Midterm 1 Flashcards

Question

Who proposed the humoral theory?

Answer 1

Hippocrates (later expanded by Galen)

Answer 2

philosophical debate about the relationship between mind and body - Body: physical being - Mind: mental properties such as thoughts, feelings

Answer 3

disease arises when the four circulating fluids of the body are out of balance (based on the elements): - blood - black bile - yellow bile - phlegm - The function of treatment is to restore balance among the humors. Specific personality types were believed to be associated with bodily temperaments in which one of the four humours predominated. (could also have an effect on the mind)

Answer 4

``` Greek physician and “Father of Medicine” - Clinical observation (e.g., heartbeat) - Noted the history of patients’ symptoms and recorded physical signs - Proposed the humoral theory ```

Answer 5

Ancient Greeks

Answer 6

- Blood: Sanguine (cheerful) - Phlegm: Phlegmatic (sluggishness, apathy) - Yellow Bile: Choleric (hot-tempered, irritable) - Black Bile: Melancholia (depressive, sad) Could result in illness or personality changes

Answer 7

- Diet, rest, baths, herbs - Regulating the environment (temperature, moisture) or change of scenery - In the Middle Ages: bloodletting, leeches

Answer 8

One of the greatest figures in ancient Greek & Roman medicine - Influenced by humoral theory - Scientific approach in medicine - Dissected animals and treated injuries of Roman gladiators - Discoveries about anatomy - Diseases can be localized in specific parts of the body - Believed in treatment of opposites, if you had a fever, then you would be treated by a cold treatment - The church backed him up as he believed the body fit perfectly together (which the church supported as they felt the body was perfect)

Answer 9

- Exorcism - Torture to drive out evil spirits - Humours: bloodletting, leeches - Killing “witches” - Later, penance through prayer and good works (people had to believe in the church in order to get help)

Answer 10

trying to do something good to make up for what you did bad

Answer 11

Mind: Theologians, priests, and philosophers Body: Physicians and Physical evidence was the sole basis for diagnosis

Answer 12

17th Century French philosopher & mathematician Came up with Cartesian Dualism

Answer 13

The mind and the body are separate entities.

Answer 14

Discovered bacteria, microscopic life via microscopy

Answer 15

Focused on anatomical pathology via autopsies

Answer 16

Theory that diseases are caused by specific micro-organisms - Promoted biology as sole cause of disease - Dualism - Reductionism - search for “magic bullet”

Answer 17

Reductionist: looking for a certain/singular type of cause for disease --> disadvantage is that there is more than one cause for disease

Answer 18

There was a mold growing in the petry dish which was killing the bacteria/infection and in time it was called Penicillin and it was successful in killing the infection

Answer 19

According to this model, illnesses are due to bodily dysfunction (For example: biochemical imbalances, injury, infections, neurophysiological abnormalities) - Focus on illness/disease rather than wellness - Dominant model for the past 300 years - Mental and social factors were assumed to be irrelevant The viewpoint that illness can be explained on the basis of aberrant somatic processes and that psychological and social processes are largely independent of the disease process; the dominant model in medical practice until recently.

Answer 20

Led to development of vaccines and antibiotics Fewer deaths due to infectious diseases Most prevalent causes of death are no longer due to acute conditions (Most are from chronic conditions (like cancer) no longer acute conditions (like a fever or cold))

Answer 21

- Fails to recognize social & psychological influences on health - Focus on illness rather than health promotion - Cannot explain many puzzling medical observations - It is a reductionistic model. This means that it reduces illness to low-level processes, such as disordered cells and chemical imbalances, rather than recognizing the role of more general social and psychological processes. - The biomedical model is also essentially a single-factor model of illness. That is, it explains illness in terms of a biological malfunction rather than recognizing that a variety of factors, only some of which are biological, may be responsible for the development of illness. - The biomedical model implicitly assumes a mind–body dualism, maintaining that mind and body are separate entities. Finally, the biomedical model clearly emphasizes illness over health. That is, it focuses on aberrations that lead to illness rather than on the conditions that might promote health - The biomedical model also has difficulty accounting for why a particular set of somatic conditions need not inevitably lead to illness. Why, for example, if six people are exposed to measles, do only three develop the disease? There are psychological and social factors that influence the development of illness, and these are ignored by the biomedical model.

Answer 22

Yes, life expectancy is increasing fast

Answer 23

``` In 1921 illnesses like: - influenza, bronchitis and pneumonia - Tuberculosis - Disease of early infancy were all leading causes in death, these are no longer relevant in 2017 ``` ``` In 2017 illnesses like: - Cancer - Hear disease - Accidents (like overdose) - Stroke are much more common in leading causes of death ```

Answer 24

From acute conditions - Short-term medical illnesses To chronic conditions - Slow-developing diseases - Often these cannot be cured, only managed - Health care costs rise - Quality of life decreases Impending crisis: Aging population (“baby boomers”)

Answer 25

Viennese physician and founder of psychoanalysis His theories have had a lasting influence in psychology & society

Answer 26

Unconscious conflicts were “converted” into physical disturbances (Freud) If a person can convert their unconscious conflict into physical disturbances, then they can overcome these conflicts. The patient converts the conflict into a symptom via the voluntary nervous system; he or she then becomes relatively free of the anxiety the conflict would otherwise produce. --> supports the holistic model

Answer 27

During Glove Anesthesia, the entire hand becomes numb. but you can feel above the wrist ---> Freud thought there must be some kind of psychological conflict that is creating this

Answer 28

Field related to psychiatry & psychology in that medical problems are caused by emotional conflicts - Originally focused on medical problems believed to be caused by emotional conflicts - -> Examples: Ulcers, hyperthyroidism, arthritis, hypertension, colitis, asthma

Answer 29

It differs from health psychology because there is more mechanistic focus

Answer 30

repressed emotions resulting from frustrated dependency and love-seeking needs were said to increase the secretion of acid in the stomach, eventually eroding the stomach lining and producing ulcers --> it turns out it was due to a bacteria in the stomach (however only 2/3 of people have this bacteria and stress is linked to shutting down the immune system allowing the bacteria to grow in numerous amounts)

Answer 31

Type A personality as a risk factor for heart | disease

Answer 32

Psychological conflicts, anxiety, physiological | effect via autonomic nervous system

Answer 33

Whereas Freud believed that conversion reactions occur via the voluntary nervous system with no necessary physiological changes, Dunbar and Alexander argued that conflicts produce anxiety, which becomes unconscious and takes a physiological toll on the body via the autonomic nervous system, which eventually produces an actual organic disturbance.

Answer 34

A field within psychiatry, related to health psychology, that developed in the early 1900s to study and treat particular diseases believed to be caused by emotional conflicts, such as ulcers, hypertension, and asthma; the term is now used more broadly to mean an approach to health-related problems and diseases that examines psychological as well as somatic origins.

Answer 35

the onset of disease requires the interaction of a variety of factors; these factors include psychological and social factors: - a possible genetic weakness in the organism - the presence of environmental stressors - early and current ongoing learning experiences and conflicts - individual cognitions and coping efforts

Answer 36

The interdisciplinary field concerned with integrating behavioural science and biomedical science for understanding physical health and illness and for developing and applying knowledge and techniques to prevent, diagnose, treat, and rehabilitate.

Answer 37

the relationship between patient and practitioner, and expectations about pain and discomfort

Answer 38

- good health habits, which are for the most part under one’s personal control - by such socially determined factors like culture, socio-economic status, place, stress, availability of health resources, and social support.

Answer 39

the interrelation of all of the body’s systems, and view illness as a disharmony between these systems

Answer 40

Healing is accomplished through techniques and treatments that help to restore both physical and psychological balance, such as meditation, massage therapy, acupuncture, herbal remedies, and homeopathy

Answer 41

Yes, the West is starting to accept some of the ideas and treatments from the East that may be beneficial Overall there is a growing interest in holistic health care remedies across the West eg over-the-counter natural remedies such as vitamins, homeopathic medicines, herbal remedies, traditional Chinese medicines, and probiotics

Answer 42

Biomedical: - Reductionistic - Single causal factor considered - Assumes mind–body dualism - Emphasizes illness over health Biopsychosocial: - Macrolevel as well as microlevel - Multiple causal factors considered - Mind and body inseparable - Emphasizes both health and illness

Answer 43

psychological and social factors

Answer 44

biological

Answer 45

The viewpoint that all levels of an organization in any entity are linked to each other hierarchically and that change in any level will bring about change in other levels. ---> This means that the microlevel processes (such as cellular changes) are nested within the macrolevel processes (such as societal values) and that changes on the microlevel can have macrolevel effects (and vice versa).

Answer 46

1. he biopsychosocial model maintains that the process of diagnosis should always consider the interacting role of biological, psychological, and social factors in assessing an individual’s health or illness. Therefore, an interdisciplinary team approach may be the best way to make a diagnosis. 2. The biopsychosocial model maintains that recommendations for treatment must also examine all three sets of factors. By doing this, it should be possible to target therapy uniquely to a particular individual, consider a person’s health status in total, and make treatment recommendations that can deal with more than one problem simultaneously. Again, a team approach may be most appropriate. 3. The biopsychosocial model makes explicit the significance of the relationship between patient and practitioner. An effective patient–practitioner relationship can improve a patient’s use of services as well as the efficacy of treatment and how well the patient adheres to the treatment recommendations.

Answer 47

1930s-1950s: early psychosomatic medicine | arose from psychiatry & medicine

Answer 48

Criticisms of early psychosomatic medicine - Simplistic - Not methodologically sound ---> Laid groundwork for the biopsychosocial model

Answer 49

1930s-1970s: discoveries about the effects of stress on physiological systems 1970s: health psychology and behavioural medicine emerged as fields

Answer 50

Present Day: health psychology is an active field engaging in education, research, practice, and policy

Answer 51

Emphasis on both health and illness

Answer 52

- Changing patterns of disease | - Psychological and social influences on health

Answer 53

Expected to spend $253.5 billion - --> cost is rising by 4.2% - --> almost $7000 a perosn - --> 11% of GDP

Answer 54

- Socioeconomic status (such as income, education) - Ethnicity and race (such as Indigenous --> White men live 7 years longer than indigenous men) - Gender - Sexual minorities - Rural vs. urban

Answer 55

men who worked low ranked jobs had a life expectancy of three years less than those who worked in higher ranked jobs (based on british study where every job was ranked)

Answer 56

Lower life-expectancy

Answer 57

- Physical activity - Fruit and vegetable consumption - Sleep habits - Adherence to medical regimens

Answer 58

- Smoking - Alcohol & substance use - Poor eating habits - Obesity

Answer 59

Almost 20% of Canadians ages 12 | and older smoke.

Answer 60

There hasn't been much fluctuation in the last few years in physical activity

Answer 61

More seniors than children after 2016 ---> This impacts labour issues, and where we put money in health care

Answer 62

It is highish at >1 and after remains stable until age 55 and then it starts to increase drastically after age 55 each year

Answer 63

- Feelings of isolation, disconnectedness, and not belonging - Reflects the discrepancy between one’s desired and one’s actual relationships - Not necessarily the same as “being alone”

Answer 64

It is the relationship between percieved loneliness and health --> Repulsion/isolation and Attraction/Connectedness lead to peoples perceived loneliness and this in turn changes how people perceive social situations and can lead to people overthinking negative situations (making them more lonely) and vice versa ***double check if I need to memorzie graph in lecture 3

Answer 65

Theory: a set of ideas that provides a framework for asking questions, gathering information, and interpreting a phenomenon Example: Loneliness affects how we interpret our social worlds

Answer 66

Hypothesis: Specific predictions about the phenomenon, based on a theory - Testable and disprovable Example: Lonelier people will show greater increases in heart rate to the stress task, compared to less-lonely people.

Answer 67

Illnesses or other medical problems that occur over a short period of time, that are usually the result of an infectious process, and that are reversible.

Answer 68

Illnesses or other medical problems that occur over a short period of time, that are usually the result of an infectious process, and that are reversible.

Answer 69

People can survive acute illness now, there is a shift towards more chronic illnesses being the leading cause of death (especially in industrialized countries)

Answer 70

1. These are diseases in which psychological and social factors are implicated as causes. For example, personal health habits, such as diet and smoking, are implicated in the development of heart disease and cancer, and sexual activity is critically important in the likelihood of developing AIDS (acquired immune deficiency syndrome). 2. Because people may live with chronic diseases for many years, psychological issues arise in connection with them. Health psychologists help people living with chronic illness adjust psychologically and socially to their changing health state.

Answer 71

Chronic illnesses affect family functioning, including relationships with a partner or children, and health psychologists both explore these changes and help ease the problems in family functioning that may result.

Answer 72

Have made it possible to identify carriers of illness and to test a fetus for the presence of particular life-threatening or severely debilitating illnesses

Answer 73

Certain treatments that may prolong life severely compromise quality of life. Increasingly, patients are asked their preferences regarding life-sustaining measures, and they may require counselling in these matters.

Answer 74

The study of the frequency, distribution, and causes of infectious and non-infectious disease in a population, based on an investigation of the physical and social environment. Focus on Morbidity and Mortality

Answer 75

The number of cases of a disease that exist at a given point in time; it may be expressed as the number of new cases (incidence) or as the total number of existing cases (prevalence). Morbidity statistics, then, tell us how many people are suffering from what kinds of illnesses at any given time

Answer 76

Refers to the numbers of deaths due to particular causes.

Answer 77

1. Accidents, especially automobile accidents, have historically been the major cause of death among children, adolescents, and young adults has led to the initiation of a variety of safety measures including child safety restraint systems and laws, mandatory seat belt laws, and airbags. 2. Knowing that cardiac disease is the major cause of premature death (that is, death that occurs prior to the expected age of death for an individual) has led to programs such as the Canadian Heart Health Initiative, a countrywide strategy to reduce behavioural risk factors among those most vulnerable, including smoking reduction efforts, implementation of dietary changes, cholesterol reduction techniques, increased exercise, and weight loss.

Answer 78

Lalonde Report proposed a framework for health that rested on four main cornerstones: human biology, environment, lifestyle, and health care organization.

Answer 79

This proposal led to the initiation of several health promotion programs to increase awareness of the importance of healthy behaviours and the risks associated with other behaviours such as smoking and alcohol use, such as the popular media campaign ParticipACTION

Answer 80

The Epp Report released in the 1980s proposed a health promotion approach to health in Canada that further echoed the need to view health in non-medical terms and give greater consideration to the social factors that contour health

Answer 81

health is viewed not as a state, but more broadly as a capacity or resource that is linked to the ability to achieve one’s goals, to learn, and to grow

Answer 82

is aimed at improving the health of both individuals and communities, primarily through highlighting the need for social policy changes and action. This model of health shares many of the same values and assumptions of the biopsychosocial model and views health as resulting from the combined interaction of a multitude of microlevel and macrolevel factors, including social context and place

Answer 83

takes into account a wide range of individual and social factors and how they interact to influence health: 1. Income and social status 2. Social support networks 3. Education 4. Employment/working conditions 5. Social environments 6. Physical environments 7. Personal health practices and coping skills 8. Healthy child development 9. Biology and genetic endowment 10. Health services 11. Gender 12. Culture

Answer 84

the cost of health care expenditures in Canada has increased substantially since the mid-1980s (Canadian Institute for Health Information, 2006a), the burden of which falls mainly on the shoulders of taxpayers. It will likely keep increasing too.

Answer 85

1. Because containing health care costs is so important, health psychology’s main emphasis on prevention—namely, modifying people’s risky health behaviours before they ever become ill—has the potential to reduce the amount of money devoted to the management of illness. 2. Health psychologists have done substantial research on what makes people satisfied or dissatisfied with their health care and therefore whether or not they engage in treatment-related behaviours (see Chapters 8 and 9). Thus, they can help in the design of user-friendly health care systems. 3. The health care industry employs thousands of individuals in a variety of jobs. Nearly every individual in the country has direct contact with the health care system as a recipient of services. Thus, its impact on people is enormous.

Answer 86

proposes that understanding individual health-related behaviour depends upon how this health behaviour is framed over time (Waterloo University)

Answer 87

developed by researchers at McGill University, focuses on understanding the role of compensatory beliefs for explaining why people fail to bridge the intention-behaviour gap in the context of tempting unhealthy alternative choices

Answer 88

Trained and licensed individuals who help people with muscle, nerve, joint, or bone diseases to overcome their disabilities as much as possible. Work primarily with accident victims, children with disabilities, people with chronic illness, and older people - responsible for the administration and interpretation of tests of muscle strength, motor development, functional capacity, and respiratory and circulatory efficiency - develop individualized treatment programs, the goals of which are to increase strength, endurance, coordination, and range of motion - help patients learn to use adaptive devices and become accustomed to new ways of performing old tasks

Answer 89

Licensed occupational therapists work in schools, hospitals, rehabilitation centres, long-term care facilities, and mental health agencies. Work with individuals who are emotionally and physically disabled (e.g., people who have mental illness, substance abuse problems, or a disabling chronic illness) - evaluate the existing capacities of patients, help them set goals, and plan a therapy program to improve their occupational abilities and skills for daily living - help patients regain physical, mental, or emotional stability; relearn daily routines, such as eating, dressing, writing, or using a telephone; and prepare for employment - can also teach creative tasks, such as painting, weaving, and other craft activities that help relax patients, provide a creative outlet, and offer some variety to those who are institutionalized

Answer 90

Many dietitians are employed as administrators and apply the principles of nutrition and food management to meal planning for hospitals, universities, schools, and other institutions. Others work directly with people who have a chronic illness (e.g., diabetes, coronary heart disease, or obesity-related disorder) - assess the dietetic needs of patients, supervise the service of meals, instruct patients in the requirements and importance of their diets, and suggest ways of maintaining adherence to diets after discharge - help plan and manage special diets, and help people control their caloric intake and the types of foods they eat

Answer 91

Work in hospitals, clinics, community mental health centres, rehabilitation centres, and long-term care facilities. Help individuals and families with the many social problems that can develop during illness and recovery. - often responsible for assessing where patients go after discharge, decisions that are enlightened by knowledge of the psychosocial needs of individual patients - help connect patients with resources such as vocational resources, homemaker help, and support groups, which may be led by a social worker - can help a patient understand his or her illness more fully and deal with emotional responses to illness, such as depression or anxiety, through therapy

Answer 92

Public health researchers are involved in research and interventions that have the broad goal of improving the health of the general population. Public health researchers typically work in academic settings, public agencies (such as regional health departments), Health Canada, family-planning clinics, and the Canadian Health Network and its constituent organizations and agencies, as well as in hospitals, clinics, and other health care agencies.

