PSK409-Health Psychology

Transcription

1 PSK409-Health Psychology An Introduction to Health Psychology Val Morrison and Paul Bennett Chapter 3 Health Risk Behavior Assoc. Prof. Okan Cem Çırakoğlu okanc@baskent.edu.tr

2 Learning Outcomes By the end of this chapter, you should have an understanding of: how to define and describe health behaviour the prevalence of key health behaviours associated with elevated disease risk the range and complexity of influences upon the uptake and maintenance of health-risk behaviour some of the challenges facing health behaviour research

3 Health Behaviour Kasl and Cobb (1966) define health behaviour as: any activity undertaken by a person believing themselves to be healthy for the purposes of preventing disease or detecting it at an asymptomatic stage. Harris and Guten (1979) define health behaviour as behaviour performed by an individual, regardless of his/her perceived health status, with the purpose of protecting, promoting or maintaining his/her health.

4 Health Behaviour Matarazzo (1984) distinguished between: behavioural pathogens: a behavioural practice thought to be damaging to health e.g. smoking (health-risk behaviour) behavioural immunogens: a behavioural practice thought to be health protective behaviours e.g. Exercise (health-protective behaviour)

5 Alameda Seven The Alameda County study (Belloc and Breslow 1972; Breslow 1983) identified seven key behaviours associated with health and longevity: sleeping 7 8 hours a night; not smoking; consuming no more than 1 2 alcoholic drinks per day; getting regular exercise; not eating between meals; eating breakfast; being no more than 10% overweight. The benefits of such behaviours were multiplicative and cumulative e.g. moderate drinking plus not smoking is more beneficial than either behaviour alone, and benefits of grow over time.

6 Health-Risk Behaviour The message of the Director-General of the World Health Organization (WHO), in the opening to the World Health Report (2002, p3) was stark, but clear. It stated: in many ways, the world is a safer place today. Safer from what were once deadly or incurable diseases. Safer from daily hazards of waterborne and food-related illnesses. Safer from dangerous consumer goods, from accidents at home, at work or in hospitals. But in many other ways, the world is becoming more dangerous. Too many of us are living dangerously whether we are aware of that or not.

7 Disease and Health-Risk Behaviour Behaviours associated with high levels of mortality: Heart disease: smoking tobacco, high-cholesterol diet, lack of exercise; Cancer: smoking tobacco, alcohol, diet, sexual behaviour; Stroke: smoking tobacco, high-cholesterol diet, alcohol; Pneumonia, influenza: smoking tobacco, lack of vaccination; HIV/AIDS: unsafe/unprotected sexual intercourse.

8 Burden of Ill-Health The burden of ill health that can be attributed to behaviour or behaviour-related conditions

9 Smoking Prevalence After caffeine and alcohol, nicotine is the next most commonly used psychoactive drug in society today. In the UK, Government target were reached in terms of smoking prevalence (Peto et al. 2000; ONS 2012; British Heart Foundation 2012): 1950s 80% of men; 40% of women % of men; 41 % of women % of men; 20% of women There are age difference in smoking prevalence: Highest among men aged 25 34, women aged Lowest levels are seen in those over 60 (around 13%)

10 Prevalence of cigarette smoking among adults in Great Britain, by age group, 2000 and 2012

11 Alcohol Consumption Alcohol (ethanol) is the second most widely used psychoactive substance in the world (after caffeine) (Julien, 1996: 101). There was a significant increase in both the prevalence and amount of alcohol consumed in year olds between 1990 and 2000 In 1996, 27% of boys; 26% of girls In 2010, 13% of boys and girls A decrease has also been recorded in the prevalence of heavy drinking among year olds Similar levels in the year old age group Lowest prevalence of heavy drinking among those aged 65+

12 International Standard Unit and Daily Limits (2015)

13 Illicit Drug Use Perceptions of drug use take on two models: Dependence model addicts, possibly ill or no control Criminal model irresponsible, dangerous, Relatively low prevalence 1 in 3 of UK residents, aged 16 59, have tried an illegal drug at least once (British Crime Survey, 2008) Cannabis is most used, but only 7.6% in past year Should there be equal attention/resources, or more focus on the more prevalent and potentially harmful behaviours such as alcohol and smoking?

14 Negative Health Effects of Smoking Approximately 9% of deaths worldwide are attributed to tobacco use (Global Health Risks report, 2009) Smoking is thought to be responsible for: 30% of coronary heart disease (CHD) cases 70% of cancers (90% of lung cancer) 80% of cases of chronic obstructive airways disease Passive smoking accounts for 25% of lung cancer deaths among non-smokers and carriers significant risk to unborn babies.

15 Negative Health Effects of Substance/Illicit Drug Use Approximately 40 deaths per million of the population aged between 15 and 64 were attributed to illicit drug use in 2012, which was lower than in 2011 (United Nations 2014). Worldwide, approximately 12.7 million people inject drugs, of whom: 13% have an HIV diagnosis More than half have Hepatitis C The UK is the addiction capital of Europe in part due to increased use of legal highs by young people.

16 Initiation Genetics: Some evidence of genetic factors and the reception and transport of the neurotransmitter dopamine being involved in initiation and possibly smoking maintenance. Curiosity: That first drink of alcohol, first cigarette, or first joint of cannabis is curiosity about what it tastes like, how it feels, usually occurring when others have talked about the behaviour or been seen doing it i.e next point. Modelling, social learning and reinforcement: Children with peers, elder siblings or parents who smoke are more likely to initiate smoking than children with non-smoking significant others. This may be linked to development of positive attitudes, or reduced perception of risk. Social pressure: Positively encouraged by significant others i.e. if friends smoke, a young person may feel a need to conform.

