Manana Maridashvili.

MD. PhD. Professor

Health and Society III

(Medical Sociology, Equality)

Topic 6

Health behavior and lifestyles: health lifestyles.

Preventive care.

What are health behaviors?

Health behaviors are actions individuals take that affect their health.
They include actions that lead to improved health, such as eating well and being physically active,
and actions that increase one's risk of disease, such as smoking, excessive alcohol intake, and risky
sexual behavior.

Kasl and Cobb (1966) defined three types of health related behaviors:

1) a health behavior

2) an illness behavior

3) a sick role behavior

a health behavior is a behavior aimed at preventing disease (e.g. eating a healthy diet);

an illness behavior is a behavior aimed at seeking a remedy (e.g. going to the doctor);

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a sick role behavior is an activity aimed at getting well (e.g. taking prescribed medication or
resting). Health behavior and lifestyles

Health behaviors have also being defined by Matarazzo (1984) in terms of either: Health impairing
habits, which he called "behavioral pathogens" (for example smoking, eating a high fat diet), or
Health protective behaviors, which he defined as "behavioral immunogens" (e.g. attending a health
check).

Behavior and mortality

50% of mortality from the 10 leading causes of death is due to behavior. Doll and Peto (1981)
estimated that 75% of cancer deaths were related to behavior. 90% of all lung cancer mortality is
attributable to cigarette smoking, which is also linked to other illnesses such as cancers of the
bladder, pancreas, mouth, and esophagus and coronary heart disease.

Bowel cancer is linked to behaviors such as a diet high in total fat, high in meat and low in fiber.

Lifestyle and health

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).

Holy Four

Four behaviors in particular are associated with disease:

1) smoking,

2) alcohol misuse,

3) poor nutrition

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 4) lower levels of exercise;

these are called the “holy four”. Conversely, rarely eating between meals, sleeping for seven to
eight hours each night, and eating breakfast nearly every day have been associated with good health
and longevity (Breslow and Enstrom 1980). Recently high-risk sexual activity has been added to
the risk factor list.

Tips for a health behavior

Belloc and Breslow (1972)Belloc and Breslow (1972) conducted an epidemiological study asking
a representative sample of 6928 residents of Almeida County, California whether they engaged in
the following seven health practices:

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 height adjusted weight

5. Never smoking cigarettes

6. Moderate or no use of alcohol

7. Regular physical activity.

Positive attitude

Having a positive attitude towards life has been found to increase longevity (Levy et al, 2002).
The team used data gathered in 1975 in Oxford, Ohio, where almost everybody over 50 was
questioned about their life and health. By tracing the deaths of participants over 23 years, the team
was able to match lifespan against attitudes towards ageing expressed at the start.

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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.

the Journal 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.

The ‘behavioral change’ approach

There are several methodological criticisms that can be made of the original study by Belloc and
Breslow and the follow-up studies. First, the sample is not particularly representative as all the
participants came from the same area in the USA. Second, the study establishes a correlation
between seven specific health preventive behaviors and longevity, but does not prove that these
behaviors actually caused some of the participants to live longer.

It is possible, although unlikely, that some other factor — personality, for example — affected
both behavior and lifespan.

The ‘behavioral change’ approach to promoting health raises a couple of ethical issues. First, it
can lead to ‘victim-blaming’. If we believe too strongly that individuals can prevent themselves
from falling ill by choosing to carry out health preventive behaviors, then we may go on to blame
those individuals for failing to protect their own health if they do fall ill.

have been cases where doctors have refused to treat certain patients because they felt that they had
brought their illnesses on themselves. The greatest contributions to health have been through
developments in medical science and through public health initiatives such as improved sanitation,
and not through individual behavioral change.

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The second problem with the behavioral change approach is the narrow line that exists between
persuading someone to change his or her behavior 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 force them to change
their behavior?

Genetic theories

it possible, however, for a person’s genetic inheritance to directly affect their health-related
behavior? 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 are more likely to become alcoholic
themselves.

it is notoriously difficult to determine whether a correlation such as this is due to genetic factors
or arises as a result of social learning, some psychologists argue that, although there probably is
no such thing as an ‘alcoholism gene’, certain genetically inherited personality traits may pre-
dispose an individual towards alcohol abuse.

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’ food preferences. Fischer and Dyer (1981) reported that family history of obesity
was related to increased intake of sweets, dairy products, and fatty foods in a sample of 116 high
school girls.

