HEALTH PSYCHOLOGY

(Notes)

UNIT 1 - Introduction

● Health Psychology
a. Definition, Need, Aim and Future of Health psychology
● Aims and Future of the Biomedical Model of Health
● Biopsychosocial Model in Health Psychology
● Health Inequalities:
a. Sex
b. Geographic location
c. Medical interventions
d. Behaviour

HEALTH PSYCHOLOGY

Definition
● We commonly think about health in terms of an absence of (1) objective signs that the
body is not functioning properly, such as measured high blood pressure, or (2)
subjective symptoms of disease or injury, such as pain or nausea.
● The term health to mean a positive state of physical, mental, and social
well-being—not simply the absence of injury or disease—that varies over time along a
continuum.
● Health psychology is an exciting and relatively new field devoted to understanding
psychological influences on how people stay healthy, why they become ill, and how they
respond when they do get ill.
● The World Health Organization (1948) defined health as “a complete state of
physical, mental, and social well-being and not merely the absence of disease or
infirmity.”
● Rather than defining health as the absence of illness, health is recognized to be an
achievement involving balance among physical, mental, and social well-being. Many use
the term wellness to refer to this optimum state of health.

Illness Today and in the Past

● During the 17th, 18th, and 19th centuries, people in North America suffered and died
chiefly from two types of illness:
 - Dietary diseases result from malnutrition—for example, beriberi is caused by a
lack of vitamin B1 and is characterised by anaemia, paralysis, and wasting away.
- Infectious diseases are acute illnesses caused by harmful matter or
microorganisms, such as bacteria or viruses, in the body. In much of the world
today, infectious diseases continue to be a main cause of death.
● From the early colonial days in America through the 18th century, colonists experienced
periodic epidemics of many infectious diseases, especially smallpox, diphtheria, yellow
fever, measles, and influenza.
● It was not unusual for hundreds, and sometimes thousands, of people to die in a single
epidemic.
● Two other infectious diseases, malaria and dysentery, were widespread and presented an
even greater threat.
● Although these two diseases generally did not kill people directly, they weakened their
victims and reduced their ability to resist other fatal diseases.

Early Cultures
● Best educated people thousands of years ago believed physical and mental illness were
caused by mystical forces, such as evil spirits.
● Researchers found ancient skulls in several areas of the world with coin-size circular
holes in them that could not have been battle wounds. These holes were probably made
with sharp stone tools in a procedure called trephination.
● This procedure was done presumably for superstitious reasons—for instance, to allow
illness causing demons to leave the head.

Ancient Greece and Rome

● The philosophers of ancient Greece produced the earliest written ideas about physiology,
disease processes, and the mind between 500 and 300 B.C. Hippocrates, often called “the
Father of Medicine,” proposed a humoral theory of illness.
● Greek philosophers, especially Plato, were among the first to propose that the mind and
the body are separate entities.
● The mind was considered to have little or no relationship to the body and its state of
health.
● Today, the body and mind are separate concepts: The body refers to our physical being,
including our skin, muscles, bones, heart, and brain; the mind refers to an abstract process
that includes our thoughts, perceptions, and feelings (mind body relationship).

The Middle Ages

● People’s ideas about the cause of illness took on pronounced religious overtones, and the
belief in demons became strong again. Sickness was seen as God’s punishment for doing
evil things.
 ● As a result, the Church came to control the practice of medicine, and priests became
increasingly involved in treating the ill, often by torturing the body to drive out evil
spirits.

The Renaissance and After

(renaissance means rebirth)
● Europe saw a rebirth of inquiry, culture, and politics. Scholars became more
“human-centred” than “God-centred” in their search for truth and “believed that truth can
be seen in many ways, from many individual perspectives”
● The 17th-century French philosopher and mathematician Rene Descartes probably had
the greatest influence on scientific thought of any philosopher in history.
● He regarded the mind and body as separate entities, but he introduced three important
innovations. First, he conceived of the body as a machine and described the mechanics of
how action and sensation occurred.
● Second, he proposed that the mind and body, although separate, could communicate
through the pineal gland, an organ in the brain.
● Third, he believed that animals have no soul and that the soul in humans leaves the body
at death.
● This belief meant that dissection could be an acceptable method of study—a point the
Church was now ready to concede.
● In the 18th and 19th centuries, knowledge in science and medicine grew quickly, helped
greatly by improvements in the microscope and the use of dissection in autopsies.
● These advances, coupled with the continuing belief that the mind and body are separate,
laid the foundation for a new approach, or “model,” for conceptualising health and
illness.
● This approach—called the biomedical model—proposes that all diseases or physical
disorders can be explained by disturbances in physiological processes, which result from
injury, biochemical imbalances, bacterial or viral infection, and the like.

Need
(Psychology’s Role in Health)
● They conquered many infectious diseases, such as polio and measles, through the
development of vaccines. They also developed antibiotics, which made it possible to cure
illnesses caused by bacterial infection.

Problems in the Healthcare System

● health care costs are rising rapidly; main health problems now are chronic diseases.
● Although detection occurs earlier today partly because diagnostic methods have
improved, another part of the reason is that people have changed.
 ● Many individuals are more aware of signs and symptoms of illness, more motivated to
take care of their health, and better able to afford visits to physicians than they were in
the past.

The Person in Health and Illness

● Differences between people can result from biomedical sources, such as variations in
physiological processes and exposure to harmful microorganisms. But psychological and
social factors also play a role.

Lifestyle and Illness

● Occurrence of infectious diseases declined in some nations in the late 19th century
chiefly because of preventive measures, such as improved nutrition and personal hygiene.
● These measures involved changing people’s lifestyles—their everyday patterns of
behaviour, such as in washing, preparing, and eating healthful foods.
● Characteristics or conditions that are associated with the development of a disease or
injury are called risk factors for that health problem.
● Some risk factors are biological, such as having inherited certain genes, others are
behavioural.
● For example, it is well known that people who smoke cigarettes face a much higher risk
of developing cancer and other illnesses than nonsmokers do.
● Other risk factors for cancer include eating diets high in saturated fat and having a family
history of the disease.

Personality and Illness

● The term personality refers to a person’s cognitive, affective, or behavioural tendencies
that are fairly stable across time and situations. Researchers have found evidence linking
personality traits and health:
- Low levels of conscientiousness measured in childhood or adulthood are more
likely to die at earlier ages.
- High levels of positive emotions, such as happiness or enthusiasm, tend to live
longer than individuals with low levels of these emotions.
● Illness can affect one’s emotional adjustment and outlook, too:
- People who suffer from serious illness and disability often experience feelings of
anxiety, depression, anger, and hopelessness.
- But even minor health problems, such as the flu or a toothache, produce
temporary negative thoughts and feelings.
- People who are ill and overcome their negative thoughts and feelings can speed
their recovery.

Aim and Future of Health Psychology

AIMS AND FUTURE OF BIOMEDICAL MODEL OF HEALTH

● As the science of cellular pathology progressed, the humoral theory of illness was put to
rest. Medical practice drew increasingly on laboratory findings and looked to bodily
factors rather than to the mind as bases for health and illness.
● In an effort to break with the superstitions of the past, practitioners resisted
acknowledging any role for the mind in disease processes.
● Instead, they focused primarily on organic and cellular pathology as a basis for their
diagnoses and treatment recommendations.
● The resulting biomedical model, which has governed the thinking of most health
practitioners for the past 300 years, maintains that all illness can be explained on the basis
of aberrant somatic bodily processes, such as biochemical imbalances or
neurophysiological abnormalities.
● The biomedical model assumes that psychological and social processes are largely
irrelevant to the disease process.
Why Is It Ill-suited to Understanding Illness?
● Reduces illness to low-level processes such as disordered cells and chemical imbalances.
● Fails to recognize social and psychological processes as powerful influences over bodily
estates—assumes a mind-body dualism
● Emphasises illness over health rather than focusing on behaviours that promote health
● Model cannot address many puzzles that face practitioners: why, for example, if six
people are exposed to a flu virus, do only three develop the flu?

How the Role of Psychology Emerged

● Sigmund Freud noticed that some patients showed physical symptoms with no detectable
organic disorder.
● Using his psychoanalytic theory, Freud proposed that these symptoms were “converted”
from unconscious emotional conflicts.
● He called this condition conversion hysteria; one form it can take is called glove
anaesthesia because only the hand has no feeling.
● The need to understand conditions such as conversion hysteria led to the development of
psychosomatic medicine, the first field dedicated to studying the interplay between
emotional life and bodily processes.

