Ch. 3: Health Behaviors
How is the Theory of Planned Behavior applied to adopting a health diet?
*Attitudes toward specific action:* Beliefs abt outcomes of behavior -If I change diet, I'll lose weight, improve health, & be more attractive Evals of outcomes of behavior -Being healthy & looking good are desirable *Subjective norms regarding action:* Normative beliefs -My family & friends think I should change my diet Motivation to comply -I want to do what they want me to do *Perceived behavioral control:* -I will be able to change my died = Behavioral intention -Intending to change my diet = Health behavior -Adopting healthier diet
How is the Health Belief Model applied to the health behavior of stopping smoking?
*Belief in health threat:* General health values -I'm concerned abt my health Specific beliefs abt vulnerability -As smoking, I could get lung cancer Beliefs abt severity of disorder -I would die if I developed lung cancer *Belief that specific health behavior can reduce threat:* Belief that specific measure can be effective against specific threat -If I stop smoking now, I will not develop lung cancer Belief that benefits of health measure exceeds costs -Even though it will be heard to stop smoking, it's work it to avoid risk of lung cancer = Health behavior -I will stop smoking
How are health risks & habit different for ethnic & gender differences?
AA & Hispanic less like to exercise than White= more likely to be overweight White & AA more likely to smoke than hisp Men > women in alcohol consumption Smoking- white men
What is the transtheoretical model of behavior change? What are the stages?
Analyzes stages & processes ppl go through in bring abt change in behavior Suggested treatment goals & interventions for ea. stage Precontemplation Contemplation Preparation Action Maintenance
What is relapse prevention?
Ask ppl to ID sits that may lead to relapse- help them develop coping skills that'll healp them manage stressful event -schedule lunch rather than bars w/ friends; sham drink Mentally rehearsing coping responses in high-risk sit. to promote self-efficacy Constructive *Self-talk*to help them talk themselves through tempting sit. Cue elimination: restructuring env't to avoid sits that evoke target behavior -avoid bars Sometimes impossible to completely eliminate Some programs deliberately expose ppl to sits that evoke old behavior to give them practice using coping skills Making sure new habits practiced in as many new contexts as poss to ensure it endures
What is the Theory of Planed Behavior?
Attempts to link health beliefs directly to behavior Health behavior is direct result of a behavioral intention Behavioral intentions: 1. Attitudes towards specific action -likely outcomes of action & eval of those outcomes 2. Subjective norms regarding action -what person believes others think that person should do (normative beliefs) 3. Perceived behavioral control -perception that one can perform action & action will have intended effect (self-efficacy) ex: smokers who believe smoking causes serious health outcomes, believes other ppl think they should stop smoking, motivated to comply w/ normative beliefs, believe they're capable of stopping smoking, & form specific intention to do so = more likely to stop smoking
What is the health belief model?
Attitude theory of why ppl practice health behaviors Whether a person practices health behavior depends on: 1. Whether they perceive personal health threat 2. Whether they believe that particular health practice will be effective in reducing threat
What are fear appeals? Is it beneficial?
Attitudinal approaches to changing health habits If ppl are afraid that particular habit is hurting health, will change behavior to reduce fear Not always true: Too much fear = Undermine health behavior change Fear increases defensiveness- reduces how effective appeal can be Fear alone may not be sufficient to change behaviors Specific action recommendations- where & how to get flue shot- may be needed
What is the contemplation stage?
Aware they have problem Thinking abt it but haven't made commitment to take action Can remain in this stage for years Interventions aimed at increasing receptivity to behavior change
How can emotional factors lead to/ perpetuate unhealthy behaviors?
Behaviors pleasurable, automatic, addictive, & resistant to change Threatening messages designed to chance health habits can produce psychological distress - lead ppl to respond defensively, distorting risk to health May perceive health threat to be less relevant than it really is May falsely see themselves as less vulnerable than/ dissimilar to other ppl w/ same habit Continuing to practice risky behavior may lead ppl to minimize risks & feel false sense of security
What are health behaviors?
Behaviors undertaken by ppl to enhance/maintain health
What is self-efficacy?
