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Lifestyles and health behaviour
determinants of health-enhancingbehaviours
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What are health behaviours?
Kasl and Cobb (1966) defined three types ofhealth related behaviours. They suggested that;
a health behaviour is a behaviour aimed at preventingdisease (e.g. eating a healthy diet);
an illness behaviour is a behaviour aimed at seeking a
remedy (e.g. going to the doctor); a sick role behaviour is an activity aimed at getting
well (e.g. taking prescribed medication or resting).
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What are health behaviours?
Health behaviours have also being defined by
Matarazzo (1984) in terms of either: Health impairing habits, which he called "behavioural
pathogens" (for example smoking, eating a high fat
diet), or
Health protective behaviours, which he defined as"behavioural immunogens" (e.g. attending a health
check).
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Behaviour and mortality
50% of mortality from the 10 leading causes of death isdue to behaviour.
Doll and Peto (1981) estimated that 75% of cancerdeaths were related to behaviour. 90% of all lung cancermortality is attributable to cigarette smoking, which is alsolinked to other illnesses such as cancers of the bladder,
pancreas, mouth, and oesophagus and coronary heartdisease. Bowel cancer is linked to behaviours such as adiet high in total fat, high in meat and low in fibre.
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ifestyle andhealth
About 50% of premature deaths in western
countries can be attributed to lifestyle(Hamburg et al., 1982). Smokers, on average,
reduce their life expectancy by five years and
individuals who lead a sedentary (i.e. none
active) lifestyle by two to three years
(Bennett and Murphy, 1997).
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ifestyle andhealth
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Holy Four
Four behaviours in particular are associated withdisease: smoking, alcohol misuse, poor nutrition
and lower levels of exercise; these are called theholy four.
Conversely, rarely eating between meals, sleepingfor seven to eight hours each night, and eating
breakfast nearly every day have been associatedwith good health and longevity (Breslow andEnstrom 1980). Recently high-risk sexual activityhas been added to the risk factor list.
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Belloc and Breslow (1972)
Belloc and Breslow (1972) conducted an
epidemiological study asking a representativesample of 6928 residents of Almeida County,
California whether they engaged in the
following seven health practises:
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Belloc and Breslow (1972)
1. sleeping seven to eight hours daily
2. eating breakfast almost every day
3. never or rarely eating between meals
4. currently being at or near prescribed heightadjusted weight
5. never smoking cigarettes6. moderate or no use of alcohol
7. regular physical activity.
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Positive attitude
Having a positive attitude towards lifehas been found to increase longevity
(Levy et al, 2002).The team used datagathered in 1975 in Oxford, Ohio, wherealmost everybody over 50 wasquestioned about their life and health. By
tracing the deaths of participants over 23years, the team was able to matchlifespan against attitudes towards ageingexpressed at the start.
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Positive attitude
Participants had been asked to agree or disagree
with statements such as: Things keep getting
worse as I get older or I have as much pep as I
did last year or I am as happy now as I was when
I was younger. The participants were scored on a
scale of zero to five, in which five represented the
most positive attitude towards growing older and
zero the most negative.
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Positive attitude
In theJournal of Personality and Social
Psychology, the team says that the median
survival for the most negative thinkers was
15 years, while for the most positive it was
22.5 years.
Controlling for age, sex, wealth, health and
loneliness did not alter the finding.
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Evaluation
There are several methodological criticisms that canbe made of the original study by Belloc andBreslow and the follow-up studies. First, the sampleis not particularly representative as all the
participants came from the same area in the USA.
Second, the study establishes a correlation betweenseven specific health preventive behaviours andlongevity, but does not prove that these behavioursactually caused some of the participants to livelonger. It is possible, although unlikely, that someother factorpersonality, for exampleaffected
both behaviour and lifespan.
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Evaluation
The behavioural change approach to promoting
health raises a couple of ethical issues. First, it can
lead to victim-blaming. If we believe too stronglythat individuals can prevent themselves from falling
ill by choosing to carry out health preventive
behaviours, then we may go on to blame those
individuals for failing to protect their own health ifthey do fall ill.