Psychosomatic Medicine
● The idea that specific illnesses are produced by people’s internal conflicts was
perpetuated in the work of Flanders Dunbar in the 1930s (Dunbar, 1943) and Franz
Alexander in the 1940s (Alexander, 1950).
● Unlike Freud, these researchers linked patterns of personality, rather than a specific
conflict, to specific illnesses. For example, Alexander developed a profile of the
ulcer-prone personality as someone with excessive needs for dependency and love.
● Dunbar and Alexander maintained that conflicts produce anxiety, which becomes
unconscious and takes a physiological toll on the body via the autonomic nervous system.
The continuous physiological changes eventually produce an actual organic disturbance
● The field called psychosomatic medicine was formed in the 1930s and began publishing
the journal Psychosomatic Medicine.
● Its founders were mainly trained in medicine, and their leaders included psychoanalysts
and psychiatrists. The field was soon organised as a society now called the American
Psychosomatic Society.
● The term psychosomatic does not mean a person’s symptoms are “imaginary”; it means
that the mind and body are both involved.
● Early research in psychosomatic medicine focused on psychoanalytic interpretations for
specific, real health problems, including ulcers, high blood pressure, asthma, migraine
headaches, and rheumatoid arthritis.
 ● It is currently a broader field concerned with interrelationships among psychological and
social factors, biological and physiological functions, and the development and course of
illness.

Behavioral Medicine and Health Psychology

Two new fields emerged in the 1970s to study the role of psychology in illness:

1. Behavioural Medicine
- The field of behavioural medicine formed an organisation called the Society of
Behavioral Medicine, which publishes the Annals of Behavioral Medicine.
- First, its membership is interdisciplinary, coming from a wide variety of fields,
including psychology, sociology, and various areas of medicine.
- Second, it grew out of the perspective in psychology called behaviourism, which
proposed that people’s behaviour results from two types of learning: Classical
Conditioning and Operant Conditioning.
2. Health Psychology
- Conditioning methods had shown a good deal of success as therapeutic
approaches in helping people modify problem behaviours, such as overeating, and
emotions, such as anxiety and fear.
- By the 1970s, physiological psychologists had clearly shown that psychological
events—particularly emotions—influence bodily functions, such as blood
pressure.
- And researchers had demonstrated that people can learn to control various
physiological systems if they are given feedback as to what the systems are doing.
- Revealed that the link between the mind and the body is more direct and
pervasive than was previously thought.
- Soon they led to an important therapeutic technique called biofeedback, whereby
a person’s physiological processes, such as blood pressure, are monitored by the
person so that he or she can gain voluntary control over them. This process
involves operant conditioning: the feedback serves as reinforcement.
- Biofeedback is useful in treating a variety of health problems, such as headaches.
- Behaviorism also served as an important foundation for health psychology;
- The American Psychological Association has many divisions, or subfields; the
Division of Health Psychology was introduced in 1978.
● Four goals of Health Psychology:
- To promote and maintain health.
- To prevent and treat illness.
- To identify the causes and diagnostic correlates of health, illness, and related
dysfunction.
- To analyse and improve health care systems and health policy.
An Integration
● The three fields are separate mainly in an organisational sense, and many professionals
are members of all three organisations.
● The main distinctions among the fields are the degree of focus they give to specific topics
and viewpoints, and the specific disciplines and professions involved.
● Psychosomatic medicine is an interdisciplinary field that includes physicians and
behavioural scientists but continues to be closely tied to medical disciplines, including
the application of psychiatry to understanding and treating physical illness.
● Behavioural medicine is also an interdisciplinary field, and tends to focus on
interventions that promote healthy lifestyles without using drugs or surgery.
● Health psychology is based in psychology and draws heavily on other psychology
subfields—clinical, social, developmental, experimental, and physiological—to identify
and alter lifestyle and emotional processes that lead to illness, and to improve functioning
and recovery for people who are sick.

Health Psychology - The Profession

● Most health psychologists work in hospitals, clinics, and academic departments of
colleges and universities. In these positions, they either provide direct help to patients or
give indirect help through research, teaching, and consulting activities.
● The direct help health psychologists provide generally relates to the patient’s
psychological adjustment to, and management of, health problems.
● Health psychologists with clinical training can provide therapy for emotional and social
adjustment problems that being ill or disabled can produce.
● Health psychologists provide indirect help, too. Their research provides information
about lifestyle and personality factors in illness and injury.
● They can apply this and other knowledge to design programs that help people practise
more healthful lifestyles, such as by preventing or quitting cigarette smoking.
● They can also educate health professionals toward a fuller understanding of the
psychosocial needs of patients.

BIOPSYCHOSOCIAL MODEL IN HEALTH PSYCHOLOGY

● The biomedical viewpoint began to change with the rise of modern psychology,
particularly with Sigmund Freud’s (1856–1939) early work on conversion hysteria.
● According to Freud, specific unconscious conflicts can produce physical disturbances
that symbolise repressed psychological conflicts.

● This new perspective, called the biopsychosocial model, expands the biomedical view by
adding to biological factors connections to psychological and social factors.
 ● This new model proposes that all three factors affect and are affected by the person’s
health, and it has been a key part of the foundation of health psychology.

The Role of Biological Factors

● Genetic materials and processes by which we inherit characteristics from our parents. It
also includes the function and structure of the person’s physiology.
● For example, does the body contain structural defects, such as a malformed heart valve or
damage in the brain, that impair the operation of these organs?
● The body is made up of enormously complex physical systems; The efficient, effective,
and healthful functioning of these systems depends on the way these components operate
and interact with each other.

The Role of Psychological Factors

(cognition, emotion, and motivation)
● Cognition is a mental activity that encompasses perceiving, learning, remembering,
thinking, interpreting, believing, and problem solving.
● Suppose, for instance, you strongly believe, “Life is not worth living without the things I
enjoy.” If you enjoy smoking cigarettes, would you quit to reduce your risk of getting
cancer or heart disease? Probably not.
● Emotion is a subjective feeling that affects, and is affected by, our thoughts, behaviour,
and physiology. Some emotions are positive or pleasant, such as joy and affection, and
others are negative, such as anger, fear, and sadness.
● For instance, people whose emotions are relatively positive are less disease-prone and
more likely to take good care of their health and to recover quickly from an illness than
are people whose emotions are relatively negative.
● Motivation is the process within individuals that gets them to start some activity, choose
its direction, and persist in it. A person who is motivated to feel and look better might
begin an exercise program, choose the goals to be reached, and stick with it.

The Role of Social Factors

● People live in a social world. As we interact with people, we affect them and they affect
us. For example, adolescents often start smoking cigarettes and drinking alcohol as a
result of peer pressure.
● On a fairly broad level, our society affects the health of individuals by promoting certain
values of our culture, such as that being fit and healthy is good.

Advantages of Biopsychosocial Model

● Both macro level processes (such as the existence of social support or the presence of
depression) and microlevel processes (such as cellular disorders or chemical imbalances)
continually interact to influence health and illness and their course.
 ● From this viewpoint, health becomes something that one achieves through attention to
biological, psychological, and social needs, rather than something that is taken for
granted.

Clinical Implications of the Biopsychosocial Model

● The biopsychosocial model is useful for clinical practice with patients as well. First, the
process of diagnosis can benefit from understanding the interacting role of biological,
psychological, and social factors in assessing a person’s health or illness;
Recommendations for treatment can focus on all three sets of factors.
● An effective patient-practitioner relationship can improve a patient’s use of services, the
efficacy of treatment, and the rapidity with which illness is resolved.

HEALTH INEQUALITIES
● Due to the internet and the publication of online reports there is now a huge volume of
data available from respected bodies such as the World Health Organization (WHO) and
the Office for National Statistics (ONS), health charities such as British Heart Foundation
(BHF), Cancer Research UK (CRUK), the British Diabetes Association (BDA) and the
American Cancer Society (ACS) as well as academic groups such as the European Heart
Network.
● These data provide insights into health inequalities across the world and within individual
countries, and evidence generally indicates that the diseases people are diagnosed with
and whether or not they die from them vary according to four key dimensions:
geographical location; time; SES and gender.