Belief that one can control one's practice of a particular behavior smokers who believe they can't stop smoking are unlikely to make effort
How is social engineering be more and less successful than individual behavior modification?
Beneficial: lowering speed limit impacts death/disability more than interventions to get ppl to change driving habits raising drinking age & banning smoking = major effects on health problems controlling what's in vending machines & advertisement of bad food to reduce obesity Bad: Most health behavior change can't be legally mandated Ppl's cont. to engage in bad habits even when freedom are limited by social engineering
How are self-help groups a venue for health-habit modification?
Bring together ppl w/ same health habit problem W/ help of counselor, attempt to solve problem together Employ C-B principles in programs Overeaters anonymous, TOPS (take off the pounds sensibly), Alcoholics Anonymous major venue for health-habit modification in US
What is the important of internal monologues in health habits?
CBT focuses heavily on beliefs that ppl hold abt health habits Often generate internal monologues that interfere w/ ability to change behavior Self-doubts (I'll never be able to give up smoking) Unless internal monologues modified, will be unlikely to change health habit & maintain change over time Ppl's cognition abt their health habits imp. in producing behavior change Importance of involving patient as co-therapist in behavior-change intervention
Why is it important to focus interventions on at-risk people?
Can be efficient & effective use of health promo dollars Disease may be prevented altogether -men w/ history of heart disease stop smoking can prevent coronary heart disease When risk factor has implications, make sense to target them when relevant -hypertension implicates salt sensitivity = be vigilant abt controlling salt intake Helps ID other factors that may lead to increase risk -focusing esp. on ppl who are at risk, other factors that contribute dev. (diet) may be ID
How are workplace interventions a venue for health-habit modification?
Can reach much of adult popn On-the-job health promotion programs stop smoking, reduce stress, change diet, exercise reg, lose wt, control hypertension, & limit drinking Health clubs, restaurants w/ health food, gyms Benefits: higher morale, greater productivity, & reduced health care costs
What is a discriminative stimulus?
Capable of eliciting target behavior sight & smell of food DS for eating sight of pack of cig or smell of coffee - smoking Imp b/c signals that positive reinforcement will subsequently come CBT aims to eliminate/modify DS
What are the advantages of CBT?
Carefully selected set of techniques can deal w/ all aspects of problem Self-observation & self-monitoring: define dimensions of problem Stimulus control: enables person to modify antecedents Self-reinforcement: controls consequences Social skills & relaxation training: replace maladaptive behavior Therapeutic plan can be tailored to ea. individual's problem Range of skills imparted by multimodal interventions may enable ppl to modify several health habits simultaneously rather than one at time -diet & exercise considerable success for broad array of health behaviors
What are the advantages of behavioral assignments?
Client becomes involved in treatment process Client produces analysis of behavior that's useful in planning further interventions Client becomes committed to treatment process through contractual agreement to discharge certain responsibilities Responsibility for behavior change gradually shifted to client Use of homework assignments increases client's sense of self-control
What is self-control?
Client needs to actively monitory own behaviors & apply techniques to CBT to bring change Acts as own therapist &, w/ outside guidance, learns to control antecedents & consequences of target behavior
What are characteristics (educational appeals) that make health communications especially persuasive?
Comms should be colorful & vivid, not steeped in stats & jargon; use case histories Should be expert, prestigious, trustworthy, likable, & similar to audience Strong arguments at beginning & end, not middle Messages: short, clear, & direct; state conclusion explicitly Extreme messages = more attitude change to a point -Very extreme messages discounted Illness detection behaviors (HIV testing; mammogram)- emphasize problems if behaviors not undertaken Health promotion behaviors (sunscreen)- emphasize benefits Audience receptive to change- only include favorable points Audience not inclined to accept message- discuss b/ sides of issue Intentions- sensitive to social norms -Family-directed esp. effective for Latino community
What is the importance of a reinforcement schedule for operant conditioning?
