health behaviour 1 - determinants of health Flashcards
define health - WHO (1946)
a state of complete physical mental and social well-being and not merely the absence of disease or infirmity
other perspectives on health (4)
people with chronic health conditions can still manage to have a good quality of life thanks to advancements in medicine
health is not a binary state -> health on a spectrum
WHO definition out of date and not fit for purpose due to:
- ageing population
- ability to manage chronic health conditions
Huber et al., (2011)
propose shifting the emphasis of health towards the ability to adapt and self-manage in the face of social, physical and emotional challenges
leading causes of death in 1990s (10)
Pneumonia/flu
Tuberculosis (TB)
Diarrhoea
Heart disease
Intracranial lesions (vasc.)
Nephritis
Accidents
Cancer
Senility
Diphtheria
5 major causes of death in UK (2006)
cardiovascular disease (M35%, W34%)
cancers (M29%, W26%)
respiratory disease (M13%, W14%)
accidents and injuries (M5%, W3%)
other causes (M18%, W23%)
age correlations with death from CVD (cardiovascular disease)
increase in CVD with age
but from age 35-64, almost double the men die from CVD than women –> very early spike
women is much more linear
age correlations with death from cancer
curved shape graph
highest risk at middle ages - 45-74
more women than men die from cancer until age 75, from then more men than women
reasons for changes in causes of death with age over time
changes in behaviours such as smoking, diet, alcohol, regular physical activity –> because of understandings about health outcomes (Adler et al. 1999)
behavioural factors account for around 50% of premature deaths from the 10 leading causes (Gruman & Follick, 1998)
health behaviour –> Doll and Hill (1964) studied British doctors in the 1950s and found smoking was a major precursor of premature mortality
define health behaviour
any activity undertaken for the purpose of preventing or detecting disease or for improving health/well being (Conner & Norman, 1996)
Broadest sense health behaviours = behaviours individuals engage in that affect their health
positive and negative health behaviour effects
Steptoe, Gardner & Wardle, 2010
positive (protective) health behaviour =
“activities that may help to prevent disease, detect disease and disability at an early stage, promote and enhance health, or protect from risk of injury”
e.g. sleep, stress management, exercise
negative (Risky) health behaviour =
“activities undertaken by people with a frequency of intensity that increases risk of disease or injury”
e.g. social isolation, alcohol use, drink driving, overworking, lack of physical activity
measuring health behaviours (3 with limitations)
behaviour is often used as the DV
measured in categorical or continuous measurements using self-report questionnaires
limitations of measuring behaviour:
- social desirability bias
- subject to recall bias
observation (e.g. CCTV)
proxy measures (blood tests, step counters, pill counters)
limitations of proxy measures:
- blood tests depend on metabolic rate
- pill counters rely on pills actually being taken out of the bottle
- stap counters can have errors in measurement or be falsified
Belloc (1973) - features of a healthy lifestyle study - negative behaviours
Alameda county study
~7000 adults
baseline postal questionnaire in 1965 followed by regular surveys of death and illness
7 baseline negative health behaviours predicted mortality:
- lack of exercise
- snacking between meals
- smoking
- sleep (more than 8 hrs, less than 7),
- skipping breakfast
- regularly drinking more than 5 units of alcohol
- over/underweight
Belloc (1973) - features of a healthy lifestyle study - positive behaviours
7 features of a healthy lifestyle:
- non-smoking
- moderate alcohol intake
- 7-8 hours sleep per night
- regular exercise
- maintain a healthy body weight
- avoid high-calorie snacks
- regularly eat breakfast
proposed people over 75 who do all 7 of these had health comparable to those age 35-44 who did less than 3
Norfolk longitudinal study of health behaviours
Khaw et al (2008)
EPIC study of 20,000 men and women
baseline no known CVD/cancer, aged 45-79
followed up over 14 years
survival was associated with four health behaviours:
- not smoking,
- being physically active,
- drinking moderately,
- eating 5 or more servings of fruit and veg a day
fewer of these behaviours performed = greater risk of death
those engaging in all 4, had around a 95% survival rate
those engaging in none had survival of nearer 75%
USA study of preventable causes of death
Danaei et al., (2009)
health behaviours can be linked to range of different causes of death
smoking (highest cause of death) attributable to CVD, cancer, diabetes and respiratory diseases
alcohol use results in lower death from cardiovascular, but increase in injury and cancer related deaths (but confounds as if you can afford the alcohol you may be able to afford a healthier lifestyle too)
health behaviours in the modern world (4 changes in how they are viewed)
concept of health behaviour is fluid, and behaviours that are included can change as medical knowledge develops - e.g. smoking
health behaviours are not uniformly important, but vary in their influence across time and across different populations (e.g. starting to wear face masks)
strength of the evidence relating behaviours with health outcomes is variable:
- case control, prospective, experimental, cross-sectional (but association ≠ causation)
- stronger evidence = there are consistent results with different samples and study designs, and a clear biological mechanism
behaviours may be done for non-health purposes, e.g. limiting fat in the diet, going to the gym may be motivated by concern for appearance rather than health
how do health behaviours need to be viewed
health psychologists need to view behaviour in a broad context and recognise that health motivations and cognitions are part of a wider set of influences on health behaviour
5 important health behaviours in the modern world
diet
- in 2018 only 28% adults eating 5+ servings of fruit/veg a day (NHS, 2020)
physical activity
* more than 80% of adolescents and 27% of adults do not meet WHO’s recommended levels of physical activity (WHO, 2022)
smoking
* rates declined over the last decade, but ~8 million adults in the UK smoke (ONS, 2021).
