Health Psychology

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Health Psychology

• Lecture 4
• Health Behaviors

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Lecture 4 - Outline

• Part 1
• Health Promoting Behavior
• Diet
• Exercise
• Part 2
• Health Harming Behavior
• Smoking
• Alcohol
• Part 3
• Self-Change (Goal setting theory and false hope
  syndrome)

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Question

• How strong is the link between behavior and
  health?

• Genetics 20
• Medical care 10
• Other factors 30
• Behavior 40

Kaplan et al (1993)
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Health Behaviors

• Behaviors which are related to the health status
  of the individual.
• Divided into two types
• Health-enhancing behaviors (immunogens)
• Health-harming behaviors (pathogens)

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Barriers to good health behaviors

• Within medicine
• Within society
• Within individual
• Early learning
• Delayed vs. immediate reward
• Unrealistic optimism
• Lack of motivation
• Health behaviors unrelated and unstable

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Why unrelated and unstable?

• Health behaviors are acquired, elicited, and
  maintained by different factors for different
  people. These factors may change over time.

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Health-Enhancing Behaviors

• Behavioral Immunogens
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Health-Enhancing Behaviors

• Diet
• Until 1940s, illness due to lack of
  food/nutrients
• Now illness due to excess food/nutrients
• Current Western diet linked to
• Obesity
• Heart disease
• Diabetes
• Osteoporosis
• Cancer

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Health-Enhancing Behaviors

• Diet and Obesity
• Body Mass Index (BMI)
• Weight (kgs) / Height (m)2
• 18.5-25 normal
• 26-30 overweight
• gt30 obese

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Proportion of people with high blood
cholesterol, 1999-2000 .
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Diet and Cancer (?)
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Dietary Change

• Possible targets of intervention
• Schools, e.g., psychoeducation
• Community, e.g., supermarkets, mass-media
• Individual, e.g., cognitive-behavioral

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Dietary Change

• Eat, Drink, and Be Healthy (Willet, 2003)
• Maintain a stable, healthy weight
• Replace saturated and trans fats with unsaturated
  fats
• Replace refined carbohydrates with whole-grain
  carbohydrates
• Choose healthier sources of protein by trading
  red meat for nuts, beans, chicken, and fish.
• Eat plenty of fruits and vegetables, but hold on
  the potatoes
• Use alcohol in moderation (1 glass a day is good)
• Take a multivitamin for insurance

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Health-Enhancing Behavior

• Aerobic Exercise
• Exercise which requires 70 of maximum oxygen
  consumption
• Direct Benefits
• Improve fitness, muscle strength, muscle
  endurance, flexibility, cardiorespiratory
  fitness, weight control

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American College of Sports Medicine

• Recommendations for Exercise
• Type Large muscle activity that is rhythmic and
  repetitive (e.g., walking, running, swimming,
  cycling)
• Duration At least 20 minutes continuously
• Frequency 3 to 4 times per week
• Intensity Vigorous (defined as at least 60 to
  80 of maximal capacity)

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Pale et al. (1995)

• Recommendations for Exercise
• Every adult should accumulate 30 minutes of
  moderate physical activity every day, or at least
  on most days.

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Why Exercise?

• Western population sedentary.
• Less than 10 of US population meet
  recommendations for exercise (esp. 30)
• Physical inactivity ranks second to cigarette
  smoking in burden of disease
• Physical exercise can
• promote fitness (regular, vigorous)
• promote health (moderate, less vigorous)

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2 000 k/calories week
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Benefits of Exercise

• Fitness
• Physical health
• Psychological wellbeing
• Decreased depression
• Decreased state anxiety
• Buffer against stress
• Increased self-esteem

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Drop out from Exercise

• Drop out rates
• 50 in first 6 months
• 20 in 3 years
• Why drop out?
• Person variables
• Social-environmental variables
• Exercise program variables
• Behavioral programs best at promoting adherence

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Health-Harming Behaviors

• Behavioral Pathogens
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Health-Harming Behaviors

• Deaths from Drugs
• Tobacco 72
• Alcohol 25
• Opiate 2
• Other illegal drugs 1
• Total 100

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Health Risks of Smoking

• Smoking is the greatest single cause of
  preventable deaths (gt 20 of all deaths)
• Half of those who smoke throughout their life
  will die as a direct result of their habit
• Half of these deaths will occur in middle age
  with an average of 21 years of life lost
• The rest will occur in old age, with around 8
  years lost
• Average reduction of life expectancy 5-9 years

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Health Risks of Smoking

• Smoking contributes to
• Heart disease
• Cancer
• Stroke
• Influenza and pneumonia
• Chronic bronchitis
• Emphysema
• Peptic ulcers
• Respiratory disorders
• Lower birth weight in offspring
• May have synergistic effects (Perkins, 1985)
  

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Components of Cigarette Smoke

• Nicotine
• Primary addictive substance, pleasurable
• Acts directly on CNS
• Tars
• Chemicals which are carcinogenic
• Carbon Monoxide (CO)
• CO reduced amount of O2 in blood and places
  strain on heart muscle

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Who smokes?