Continuous reinforcement = behavior reinforced every time it occurs Vulnerable to extinction If behavior occasionally not paired w/ reinforcement, may cease performing the behavior, having come to anticipate reinforcement ea. time Behavior more resistant to extinction if maintained by variable or intermittent reinforcement schedule
How have patterns of disease in the US change? What is clearly a factor in this development?
Decline in acute infectious disorders b/c changes in public health standards Increase in preventable disorders - lung cancer, cardiovascular disease, alcohol & drug abuse Role of behavioral factors in development of disorders clear Nearly half deaths in US caused by preventable factors Three main causes: Smoking, obesity, & problem drinking
What factors lead one person to live a healthy life and another to compromise their health?
Demographic factors -Younger, more affluent, better-educated ppl b/ low lvls of stress & high lvls of social support better than ppl under higher lvls of stress & fewer resources Age -good in childhood, deteriorate in adol & young adulthood, improve again among older ppl Values -exercise for women desirable in some cultures not others Personal control -Ppl who regard health as under their personal control better than who regard health as due to chance Health locus of control scale Social influence -Family, friends, & workplace companions can be beneficial or adverse -peer pressure in adol leads to smoking, by in adulthood influence to stop Personal goals & values -is personal fitness imp. value to them? Perceived symptoms -smoker wakes up w/ smoker's cough & raspy voice may cut back b/c belief that they're vulnerable to health problems Access to health care delivery system -Obtaining reg. Pap smear, mammograms, & receiving immunizations developed on access to health care -Losing weight & stopping smoking- indirectly encouraged by health care system Knowledge & intelligence -More knowledgeable & smarter ppl take better care of themselves -ppl intelligent in childhood have better health-related biological profiles in adulthood -practice of better health behaviors in early life
What are some problems with focusing interventions on at-risk people?
Don't always perceive risk correctly Unrealistically optimistic & view poor health behavior as widely shared but healthy behaviors are more distinctive -smokers overestimate # of other ppl who smoke Testing positive for risk factors = needless worry or hypervigilant behavior Can become defensive, minimize significance of risk factor, & avoid using appropriate services or monitoring condition
What is socialization and why is it important?
Early socialization strongly affects health habits Influence of parents as b/ teachers & role models Parents instill certain habits in children (or not)- becomes automatic (brushing teeth, breakfast) Basic health habits not taught or slips through crack b/c Parents separated or chronic family stress Adol: sometimes ignore early training of parents Exposed to alcohol, smoking, drug, & sexual risk taking Esp. if parents aren't monitoring closely & peers practice these behaviors
At what point is it appropriate to alarm at-risk people if their personal risk is unknown?
Ethical issue- controversial Should adol daughter of breast cancer patients be alerted to risk & alarmed at time when coming to terms w/ emerging sexuality & needs for self-esteem? Psychological distress may be created in exchange for instilling risk reduction behaviors Ppl predisposed to depression may react poorly to info abt risk Cases involving genetic risk factors- may not be any effective intervention -offspring of alcoholism- still don't know how to intervene yet Can raise complicated issues of family dynamics
What is one of the biggest problems faced in health habit modification? What is abstinence violation effect?
Following initial successful behavior change, ppl often return to old bad habits Particular problem w/ addictive disorders- alcoholism, smoking, drug, overeating Abstinence violation effect: Feeling of loss of control that results when person violated self-imposed rules Result- can be more serious relapse, as person's resolve falters True for addictive behaviors person must also cope w/ reinforcing impact of substance itself
What is the relationship between health behavior change and the brain?
Gave ppl persuasive messages promoting sunscreen use Showed significant activation in medial prefrontal cortex (mPFC) & posterior cingulate cortex (pCC) in response to messages Attitude change abt sunscreen use in response to persuasive message only weakly predicted intentions to sunscreen use, but activity in these tow regions strongly predicted us reason not known yet Process not accessible to consciousness; outside of awareness
How is the mass media a venue for health-habit modification?
Goal of health promo: Reach as many ppl as poss Mass media has great potential In shows: Characters smoking will increase likelihood adols will smoke Characters in healthy activity can encourage healthy behavior change in viewers Presenting consistent media message over time can have cumulative effect in changing values associated w/ health practices -antismoking mass media messages on social norms abt smoking have been substantial
What is the Self-Determination Theory (SDT)?
