Health Psychology Ch.4: Health Promoting Behaviors

Initiation & Prediction

Believing that physical activity is important predicts initiation of an exercise program, whereas barriers, such as no time or few places to get exercise, predict maintenance. Self efficacy about one's ability to overcome barriers is a predictor of maintenance Family-based interventions Worksite interventions to promote exercise Text messaging

Interventions to Modify Diet

Recent efforts to induce dietary change have focused heavily on reducing portion size, snacking, and sugary drink consumption. Portion size has increased greatly over the past decades, contributing to obesity. Snacking has also been tied to obesity. Sugary drinks have been tied to higher heart disease risk and are suspected of contributing to the rising rates of type 2 diabetes. Accordingly, interventions have been directed to these issues, as well as to reducing fat and increasing vegetable and fruit consumption. Specific health risks such as obesity, diabetes, or CHD often lead people to change their diets, and physicians, nurses, dieticians, and health psychologists work with patients to develop an appropriate diet. Most diet change is implemented through cognitive-behavioral interventions. Efforts to change diet begin with education and training in self-monitoring: Most people are poorly informed about what a healthy diet is and do not pay sufficient attention to what they actually eat. Additional components are stimulus control, and contingency contracting, coupled with relapse prevention techniques for high-risk-for-relapse situations, such as parties. Drawing on social support for making a dietary change and increasing one's sense of self-efficacy are two critical factors for improving diet. Self affirmation and motivational interviewing have shown to be helpful in getting people to increase their fruit and vegetable intake and otherwise improve their diets. Training in self-regulation, including planning skills and formation of explicit behavioral intentions, can improve dietary adherence. Implementation intentions regarding exactly when, where, and what food will be consumed can also help people bring snacking under intentional control. However, much eating and snacking occurs mindlessly, when people are exerting little self-control. In such cases, simple environmental interventions, such as a sign in a cafe promoting healthy eating, can help people make good choices. Recent efforts to change the dietary habits of highrisk people have focused on the family. Eating meals together promotes better eating habits. In family interventions, family members typically meet with a dietary counselor to discuss ways to change the family diet. When all family members are committed to and participate in dietary change, it is easier for a target family member (such as a cardiac patient) to do so as well. Children who are involved in these interventions may practice better dietary habits into adolescence and adulthood. An intervention with Latino mothers with Type 2 diabetes and their overweight daughters made use of this strong social tie to promote weight loss and healthy eating. Community interventions aimed at dietary change have been undertaken. For example, nutrition education campaigns in supermarkets have shown some success. In one study, a computerized, interactive nutritional information system placed in supermarkets significantly decreased high-fat purchases and somewhat increased high-fiber purchases (Jeffery, Pirie, Rosenthal, Gerber, & Murray, 1982; Winett et al., 1991). Tailoring dietary interventions to ethnic identity and making them culturally and linguistically appropriate may achieve particularly high rates of success (Eakin et al., 2007; Martinez et al., 2008; Resnicow, Davis, et al., 2008). In Latino populations, face-toface contact with a health adviser who goes through the steps for successful diet modification may be especially important, due to the emphasis on personal contact in Latino culture and communities (Elder et al., 2005). Researchers are moving toward interventions that are cost-effective to alter behavior related to diet and exercise, rather than large-scale CBT interventions. For example, computer-tailored dietary fat intake interventions can be effective both with adults and with adolescents (Haerens et al., 2007). Telephone counseling can achieve beneficial effects (Madlensky et al., 2008). Such interventions can reach many people at relatively low cost. Change is likely to come from social engineering as well. When children have access to school snack bars that include sodas, candy, and other unhealthy foods, it undermines their consumption of healthier foods (Cullen & Zakeri, 2004). Some of these interventions may seem heavyhanded. After all, most people eat what they want based on their preferences or what is available. Nudging people in the right direction through subtle messages may work as well as, or better than, explicit warnings (Wagner, Howland, & Mann, 2015). Eliminating snack foods from schools, making school lunch programs more nutritious, making snack foods more expensive and healthy foods less so, and taxing products high in sugar or fats (Brownell & Frieden, 2009) will make some inroads into promoting healthy food choices.

