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Introduction: The Links Between Health and BehaviorChapter 1

Edberg, M. C. (2015). Essentials of Health Behavior: Social and Behavioral Theory in Public Health. (2nd ed.). R. Riegelman (Ed.). Burlington, MA: Jones and Bartlett Learning

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Introduction

How do you define: Health Social and Behavioral Sciences Health Behavior

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WHO definition of Health World Health Organization

Health is a state on complete physical, mental, and social well-being and not merely the absence of disease or infirmity Reference: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York,

19-22 June, 1946)

This is a biopsychosocial approach to health

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Social and Behavioral Sciences

Defining social and behavioral – Social

Cultural (race, ethnicity, gender), economics, demographic (age, geography) and social contexts (group dynamics)

Refers to interactions of organisms and other organisms, their collective co-existence, & voluntary or involuntary interaction

Reference: Sydnor, 2012

Behavioral Actions that derive from cognition (thinking), emotion (feeling), temperament

(predispositions), and motivation Reference: Report – Social Science Research at NIH

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Health Behavior

What influences health behavior? Motives Causal and contributing factors Contexts Cues Other issues related to why people do what they do

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Sam Brushing his teeth

Influences Health purposes To look like a male icon (cultural factor) To stand out from the crowd & be as attractive as possible

to a person of the opposite sex, & a special person at that (related to #2, with a little biology thrown in)

Habit Not wanting bad breath Family/personal income, status, insurance coverage

(concerned about maintaining health because dentist is out of reach, no money to pay, therefore overly concerned with preventing health issues)

Influence from parents

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Health Behavior

Field of study and practice concerning the complex nature of health behavior

The goal is to implement programs and interventions that seek to promote change in behavior to improve the health of the public or a segment of the public.

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Programs and Interventions Campaigns to stop smoking

Warnings on advertisements and cigarette packaging

Lawsuits against tobacco companies

TV ads and school programs warning young people about drug and alcohol use, or about drinking and driving (MADD, Say no)

Public campaigns, billboard ads, metro and bus ads, internet pop-ups

Public campaigns, including billboard ads, metro and bus ads, internet pop-ups, and TV ads, about the risks of transmitting HIV and the benefits of HIV testing (Greater than Aids)

Public campaigns about cardiovascular health and diet, low-carb diets, or low-cholesterol food choices (Let’s move – Michelle Obama)

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Tobacco Use Tobacco use remains the single largest preventable cause of morbidity

(disease) and mortality (death)

Cigarette smoking kills more than 480,000 Americans each year

20 million American deaths since 1964

Tobacco use, smoking, and second hand smoking are linked to: Lung cancer, diabetes, stroke, blindness, cataracts, ectopic pregnancies,

coronary heart disease, pneumonia, erectile dysfunction, decreased immune function, arthritis, asthma, tuberculosis, chronic obstructive pulmonary disease, and other respiratory issues

Reference: CDC Reference: Surgeon General’s Report

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Smoking Campaigns

Warnings on advertisements

cigarette packaging

lawsuits against tobacco companies

Smoking Prevalence in the United States 42.4% in 1965 vs. 17.8% in 2013Reference: CDC

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Smoking Campaigns

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The Public Health Question Why do people behave in healthy or unhealthy ways?

Why do people do what they do?

What influences or motivates behavior or health behavior?

Are there factors at play: Culture Socioeconomic circumstances Environmental conditions Public policies and regulations Factors outside of our control

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The Complex Social-Ecological Web

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Social-Ecological Web

Proposes the idea that human behavior regarding health and other issues are influenced by a complex and sometimes random group of factors

Ecological Model Focus on the multiplicity of influences on behavior Assumptions

No single factor influences people’s behavior A complex interaction between individuals and an environment is a process that

influences behavior

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Social Determinants

Social Determinants of health Societal conditions in which people are born, grow, live, work, and age that

predispose health inequities Reference: WHO

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Health Inequity

Health Inequities “are avoidable inequalities in health between groups of people within

countries and between countries. These inequities arise from inequalities within and between societies.”

Reference: WHO

“are differences in health that are not only unnecessary and avoidable but, in addition, are considered unfair and unjust.  Health inequities are rooted in social injustices that make some population groups more vulnerable to poor health than other groups.”

Reference: http://www.bphc.org/chesj/about/Pages/WhatisHealthEquityDisparities.aspx

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Health Disparities

Health disparities: are preventable differences in the burden of disease, injury, violence, or

opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”

Health disparities result from multiple factors, including Poverty Environmental threats Inadequate access to health care Individual and behavioral factors Educational inequalities

Reference: http://www.cdc.gov/healthyyouth/disparities/

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Health Disparities

Healthy People 2020 defines a health disparity as: “a particular type of health difference that is closely linked with social,

economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”

Reference: http://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities#6

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Contributors to Behavior

1. Individual factors Awareness and knowledge Biophysical characteristics Personal attitudes and motivations Developmental stage Behavior/habit socialization

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Contributors to Behavior

2. Social/cultural/group factors Social/peer group lifestyle patterns Cultural attitudes/beliefs (and their implications for health)

Culture defined as shared beliefs, attitudes, values, and behaviors (Flores, 2000).

Refers to the “sum total of the attainment and learned behavior patterns of any specific period, race or people (Funk and Wagnalls Standard Desk Dictionary)

Level of social support Social Support defined as “resources provided by other persons” (Cohen and Syme,

1985). Social support leads an individual to believe that he or she is cared for and loved, is esteemed and valued and belongs to a social network (Cobb, 1976). Types of support include emotional, instrumental or practical, negative interaction (Marmot & Wilkinson, 2006).

Religion

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Contributors to Behavior

3. Socioeconomic and structural factors Poverty Education Access to health care and prevention services/information Social stressors such as civil strife, neighborhood violence, racial and other

discrimination Access to clean water

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Socioeconomic Status (SES)

Social standing or class of an individual or group.

Based off of the total measure of a person’s work experience and of an individual’s or family’s economic and social position in relation to others” (Glanz, Rimer, Viswanath (eds.), 2008).

Indicators of SES Income Education Occupation

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Contributors to Behavior

4. Political Factors Policies and funding for health promotion programs Health insurance Regulations that affect health risk

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Contributors to Behavior

5. Environmental factors Presence of an environmental risk, such as air or water pollution Disasters Conditions for spread of an infectious disease

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Contributors to Behavior

Factors operate together and can influence health behavior and health outcomes

Ecology Describes a system of relationships A system of interactions between organisms and in environment The complex relationships among organisms in the system (niches) The dependent relationship among members/components of the system,

where if one part of the system is disturbed, other parts will be affected