Answer 93

The rise of health psychology can be tied to several factors, including the increase in chronic or lifestyle-related illnesses, the changing perspective on the definition of health, the increasing burden of health care expenditures, the realization that psychological and social factors contribute to health and illness, the demonstrated importance of psychological interventions to improving people’s health, and the rigorous methodological contributions of expert researchers.

Answer 94

A general philosophy that maintains that health is a personal and collective achievement; the process of enabling people to increase control over and improve their health. Health promotion may occur through individual efforts, through interaction with the medical system, and through a concerted health policy effort.

Answer 95

For the individual, health promotion involves developing a program of good health habits early in life and carrying them through adulthood and old age.

Answer 96

For the medical practitioner, health promotion involves teaching people how best to achieve this healthy lifestyle and helping people at risk for particular health problems learn behaviours to offset or monitor those risks.

Answer 97

For the psychologist, health promotion involves the development of interventions to help people practise healthy behaviours and change poor ones.

Answer 98

For community and national policymakers, health promotion involves a general emphasis on good health, the availability of information to help people develop and maintain healthy lifestyles, and the availability of resources, conditions, and facilities that can help people change poor health habits.

Answer 99

The mass media can contribute to health promotion by educating people about health risks posed by certain behaviours, such as smoking or excessive alcohol consumption. Legislation can contribute to health promotion by mandating certain activities that may reduce risks, such as the use of child-restraining seats and seat belts, and banning smoking within indoor public places.

Answer 100

Different: 1. Health promotion is a positive conception of health that takes a more holistic approach, and in this respect is reflective of a biopsychosocial model of health. Disease prevention, in contrast, takes a negative view of health as being the absence of disease, and concentrates efforts on early detection and prevention that is more aligned with the biomedical model. 2. Disease prevention occurs in stages along a continuum from disease risk to development. 3. Primary prevention includes behaviours that reduce the risk of disease (e.g., healthy diet and physical activity), secondary prevention includes behaviours that help slow the progression of disease in its early stages (e.g., cancer screening and regular blood pressure checks), and tertiary prevention includes behaviours that help reduce the impact of disease once it has developed (e.g., blood tests, follow-up examinations; Association of Faculties of Medicine of Canada, n.d.). Similar: Despite these conceptual differences, in practice both health promotion and disease prevention focus on the importance of health behaviours for keeping people healthy

Answer 101

Lalonde Report in 1974 At the core of these initiatives is understanding the importance of practising health-promoting and health-maintaining behaviours and finding effective and theoretically sound approaches to changing health behaviours to maximize health across the lifespan.

Answer 102

A state of vulnerability to a particular health problem by virtue of heredity, health practices, or family environment.

Answer 103

Behaviours undertaken by people to enhance or maintain their health, such as exercise or the consumption of a healthy diet. -->These behaviours can include positive health behaviours that promote good health and prevent the onset of illness, negative health behaviours that create risk for illness, and treatment-related behaviours that optimize health and prevent further illness-related complications for those who have been diagnosed with an ongoing health condition. Poor health behaviours are important to understand and prevent not only because they are implicated in illness but also because they may easily become poor health habits.

Answer 104

A health-related behaviour that is firmly established and often performed automatically, such as buckling a seat belt or brushing one’s teeth.

Answer 105

These habits usually develop in childhood and begin to stabilize around age 11 or 12

Answer 106

Wearing a seat belt, brushing one’s teeth, and eating a healthy diet are examples of these kinds of behaviours.

Answer 107

Although a health habit may have developed initially because it was reinforced by specific positive outcomes, such as parental approval, it eventually becomes independent of the reinforcement process and is maintained by the environmental factors with which it is customarily associated. As such, it can be highly resistant to change. Consequently, it is important to establish good health behaviours and to eliminate poor ones early in life.

Answer 108

A dramatic illustration of the importance of good health habits in maintaining good health is provided by a classic study of people living in Alameda County, California, conducted by Belloc and Breslow (1972). These scientists began by defining seven important good health habits: - Sleeping seven to eight 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 They then asked nearly 7000 county residents to indicate which of these behaviours they practised. Residents were also asked how many illnesses they had had, which illnesses they had had, how much energy they had, and how disabled they had been (e.g., how many days of work they had missed) over the previous 6- to 12-month period. The researchers found that the more good health habits people practised, the fewer illnesses they had had, the better they had felt, and the less disabled they had been. A follow-up of these individuals 9 to 12 years later found that mortality rates were dramatically lower for people practising the seven health habits. Specifically, men following these practices had a mortality rate only 28 percent that of the men following zero to three of the health practices, and women following the seven health habits had a mortality rate 43 percent that of the women following zero to three of the health practices

Answer 109

Measures designed to combat risk factors for illness before an illness has a chance to develop.

Answer 110

There are two general strategies of primary prevention. 1. The first and most common strategy has been to employ behaviour-change methods to get people to alter their problematic health behaviours. The many programs that have been developed to help people lose weight are an example of this approach. 2. The second, more recent approach is to keep people from developing poor health habits in the first place. Smoking prevention programs with young adolescents are an example of this approach. Of the two types of primary prevention, it is obviously far preferable to keep people from developing problematic behaviours than to try to help them stop the behaviours once they are already in place.

Answer 111

Simultaneously, there has been an increase in what have been called the “preventable” disorders, including lung cancer, cardiovascular disease, alcohol and other drug abuse, and vehicular accidents

Answer 112

It is estimated that nearly half the deaths in Canada are caused by modifiable behaviours, with smoking, poor diet, and physical inactivity as the leading social/behavioural risk factors. Cancer deaths alone could be reduced by 50 percent simply by getting people to avoid smoking, eat more fruits and vegetables, boost their physical activity, protect themselves from the sun, tell their doctor when their health changes, handle hazardous materials carefully, and obtain early screening for breast and cervical cancer

Answer 113

Heart disease ---> High blood pressure (hypertension), high blood cholesterol, diabetes, being overweight, excessive alcohol consumption, physical inactivity, smoking, stress Cancer ----> Smoking, unhealthy diet, physical inactivity, excessive alcohol consumption, excessive exposure to UV light, environmental factors Stroke ----> High blood pressure (hypertension), high blood cholesterol, heart disease (atrial fibrillation), diabetes, being overweight, excessive alcohol consumption, physical inactivity, smoking, stress Accidental injuries ---->Not buckling up; driving while intoxicated; being unaware of surroundings; not wearing appropriate safety gear; not learning more about how to prevent falls, poisoning, fires, and motor vehicle collisions Chronic lung disease ---->Smoking and second-hand smoke, environmental factors (air pollution, aerosol sprays, toxic fumes such as chemicals, solvents, and paints), physical inactivity

Answer 114

Successful modification of health behaviours, then, will have several beneficial effects. 1. It will reduce deaths due to lifestyle-related diseases. 2. It may delay time of death, thereby increasing individual longevity and general life expectancy of the population. 3. 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. 4. Successful modification of health behaviours may begin to make a dent in the more than $219.1 billion that was spent in Canada in 2015 on health services

Answer 115

According to both the biopsychosocial model and the public health promotion model, health and health behaviours result from and are maintained by a complex set of intertwining social and individual factors. Thus, individual health behaviours are influenced by the social, cultural, and physical environments in which they occur 1. Socio-Economic Factors 2. Age 3. Gender 4. Values 5. Personal Control 6. Social Influence 7. Personal Goals 8. Perceived Symptoms 9. Access to Health Care Services 10. Place 11. Supportive Environments 12. Cognitive Factors

Answer 116

1. Socio-Economic Factors Health behaviours differ according to demographic factors. Younger, more affluent, better educated people under low levels of stress with high levels of social support typically practise better health habits than people under higher levels of stress with fewer resources, such as individuals low in social class

Answer 117

2. Age Health behaviours vary with age and the type of health behaviour. Typically, health habits are good in childhood, deteriorate in adolescence and young adulthood, improve again among retired adults under 73, but then may deteriorate among adults 73 and older.

Answer 118

3. Gender There are significant gender differences in the practice of health-related behaviours, which may vary by age or developmental stage. For example, among school-aged children, girls tend to eat more nutritious foods than boys, but girls also engage in more unhealthy dieting and meal skipping. Girls are also less likely to engage in sports activities compared to boys. There are also gender differences in the practice of health-compromising behaviours such as smoking.

Answer 119

4. Values Values heavily influence the practice of health habits. For example, exercise for women may be considered desirable in one culture but undesirable in another, with the result that exercise patterns among women will differ greatly between the two cultures

Answer 120

5. Personal Control Perceptions that one’s health is under personal control also determine health habits. For example, research on the health locus of control scale measures the degree to which people perceive themselves to be in control of their health, perceive powerful others to be in control of their health, or regard chance as the major determinant of their health. Those people who are predisposed to see health as under personal control may be more likely to practise good health habits than those who regard their health as due to chance factors.

Answer 121

6. Social Influence Social influence affects the practice of health habits. Family, friends, and workplace companions can all influence health-related behaviours—sometimes in a beneficial direction, other times in an adverse direction. For example, peer pressure often leads to smoking in adolescence but may influence people to stop smoking in adulthood. Social influence from indirect sources such as the media (television, magazines, Internet) may also influence health behaviours, for better or worse.

Answer 122

7. Personal Goals Health habits are heavily tied to personal goals. If personal fitness or athletic achievement is an important goal that does not interfere with the achievement of other goals, such as family goals, the person will be more likely to exercise on a regular basis than if fitness is not a prioritized personal goal.

Answer 123

8. Perceived Symptoms Some health habits are controlled by perceived symptoms. For example, smokers may control their smoking on the basis of sensations in their throat. A smoker who wakes up with a smoker’s cough and raspy throat may cut back in the belief that he or she is vulnerable to health problems at that time. 10. Place There is growing evidence that where someone lives can have a significant impact on the practice of health behaviours. Living in a rural area where there is less access to health care services may make it difficult to follow through with intentions to practise preventive health behaviours, such as cancer screening behaviours. There is also some evidence that suggests that those living in rural areas, such as communities in Northern Canada, have less healthy eating habits, lower leisure time physical activity, and higher rates of smoking compared to urban residents, although the reasons for these relations are unclear.

Answer 124

9. Access to Health Care Services Access to health services can also influence the practice of health behaviours. Using the tuberculosis screening programs, obtaining a regular Pap smear, obtaining mammograms, and receiving immunizations for childhood diseases are examples of behaviours that are directly tied to the health care delivery system. Other behaviours, such as losing weight and stopping smoking, may be indirectly encouraged by the health care system because many people now receive lifestyle advice from their health care providers.

Answer 125

10. Place There is growing evidence that where someone lives can have a significant impact on the practice of health behaviours. Living in a rural area where there is less access to health care services may make it difficult to follow through with intentions to practise preventive health behaviours, such as cancer screening behaviours. There is also some evidence that suggests that those living in rural areas, such as communities in Northern Canada, have less healthy eating habits, lower leisure time physical activity, and higher rates of smoking compared to urban residents, although the reasons for these relations are unclear.

Answer 126

11. Supportive Environments Increasingly, the importance of supportive environments is being recognized as playing a role in the health behaviours that people practise. For example, creating communities and cities that include green space and walking and biking pathways, and that provide availability and access to healthy and nutritious food options may help curb childhood obesity and promote health across all age groups.

Answer 127

12. Cognitive Factors Finally, the practice of health behaviours is tied to cognitive factors, such as the belief that certain health behaviours are beneficial or the sense that one may be vulnerable to an underlying illness if one does not practise a particular health behaviour. Similarly, being less health conscious and thinking less about the future can also lead to unhealthy behavioural choices.

Answer 128

young children used to get enough exercise, but recent research suggests this is no longer the case as many do not meet the recommended 60 minutes of physical activity per day, and physical activity among children has decreased in recent years

Answer 129

less physical activity is also associated with greater weight and less sleep duration in children—two important correlates of obesity

Answer 130

people often have little immediate incentive for practising good health behaviour.

Answer 131

1. Health habits develop during childhood and adolescence, when most people are healthy. Smoking, drinking, poor nutrition, and lack of exercise initially have no apparent effect on health and physical functioning. The cumulative damage that these behaviours cause may not become apparent for years, and few children and adolescents are sufficiently concerned about what their health will be like when they are 40 or 50 years old. 2. Once their bad habits are ingrained, people are not always highly motivated to change them. Unhealthy behaviours can be pleasurable, automatic, addictive, and resistant to change. Consequently, many people find it too difficult to change their health habits because their bad habits are enjoyable. 3. Health habits are only modestly related to each other. Knowing one health habit does not enable one to predict another with great confidence. The person who exercises faithfully does not necessarily wear a seat belt, and the person who controls his or her weight may continue to smoke. It can be difficult to teach people a concerted program of good health behaviour, and health behaviours must often be tackled one at a time.

Answer 132

1. Different health habits are controlled by different factors. For example, smoking may be related to stress, whereas exercise may depend on ease of access to sports facilities. 2. Different factors may control the same health behaviour for different people. Thus, one person’s overeating may be “social,” and she may eat primarily in the presence of other people. In contrast, another individual’s overeating may depend on levels of tension, and he may overeat only when under stress. 3. Factors controlling a health behaviour may change over the history of the behaviour. The initial instigating factors may no longer be significant, and new maintaining factors may develop to replace them. Although peer group pressure (social factors) is important in initiating the smoking habit, over time, smoking may be maintained because it reduces craving and feelings of stress. One’s peer group in adulthood may actually oppose smoking. 4. Factors controlling the health behaviour may change across a person’s lifetime. Regular exercise occurs in childhood because it is built into the school curriculum, but in adulthood, this automatic habit must be practised consciously. 5. Health behaviour patterns, their developmental course, and the factors that change them across a lifetime will vary substantially between individuals (Zanjani, Schaie, & Willis, 2006). Thus, one individual may have started smoking for social reasons but continue smoking to control stress; the reverse pattern may characterize the smoking of another individual.

Answer 133

The process by which people learn the norms, rules, and beliefs associated with their family and society; parents and social institutions are usually the major agents of socialization. (doesn't always work - there can be gaps_

Answer 134

As children move into adolescence, they sometimes backslide or ignore the early training they received from their parents, because they often see little apparent effect on their health or physical functioning. In addition, adolescents are vulnerable to an array of problematic health behaviours, including excessive alcohol consumption, smoking, drug use, and sexual risk taking, particularly if their parents aren’t monitoring them very closely and their peers practise these behaviours. Adolescents appear to have an incomplete appreciation of the risks they encounter through faulty habits such as smoking and drinking. Consequently, interventions with children and adolescents are high priority.

Answer 135

The idea that certain times are more effective than others for teaching particular health practices; pregnancy constitutes a teachable moment for getting women to stop smoking.

Answer 136

Many teachable moments arise in early childhood. ---> Parents have opportunities to teach their children basic safety behaviours, such as putting on a seat belt in the car or looking both ways before crossing the street, and basic health habits, such as drinking water instead of soda with dinner. Nonetheless, parents can have a limited understanding of the importance of their role in promoting healthy behaviour in their children and may fail to follow up after initially communicating about health-related rules. Other teachable moments arise because they are built into the health care delivery system. ---> For example, family physicians often make use of a newborn’s early visits to teach motivated new parents the basics of accident prevention and safety in the home. Such visits also ensure that children receive their basic immunizations. Dentists use a child’s first visit to teach both the parents and child the importance of correct brushing.

Answer 137

Certainly, very young children have cognitive limitations that keep them from fully comprehending the concept of health promotion, yet intervention programs with children clearly indicate that they can develop personal responsibility for aspects of their health. Such behaviours as choosing nutritionally sound foods, brushing teeth regularly, using car seats and seat belts, participating in exercise, crossing the street safely, and behaving appropriately in real or simulated emergencies (such as fire drills) are clearly within the comprehension of children as young as age three or four, as long as the behaviours are explained in concrete terms and the implications for actions are clear

Answer 138

Teachable moments are not confined to childhood and adolescence. Pregnancy represents a teachable moment for several health habits, especially stopping smoking and eating healthier. Adults with newly diagnosed coronary artery disease may also be especially motivated to change their health habits, such as smoking and diet, due to the anxiety their recent diagnosis has caused.

Answer 139

Identifying teachable moments—that is, the crucial point at which a person is ready to modify a health behaviour—is a high priority for primary prevention.

Answer 140

Time when people are more vulnerable to particular health problems; for example, early adolescence constitutes a window of vulnerability for beginning smoking, drug use, and alcohol abuse.

Answer 141

Junior high school appears to be a particularly important time for the development of several health-related habits. For example, food choices, snacking, and dieting all begin to crystallize around this time. There is also a window of vulnerability for smoking and drug use that occurs in junior high school when students are first exposed to these habits among their peers and older siblings

Answer 142

Research shows that precautions taken in adolescence may be better predictors of disease after age 45 than are adult health behaviours. This means that the health habits people practise as teenagers or college or university students may well determine the chronic diseases they have and what they ultimately die of in adulthood. ---> For adults who decide to make changes in their lifestyle, it may already be too late. Research to date suggests that this is true for sun exposure and skin cancer and for calcium consumption for the prevention of osteoporosis. For example, although the negative effects of sun exposure are accumulative over the lifetime, 80 percent of all lifetime sun exposure takes place before the age of 18. Thus, excessive sun exposure, sun burns, and poor sun safety behaviours in childhood heighten the risk for the development of cancers in adulthood. Consequently, despite the sense of invulnerability that many adolescents have, adolescence may actually be a highly vulnerable time for a variety of poor health behaviours that lay the groundwork for future problems in adulthood.

Answer 143

Children and adolescents are two vulnerable populations toward which health promotion efforts have been heavily directed. Another vulnerable group consists of people who are at risk for particular health problems. ---> For example, a family physician may work with obese parents to control the diet of their offspring in the hopes that obesity in the children can be avoided. If the dietary changes produce the additional consequence of reducing the parents’ weight, so much the better. Daughters of women who have had breast cancer are a vulnerable population who need to obtain regular mammograms and monitor themselves for any changes in the breast tissue. As the genetic basis for other disorders is becoming clearer, health promotion efforts with at-risk populations are likely to assume increasing importance.

