Putting on your own and child s seat belt before driving Emphasizing correct brushing at dental visit Proper diet for a coronary heart patient following surgery Stopping smoking during pregnancy

9 Interventions with At-Risk People Early identification may prevent poor health habits that contribute to vulnerability Knowledge helps individuals monitor their situation Problem People don t always perceive risk correctly Most people are unrealistically optimistic about their own vulnerability to risk Ethical Issues an area of controversy At what point should people be alerted to their risk?

10 The Elderly: By age 80, health behaviors are the major determinant of well-being Maintaining a healthy, balanced diet Developing an exercise regimen Taking steps to reduce accidents Eliminating smoking Reducing inappropriate use of prescription drugs Obtaining vaccinations against influenza

11 Models of health behaviour change 1. Health belief model 2. Theory of planned behavior

12 Health belief model social psychological model was developed in the 1950s first model to be developed to study health behaviours per se focuses on: attitudes toward the specific health behaviour beliefs about the specific health behaviour was developed to explain and predict the lack of public participation in health screening and prevention programs

13 Changing Health Habits: Attitude Change and Health Behavior Health Belief Model Whether a person practices a health behavior depends on The degree to which the person perceives a personal health threat The perception that a particular behavior will effectively reduce the threat

14 Health belief model We can predict whether a person will practice a health behaviour if we know his/her degree of:

15 An Empirical Example: Does the HBM predict who practices testicular self-examination? Testicular cancer is the most common cancer among young men (20-40 years old) Can the health belief model components explain which individuals are more likely to perform testicular selfexamination (TSE)? 195 undergraduate men years old Retrospective design: Frequency of TSE during the last year: 61% knew how to perform TSE 62% intended to perform TSE 41% never performed TSE 5% performed TSE once a month or more 5% performed TSE 10 or 11 times per year McClenahan et al., 2007

16 Measures Health value: I eat a well balanced diet I exercise regularly-at least three times a week Susceptibility: My chances of getting testicular cancer are great if I fail to perform testicular self-examination My physical health makes it more likely that I will get testicular cancer if I fail to perform testicular self-examination Severity: The thought of testicular cancer scares me Testicular cancer is a hopeless disease Benefits: I have a lot to gain by doing testicular self-examinations If I do monthly self-examinations, I may find a lump before it is discovered by regular health check-ups Barriers: It is embarrassing for me to do monthly examinations Testicular self-examinations can be painful Testicular self-examinations can be time consuming

17 Results 21% in frequency of TSE How many times during the last year have you performed TSE?

18 Health Belief Model adapted to explore a variety of long- and short-term health behaviors including: weight maintenance Smoking alcohol use oral hygiene sexual risk behaviors the transmission of HIV/AIDS

19 Health belief model and behavior change If we want to predict and achieve health behavior change, we need to acknowledge the role of intentions Intention

20 Changing Health Habits: Theory of Planned Behavior Linking health attitudes directly to behavior A health behavior is the direct result of a behavioral intention Behavioral intentions are made up of Attitude toward the specific action Subjective norms regarding the action Perceived behavioral control

21 Theory of Planned Behavior Revision of the Theory of Reasoned Action Authors: Fishbein and Ajzen (1980) Applied frequently to the study of health behaviors and consumer behaviors

22 Factors Considered in the Theory of Planned Behavior Outcome Expectancy What will happen if I change my behavior? Outcome Desirability Is what I think will happen desirable? Perceived Behavioral Control Do I have the ability to control my behavior?

23 Factors Considered in the Theory of Planned Behavior Normative Beliefs What do others think I should do? Motivation to comply Do I want to comply with what they want? Intention Do I intend to change my behavior?

24 Theory of Planned Behavior Fishbein & Ajzen

25 The theory of planned behaviour has been found to predict: condom use However, the theory of sunbathing and sunscreen use planned behaviour has not use of oral contraceptives been successful in breast self-examination predicting long-term mammography participation behaviour change testicular self-examination Intention-behaviour gap exercise mother s restriction of children s sugar intake participation in cancer screening programmes AIDS risk-related behaviours Amount of sleep Taking vitamins Health care provider behaviour

26 Does the TPB predict who practices testicular self-examination? The HBM predicted 21% of the variance in TSE Can the TPB better explain who is more likely to perform TSE?