Gender/Sex
● The third clear source of variation in health and illness is gender. The data shown already
illustrate gender differences in diabetes, obesity and lung cancer.
● It is also established that women tend to live longer than men and at present the average
life expectancy for women in the UK is 81.9 years and for men 77.7 years (from birth).
● Life expectancy for men and women over time is shown in which shows an increase for
both men and women since 1980, that women live longer than men but that the gap
between men and women is gradually closing.

Geographic Location
● It is clear that the prevalence of a range of diseases and their mortality rates vary both
between and within countries.
● huge variations across the world, with the highest death rates being in Sub-Saharan
Africa, Afghanistan, Russia and Eastern Europe.
● Childhood mortality rates also vary by geographical area. For example, data from the
WHO illustrates that the highest child mortality rates are in Africa, the Eastern
 Mediterranean region and South-East Asian region with the lowest rates being in Europe
and the Americas.
● There are also geographical differences in specific diseases. For example, the global
prevalence of HIV in 2009 shows that the highest rates were in Sub-Saharan Africa and
Russia.
● Finally, there is also geographical variation within countries. For example, mortality rates
in people aged under 75 vary across England. It can be seen that mortality rates from all
causes are higher in northern England than southern England and even vary within
London, with the highest rates being in East London.

Medical Interventions
● From a medical perspective, variations in health and illness are explained with a focus on
the success or failure of medical interventions and the availability of health care.
● Research indicates wide variations in health care provision and access, particularly by
geographical area in terms of the types and costs of medicines, the training and expertise
of health care professionals, the distances needed to travel to access health care and the
availability of free health care versus the need for health insurance.
● A good example of the impact of medical interventions is that of HIV/AIDS. In the
western world HIV/AIDS is now considered a chronic illness with many people living
with the HIV virus having a normal life expectancy.

Behavior
● McKeown (1979) examined health and illness throughout the twentieth century and
argued that contemporary illness is caused by ‘influences . . . which the individual
determines by his own behaviour (smoking, eating, exercise, and the like). More recent
data support this emphasis on chronic illnesses which are related to behaviour.
● For example, in 2008 Allender et al. published data on the most common causes of death
across Europe (including the UK) and concluded that cardiovascular diseases and cancer
account for 64 per cent of male and 71 per cent or female deaths.
● Similar figures are also found in the USA where cardiovascular diseases and cancer
accounted for 56 pet cent of deaths in men and 55 per cent of deaths in women (National
Center for Health Statistics 2009).

Behavior and Longetivity

The role of behaviour has also been highlighted by the work of Belloc and Breslow and their
colleagues, They concluded from their original correlational analysis that seven behaviours were
related to positive health status. These behaviours were:
1. Sleeping 7–8 hours a day.
2. Having breakfast every day.
3. Not smoking.
 4. Rarely eating between meals.
5. Being near or at prescribed weight.
6. Having moderate or no use of alcohol.
7. Taking regular exercise.

Behavior and Mortality

Weg (1983) examined the longevity of the Abkhazians and suggested that, relative to that in
other countries, it is due to a combination of biological, lifestyle and social factors including:
1. Genetics.
2. Maintaining vigorous work roles and habits.
3. A diet low in saturated fat and meat and high in fruit and vegetables.
4. No alcohol or nicotine.
5. High levels of social support.
6. Low reported stress levels.

Analysis of this group of people suggests that health behaviours may be related to longevity and
are therefore worthy of study. However, such cross-sectional studies are problematic to interpret,
particularly in terms of the direction of causality.

UNIT 2 - Health Belief and Health Enhancing Behaviour

● Health Theories:
a. Health Belief Model
b. Attribution Theory for Health Related Outcomes
c. Self-Affirmation Theory
d. Self Deterministic Theory
e. Transtheoretical Theory of Behaviour Change
f. HAPA
g. Protection Motivation Theory
h. Theory of Reasoned Action and Theory of Planned Behaviour
● Health Enhancing Behaviour
a. Exercise
b. Maintaining a Healthy Diet
c. Food Habits
d. Weight Control
● Health Compromising
● Characteristics of Health Compromising Behaviour
a. Obesity
b. Eating Disorder
 c. Smoking
d. Drinking

*extra information that was covered in class*

HEALTH PROMOTION

● Health promotion is a philosophy that has at its core the idea that good health, or
wellness, is a personal and collective achievement.
● For the individual, it involves developing a program of good health habits.
● For the medical practitioner, health promotion involves teaching people how to achieve a
healthy lifestyle and helping people at risk for particular health problems off-set or
monitor those risks.
● For the health psychologist, health promotion involves the development of interventions
to help people practise healthy behaviours.
● For community and national policy makers, health promotion involves emphasising good
health and providing information and resources to help people change poor health habits.
● Successful modification of health behaviours will have several beneficial effects:
- First, it will reduce deaths due to lifestyle-related diseases.
- Second, it may delay time of death, thereby increasing life expectancy.
- Third and most important, the practice of good health behaviours may expand the
number of years during which a person may enjoy life free from the
complications of chronic disease.
- Finally, modification of health behaviours may begin to make a dent in the more
than $2.6 trillion that is spent yearly on health and illness.

Health Behaviours and Health Habits

● Health behaviours are behaviours undertaken by people to enhance or maintain their
health.
● A health habit is a health behaviour that is firmly established and often performed
automatically, without awareness. These habits usually develop in childhood and begin to
stabilise around age 11 or 12.
● An illustration of the importance of good health habits is provided by a classic study of
people living in Alameda County, California, conducted by Belloc and Breslow (1972).
These scientists focused on several important health habits:
- Sleeping 7 to 8 hours a night
- Not smoking
- Eating breakfast each day
- Having no more than one or two alcoholic drinks each day
- Getting regular exercise
 - Not eating between meals
- Being no more than 10 percent overweight
● Primary Prevention: Instilling good health habits and changing poor ones is the task of
primary prevention. This means taking measures to combat risk factors for illness before
an illness has a chance to develop.
● There are two general strategies of primary prevention.
- The first and most common strategy is to get people to alter their problematic
health behaviours, such as helping people lose weight through an intervention.
- The second, more recent approach is to keep people from developing poor health
habits in the first place. Smoking prevention programs with young adolescents.

Practising and Changing Health Behaviours

- Demographic Factors
- Age
- Values
- Personal Control
- Social Influence
- Personal Goals and Values
- Perceived Symptoms
- Access to the Health Care Delivery System
- Knowledge and Intelligence

Barriers to Modifying Poor Health Behaviours

There is often little immediate incentive for practising good health behaviours

● Smoking, a poor diet, and lack of exercise have no apparent effect on health for years,
and few children and adolescents are concerned about what their health will be like when
they are 40 or 50 years old.
● Emotional Factors: Emotions may lead to or perpetuate unhealthy behaviours. These
behaviours can be pleasurable, automatic, addictive, and resistant to change.

Intervening with Children and Adolescents Socialisation

● Health habits are strongly affected by early socialisation, especially the influence of
parents as both teachers and role models.
● Many teachable moments arise in early childhood. Parents can teach their children basic
safety behaviours, such as looking both ways before crossing the street, and basic health
habits, such as drinking milk instead of soda with dinner.
● Other teachable moments are built into the health care system. For example, many infants
in the United States are covered by well-baby care.
 ● There is also a window of vulnerability for smoking and drug use during middle school,
when students are first exposed to these habits among their peers.

● Another vulnerable group is people who are at risk for particular health problems. For
example, people from families with a familial disorder may know that their personal risk
is higher.
● Benefits of Focusing on At-Risk People:
- First, disease may be prevented altogether. For example, helping men with a
family history of heart disease to stop smoking can prevent coronary heart
disease.
- Focusing on at-risk people helps to identify other factors that may increase risk.
For example, not everyone who has a family history of hypertension will develop
hypertension, but by focusing especially on people who are at risk, other factors
that contribute to its development, such as diet, may be identified.
● Problems of Focusing on At-Risk People:
- People do not always perceive their risk correctly. Most people are unrealistically
optimistic and view their poor health behaviours as widely shared but their
healthy behaviours as more distinctive. For example, smokers overestimate the
number of other people who smoke.
- People can become defensive, minimise the significance of their risk factor, and
avoid using appropriate services or monitoring their condition.