Answer 144

1. Early identification of these people may prevent or eliminate poor health habits that can exacerbate vulnerability. For example, helping men at risk for heart disease avoid smoking or getting them to stop at a young age may prevent a debilitating chronic illness. Even if no intervention is available to reduce risk, knowledge of risk can provide people with information they need to monitor their situation. Women at risk for breast cancer are an example of such a group. 2. Working with at-risk populations represents an efficient and effective use of health promotion dollars. When a risk factor has implications for only some people, there is little reason to implement a general health intervention for everyone. Instead, it makes sense to target those people for whom the risk factor is relevant. 3. Focusing on at-risk populations makes it easier to identify other risk factors that may interact with the targeted factor in producing an undesirable outcome. For example, not everyone who has a family history of hypertension will develop hypertension, but by focusing on those people who are at risk, other factors that contribute to its development may be identified.

Answer 145

1. People do not always perceive their risk correctly. Generally speaking, most people are unrealistically optimistic about their vulnerability to health risks. 2. Sometimes, testing positive for a risk factor leads people into needlessly hypervigilant and restrictive behaviour. For example, women at genetic risk for breast cancer appear to be more physiologically reactive to stressful events, raising the possibility that the chronic stress associated with this familial cancer risk may actually have consequences of its own through changes in psychobiological reactivity. 3. People may also become defensive and minimize the significance of their risk factor and avoid using appropriate services or monitoring their condition. Providing people with feedback about their potential genetic susceptibility to a disorder such as lung cancer can have immediate and strong effects on relevant behaviours—in this case, a reduction in smoking.

Answer 146

1. Among people at risk for a particular disorder, only a certain percentage will develop the problem and, in many cases, only many years later. For example, should daughters of breast cancer patients be alerted to their risk and alarmed even if their risk is low? Given that high levels of cancer-related worry do not match actual genetic contribution to risk, unnecessarily creating distress may not justify instilling risk-reducing behaviours. 2. Some people, such as those predisposed to depression, may react especially badly to the prospect or results of genetic testing for health disorders. These effects may occur primarily just after testing positive for a risk factor and may not be long term. In many cases, there is no successful intervention for genetically based risk factors, and in other cases, an intervention may not work. For example, identifying boys at risk for coronary artery disease and teaching them how to manage stress effectively may be ineffective in changing their risk status. 3. For other disorders, we may not know what an effective intervention will be. For example, alcoholism is now believed to have a genetic component, particularly among men, and yet exactly how and when we should intervene with the offspring of adult alcoholics is not yet clear. 4. Emphasizing risks that are inherited can raise complicated issues of family dynamics, potentially pitting parents and children against each other and raising issues of who is to blame for the risk. Daughters of breast cancer patients may suffer considerable stress and behaviour problems, due in part to the enhanced recognition of their risk. Matters can be even more complicated when considering that dying family members with cancer who have not received genetic testing literally take their DNA cancer clues with them to the grave. One study of dying cancer patients found that although 23 percent qualified for genetic testing, none had received testing that could have helped identify whether their cancer was hereditary. Intervening with at-risk populations is still a controversial issue.

Answer 147

1. Exercise is one of the most important health behaviours because exercise helps keep people mobile and able to care for themselves. - --> Even just keeping active also has health benefits. Participating in social activities, running errands, and engaging in other normal activities that probably have little effect on overall fitness nonetheless reduce the risk of mortality, perhaps by providing social support or a general sense of self-efficacy. Among the very old, exercise has particularly beneficial long-term benefits, substantially increasing the likelihood that the elderly can maintain the basic activities of daily living, and even reversing age-related cognitive deficits. There is also evidence that exercise may be beneficial not just for healthy older adults, but also for the frail elderly. For example, researchers from the University of Quebec at Montreal found that after a 12-week exercise program, both healthy and frail seniors reported significant improvements in their functional capabilities, strength, cognitive functioning, and overall quality of life. 2. Controlling alcohol consumption is an important target for good health among the elderly as well. Some elderly people develop drinking problems in response to age-related issues, such as retirement or loneliness. Others may try to maintain the drinking habits they had throughout their lives, which become more risky in old age. For example, metabolic changes related to age may reduce the capacity for alcohol. Moreover, many older people are on medications that may interact dangerously with alcohol. Alcohol consumption increases the risk of gastrointestinal disorders and accidents, which, in conjunction with osteoporosis, can produce broken bones, which limit mobility, creating further health problems. The elderly are at risk for depression, which also compromises health habits leading to accelerated physical decline. Thus, addressing depression, commonly thought of as a mental health problem, can have effects on physical health as well. 3. Vaccinations against influenza are important for several reasons. First, influenza (flu) is a major cause of death among the elderly. Moreover, it increases the risk of heart disease and stroke because it exacerbates other underlying disorders that an elderly person may have. Finding ways to ensure that elderly people get their flu vaccinations each fall, then, is an important health priority. 4. The emphasis on health habits among the elderly is well placed. By age 80, health habits are the major determinant of whether an individual will have a vigorous or an infirmed old age. Moreover, current evidence suggests that health habit changes are working. Reports indicate that most Canadian seniors rate their health as excellent, very good, or good.

Answer 148

1. Alcohol consumption is a substantially greater problem among men than women, and smoking is a somewhat greater problem for non-minority men than for other groups. Smoking rates among Aboriginal youth are about triple the rate for Canadians in general. Aboriginal people are also less likely to exercise regularly than non-Aboriginals, and are therefore more likely to be overweight. In fact, the rate of diabetes among Canada’s Aboriginal peoples is considered an epidemic, being three times the national rate. 2. Research suggests that South Asians and Chinese may have more dangerous abdominal fat than Europeans with the same total amount of body fat, thus putting them at greater risk for cardiovascular disease, hypertension, diabetes, and other related health complications. As these findings indicate, the current guidelines for assessing healthy weights may need to change to account for ethnic differences. 3. Health promotion programs for ethnic groups also need to take account of co-occurring risk factors. The combined effects of low socio-economic status and a biologic predisposition to particular illnesses put certain groups at substantially greater risk. An example is diabetes among Aboriginal people.

Answer 149

Educational appeals make the assumption that people will change their health habits if they have correct information.

Answer 150

Efforts to change attitudes by arousing fear to induce the motivation to change behaviour; fear appeals are used to try to get people to change poor health habits.

Answer 151

Research has provided us with the following suggestions of the best ways to persuade people through educational appeals: 1. Communications should be colourful and vivid rather than steeped in statistics and jargon. For example, a vivid account of the health benefits of regular exercise, coupled with a case history of someone who took up bicycling after a heart attack, may be persuasive to someone at risk for heart disease. 2. The communicator should be expert, prestigious, trustworthy, likable, and similar to the audience. Similarity may be especially important when the appeal is directed toward a particular cultural group and for people whose identity is strongly tied to their cultural group identity. For example, a health message targeting eating habits among First Nations peoples will be more persuasive if it comes from a respected, credible Aboriginal public figure rather than from a non-Aboriginal expert. 3. Strong arguments should be presented at the beginning and end of a message, not buried in the middle. 4. Messages should be short, clear, and direct. 5. Messages should state conclusions explicitly. For example, a communication extolling the virtues of a low-cholesterol diet should explicitly conclude that the reader should alter his or her diet to lower cholesterol. 6. Extreme messages produce more attitude change, but only up to a point. Very extreme messages are discounted. For example, a message that urges people to exercise for at least half an hour three days a week will be more effective than one that recommends several hours of exercise a day. 7. For illness detection behaviours (such as HIV testing or obtaining a mammogram), emphasizing the problems that may occur if it is not undertaken (i.e., loss-framed messages) will be most effective. For health promotion behaviours (such as sunscreen use), emphasizing the benefits to be gained may be more effective. 8. If the audience is receptive to changing a health habit, then the communication should include only favourable points, but if the audience is not inclined to accept the message, the communication should discuss both sides of the issue. For example, messages to smokers ready to stop should emphasize the health risks of smoking. Smokers who have not yet decided to stop may be more persuaded by a communication that points out its risk while acknowledging and rebutting its pleasurable effects. 9. Providing information does not ensure that people will perceive that information accurately. Sometimes when people receive negative information about risks to their health, they process that information defensively. Instead of making appropriate health behaviour changes, the person may come to view the problem as less serious or more common than he or she had previously believed, particularly if he or she intends to continue the behaviour. Smokers, for example, know that they are at a greater risk for lung cancer than are non-smokers, but they see lung cancer as less likely or problematic and smoking as more common than do non-smokers.

Answer 152

Common sense suggests that the relationship between fear and behaviour change should be direct: the more fearful an individual is, the more likely he or she will be to change the relevant behaviour. However, persuasive messages that elicit too much fear may actually undermine health behaviour change. Moreover, research suggests that fear alone may not be sufficient to change behaviour. Strong fear appeals coupled with recommendations for action or information about the efficacy of the health behaviour may be needed to produce the greatest behaviour changes.

Answer 153

The theory that different presentations of risk information will change people’s perspectives and actions.

Answer 154

Messages that emphasize potential problems (loss-framed) should work better for behaviours that have uncertain outcomes (high risk), whereas messages that stress benefits (gain-framed) may be more persuasive for behaviours with certain outcomes (low risk). ---> For example, messages focusing on the relationship threat (high risk) associated with not using condoms were rated as more convincing by university students when they were loss-framed versus gain-framed, whereas messages that focused on disease prevention (low risk) were seen as more convincing when they were gain-framed rather than loss-framed. Similarly, messages for increasing exercise behaviour may be more effective when framed from a promotion self-regulatory perspective than from a prevention perspective.

Answer 155

The effectiveness of the type of message framing may also depend on how congruent the message is with the individual’s own motivation. People who are approach-oriented or who seek to maximize rewards are more influenced by messages that are gain-framed (e.g., “great breath and healthy gums are only a floss away”), whereas people who are avoidance-oriented or who seek to minimize losses are influenced by messages that are loss-framed (e.g., “floss now and avoid bad breath and gum disease”). One reason for the effectiveness of congruency-framed messages is that they increase feelings of self-efficacy for engaging in the behaviour. However, the effectiveness of the health message framing may also depend on matching the message to the current emotional state of the message recipient.

Answer 156

Models that propose that the beliefs people hold about a particular health behaviour motivate their decision to change that behaviour. ---> These models are based on the core assumptions of the expectancy-value theory

Answer 157

The theory that suggests that people will choose to engage in behaviours that they expect to succeed in and that have outcomes that they value. ---> For example, people are more likely to engage in behaviours such as disposing old medications and keeping walkways free of tripping hazards if they believe that household safety is important and that these behaviours will help make their home a safer place. Accordingly, outcome expectancies figure prominently in these models.

Answer 158

The belief that one is able to control one’s practice of a particular behaviour.

Answer 159

Self-efficacy is a core concept in Bandura’s social cognitive theory, which states that behaviour results from efficacy expectancies (the confidence that one can successfully engage in a behaviour to produce desired outcomes) and outcome expectancies (the belief that a given behaviour will result in a particular outcome). Outcome expectancies can motivate behaviour change by linking behaviours to outcomes and are, therefore, most important for the development of intentions to engage in behaviours. Efficacy expectancies play a critical role once intentions are formed by providing motivation to initiate and maintain behaviour change. ----> For example, smokers who believe that using the patch will help them quit and believe that they will be able to break their habit are more likely to try to quit.

Answer 160

Self-efficacy can be a powerful determinant of behaviour by promoting persistence in the face of difficulties as well as a strong conviction to follow through with behaviour. Self-efficacy affects health behaviours as varied as quitting smoking, weight control, condom use, exercise, dietary change, and health behaviours among older adults. Typically, research finds a strong relationship between perceptions of self-efficacy and both initial health behaviour change and long-term maintenance of that behaviour change.

Answer 161

A social cognitive model A theory of health behaviours; the model predicts that whether a person practises a particular health habit can be understood by knowing the degree to which the person perceives a personal health threat and the perception that a particular health practice will be effective in reducing that threat.

Answer 162

States that whether a person practises a particular health behaviour can be understood by knowing 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. Later the health belief model was updated to include two new factors—cues to action and self-efficacy—to help address the challenges of changing unhealthy behaviours such as smoking and unhealthy eating

Answer 163

The perception of a personal health threat is influenced by at least three factors: general health values, which include interest and concern about health; perceived susceptibility, which refers to specific beliefs about personal vulnerability to a particular disorder; and perceived severity, which involves 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 threat of heart disease is severe.

Answer 164

Whether a person believes a health measure will reduce a threat has two subcomponents—perceived efficacy (i.e., whether the individual thinks a health practice will be effective) and perceived barriers (i.e., whether the cost of undertaking that measure exceeds the benefits of the measure; Rosenstock, 1974). For example, the man who feels vulnerable to a heart attack and is considering changing his diet may believe that dietary change alone would not reduce the risk of a heart attack and that changing his diet would interfere with his enjoyment of life too much to justify taking the action. Thus, although his belief in his personal vulnerability to heart disease may be great, if he lacks faith that a change of diet would reduce his risk, he would probably not make any changes.

Answer 165

The health belief model also posits that the perception of the health threat and the perceived threat reduction account for an individual’s readiness to act. The cues to action then are people, events, or things that activate this readiness and stimulate behaviour. For example, an internal cue to quitting smoking might be coughing after engaging in mild physical activity, whereas external cues might be reading the health warning label on a cigarette package or learning that a relative has been diagnosed with lung cancer.

Answer 166

As we previously discussed, self-efficacy is a powerful determinant of health behaviour change and maintenance. It is also an important factor for understanding why some individuals may not perform a health behaviour that they feel will effectively reduce a health threat. For example, not having confidence that you can successfully quit smoking may interfere with successful attempts, even when other cues to action may activate your readiness to change your smoking behaviour. A diagram of the health belief model applied to smoking is presented in

Answer 167

The health belief model explains people’s practice of health habits quite well. For example, it predicts preventive dental care, breast self-examination, AIDS risk-related behaviours, sexual risk-taking behaviours among college and university students, and drinking and smoking intentions among adolescents. Typically, health beliefs are a modest determinant of intentions to take these health measures.

Answer 168

Interventions that draw on the health belief model have generally supported its predictions. Highlighting perceived vulnerability and simultaneously increasing the perception that a particular health behaviour will reduce the threat are somewhat successful in changing behaviour, whether the behaviour is smoking, preventive dental behaviour or osteoporosis prevention measures, for example. However, the health belief model focuses mainly on beliefs regarding risk rather than the emotional responses to perceived risk, which are known to predict behaviour. In addition, the health belief model leaves out an important component of health behaviour change: the perception that one will be able to engage in the health behaviour. Although the health belief model continues to be used as s means for understanding and effecting health behaviour change, several other social cognitive models have gained popularity among researchers.

Answer 169

Derived from the theory of reasoned action, this theoretical viewpoint maintains that a person’s behavioural intentions and behaviours can be understood by knowing the person’s attitudes about the behaviour, subjective norms regarding the behaviour, and perceived behavioural control over that action. ---> Attitudes toward the action are based on beliefs about the likely outcomes of the action and evaluations of those outcomes. Subjective norms are what a person believes others think that person should do (normative beliefs) and the motivation to comply with those normative references. Perceived behavioural control is when an individual needs to feel that he or she is capable of performing the action contemplated and that the action undertaken will have the intended effect; this component of the model is very similar to self-efficacy. These factors combine to produce a behavioural intention and, ultimately, behaviour change.

Answer 170

Image on desktop

Answer 171

Image on desktop

Answer 172

The theory of planned behaviour is a useful addition to understanding health behaviour-change processes for two reasons. 1. it provides a model that links beliefs directly to behaviour. 2. it provides a fine-grained picture of people’s intentions with respect to a particular health habit. This theory is not without its critics. Some researchers have called into question the validity of the theory as there are few experimental tests of its predictions, as well as its utility, suggesting that the field of health behaviour change has evolved past the theory of planned behaviour and that it should now be retired. Despite these criticisms, the theory of planned behaviour continues to be a standard model for understanding and changing health behaviour.

Answer 173

The theory of planned behaviour predicts a broad array of health behaviours, including condom use among injection drug users, sunbathing and sunscreen use, use of oral contraceptives, consumption of soft drinks by adolescents, mammography participation, exercise, participation in cancer screening programs, chlamydia screening, smoking, healthy eating, medication adherence for people with tuberculosis or HIV/AIDS, follow-up appointments for abnormal cervical screening results, and intentions to perform health protective behaviours, including getting enough sleep and taking vitamins.

Answer 174

Specific behavioural intentions that highlight the how, when, and where of a behaviour, and also include “if-then” contingency plans to deal with anticipated barriers to the behaviour. ---> For example, instead of the general intention of “I will exercise more,” an implementation intention would be “I will go jogging in my neighbourhood on Monday, Wednesday, and Friday evenings this week from 4 to 5 p.m.” It might also include an if-then plan to deal with social invitations that might derail exercise intentions, such as “If my friend asks me to go out, I will reschedule to a night that I am not exercising.”

Answer 175

This more specific type of intention provides a clear plan of how the intention can be carried out even in less-than-ideal circumstances, and accordingly has a stronger influence on behaviour than more general intentions for behaviour. ---> For example, making more specific intentions is a better predictor of increasing physical activity than simply making a greater number of intentions. Implementation intentions have been found to be an effective way to shield ongoing dieting and exercise goals from interfering states, such as cravings and disruptive thoughts, and are effective for promoting physical activity. When used as an intervention strategy, implementation intentions are an effective way to increase fruit consumption, especially when paired with mental imagery. Moreover, implementation intentions can be especially effective for those with strong unhealthy snacking habits when the implementation intentions are framed in a manner that is congruent with personal approach or avoidance tendencies.

