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Introduction
• How Is Public Health Related to Social and Behavioral Sciences?
• How Does Socioeconomic Status Affect Health?
• What Other Social Factors Explains Differences in Health and Response to Disease?
Introduction
• Can Health Behavior Be Changed?
• Why are Some Individual Health Behaviors Easier to Change Than Others?
• How Can Individual Behaviors Be Changed?
• What Stages Do Individuals go Through in Making Behavioral Change?
Introduction
• How Can Group Behaviors Be Changed?
• How Can We Combine Individual, Group, and Social Efforts to Implement Behavioral Change?
Introduction
You travel to a country in Asia and find that the culture affects most parts of life including health. From the food they eat and their method of cooking to their attitudes toward medical care and their beliefs about the cause of disease and the ability to alter it through public health and medical interventions, this country is profoundly different from the United States.
Introduction
You travel to a country with strict Islamic practices and find that religion, like culture, can have major impacts on health. Religious practices, including beliefs about food and alcohol, sexual practices such as circumcision and female sexual behavior, and acceptance or rejection of interventions aimed at women’s health, can dramatically affect health.
Introduction
You’re trying to help your spouse quit smoking cigarettes and your kids from starting. You know that gentle encouragement and support on a one-to-one basis are essential but are often not enough since cigarettes cause addiction that produces withdrawal and long term cravings. Like most addictions, quitting requires a combination of individual motivation, support from family and friends, and sometimes use of medications. But you wonder: do warning labels on cigarettes, taxes on cigarettes, and no smoking zones in public places make any difference?
Introduction
Your efforts to convince teenagers to avoid smoking or at least stop smoking focuses on giving them the facts about how cigarettes cause lung cancer, throat cancer, and serious heart disease. You are frustrated at how little impact you have had and are surprised that others are more successful by focusing on immediate impacts such as stained teeth and bad breadth as well as the loss of control that goes along with addiction to nicotine.
Introduction
As a new parent you hear from your pediatrician, nurses in the hospital, and even from the makers of your brand of diapers that babies should sleep on their backs. They call it “back-to-bed.” You’re surprised to find that it’s part of the class on babysitting given by the local community center and a required part of the training for those who work in registered day care centers. It’s all part of a social marketing campaign, you find out, and it has reduced by half the number of deaths from sudden infant death syndrome.
Examples of contributions of social and behavioral sciences to public health
SocialScience
discipline
Examples of disciplinary contributions to public health
PsychologyTheories of the origins of behavior and risk taking
tendencies and methods for altering individual and social behaviors
SociologyTheories of social development, organizational behavior,
and systems thinking. Social impacts on individual and group behaviors
AnthropologySocial and cultural influences on individual and population
decision making for health with a global perspective
Examples of contributions of social and behavioral sciences to public health
SocialScience
discipline
Examples of disciplinary contributions topublic health
Political science/Public policy
Approaches to government and policy making related topublic health. Structures for policy analysis and theimpact of government on public health decision making
EconomicsUnderstanding the micro- and macroeconomic impact onpublic health and health care systems
CommunicationsTheory and practice of mass and personalizedcommunication and the role of media in communicatinghealth information and health risks
Examples of contributions of social and behavioral sciences to public health
SocialScience
discipline
Examples of disciplinary contributions to public health
DemographyUnderstanding demographic changes in populationsglobally due to aging, migration, and differences in birthrates, plus their impact on health and society
GeographyUnderstanding of the impacts of geography on disease anddeterminants of disease, as well as methods for displayingand tracking the location of disease occurrence
Examples of ways that socioeconomic status may affect health
Type Examples
Living conditions Increases in sanitation, reductions in crowding, methods of heating and cooking
Overall educational opportunities
Education is the strongest association with health behaviors and health outcomes.
May be due to better appreciation of factors associated with disease and greater ability to control these factors
Educational opportunities for
women
Education for women has an impact on the health of children and families
Examples of ways that socioeconomic status may affect health
Type ExamplesOccupational exposures Lower socioeconomic jobs are traditionally
associated with increased exposures to health risks
Access to goods and services
Ability to access goods, such as protective devices and high quality foods and services, including medical and social services to protect and promote health
Family size Large family size traditionally associated with lower socioeconomic status and with lower health status
Examples of ways that socioeconomic status may affect health
Type ExamplesExposures to high risk
behaviorsSocial alienation related to poverty may be
associated with violence, drugs, other high risk behaviors
Environmental Lower socioeconomic status associated with greater exposure to environmental pollution, “natural” disasters, and dangers of the “built environment”
Examples of ways that Culture may affect Health
Ways thatculture may affect health
Examples
Culture is related tobehavior—socialpractices may putindividuals and
groups at increasedor reduced risk
Food preferences—vegetarian, Mediterranean diet
Cooking methodsHistory of binding of feet in China
Female genital mutilationRole of exercise
Examples of ways that Culture may affect Health
Ways that culture may
affect health
Examples
Culture is related toresponse to
symptoms, such asthe level of urgency
to recognizesymptoms, seek
care, andCommunicate
symptoms
Cultural differences in seeking care andself-medication
Social, family, and work structuresprovide varying degree of social support
low degree of social support may beassociated with reduced health-related
quality of life
Examples of ways that Culture may affect Health
Ways that culture may
affect health
Examples
Culture is related tothe types of
interventions that areacceptable
Variations in degree of acceptance of traditional Western medicine including
reliance on self-help and traditional healers
Culture is related tothe response todisease and tointerventions
Cultural differences in follow-up, adherence to treatment, and acceptance
of adverse outcome
Examples of ways that Religion may affect Health
Ways that religion affects
health
Examples
Religion may affectsocial practices thatput individuals at
increased or reducedrisk
Sexual: circumcision, use of contraceptiveFood: avoidance of seafood, pork, beefAlcohol use: part of religion versusprohibitedTobacco use: actively discouraged byMormons and Seventh-Day Adventists aspart of their religion
Religion may affectresponse tosymptoms
Christian Scientists reject medical care asa response to symptoms
Examples of ways that Religion may affect Health
Ways that religion affects
health
Examples
Religion may affectthe types of
interventions that areacceptable
Prohibition against blood transfusionsAttitudes toward stem cell research issueAttitudes toward abortionEnd-of-life treatments
Religion may affectthe response todisease and tointerventions
Role of prayer as an intervention to alteroutcome
Stages of Behavioral ChangeStages of change Actions Example—Cigarette
Smoking
Precontemplation Prognosticate
Individuals not considering change
Assessing readiness for change—timing is key
Determine individual'sreadiness to quit. If notready, indicate receptivity tohelp in the future
Look for receptive timingsuch as during acuterespiratory symptoms
Social factors, such asworkplace and indoorrestriction on smoking andtaxation, increase likelihoodof entering precontemplationPhase.