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Evaluation
There have been cases where doctors haverefused to treat certain patients because they
felt that they had brought their illnesses onthemselves. The greatest contributions tohealth have been through developments inmedical science and through public health
initiatives such as improved sanitation, andnot through individual behavioural change.
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Evaluation
The second problem with the behavioural
change approach is the narrow line that
exists between persuading someone tochange his or her behaviour and coercion.
Do we have a right to assume that we
know better than someone else what is
best for their own health, and to forcethem to change their behaviour?
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Genetic theories
Is it possible, however, for apersonsgenetic
inheritance to directly affect their health-
related behaviour? It may be, for example,
that alcoholism is partly hereditary. In his
book on this topic, Sher (1991) describes
evidence that the children of alcoholics aremore likely to become alcoholic themselves.
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Genetic theories
Although it is notoriouslydifficult to determine whether
a correlation such as this isdue to genetic factors or arisesas a result of social learning,some psychologists argue that,
although there probably is nosuch thing as an alcoholismgene, certain geneticallyinherited personality traits
may pre-dispose an individualtowards alcohol abuse.
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Family genetics and history of
dietary risk factors. Several studies have provided evidence
that family history of dietary risk factors
may be related to adolescents foodpreferences. Fischer and Dyer (1981)reported that family history of obesity wasrelated to increased intake of sweets, dairy
products, and fatty foods in a sample of116 high school girls. Their results alsoindicated that having a family history ofheart problems was related to decreased
consumption of milk, eggs, and saltyfoods.
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Family genetics and history of
dietary risk factors. Levine, Lewy, and New (1976) found a
family history of hypertension to beassociated with a greater prevalence of
obesity among African Americanadolescents. Some investigators havealso analyzed dietary intake among twin
populations as evidence of a genetic
variance for nutrient intake. In one ofthese studies, De Castro (1993) foundsignificant heritabilities for identical andfraternal twins with regard to the
amount of food energy andmacronutrients eaten daily.
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Family genetics and history of
dietary risk factors. In contrast, Fabsitz, Garrison, Feinleib, and
Hjortland (1978) demonstrated that, in addition to a
genetic variance, environmental effects (e.g., howfrequently twins saw each other) were important inaccounting for similarities in twins nutrientintakes. These results suggest that there may be an
interaction between genetic and environmentalfactors that influence eating behaviors amongadolescents.
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Genetic theories
Genetic theoriessuggest that there may be agenetic predisposition to becoming an
alcoholic or a smoker. To examine theinfluences of genetics, researchers haveexamined either identical twins reared apartor the relationship between adoptees and
their biological parents. Thesemethodologies tease apart the separateeffects of environment and genetics.
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Genetic theories
In an early study on genetics and smoking, Sheilds(1962) reported that of 42 twins reared apart, only 9
were discordant (showed different smokingbehaviour). He reported that 18 pairs were bothnon-smokers and 15 pairs were both smokers. Thisis a much higher rate of concordance than predicted
by chance. Evidence for a genetic factor in smokinghas also been reported by Eysenck (1990) and in anAustralian study examining the role of genetics in
both the uptake of smoking (initiation) and
committed smoking (maintenance) (Murray et al.1985).
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Genetic theories
Research into the role of genetics inalcoholism has been more extensive
and reviews of this literature can befound elsewhere (Peele 1984;Schuckit 1985). However, it has beenestimated that a male child may be
up to four times more likely todevelop alcoholism if he has abiological parent who is an alcoholic.
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Behaviourist learning
theories Classical conditioning is a process in which
the individual associates an automatic
response with a neutral stimulus. Ivan Pavlov(18491936) described this process after henoticed that laboratory dogs would salivate
when he turned a light on because they hadlearnt to associate the light with the presenceof food.
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Behaviourist learning
theories
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Behaviourist learning
theories Classical conditioning could explain certain health-
related behaviours such as comfort eating, for
example. If a parent regularly offers a child sweetsor chocolate at the same time as physical andemotional affection, then the child may learn toassociate sweet foods with the reassuring feelings
that arise out of parental love. In later life, the childmay try to recreate these pleasant feelings by eatingchocolate when he or she is stressed or depressed.