Answer 176

1. Despite the success of theories that link beliefs to behaviour and modification of health habits, attitudinal and social cognitive approaches are not very successful for explaining spontaneous behaviour change, nor do they predict long-term behaviour change very well. An additional complication is that communications designed to change people’s attitudes about their health behaviours sometimes evoke defensive or irrational processes: People may perceive a health threat to be less relevant than it really is, they may falsely see themselves as less vulnerable than others, and they may see themselves as dissimilar to those who have succumbed to a particular health risk. 2. Moreover, thinking about disease can produce a negative mood, which may, in turn, lead people to ignore or defensively interpret their risk. Although some studies have found that inaccurate risk perception can be modified by information and educational interventions, other reports suggest that simple interventions such as self-affirmation—reflecting on personal values—can be effective for reducing defensive responses to health risk information and increasing intentions to engage in health protective behaviours, especially when health messages are ambiguous. 3. Social cognitive models view health behaviour change as largely a rational process and can therefore neglect to consider other important factors such as the role of affective variables. One study found that feeling positive about physical activity was a better predictor of the actual physical activity engaged in than attitudes, perceived control, and other beliefs about staying active. Moreover, affective responses explained the link between attitudes and behaviour, suggesting that affective associations may be an important consideration when understanding health behaviour change. Other research has noted that positive affect may act as a self-regulation resource to reduce or balance negative mood which can disrupt the practice of health behaviours. Nonetheless, a meta-analysis of the limited evidence to date found little support for the effects of inducing positive mood on health behaviours and cognitions, suggesting that more research in this area is needed. 5. Because health habits are often deeply ingrained and difficult to modify, attitude change procedures may not go far enough in simply providing the informational base for altering health habits. The attitude change procedures may instill the motivation to change a health habit but not provide the preliminary steps or skills necessary to actually alter behaviour and maintain behaviour change. Consequently, health psychologists have also turned to identifying when such interventions might be most effective.

Answer 177

An analysis of the health behaviour change process that draws on the stages and processes people go through in order to bring about successful long-term behaviour change. The stages include precontemplation, contemplation, preparation, action, and maintenance. Successful attitude or behaviour change at each stage depends on the appropriateness of intervention. This model accounts for and analyzes the stages of change that people go through as they attempt to change a health behaviour, and suggests treatment goals and interventions for each stage. Originally developed to treat addictive disorders, such as smoking, drug use, and alcohol addiction, the transtheoretical model of behaviour change (or stages of change model, as it is often referred to) has also been applied to other health habits, such as diet change and exercising

Answer 178

1. Precontemplation The precontemplation stage occurs when a person has no intention of changing his or her behaviour. Many individuals in this stage are not even aware that they have a problem, although families, friends, neighbours, or co-workers may well be. An example is the problem drinker who is largely oblivious to the problems he or she creates for his or her family. Sometimes people in the precontemplation phase seek treatment, but typically they do so only if they have been pressured by others and feel themselves coerced into changing their behaviour. 2. Contemplation Contemplation is the stage in which people are aware that a problem exists and are thinking about it but have not yet made a commitment to take action. Many individuals remain in the contemplation stage for years, such as the smoker who knows he or she should stop but has not yet made the commitment to do so. Individuals in the contemplation stage are typically still weighing the pros and cons of changing their behaviour, continuing to find the positive aspects of the behaviour enjoyable. Those who do decide to change their behaviour have typically formed favourable expectations about their ability to do so and the rewards that will result. 3. Preparation In the preparation stage, individuals intend to change their behaviour but may not yet have begun to do so. In some cases, it is because they have been unsuccessful in the past, or they may simply be delaying action until they can get through a certain event or stressful period of time. In some cases, individuals in the preparation stage have already 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 The action stage is the one in which individuals 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 so as to rid one’s life of cues associated with the behaviour. 5. Maintenance Maintenance is the stage in which people work to prevent relapse and to consolidate the gains they have made. Typically, if a person is able to remain free of the addictive behaviour for more than six months, he or she is assumed to be in the maintenance stage. ---> As discussed previously, self-efficacy is important to consider when people are trying to make behaviour changes. This is also the case when understanding health behaviours from the lens of the transtheoretical model. For example, self-efficacy can help individuals deal with the temptations they encounter while making a health behaviour change, and therefore help prevent relapse.

Answer 179

The stage model of health behaviour change is potentially important for several reasons. 1. It captures the processes that people actually go through while they are attempting to change their behaviour 2. It illustrates that successful change may not occur on the first try or all at once 3. It also explicates why many people are unsuccessful in changing their behaviour. Specifically, people who are in the precontemplation stage or the contemplation stage are not ready to be thrust into action. ---> For example, a study of smokers revealed that 10 to 15 percent were prepared for action, 30 to 40 percent were in the contemplation stage, and 50 to 60 percent were in the precontemplation stage. These statistics help explain why so many interventions show dismal rates of success. When success rates are recalculated to include only individuals who are ready to change their behaviour—namely, those people in the action or preparation stage—most of these programs look more successful.

Answer 180

Applications of the stages of change model of health behaviour have shown mixed success. The model has been used with many different health behaviours, including smoking cessation, quitting cocaine use, weight control, modification of a high-fat diet, adolescent delinquent behaviour, practice of safe sex, condom use, sunscreen use, control of radon gas exposure, exercise acquisition, and regular mammograms.

Answer 181

The use of principles from learning theory to modify the cognitions and behaviours associated with a behaviour to be modified; cognitive-behavioural approaches are used to modify poor health habits, such as smoking, poor diet, and alcoholism.

Answer 182

Cognitive-behaviour therapy (CBT) approaches to health habit modification change the focus to the target behaviour itself—the conditions that elicit and maintain it and the factors that reinforce it. Cognitive-behaviour therapy also focuses heavily on the beliefs that people hold about their health habits and, therefore, it may be an effective way to support health behaviour change, especially when used in the context of social cognitive models that highlight the role of beliefs about health behaviours. ---> For example, a person who wishes to give up smoking may derail the quitting process by generating self-doubts (“I will never be able to give up smoking”; “I’m one of those people who simply depend on cigarettes”; “I’ve tried before, and I’ve never been successful”). Unless these internal monologues are modified, cognitive-behavioural therapists argue, the person will be unlikely to change a health habit and maintain that change over time. Recognition that people’s cognitions about their health habits are important in producing behaviour change has led to another insight: the importance of involving the patient as a co-therapist in the behaviour-change intervention. Most behaviour-change programs begin with the client as the object of behaviour-change efforts, but in the therapeutic process, control over behaviour change shifts gradually from the therapist to the client. By the end of the formal intervention stage, clients are monitoring their own behaviours, applying the techniques of cognitive-behavioural interventions to their behaviour, and rewarding themselves, or not, appropriately. Cognitive-behavioural interventions draw on a variety of behaviour-change techniques, including some of the following strategies.

Answer 183

Assessing the frequency, antecedents, and consequences of a target behaviour to be modified.

Answer 184

Assessing the frequency, antecedents, and consequences of a target behaviour to be modified.

Answer 185

Many programs of cognitive-behavioural modification use self-observation and self-monitoring as the first steps toward behaviour change. The rationale is that a person must understand the dimensions of a target behaviour before change can be initiated. Self-observation and self-monitoring assess the frequency of a target behaviour and the antecedents and consequences of that behaviour (Lootens & Nelson-Gray, 2010). This process also sets the stage for enlisting the patient’s joint participation early in the effort to modify health behaviours.

Answer 186

1. The first step in self-observation is to learn to discriminate the target behaviour. Although for some behaviours (such as smoking) this step is easy, for others (such as the urge to smoke) discrimination may be more difficult. 2. A second stage in self-observation is recording and charting the behaviour. Techniques range from very simple counters for recording the behaviour each time it occurs, to complex records documenting the circumstances under which the behaviour was enacted as well as the feelings it aroused. - --> For example, a smoker may be trained to keep a detailed behavioural record of all smoking events, such as each time he or she smokes a cigarette, the time of day, the situation in which the smoking occurred, and whether anyone else was present. The person may also record the subjective feelings of craving that were present when lighting the cigarette. In this way, the smoker can begin to get a sense of the circumstances in which he or she is most likely to smoke and can then initiate a structured behaviour-change program that deals with these contingencies.

Answer 187

Although self-observation is usually only a beginning step in behaviour change, it may itself produce behaviour change. Despite the fact that self-monitoring is important for the effective self-regulation of health behaviours more generally, often people are resistant to tracking their health behaviours because the desire to self-protect or self-enhance when behaviour change is slow can conflict with the desire to reach one’s health behaviour goal. This tendency, referred to as the “ostrich problem,” can interfere with successful health behaviour change

Answer 188

The pairing of a stimulus with an unconditioned reflex, such that over time the new stimulus acquires a conditioned response, evoking the same behaviour; the process by which an automatic response is conditioned to a new stimulus.

Answer 189

First described by Russian physiologist Ivan Pavlov in the early twentieth century, classical conditioning was one of the earliest principles of behaviour change identified by researchers. The essence of classical conditioning is the pairing of an unconditioned reflex with a new stimulus, producing a conditioned reflex.

Answer 190

Classical conditioning was one of the first methods used for health behaviour change. For example, consider its use in the treatment of alcoholism. Antabuse (unconditioned stimulus) is a drug that produces extreme nausea, gagging, and vomiting (unconditioned response) when it is taken in conjunction with alcohol. Over time, the alcohol will become associated with the nausea and vomiting caused by the Antabuse and elicit the same nausea, gagging, and vomiting response (conditioned response). Classical conditioning approaches to health-habit modification do work, but clients know why they work. Alcoholics, for example, know that if they do not take the drug, they will not vomit when they consume alcohol. Thus, even if classical conditioning has successfully produced a conditioned response, it is heavily dependent on the client’s willing participation. Procedures like these produce health risks as well, and as a result, they are no longer as widely used.

Answer 191

The pairing of a voluntary, non-automatic behaviour to a new stimulus through reinforcement or punishment.

Answer 192

The key to operant conditioning is reinforcement. When an individual performs a behaviour and that behaviour is followed by positive reinforcement, the behaviour is more likely to occur again. Similarly, if an individual performs a behaviour and reinforcement is withdrawn or the behaviour is punished, the behaviour is less likely to be repeated. Over time, these contingencies build up those behaviours paired with positive reinforcement, and behaviours that are punished or not rewarded decline. Many health habits can be thought of as operant responses. For example, drinking may be maintained because mood is improved by alcohol, or smoking may occur because peer companionship is associated with it. In both of these cases, reinforcement maintains the poor health behaviour. Thus, using this principle to change behaviour requires altering the reinforcement or its schedule.

Answer 193

Operant conditioning is often used to modify health behaviours. At the beginning of an effort to change a faulty health habit, people typically will be positively reinforced for any action that moves them closer to their goal. As progress is made toward reducing or modifying the health habit, greater behaviour change may be required for the same reinforcement. ---> For example, suppose Mary smokes 20 cigarettes a day. She might first define a set of reinforcers that can be administered when particular smoking-reduction targets are met—reinforcements such as going out to dinner or seeing a movie. Mary may then set a particular reduction in her smoking behaviour as a target (such as 15 cigarettes a day). When that target is reached, she would administer a reinforcement (the movie or dinner out). The next step might be reducing smoking to ten cigarettes a day, at which time she would receive another reinforcement. The target then might be cut progressively to five, four, three, one, and none. Through this process, the target behaviour of abstinence would eventually be reached.

Answer 194

Learning gained from observing another person performing a behaviour. ---> Observation and subsequent modelling can be effective approaches to changing health habits. For example, high school students who observed others donating blood were more likely to do so themselves. However, modelling can also occur by observing someone in a video successfully engaging in health behaviour.

Answer 195

Modelling can be an important long-term behaviour-change technique. For example, the principle of modelling is implicit in some self-help programs that treat destructive health habits, such as alcoholism (e.g., Alcoholics Anonymous) or drug addiction. In these programs, a person who is newly committed to changing an addictive behaviour joins individuals who have had the same problem and who have had at least some success in solving it. In meetings, people often share the methods that helped them overcome their health problem. By listening to these accounts, the new convert can learn how to do likewise and model effective techniques in his or her own rehabilitation.

Answer 196

Modelling can also be used as a technique for reducing the anxiety that can give rise to some bad habits or the fears that arise when going through some preventive health behaviours, such as receiving inoculations. When modelling is used to reduce fear or anxiety, it is better to observe models who are also fearful but are able to control their distress rather than models who are demonstrating no fear in the situation because fearful models provide a realistic portrayal of the experience. Modelling, or imitative learning, has an important role in the modification of health habits because it exposes an individual to other people who have successfully modified the health habit.

Answer 197

Modelling may be most successful when it shows the realistic difficulties that people encounter in making these changes.

Answer 198

Individuals who practise poor health habits, such as smoking, drinking, and overeating, develop ties between those behaviours and stimuli in their environments. Each of these stimuli can come to act as a discriminative stimulus that is capable of eliciting the target behaviour. ---> For example, the sight and smell of food act as discriminative stimuli for eating. The discriminative stimulus is important because it signals that a positive reinforcement will subsequently occur. Stimulus-control interventions with patients who are attempting to alter their health habits take two approaches: 1. ridding the environment of discriminative stimuli that evoke the problem behaviour 2. creating new discriminative stimuli signalling that a new response will be reinforced. - --> For example, to reduce overeating, a person could remove rewarding but unhealthy foods from his or her home, not eat while engaged in other activities (such as watching television), and introduce other reinforcers such as reminders of the rewards that will come from not overeating.

Answer 199

An environmental stimulus that is capable of eliciting a particular behaviour; for example, the sight of food may act as a discriminative stimulus for eating.

Answer 200

Interventions designed to modify behaviour that involve the removal of discriminative stimuli that evoke a behaviour targeted for change and the substitution of new discriminative stimuli that will evoke a desired behaviour.

Answer 201

A state in which an individual desiring to change behaviour learns how to modify the antecedents and the consequences of that target behaviour.

Answer 202

Systematically rewarding or punishing oneself to increase or decrease the occurrence of a target behaviour.

Answer 203

Positive self-reward involves reinforcing oneself with something desirable after successful modification of a target behaviour. An example of positive self-reward is allowing oneself to go to a movie following successful weight loss.

Answer 204

Negative self-reward involves removing an aversive factor in the environment after successful modification of the target behaviour. An example of negative self-reward is taking the picture of The Biggest Loser star from the beginning of the season off the refrigerator once regular controlled eating has been achieved. When used in the context of other lifestyle interventions, self-reinforcement can be effective for helping overweight youth achieve better weight-related outcomes

Answer 205

1. Positive self-punishment involves the administration of an unpleasant stimulus to punish an undesirable behaviour, such as a smoker making himself do 20 push-ups every time he smokes. 2. Negative self-punishment consists of withdrawing a positive reinforcer in the environment each time an undesirable behaviour is performed, such as a smoker reducing the time he plays video games every time he smokes.

Answer 206

Studies that have evaluated the success of self-punishment suggest two conclusions: (1) positive self-punishment works somewhat better than negative self-punishment, and (2) self-punishment works better if it is also coupled with self-rewarding techniques.

Answer 207

A procedure in which an individual forms a contract with another person, such as a therapist, detailing what rewards or punishments are contingent on the performance or non-performance of a target behaviour.

Answer 208

Self-punishment is effective only if people actually perform the punishing activities. When self-punishment becomes too aversive, people often abandon their efforts. However, one form of self-punishment that works well and has been used widely in behaviour modification is contingency contracting. In contingency contracting, an individual forms a contract with another person, such as a therapist, detailing what rewards or punishments are contingent on the performance or non-performance of a behaviour. ---> For example, a person who wanted to stop drinking might deposit a sum of money with a therapist and arrange to be fined each time he or she had a drink and to be rewarded each day that he or she abstained.

Answer 209

The manipulation and alteration of private events, such as thoughts, through principles of reinforcement and self-instruction. ---> Sometimes the modified cognitions are antecedents to a target behaviour. For example, if a smoker’s urge to smoke is preceded by an internal monologue that she is weak and unable to control her smoking urges, these beliefs are targeted for change. The smoker would be trained to develop antecedent cognitions that would help her stop smoking (e.g., “I can do this” or “I’ll be so much healthier”).

Answer 210

A method of modifying internal monologues in stress-producing situations; clients are trained to monitor what they say to themselves in stress-provoking situations and then to modify their cognitions in adaptive ways. ---> In a typical intervention, clients are first trained to monitor their monologues in stress-producing situations so that they learn to recognize what they say to themselves during times of stress. They are then taught to modify their self-instructions to include more constructive cognitions.

Answer 211

Internal monologues; people tell themselves things that may undermine or help them implement appropriate health habits, such as I can stop smoking (positive self-talk) I’ll never be able to do this (negative self-talk).

Answer 212

The client then attempts to deal with his stressful situation while the therapist teaches him positive self-instruction. In the next phase of training, the client attempts to cope with the stress-producing situation, instructing himself out loud. Following this phase, self-instruction may become a whisper, and finally the client performs the anxiety-reducing self-instruction internally.

Answer 213

Psychologists have realized that some poor health habits develop in response to or are maintained by the anxiety that people experience in social situations. ---> For example, adolescents often begin to smoke in order to reduce their social anxiety by communicating a cool, sophisticated image. Social anxiety then can act as a cue for the maladaptive habit, necessitating an alternative way of coping with the anxiety.

Answer 214

The goals of social skills programs as an ancillary technique in a program of health behaviour change are (1) to reduce anxiety that occurs in social situations (2) to introduce new skills for dealing with situations that previously aroused anxiety (3) to provide an alternative behaviour for the poor health habit that arose in response to social anxiety.

Answer 215

Social Skills Training: A number of programs designed to alter health habits include either social skills training or assertiveness training, or both, as part of the intervention package. Assertiveness Training: Techniques that train people how to be appropriately assertive in social situations; often included as part of health behaviour modification programs, on the assumption that some poor health habits, such as excessive alcohol consumption or smoking, develop in part to control difficulties in being appropriately assertive.

Answer 216

Motivational interviewing is increasingly used in the battle for health promotion. Originally developed to treat addiction, the techniques have been adapted to target smoking, dietary improvements, exercise, cancer screening, and alcohol behaviour, among other habits.

Answer 217

Motivational interviewing is an amalgam of principles and techniques drawn from psychotherapy and behaviour-change theory that draws on many of the principles just discussed. It is a client-centred counselling style designed to get people to work through whatever ambivalence they may be experiencing about changing their health behaviours. It appears to be especially effective for those who are initially wary about whether to change their behaviours.