Changing Health Habits

● Educational appeals make the assumption that people will change their health habits if
they have good information about their habits.
● Attitudinal approaches to changing health habits often make use of fear appeals. This
approach assumes that if people are afraid that a particular habit is hurting their health,
they will change their behaviour to reduce their fear. However, this relationship does not
always hold.
● Persuasive messages that elicit too much fear may actually undermine health behaviour
change. Moreover, fear alone may not be sufficient to change behaviour.
● Specific action recommendations, such as where and how one can obtain a flu shot, may
be needed. Fear can increase defensiveness, which reduces how effective an appeal will
be.
● A health message can be phrased in positive or negative terms. For example, a reminder
card to get a flu immunisation can stress the benefits of being immunised or stress the
discomfort of the flu itself.

HEALTH THEORIES
Attitudinal approaches to health behaviour change have been formalised in several specific
theories that have guided interventions to change health behaviours.

Health Belief Model

● An early influential attitude theory of why people practise health behaviours is the health
belief model.
● According to this model, whether a person practises a health behaviour depends on two
factors: whether the person perceives a personal health threat, and whether the person
believes that a particular health practice will be effective in reducing that threat.

● Perceived Health Threat:

- The perception of a personal health threat is influenced by at least three factors:
general health values, which include interest in and concern about health; specific
beliefs about personal vulnerability to a particular disorder; and beliefs about the
consequences of the disorder, such as whether they are serious.
- Thus, for example, people may change their diet to include low cholesterol foods
if they value health, feel threatened by the possibility of heart disease, and
perceive that the personal threat of heart disease is severe.
● Perceived Threat Reduction:
- Whether a person believes a health measure will reduce threat has two
subcomponents: whether the person thinks the health practice will be effective,
and whether the cost of undertaking that measure exceeds its benefits.
- For example, the man who is considering changing his diet to avoid a heart attack
may believe that dietary change alone would not reduce his risk of a heart attack
and that changing his diet would interfere with his enjoyment of life too much to
justify taking the action.
- So, even if his perceived vulnerability to heart disease is great, he would probably
not make any changes.
 ● Support for the Health Belief Model:
- Many studies have used the health belief model to increase perceived risk and
increase perceived effectiveness of steps to modify a broad array of health habits,
ranging from health screening programs to smoking.
- The health belief model does, however, leave out an important component of
health behaviour change, and that is a sense of self-efficacy: the belief that one
can control one’s practice of a particular behaviour. For example, smokers who
believe they cannot stop smoking are unlikely to make the effort.

Attribution Theory for Health Related Outcomes

● The origins of attribution theory can be found in the work of Heider (1944, 1958), who
argued that individuals are motivated to see their social world as predictable and
controllable – that is, a need to understand causality.
● Kelley (1967, 1971) developed these original ideas and proposed a clearly defined
attribution theory suggesting that attributions about causality were structured according to
causal schemata made up of the following criteria:
- Distinctiveness: the attribution about the cause of a behaviour is specific to the
individual carrying out the behaviour.
- Consensus: the attribution about the cause of a behaviour would be shared by
others.
- Consistency over time: the same attribution about causality would be made at any
other time.
 - Consistency over modality: the same attribution would be made in a different
situation.
● Kelley argued that attributions are made according to these different criteria and that the
type of attribution made (e.g. high distinctiveness, low consensus, low consistency over
time, low consistency over modality) determine the extent to which the cause of a
behaviour is regarded as a product of a characteristic internal to the individual or external
(i.e. the environment or situation).
● Since its original formulation, attribution theory has been developed extensively and
differentiations have been made between self-attributions (i.e. attributions about one’s
own behaviour) and other attributions (i.e. attributions made about the behaviour of
others). In addition, the dimensions of attribution have been redefined as follows:
- internal versus external (e.g. my failure to get a job is due to my poor
performance in the interview versus the interviewer’s prejudice);
- stable versus unstable (e.g. the cause of my failure to get a job will always be
around versus was specific to that one event);
- global versus specific (e.g. the cause of my failure to get the job influences other
areas of my life versus only influenced this specific job interview);
- controllable versus uncontrollable (e.g. the cause of my failure to get a job was
controllable by me versus was uncontrollable by me)
● Brickman et al. (1982) have also distinguished between attributions made about the
causes of a problem and attributions made about the possible solution.
● For example, they claimed that whereas an alcoholic may believe that he is responsible
for becoming an alcoholic due to his lack of willpower (an attribution for the cause), he
may believe that the medical profession is responsible for making him well again (an
attribution for the solution).

Research
● Herzlich (1973) interviewed 80 people about the general causes of health and illness and
found that health is regarded as internal to the individual and illness is seen as something
that comes into the body from the external world.
● A further study by King (1982) examined the relationship between attributions for an
illness and attendance at a screening clinic for hypertension.
● The results demonstrated that if the hypertension was seen as external but controllable by
the individual then they were more likely to attend the screening clinic (‘I am not
responsible for my hypertension but I can control it’).

Health Locus of Control

● The internal versus external dimension of attribution theory has been specifically applied
to health in terms of the concept of a health locus of control.
 ● Individuals differ as to whether they tend to regard events as controllable by them (an
internal locus of control) or uncontrollable by them (an external locus of control).
● Wallston and Wallston (1982) developed a measure of the health locus of control which
evaluates whether an individual regards their health as controllable by them (e.g. ‘I am
directly responsible for my health’), whether they believe their health is not controllable
by them and in the hands of fate (e.g. ‘whether I am well or not is a matter of luck’), or
whether they regard their health as under the control of powerful others (e.g. ‘I can only
do what my doctor tells me to do’).
● It is related to whether an individual changes their behaviour (e.g. gives up smoking) and
to the kind of communication style they require from health professionals.
● For example, if a doctor encourages an individual who is generally external to change
their lifestyle, the individual is unlikely to comply if they do not deem themselves
responsible for their health.

Unrealistic Optimism
● Weinstein (1983, 1984) suggested that one of the reasons why people continue to practise
unhealthy behaviours is due to inaccurate perceptions of risk and susceptibility – their
unrealistic optimism.
● He asked subjects to examine a list of health problems and to state ‘compared to other
people of your age and sex, what are your chances of getting [the problem] greater than,
about the same, or less than theirs?’ The results of the study showed that most subjects
believed that they were less likely to get the health problem.
● Weinstein called this phenomenon unrealistic optimism as he argued that not everyone
can be less likely to contract an illness.
● Weinstein (1987) described four cognitive factors that contribute to unrealistic optimism:
1. lack of personal experience with the problem;
2. the belief that the problem is preventable by individual action;
3. the belief that if the problem has not yet appeared, it will not appear in the future;
and
4. the belief that the problem is infrequent.
● These factors suggest that perception of one's own risk is not a rational process.
● In an attempt to explain why individuals’ assessment of their risk may go wrong, and
why people are unrealistically optimistic, Weinstein (1983) argued that individuals show
selective focus.
● He claimed that individuals ignore their own risk-increasing behaviour (‘I may not
always practise safe sex but that’s not important’) and focus primarily on their
risk-reducing behaviour (‘but at least I don’t inject drugs’).
● He also argues that this selectivity is compounded by egocentrism; individuals tend to
ignore others’ risk-decreasing behaviour (‘my friends all practise safe sex but that’s
irrelevant’).
 ● Therefore, an individual may be unrealistically optimistic if they focus on the times they
use condoms when assessing their own risk and ignore the times they do not and, in
addition, focus on the times that others around them do not practise safe sex and ignore
the times that they do.

Self Affirmation Theory

● Central to unrealistic optimism and risk compensation is the notion of risk perception and
the proposal that individuals can process risk information in ways that enable them to
continue their unhealthy behavior.
● An example of this is smokers’ ability to continue to smoke even when the words
‘smoking kills’ are written on their packet of cigarettes.
● Recently, however, it has been suggested that self-affirmation may help reduce the
tendency to resist threat information.
● Self-affirmation theory suggests that people are motivated to protect their sense of
self-integrity and their sense of themselves as being ‘adaptively and morally adequate’
● Therefore, if presented with information that threatens their sense of self, they behave
defensively and either ignore or reject it.
● However, if given the opportunity to self-affirm in another domain of their lives, then
their need to become defensive is reduced.
● For example, if a smoker thinks that they are a sensible person, when confronted with a
message that says that smoking is not sensible, their integrity is threatened and they
behave defensively by blocking the information.
● If given the chance, however, to think about another area in which they are sensible, then
they are less likely to become defensive about the antismoking message.
● This approach has implications for a wide range of health-related behaviours and the
development of more effective interventions to change behavior.