Resistance to Modifying Diet

The typical reason that people switch to a diet low in cholesterol, fats, calories, and additives and high in fiber, fruits, and vegetables is to improve appearance, not to improve health. Even so, fewer than half of U.S. adults meet the dietary recommendations for reducing fat levels and for increasing fiber, fruit, and vegetable consumption Rates of adherence to a new diet may be high at first but fall off over time. Some diets are restrictive, monotonous, expensive, and hard to implement. Changes in shopping, meal planning, cooking methods, and eating habits may be required. In addition, tastes are hard to alter. Foods that are high in fat and sugars help turn off stress hormones, such as cortisol, but they contribute to an unhealthy diet (Dallman et al., 2003). A preference for meat, a lack of health consciousness, a limited interest in exploring new foods, and low awareness of the link between eating habits and illness are all tied to poor dietary habits.

A Good Night's Sleep

• Get regular exercise, at least three times a week. • Keep the bedroom cool at night. • Sleep in a comfortable bed that is big enough. • Establish a regular schedule for awakening and going to bed. • Develop nightly rituals that can get you ready for bed, such as taking a shower. • Use a fan or other noise generator to mask background sound. • Don't consume too much alcohol and don't smoke. • Don't eat too much or too little at night. • Don't have strong smells in the room, such as from incense, candles, or lotions. • Don't nap after 3 p.m. • Cut back on caffeine, especially in the afternoon or evening. • If awakened, get up and read quietly in another place, so that bed is associated with sleep, not sleeplessness.

Home and Workplace Accidents

Accidents in the home, such as accidental poisonings and falls, are the most common causes of death and disability among children under age 5 Interventions to reduce home accidents are typically conducted with parents because they have control over the child's environment. Putting safety catches and gates in the home, placing poisons out of reach, and teaching children safety skills are components of these interventions. Pediatricians and their staff often incorporate such training into visits with new parents. Parenting classes help parents to identify the most common poisons in the home and to keep these away from young children. Evaluations of interventions that train parents how to childproof a home At one time, workplace accidents were a primary cause of death and disability. However, statistics suggest that overall, accidents in the workplace have declined since the 1930s. This decline may be due, in part, to better safety precautions by employers. However, accidents at home have actually increased. Social engineering solutions, such as safety caps on medications and required smoke detectors in the home, have mitigated the increase, but the trend is worrisome.

Characteristics of the Setting

Convenient and easily accessible exercise settings promote exercise When people believe their neighborhoods are safe, when they are not socially isolated, and when they know what exercise opportunities are available to them in their area, they are more likely to engage in physical activity Vigorous walking in your neighborhood can be maintained more easily than participation in an aerobics class in a crowded health club 5 miles from your home. Lack of safe places to do exercise is a particular barrier for people who live in low socioeconomic status neighborhoods

screening through mammography for high-risk women

One in every eight women in the United States develops breast cancer. ∙ The majority of breast cancers are detected in women over age 40, and so screening this age group is cost effective. ∙ Early detection, as through mammograms, can improve survival rates. Unfortunately, compliance with mammography recommendations is low. Fear of radiation, embarrassment over the procedure, anticipated pain, anxiety, fear of cancer (Gurevich et al., 2004; Schwartz, Taylor, & Willard, 2003), and, most importantly, especially among poorer women, concern over costs act as deterrents to getting regular mammograms (Lantz, Weigers, & House, 1997). Lack of awareness of the importance of mammograms, little time, and lack of available services also contribute to low screening rates.

Who Controls Their Diet?

People who are high in conscientiousness and intelligence do a better job of adhering to a healthy diet. People who have high self-control are better able to manage a healthy diet than people without executive control skills (Hall, 2011). A strong sense of self-efficacy, knowledge about dietary issues, family support, and the perception that dietary change has important health benefits are also critical to developing a healthy diet . When people are informed about social norms regarding diet, they are more likely to make a change toward those norms. For example, if the people around you have stopped drinking soda because they think it is unhealthy, you are more likely to do so as well.