Answer 218

In motivational interviewing, there is no effort to dismantle the denial often associated with the practice of bad health behaviours or to confront irrational beliefs or even to persuade a client to stop drinking, stop smoking, or otherwise improve health. Instead, the goal is to get the client to think through and express some of his or her own reasons for and against change and for the interviewer to listen and provide encouragement rather than give advice.

Answer 219

Procedures that help people relax; include progressive muscle relaxation and deep breathing; may also include guided imagery and forms of meditation or hypnosis.

Answer 220

In 1958, psychologist Joseph Wolpe (1958) developed a procedure known as systematic desensitization for the treatment of anxiety. The procedure involved training clients to substitute relaxation in the presence of circumstances that usually produced anxiety. To induce relaxation, Wolpe taught patients how to engage in deep breathing and progressive muscle relaxation ( relaxation training).

Answer 221

In deep breathing, a person takes deep, controlled breaths, which produce a number of physiological changes, such as decreased heart rate and blood pressure and increased oxygenation of the blood. People typically engage in this kind of breathing spontaneously when they are relaxed. In progressive muscle relaxation, an individual learns to relax all the muscles in the body to discharge tension or stress, a technique that can be effectively used for stress reduction. As just noted, many deleterious health habits, such as smoking and drinking, represent ways of coping with social anxiety. Thus, in addition to social skills training or assertiveness training, people may learn relaxation procedures to cope more effectively with their anxiety.

Answer 222

The use of a broad array of cognitive-behavioural intervention techniques to modify an individual’s health behaviour.

Answer 223

The most effective approach to health-habit modification often comes from combining multiple behaviour-change techniques. This eclectic approach has been termed broad-spectrum cognitive-behaviour therapy, sometimes known as multimodal cognitive-behaviour therapy (A. A. Lazarus, 1971). From an array of available techniques, a therapist selects several complementary methods to intervene in the modification of a target problem and its context.

Answer 224

The advantages of a broad-spectrum approach to health behaviour change are several. 1. A carefully selected set of techniques can deal with all aspects of a problem: Self-observation and self-monitoring define the dimensions of a problem; stimulus control enables a person to modify antecedents of behaviour; self-reinforcement controls the consequences of a behaviour; and social skills training may be added to replace the maladaptive behaviour once it has been brought under some degree of control. 2. Advantage is that the therapeutic plan can be tailored to each individual’s problem. Each person’s faulty health habit and personality is different, so, for example, the particular package identified for one obese client will not be the same as that developed for another obese client. Third, multimodal interventions impart a broad range of skills that can be used to modify not one but several health habits (e.g., diet and exercise) at the same time (Persky, Spring, Vander Wal, Pagoto, & Hedeker, 2005; J. J. Prochaska & Sallis, 2004).

Answer 225

One of the biggest problems faced in health-habit modification is the tendency for people to relapse to their previous behaviour following initial successful behaviour change (e.g., McCaul, Glasgow, & O’Neill, 1992). This problem occurs both for people who make health-habit changes on their own and for those who join formal programs to alter their behaviour.

Answer 226

A single cigarette smoked at a cocktail party or the consumption of a pint of ice cream on a lonely Saturday night does not necessarily lead to permanent relapse. However, over time, initial vigilance may fade and relapse may set in. Research suggests that relapse rates tend to stabilize at about three months, which initially led researchers to believe that most people who are going to relapse will do so within the first three months. However, subsequent research suggests that, although relapse rates may remain constant, the particular people who are abstaining from a bad health habit at one point in time are not necessarily the same people who are abstaining at another point in time. Some people go from abstinence to relapse; others, from relapse back to abstinence.

Answer 227

Our knowledge of who relapses is limited. 1. Genetic factors may be implicated in alcoholism, smoking, and obesity. Withdrawal effects occur in response to abstinence from alcohol and cigarettes and may prompt a relapse, especially shortly after efforts to change behaviour. Conditioned associations between cues and physiological responses may lead to urges or cravings to engage in the habit. - --> For example, people may find themselves in a situation in which they used to smoke, such as at a party, and relapse at that vulnerable moment. 2. Relapse is more likely when people are depressed, anxious, or under stress. - --> For example, when people are moving, breaking off a relationship, or encountering difficulties at work, they may have greater need for their addictive habits than is true at less stressful times. Relapse occurs when motivation flags or goals for maintaining the health behaviour have not been established. Relapse is less likely if a person has social support from family and friends to maintain the behaviour change, but it is more likely to occur if the person lacks social support or is involved in a conflictual interpersonal situation. 3. A particular moment that makes people vulnerable to relapse is when they have one lapse in vigilance. The abstinence violation effect—that is, a feeling of loss of control that results when a person has violated self-imposed rules—can result when someone dieting who is trying to avoid sweets has a bad day and eats a whole pint of ice cream, or a smoker trying to quit has a single cigarette to calm her nerves. The result is that a more serious relapse is then likely to occur as the individual sees his or her resolve falter. This may be especially true for addictive behaviours because the person must cope with the reinforcing impact of the substance itself.

Answer 228

Clearly, relapse produces negative emotions, such as disappointment, frustration, unhappiness, or anger. Even a single lapse can lead a person to experience profound disappointment, a reduced sense of self-efficacy, and a shift in attributions for controlling the health behaviour from the self to uncontrollable external forces. A relapse could also lead people to feel that they can never control the habit—that it is simply beyond their efforts.

Answer 229

In some cases, however, relapse may have paradoxical effects, leading people to perceive that they can control their habits, at least to a degree. With smoking, for example, multiple efforts to stop often take place before people succeed, suggesting that initial experiences with stopping smoking may prepare people for later success. The person who relapses may nonetheless have acquired useful information about the habit and have learned ways to prevent relapse in the future.

Answer 230

1. Booster sessions following the termination of the initial treatment phase have been one method. Several weeks or months after the end of a formal intervention, smokers may have an additional smoking-prevention session or dieters may return to their group situation to be weighed in and to brush up on their weight-control techniques. - --> Although booster sessions were originally thought to be ineffective, recent evidence suggests that booster sessions may be successful at reducing relapse but that their effects may not emerge immediately following the session. 2. Another approach to relapse prevention is to consider abstinence a lifelong treatment process, as is done in such programs as Alcoholics Anonymous and other well-established lay treatment programs. Although this approach can be successful, it also has certain disadvantages. The philosophy can leave people with the perception that they are constantly vulnerable to relapse, potentially creating the expectation of relapse when vigilance wanes. Moreover, the approach implies that people are not in control of their habit, and research on health-habit modification suggests that self-efficacy is an important component in initiating and maintaining behaviour change.

Answer 231

A set of techniques designed to keep people from relapsing to prior poor health habits after initial successful behaviour modification; includes training in coping skills for high-risk-for-relapse situations and lifestyle rebalancing.

Answer 232

1. Those people who are initially highly committed to the program and motivated to engage in behaviour change are less likely to relapse. These observations imply that one important focus of programs must be to increase motivation and maintain commitment. - --> For example, programs may create a contingency management procedure in which people are required to deposit money, which is returned if they successfully attend meetings or change their behaviour. 2. Once motivation and commitment to follow through have been instilled, techniques must be developed in the behaviour-change program itself to maintain behaviour change and act as relapse-prevention skills once the program terminates. - --> One such strategy involves having people identify the situations that are likely to promote a relapse and then develop coping skills that will enable them to manage that stressful event successfully. This strategy draws on the fact that successful adherence promotes feelings of self-control and that having available coping techniques can enhance feelings of control still further. In addition, the mental rehearsal of coping responses in a high-risk situation can promote feelings of self-efficacy, decreasing the likelihood of relapse. 3. Cue elimination, or restructuring the environments to avoid situations that evoke the target behaviour, can be used. The alcoholic who drank exclusively in bars can avoid bars. For other habits, however, cue elimination is impossible. ---> For example, smokers are usually unable to completely eliminate the circumstances in their lives that led them to smoke. Consequently, some relapse-prevention programs deliberately expose people to the situations likely to evoke the old behaviour to give them practice in using their coping skills. The power of the situation may be extinguished over time if the behaviour does not follow. Moreover, such exposure can increase feelings of self-efficacy and decrease the positive expectations associated with the addictive behaviour. Making sure that the new habit (such as exercise or alcohol abstinence) is practised in as broad an array of new contexts is important as well for ensuring that it endures.

Answer 233

Overall, at present, relapse prevention seems to be most successful when people perceive their successful behaviour change to be a long-term goal, develop coping techniques for managing high-risk situations, and integrate behaviour change into a generally healthy lifestyle.

Answer 234

Social or lifestyle change through legislation; for example, water purification is done through social engineering rather than by individual efforts. ---> eg Banning the use of certain drugs, such as heroin and cocaine, and regulating the disposal of toxic wastes are examples of health measures that have been mandated by legislation. Alcohol consumption is legally restricted to particular circumstances and age groups. As of 2010, all Canadian provinces and territories have legislated smoke-free indoor work environments, and nine of these jurisdictions have banned smoking in indoor public spaces.

Answer 235

Many times, social engineering solutions to health problems are more successful than individual ones. We could urge parents to have their children vaccinated against the major childhood disorders of measles, influenza, hepatitis, diphtheria, and tetanus, but requiring immunizations for school entry has been very successful. Requiring vaccinations for school entry in some provinces has led to more than 98 percent of children receiving most of the vaccinations they need. The establishment of a smoke-free Canada through banning smoking in the workplace and in indoor public places has reduced non-smokers’ exposure to second-hand smoke, and has helped motivate many smokers to quit. The introduction of regulations to eliminate the amount of trans fats allowed in foods has also led to reductions in the amount of this harmful saturated fat, especially in fast food, and should help combat the rising rates of obesity in Canada.

Answer 236

The prospects for continued use of social engineering to change health habits are great. Controlling what is contained in vending machines at schools, putting a surcharge on foods high in fat and low in nutritional value, and controlling advertising of high-fat and high-cholesterol products are approaches that have and should be considered to combat the enormous rise in obesity that has occurred over the past three decades.

Answer 237

There are limits on social engineering more generally. Even though smoking has been banned in public areas, it is still not illegal to smoke; if this were to occur, most smokers and a substantial number of non-smokers would find such mandatory measures unacceptable interference with civil liberties. Even when the health advantages of social engineering can be dramatically illustrated, the sacrifice in personal liberty may be considered too great. Thus, many health habits will remain at the discretion of the individual. It is to such behaviours that psychological interventions delivered within specific venues speak most persuasively.

Answer 238

Health-habit modification can be undertaken in the health practitioner’s office. Many people have regular contact with a physician or another health care professional who knows their medical history and can help them modify their health habits. Among the advantages of intervening in the physician’s office is that physicians are highly credible sources for instituting health-habit change, and their recommendations have the force of their expertise behind them. Nonetheless, as in the case of private therapy, the one-to-one approach reduces only one person’s risk status at a time.

Answer 239

1. children learn their health habits from their parents, so making sure the entire family is committed to a healthy lifestyle gives children the best chance at a healthy start in life. 2. families, especially those in which there are children and one or more adults who work, typically have more organized, routinized lifestyles than single people do, so family life often builds in healthy behaviours, such as getting three meals a day, sleeping eight hours, brushing teeth, and using seat belts. The health-promoting aspects of family life are evident in the fact that married men have far better health habits than single men, in part because wives often run the home life that builds in these healthy habits. Single and married women have equally healthy lifestyles, with the exception of single women with children who are disadvantaged with respect to health. 3. multiple family members are affected by any one member’s health habits. A clear example is second-hand smoke, which harms not only the smoker but also those around him or her. 4. if behaviour change is introduced at the family level—such as a low-cholesterol diet or stopping smoking—all family members are on board, ensuring greater commitment to the behaviour-change program and providing social support for the person whose behaviour is the target. Evidence suggests that the involvement of family members can increase the effectiveness of an intervention substantially.

Answer 240

Aboriginal, Asian, or southern European cultures; people in these latter cultures may be more persuaded to engage in behaviour change when the good of the family is at stak

Answer 241

These self-help groups bring together individuals with the same health-habit problem, either in person or online and, often with the help of a counsellor, they attempt to solve their problem collectively. Some prominent self-help groups include Overeaters Anonymous for obesity, Alcoholics Anonymous for alcoholism, and Smokenders for smoking. Many of the leaders of these groups employ cognitive-behavioural principles in their programs. The social support and understanding of mutual sufferers are also important factors in producing successful outcomes. At the present time, self-help groups constitute a major venue for health-habit modification in this country.

Answer 242

A number of factors make schools a desirable venue for health-habit modification. 1. most children go to school; therefore, virtually the entire population can be reached, at least in their early years. 2. the school population is young. Consequently, we can intervene before children have developed poor health habits. - --> Moreover, when young people are taught good health behaviours early, these behaviours may become habitual and stay with them their whole lives. 3. schools have a natural intervention vehicle—namely, classes of approximately an hour’s duration; many health interventions can fit into this format. 4. certain sanctions can be used in the school environment to promote health behaviours. For example, school systems in several provinces now require that children receive a series of inoculations before they attend school. For these reasons, then, the schools are often used as a venue for influencing health habits. ---> For example, interventions in elementary schools targeted to increasing exercise and knowledge about proper nutrition have documented improvements in diet and exercise patterns that have especially benefited unfit and obese children.

Answer 243

Very young children and the elderly can be reached through the health care system to promote healthy behaviour. Children and adolescents can be contacted through the schools. The bulk of the adult population, however, is often difficult to reach. They do not use medical services regularly, and it is difficult to reach them through other organizational means. Because a substantial proportion of the adult population is employed, the workplace can be utilized to reach this large percentage of the population.

Answer 244

An assessment designed to identify employees’ specific risks based on current age, family history, and lifestyle factors that provide employers with a general view of their employees’ health and areas for improvement.

Answer 245

Over 400 employers from public, private, and non-profit organizations responded to the survey. 14 percent of companies are offering work/family life balance programs. 87 percent of companies do not measure the health status of their employees.

Answer 246

A review of 16 work-site health-promotion programs aimed at improving employee diets suggests that they may be moderately successful. ---> For example, employees enrolled in the Tune Up Your Heart program, which is aimed at improving workforce cardiovascular disease (CVD) risk, experienced significant improvements in a number of CVD risk factors, including weight loss among 36 percent of participants, reduced BMI, decreased blood pressure, smoking cessation, and increased adherence to diet and exercise regimens

Answer 247

Formal evaluation and high rates of success will be critical in the continuation of such programs, as implementing such programs involves the use of valuable resources by the employer. If corporations can see reductions in absenteeism, insurance costs, accidents, and other indicators that these programs are successful, they will be more likely to continue to support them. Future research should, therefore, include concurrent measures of these more objective indicators of the benefits of work-site health-promotion programs to demonstrate their practical benefits

Answer 248

Community-based interventions encompass a variety of specific approaches that have the potential to reach large numbers of individuals. ---> A community-based intervention could be a door-to-door campaign informing people of the availability of a breast cancer screening program, a media blitz alerting people to the risks of smoking, a diet-modification program that recruits through community institutions, or a mixed intervention involving both media and interventions directed to high-risk community members. ---> Several prominent community-based interventions have been developed to reduce risk factors associated with heart disease. For example, the Multiple Risk Factor Intervention Trial (MRFIT) in the United States, the North Karelia project in Finland, and the Canadian Heart Health Initiative (CHHI) were all designed to modify cardiovascular risk factors such as smoking, dietary cholesterol level, and blood pressure through a combination of media interventions and behaviour-change efforts targeted to high-risk groups.

Answer 249

1. The first is the provision of on-the-job health-promotion programs that help employees practise better health behaviours. In Canada, most employers offer some form of wellness initiative to help promote the health of their employees. These programs include smoking cessation, stress management, weight control, physical fitness, nutrition awareness, cardiovascular health and diabetes awareness, CPR and first aid training, and back care. Often such programs begin with a health risk assessment (HRA) to identify employees’ specific risks based on current age, family history, and lifestyle factors. These HRAs provide employers with a general view of their employees’ health and, more importantly, help identify specific areas for employees’ health behaviour improvement before they undertake wellness interventions. Participation in wellness initiatives may be supplemented by individual health coaching, which can be delivered in person or online. 2. By structuring the environment to help people engage in healthy activities. For example, many companies provide health clubs for employee use or restaurant facilities that serve meals that are low in fat, sugar, and cholesterol. 3. Some industries provide special incentives, such as reduced insurance premiums for individuals who successfully modify their health habits (e.g., individuals who stop smoking or lose weight). Health psychologists have also been involved in the creation of general wellness programs designed to address multiple health habits.

Answer 250

There are several potential advantages of community-based interventions. 1. such interventions reach more people than individually based interventions or interventions in limited environments, such as a single workplace or classroom. 2. community-based interventions can build on social support for reinforcing compliance with recommended health changes. - --> For example, if all your neighbours have agreed to switch to a low-cholesterol diet, you are more likely to do so as well. 3. community-based interventions can potentially address the problem of behaviour-change maintenance by restructuring the community environment to reduce or eliminate cues and reinforcers of risky behaviour and replace them with cues and reinforcements for healthy behaviours.

Answer 251

The effectiveness of community interventions is controversial. Some researchers have argued that these interventions show good success rates. ----> For example, the North Karelia project appears to have produced declines in cardiovascular mortality, and the MRFIT program brought about reductions in cigarette smoking, reductions in blood pressure, and improvements in dietary knowledge. However, the program effectiveness may vary widely depending on whether the community is urban, suburban, or rural. ---> For example, the Quebec Heart Health Demonstration Project, part of the CHHI, targeted three different communities in the Montreal area over a five-year period with an intervention program to change smoking, diet, and physical activity. Although the program was based on several well-established health-education strategies including Bandura’s (1986) social learning theory and the theory of planned behaviour, the suburban and urban sites showed dietary improvement while dietary behaviours deteriorated for the rural site. Large-scale and expensive intervention studies that involve individualized behaviour therapy for those at high risk are, however, unlikely to be sustainable in the future on the basis of expense. Thus, more modest efforts to integrate healthy lifestyle programs into existing community outreach programs are likely to continue.