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Behaviourist learning
theories
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Operant conditioning
Operant conditioning is when people respond to
reward or punishment by either repeating a
particular behaviour, or else stopping it. If anindividual carries out a behaviour that clearly seems
to be bad for his or her health, such as smoking
cigarettes, a deeper look may well reveal benefits
for the individual, such as social approval, the
nicotine buzz and so on.
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Operant conditioning
A striking example of how operant conditioning canaffect health behaviour is the study by Gil et al
(1988). They conducted research on childrensuffering from a chronic skin disorder that causessevere itching. They videotaped the children withtheir parents in the hospital and observed that when
parents tried to stop their children scratching (inorder to prevent peeling and infection) this actuallyincreased the scratching behaviour by rewarding itwith attention.
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Operant conditioning
When they asked parents to ignore their childrenwhen they scratched and give them positive
attention when they did not scratch, the amount ofscratching was significantly reduced.
Drinking, eating, smoking, drug and sexualaddictions all have the irrationalcharacteristic that
the total amount of pleasure gained from theaddiction seems much less than the suffering caused
by it. According to learning theorists, the reason forthis lies in the nature of the gradient of
reinforcement.
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Operant conditioning
Addictive behaviours are typically those inwhich pleasurable effects occur rapidly after
the addictive behaviour while unpleasantconsequences occur after a delay. The simplemechanism of operant conditioning and the
gradient of reinforcement is able, as it were,to overpower the mindscapacity for rationalcalculation.
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Social learning
Social learning occurs when an individual
observes and imitates another persons
behaviour, either because the individual
looks up to that person as a role model or
else through vicarious reinforcement
that is, .the individual sees the person beingrewarded for his or her actions.
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Social learning
Social learning can clearly be very influentialin encouraging people to do things that are
bad for their health (for example, a teenagermay take up smoking because he or she hasan admired elder brother who smokes, or
may try illegal drugs because he or she seesother people taking them and having a goodtime).
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Social learning
Another example of how vicarious reinforcement can lead tounhealthy behaviour concerns young women with eatingdisorders, who see images of very thin models in magazines
being rewarded with success, money, glamour and fame. Onthe other hand, many health promotion campaigns use
positive role models to try to get people to lead healthierlifestyles. The advertising industry, whose reason for
existing is to persuade people to change their behaviour,often depicts successful, good-looking and happy peopleusing a certain product in the hope that this will make others
want to use the product as well.
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Social learning
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self-efficacy
Bandura (1977) has been particularly influential in
emphasising the importance of learning by
imitation in linking it to his concept of self-efficacy,personality traits consisting of having confidence in
ones ability to carry out ones plans successfully.
People with lower self-efficacy are much more
likely to imitate undesirable behaviours than those
with higher self-efficacy.
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self-efficacy
Heather and Robertson (1997) give a usefuldiscussion of the application of these principles to
drinking. Patterns of drinking by parents areobserved by children who may then imitate them inlater life, especially the behaviour of the same sex
parents. In adolescence, the drinking behaviour of
respected older peers may also be imitated, andsubsequently that of higher status colleagues atwork, a phenomena, which may explain the
prevalence of heavy drinking in certain professionssuch as medicine and journalism.
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Commentary
Many psychologists criticize behaviourist-learning theories on the grounds that they are
too mechanistic. In other words, theyassume that human beings respondautomatically to specific situations. Not onlydoes this imply a lack of freewill, but also italso ignores the effect on behaviour ofcognitive factors.
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Social and environmental
factors There are many different social and environmental
factors contributing to peoples health behaviour.
For example, a common explanation for youngpeople taking drugs or smoking cigarettes is peer
pressure. It may be that people imitate their peers
because of the explanation given above that is,
vicarious reinforcement; they see others getting a
reward for a certain behaviour, so they copy it.
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Social and environmental
factors Social factors such as culture influence
dietary behaviour. Culture affects an
individuals food selection, preparation, andeating patterns. Certain tastes or food areassociated with specific feelings andmeanings within a culture (for example, soulfood may denote fried and barbecue meatswithin the African American community).
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Social and environmental
factors Mexican American women often feel
uncomfortable with focusing on themselves
as individuals therefore a successful
approach to losing weight would target the
whole family rather than the individual
woman (Foreyt et al, 1991).
