Health Psychology
Lecture 4
Health Behaviors
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)
Question
How strong is the link between behavior and health?
• Genetics = 20%
• Medical care = 10%
• Other factors = 30%
• Behavior = 40%
Kaplan et al (1993)
Health Behaviors
Behaviors which are related to the health status of the
individual.
Divided into two types:
1. Health-enhancing behaviors (“immunogens”)
2. Health-harming behaviors (“pathogens”)
Barriers to good health behaviors
• Within medicine
• Within society
• Within individual
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Early learning
Delayed vs. immediate reward
Unrealistic optimism
Lack of motivation
Health behaviors unrelated and unstable
Why unrelated and unstable?
• Health behaviors are acquired, elicited, and
maintained by different factors for different
people. These factors may change over time.
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:
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Obesity
Heart disease
Diabetes
Osteoporosis
Cancer
Health-Enhancing Behaviors
Diet and Obesity
– Body Mass Index (BMI)
– Weight (kgs) / Height (m)2
• 18.5-25 = normal
• 26-30 = overweight
• >30 = obese
Proportion of people with high blood cholesterol, 1999-2000
.
Diet and Cancer (?)
Dietary Change
Possible targets of intervention…
• Schools, e.g., psychoeducation
• Community, e.g., supermarkets, mass-media
• Individual, e.g., cognitive-behavioral
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
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
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)
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.
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)
2 000 k/calories week
Benefits of Exercise
• Fitness
• Physical health
• Psychological wellbeing
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Decreased depression
Decreased state anxiety
Buffer against stress
Increased self-esteem
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
Health-Harming Behaviors
Behavioral Pathogens…
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Health-Harming Behaviors
Deaths from Drugs
1.
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Tobacco
72%
Alcohol
25%
Opiate
2%
Other illegal drugs 1%
Total
100%
Health Risks of Smoking
• Smoking is the greatest single cause of
preventable deaths (> 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
Health Risks of Smoking
• Smoking contributes to…
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Heart disease
Cancer
Stroke
Influenza and pneumonia
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Chronic bronchitis
Emphysema
Peptic ulcers
Respiratory disorders
Lower birth weight in offspring
– ** May have synergistic effects (Perkins, 1985) **
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
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
Proportion of people who are daily smokers (2001)
Proportion of people who are daily smokers
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)
Categories of Regular Smokers
• Positive affect smokers
• Negative affect smokers
• Habitual smokers
• Addictive smokers
 stimuli affect smokers differently
(Tomkins, 1966)
Prevention of Smoking
• Public Health Measures
• Educational Programs
• Inoculation Programs
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
Stages of Change
Trans-Theoretical Model (Prochaska & DiClemente)
1. .
2. .
3. .
4. .
5. .
Treatment Implications
Trans-Theoretical Model (Prochaska & DiClemente)
•
Must intervene at the appropriate stage (ie action
stage) for the intervention to be successful
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Relapse is common
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Cycle through stages before successful termination of
target behavior
Treatments for Smoking
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Nicotine-replacement therapy
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Aversion therapies
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Self-management strategies
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Multi-modal approaches
Relapse
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Relapse rate = 70-80% after 1 year
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Factors
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Abstinence-violation effect
Weight gain (2 pounds)
Social support
Intrinsic motivation (better than extrinsic)
Stress
 Good programs include relapse prevention
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 (Korsakoff’s Syndrome)
– Crime
– Poor job performance and absenteeism
– * side effects - mood and aggression *
“alcohol affects every organ in the body”
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
Why do people drink?
• Start
– Social learning (modeling)
– Peer pressure
• Continue
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Dependence
Reduce social anxiety
Tension relief
Reinforcement
Treatments for Alcohol Abuse
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Detoxification
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Alcoholics Anonymous
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Psychotherapy
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Aversion therapies
Health Behaviors
Theories of Self-Change
• Goal Setting Theory
• Expectancy-Value Theory (motivation to change)
• False Hope Syndrome
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
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
Moderator Variables
6 Key Moderator Variables
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Participative vs. Assigned Goals
Goal Commitment
Availability of Feedback
Individual Differences
Task Complexity
Group vs. Individual Goals
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
False-Hope Syndrome Model
Unrealistic Expectations
(Amount, Speed, Ease,
Consequences)
Recommitment to Goals
(unrealistic expectations)
Attributions for Failure
(reasons for failure
can be corrected)
Commitment to Change
(Feelings of control)
Initial Efforts
(Early successes)
Resistance to Change
(Change stops)
Abandon Attempt
(Failure)
False-Hope Syndrome
Consequences of repeated failure - dieting
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Physical health (weight fluctuations)
Psychological health (mood, fatigue, irritability)
Obsession with food (making weight loss difficult)
Is the theory overly pessimistic?
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“can achieve anything if you work hard enough”
Overconfidence is at the heart of false-hope
Choose your goals wisely