Answer 252

One of the goals of health promotion efforts is to reach as many people as possible, and consequently, the mass media have great potential. Evaluations of the effectiveness of health appeals in the mass media suggest some qualifications regarding their success. Generally, mass media campaigns bring about modest attitude change but less long-term behaviour change.

Answer 253

The mass media appear to be most effective in alerting people to health risks that they would not otherwise know about. For example, the media campaign on the health risks of second-hand smoke as illustrated by the story of Heather, a waitress who never smoked but who was dying of lung cancer, alerted thousands of Canadians to the problem of second-hand smoke, and helped fuel support for the nationwide smoke-free legislation. By presenting a consistent media message over time, the mass media can also have a cumulative effect in changing the values associated with health practices. ---> For example, the cumulative effects of anti-smoking mass media messages have been substantial, and the climate of public opinion is now clearly on the side of the non-smoker. In conjunction with other techniques for behaviour change, such as community interventions, the mass media can also reinforce and underscore elements in existing behaviour-change programs.

Answer 254

It provides low-cost access to health messages for millions of people who can potentially benefit from the information, suggestions, and techniques offered on websites. - --> For example, Health Canada has launched two Internet-based programs to help people quit smoking. 1. “On the Road to Quitting” is a self-help online program designed to help smokers understand their smoking motivations, find the right ways to quit, and use the tools to deal with their cravings and stress as they quit smoking. 2. “Quit 4 Life” is a similar four-step program designed specifically to help teenage smokers kick the habit. In addition, websites designed to convey important health-promotion methods can be effective venues for health behaviour change by providing information about certain health risks and how they can be avoided. For example, Alberta’s “dontyougetit" campaign (www.dontyougetit.ca/) features a website dedicated to increasing awareness about the increase in syphilis infections in recent years and the behaviours that can help reduce people’s risk for becoming infected.

Answer 255

For more than three decades, ParticipACTION has been associated with healthy living and physical fitness for many Canadians. Originally launched in 1972 as a non-profit government program to encourage Canadians to get fit and practise other healthy living habits, ParticipACTION is perhaps the best-known health-related media campaign in Canada’s history. Although the program is probably best remembered for its television and media ads, the ParticipACTION program involved a number of pioneering initiatives to help raise the fitness levels of Canadians. These included community fitness programs, the first of which started in Saskatoon; joint initiatives with sponsor organizations to build activity trails across 100 communities (1976); information booklets about the growing problems of childhood obesity (1979); and information campaigns to promote employee fitness (1981), to name a few. In the early years, a variety of television and other media ads were used to make Canadians aware of their poor fitness and inactivity. For example, a 1976 television ad suggesting that a 60-year-old Swede was as fit as the average 30-year-old Canadian provided a provocative and powerful message about the need for Canadians to get fit. For the 1980s, ParticipACTION tackled the issue of getting started becoming physically fit with the popular media message “Don’t Just Think About It—Do It!” in its television, radio, and print media campaigns. In the early 1990s, the Body Break campaign emerged with its hosts Hal Johnson and Joanne McLeod, who focused on promoting simple physical activities that anyone could do while at work, on the road, or at home with the message “Keep fit and have fun.” In its final years during the late 1990s, the focus of the ParticipACTION campaigns shifted to prevention of chronic illnesses and other health and social issues through physical activity. These ads were considered particularly influential as they featured real people sharing their stories of the positive impact of physical activity on their lives, modelling the benefits of staying active. Over the years ParticipACTION was funded by a number of sources including Health Canada, the private sector, provincial/territorial governments, and mass media partners who provided free media exposure of the popular ParticipACTION ads. However, by 1999, funding sources became scarce and ParticipACTION stopped producing new national public service announcement campaign material. Soon after, in 2001, all government funding was cut and the ParticipACTION program was officially closed. After a six-year absence, ParticipACTION returned. Recognizing the need to deal with Canada’s rising obesity levels and declining rates of physical activity, the Canadian government announced in early 2007 that it would provide $5 million to support the renewal of ParticipACTION. The newly revived program was launched October 2007 and includes a new website (www.participaction.com) as an interactive community designed to help Canadians “get up and get moving.” Through a combination of active living tips, information about community resources, and interactive tools, the new ParticipACTION aims to continue to be the voice of physical activity in Canada. In 2015, for example, ParticipACTION was the number one physical activity brand in Canada (ParticipACTION, 2015). Although the effectiveness of this media campaign to change Canadians’ fitness behaviours has not been formally evaluated, the revival of ParticipACTION offers an opportunity for researchers to examine this in the coming years.

Answer 256

Health promotion is the process of enabling people to increase control over and improve their health. It involves the practice of good health behaviours and the avoidance of health-compromising ones. The impetus for health promotion has come from recognizing the impact of lifestyle factors—such as smoking, drinking, and controlling weight—on chronic health disorders.

Answer 257

Health behaviours are determined by socio-economic factors, social factors (such as early socialization in the family), gender, values and cultural background, perceived symptoms, access to medical care, place, and cognitive factors (such as health beliefs). Health behaviours are only modestly related to each other and are highly unstable over time. Health promotion efforts target children and adolescents before bad health habits are in place. They also focus on individuals and groups at risk for particular disorders to prevent those disorders from occurring. An increasing focus on health promotion among the elderly may help contain the soaring costs of health care at the end of life.

Answer 258

Attitudinal approaches to health behaviour change can instill knowledge and motivation. But approaches such as fear appeals and information appeals have had limited effects on behaviour change, and may be most effective when combined with other motivational factors. Research using the health belief model, the self-efficacy principle, and the theory of planned behaviour have identified the attitudes most directly related to health-habit modification. These attitudes are the belief that a threat to health is severe, that one is personally vulnerable to the threat, that one is able to perform the response needed to reduce the threat (self-efficacy), that the response will be effective in overcoming the threat (response efficacy), and that social norms support one’s practice of the behaviour. Behavioural intentions and more specific implementation intentions are also important determinants of behaviour. Successful modification of health habits does not occur all at once. Individuals go through stages, which they may cycle through several times: precontemplation, contemplation, preparation, action, and maintenance. When interventions are targeted to the stage an individual is in, they may be more successful.

Answer 259

Cognitive-behavioural approaches to health-habit change use principles of self-monitoring, classical conditioning, operant conditioning, modelling, and stimulus control to modify the antecedents and consequences of a target behaviour. Cognitive-behaviour therapy brings patients into the treatment process by teaching them principles of self-control and self-reinforcement. Social skills training and relaxation training methods are often incorporated into broad-spectrum, or multimodal, cognitive-behavioural interventions to deal with the anxiety or social deficits that underlie some health problems. Increasingly, interventions focus on relapse prevention, which is the training of clients in methods to avoid the temptation to relapse. Learning coping techniques for high-risk-for-relapse situations is a major component of such interventions.

Answer 260

Some health habits are best changed through social engineering, such as mandated childhood immunizations or banning smoking in the workplace and indoor public places. Others are best changed in the context of specific venues. Expensive methods that reach one individual at a time are giving way to group methods that may be cheaper, including self-help groups and school, work-site, and community interventions. The mass media can reinforce health campaigns implemented via other means and can alert people to health risks.

Answer 261

Health psychology is the field within psychology devoted to understanding psychological influences on how people stay healthy, why they become ill, and how they respond when they do get ill. It focuses on health promotion and maintenance; prevention and treatment of illness; the etiology and correlates of health, illness, and dysfunction; and improvement of the health care system and the formulation of health policy.

Answer 262

The interaction of the mind and the body has concerned philosophers and scientists for centuries. Different models of the relationship have predominated at different times in history, but current emphasis is on the inextricable unity of the two.

Answer 263

The biomedical model, which dominates medicine, is a reductionistic, single-factor model of illness that regards the mind and body as separate entities and emphasizes illness concerns over health. The biomedical model is currently being replaced by the biopsychosocial model, which regards any health or illness outcome as a complex interplay of biological, psychological, and social factors. The biopsychosocial model recognizes the importance of both macrolevel and microlevel processes in producing health and illness and maintains that the mind and body cannot be distinguished in matters of health and illness. Under this model, health is regarded as an active achievement.

Answer 264

The rise of health psychology can be tied to several factors, including the increase in chronic or lifestyle-related illnesses, the changing perspective on the definition of health, the increasing burden of health care expenditures, the realization that psychological and social factors contribute to health and illness, the demonstrated importance of psychological interventions to improving people’s health, and the rigorous methodological contributions of expert researchers.

Answer 265

Health psychologists perform a variety of tasks. They research and examine the interaction of biological, psychological, and social factors in producing health and illness. They help treat patients suffering from a variety of disorders and conduct counselling for the psychosocial problems that illness may create. They develop worksite interventions to improve employees’ health habits and work in organizations as consultants to improve health and health care delivery.

Answer 266

surveys show that the most common New Year’s resolutions, in addition to saving money, are losing weight and getting exercise.

Answer 267

Worldwide, 1.2 million people died as a result of road-traffic injuries, and the estimated economic cost of unintentional injuries is $518 billion per year

Answer 268

Bicycle accidents were responsible for more than 4300 hospitalizations between 2009 and 2010, and constitute the major cause of head injury, thereby making helmet use an important issue ---> Indeed, over a four-year period, child and youth head injury rates were 25 percent lower in provinces with bicycle helmet legislation compared to provinces without such legislation. However, to date, six provinces have introduced legislation for mandatory bicycle helmet use, but only four of these provinces have legislation that applies to all ages. Not surprisingly, rates of helmet use are highest in all but one of the provinces that have helmet legislation.

Answer 269

Several million people are injured each year in Canada, and falls are the leading cause of serious injury

Answer 270

Although household activities such as engaging in chores are a leading cause of non-lethal injury among adults, 35 percent of injuries occur while Canadians engage in sports activities or exercise. Adolescents are particularly vulnerable to being injured while engaging in sports activities.

Answer 271

Preventable injuries at work and their resulting impact on disability are a particular health risk for working men

Answer 272

Sport/Exercise accidents

Answer 273

Unintentional injuries in the home, such as accidental poisonings and falls, are the most common causes of death and disability among children under age five.

Answer 274

Interventions to reduce preventable injuries at home are typically conducted with parents because they have control over the child’s environment.

Answer 275

Parents are most likely to undertake injury prevention activities if they believe that the recommended steps really will avoid injuries, if they feel knowledgeable and competent to teach safety skills to their children, and if they have a realistic sense of how much time will actually be involved in doing so ---> Providing education and resources about how to keep the home safe is key to preventing accidents in the home. For example, family physicians can incorporate such training into their interactions with new parents, and parenting classes can be used to teach parents to identify the most common poisons in their household and how to keep these safeguarded or out of reach of young children. In addition, home safety information and resources are now readily available on the Internet through the Public Health Agency of Canada website. Parents can learn ways of keeping their home and children safe and can find a wealth of information on topics ranging from the dangers of poisons and baby walkers, to balloon injuries and unsafe toys.

Answer 276

The single greatest cause of death from unintentional injury is motorcycle and automobile accidents

Answer 277

To date, little psychological research has gone into helping people avoid vehicular traffic accidents. Instead, efforts have concentrated on such factors as the maintenance of roadways, the volume of travel, and safety standards in automobiles. However, psychological research can address factors associated with accidents, including driving distractions the way people drive, the speed at which they drive, and the use of preventive measures to increase safety.

Answer 278

One study comparing performance during a driving simulation with no conversation, conversation with a passenger, and conversation on a cellphone found that cellphone conversations were more distracting and consumed more attention resources than conversations with passengers

Answer 279

A review conducted by researchers from Dalhousie University suggests that talking on the phone while driving, whether it is a cellphone or a hands-free phone, negatively impacts driving performance. Detecting and identifying events were particularly compromised, and drivers compensated for the effects of cellphone use but not hands-free phones despite the fact that performance deficits for each were roughly the same.

Answer 280

One study of university students suggests that positive illusions and high illusory control may partly explain why. After predicting their driving performance with and without a cellphone, students completed a driving simulation task. Cellphone use negatively impacted driving performance, and perceiving oneself as being able to compensate for driving distractions and overestimating driving simulator performance while using the cellphone predicted greater cellphone use while driving.

Answer 281

It is clear that safety measures such as reducing highway driving speeds, requiring seat belts, and placing young children in safety restraint seats have reduced the number of severe injuries and vehicular fatalities. Making themselves visible through reflective or fluorescent clothing and the use of helmets among bicycle and motorcycle riders has reduced the severity of accidents by a substantial degree, especially preventing serious head injury.

Answer 282

Although the rate of seat belt use in Canada is generally high, younger drivers tend to wear seat belts less. To promote the use of seat belts, a combination of social engineering, health education, and psychological intervention may be most appropriate. ---> For example, Transport Canada requires that infants and toddlers up to age three or four, or about 18 kilograms (40 lbs.), be restrained in safety seats. Guidelines for the use of booster seats vary slightly across the provinces and territories (8–10 years old, 36–45 kg [80–100 lbs.]), although most recommend that children are at least the recommended height of 145 cm (or 4 feet, 9 inches) for wearing seat belts alone before they can ride in a car without a booster seat.

Answer 283

Interventions to increase seat belt use have involved social influence and social engineering principles. ---> For example, a study in Norway found that signs reminding drivers of “seat belt enforcement” were somewhat effective in increasing drivers’ intentions to wear seat belts. Whether this simple approach actually translates into increased seat belt use behaviour is, however, difficult to assess. But on the whole, social engineering solutions may be more effective—specifically, penalizing people for not using seat belts. Enforcement of penalties is also essential, as decreases in seat belt use are known to correspond with decreases in enforcement of fines for non-use.

Answer 284

1 out of 4

Answer 285

Although breast cancer is the most common cancer in women in Canada and worldwide, recent figures indicate that the death rate from breast cancer in Canada has dropped 25 percent since the time that breast screening programs were initiated across Canada in 1986. Still, breast cancer remains one of the leading causes of cancer deaths among Canadian women and the most common cause of cancer death in women under 50, striking one out of every nine women at some point during her life.

Answer 286

A thorough physical examination of the breast by a health care professional to detect changes or abnormalities that could indicate the early signs of breast cancer.

Answer 287

Although clinical breast exams were formerly recommended, the current recommendations are to not routinely perform this exam as a screen for breast cancer. ---> Women aged 50 to 69 should have a mammogram every two years. Although breast self-exams (BSE) were once commonly used for screening, current evidence suggesting that the BSE is not an effective method of screening has led the World Health Organization to recommend that national cancer screening programs should not recommend BSE as a screening activity.

Answer 288

1. The prevalence of breast cancer in this country remains high, with approximately 22 000 Canadian women being diagnosed each year. 2. The majority of breast cancers continue to be detected in women over age 40, so screening this age group is cost-effective. However, mammography is usually warranted only for women under 50 if recommended by a nurse or doctor, as the benefits of mammography for this age group remain unclear. 3. Most important, early detection, as through mammograms, can improve survival rates.

Answer 289

The recent decrease in breast cancer mortality has been linked in part to better screening.

Answer 290

1. There remain significant gaps in participation between women in the highest and lowest income groups, and these gaps have increased since 2001. 2. Women who are immigrants, who smoke, and who do not have a regular family doctor are less likely to get screened. 3. Although rates of time-appropriate mammography were highest in British Columbia previously, in 2008, non-use was highest in British Columbia, Prince Edward Island, and Nunavut. I 4. Increases in the immigrant population in British Columbia may be one reason for the shift in rates. 5. Fear of radiation, embarrassment over the procedure, anticipated pain, anxiety, fear of cancer 6. Perception of need act as deterrents to getting regular mammograms. 7. Lack of awareness, time, incentive, and availability are also important.

Answer 291

Research has focused on how to increase women’s use of mammographic services. - --> One study found that repeat mammography use among women aged 50 and over increased substantially with an intervention that included the mailing of a “mammogram due soon” postcard and two follow-up automated phone calls. - --> Counselling and mailed materials promoting mammography are also effective at increasing the use of this important screening procedure

Answer 292

Researchers applied J. O. Prochaska’s transtheoretical model of behaviour change to predict mammogram use. Using responses to questions about intentions to get a mammogram and previous history of using mammography, researchers established the women’s stage of change to examine whether it predicted getting a mammogram at the two-year follow-up. Consistent with the stages of change model, women in the precontemplation, relapse, contemplation, and action stages were significantly less likely to report a recent mammogram during follow-up compared to those in the maintenance stage. These findings support the suggestions of other researchers that interventions for increasing mammography behaviour may be more successful if they are geared to the stage of readiness of prospective participants

Answer 293

Changing attitudes toward mammography may increase the likelihood of obtaining a mammogram. In particular, the health belief model, especially the attitudes of perceiving benefits of mammograms and encountering few barriers to obtaining one, has been associated with a greater likelihood of obtaining a mammogram. However, educational programs designed to raise awareness of the need for mammography also need to be culturally sensitive, and consider the cultural beliefs, attitudes, and practices of certain minority groups, such as Aboriginal women and South Asian immigrants, who are less likely to have regular cancer screening.

Answer 294

The theory of planned behaviour has also been used as a framework to predict the likelihood of obtaining regular mammograms: Although perceived behaviour control may be most important for predicting mammography use, the addition of other factors such as optimism and risk perception may also enhance the effectiveness of this model for explaining mammography use. Social support also predicts getting a mammogram and may be especially important for low-income and older women.

Answer 295

Interventions need to be directed to health professionals to ensure that physicians routinely refer their older and minority female patients to mammography centres, and health care delivery services need to be established so that mammography is more accessible to older and rural-dwelling women, as well as women from ethnic-minority groups

Answer 296

In Canada, prostate cancer is the most common cancer among men, with one in eight men likely to develop prostate cancer during their lifetime

Answer 297

Risk for prostate cancer increases with age, and men over age 50 are encouraged to discuss screening options with their family doctor.

Answer 298

Although there are two recommended screening tests for early detection of prostate cancer, there is some controversy over their effectiveness. 1. The digital rectal exam (DRE) is the most common screening method 2. The prostate specific antigen test (PSA) involves a blood test to screen for prostate problems. However, both are susceptible to false positives, detecting cancer that is not present, and false negatives, missing cancer that is present. As such, recommendations for screening depend on the presence of risk factors such as age, family history, and African ethnicity.