Self Determination Theory

● Self-determination theory (SDT), a theory that also guides health behaviour modification,
builds on the idea that people are actively motivated to pursue their goals.
● Th e theory targets two important components as fundamental to behavior change,
namely autonomous motivation and perceived competence.
● People are autonomously motivated when they experience free will and choice when
making decisions. Competence refers to the belief that one is capable of making the
health behavior change.
● Accordingly, if a woman changes her diet because her physician tells her to, she may not
experience a sense of autonomy and instead may experience her actions as under
another’s control. This may undermine her commitment to behaviour change.
 ● However, if her dietary change is autonomously chosen, she will be intrinsically
motivated to persist.
● SDT has given rise to interventions that target these beliefs, namely autonomous
motivation and competence, and have shown some success in changing behaviours
including smoking to alcohol use.

Criticisms of Attitude Theories

● Because health habits are often deeply ingrained and difficult to modify, attitude-change
interventions may provide the informational base for altering health habits but not always
the impetus to take action.
● Moreover, attitude change techniques assume that behaviour changes are guided by
conscious motivation, and these approaches ignore the fact that some behaviour change
occurs automatically and is not subject to awareness.
● That is, a general limitation of health behaviour change models is the fact that they
heavily emphasise conscious deliberative processes in practising health behaviours;
● Perhaps the most obvious example concerns health habits that are accomplished
automatically in response to a minimal cue, such as putting on a seatbelt when one gets
into a car.

Implementation Intentions
● A theoretical model that emphasises implementation intentions integrates conscious
processing with automatic behavioural enactment.
● When a person desires to practise healthy behaviour, it can be achieved by making a
simple plan that links critical situations or environmental cues to goal-directed responses.
● For example, a person might tell herself, “When I finish breakfast, I will take out the
dog’s leash and walk her.”
● The theory underscores the importance of planning exactly how, when, and where to
implement healthy behaviour.
● Without these explicit links to action, the good intention might remain at the intention
stage.
● A second important feature of the theory is the idea that, by forming an implementation
intention, one can delegate the control of goal-directed responses to situational cues (e.g.,
completing breakfast), which may then elicit the behaviour automatically (in this case,
the action of taking out the leash to walk the dog).
● Over time, the link from the implementation to the goal-directed response becomes
automatic and need not be brought into conscious awareness to be enacted.
● Forming implementation intentions can be a simple but effective way to promote health
behaviours.
● When a person has a particular health goal, such as remembering to use sunscreen, he or
she can strategically engage automatic processes in an effort to make good on that goal.
 ● So, for example, a person wanting to practise better sun safety behaviours might say,
“Whenever I am going to the beach, I will put on sunscreen first.”
● Having created this implementation intention, she then delegates the control of sunscreen
use to anticipated situational cues, in this case, getting ready to go to the beach.
● Thus, although the original implementation intention is consciously framed, the relation
of the health behaviour itself to the situation in which it is relevant becomes an automatic
process.
● Adding implementation intentions to attitude models of health behaviour has improved
their ability to predict behaviour.

Health Behavior Change and the Brain

● Some successful health behaviour change in response to persuasive messages occurs
outside of awareness.
● Despite being inaccessible to conscious awareness, this change may be reflected in
patterns of brain activation.
● Emily Falk and colleagues (Falk, Berkman, Mann, Harrison, & Lieberman, 2010) gave
people persuasive messages promoting sunscreen use.
● People who showed significant activation in two particular brain regions, the medial
prefrontal cortex (mPFC) and posterior cingulate cortex (pCC), in response to the
messages increased their sunscreen use.
● Most importantly, attitude change about sunscreen use in response to the persuasive
message only weakly predicted people’s intentions to use sunscreen, but activity in these
two brain regions quite strongly predicted sunscreen use, independent of attitudes and
behavioural intentions.
● In other words, processes apparently not accessible to consciousness nonetheless
significantly predicted changes in sunscreen use.

Transtheoretical Theory of Behaviour Change

● Changing a bad health habit does not take place all at once. People go through stages
while they are trying to change their health behaviours.

Stages of Change
● J. O. Prochaska and his associates developed the transtheoretical model of behaviour
change, a model that analyses the stages and processes people go through in bringing
about a change in behaviour and suggested treatment goals and interventions for each
stage.
● Originally developed to treat addictive disorders, such as smoking, drug use, and alcohol
addiction, the stage model has now been applied to a broad range of health habits, such as
exercising and sun protection behaviours.
1. Precontemplation
- when a person has no intention of changing his or her behaviour. Many people in
this stage are not aware that they have a problem, although families, friends,
neighbours, or coworkers may well be.
- An example is the problem drinker who is largely oblivious to the problems he
creates for his family.
- Sometimes people in the precontemplation phase seek treatment if they have been
pressured by others to do so.
- Not surprisingly, these people often revert to their old behaviours and so make
poor targets for intervention.

2. Contemplation
- People are aware that they have a problem and are thinking about it but have not
yet made a commitment to take action.
- Many people remain in the contemplation stage for years. Interventions aimed at
increasing receptivity to behaviour change can be helpful.

3. Preparation
- People intend to change their behaviour but have not yet done so successfully.
- In some cases, they have modified the target behaviour somewhat, such as
smoking fewer cigarettes than usual, but have not yet made the commitment to
eliminate the behaviour altogether.

4. Action
- People modify their behaviour to overcome the problem. Action requires the
commitment of time and energy to making real behaviour change.
- It includes stopping the behaviour and modifying one’s lifestyle and environment
to rid one’s life of cues associated with the behaviour.

5. Maintenance
- People work to prevent relapse and to consolidate the gains they have made.
- For example, if a person is able to remain free of addictive behaviour for more
than 6 months, he or she is assumed to be in the maintenance stage.
- Because relapse is the rule rather than the exception with many health behaviours,
this stage model is conceptualised as a spiral.
- A person may take action, attempt maintenance, relapse, return to the
precontemplation phase, cycle through the subsequent stages to action, repeat the
cycle again, and do so several times until they have eliminated the behaviour.
Using the Stage Model of Change
● At each stage, particular types of interventions may be most appropriate. Specifically,
providing people in the precontemplation stage with information about their problem may
move them to the contemplation phase.
● To move people from the contemplation phase into preparation, an appropriate
intervention may induce them to assess how they feel and think about the problem and
how stopping it will change them.
● Interventions designed to get people to make explicit commitments as to when and how
they will change their behaviour may bridge the gap between preparation and action.
● Interventions that emphasise providing self-reinforcement, social support, stimulus
control, and coping skills should be most successful with individuals already moving
through the action phase into long-term maintenance.
● The stage model of health behaviour change deserves to be true, but so far its use has
shown mixed success.

HAPA (The Health Action Process Approach)

● The health action process approach (HAPA) was developed by Schwarzer (1992)
following his review of the literature, which highlighted the need to include a temporal
element into the understanding of beliefs and behaviour.
● In addition, it emphasised the importance of self-efficacy as a determinant of both
behavioural intentions and self-reports of behaviour.
● The HAPA includes several elements from all previous theories and attempts to predict
both behavioural intentions and actual behavior.

Components of the HAPA

● The main addition made by the HAPA to the existing theories is the distinction between a
decision-making/motivational stage and an action/maintenance stage.
● Therefore, the model adds a temporal and process factor to understanding the relationship
between beliefs and behaviour and suggests individuals initially decide whether or not to
carry out a behaviour (the motivation stage), and then make plans to initiate and maintain
this behaviour (the action phase).
● According to the HAPA, the motivation stage is made up of the following components:
- self-efficacy (e.g. ‘I am confident that I can stop smoking’);
- outcome expectancies (e.g. ‘stopping smoking will improve my health’), which
has a subset of social outcome expectancies (e.g. ‘other people want me to stop
smoking and if I stop smoking I will gain their approval’);
- threat appraisal, which is composed of beliefs about the severity of an illness and
perceptions of individual vulnerability.
 ● According to the HAPA the end result of the HAPA is an intention to act. The action
stage is composed of cognitive (volitional), situational and behavioural factors.
● The integration of these factors determines the extent to which a behaviour is initiated
and maintained via these self-regulatory processes.
● The cognitive factor is made up of action plans (e.g. ‘if offered a cigarette when I am
trying not to smoke I will imagine what the tar would do to my lungs’) and action control
(e.g. ‘I can survive being offered a cigarette by reminding myself that I am a
non-smoker’).
● These two cognitive factors determine the individual’s determination of will. The
situational factor consists of social support (e.g. the existence of friends who encourage
nonsmoking) and the absence of situational barriers (e.g. financial support to join an
exercise club).
● Schwarzer (1992) argued that the HAPA bridges the gap between intentions and
behaviour and emphasises self-efficacy, both in terms of developing the intention to act
and also implicitly in terms of the cognitive stage of the action stage, whereby self
efficacy promotes and maintains action plans and action control, therefore contributing to
the maintenance of the action.
● He maintained that the HAPA enables specific predictions to be made about causality and
also describes a process of beliefs whereby behaviour is the result of a series of
processes.