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Social and environmental
factors Television advertising also exerts a larger influence
over dietary behaviour. Advertisers often target
adolescents by promoting fast foods high in fat,cholesterol, sodium, and sugar. It has been foundthat childrens television viewing positivelycorrelates with smoking behaviour and attempts to
influence parents shopping selections (Dietz andGortmaker, 1985). Television viewing is alsohighly correlated with obesity in children (Bowen etal, 1991).
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Commentary
Conformity does not exert an equallystrong influence in all situations and with
all individuals, It is likely to be morepowerful in ambiguous situations, whenothers are perceived as having moreexpertise, or when the individual has lowself-confidence, poor self-esteem and aweak sense of self-efficacy.
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High-risk sexual behaviour
Hawkins et al. (1995) reported that the mostfrequent safer sex behaviour amongst well-educated
heterosexual students was the use of thecontraceptive pill. The least frequent sexual
practice, reported by only 24% of the sample, wasthe use of condoms. An important factor is that the
majority of young persons do not see themselves asat risk of HIV infection or have feelings ofinvulnerability towards the disease.
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Exercise
Those who are physically active throughout the adultlife live longer than those who are sedentary.
Paffenburger et al (1986) monitored leisure timeactivity in a cohort of 17000 Harvard graduatesdating back to 1916. Using questionnaires it wasfound that those who were least active after
graduation had a 64% increased risk of heart attackcompared with their more energetic classmates.Those who expended more than 2000 calories ofenergy in active leisure activities per week lived, onaverage, two and a half years longer than thoseclassified as inactive.
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Exercise
About a quarter of the UK population engage in healthpromoting levels of exercise, with a similar picture
in the USA. In recent years these levels havedramatically increased. For example in Wales 20%of men and 2% of women took sufficient exercisein 1985 but by 1990 this had increased to 27% of
the population. Those who engage in exercise aremore likely to be young, male and well-educatedadults, members of higher socio-economic groups,and those who have exercised in the past.
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Exercise
Those least likely to exercise tend to be in the lower
socio-economic groups, older individuals, and those
whose health is likely to be at risk as a consequenceof being overweight and smoking cigarettes
(Dishman 1982). Obstacles to exercise include not
having enough time, lack of support from family or
friends and perceived incapacity due to ageing.
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five different types of exercise.
Brannon & Feist (1997) describe five
different types of exercise.
1.Isometric exercise involves pushing the
muscles hard against each other or against an
immovable object. The exercise strengthens
muscle groups but is not effective for overall
conditioning.
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five different types of exercise.
2. Isotonic exercise involves the contraction
of muscles and the movement of joints, as
in weight lifting. Muscle strength and
endurance may be improved but the general
improvement is in body appearance rather
than improving fitness and health.
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five different types of exercise.
3. Isokinetic exercise uses specialised
equipment that requires exertion for lifting
and additional effort to return to the starting
position. This exercise is more effective
than both isometric and isotonic exercise
and promotes muscle strength and muscleendurance (Pipes and Wilmore, 1975).
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five different types of exercise.
4. Anaerobic exercise involves short, intensive
bursts of energy without an increased amount of
oxygen such as in short distance running. Suchexercises improve speed and endurance but do not
increase the fitness of the coronary and
respiratory systems and indeed may be dangerous
for people with coronary heart disease.
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five different types of exercise.
5. Aerobic exercise requires dramatically increasedoxygen consumption over an extended period of
time such as in jogging, walking, dancing, ropeskipping, swimming and cycling. The heart ratemust be in a certain range which is computedfrom a formula based on age and the maximum
possible heart rate. The heart rate should stay atthis elevated level for at least 12 minutes, andpreferably 15 to 30 minutes. This exerciseimproves the respiratory system and the coronarysystem.
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Organic & Dynamic Fitness
Kuntzleman (1978)
Organic fitness-our capacity for action andmovement determined by inherent factors
such as genes, age and health status.
Dynamic fitness-determined by our
experience.
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London bus crews
Maurice et al. (1953)studied London double
decker bus drivers andtheir conductors. Themore active conductorshad significantly less
incidence of C. H. D.than did the sedentarydrivers. Can you thinkof any confoundingfactors in this study?