27 Measures Intention I intend to perform testicular self-examination once a month Attitude My performing testicular self-examination in the next month would be: extremely harmful-beneficial, extremely negativepositive, extremely unpleasant-pleasant, extremely bad-good Subjective norms Most people who are important to me think that I should perform testicular self-examination in the next month Perceived behavioural control Whether or not I perform testicular self-examination in the next month is entirely up to me

28 Results 50% in intention to perform TSE 20% in frequency of TSE Intention explained 22% of the variance in TSE frequency

29 Weight Control and Health

30 Percentage distribution of body mass index (BMI), by sex, household population aged 18 or older, Canada excluding territories, 2004 Both sexes Men Women % % % Underweight Normal weight Overweight (not obese) Overweight and obese (BMI 25) Obese (BMI 30) Significantly different from estimate for women (p < 0.05) Data source: 2004 Canadian Community Health Survey: Nutrition

31 Canada vs. US in obesity 29.7% of Americans aged 18 or older were obese in , significantly above the 2004 figure for Canada 23.1% Difference attributable to: Women: 23.2% of Canadian women were obese vs. 32.6% of American women Men: 22.9% of Canadian men were obese vs. 26.7% of American men The racial make-up of the two countries might explain some of the differences. However: 30.3% of White American women were obese vs. 24.8% White Canadian Women. The percentages of White American and Canadian men who were obese did not differ.

32 Supersize me

33 Why is obesity a health risk? Obesity excessive body fat Women: fat should be 20% to 27% of body tissue Men: fat should be 15% to 22% of body tissue Global epidemic of obesity 300 million worldwide are obese Americans are fattest in the world Epidemic stems from Genetic susceptibility Increasing availability of high-fat, high-energy foods Low levels of physical activity

34 Maintaining a Healthy Diet: Why is Diet Important? Dietary factors contribute to broad array of diseases Example: relation of dietary factors to total serum cholesterol level Estimates of degree to which diet contributes to incidence of cancer exceed 40% Poor diets are problems in conjunction with other risk factors, such as stress Good News! Changing one s diet improves health Controversy Will reducing calories increase the life span?

35 Obesity rates, by fruit and vegetable consumption and sex, household population aged 18 or older, Canada excluding territories, 2004

36 Obesity rates, by leisure-time physical activity level and sex, household population aged 18 or older, Canada excluding territories, 2004

37 Why is obesity a health risk? Links with other risk factors, i.e., blood pressure Increases risks during surgery, anesthesia administration, and childbearing Chief cause of disability number of people aged who cannot care for themselves has jumped by 50% Problems with health care May not fit in standard wheelchairs X-rays may not penetrate far enough Blood pressure cuffs may not fit Estimate: 4,000 Canadians die every year as a result of overweight and obesity Overweight and suicide in adolescents (2009): raises rates of suicide by 6%

38 Prevalence of high blood pressure, by BMI category and sex, household population aged 18 or older, Canada excluding territories, 2004

39 Prevalence of diabetes, by BMI category and sex, household population aged 18 or older, Canada excluding territories, 2004

40 Prevalence of heart disease, by BMI category and sex, household population aged 18 or older, Canada excluding territories, 2004

41 Maintaining a Healthy Diet: Resistance to Modifying Diet People switch to healthier diets more often to improve appearance than to improve health! Maintaining change is difficult Long-term monitoring, relapse prevention is critical Tastes are difficult to alter Dietary changes may affect mood and personality Helpful factors Strong sense of self-efficacy Family support Perception that dietary change has important benefits

42 Maintaining a Healthy Diet: Resistance to Modifying Diet Stress has a direct effect on eating Especially true for adolescents Greater stress tied to Eating more fatty foods Eating less fruit and vegetables Skipping breakfast More between-meals snacks