17 Initiation Image: Important during adolescence, wanting to fit in and be seen as sociable. Self-concept and self-esteem: Adolescent girls particularly point out the importance of what one is and one s value or worth. Weight control: Identified as a motive for smoking initiation and maintenance among young girls. Risk-taking: Smoking is often associated with other problem behaviours such as truancy, petty theft and underage drinking. Health cognitions such as unrealistic optimism regarding the potential of experiencing negative health outcomes. Stress and distress: There is evidence of depressive symptomatology in smoking onset.

18 Continuing Unhealthy Behaviour and Developing Dependence The main aspects considered are: Genetics and family history of problem drinking Personality characteristics i.e. anxiety, sensation-seeking Social learning theory (learned behaviour through reinforcement) Health promotion efforts target: Primary prevention educating children about risks of heavy drinking and safe levels of consumption; Secondary prevention changing behaviour of those already in heavy drinking (applying behavioural principles to treatment).

19 Maintenance and Stopping The Habit People generally continue smoking for: pleasure or enjoyment of the behaviour, taste and effects reinforces positive attitudes towards smoking; smoking out of habit (psychological and/or physical dependence); a form of stress self-management/coping, anxiety control; a lack of belief in their ability to stop smoking. Reasons to stop smoking: Stopping at aged 30 more than 90% of lung cancer risk being avoided AND average of 10 life years gained; Stopping at avoid most subsequent risk of developing lung cancer or other smoking-related disease or disability AND average of 5 life years gained.

20 Unprotected Sexual Behaviour Negative health consequences include the following: unwanted pregnancy; diseases such as chlamydia, gonorrhoea, herpes, HIV, and more recently HPV. Sexual behaviour as a risk factor for disease received growing attention since the arrival of the human immunodeficiency virus (HIV) in the 1980s. Unlike other behaviours, sexual practices are not inherently individual but behaviour that occurs in the context of an interaction between two individuals.

21 HIV in Western Europe (2014) Of the reported 27,325 people diagnosed: 33.7% acquired HIV through heterosexual contact; 43.9% became infected through male-to-male sexual contact; 3.1% became infected through injecting drug use; 0.8% was via mother-to-child transmission; 10.6% were 15 to 24 years old; and for 18.1% transmission was unknown.

22 NATional survey of Sexual Attitudes and Lifestyles: Use of Condoms Young people and males use condoms more than counterparts Condom use was highest with new sexual partners 34% m; 41% f Declined use in those who reported having had multiple new partners 17.5% m; 10% f Condom use was lowest in males with multiple partners who were not new sexual partners only 5.7% always used a condom Female condom use was less affected by whether multiple partners were new to them or not 14.3% always used a condom with not-new multiple partners

23 NATional survey of Sexual Attitudes and Lifestyles NATSAL 2003 Follow-Up Condom use was higher among young and for those with new sexual partners; Increased use in males and females; M 43% to 51% vs. F 30% to 39% Those with multiple partners high risk were most likely to report condom use Prevention of pregnancy was primary reason for use In year old subsample HIV and STIs prevention

24 Barriers to Condom Use Some negative attitudes to condom use shared by males and females: Reduces spontaneity of behaviour or reduces sexual pleasure. Unrealistically optimistic estimates of personal risk of infection. Women face additional barriers: anticipated male objection to a female suggesting condom use (denial of their pleasure); difficulty/embarrassment in raising the issue of condom use with a male partner; worry that suggesting use to a potential partner implies that they or their partner is HIV positive or has another STD; lack of self-efficacy or mastery in condom usage.

25 Unhealthy Diet What and how (e.g. snacking, bingeing) we eat plays an important role in our health. Direct associations between diet and heart disease and some cancers, while it may confer indirect risks for disease through obesity. Fat intake and cholesterol: Excessive saturated fat intake, if not burned off through exercise, can cause arteries to harden or blockages to build up. Coronary artery disease is a major predictor of angina and heart disease. Salt: High salt (sodium chloride) intake has been implicated with persistent high blood pressure, i.e. hypertension, however mixed evidence to whether the relationship is linear.

26 Obesity Definition Obesity is measured in terms of an individual s body mass index (BMI), calculated as weight/height. normal weight, BMI between 20 and 24.9; overweight, BMI between 25 and 29.9; clinically obese, BMI between 30 and 39.9; severely obese, BMI 40 or greater. Prevalence 31% of the EU adult population are overweight 18% of European adults are obese (Boniol and Autier 2010) Three-fold increase of obesity in US, Australasia, China and UK 9% increased prevalence of overweight children aged 2 10 years in England

27 Negative Consequences of Obesity Hypertension Heart disease Type-2 diabetes Osteoarthritis Respiratory problems Lower back pain Some forms of cancer Psychological ill-health Mortality The relationship between body mass index and mortality at 23-year follow-up

28 What Causes Obesity? Simple explanation: Obesity results when energy intake grossly exceeds energy output (Pinel 2003) Genetic explanations: Obese individuals are born with more fat cells. Obese persons inherit lower metabolic rates. Obese persons may have deficiencies in a hormone responsible for appetite control, or lack of control e.g. leptin studies. A neurotransmitter, serotonin, involved in producing satiety (i.e where hunger is no longer felt) may have a role in obesity reduction.

29 What Causes Obesity? Behavioural and environmental factors: Sedentary lifestyle e.g. watching TV, computing; Lack of physical activity slows down metabolism; Overeating e.g. portion size too high; Eating the wrong food e.g. high saturated fat; Stress can lead to overeating and fatty food intake. A final thought: Extreme dietary restriction is also unhealthy.