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Exercise
Exercise has been found to lower depressivemoods in a variety of people, including
young pregnant women from ethnicallydiverse backgrounds (Koniak-Griffin, 1994)and nursing home residents aged 66 to 97(Ruuskanen and Parkatti, 1994). Thesefindings could be due to the release ofendogenous Opiates during exercise.
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Exercise
Exercise is a buffer against stress. This could be
because of the positive effect on the immune
system. Exercise produces a rise in natural killercell activity and an increase in the percentage of T-
cells (lymphocytes) that bear natural killer cell
markers (indicating the sites where killer cells are
produced). This warns off invading cells before
they have the chance to harm the body.
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Exercise
Both exercise and stress reduce adrenaline andother hormones yet exercise has a beneficial effect
on heart functioning whereas stress may producelesions in heart tissue. In exercise adrenalinemetabolises differently and is released infrequentlyand gradually under conditions for which it was
intended (e.g. jogging). In conditions of stressadrenaline is discharged in a chronic and enhancedmanner.
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ietary habits The MRFIT study (Stamler et al. 1986), was a
longitudinal study over six years of three hundred
and fifty thousand adults. A linear relationship wasfound between blood cholesterol level and the
incidence of coronary heart disease (CHD) or
stroke. The risk for individuals within the top third
of cholesterol levels was three and a half times
greater than those in the lowest third.
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ietary habits A 24 year longitudinal study of American
men working for western electricity found
that men who consumed high levels ofcholesterol were twice as likely to developlung cancer compared with men whoconsumed low levels of cholesterol. Much ofthe cholesterol came from eggs (Shekelle etal, 1991).
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ietary habits High fibre diets protect men and women
from cancer of the colon and the rectum.
Fibre from fruits and vegetables offer moreprotection against colon cancer than thatfrom cereals and other grains. Fruitconsumption offers protection against lungcancer and we should be eating fruit 3 to 7times per week (Fraser et al, 1991).
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Obesity and eating disorders
More than a quarter of children in Englishsecondary schools are clinically obese,
almost double the proportion a decadeago, and an official survey released in
April 2006 also showed that girls weresuffering more than boys from a crispand chocolate-fuelled life of too mucheating and too little exercise.
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Obesity and eating disorders
Researchers measured the height andweight of 11-15 year olds, and found
26.7% of girls and 24.2% of boysqualified as obese - nearly double therate in 1995. Among children aged 2-10,12.8% of girls and 15.9% of boysweighed above the obesity threshold -also well up on 10 years before.
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Obesity and eating disorders
The increase in obesity accelerated
sharply in 2004, especially among girls,
the survey said. Figures for the 11-15
age group showed the proportion of
obese girls grew from 15.4% in 1995 to
22.1% in 2003. But in 2004 it shot up to26.7%.
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Obesity and eating disorders
The survey also found that the obesityrate among adults had risen to 24%, in
spite of people exercising more andeating more fruit and vegetables.
However, more men gave up smoking
than women, and in 2004 there were forthe first time more women smokers(23%) than there were men (22%).
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Obesity and eating disorders
Obesity is defined in terms of the percentageand distribution of an individual's body fat.
Techniques used to assess the body fat rangefrom using computer tomography (e.g.ultrasound waves) to magnetic resonanceimaging (MRI). Obesity may also be defined interms of body mass index (B. M. I.) which iscalculated by dividing a person's weight bytheir height squared using metric units (i.e.kilogrammes and metres squared).
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Obesity and eating disorders
Stunkarda (1984) suggested that obesityshould be categorised as either mild (20
to 40% overweight), moderate (41 to100% overweight) or severe (more than100% overweight). This would suggestthat 24% of American men and 27% of
American women are at least mildlyobese (Kuczmarski, 1992).
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Obesity
There are three different types of theories thatattempt to explain obesity; they are:
1. Physiologicaltheories suggesting that there are geneticelements.
2. Metabolic ratetheories proposing that obese peoplehave a lower resting metabolic rate, burn up less calorieswhen resting and therefore require less food. They also
tend to have more fat cells which are geneticallydetermined.
3. Behaviouraltheories suggest that obese people tend tobe less physically active and eat more food than required.
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Eating disorders
The two main eating disorders are anorexia
nervosaand bulimia.