Guides health behavior modification Builds on idea that ppl are actively motivated to pursue goals Targets 2 components as fundamental to behavior change: 1. Autonomous motivation -experience free will & choice when making decisions 2. Perceived competence -belief that one is capable of making health behavior change ex: woman changes diet b/c Dr tells her to, may not experience sense of autonomy - experiences actions as under another's control; if dietary change is autonomously chosen, will be intrinsically motivated to persist SDT gave rise to interventions that target autonomous motivation & competence some success in changing behaviors or smoking & alcohol
What is an example of a systematic behavioral assignment for an obese client?
HW for client: Using counter, count bites taken Record # of bites, time, location, & what you ate Record everything for 1 wk Call for appointment Bring record HW for therapist: Reread articles on obesity
What is the precontemplation stage?
Has no intention of changing behavior Not aware they have problem (others might be aware) Largely oblivious to problem created for family Some seek treatment if pressured to do so by others Often revert back to old behaviors Make poor targets for interventions
What is a health habit?
Health behavior that's firmly est. Often performed automatically, w/o awareness Usually develop in childhood, begin to stabilize 11-12 Highly resistant to change Imp. to est. good health behaviors and eliminate poor ones early in life May develop initially b/c reinforced by positive outcomes (parental approval) Eventually becomes truly independent of reinforcement process
Why are health habits relatively independent of each other and unstable?
Health behaviors elicited & maintained by diff. factors for diff. ppl; change over lifetime & course of health habit = Interventions have focused heavily on who may be helped most- child & adol Diff. health habits controlled by diff factors -smoking may related to stress, exercise to access of facilities Diff. factors may control same behavior for diff. ppl -overeating is "social" so eat in presence of other; another may eat under stress Factors controlling behavior may change over history of behavior -peer group pressure (social factor) imp. to initiate smoking, later maintained b/c reduces stress Factors may change across lifetime -childhood exercise b/c school, adulthood needs to be practiced intentionally
When are social skills training & assertiveness training used?
Health habits can be response to anxiety ppl experience in social sit. ex: smoke to reduce anxiety in social sit.; drinking & overeating Social anxiety can act as cue for maladaptive habit Need to find alternative method of coping w/ anxiety Trained in methods that help them deal more effectively w/ social anxiety
What are some criticisms of attitude change theories?
Health habits often deeply ingrained & difficult to modify Attitude-change interventions provide informational base for altering health habits, but not always impetus to take action Assume that behavior changes are guided by conscious motivation Ignore fact that some behavior change occurs automatically & isn't subject to awareness General limitation: Heavily emphasize conscious deliberative processes in practicing health behaviors
Why is health promotion important in older adults?
Healthy older adult ppn essential not only for quality of life but also controlling health care spending By 80, health habits are major det. of whether person will have vigorous or infirmed old age
What is a cognitive-behavioral model of the relapse process?
High-risk sit. Effective coping response Increased self-efficacy Decreased probability of relapse High-risk sit. Ineffective coping responses Decreased self-efficacy & positive outcome expectancies for effects of alcohol Lapse (initial use of alcohol) Abstinence violence effect & perceived positive effects of alcohol Increased probability of relapse
What is health promotion?
Idea that good health, or wellness, is a personal & collective achievement Individual- developing program of good health habits Medical practitioner- teaching ppl how to achieve healthy lifestyle & helping ppl *at risk* for particular health problems offset or monitor those risks Health psych- development of interventions to help ppl practice healthy behaviors Community & national policy makers- emphasizing good health & providing info & resources to help ppl change poor health habits
Why do people relapse?
Initially, when ppl change behaviors, are vigilant, but over time it fades & likelihood of relapse increases Low self-efficacy for behavior change initially- more likely to relapse Sometimes think they've beating health problem, so giving in to temptation would have few costs (couple drinks will relax me) Negative affect Relapse more likely when depressed, anxious, under stress break up, work difficulty
What is primary prevention? What are the two strategies?