Stages of Behavioral Change
Stages of change Actions Example—Cigarette Smoking
Contemplation Motivate changeIndividual thinks activelyabout the health risk andaction required to reduce thatrisk
Issue of change is on theindividual’s agenda but noaction planned
Provide information focused onshort and intermediate gainsfrom behavioral change, as wellas long term benefits
Doubtful, dire, and distantimpacts are less effective
Reinforce increase inexercise level, reduction incough, financial savings,serving as example tochildren, protection of fetus,etc.
Also continue to inform oflonger term effects on health
Establish baseline to assessseverity of the problem; focusattention on the problem andprovide basis for comparison
Develop log of timing,frequency, and quantity ofsmoking, as well asassociated events
Stages of Behavioral ChangeStages of change Actions Example—Cigarette
Smoking
Preparation Plan changePrepare for action includingdeveloping a plan and settinga timetable
Set specific measurable andobtainable goals with deadlines
Quit date or possible tapering ifheavy smoker
Two or more well chosensimultaneous interventions maymaximize effectiveness
Family support, peer support,individual planning, medication,etc. may reinforce and multiplyimpacts
Recognize habitual nature ofexisting behavior and removeassociated activities
Remove cigarettes, ashtrays, andother associated smokingequipment;Remove personal andenvironmental impacts of pastsmoking, such as teeth cleaningand cleaning of drapery;Anticipate temptations, such asassociations with food, drink, andsocial occasions
Stages of Behavioral ChangeStages of change Actions Example—Cigarette
Smoking
Action Reinforce changeObservable changes inbehavior with potential forrelapse
Provide/suggest tangiblerewards
Provide rewards, such asalternative use of money—focuson personal hygiene or personalenvironment
Positive feedbackencouragement of newbehavior.
Anticipate adverse effectsand frustrations
Focus on measurable progresstoward new behavior;Provide receptive environment,but avoid focus on excuses;Take short term one-day-at-atime approach;Recognize cravings and have
planincluding use of medications;Recognize potential forsymptoms to worsen at firstbefore improvement occurs;Anticipate potential for weightgain and encourage exercise andother behaviors to reducepotential for weight gain
Utilize group/peer support Family and peer reinforcementcritical during action phase
Stages of Behavioral Change
Stages of change Actions Example—Cigarette Smoking
Maintenance Maintain changeNew behavior needs to beconsolidated as part ofpermanent lifestyle change
Practice/reinforce methods formaintaining new behavior
Avoid old associations andprepare/practice responsewhen encountering oldcircumstances
Recognize long term nature ofbehavioral change and need forsupportive peers and socialreinforcement
Negative social attitudestoward smoking among peersand society along with socialrestrictions, such as limitingpublic indoor smoking andsocial actions, such astaxation, help preventsmoking and reinforcemaintenance of cessation
Stages of change—Individual, group and population/social interventions to change
cigarette smoking behavior Stage of change
Individual At-risk group Population/society
Precontemplation Assess readiness for change and offer future help
Social marketing aimed at specific groupsRestriction on smoking at work
Cost affected by taxes, restrictions on smoking in public places, warning labels on packages
Contemplation Information on hazards of smoking and gains from quitting
More receptive to social marketing aimed at specific groupsRestriction on smoking at work
More receptive to costs of cigarettes, restrictions on smoking in public places, and warning labels
Stages of change—Individual, group and population/social interventions to change
cigarette smoking behavior
Stage ofchange
Individual At-risk group Population/society
Preparation Set individual goalsand develop strategy;
Medication may behelpful
Support group/friendsand family reinforceindividual preparation;
telephone “quit lines”
National efforts, e.g.,American CancerSociety National QuitDay
Action Remove connectionsbetween cigarettes andpleasurable activities
Use of medications ifneeded
Public commitment toaction—announce tofamily, friends, andwork colleagues
Pay for medicationand other assistancewith cessation as partof insurance
Stages of change—Individual, group and population/social interventions to change
cigarette smoking behavior
Stage of change
Individual At-risk group Population/society
Maintenance Education regardinglong term physicaladdiction andpotential for relapse
Continuedreinforcement atwork and by peerand social groups
Continuedreinforcement bysocial marketing,taxes, andrestriction onsmoking
Health professionals, health care institutions, and health care systems
Health Care System
HealthProfessionals
Chapter 9
Health CcareInstitutionsChapter 10
HealthCare Systems
Chapter 11
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