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Anorexia
Individuals are diagnosed as anorexic only if they weigh atleast 15% less than their minimal normal weight and havestopped menstruating. In extreme cases, anorexics may
weight less than 50% of their normal weight. Weight lossleads to a number of potentially dangerous side-effects,including emaciation (wasting of the body), susceptibility toinfection and other symptoms of under nourishment.Females are 20 times more likely to develop anorexia thanmales. But horseracing Jockeys, who are usually male, aresusceptible to anorexia. Anorexia particularly affects white,Western, middle to upper class, teenage women.
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Anorexia
Another characteristic of anorexia nervosa is that of
distortion of body image. Anorexics think that they are too
fat. This was investigated by Garfinkel and Garner (1982).
Participants used a device that could adjust pictures of
themselves and others up to 20 per cent above or below their
actual body size. An anorexic was more likely to adjust the
picture of herself so that it was larger than the actual size.
They did not do the same for photographs of other people.
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Anorexia
American undergraduates were shown figures oftheir own sex and asked to indicate the figure that
looked most like their own shape, their ideal figureand the figure they found would be most attractiveto the opposite sex. Men selected very similarfigures for all three body shapes! Women choseideal and attractive body shapes that were muchthinner than the shape that was indicated asrepresenting their current shape. Women tended tochoose thinner body shapes for all three choices(ideal, attractive and current) compared to the men
(Fallon and Rozin, 1985).
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Anorexia
The perfect figure has changed over the
years. In the 1950s female sex symbols had
much larger bodies compared with present-
day female sex symbols.
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Anorexia
The hypothalamus is implicated in anorexia.
The hypothalamus controls both eating and
hormonal functions (which may also explain
irregularities in menstruation).
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Anorexia
Personality factors and family dynamics could alsoplay a part in anorexia. The anorexic lacks self-
confidence, needs approval, is conscientious, is aperfectionist and feels the pressure to succeed(Taylor, 1995).
Parental psychopathology or alcoholism also plays
a part as does being in an extremely close orinterdependent family with poor skills forcommunicating emotion or dealing with conflict(Rakoff, 1983).
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Anorexia
The mother daughter relationship has been
implicated. Mothers of anorexic daughters tend to
be dissatisfied with their daughter's appearance andtend to be vulnerable to eating disorders themselves
(Pike and Rodin, 1991).
Genetics could explain this result as De Castro
(2001)has found that identical twins have similar
eating patterns compared with fraternal twins
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Bulimia
Bulimia is characterised by recurrent episodes ofbinge eating followed by attempts to purge theexcess eating by vomiting or using laxatives. The
binges occur at least once a day usually in theevening and when alone. Vomiting and the use of
laxatives disrupts the balance of the electrolytepotassium resulting in dehydration, cardiacarrhythmias and urinary infections.
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Bulimia
This disorder mainly affects young women and ismore common than anorexia affecting five to ten%of American women. Bulimia is not confined tomiddle or upper-class females and transcends racial,ethnic and socioeconomic boundaries. Like
anorexia explanations encompass biological,personality and social factors. Bulimics often sufferfrom other disorders such as alcohol or drug abuse,impulsivity and kleptomania.
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Bulimia
It may be triggered by life events such as feelingguilty or feeling depressed. There is a stronger link
between depression and bulimia compared withdepression and anorexia. The depression seems to
be linked to a deficit in the neurotransmitter
substance serotonin. Bulimics may report lackingself-confidence and use food to fulfil their feelingsof longing and emptiness. The binge eating andvomiting is justified in terms of needing to have a
high calorie intake of food and a desire to stay slim.
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Bulimia
Treatment involves medication and cognitivebehavioural therapy. Antidepressants drugs are usedin combination with psychotherapy. Treatment for
bulimia tends to be more successful becausebulimics recognise that they have a problem
whereas anorexics don't.
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Health and Poverty
It is important to point out that the most
damaging lifestyles for our health are those
associated with low incomes. Throughout theWestern world, the most consistent predictor
of illness and early death is income. People
who are unemployed, homeless, or on lowincomes have higher rates of all the major
causes of premature death (Fitzpatrick and
Dollamore, 1999).