Instilling good health habits & changing poor ones Taking measures to combat risk factors before illness has chance to develop Most common: Get ppl to alter problematic health behaviors -lose weight through interventions Most recent approach: Keep ppl from developing poor health habits in first place -smoking prevention programs w/ young adol
How is the family a venue for health-habit modification?
Intact families have better health habits than those alone or from fractured More organized, routinized lifestyle than single ppl Fam life suited to build healthy behaviors (3 meals/day, sleep schedule, brush teeth) Children learn health habits from parents Committing entire fam to healthy lifestyle gives children best chance at health start Multiple members affected by any one's health habits, so modifying one (diet) can affect other members If all members on board, ensure great commitment to behavior-change program Social support Some cultures place strong emphasis on fam
What are implementation intentions?
Integrates conscious processing w/ automatic behavioral enactment When person desires to practice health behavior, achieved by making simply plan that links critical situation/env'tal cues to goal-directed responses ex: "when I finish breakfast, I'll take out dog's leash & walk her" Theory underscores importance of planning exactly how, when, & where to implement health behavior W/o explicit links to action, good intention might reman at intention stage By forming implementation intention, can delegate control of goal-directed responses to situational cues (completing breakfast), which may elicit behavior automatically (take out leash & walk) Over time, link from implementation to goal-directed response becomes automatic & need not be brought on by conscious awareness to enact Adding implementation intention improves ability to predict behavior
What is the preparation stage?
Intent to change behavior but haven't done so successfully Haven't yet made commitment to eliminate behavior altogether Might have modified target behavior sometimes (smoking less than usual)
What is modeling?
Learning that occurs from witnessing another person perform behavior Observation & subsequent modeling can be effective approaches to changing heath habits Similarity imp. See self as similar to type of person who doesn't engage in risky behavior- may change behavior ex: swimmer decline cig b/c perceives that most great swimmers don't smoke
What is lifestyle rebalancing?
Long-term maintenance of behavior change promoted by leading person to make other health-oriented lifestyle changes Adding exercise program or using stress management techniques- To promote healthy lifestyle more generally & help reduce likelihood of relapse Social support? Helpful, but sometimes not
How are cell phones and landlines a venue for health-habit modification?
Low-cost interventions Automated phone interventions- prompt to maintain health behavior change Personalized text- help young smokers quit Contact older adults by telephone to make sure needs are being met Inc. lifestyle advice into it - physical activity Increases experience of social support
What are health promotion efforts with older adults focused on?
Maintaining healthy, balanced diet Regular exercise -reduce risk of mortality, social support or general sense of self-efficacy Reduce accidents Controlling alcohol consumption -dev. drinking problems as response to age-related issues, loneliness -maintain drinking habits had throughout life -metabolic changes may reduce capacity for alcohol Eliminate smoking Reduce inappropriate use of prescription drugs -poor may cut back on meds to save money Vaccination for flu -major cause of death; increases risk of heart disease & stroke Socially engaged -Depression - compromises health habits- leads to accelerated physical decline -increase social engagement
What is self-monitoring?
Many C-B mod programs use this First step toward behavior change Person must understand dimensions of poor health habit before change can begin Assesses frequency of target behavior & antecedents & consequences of behavior 1. Learn to discriminate target behavior Monitor internal sensations closely to ID target behavior more readily -some easy (smoker can tell when smoking) but some may be less easy to discriminate (urge to smoke) 2. Charting behavior Detailed record (of smoking-related events: when smoked, time, situation, surrounding) Record subjective feelings of craving prior (anxiety, tension) Feelings generated by actual behavior (smoking) = Can being to get sense of conditions most likely to smoke it understanding circumstances surrounding target behavior only beginning step, but can produce some behavior change itself
How is a health practitioner's office a venue for health-habit modification?
Many ppl have reg contact w/ dr Professional who knows medical history & can help modify health habits Highly credible sources- Recs have force of expertise behind them :( - One-to-one approach reduces only one person's risk at time Some clinics focus on this = number of ppl can be reached simultaneously Direct link from knowledge of person's health risk to type of intervention received
What is the health locus of control?