Support for the HAPA

 ● The individual components of the HAPA have been tested providing some support for the
model.
● In particular, Schwarzer (1992) claimed that self-efficacy was consistently the best
predictor of behavioural intentions and behaviour change for a variety of behaviours such
as the intention to dental floss, frequency of flossing, effective use of contraception,
breast self-examination, drug addicts’ intentions to use clean needles, intentions to quit
smoking, and intentions to adhere to weight loss programmes and exercise.

Criticisms of the HAPA

● The social cognition models attempt to address the problem of the social world in their
measures of normative beliefs.
● However, such measures only access the individual’s cognitions about their social world.

Protection Motivation Theory

● Rogers developed the protection motivation theory (PMT), which expanded the HBM to
include additional factors.

Components of the PMT

● The original protection motivation theory claimed that health-related behaviours are a
product of four components:
1. Severity (e.g. ‘Bowel cancer is a serious illness’);
2. Susceptibility (e.g. ‘My chances of getting bowel cancer are high’);
3. Response effectiveness (e.g. ‘Changing my diet would improve my health’);
4. Self-efficacy (e.g. ‘I am confident that I can change my diet’).
● These components predict behavioural intentions (e.g. ‘I intend to change my
behaviour’), which are related to behaviour.
● Rogers (1985) has also suggested a role for a fifth component, fear (e.g. an emotional
response), in response to education or information.
● The PMT describes severity, susceptibility and fear as relating to threat appraisal (i.e.
appraising to outside threat) and response effectiveness and self-efficacy as relating to
coping appraisal (i.e. appraising the individual themselves).
● According to the PMT, there are two types of sources of information, environmental (e.g.
verbal persuasion, observational learning) and intrapersonal (e.g. prior experience).
● This information influences the five components of the PMT (self-efficacy, response
effectiveness, severity, susceptibility, fear), which then elicit either an ‘adaptive’ coping
response (i.e. behavioural intention) or a ‘maladaptive’ coping response (e.g. avoidance,
denial).
Using the PMT
● If applied to dietary change, the PMT would make the following predictions: information
about the role of a high fat diet in coronary heart disease would increase fear; increase the
individual’s perception of how serious coronary heart disease was (perceived severity);
and increase their belief that they were likely to have a heart attack (perceived
susceptibility/susceptibility).
● If the individual also felt confident that they could change their diet (self-efficacy) and
that this change would have beneficial consequences (response effectiveness), they would
report high intentions to change their behaviour (behavioural intentions).

Support for the PMT

● Rippetoe and Rogers (1987) gave women information about breast cancer and examined
the effect of this information on the components of the PMT and their relationship to the
women’s intentions to practise breast self-examination (BSE).
● The results showed that the best predictors of intentions to practise BSE were response
effectiveness, severity and self-efficacy.
● In a further study, the effects of persuasive appeals for increasing exercise on intentions
to exercise were evaluated using the components of the PMT.
● The results showed that susceptibility and self-efficacy predicted exercise intentions but
that none of the variables were related to self-reports of actual behaviour.

Criticisms of the PMT

● The PMT has been less widely criticised than the health belief model; however, many of
the criticisms of the HBM also relate to the PMT.
● For example, the PMT assumes that individuals are conscious information processors, it
does not account for habitual behaviours, nor does it include a role for social and
environmental factors.
Theory of Reasoned Action and Theory of Planned Behavior
● The theory of reasoned action (TRA) was extensively used to examine predictors of
behaviours and was central to the debate within social psychology concerning the
relationship between attitudes and behaviour.
● The theory of reasoned action emphasised a central role for social cognitions in the form
of subjective norms (the individual’s beliefs about their social world) and included both
beliefs and evaluations of these beliefs (both factors constituting the individual’s
attitudes).
● The TRA was therefore an important model as it placed the individual within the social
context and in addition suggested a role for value which was in contrast to the traditional
more rational approach to behaviour.
● The theory of planned behaviour (TPB) was developed by Ajzen and colleagues and
represented a progression from the TRA.
Components of the TPB
● The TPB emphasises behavioural intentions as the outcome of a combination of several
beliefs.
● The theory proposes that intentions should be conceptualised as ‘plans of action in
pursuit of behavioural goals’ and are a result of the following beliefs:
- Attitude towards a behaviour, which is composed of both a positive or negative
evaluation of a particular behaviour and beliefs about the outcome of the
behaviour (e.g. ‘exercising is fun and will improve my health’);
- Subjective norm, which is composed of the perception of social norms and
pressures to perform a behaviour and an evaluation of whether the individual is
motivated to comply with this pressure (e.g. ‘people who are important to me will
approve if I lose weight and I want their approval’);
- Perceived behavioural control, which is composed of a belief that the individual
can carry out a particular behaviour based upon a consideration of internal control
factors (e.g. skills, abilities, information) and external control factors (e.g.
obstacles, opportunities), both of which relate to past behaviour.
● According to the TPB, these three factors predict behavioural intentions, which are then
linked to behaviour.
● The TPB also states that perceived behavioural control can have a direct effect on
behaviour without the mediating effect of behavioural intentions.

Using the TPB

 ● If applied to alcohol consumption, the TPB would make the following predictions: if an
individual believed that reducing their alcohol intake would make their life more
productive and be beneficial to their health (attitude to the behaviour) and believed that
the important people in their life wanted them to cut down (subjective norm), and in
addition believed that they were capable of drinking less alcohol due to their past
behaviour and evaluation of internal and external control factors (high behavioural
control), then this would predict high intentions to reduce alcohol intake (behavioural
intentions).
● The model also predicts that perceived behavioural control can predict behaviour without
the influence of intentions.
● For example, if perceived behavioural control reflects actual control, a belief that the
individual would not be able to exercise because they are physically incapable of
exercising would be a better predictor of their exercising behaviour than their high
intentions to exercise.

Support for the TPB

● The theory of planned behaviour has been used to assess a variety of health-related
behaviours.
● For example, Brubaker and Wickersham (1990) examined the role of the theory’s
different components in predicting testicular self-examination and reported that attitude
towards the behaviour, subjective norm and behavioural control (measured as
self-efficacy) correlated with the intention to perform the behaviour.

Criticisms of the TPB

● Schwarzer (1992) has criticised the TPB for its omission of a temporal element and
argues that the TPB does not describe either the order of the different beliefs or any
direction of causality.
● However, in contrast to the HBM and the PMT, the model attempts to address the
problem of social and environmental factors (in the form of normative beliefs).
● In addition, it includes a role for past behaviour within the measure of perceived
behavioural control.

HEALTH ENHANCING BEHAVIOR

Exercise

Exercise and Its Benefits:

● Exercise is a critical health-promoting behavior that improves both physical and
psychological well-being.
 ● Participation in regular exercise is associated with various demographic factors such as
gender, race, age, and income.
● Recommended exercise prescriptions for adults include 30 minutes of moderate-intensity
activity most days or 20 minutes of vigorous activity at least 3 days a week.
● Aerobic exercise includes activities like running, bicycling, rope jumping, and
swimming.

Psychological Effects of Exercise:

● Regular exercise enhances mood and general well-being.
● Positive effects on mood may arise from social interactions during exercise and improved
self-efficacy.
● Exercise has been used as a treatment for depression and has shown to prevent depression
in women.
● Exercise benefits cognitive functioning, memory, and executive control in both adults and
children.