Exercise Interventions

Self-control & Motivation. Helping people to form implementation intentions, and following up with brief text messages can promote activity as well transtheoretical model of behavioral change: (that is, the stages of change model) for increasing physical activity. Interventions designed to increase and maintain physical activity that are matched to stage of readiness are more successful than interventions that are not

Stress and Diet

Stress has a direct and negative effect on diet. People under stress eat more fatty foods, fewer fruits and vegetables, and are more likely to snack and skip breakfast (O'Connor, Jones, Ferguson, Conner, & McMillan, 2008). People with low status jobs, high workloads, and little control at work also have less healthy diets. When people are under stress, they are distracted, may fail to practice self-control, and may not pay much attention to what they are eating (Devine, Connors, Sobal, & Bisogni, 2003). Thus, the sheer cognitive burden of daily life can interfere with the ability to control food consumption by preventing people from monitoring their eating

VACCINATIONS AND SCREENING

Vaccinations and screening represent two ways of avoiding or detecting early some of the main causes of death in the United States. Yet many people fail to use these health resources, which makes behavior change important for health psychologists.

EXERCISE

any kind of exercise has benefits, especially for middle-aged and older adults.

Accidents and Older Adults

12,000 older adults die from fall-related injuries each year. At least 25 percent of older adults may remain hospitalized for at least a year due to injuries from a fall Consequently, strategies to reduce accidents among older adults have increasingly been a focus of health psychology research and interventions. Dietary and medication intervention to reduce bone loss can affect risk of fracture. Physical activity training involving balance, mobility, and gait training reduces the risk of falls. Teaching older adults to make small changes in their homes that reduce tripping hazards can help, including nonslip bathmats, shower grab bars, hand rails on both sides of stairs, and better lighting . The evidence suggests that fall prevention programs, often led by health psychologists, can reduce mortality and disability among older adults substantially

ACCIDENT PREVENTION

Accidents represent one of the major causes of preventable death, both worldwide and in the United States. Moreover, this cause of death is increasing. Worldwide, nearly 1.3 million people die as a result of road traffic injuries Nationally, bicycle accidents cause more than 900 deaths per year, prompt more than 494,000 emergency room visits, and constitute the major cause of head injury, making helmet use an important issue . Over 2,000 people a day are accidentally poisoned in the United States, usually by prescription or illegal drugs, and more than 40,000 people die of poisoning each year. Occupational accidents and their resulting disability are a particular health risk for working men.

Sleep & Health

An estimated 50-70 million Americans suffer from chronic sleep disorders—most commonly, insomnia 54 percent of people over age 55 report insomnia at least once a week. For women, sleep disorders may be tied to hormonal levels related to menopause. Even children who sleep too little or too much incur health risks, including risk of early death; low socioeconomic status contributes to poor sleep among children. Insufficient sleep (less than 7 hours a night) affects cognitive functioning, mood, job performance, and quality of life. Insomnia compromises well-being on the short term and quality of life on the long term. Poor sleep can be a particular problem in certain high-risk occupations, such as police work, in which officers are exposed to traumatic events As noted, there are health risks of inadequate sleep . Chronic insomnia can compromise the ability to secrete and respond to insulin; it increases the risk of coronary heart disease; it increases blood pressure and dysregulates stress physiology; it can affect weight gain; it can reduce the efficacy of flu shots; and it is tied to adverse immune changes including chronic inflammation. More than 70,000 of the nation's annual automobile crashes are accounted for by sleepy drivers, and 1,550 of these are fatal each year. In one study of healthy older adults, sleep disturbances predicted all-cause mortality over the next 4-19 years of follow-up. Children who do not get enough sleep may show behavioral problems. By contrast, good sleep quality can act as a stress buffer.