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Health and Poverty
The reasons for this are not clear although
there are two main lines of argument. First, it
is possible that people with low incomesengage in risky behaviours more frequently,
so they might smoke more cigarettes and
drink more alcohol. This argument probablyowes more to negative stereotypes of
working-class people than it does to any
systematic research.
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Health and Poverty
The second line of argument is that poor
people are exposed to greater health risks in
the environment in the form of hazardousjobs and poor living accommodation. Also,
people on low incomes will probably buy
cheaper foods which have a higher content offat (regarded as a risk factor for coronary
heart disease).
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Health and Poverty
All this means that psychological
interventions on behaviour can only have a
limited effect, since it is economiccircumstances that most affect the health of
the nation.
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Health and Poverty
The effects of poverty are long lasting and
far-reaching. A remarkable study by Dorling
et al. (2000) compared late 20th centurydeath rates in London with modern patterns
of poverty, and also with patterns of poverty
from the late 19th century.
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Health and Poverty
The researchers used information from
Charles Booths survey of inner London
carried out in 1896, and matched it tomodern local government records.
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Health and Poverty
When they looked at the recent mortality
(death) rates from diseases that are
commonly associated with poverty (such asstomach cancer, stroke and lung cancer), they
found that the measures of deprivation from
1896 were even more strongly related tothem than the deprivation measures from the
1990s. They concluded that patterns of
disease must have their roots in the past.
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Health and Poverty
It is remarkable, but true, that geographical
patterns of social deprivation and disease are
so strong that a century of change in innerLondon has not disrupted them.
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Health and Poverty
Another study by Dorling et al. (2001)
plotted the mortality ratio (rate of deaths
compared to the national average) againstvoting patterns in the 1997 general election.
They divided the constituencies into ten
categories, ranging from those who had thehighest Labour vote to those who had the
lowest.
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Health and Poverty
The analysis found that the constituencies
with the highest Labour vote (72 per cent on
average) had the highest mortality ratio(127), and that this ratio decreased in line
with the proportion of people voting Labour,
down to the lower Labour vote (22 per centon average) where there was a much lower
mortality ratio (84).
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Health and Poverty
This means that early death, and presumably
poor health, was more common in areas that
chose to vote Labour. If we take Labourvoting as still being influenced by class and
social status then this study gives us another
measure of the effects of wealth on health.
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Health and Poverty
The influence of poverty shows up in a
number of ways. Glaucoma is a damaging
eye disease that can cause blindness ifuntreated. A study by Fraser et al. (2001)
looked at the differences between people
who sought medical help early (earlypresenters) and those who sought help for the
first time when the disease was already quite
advanced (late presenters).
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Health and Poverty
The late presenters were more likely to be in
lower occupational classes, more likely to
have left full-time education at age 14 oryounger, more likely to be tenants than
owner occupiers, and less likely to have
access to a car.
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Health and Poverty
It showed that a persons personal
circumstances and the area they lived in had
an effect on their decision to seek help withtheir vision. It also appeared that the disease
developed more quickly in people with low
incomes.
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Health and Poverty
One uncomfortable explanation of the
differences in mortality rates for rich and
poor might be that the poor receive worsetreatment from the NHS. Affluent women
have a higher incidence of breast cancer than
women who are socially deprived, but theyhave a better chance of survival.
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Health and Poverty
A study to investigate the care of the breast
cancer patients from the most and least well-
off areas in Glasgow was carried out byMacleod et al. (2000). They looked at
records from hospital and general practice to
evaluate the treatment that was given, thedelay between consultation and treatment,
and the type and frequency of follow-up care.
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Health and Poverty
The data showed that women from the
affluent areas did not receive better care from
the NHS. The women from the deprivedareas received similar treatment, were
admitted to hospital more often for other
conditions than the cancer, and had moreconsultations after the treatment than the
women from the affluent areas.
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Health and Poverty
Perhaps the reasons for the worse survival
rate of women from deprived areas are not
related to the quality of care, but to thenumber and severity of other diseases that
they have alongside the cancer.
THE TYPE A BEHAVIOUR
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THE TYPE A BEHAVIOURPATTERN
Do some lifestyles make people more vulnerable to
disease? Are we justified, for example, in
associating high stress behaviour with certain healthproblems such as heart disease? Friedman and
Rosenman (1959) investigated this and created a
description of behaviour patterns that has generated
a large amount of research and also become part ofthe general discussions on health in popular
magazines.