* highest rates among 25-34 year olds (ONS, 2021)
sexual behaviour
* 47% of sexually active young people do not use a condom when sleeping with someone for the first time (YouGov Poll, 2017)
alcohol
* -28% of adult drinkers in UK binge on alcohol on their heaviest drinking day (ONS, 2017)
* 16-24 year olds-> less likely to drink than any other age group but most likely to binge drink when they do (ONS, 2017)
3 types of behaviour change
initiate a new behaviour
e.g., wearing face masks
stopping an existing behaviour
e.g. stopping smoking, stop hugging friends/family
how a behaviour is performed
e.g. changing frequency, intensity, duration of a behaviour (exercising more, eating less)
primary motivational concerns in life
same for humans as they are for most animals
food, water, air, reproduction etc.
challenging primary motivational concerns in behaviours - 3 examples - and what is needed to be considered to change behaviour
Sexual behaviour e.g. condom use
Energy seeking behaviour e.g. eating habits
Energy conservation behaviour e.g. exercise levels
therefore we need to first understand behaviour in order to change it, this requires adopting a biopsychosocial approach to health
requires an appreciation of the evolutionary/biological, psychological and social contexts in which it takes place
biopsychosocial approach to health behaviour determinants
biological, psychological, and social
bio:
- gender
- physical illness
- disability
- genetics
psycho:
- learning
- attitudes
- personality
- behaviour
- emotions
- coping
social:
- family background
- culture
- SES
- education
- social support
biological determinants of health behaviour (3)
twin studies = suggest heritable component to: smoking initiation, nicotine addiction, body weight, and obesity (Plomin et al. 2000)
physiological response to health behaviours (smoking, drinking, eating, exercising) releasing dopamine, endorphins which can reinforce the behaviour
personal health and ability to carryout many health behaviours:
- disabilities may impact ability to carry out physical activity
- symptoms can act as cues to change or stop behaviour (e.g. smoking, adherence to medications etc)
social determinants of health behaviour (3)
health behaviours are strongly affected by peer group influences, family habits and social networks (Baranowski, 1997):
- early socialisation (observational learning –> health habits e.g. brushing your teeth, smoking)
- culturally valued or discouraged behaviour (e.g. alcohol consumption in some religions)
- peer pressure in adolescence = origin of many risk behaviours
socioeconomic status (Pampel, Krueger, Denney, 2010):
- financial barriers to health behaviours e.g. gym, dental
- lack of available resource
- lower education
legislative laws (DeJong & Hingson, 1998):
- e.g. seat belt use, drink driving
psychological determinants of health behaviour (2)
emotion (Ferrer & Mendes, 2018)
- stress - smoking, drinking, overeating and exercise
- fear - avoidance of healthcare (e.g. dental; delay in response to symptoms, screening etc)
- disgust > fear avoidance (blood test, cervical screening)
cognition (Armitage and Conner, 2000)
- attitudes/beliefs
- social cognition models (e.g. Theory of Planned Behaviour (Azjen, 1991)
- interventions based on Theory of Planned Behaviour to improve health behaviour