DEVELOPING A HEALTHY DIET

Diet is an important and controllable risk factor for many of the leading causes of death and disease. For example, diet is related to serum cholesterol level and to lipid profiles. The dramatic rise in obesity in the United States has added urgency to this issue. However, only about 13 percent of adults get the recommended servings of fruit and only about 9 percent get the recommended servings of vegetables each day Dietary change is critical for people at risk for or already diagnosed with chronic diseases such as coronary artery disease, hypertension, diabetes, and cancer (Center for the Advancement of Health, 2000f). These are diseases for which people low in SES are more at risk, and diet may explain some of the relation between low SES and these disorders. For example, supermarkets in high-SES neighborhoods carry more health-oriented food products than do supermarkets in low-income areas. Thus, even if the motivation to change one's diet is there, the food products may not be Switching from trans fats (as are used for fried and fast foods) and saturated fats (from meat and dairy products) to polyunsaturated fats and monounsaturated fats is a healthful change as well (Marsh, 2002, September 10). Current U.S. government guidelines for a balanced diet are described in Table 4.2. Several specific diets, in addition to low-fat diets, have health benefits. Healthy "Mediterranean" diets are rich in vegetables, nuts, fruits, and fish and low in red meat. Low-carbohydrate diets with vegetarian sources of fat and protein and little bread and other high-carbohydrate foods can have healthful effects. Many people like these diets, and so they can be fairly easily adopted and adhered to over time.

Colorectal Cancer Screening

In Western countries, colorectal cancer is the secondleading cause of cancer deaths. In recent years, medical guidelines have recommended routine colorectal screening for older adults Factors that predict the practice of other health behaviors also predict participation in colorectal cancer screening, including self-efficacy, perceived benefits of the procedure, a physician's recommendation to participate, social norms favoring participation, and few barriers to taking advantage of a screening program. As is true of many health behaviors, beliefs predict the intention to participate in colorectal screening, whereas life difficulties (low SES, poor health status) interfere with actually getting screened . Community-based programs that use the mass media, community-based education, interventions through social networks such as churches, health care provider recommendations, and reminder notices promote participation in cancer screening programs and can attract older adults . Telephone-based interventions tailored to people's resistance to colorectal screening can increase the likelihood of obtaining screening as well (Menon et al., 2011). Hispanics are at particular risk for colorectal cancer, and so it is especially important to reach them .

Vaccinations

Parents are urged to get their children vaccinated against measles, polio, diphtheria, whooping cough, and tetanus, among other childhood diseases. Most do, because school registration typically requires these vaccines. However, some do not and instead are freeriders; that is, if most children are vaccinated, the minority that is not are protected by those who are. In some cases, refusing to get vaccinations for one's children comes from the mistaken beliefs that a vaccine actually causes the disease or that the vaccine causes another disorder, such as autism. Interventions have attempted to correct the incorrect beliefs that can undermine vaccination and stressed the social benefits of vaccination in the hopes of keeping rates high. Vaccinations of girls and boys against HPV (human papillomavirus) by age 13 is now recommended by the National Institutes of Health. HPV is a sexually transmitted virus tied to cervical as well as other cancers. The Centers for Disease Control and Prevention report, however, that as of 2016, only 40% of girls and 21% of boys had received it. This rate compares very unfavorably to many other countries, including Australia (75%), the United Kingdom (about 88%) and Rwanda (93%). Family-focused messages aimed at parents and adolescents have been suggested as one focus of public health interventions to increase vaccination rates , and direct payments to adolescents in the UK have been tried . As yet, the most effective way to encourage this behavior has not been found. .

Who can't sleep?

People who are going through major stressful life events or traumas, who are suffering from major depression, who are experiencing stress at work, who are experiencing socioeconomic adversity, who have high levels of hostility or arousal , who use maladaptive coping strategies to cope with stress, and who ruminate on the causes of their stress ,have poor sleep quality and report sleep disturbances. Stressful events regarded as uncontrollable can produce insomnia . People who deal with stressful events by ruminating or focusing on them are more prone to insomnia than are those who deal with stressful events by blunting their impact or distracting themselves . Sleep may have particular significance for people low in SES, as low SES is linked to poor subjective and objective sleep quality . Abuse of alcohol is also related to poor sleep quality. Although the health risks of insufficient sleep are now well known, less well known is the fact that people who habitually sleep more than 7 hours every night also incur health risks. Long sleepers, like short sleepers, also have more symptoms of psychopathology, including chronic worrying .

Who Exercises?