THE TYPE A BEHAVIOUR
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THE TYPE A BEHAVIOURPATTERN
Before we look at the work of Friedman and
Rosenman, it is worth making a
psychological distinction between behaviourpatterns and personality. Textbooks and
articles often refer to the Type A personality,
though, at least in the original paper, theauthors describe it as a behaviour pattern
rather than a personality type.
THE TYPE A BEHAVIOUR
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THE TYPE A BEHAVIOURPATTERN
The difference between these two is that a
personality type is what you are, whereas a
behaviour pattern is what you do. The importanceof this distinction comes in our analysis of why we
behave in a particular way (I was made this way
or I learnt to be this way), and what can be done
about it. It is easier to change a persons pattern oflearnt behaviour than it is to change their nature.
THE TYPE A BEHAVIOUR
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THE TYPE A BEHAVIOURPATTERN
Friedman and Rosenman devised a
description of Pattern A behaviour that they
expected to be associated with high levels ofblood cholesterol and hence coronary heart
disease. This description was based on their
previous research and their clinicalexperience with patients.
THE TYPE A BEHAVIOUR
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THE TYPE A BEHAVIOURPATTERN
A summary of Pattern A behaviour is given
below:
(1) an intense, sustained drive to achieve
personal (and often poorly defined) goals
(2) a profound tendency and eagerness to
compete in all situations (3) a persistent desire for recognition and
advancement
THE TYPE A BEHAVIOUR
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THE TYPE A BEHAVIOURPATTERN
(4) continuous involvement in several activities
at the same time that are constantly subject to
deadlines (5) an habitual tendency to rush to finish
activities
(6) extraordinary mental and physical alertness.
THE TYPE A BEHAVIOUR
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THE TYPE A BEHAVIOURPATTERN
Pattern B behaviour, on the other hand, is the
opposite of Pattern A, characterised by the
relative absence of drive, ambition, urgency,desire to compete, or involvement in
deadlines.
Research into type A
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Research into type Abehaviour
The classic study of Type A and Type B
behaviour patterns was a twelve-year
longitudinal study of over 3,500 healthymiddle-aged men reported by Friedman and
Rosenman in 1974. They found that,
compared to people with the Type Bbehaviour pattern, people with the Type A
behaviour pattern were twice as likely to
develop coronary heart disease
Research into type A
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Research into type Abehaviour
Other researchers found that differences in
the kinds of Type A behaviour correlated
with different kinds of heart disease: anginasufferers tended to be impatient and
intolerant with others, while those with heart
failure tended to be hurried and rushed,inflicting the pressures on themselves.
Research into type A
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Research into type Abehaviour
Recent reviews of Type A behaviour suggest
that it is not a useful measure for predicting
whether someone will have a heart attack ornot. Myrtek (2001), for example, looked at a
wide range of studies on this issue and
concluded that measures of Type A and ofhostility were so weakly associated with
coronary heart disease as to make them no
use for prevention or prediction
Research into type A
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Research into type Abehaviour
The lasting appeal of the Type A behaviour
pattern is its simplicity and plausibility.
Unfortunately, health is rarely that simpleand the interaction of stress with
physiological, psychological, social and
cultural factors cannot be reduced to twosimple behaviour patterns.
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RELIGIOSITY AND
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RELIGIOSITY ANDHEALTH
It was not a very diverse sample, as they
were mostly selected from white middle-
class families, but this apparent weakness isa strength if we want to look at the effect of
selected variables that do not include
ethnicity and class.
RELIGIOSITY AND
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RELIGIOSITY ANDHEALTH
Data was collected over the years and in
1950 (when the participants were aged about
40) they were asked about their religiosity ona four-point scale (not at all: little: moderate:
strong). Forty years later the researchers
were able to compare this data against themortality of the sample.
RELIGIOSITY AND
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RELIGIOSITY ANDHEALTH
To cut to the chase, once the researchers had
accounted for all the other variables they
were able to say that people who were morereligious lived longer (Clark et al. 1999).
Th d
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The end