Measures degree ppl perceive their health to be under personal control, control of health practitioner, or chance
What is social engineering?
Modifies env't in ways that affect ppl's abilities to practice particular health behavior Often legally mandated vaccines for school entry, banning drugs, controlling disposal of toxic waste
What is cognitive-behavior therapy (CBT)?
Most effective approach to health habit modification Use several complementary methods to intervene in modification of target problem & its context May be implemented individual, group setting, or on Internet Versatile & effective way of intervening to modify poor health habits
Why do bad habits have a chance to make inroads?
Often little immediate incentive for practicing good health behaviors Health habits dev. during childhood & adol, when most ppl are healthy Smoking, poor diet, & lack of exercise have no apparent effect on health for years Few child. & adol care abt future health
What are stimulus-control interventions?
Once circumstances surrounding target behavior understood, factors in env't that maintain poor habit (smoking, drinking, overeating) can be modified Ridding env't of discriminative stimuli that evoke problem behavior, & creating new DS, signaling that new response will be reinforced ex: eating is under control of DS- presence of desirable foods & activities (watching tv). Lose weight- eliminate DS for eating: ridding home of rewarding/fattening foods, restricting eating to one room, avoiding eating while engaged in other act. Once stimuli introduced to env't to indicate controlled eating will now be followed by reinforcement ex: place signs in strategic locations to remind them of reinforcements after successful behavior change
What is contingency contracting?
One form of self-punishment that's effective in behavior mod. Forms contract w/ another person detailed what rewards/punishments are contingent on performance/nonperformance of behavior ex: stop drinking- deposit sum of money w/ therapist & arrange to be fined ea. time drink or reward ea. day abstained
Are health habits related to each other? Are they stable?
Only modestly -exercise faithfully but doesn't mean wear seat belt Health habits must be tackled one at time Health habits unstable over time -may stop smoking for year but do again when stressed
What is classical conditioning?
Pairing of unconditioned reflex w/ new stimulus, producing conditioned reflex One of first methods used for health behavior change Problem: Approach works, but clients know why they work Heavily dependent on client's willing participation
What is operant conditioning?
Pairs voluntary behavior w/ systematic consequences Key is reinforcement Behavior + positive reinforcement= more likely to occur again Behavior + reinforcement w/drawn or punished= less likely to be repeated Contingencies build up behaviors paired w/ positive reinforcement Behaviors punished/not rewarded decline ex: drinking maintained b/c mood improved by alcohol, smoking occur b/c peer companionship associated w/ it Reinforcement maintains poor health behavior =alter reinforcement
What is perceived health threat and what is it influenced by?
Perception that personal health threat is influenced by: General health values -interest in & concern abt health Specific beliefs abt personal vulnerability to particular disorder Beliefs abt consequences of disorder -whether they're serious ppl may change died to include low cholesterol foods if they value health, feel threatened by poss. of heart disease, & perceive personal threat of heart disease as severe
How is classical conditioning approach used to treat alcoholism?
Phase one: Unconditioned stimulus produces reflexive responses US (Antabuse) -> UR (nausea, gagging, vomiting) Phase two: Unconditioned stimulus paired w/ new stimulus US (Antabuse) + CS (alcohol) -> UR (nausea, gagging, vomiting) Phase three: Conditioned stimulus evokes response CS (alcohol) -> CR (nausea, gagging, vomiting)
How are schools a venue for health-habit modification?
Popn young May be able to intervene before child dev. poor health habits Schools have natural intervention vehicle Classes ~ hr long = can fit into format Change social climate in school regarding health habits in ways that foster behavior change
How can a message be framed? Why is more successful?
Positive or negative Reminder card to get flu vac can stress benefits of being immunized or discomfort of flu itself Messages that emphasize problems: Works better for behaviors w/ uncertain outcomes Need to be practiced only one (vaccinations) Issues abt which ppl are fearful Messages that stresses benefits: More persuasive for behaviors w/ certain outcomes Encouraging health behaviors (skin cancer prevention, smoking cessation, physical activity)
What do educational appeals make the assumption about changing health behaviors?