People who come from families in which exercise is practiced, who have positive attitudes toward physical activity, who have a strong sense of self-efficacy for exercising, who have energy, and who are extroverted and sociable. People who perceive themselves as athletic or as the type of person who exercises, who have social support from friends to exercise, who enjoy their form of exercise, and who believe that people should take responsibility for their health are also more likely to get exercise than people who do not have these attitudes

Effects on Psychological Health

Some of the positive effects of exercise on mood may stem from factors associated with exercise, such as social activity or being outside . An improved sense of self-efficacy can also underlie some of the mood effects of exercise. Because of its beneficial effects on mood and self esteem, exercise has even been used as a treatment for depression Health psychologists have also found beneficial effects of exercise on cognitive functioning. Currently, only about half of youth meet physical activity requirements of 60 minutes a day. Children get regular exercise through required physical education classes in school, but even these classes have faced budget cutbacks. Moreover, by adolescence, the practice of regular exercise has declined substantially, especially among girls and among boys not involved in formal athletics. Adults report lack of time, stress, interference with daily activities, and fatigue as barriers to obtaining exercise .

Benefits of Exercise

The health benefits of exercise are substantial. A mere 30 minutes of exercise a day can decrease the risk of several chronic diseases, including heart disease, diabetes, and some cancers. Exercise accelerates wound healing in those with injuries and can be critical to recovery from disabilities, such as hip fracture • Helps you control your weight • Reduces your risk of cardiovascular disease • Reduces your risk for Type II diabetes and metabolic syndrome • Reduces your risk of some cancers • Strengthens your bones and muscles • Decreases resting heart rate and blood pressure and increases strength and efficiency of heart • Improves sleep • Increases HDL (good) cholesterol • Improves immune system functioning • Promotes the growth of new neurons in the brain • Promotes cognitive functioning Exercise can improve executive functioning involved in planning and higher-order reasoning. Exercise appears to promote memory and healthy cognitive aging and may improve cognitive functioning and executive control in children as well. Even modest exercise or increases in activity level can have these beneficial effects on cognitive functioning. Exercise may offer economic benefits as well. Employee fitness programs can reduce absenteeism, increase job satisfaction, and reduce health care costs, especially among women employees.

Motorcycle and Automobile Accidents

The single greatest cause of accidental death is motorcycle and automobile accidents social engineering solutions may be more effective. Seat belt use is more prevalent in states with laws that mandate their use, and states that enforce helmet laws for motorcycle riders have reduced deaths and lower health care costs related to disability due to motorcycle accidents psychological interventions can also address factors associated with accidents. These include the way people drive, the speed at which they drive, and the use of preventive measures to increase safety, such as interventions to reduce cell phone usage while driving.

Screenings

The two most common cancers in the United States are breast cancer in women and prostate cancer in men. men who are symptomatic or at high risk (who have a family history of prostate cancer; Watts et al., 2014) and women who are symptomatic or at high risk (having a family history of breastcancer; having genes implicated in breast cancer) should be monitored. Otherwise, routine PSA screening is not recommended and a mammogram is recommended every year between ages 45 and 55 and every other year for women between the ages of 55 and 74.

How Much Exercise?

The typical exercise prescription for a normal adult is 30 minutes or more of moderate-intensity activity on most or all days of the week or 20 minutes or more of vigorous or aerobic activity at least 3 days a week

Sleep

has a powerful effect on risk of infectious disease, risk of depression, poor responses to vaccines, and the occurrence and progression of several chronic disorders, including cardiovascular disease and cancer. There are two broad types of sleep: non-rapid eye movement (NREM) and rapid eye movement (REM). NREM sleep consists of four stages. Stage 1, the lightest and earliest stage of sleep, is marked by theta waves, when we begin to tune out the sounds around us, although we are easily awakened by any loud sound. In stage 2, breathing and heart rates even out, body temperature drops, and brain waves alternate between short bursts called sleep spindles and large Kcomplex waves. Stages 3 and 4, deep sleep, are marked by delta waves. These are the phases most important for restoring energy, strengthening the immune system, and prompting the body to release growth hormone. During REM sleep, eyes dart back and forth, breathing and heart rates flutter, and we often dream vividly. This stage of sleep is marked by beta waves and is important for consolidating memories, solving problems from the previous day, and turning knowledge into long-term memories All of these phases of sleep are essential..