• About 25 (US, Canada, Australia, etc)
• Men (28), Women (23), gap is narrowing
• Unemployed and less educated smoke more
• Smoking rates have decreased
• Teenage girls levels decreased least

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Proportion of people who are daily smokers (2001)
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Proportion of people who are daily smokers
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Why do people smoke?

• Start
• Social learning (modeling)
• Peer pressure
• 95 begin in teen years
• Know smoking is dangerous but say will stop
• Rule of thumb
• Continue
• Genetic (?)
• Dependence (nicotine-regulation)
• Reinforcement (peers, feeling good, performance)

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Categories of Regular Smokers

• Positive affect smokers
• Negative affect smokers
• Habitual smokers
• Addictive smokers
• ? stimuli affect smokers differently
• (Tomkins, 1966)

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Prevention of Smoking

• Public Health Measures
• Educational Programs
• Inoculation Programs

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Quitting Smoking

• About 95 do so on their own
• Easier for light smokers, motivated, social
  support, persistent, self-efficacy
• Successful quitters tend to
• Quit cold turkey
• Provide themselves with rewards
• Use positive self-statements

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Stages of Change

• Trans-Theoretical Model (Prochaska DiClemente)
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Treatment Implications

• Trans-Theoretical Model (Prochaska DiClemente)
• Must intervene at the appropriate stage (ie
  action stage) for the intervention to be
  successful
• Relapse is common
• Cycle through stages before successful
  termination of target behavior

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Treatments for Smoking

• Nicotine-replacement therapy
• Aversion therapies
• Self-management strategies
• Multi-modal approaches

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Relapse

• Relapse rate 70-80 after 1 year
• Factors
• Abstinence-violation effect
• Weight gain (2 pounds)
• Social support
• Intrinsic motivation (better than extrinsic)
• Stress

? Good programs include relapse prevention
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Health Risks of Alcohol?

• Alcohol abuse contributes to
• Some cancers
• Motor vehicle and other accidents (users and
  bystanders)
• Suicide
• Cirrhosis of the liver
• Brain damage (Korsakoffs Syndrome)
• Crime
• Poor job performance and absenteeism
• side effects - mood and aggression
• alcohol affects every organ in the body

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Who drinks?

• About 70 of adults drink alcohol at least
  occasionally
• about 10 are problem drinkers (health damage)
• About 5 are alcoholic (alcohol dependence)
• Two vulnerable times
• Teenage years
• Late middle age

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Why do people drink?

• Start
• Social learning (modeling)
• Peer pressure
• Continue
• Dependence
• Reduce social anxiety
• Tension relief
• Reinforcement

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Treatments for Alcohol Abuse

• Detoxification
• Alcoholics Anonymous
• Psychotherapy
• Aversion therapies

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Health Behaviors

• Theories of Self-Change
• Goal Setting Theory
• Expectancy-Value Theory (motivation to change)
• False Hope Syndrome

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Goal-Setting Theory (Locke Latham, 1990)

• Goals performance targets
• Facilitate performance by
• motivate search for performance strategies
  planning
• direct attention/effort towards task-relevant
  behaviors rather than unrelated activities
• Well-researched theory tested using many
  different tasks, jobs, employees, etc

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Basic Principles of Goal-Setting

• Characteristics of effective goals
• specific, difficult goals result in higher
  performance than general, do-your best, or no
  goals
• no difference between last 3 goal types on
  performance
• Research has identified 6 key moderators of the
  relationship between specific, difficult goals
  and performance
• i.e,. Variables that affect the strength of this
  relationship

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Moderator Variables

• 6 Key Moderator Variables
• Participative vs. Assigned Goals
• Goal Commitment
• Availability of Feedback
• Individual Differences
• Task Complexity
• Group vs. Individual Goals

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Expectancy-Value Theory

• 3 basic concepts expectancy, instrumentality,
  valence
• Expectancy (E) that effort will lead to
  successful change
• Instrumentality (I) strength of relationship
  between change and various outcomes (e.g., money,
  satisfaction, recognition from others)
• Valence (V) attractiveness / value attached to
  these outcomes

effort depends on expectancy that (a) effort will
result in adequate self-change, and (b) that this
self-change will result in valued/attractive
outcomes
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False-Hope Syndrome Model
Unrealistic Expectations (Amount, Speed, Ease,
Consequences)
Commitment to Change (Feelings of control)
Initial Efforts (Early successes)
Recommitment to Goals (unrealistic expectations)
Resistance to Change (Change stops)
Attributions for Failure (reasons for failure
can be corrected)
Abandon Attempt (Failure)
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False-Hope Syndrome

• Consequences of repeated failure - dieting
• Physical health (weight fluctuations)
• Psychological health (mood, fatigue,
  irritability)
• Obsession with food (making weight loss
  difficult)
• Is the theory overly pessimistic?
• can achieve anything if you work hard enough
• Overconfidence is at the heart of false-hope
• Choose your goals wisely