Answer 299

In Western countries, colorectal cancer is the second-highest cause of cancerous deaths, and in Canada, it is the fourth-most common cancer for men and women.

Answer 300

In addition, colorectal cancer is increasing at higher rates among Canada’s Aboriginal population than among the general public, and may surpass the levels found among non-Aboriginal Canadians if preventive measures are not taken

Answer 301

In recent years, medical guidelines have increasingly recommended routine colorectal screening for older adults. Colorectal screening is distinctive for the fact that people often learn that they have polyps (a benign condition that can increase risk for colorectal cancer) but not detected malignancies. The Canadian Cancer Society recommends screening for colorectal cancer with a fecal occult blood test at least once every two years for men and women over 50 with normal risk, and more frequently for those at high risk.

Answer 302

Factors that predict the practice of other cancer-related health behaviours also predict participation in colorectal cancer screening, specifically self-efficacy, perceived benefits of the procedure, a physician’s recommendation to participate, and low perceived barriers to taking advantage of the screening program. Community-based programs that employ such strategies as mass media, community-based education, use of social networks, interventions through churches, health care provider recommendations, and reminder notices promote participation in cancer screening programs, including colorectal cancer, and indicate that community-based interventions can attract older populations to engage in appropriate screening behaviours. An intervention aimed at a hard-to-reach group of older adults that provided reassuring information regarding colorectal screening was effective in modifying initially negative attitudes and increasing rates of screening attendance

Answer 303

Each year in Canada there are more than 80 000 new cases of skin cancer diagnosed, and the rates have been rising steadily since 1992. Although common basal cell and squamous cell carcinomas do not typically kill, malignant melanoma takes nearly 900 lives each year in Canada. Moreover, these cancers are among the most common, yet most preventable, cancers we have

Answer 304

The chief risk factor for skin cancer is well known: excessive exposure to ultraviolet radiation. Living or vacationing in southern latitudes, participating in outdoor activities, and using tanning salons all contribute to dangerous sun exposure. Women are more likely than men to practise sun-protective behaviours, although about half of Canadian adults report being sunburned each year, and 45 percent of children have been sunburned at least once. Sun safety behaviours do increase with age, but rates of sun exposure and lack of sun protective practices are lowest among those ages 15 to 24.

Answer 305

Health psychologists have increased their efforts to promote safe sun practices. Typically, these efforts have included educational interventions designed to alert people to the risks of skin cancer and to the effectiveness of sunscreen use for reducing risk. There is some debate as to whether individualized or generic materials are more effective for changing sun safety behaviours. At least one study suggests that both are equally effective, with generic materials having the advantage of reaching a greater number of people.

Answer 306

Problems with getting people to engage in safe sun practices stem from the fact that tans are perceived to be attractive. Young adults who are especially concerned with their physical appearance and who believe that tanning enhances their attractiveness are most likely to expose themselves to ultraviolet radiation through tanning. Even people who are persuaded of the importance of safe sun habits often practise them incompletely. Many of us use an inadequate sun protection factor (SPF), and few of us apply sunscreen as often as we should during outdoor activities.

Answer 307

Effective sunscreen use is influenced by a number of factors, including perceived need for sunscreen, perceived efficacy of sunscreen as protection against skin cancer, and social norms regarding sunscreen use and attitudes toward the appearance-related benefits of tanning, among other factors. However, there is evidence that just simply getting into the habit of using sunscreen may be one of the best predictors of effective sunscreen use, especially during any outdoor activities. Consistent with the tenets of the health belief model, increasing perceived self-efficacy and reducing perceived barriers have been found to be important for encouraging sun safe behaviours. Health communications that enhance these perceptions may also be helpful in increasing the practice. Communications to adolescents and young adults that stress the gains that sunscreen use will bring them, such as freedom from concern about skin cancers, appear to be more successful than those that emphasize the risks. When the risks are emphasized, it is important to stress the immediate adverse effects of poor health habits rather than the long-term risks of chronic illness, since adolescents and young adults are especially influenced by immediate concerns. In one clever investigation, beachgoers were given a photo-aging intervention that showed premature wrinkling and age spots; a second group received a novel ultraviolet photo intervention that made negative 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 protective behaviours for incidental sun exposure, and the combination of the UV photo with the photo-aging information led to substantially less sunbathing over the long term. Findings from a study in Australia may provide some additional motivation for people to use sunscreen by appealing to their vanity. In a large randomized trial, regular use of sunscreen was found to slow down skin aging compared to placebo in healthy middle-aged men and women who used sunscreen over a four-year period. Campaigns that highlight these benefits may therefore be successful in counteracting the attractiveness beliefs associated with tanning that can interfere with motivations to use sunscreen.

Answer 308

Similar interventions may be effective in reducing the use of tanning salons (Gibbons, Gerrard, Lane, Mahler, & Kulik 2005). Communications drawing on the stages of change model, which aim to move the tanning public from a precontemplation to a contemplation stage and subsequently to implementation of sun-protective behaviours, may also be successful (Pagoto, McChargue, & Fuqua, 2003).

Answer 309

Social engineering solutions to the sun exposure problem may be needed as well. Few schools have sun protection policies that encourage children and teens to use sunscreen. However, programs such as Health Canada’s Children’s UV Index Sun Awareness Program encourage high school and elementary school teachers to register their schools and make use of available resources, educate students on sun safe practices, and initiate their own sun-savvy policies for their school. Although this program is voluntary, it offers the potential of intervening in the school to address this important health issue.

Answer 310

High-intensity, long-duration, and high-endurance exercise, believed to contribute to cardiovascular fitness and other positive health outcomes. Examples are jogging, bicycling, running, and swimming. ---> Among the forms of exercise that meet these criteria are jogging, bicycling, rope jumping, running, and swimming.

Answer 311

weightlifting, for example

Answer 312

such as sprinting

Answer 313

Other forms of exercise—such as isokinetic exercises (weightlifting, for example) or high-intensity, short-duration, low-endurance exercises (such as sprinting)—may be satisfying and build up specific parts of the body, but have less effect on overall fitness because they draw on short-term stores of glycogen rather than on the long-term energy conversion system associated with aerobics.

Answer 314

Regular exercise can decrease the risk of chronic disease including heart disease and some cancers including breast cancer. Exercise, coupled with dietary change, can cut the risk of Type II diabetes in high-risk adults significantly. However, only 49 percent of Canadians are at least moderately active during their leisure time. Other health benefits of exercise include increased efficiency of the cardiorespiratory system, improved physical work capacity, the optimization of body weight, the improvement or maintenance of muscle tone and strength, an increase in soft tissue and joint flexibility, the reduction or control of hypertension, improved cholesterol level, improved glucose tolerance, improved tolerance of stress, and reduction in poor health habits, including cigarette smoking, alcohol consumption, and poor diet Exercise also accelerates wound healing.

Answer 315

Moreover, results from the Canadian Health Measures Survey suggest that fitness levels among Canadian adults and children have declined significantly between 1981 and 2007–09

Answer 316

Physical inactivity is more common among women than men, among older than younger adults, among those with lower versus higher incomes and education levels, and among Aboriginal versus non-Aboriginal Canadians.

Answer 317

Increases maximum oxygen consumption. Decreases resting heart rate. Decreases blood pressure (in some). Increases strength and efficiency of heart (pumps more blood per beat). Decreases use of energy sources, such as glutamine. Increases slow wave sleep. Increases HDL, unchanged total cholesterol. Decreases cardiovascular disease. Decreases obesity. Increases longevity. Decreases menstrual cycle length, decreases estrogen and progesterone. Decreases risk of some cancers. Increases immune system functions. Decreases negative mood. Improves cognitive functioning.

Answer 318

Perhaps more surprising is the fact that health practitioners do not uniformly recommend physical exercise, even to their patients who could especially benefit from it, such as their elderly patients; yet studies show that a physician’s recommendation is an effective way to get people to increase their exercise

Answer 319

Exercise is considered to be the most important health habit for the elderly, and cardiovascular benefits of exercise have been found even for preschoolers

Answer 320

Strenuous exercise in adolescents and moderate exercise in post-menopausal women may even reduce the risk of breast cancer

Answer 321

The effects of exercise translate directly into increased longevity. Even a single weekly exercise session of moderate to high intensity can reduce all-cause and cardiovascular mortality in both women and men

Answer 322

Regular exercise can also have cognitive benefits, which may be especially important for older adults. A review of studies examining the effects of exercise on cognitive functioning found that engaging in moderate levels of aerobic exercise for as little as six months can significantly improve cognitive functioning in adults aged 60 to 75. However, the effects of exercise on cognitive functioning and performance are not isolated to older adults. Another review examining the effects on people of different ages suggests that regular cardiovascular exercise can improve academic performance and cognitive functioning for children, and adults as well

Answer 323

The typical exercise prescription for a normal adult is to accumulate 60 minutes of physical activity every day to stay healthy, and 30 minutes of moderate-intensity activity four days a week. However, recent revisions to these recommendations have been made to better harmonize Canadian recommendations with those of other countries such as Australia, the United Kingdom, and the United States. The new recommendations are that adults should strive to engage in at least 150 minutes per week of moderate-to-vigorous physical activity, which can be accumulated in bouts lasting at least 10 minutes each. ---> For example, exercising five days per week for 30 minutes would satisfy this new recommendation.

Answer 324

Recent findings indicate that only 15.4 percent of Canadians achieve the recommended 150 minutes per week, suggesting that educational interventions may be necessary to improve awareness about how much exercise is enough

Answer 325

Youth aged 12 to 19 years tend to have the highest rates of being moderately physically active, whereas adults over 65 years tend to have the lowest rates. Whether someone meets these recommendations may also depend on where they live in Canada. For example, there are regional variations in physical activity levels, with British Columbia, the Yukon, and Alberta showing the largest proportion of active or moderately active individuals.

Answer 326

A person with low cardiopulmonary fitness may derive benefits with even less exercise each week. Even short walks, often recommended for older individuals or those with some infirmities, may have benefits for both physical and psychological health. Lifestyle interventions designed to increase activity levels more generally may eventually lead to a commitment to exercise as well. Because it is difficult to get sedentary adults committed to a full-fledged exercise program, a lifestyle intervention aimed at increasing physical activity may represent a good start for aging sedentary adults and for those who are obese.

Answer 327

Researchers have examined the effect of aerobic exercise on psychological states, such as mood, anxiety, depression, and tension, and have found a beneficial role of exercise on both mental and physical health. ---> Regular exercise improves mood and feelings of well-being immediately after a workout; there may also be some improvement in general mood and well-being as a result of long-term participation in an exercise program.

Answer 328

One study on the effects of exercise duration on mood state noted mood improvements after just 10 minutes of exercise building up to 20 minutes, but no additional improvements over longer duration. However, another study found that even a single 30-minute bout of moderate-intensity exercise had beneficial effects on the mood of people with major depressive disorder. Thus, even acute exercise may provide beneficial psychological effects.

Answer 329

At least some of the positive effects of exercise on mood may stem from factors associated with exercise, such as social activity and a feeling of involvement with others. For example, the group cohesion and social support arising from shared exercise classes can increase both positive mood and self-efficacy to exercise. The increased self-efficacy associated with social support during exercise also increases the likelihood that people will maintain their exercise programs

Answer 330

An improved sense of self-efficacy can also underlie some of the mood effects of exercise. In one study, researchers recruited participants for an exercise group and manipulated the experience of self-efficacy during the program by providing contrived feedback to the participants about how well or poorly they were doing. Results indicated that, compared with a control group, people in the efficacy condition had significantly higher levels of perceived self-efficacy, and these perceptions were associated with improvements in mood and psychological well-being.

Answer 331

Because of its beneficial effects on mood and self-esteem, exercise has been used as a treatment for depression and for symptoms of stress, anxiety, and depression associated with menopause. One study assigned depressed women to an exercise condition, a drug treatment session, or a combined treatment. The exercise group improved their mood significantly and as much as those who received only the drug or the combined treatment. More important, once treatment was discontinued, those who continued to exercise were less likely to become depressed again when compared with those who had been on the drug treatment. Thus, an increase in symptoms of depression is one of the risks of stopping exercis.

Answer 332

Smoking, being overweight, and teen pregnancy also account for some of the decline in physical activity. Adults cite lack of time and other stressors in their lives as factors that undermine their good intentions

Answer 333

Many people seem to share this attitude toward exercise. Participation levels for exercise programs tend to vary with the type of exercise engaged in, as well as with individual factors such as the level and location of current pain among people with chronic pain conditions, and whether exercise is engaged in for its own sake or for achieving a specific outcome. People may begin an exercise program but find it difficult to make exercise a regular activity. Paradoxically, although exercise seems to be a stress buster, stress itself is one of the most common reasons that people fail to adhere to their exercise regimens, especially if they have not reached the maintenance stage in their exercise behaviour. Accordingly, research has attempted to identify the factors that lead people to participate in exercise programs over the long term.

Answer 334

1. People who perceive themselves as athletic or as the type of person who exercises, who enjoy their form of exercise, and who have positive attitudes toward physical activity, a strong sense of self-efficacy for exercising, and social support from friends to exercise are more likely to get involved in exercise programs initially than people who do not have these attitudes. However, these factors do not predict participation in exercise programs over the long term. 2. There are also important sex-related differences to consider. From an early age, boys get more exercise than girls. Despite the known benefits of exercise for middle-aged and older women, there are several reasons why these groups of women are especially unlikely to get exercise. The lifestyles of older women may not afford opportunities for regular exercise. Women also report significant barriers to getting exercise, including caregiving responsibilities and concomitant lack of energy. 3. Race also predicts who is more likely to exercise. Findings from the 2005 Canadian Community Health Survey indicate that compared to non-Aboriginal Canadians, First Nations (people off reserve) and Métis people are more likely to have physically active lifestyles. 4. Social support predicts exercise. Among people who participate in group exercise programs such as running groups or walking groups, a sense of support and group cohesion contributes to participation. One reason may be that engaging in exercise with others serves to reinforce social norms, which, according to the theory of planned behaviour, contribute to the performance of health behaviours. 5. People who are high in self-efficacy with respect to exercise (that is, believing that one will be able to perform exercise regularly) are more likely to practise it and more likely to perceive that they are benefiting from it than those people low in self-efficacy. In one study of sedentary, middle-aged adults, those with high self-efficacy beliefs with respect to their exercise plan perceived themselves to expend less effort and reported more positive mood during exercise than did those with low beliefs in self-efficacy. The positive emotions experienced during exercise, in turn, predicted subsequent self-efficacy beliefs, suggesting that positive affect may help maintain the practice of exercise. The converse is also true: Those individuals with low self-efficacy beliefs with respect to exercise are less likely to engage in it. Those who do not exercise regularly may have little confidence in their ability to exercise and may regard exercise as entailing nearly as many costs as benefits. Consequently, interventions aimed at modifying attitudes about the importance of exercise, especially for improving age-related cognitive deficits, and one’s ability to perform it might be successful for increasing exercise in older adults.

Answer 335

Convenient and easily accessible exercise settings lead to higher rates of adherence. f your exercise program is vigorous walking that can be undertaken near your home, you are more likely to do it than if your source of exercise is an aerobics program in a crowded health club ten kilometres from your home. Lack of resources for physical activity may be a particular barrier for regular exercise among those low of socio-economic status. Perhaps the best predictor of regular exercise is regular exercise. Studies that have assessed attitudinal and motivational predictors of exercise have found that, although exercise intentions are influenced by attitudes, long-term practice of regular exercise is heavily determined by habit. Developing a regular exercise program, embedding it firmly in regular activities, and practising it regularly for a period of time means that it begins to become automatic and habitual. However, habit has its limits. Unlike such habitual behaviours as wearing a seat belt or not lighting a cigarette, exercise requires additional thoughtfulness and planning, especially regarding its long-term benefits. Exercising takes willpower to overlook the initial short-term costs.

Answer 336

Across two studies, university students who had signed up for fitness classes at the university recreation centre were randomly assigned to one of three conditions (time-perspective intervention, goal-setting control, no intervention control) that preceded their scheduled fitness class. The time-perspective intervention included education and activities designed to make the participants more aware of the fact that a short-term time perspective inevitably highlights the immediate costs of exercise, whereas a long-term time perspective favours recognizing the obvious benefits of exercise. In addition, the researchers posited that simply making these observations would not be enough to change behaviour and therefore included activities that would help connect and reinforce the future consequences of the participants’ present behaviour. For example, in one, exercise participants generated lists of the immediate costs and benefits of exercise and then contrasted them to the long-term costs and benefits in order to recognize that the long-term benefits outweigh the short-term costs. Those who received the goal-setting intervention engaged in activities similar to the time-perspective intervention (e.g., goal setting, cost and benefits of exercise) but without any short- or long-term time perspectives imposed. Finally, those in the no-intervention group attended their fitness class as usual without any special intervention. In the first study, all students completed measures of physical activity levels and time perspective for exercise before starting the program and then at three and seven weeks later. Controlling for pre-intervention levels of physical activity, those who received the time-perspective intervention increased their monthly physical activity by almost 11 hours, compared to an increase of less than three hours reported by those who received the goal-setting intervention, and an increase of less than one hour reported by those who received no intervention. In addition, participants who received the time intervention experienced an increase in their long-term thinking about exercise. In the second study, participants were followed up six months after the intervention and similar increases in exercise behaviour were found, although long-term thinking about exercise did not change. However, those who initially had a tendency to think long term about exercise reported higher levels of physical activity six months later, suggesting that individual differences in time perspective can influence exercise behaviour even without any intervention (P. A. Hall & Fong, 2003). Thus, interventions that target an individual’s time perspective, such as goal setting and focusing on the long-term benefits of exercise before an exercise program is started, may be one way to help encourage long-term exercise participation.

Answer 337

The theory of planned behaviour can also be used to explain participation in exercise programs. For example, a study of 94 people newly enrolled at a gym found that participation was predicted from initial perceived behavioural control, and stable exercise habits developed during exercise participation further increased perceptions of behavioural control over the ability to exercise, which in turn contributed to successful maintenance of exercise behaviour. Cognitive-behavioural strategies—including contingency contracting, self-reinforcement, self-monitoring, and goal setting—have also been employed in exercise interventions and appear to promote adherence. With older adults, even simple telephone or mail reminders may help maintain adherence to a physical activity program.