43 Maintaining a Healthy Diet: Interventions to Modify Diet Individual interventions In response to specific health risk Education and self-monitoring are key Cognitive-behavioral interventions Transtheoretical Model of Change - Different interventions are required for each stage Precontemplation Contemplation Preparation Action Maintenance

44 Maintaining a Healthy Diet: Interventions to Modify Diet Family interventions Easier for target member to change when other family members change also Wives usually shop and prepare food Husband s food preferences likely to determine what the family actually eats Meet with a dietary counselor Discuss ways to change the family s diet Family members decide on specific changes

45 Maintaining a Healthy Diet: Interventions to Modify Diet Community interventions Initial success rates, but not impressive long term change More effective intervention directed toward particular at-risk groups (Hispanic dietary study) Social engineering possibilities Banning snack foods from schools Making snack foods expensive; healthy foods less

46 Weight Control: Obesity in Childhood Prevalence of overweight children in the past 20 years Doubled among those 6 to 11 years Tripled among those 12 to 17 years Why? Sedentary lifestyles TV, videogames Early eating habits 80% of all people who were overweight as children go on to be overweight as adults

47 Weight Control: Factors Associated with Obesity Childhood: Window of vulnerability Number of fat cells determined early in life by genetic factors or early eating habits.

48 Interesting video on childhood obesity v=uwv8olioryg&feature=playlist&p=ec188b6c8f3be272 &playnext=1&playnext_from=pl&index=9

49 Factors associated with obesity Family history and obesity Relationship is due to genetic and dietary factors SES, culture, and obesity Middle SES women are heaviest in Canada Higher SES men are heaviest in Canada Thinness is valued in women from developed countries

50 Obesity rates, by educational attainment and sex, household population aged 25 to 64, Canada excluding territories, 2004

51 Obesity rates, by household income and sex, household population aged 18 or older, Canada excluding territories, 2004

52 Factors associated with obesity Obesity and dieting as risk ractors Obesity is a risk factor for obesity High basal insulin levels prompt overeating due to increased hunger Obese have larger fat cells Set Point Theory Each person has ideal biological weight

53 Stress and eating 50% eat more when under stress Women more likely to eat more under stress Stress removes self-control in dieters/obese Choose salty, low caloric foods Negative emotions sweet, high-fat foods 50% eat less when under stress Men, compared to women, eat less under stress Non-dieting, non-obese suppress hunger cues

54 Weight Control: Treatment of Obesity Amazon.com has 140,000 titles about dieting Obese individuals attempt to lose weight because It is considered unattractive (a primary reason) It carries a social stigma (a primary reason) They perceive that it is a health risk It is coupled with psychological distress Obese - often blamed for their weight Few health practitioners advise losing weight

55 Weight Control: Treatment of Obesity Dieting Small losses, rarely maintained for long Risk of yo-yo dieting to CHD > than risk of obesity alone Formal investigation of low-carb diets does not suggest they are more effective than other kinds of diets Fasting usually employed with other techniques Surgery stomach stapled to reduce capacity Appetite-Suppressing drugs The multimodal approach Screening, self-monitoring, control over eating, exercise Controlling self-talk, social support, relapse prevention

56 Weight Control: Where are Weight Loss Programs Implemented? Work Site Interventions Team competitions are effective in the short term Controversy Are weight losses maintained over time? Commercial Programs TOPS (Taking Pounds Off Sensibly) Weight Watchers Jenny Craig

57 Weight Control: Evaluation of Cognitive- Behavioral Techniques Efforts are somewhat successful Losing 2 pounds/ week for 20 weeks Maintenance for 2 years Programs emphasize self-direction, exercise, and relapse prevention Health psychologists suggest Sensible eating and exercise Rather than specific weight reduction techniques

58 Weight Control: Taking a Public Health Approach Weight- Gain Prevention Women at menopause: exercise and good eating habits may prevent the weight gain that is very common Special junk food tax on foods high in sugars and fats Restriction of advertising to children Health warnings regarding foods high in sugars and fats

59 Summary Mechanisms of health behavior change Weight control- antecedents, correlates, and consequences Outlook: Health enhancing behaviors

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