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