Ppl will change health habits if have good info abt their habits Early & continuing efforts to change health habits focused heavily on education & changing attitudes Imp. automatic aspect of health habits incorporated into interventions Unconscious & nonconscious influences on practice have become increasingly apparent
Why is it important to intervene with adolescents?
Precautions taken in adol may affect disease risk after 45 more than adult health behaviors Health habits practiced during teen or college may det. which chronic disease dev. & what they ultimately die of For adults changing- may already be too late Sun exposure- skin cancer Calcium consumption- osteoporosis Coronary heart disease
How are interventions implemented in the Stage Model of change?
Precontemplation > Contemplation provide ppl w/ info abt problem Contemplation > Preparation induce them to assess how they feel & think abt problem how stopping it will change them Preparation > Action make explicit commitments to when & how they'll change behavior Action > Maintenance self-reinforcement, social support, stimulus control, & coping skills
What is the evidence for the Theory of Planned Behavior?
Predicts broad array of health behaviors Components predicts: condom use among students, soft drink consumption, food safety practices Communication tarted to part. parts of model (social norms) been found to change behaviors
How is a private practitioner's office a venue for health-habit modification?
Private one-on-one basis CB techniques Makes success more likely Can be tailored to needs of person :( only one person's behavior can change at time
How do people's own motivation affect how the message is framed for maximum effectiveness?
Promotion or approach orientation that emphasize max opportunities Messages phrased in terms of benefits -calcium will keep bones healthy More successful for ppl to initiate behavior change Prevention or avoidance orientation that emphasizes min risks of not performing health behavior -low calcium intake will increase bone loss More helpful in maintenance of behavior change over time
How is the internet a venue for health-habit modification?
Provides info & low-cost acciss to health interventions for millions of ppl Internet-delivered, computer-tailored lifestyle intervention targeting multiple risk factors simultaneously (diet, exercise, smoking) Augment effectiveness of other interventions school-based smoking cessation programs Interventions w/ patient groups Tailored e-coaching w/ individualized feedback can supplement standardized interventions for health-related behaviors (wt loss) CBT interventions via internet can be as effective as face-to-face Low cost, saves time, reduce waitlist & travel time, & providing interventions for ppl who might not seek it on own Enables research to gather participants at low cost & enable data collection
How are community-based interventions a venue for health-habit modification?
Reach more ppl than individually based interventions or interventions in limited env't (workplace or school) Can build on social support for reinforcing adherence to rec health changes -if all neighbors change diet, you more likely to Neighborhoods have profound effects of health practices, esp. adol's -monitoring behavior w/in neighborhoods tied to lower smoking & alcohol in adols Door-to-door campaign abt breast cancer Media blitz alter ppl of smoking risks Grassroots comm program to encourage exercise Dietary mod program that recruits through comm institutions Mixed intervention involving media & personal contact :( Expensive & bring only modest behavior change
What are the beneficial effects of successful modifications of health behaviors?
Reduce deaths due to lifestyle-related diseases Delay time of death- increase life expectancy Expand # of years person may enjoy life free from complications of chronic disease May begin to make dent in more than $2.6 trill spent yearly on health & illness
Why is the stage model a spiral?
Relapse is rule rather than exception May take action, attempt maintenance, relapse, turn to precontemplation stage, cycle through stages to action, repeat cycle again Do several times before eliminated behavior
What are some important health habits?
Sleeping 7-8 hrs/night Not smoking Eating breakfast ea. day No more than 1-2 alcoholic drinks/day Regular exercise Not eating b/w meals No more than 10% overweight The more good health habits ppl practice, fewer illnesses they had, better they felt, & less disabled they'd been Mortality rates dramatically lower for ppl who practice these health habits
What needs to be taken into consideration for health promotions of different ethnic groups?
Social norms that may be appropriate for group Culturally appropriate interventions -Consideration of health practices of community, informal networks of comm that can make interventions more successful, & language Efficient low-cost interventions (text mess. & automated phone mess.) can be successfully implemented when culturally adapted to target group Take account of co-occurring risk factors Combined effects of low SES & biological predisposition to illness ex: Hispanic- diabetes; AA- hypertension
What are teachable moments?