Answer 338

Stages of change identified by the transtheoretical model of behaviour change suggest that different interventions should be targeted to people at different stages of readiness to exercise. For example, people who are contemplating starting an exercise program may perceive practical barriers to it, which can be attacked through persuasive communications. Those people already engaged in exercise, however, face the problem of maintenance and relapse to a sedentary lifestyle, so interventions that provide successful techniques for not abandoning an exercise program may be more useful for them. Groups at particular risk for not exercising can be especially well served by stages of change interventions designed to increase exercise. These include sedentary mothers of young children and the frail elderly. ---> Several studies confirm the efficacy of the transtheoretical model of behavioural change (that is, the stages of change model) as successful in producing self-efficacy with respect to physical activity and higher levels of physical activity. Generally speaking, interventions designed to increase physical activity that are matched to the stage of readiness of the sample are more successful than interventions that do not have this focus.

Answer 339

Even minimal interventions to promote exercise are showing some success. In an intervention that mailed stage-targeted printed materials encouraging physical exercise to older adults, those who reported receiving and reading the intervention materials were significantly more likely to be exercising six months later. The advantage of such an intervention, of course, is its low cost and ease of implementation. One study of middle-aged and older adults found that a regular exercise program improved feelings of physical self-worth, physical condition, and health as long as 37 weeks later Incorporating exercise into a more general program of healthy lifestyle change can be successful as well. For example, among adults at risk for coronary heart disease, brief behavioural counselling matched to stage of readiness showed success in achieving maintenance to physical activity, as well as smoking reduction and reduction in fat intake (Steptoe, Kerry, Rink, & Hilton, 2001). Although interventions targeted to multiple behaviours are sometimes less easy to undertake because of their complexity, linking health habits to each other in a concerted effort to address risk can be successful, as this intervention study showed.

Answer 340

Because research has identified few individual differences, exercise-setting characteristics, or intervention strategies that promote long-term adherence, perhaps the best approach is to individualize exercise programs. Understanding an individual’s motivation and attitudes with respect to exercise provides the underpinnings for developing an individualized exercise program that fits the person well. If people participate in activities that they like, for which they can develop goals, and that they are motivated to pursue for the pleasure of exercising rather than for just achieving a specific outcome, exercise adherence will be greater). Ensuring that people have realistic expectations for their exercise programs may also improve long-term adherence.

Answer 341

There may be unintended negative effects of interventions to increase exercise that need to be guarded against in the design of any intervention program. For example, one study found that an intervention program directed to university men and women inadvertently promoted an increase in the desire to be thin, despite warnings about dieting. Such pressures can promote eating disorders. Otherwise, exercise interventions do not appear to have negative side effects.

Answer 342

Increasingly, people are turning to smartphone apps as a means to monitor their physical activity and weight management efforts. With more than 50 percent of the population owning a mobile or smartphone, this would appear to be the ideal way to effect health behaviour change on a larger scale. Despite the proliferation of different apps available, current evidence suggests that most people only implement a limited number of behaviour-change techniques, such as providing feedback, goal setting, modelling how to perform exercises, and providing exercise instructions. However, because behaviour-change theory suggests that individual techniques tend to be most effective when used together, individuals may have to use multiple apps to help them initiate and maintain their health behaviour change.

Answer 343

Despite the problems psychologists have encountered in getting people to exercise, to stay active, and to do so faithfully, the exercise level in the Canadian population has been rising. For example, the proportion of Canadians in the ten provinces who were moderately active in their leisure time rose from 43 percent to 52 percent from 1996–97 to 2005, and to 52.5 percent in 2009. This appears to be part of a larger trend toward increased physical activity among Canadians, as levels have been increasing since 1981. To be able to sustain and build on these changes in the future suggests that although the population may be aging, it may be doing so in a healthier way than in any previous generation.

Answer 344

However, in 2009, only 45.6 percent of Canadians over age 12 consumed the recommended minimum five servings of fruits and vegetables each day. Experts estimate the economic burden of a poor diet to be $6.3 billion annually, which includes $1.8 billion in direct health care costs

Answer 345

Dietary change is often critical for people at risk for or already diagnosed with chronic diseases, such as coronary artery disease, hypertension, diabetes, and cancer. These are diseases for which low-SES people are more at risk, and diet may explain some of the relation between low SES and these disorders. Research consistently shows that supermarkets in high-SES neighbourhoods 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

Answer 346

Dietary factors have been implicated in a broad array of diseases and risks for disease. Perhaps the best known is the relation of dietary factors to total serum cholesterol level and to low-density lipid proteins in particular. Although diet is only one determinant of a person’s lipid profile, it can be an important one because it is controllable and because elevated total serum cholesterol and low-density lipid proteins are risk factors for the development of coronary heart disease (CHD) and hypertension. Of dietary recommendations, 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 one of the most widely recommended courses of action.

Answer 347

Dietary habits have also been implicated in the development of several cancers. Findings from a large multinational prospective study conducted in Europe suggest links between a variety of different foods and increased and decreased risks of several cancers, including colorectal, stomach, prostate, and breast cancers. Dietary modification is also important for polyp prevention among individuals at risk for colorectal cancers, specifically a low-fat, high-fibre diet. It is estimated that the degree to which diet contributes to the incidence of cancer is over 20 percent.

Answer 348

The good news is that changing one’s diet can improve health. For example, a diet high in fibre may protect against obesity and cardiovascular disease by lowering insulin levels. A diet high in fruits, vegetables, whole grains, peas and beans, poultry, and fish, and low in refined grains, potatoes, and red and processed meats, has been shown to lower the risk of coronary heart disease in women. Modifications in diet can lower blood cholesterol level, and these modifications may, in turn, reduce the risk for atherosclerosis. A class of drugs called statins substantially reduces cholesterol in conjunction with dietary modification. In fact, the effects of statins are so rapid that low-density lipoprotein (LDL) cholesterol is lower within the first month after beginning use. Together, diet modification and a statin regimen appear to be highly successful for lowering cholesterol.

Answer 349

A controversial issue about diet that promises to occupy attention in years to come concerns reduced-calorie diets. In several organisms, caloric restriction or reduced-calorie diets have increased lifespan. It is not yet known if caloric restriction increases lifespan in humans, but experiments with nonhuman primates suggest that it may. There is already evidence that caloric restriction is associated with biomarkers that predict longevity in humans. Thus, in addition to changing specific patterns of food consumption in the future, we may also all be urged to reduce our caloric intake overall.

Answer 350

It is difficult to get people to modify their diet, even when they are at high risk for CHD or when they are under the instruction of a physician. Recall from Chapter 3 that health behaviours, including eating habits, become established by age 11 or 12. Dietary preferences may be therefore resistant to change, especially if the choice is not self-motivated. In addition, the typical reason that people switch to a diet low in cholesterol, fats, calories, and additives, and high in fibre, fruits, and vegetables is to improve appearance, not to improve health. Another difficulty with modifying the diet is the problem of maintaining change. Adherence to a new diet may be high at first, but it falls off over time. One reason is because of the factors that plague all efforts to change poor health habits: insufficient attention to the needs for long-term monitoring and relapse prevention techniques. In the case of diet, other factors are implicated as well: Self-management is essential because dietary recommendations may be monitored only indirectly by medical authorities, such as physicians. A strong sense of self-efficacy, motivation, and the perception that dietary change has important health benefits are critical to successfully making dietary change. Some dietary recommendations are restrictive, monotonous, expensive, and hard to find and prepare. Drastic changes in shopping, meal planning, cooking methods, and eating habits may be required. In addition, tastes are hard to alter. So-called comfort foods, many of which are high in fat and sugars, may help to turn off stress hormones, such as cortisol, thus contributing to eating things that are not good for us. Preferences for high-fat foods are so well established that people will consume more of a food they have been told is high in fat than one low in fat, even when that information is false. People who are high in conscientiousness and intelligence also seem to do a better job of adhering to a cholesterol-lowering diet, and people high in depression or anxiety are less likely to do so.

Answer 351

Stress has a direct effect on eating, especially in adolescence. Greater stress is tied to consuming more fatty foods and fewer fruits and vegetables, as well as to the lesser likelihood of eating breakfast, with more snacking between meals. Thus, stress may contribute to long-term risk for disease by steering the adolescents’ and young adults’ diet in an unhealthy direction. A lower-status job, high workload, and lack of control at work are also associated with less healthful diets, although scientists do not yet know exactly why. It may be that these factors enhance stress and that an unhealthy diet marked by comfort foods reduces it.

Answer 352

Many efforts to modify diet are done on an individual basis in response to a specific health problem or health risk. Physicians, nurses, dietitians, and other experts work with patients to modify a diet-responsive risk, such as obesity, diabetes, CHD, and hypertension. As with any health-habit change, the motivation to pursue dietary change and commitment to long-term health are essential ingredients for success. Any effort to change diet needs to begin with education and self-monitoring training because many people have a poor idea of the importance of particular nutrients and how much of them their diet actually includes; estimation of fat intake appears to be poor, for example.

Answer 353

Much dietary change has been implemented through cognitive-behavioural interventions. These include self-monitoring, stimulus control, and contingency contracting, coupled with relapse-prevention techniques for high-risk-for-relapse situations, such as parties or other occasions where high-fat foods are readily available. Motivational interviewing can also be successfully used to get people to increase their fruit and vegetable intake

Answer 354

Another method of dietary change adopts Prochaska’s transtheoretical stages of change model, which assumes that different interventions are required for people at different stages. Research shows that, among people given blood cholesterol tests and a questionnaire assessing diet, those already contemplating dietary change were more likely to enroll in an intervention than those at the stage of precontemplation.

Answer 355

Recently, efforts to intervene in the dietary habits of high-risk individuals have focused on the family group. There are several good reasons for focusing interventions on the family. When all family members are committed to and participate in dietary change, it is easier for the target family member to do so as well. Moreover, different aspects of diet are influenced by different family members. Regardless of whether wives do the shopping and food preparation, husbands’ food preferences can be a more powerful determinant of what the family eats if the couple does not have an egalitarian relationship style. In family interventions, family members typically meet with a dietary counsellor to discuss the need to change the family diet and ways for doing so. Although such family interventions were originally developed over 25 years ago, a recent study comparing outcomes of earlier programs to current programs suggests that they are just as effective, despite the fact that obesity rates have increased and the environment has become more obesogenic.

Answer 356

Many interventions have been implemented on the community level, and specifically within the school system. One study compared the nutrition programs among 282 schools in Nova Scotia and assessed the height, weight, and dietary intake of more than 5000 Grade 5 students to evaluate their potential effectiveness. Schools were categorized as not having a nutrition program, having a healthy-menu nutrition program, or having an intensive, multifaceted nutrition program. The students from the schools with the intensive program showed lower rates of obesity, healthier diets, and higher levels of physical activity than those from schools with or without a healthy menu. In fact, there were no differences between the latter two groups, suggesting that simply offering a healthy menu at school may not be sufficient to help reduce childhood obesity. A more recent approach to modifying diet has involved targeting particular groups for which dietary change may be especially important and designing interventions specifically directed to these groups. For example, the Kahnawake Schools Diabetes Prevention Project included both school-based and community-based activities to improve diet and lower the risk for diabetes among elementary school children in a Mohawk community near Montreal. One of the outcomes of this program was the development of a school nutrition policy that includes offering healthy foods in the school cafeteria and requiring students to bring healthy lunches and snacks to school Change can come from social engineering solutions to the problem, as well as from individual efforts to alter diet. Factors such as banning snack foods from schools, making school lunch programs more nutritious, and making snack foods more expensive and healthy foods less so will all make some inroads into promoting healthy food choices

Answer 357

Maintaining a proper diet and getting enough exercise jointly contribute to weight control. The importance of this issue has been highlighted in recent years because of the dramatic rise of obesity in the population. Consequently, our discussion on health-promoting and preventive behaviours will begin to cross the line into the area of health-compromising behaviours, as we will look at interventions both for normal, healthy adults to practise weight control, and for the obese, who may need to control their weight to promote their health.

Answer 358

All animals, including people, have sensitive and complex systems for regulating food. Taste has been called the chemical gatekeeper of eating. It is the most ancient of sensory systems and plays an important role in selecting certain foods and rejecting others. 1. Although the molecular pathways that govern weight gain and loss are not completely understood, scientists have a fairly good idea what some of these pathways are. A number of hormones control eating. Leptin and insulin, in particular, circulate in the blood in concentrations that are proportionate to body fat mass. They decrease appetite by inhibiting neurons that produce the molecules neuropeptide Y (NPY) and agouti-related peptide (AgRP), peptides that would otherwise stimulate eating. They also stimulate melacortin-producing neurons in the hypothalamus, which inhibit eating. 2. As may be evident, an important player in weight control is the protein leptin, which is secreted by fat cells. Leptin appears to signal the neurons of the hypothalamus as to whether the body has sufficient energy stores of fat or whether it needs additional energy. The brain’s eating control centre reacts to the signals sent from the hypothalamus to increase or decrease appetite. As noted, leptin inhibits the neurons that stimulate appetite and activates those that suppress appetite. These effects of leptin have made scientists optimistic that leptin may have promise as a weight-control agent, although thus far the promise of leptin as a pharmacological method of weight control has remained elusive. 3. Ghrelin may also play an important role, particularly in why dieters who lose weight often gain it back so quickly. Ghrelin stimulates the appetite by activating the NPY-AgRP-expressing neurons. It is secreted by specialized cells in the stomach, spiking just before meals and dropping afterward. When people are given ghrelin injections, they feel extremely hungry. Therefore, blocking ghrelin levels or the action of ghrelin may help people lose weight and keep it off 4. Studies with rats have suggested a possible brain mechanism for the control of at least some eating and its regulation. Rats who have a damaged ventromedial hypothalamus behave like obese humans do: They eat excessive amounts of food, show little sensitivity to internal cues related to hunger (e.g., how long it has been since they last ate), and respond to food-related external cues, such as the presence of food. This evidence implies that at least some obese humans have a malfunctioning ventromedial hypothalamus, which interferes with normal eating habits.

Answer 359

An excessive accumulation of body fat, believed to contribute to a variety of health disorders, including cardiovascular disease. ---> fat should constitute about 20 percent to 27 percent of body tissue in women and about 15 percent to 22 percent in men. Figure 4.3 presents guidelines from Health Canada for calculating your body mass index (BMI) and determining whether you are overweight or obese. The BMI nomogram is a graph for determining your BMI as a function of height on the x-axis and weight on the y-axis. A person’s BMI is the point on the chart where height and weight intersect.

Answer 360

The World Health Organization estimates that worldwide obesity has more than doubled since 1980, with more than 1.9 billion overweight adults worldwide in 2014, and of these, 600 million people are obese. The global epidemic of obesity stems from a combination of genetic susceptibility, the increasing availability of high-fat and high-energy foods, and low levels of physical activity. Although obesity is a worldwide problem, the obesity crisis is becoming a problem of increasing concern in Canada. Approximately one in five Canadian adults are obese, with more men than women falling into the overweight and obese categories. When the obese and overweight categories are combined, 61.8 percent of men (8.2 million) and 46.2 percent of women (6.1 million) faced health risks in 2014 because of their weight. What’s more, the obesity rates have doubled between 1981 and 2007–09. Considering that in Canada, five in ten women and seven in ten men consume more calories than what they need, these statistics are not surprising.

Answer 361

There is no mystery as to why people in Canada have become so heavy. The food industry spends approximately $600 million per year on ads and promotion for food. Portion sizes have increased, and healthful foods are often not available. The average Canadian’s food intake rose from 2356 calories a day in 1976 to 2788 by 2002, an 18 percent increase. Similarly, carbohydrate and fat consumption has increased 18 percent over the same time span. In addition, many Canadians get more calories from their snacks and beverages consumed between meals than from their meals.

Answer 362

Although the body mass index is a commonly used measure of risk for obesity, it is not without its limitations. For example, because BMI does not account for whether it is fat or muscle that is contributing to a person’s weight, it may tend to overestimate risk in people who are athletes or very fit. More importantly, it does not account for where the fat is distributed. Epidemiologic evidence suggests that abdominally localized fat (as opposed to excessive fat in the hips, buttocks, or thighs) is an especially potent risk factor for cardiovascular disease, diabetes, hypertension, and cancer. Assessing obesity by measuring the waist-to-hip ratio (WHR) or waist circumference (WC) may therefore be better indicators of risk for obesity-related illnesses ---> For example, in a study using the Canadian 2007–09 Health Measures Survey data, both BMI and WHR were associated with cardiovascular disease risk factors. However, among men and women within the so-called normal BMI range, in a 12-year Norwegian population-based study, WHR was the best predictor of cardiovascular disease mortality in comparison to other obesity measures, whereas BMI was the weakest indicator. Sometimes called “stress weight,” abdominal fat increases especially in response to stress. People with excessive central weight (sometimes called “apples,” in contrast to “pears,” who carry their weight on their hips) are more psychologically reactive to stress and show greater cardiovascular reactivity and neuroendocrine reactivity to stress. This reactivity to stress may be the link between centrally deposited fat and increased risk for diseases. Inasmuch as uncontrollable stress may contribute to mortality risk from such diseases as hypertension, cancer, diabetes, and cardiovascular disease, abdominally localized fat may represent a sign that health is eroding in response to stress.

Answer 363

Obesity is a risk factor for many disorders, both in its own right and because it affects other risk factors, such as blood pressure and plasma cholesterol level. Estimates suggest that more than 4000 deaths annually in Canada can be directly attributed to overweight and obesity. This number increases dramatically when deaths attributed to obesity causing diabetes, cardiovascular disease, and certain cancers are included. Obesity has been associated with atherosclerosis, hypertension, diabetes, gallbladder disease, and arthritis; obesity is also a risk for heart failure. Increased body weight contributes to increased death rates for all cancers combined and for the specific cancers of colon, rectal, liver, gallbladder, pancreas, kidney, esophagus, non-Hodgkin’s lymphoma, and multiple myeloma. Obesity also increases risks in surgery, anesthesia administration, and child-bearing, as well as increasing the risk of stroke during and after pregnancy. Recognizing these risks and their impact on the health of future Americans, the American Medical Association officially classified obesity as a disease as of June 2013.

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