Relapse prevention techniques

increase long-term adherence to exercise programs. For example, helping people figure out how to overcome barriers to obtaining regular exercise, such as stress, fatigue, and a hectic schedule, improves adherence Setting personal goals brief behavioral counseling matched to stage of readiness. forming explicit implementation intentions regarding exactly when and how to exercise facilitates practice as well; planning when to exercise can facilitate the link between intention and actual behavior Physical activity websites A physician's recommendation is one of the factors that lead people to increase their exercise, and trends show that physicians increasingly are advising their patients to begin or continue exercise (Barnes & Schoenborn, 2012). The number of people who participate in regular exercise has increased by more than 50 percent in the past few decades. although the population may be aging, it may be doing so in a healthier way than was true in recent past generations.

Aerobic exercise

is marked by high intensity, long duration, and the need for endurance, and it includes running, bicycling, rope jumping, and swimming. A person with low cardiopulmonary fitness may derive benefits from even less exercise each week. Even short walks or just increasing activity level has physical and psychological benefits for older adults

best predictor of regular exercise

is regular exercise. Social support can foster exercise. Making a commitment to another person to meet for exercise increases the likelihood that it will happen . People who participate in group exercise programs The first 3-6 months appear to be critical, and people who will drop out usually do so in that time period (Dishman, 1982). Developing a regular exercise program, embedding it in regular activities, and doing it regularly means that it begins to become automatic and habitual. However, habit has its limits. Unlike such habitual behaviors as wearing a seat belt or brushing teeth, exercise takes willpower and a belief in personal responsibility in order to be enacted on a regular basis. In summary, if people participate in activities that they like, that are convenient, that they are motivated to pursue, and for which they can develop goals, exercise adherence will be greater

SUN SAFETY PRACTICES

malignant melanoma takes over 9,000 lives each year In the past two decades, melanoma incidence has risen by 155 percent. Moreover, these cancers are among the most preventable. The chief risk factor for skin cancer is well known: excessive exposure to ultraviolet (UV) radiation. Living or vacationing in southern latitudes, participating in outdoor activities, and using tanning salons all contribute to dangerous sun exposure. Less than one-third of American children adequately protect themselves against the sun, and more than three-quarters of American teens get at least one sunburn each summer educational interventions to alert people to the risks of skin cancer and to the effectiveness of sunscreen use for reducing risk Effective sunscreen use requires knowledge about skin cancer, perceived need for sunscreen, perceived efficacy of sunscreen as protection against skin cancer, and social norms that favor sunscreen use Parents play an important role in ensuring that children reduce sun exposure Parents' own sun protection habits influence how attentive they are to their children's practices and what their children do when they are on their own When risks are emphasized, it is important to stress the immediate adverse effects of rather than the long-term risks of chronic illness, because adolescents and young adults are especially influenced by immediate concerns. especially influenced by immediate concerns. In one clever investigation, one group of beachgoers were exposed to a photo-aging intervention that showed premature wrinkling and age spots; a second group received a photo intervention that made the negative appearance-related consequences of UV exposure very salient; a third group received both interventions; and a fourth group was assigned to a control condition. Those beachgoers who received the UV photo information engaged in more sun protective behaviors, and the combination of the UV photo with the photo-aging information led to substantially less sunbathing over the long-term

Behavioral interventions for Sleep

mindfulness based interventions, relaxation therapy, control of sleep related behaviors (such as the routine a person engages in before going to sleep), and cognitive-behavioral interventions. All these treatments show success in treating insomnia. activities, such as hobbies, sports, socializing, or spending time in nature, has been tied to lower blood pressure, lower cortisol, lower weight, and better physical functioning. Satisfaction with leisure activities can improve cognitive functioning among the elderly and promote good health behaviors. Unfortunately, little other than intuition currently guides our thinking about restorative processes. Nonetheless, health psychologists suspect that rest, renewal, and savoring—involving activities such as going home for the holidays, relaxing after exams, and enjoying a walk or a sunset—have health benefits.