Determinants of Exercise:
● Individuals who come from families that value exercise, have positive attitudes, and high
self-efficacy are more likely to exercise.
● Convenient and accessible exercise settings promote exercise.
● Social support, commitment, and group cohesion can foster exercise participation.
Environmental factors and community support play a role in exercise engagement.
● Long-term practice makes exercise a habitual behavior.

Exercise Interventions:
● Interventions that enhance self-control and motivation are successful in changing exercise
habits.
● Tailoring interventions to match individuals' stage of readiness for change is
effective.
● Setting personal goals and forming implementation intentions improve exercise
adherence.
● Incorporating exercise into a broader healthy lifestyle change can lead to success.
● Long-term exercise adherence relies on maintaining motivation and overcoming barriers.

Benefits of Exercise:
● Exercise offers substantial health benefits, including weight control, reduced risk of
cardiovascular disease, diabetes, certain cancers, strengthened bones and muscles,
improved sleep, immune system enhancement, and cognitive improvements.

Maintaining A Healthy Diet

Changing Diet:
● Changing ones diet can have significant health benefits.
● Diets high in fiber can protect against obesity and cardiovascular disease by lowering
insulin levels.
● A diet rich in fruits, vegetables, whole grains, peas, beans, poultry, fish, and low in
refined grains, potatoes, red and processed meats reduces the risk of coronary heart
disease.
● Switching from trans fats and saturated fats to polyunsaturated and monounsaturated fats
is a healthy change.
● Mediterranean diets and low-carbohydrate diets with vegetarian sources of fat and protein
have health benefits.
● Resistance to modifying diet is common, even when advised by physicians. Stress,
preferences for comfort foods, and lack of health consciousness can hinder dietary
changes.

Stress and Diet:

● Stress has a negative impact on diet; people under stress tend to eat more fatty foods,
fewer fruits and vegetables, and are more likely to snack and skip breakfast.
● Individuals with low-status jobs, high workloads, and little control over their work also
tend to have less healthy diets.
● Stress can distract individuals and affect self-control over food consumption.

Who Controls Their Diet:

● People high in conscientiousness and intelligence are better at adhering to a healthy diet.
High self-control and executive control skills contribute to managing a healthy diet.
● Self-efficacy, knowledge about dietary issues, family support, and awareness of health
benefits are critical for maintaining a healthy diet.

Interventions to Modify Diet:

● Recent efforts focus on reducing portion size, snacking, and sugary drink consumption.
Computer-tailored interventions, telephone counseling, and culturally appropriate
interventions can effectively promote dietary changes.
● Social engineering, such as banning unhealthy foods in schools and making healthy foods
more accessible, can support healthier food choices.

Food Habits

Weight Control
HEALTH COMPROMISING

● Health-compromising behaviors often develop during adolescence.

● These behaviors include obesity, smoking, alcohol consumption, drug use, unsafe sexual
encounters, and vulnerability to injury.
● Peers play a significant role in the development of these behaviors, as adolescents learn
and imitate behaviors from their peers.
● Adolescents aim to be attractive to others, which is a factor in the development of various
health-compromising behaviors.

CHARACTERISTICS OF HEALTH COMPROMISING BEHAVIOR

● Many health-compromising behaviors are tied to habits and can be addictive. With proper
interventions, even deeply ingrained habits can be modified.
● Successful changes in one health behavior often lead to positive changes in other
behaviors, reducing overall risk.
● Adolescence presents a vulnerable period for the initiation of behaviors like excessive
drinking, smoking, drug use, unsafe sex, and risk-taking.
● Multiple health-compromising behaviors can cluster together as a problem behavior
syndrome.

Obesity
● Obesity is characterized by excessive accumulation of body fat. In the US, obesity levels
are high, with 68% of adults being overweight and 34% being obese.
● Obesity contributes to various health issues, including cancer, cardiovascular diseases,
diabetes, and disability.
● Abdominal obesity poses higher risks for cardiovascular diseases and other health
problems.
● Psychological distress and social stigmatization are associated with obesity.
● Obesity is linked to early mortality, reducing life expectancy by several years.
● Childhood obesity is a significant concern, with over a third of children being overweight
or obese.
● Healthy Fat Percentage: Generally, around 20–27% of body tissue in women and 15–22%
in men should be fat.
● Worldwide Statistics: The World Health Organization estimates 500 million people
globally are obese, and 1.5 billion are overweight.
 ● Body Mass Index (BMI): A measure to determine if one is overweight or obese. BMI
Categories: Normal, Overweight, Obese (classified by specific BMI values).
● BMI and Health: BMI associated with risks of various health conditions including cancer,
cardiovascular disease, atherosclerosis, hypertension, diabetes, heart failure, etc.

Obesity’s Impact on Health:

● Linked to increased risks of multiple types of cancer, cardiovascular diseases, and
diabetes.
● Increases risks in surgery, anesthesia administration, and childbearing. A chief cause of
disability, impacting the ability to perform daily tasks.

Obesity in Childhood:
- Around 37% of US children are overweight or obese.
- Genetics and early eating habits play a role in obesity.
- Sedentary lifestyles and lack of physical activity contribute.
- Overeating encouragement during childhood linked to adult obesity.

Set Point Theory of Weight:

● Concept of Set Point Theory: The set point theory suggests that individuals have an
innate ideal weight, much like a thermostat regulates temperature.
● Regulation of Weight: Just as a thermostat adjusts heating or cooling to maintain a set
temperature, the body adjusts eating behavior to maintain a set weight.
● Individual Variation: People have different set points, leading to differences in
susceptibility to obesity.
● Returning to Original Weight: Efforts to lose weight might be counteracted by the body’s
adjustments in energy expenditure to return to the original weight.

- Suggests individuals have a biological ideal weight (set point).

- The set point acts like a thermostat, regulating eating behavior.
- Efforts to lose weight may lead to compensation by the body to return to the original
weight.

Psychological and Social Impact:

● Depression and Obesity: Obesity is linked to a higher likelihood of depression and
negative emotional states.
● Personality Traits and Obesity: Personality traits like neuroticism, extraversion,
impulsivity, and conscientiousness influence obesity risks.
● Social Network Influence: Obesity can spread through social networks, possibly due to
changes in social norms.
 ● Obesity and Dieting: Obesity often involves high basal insulin levels, promoting
overeating. Larger fat cells contribute to greater fat storage capacity.
● Dieting and Obesity: Cycles of dieting and weight gain can lead to lower metabolic rates,
making it easier to regain weight.

- Psychological distress and stigma linked to obesity.

- Negative impact on self-esteem and social interactions.
- Obesity can lead to social alienation and mental health issues.

Children and Obesity:

- Childhood obesity rates are rising globally.
- Genetics, sedentary lifestyles, and early eating habits contribute. Interventions in
childhood crucial to prevent lifelong obesity.

Obesity and Dieting:

● Obesity and Insulin: Obese individuals often have high basal insulin levels, promoting
overeating due to increased hunger.
● Fat Cell Size and Obesity: Obese individuals have larger fat cells, which can store more
fat compared to smaller fat cells.
● Dieting and Obesity: Dieting can contribute to obesity by causing successive cycles of
weight loss and gain, lowering metabolic rate and making weight regain easier.

Dieting, Interventions, and Treatments:

● Dieting and Stress: Dieting can increase stress and cortisol levels, potentially leading to
weight gain due to these factors.
● Lifestyle Change vs. Dieting: Permanent lifestyle changes involving healthier eating
habits and regular exercise are more effective for sustainable weight loss.
● Behavioral Approaches: Behavioral interventions focus on controlling eating behaviors
and reinforcing positive changes.
● Self-Control and Self-Reinforcement: Teaching self-control and reinforcing positive
behaviors are important components of weight reduction programs.
● Cognitive Restructuring: Cognitive approaches involve identifying and changing
maladaptive thoughts related to weight loss.
● Surgical Options: Surgical procedures like gastric banding can be considered for extreme
obesity cases, but they come with potential side effects

Stress and Eating:

● Impact of Stress on Eating: Stress affects eating behaviors differently for different
individuals. Roughly half of people eat more under stress, while the other half eat less.
 ● Stress and Hunger Regulation: Stress or anxiety can suppress physiological cues of
hunger, leading to reduced food intake.
● Disinhibition of Eating: Stress and anxiety can remove the self-control that typically
restrains eating behavior.
● Gender Differences: Men tend to eat less under stress, while many women tend to eat
more.
● Food Preferences under Stress: People who eat in response to stress often opt for
low-calorie and salty foods. Stress eaters prefer high-calorie foods when not stressed.