Some times are better than others for modifying health practices Many during childhood Basic safety behaviors- crossing street, drinking milk -all w/in ability of children 3-4 as long as behaviors are explained concretely & they know what to do Built into health care system -Infants covered by well-baby care; Peds use visits to teach basics of accident prevention &home safety -Schools require physical & record of immunization Middle school - food choices, snacking, dieting *Window of vulnerability*- for smoking & drug us Pregnancy- stopping smoking & improving diet Newly diagnosed coronary artery disease- change health habits as smoking & poor health
Is there support for the health belief model? What does it leave out?
Studies used to increase perceived risk & increase perceived effectiveness of steps to modify broad array of health habits -health screening programs to smoking Leaves out self-efficacy
What is self-reinforcement? Self-punishment?
Systematically rewarding self to increase/decrease occurrence of target behavior Positive self-reward: rewarding self w/ something desirable after successful mod. of target behavior -going to movie after weightloss Negative self-reward: removing aversive factor in env't after successful mod of target behavior -removing poster off fridge Positive self-punishment: admin. of unpleasant stimulus to punish an undesirable behavior -self-administer shock if have desire to smoke Negative self-punishment: w/drawal of positive reinforcer in env't ea. time undesirable behavior performed -rip up money punishment only effective if ppl actually perform pushing activities Too aversive- will abandon efforts
What do cognitive-behavior approaches to health habit modification focus on?
Target behavior itself Conditions that elicit & maintain it Factors that reinforce it
What are behavioral assignments?
Technique for increasing client involvement Home practice activities that support goals of therapeutic intervention Designed to provide continuity in treatment of behavior problem ex: early session obese client involved training in self-monitory, encouraged to keep log of eating behavior; used by therapist & patient nxt session to plan future behavioral interventions Includes homework assignments for b/ client & therapist Ensure b/ parties remain committed to behavior-change process & aware of other's commitment
What is cognitive restructuring?
Trains ppl to recognize & modify internal monologues to promote health behavior change Modified cognitions as antecedents to target beahvior -urge to smoke preceded by internal monologue that he's weak & unable to control urges Beliefs are targeted for change Substitute monologues that would help stop smoking (I can do this; be so much healthier) Can also be consequence of target behavior -trying to lose wt; undermine weight-loss program by reacting w/ hopelessness to every small setback Learn to engage in self-reinforcing cognitions following successful resistance to temptation & constructive self-criticism following setbacks -nxt time I'll keep tempting food out of fridge
What is Motivational Interviewing?
Treat addition, smoking, diet, exercise, cancer screening, sexual behavior Client-centered counseling style to get ppl to work through any ambivalence experienced abt changing health behaviors Effective for ppl who're initially wary abt whether to change behavior Nonjudgmental, nonconfrontational, encouraging, & supportive style Goal: help client express positive & negative thoughts they have regarding behavior in atmosphere free of negative eval No effort to dismantle denial or irrational beliefs or persuade to stop Goal: get client to think through/express some own reasons for/against change Encouragement, not advice
What is the action stage?
When ppl modify behavior to overcome problem Requires commitment of time & energy to make real behavior change Stopping behavior & modifying one's lifestyle * env't to rid life of cues associated w/ behavior
Overall, when is relapse prevention most successful?
When ppl perceive behavior change to be long-term goal Develop coping techniques for managing high-risk sit. Integrate behavior change into generally healthy lifestyle Effective for reducing substance use & improving psychosocial functioning
What is perceived threat reduction and what are its subcomponents?
Whether person believes health measure will reduce threat 1. Thinks health practice will be effective 2. Cost of undertaking measure exceeds its benefits changing died to avoid heart attack may believe dietary change alone wouldn't reduce risk of heart attack & changing diet would interfere w/ enjoyment of life too much to justify action = even if his perceived vulnerability to heart disease is great, would probably not make changes
What is the maintenance stage?
Work to prevent relapse & consolidate gains made If remain free of behavior for 6 months = maintenance stage