Their results also indicated that having a family history of heart problems was related to decreased
consumption of milk, eggs, and salty foods.

Levine, Lewy, and New (1976) found a family history of hypertension to be associated with a
greater prevalence of obesity among African American adolescents. Some investigators have also
analyzed dietary intake among twin populations as evidence of a genetic variance for nutrient
intake. In one of these studies, De Castro (1993) found significant heritabilities for identical and
fraternal twins with regard to the amount of food energy and macronutrients eaten daily.

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In contrast, Fabsitz, Garrison, Feinleib, and Hjortland (1978) demonstrated that, in addition to a
genetic variance, environmental effects (e.g., how frequently twins saw each other) were important
in accounting for similarities in twins’ nutrient intakes. These results suggest that there may be an
interaction between genetic and environmental factors that influence eating behaviors among
adolescents.

Genetic theories suggest that there may be a genetic predisposition to becoming an alcoholic or a
smoker. To examine the influences of genetics, researchers have examined either identical twins
reared apart or the relationship between adoptees and their biological parents. These
methodologies tease apart the separate effects of environment and genetics.

an early study on genetics and smoking, Sheilds (1962) reported that of 42 twins reared apart, only
9 were discordant (showed different smoking behaviour). He reported that 18 pairs were both non-
smokers and 15 pairs were both smokers.

This is a much higher rate of concordance than predicted by chance. Evidence for a genetic factor
in smoking has also been reported by Eysenck (1990) and in an Australian study examining the
role of genetics in both the uptake of smoking (initiation) and committed smoking (maintenance)
(Murray et al. 1985).

Research into the role of genetics in alcoholism has been more extensive and reviews of this
literature can be found elsewhere (Peele 1984; Schuckit 1985). However, it has been estimated
that a male child may be up to four times more likely to develop alcoholism if he has a biological
parent who is an alcoholic.

Behaviorist learning theories

Classical conditioning is a process in which the individual associates an automatic response with
a neutral stimulus. Ivan Pavlov (1849—1936) described this process after he noticed that

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laboratory dogs would salivate when he turned a light on because they had learnt to associate the
light with the presence of food.

Classical conditioning could explain certain health-related behaviors such as ‘comfort eating’, for
example. If a parent regularly offers a child sweets or chocolate at the same time as physical and
emotional affection, then the child may learn to associate sweet foods with the reassuring feelings
that arise out of parental love. In later life, the child may try to recreate these pleasant feelings by
eating chocolate when he or she is stressed or depressed.

Operant conditioning

Operant conditioning is when people respond to reward or punishment by either repeating a

particular behavior, or else stopping it. If an individual carries out a behavior 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.

A striking example of how operant conditioning can affect health behavior is the study by Gil et
al (1988). They conducted research on children suffering from a chronic skin disorder that causes
severe itching. They videotaped the children with their parents in the hospital and observed that
when parents tried to stop their children scratching (in order to prevent peeling and infection) this
actually increased the scratching behavior by rewarding it with attention.

When they asked parents to ignore their children when they scratched and give them positive
attention when they did not scratch, the amount of scratching was significantly reduced. Drinking,
eating, smoking, drug and sexual addictions all have the ‘irrational’ characteristic that the total
amount of pleasure gained from the addiction seems much less than the suffering caused by it.
According to learning theorists, the reason for this lies in the nature of the gradient of
reinforcement.

Addictive behaviors are typically those in which pleasurable effects occur rapidly after the
addictive behavior while unpleasant consequences occur after a delay. The simple mechanism of

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operant conditioning and the gradient of reinforcement is able, as it were, to overpower the mind’s
capacity for rational calculation.

Social learning

Social learning occurs when an individual observes and imitates another person’s behavior, 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 being rewarded for his or her actions.

learning can clearly be very influential in encouraging people to do things that are bad for their
health (for example, a teenager may take up smoking because he or she has an admired elder
brother who smokes, or may try illegal drugs because he or she sees other people taking them and
having a good time).

Another example of how vicarious reinforcement can lead to unhealthy behavior concerns young
women with eating disorders, who see images of very thin models in magazines being rewarded
with success, money, glamour and fame. On the other hand, many health promotion campaigns
use positive role models to try to get people to lead healthier lifestyles. T

he advertising industry, whose reason for existing is to persuade people to change their behavior,
often depicts successful, good-looking and happy people using a certain product in the hope that
this will make others want to use the product as well.

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