Behavioral Interventions:
● Behavioral Weight-Loss Programs: Cognitive-behavioral programs offer modest success
in weight loss and maintenance.
● Diet Modification and Exercise: Successful programs emphasize diet changes,
self-direction, exercise, and relapse prevention.
● Family Involvement: Family-based interventions are promising, especially for children
and adolescents.
● Social Support: Strong social support enhances weight loss success.
● Relapse Prevention: Techniques to prevent relapse include environmental restructuring,
coping strategies, and protecting against self-recrimination.
● Social Engineering Strategies: Changes in food labeling, taxation on high-sugar and
high-fat foods, and advertising restrictions are proposed for tackling obesity.
● Exercise and Stress Management: Adding exercise and stress reduction techniques can
aid weight loss and maintenance.

Eating Disorder
● Eating disorders are serious mental health conditions that involve unhealthy attitudes and
behaviors towards food and body image.
● Anorexia nervosa is characterized by extreme food restriction, self-starvation, and a
distorted body image, often leading to dangerously low body weight.
● Bulimia involves cycles of binge eating followed by compensatory behaviors like
vomiting, excessive exercise, or fasting.

Anorexia Nervosa:
● Anorexia nervosa is an obsessive disorder characterized by self-starvation and
dangerously low body weight.
● Genetic factors and environmental risks contribute to its development.
● Personality characteristics, family interaction patterns, and body image distortions may
be causal factors.
● Treatment involves weight restoration, cognitive-behavioral therapy, and family therapy.
 ● Prevention strategies aim to address social norms about thinness and promote awareness
of health risks.

Bulimia:
● Bulimia involves cycles of binge eating and compensatory behaviors.
● It often occurs in individuals of normal weight or overweight. Altered stress responses
and hormonal dysfunctions may contribute to its development.
● Treatment includes self-monitoring, cognitive-behavioral therapy, and relapse prevention
techniques.
● Convincing individuals of the health risks and benefits of treatment is an early step in
therapy.

Smoking

Effects of Smoking on Health:

1. Smoking and Health Risks:
- Smoking is linked to numerous health problems, including cardiovascular
diseases, respiratory disorders, and cancer.
- Cardiovascular effects include increased risk of heart disease, stroke, and
peripheral vascular disease.
- Smoking causes chronic obstructive pulmonary disease (COPD), emphysema, and
chronic bronchitis.
- Lung cancer risk is significantly elevated among smokers, especially in relation to
heavy and long-term smoking. Smoking is a leading cause of preventable deaths
worldwide.

2. Secondhand Smoke and Public Health:

- Secondhand smoke exposure poses risks to nonsmokers' health, leading to
respiratory problems and cardiovascular diseases.
- Secondhand smoke is particularly harmful to children, pregnant women, and
individuals with preexisting conditions.
- Efforts to reduce secondhand smoke exposure include smoke-free policies in
public places and awareness campaigns.

Factors Influencing Smoking in Adolescents:

- Smoking initiation: initial experimentation, peer pressure, attitudes.
- Social contagion process through contact with smokers.
- Influence of peers, schools, family, and media on smoking.
- Social disparities, stressors, and depression contribute to smoking.
- Movie and TV portrayals impact adolescent smoking.
Interventions to Reduce Smoking:
- Changing attitudes: media messages, highlighting health consequences.
- Therapeutic approach: Cognitive-Behavioral Therapy (CBT).
- Nicotine replacement therapy (patches) to manage withdrawal.
- Moving through stages of change model for interventions.
- Self-determination theory for adolescents, targeting autonomy.
- Relapse prevention techniques to cope with withdrawal and triggers.
- Social Support and Stress Management
- Social networks influence smoking cessation success.
- Supportive partners and non-smoking friends aid quitting.
- Stress management training helps manage triggers.
- Lifestyle changes in diet, exercise aid in cutting down or quitting.

Brief Interventions:
● Brief interventions by healthcare professionals can promote smoking cessation and
prevent relapse. Offering smoking cessation guidelines during medical visits improves
quit rates.
● Phone counseling and newsletters through health maintenance organizations have
effectively reduced smoking rates.

1. Workplace Interventions: Workplace interventions initially showed promise but haven’t

been consistently effective. Smoke-free workplace environments lead to reduced
smoking.

2. Commercial Programs and Self-Help: Self-help aids and programs, including nicotine
patches and self-help TV programs, help smokers quit. Initial quit rates might be lower,
but long-term maintenance rates are comparable to more intensive interventions.

3. Social Influence Programs: Social influence programs aimed at preventing smoking

initiation in schools are cost-effective. Central components include conveying negative
effects of smoking, promoting nonsmoker image, and utilizing peer influence.

Drinking
● Alcohol is the third-leading cause of preventable death after tobacco and improper diet
and exercise.
● More than 20 percent of Americans drink at levels that exceed government
recommendations. About 15 million American adults meet criteria for alcohol abuse and
dependence.
● Alcohol consumption is linked to high blood pressure, stroke, liver cirrhosis, cancer,
brain atrophy, cognitive decline, sleep disorders, and immune alterations.
 ● Alcohol is responsible for a significant number of traffic-related deaths and accidents.

Economic Costs:
- Alcohol abuse costs approximately $184.6 billion per year.
- Costs include lost earnings due to alcohol-related illness, treatment costs, motor vehicle
accidents, fires, and crime.

Social Problems:
● Alcohol contributes to social issues like aggression, homicides, suicides, assaults, and
risky behaviors.
● Impulsive sexuality, poor decision-making, and risky sexual behaviors can occur under
the influence of alcohol.

Origins of Alcoholism and Problem Drinking:

● Genetic factors play a role, as evidenced by twin studies and the prevalence of alcoholism
in children of alcoholic parents.
● Modeling a parent’s drinking behavior can increase the risk. Sociodemographic factors
like low income also predict alcoholism.

Drinking and Stress:

● Alcohol consumption can increase during periods of stress. People with chronic stressors
and limited social support are more likely to become problem drinkers.
● Stressors like job loss, financial strain, and a sense of powerlessness can lead to heavy
drinking.

Substance Dependence:
● Substance dependence involves tolerance, withdrawal, and compulsive behavior.
● Tolerance is the need for increasing amounts of a substance to achieve the same effects.
Craving is a strong desire for a substance triggered by environmental cues.
● Addiction occurs when a person becomes physically or psychologically dependent on a
substance.
● Withdrawal includes unpleasant symptoms when the substance is stopped.

Alcoholism and Problem Drinking Patterns:

● Problem drinkers and alcoholics may exhibit behaviors like daily alcohol use, inability to
cut down, failed attempts to control drinking, binge drinking, memory loss while
intoxicated, and continued drinking despite health problems.

Alcohol Abuse Treatment and Prevention:

1. Alcoholics Anonymous (AA):
 - AA is a self-help organization founded in the 1930s to support individuals seeking
to overcome alcohol addiction.
- Its main requirement for membership is the desire to stop drinking. AA meetings
provide a platform for sharing experiences and coping strategies.
- The program promotes abstinence, acknowledging alcoholism as a disease
without a cure.
- Success rates vary, and it emphasizes social support, coping skills, and spiritual
growth.

2. Cognitive-Behavioral Treatments (CBT):

- CBT programs target both the biological and environmental factors associated
with alcoholism.
- Goals include reducing the reinforcing properties of alcohol, teaching new
behaviors, and modifying environments.
- CBT emphasizes coping techniques, relapse prevention skills, and learning to
manage stress.
- Self-monitoring, controlled drinking skills, and drink refusal skills are commonly
incorporated.
3. Treatment Programs and Relapse Prevention:
- Detoxification is the initial phase of treatment, often conducted under medical
supervision.
- Comprehensive treatment involves inpatient and outpatient phases, family
therapy, and stress management.
- Relapse prevention techniques are crucial due to the high rate of relapse after
initial treatment.
- Coping skills training and recognition of the normalcy of occasional lapses are
central to relapse prevention.

4. Preventive Approaches and College Drinking:

- Preventive efforts aim to reduce alcohol abuse among adolescents and college
students.
- Social influence programs focus on drink refusal skills, coping mechanisms, and
modifying social norms.
- Motivational interviewing and online interventions target behavior change and
harm reduction.
- College campuses use interventions during orientation and encourage controlled
drinking behaviors.