7.1 Introduction to Health Psychology

Health psychology:

• The scientific study of psychological processes related to health and healthcare (Friedman and Adler, 2007).

• Focuses on treating serious infections to prevent health problems linked to lifestyle choices.

• Emphasized by organizations like the World Health Organization (WHO) and the American Psychological Association (APA).

Aaron Antonovsky: Contributions and Concepts

• Medical sociologist known for research on sociological and psychological aspects of health.

• Focused on why some individuals stay healthy despite extreme stressors.

• Discovered resilient individuals, like some women who survived Nazi concentration camps, remained confident and happy despite traumatic experiences.

Core Tenets in Health Psychology:

• Views individuals as complex systems affected by various factors.

• Includes biology, behavior, and sociocultural contexts.

• The Biopsychosocial Model is a widely adopted model explaining health issues as a result of interconnected systems.

Stress and Stressors

• A negative emotional experience accompanied by physiological, cognitive, and behavioral changes.

• Any adverse or challenging event, whether physiological or psychosocial, can be labeled a stressor.

• Stress responses occur regardless of whether stressors are consciously perceived.

• Beliefs and expectations influence how individuals cope with stressors.

• Types of Stressors:

  • Acute Stressors: Sudden, short-lived, demand immediate attention (e.g., physical injury, predator attack).

  • Chronic Stressors: Long-lasting, continuous sources of worry, potentially harmful due to prolonged exposure. In chronic stress, the body may not return to its normal physiological state (homeostasis) due to constant stress presence.

• Prolonged stress can have damaging effects on the body, notably through increased cortisol levels, impacting health negatively.

Work-Related Stress: Understanding and Impact

• A healthy work environment is organized work that aligns with individuals' ability to manage it.

• A source of work-related stress arises from a mismatch between job demands and an individual's coping ability.

• Factors Contributing to Work Stress:

  • Insufficient time, lack of support, or absence of control over job handling.

  • Changes in routines, even positive ones like marriage or promotion, can induce stress due to the need for adjustment.

• Health implications of life events are stressful life events that can impact physical health, potentially leading to increased physical illness post-event.

Holmes-Rahe Scale (1967)

• Objective: To assign values to stressful events based on the impact of these events on individuals' lives.

• Methodology: An opportunity sample of 394 individuals in the US reviewed a list of 43 life events, marking those experienced in the previous 12 or 24 months.

• Rating Scale: Participants rated events based on their perceived time required for readjustment and accommodation of stressors.

• Surprising Agreement: Despite individual differences, participants displayed notable consistency in evaluating stressors' impact.

• Correlation with Health: Studies revealed a modest correlation between high-rated stressors and subsequent illness or accidents.

Physiological, Psychological, and Social Aspects of Stress

Stress and Coping:

• Coping is an effort to handle or mitigate a threat's impact on an individual.

• The perception of stress arises from the perceived discrepancy between situational demands and an individual's perceived resources, whether realistic or unrealistic.

• The impact of perception on an individual evaluation influences the approach to confronting stressful situations.

Physiological Aspects of Stress:

• The sympathetic nervous system response prepares the body for "fight or flight" by triggering physiological changes, including increased blood pressure and glucose supply to muscles.

• A stress response is an arousal facilitated by releasing stress hormones (e.g., adrenaline) from the adrenal glands to energize the body to confront or avoid the threat.

General Adaptation Syndrome (GAS) by Hans Selye (1956):

• Three Stages of Stress Response:

  • Alarm Stage: Initial fight-or-flight response to stressors.

  • Resistance Stage: Coping and attempts to reverse the effects of the alarm stage.

  • Exhaustion Stage: Reached after repeated exposure to stressors, rendering the individual incapable of further coping.

Relationship Between Stress and Health Problems:

• Long-term stress can increase cortisol levels affecting mental health (e.g., depression, memory problems) and the immune system.

• Cortisol's effects decrease the number of natural killer cells (T-cells), making individuals more susceptible to infections.

Kiecolt-Glaser et al.'s Study (1984):

• Blood Sample Analysis: Examined medical students' blood samples before and during their final exams.

• Findings: Significant decrease in T-cell activity during high-stress periods (final exams).

• Psychological Stress Influence: High levels of stressful life events and loneliness are associated with lower T-cell counts, indicating a connection between psychological stress, loneliness, and compromised immune system function.

Cognitive Aspects of Stress and Health Outcomes

• Expectations and Disease Outcomes: HIV-positive individuals with pessimistic expectations develop HIV-related symptoms more rapidly and experience a shorter lifespan.

• Attributional Style and Health: Pessimistic attributional styles predict poor health outcomes, potentially affecting T-cell counts and suppressing the immune system (Kamen and Seligman, 1987).

• Beliefs and Disease Survival: Denial and a fighting spirit predict longer survival rates for breast cancer patients (Greer et al., 1979). Optimism doesn't cure cancer but aids in coping, potentially prolonging life for optimistic patients.

Social Self-Preservation Theory:

• Threats to Social Self and Health: Threats to social esteem or status, leading to negative cognitive and affective responses (e.g., shame, humiliation), influence physical health via the immune system, or increased cortisol levels.

• Impact on HIV-Positive Individuals: HIV infection occurs in stigmatized groups (e.g., gay and bisexual men), and the disease itself carries social stigma. HIV-positive individuals sensitive to rejection related to their sexuality show faster disease progression (Kemeny et al., 2005).

Psychoneuroimmunology (PNI):

• Psychological State and Immune System: Psychoneuroimmunology assumes that an individual's psychological state can influence the immune system through the nervous system.

• "Positive Thinking" and Health: PNI provides a scientific basis for the influence of positive thinking on health outcomes, but generalized conclusions remain challenging due to the complexity of these interactions.

Social Aspects of Stress

Social Relationships and Well-being:

• Group Living and Well-being: Human well-being may be compromised if social relationships are stressful. Social stressors include family abuse, bullying, and residing in violent neighborhoods.

Alleviating Stress through Social Support:

• Role of Social Support: Social support, such as having close friends or a supportive family, can alleviate stress.

• Early Family Environment: The early family environment and cultural norms form the basis for social competence and stress management.

• Effect of Nurturing Families: Warm and nurturing families impart stress management skills to children and offer effective role models for positive social interactions.

Influence of Interpersonal Interactions on Social Support:

• Negative Interactions and Social Support: Adults displaying hostility and cynicism in interpersonal interactions tend to report lower social support (Smith et al., 1992).

• Association with Early Family Environment: Negative interaction styles may stem from unsupportive or conflict-ridden family environments experienced during early development.

Coping and Coping Strategies: Insights from Lazarus and Folkman (1975)

Transactional Model of Stress:

• Stress Transaction: Stress involves a transaction between an individual and the external world; only events perceived as stressful elicit a stress response.

• Importance of Psychological Factors: Lazarus and Folkman's model emphasizes psychological factors in stress management.

Appraisal Process:

• Primary Appraisal: Event evaluation as irrelevant, positive, or negative to one's well-being.

• Secondary Appraisal: Consideration of relevant coping strategies to effectively deal with the stressor; may involve confidence or doubt. Both appraisals are continuous and interdependent; reappraisal can lead to the adoption of more efficient coping strategies.

Coping Strategies:

• Problem-Focused Coping: Addresses the stressor directly, aiming to change the problematic situation (e.g., quitting an impossible job, or leaving an abusive partner).

• Emotion-Focused Coping: Deals with emotional aspects of stress rather than changing the situation; includes activities like relaxation exercises, seeking social support, or using substances to alleviate tension.

Relationship Between Coping Strategies:

• Control and Coping Strategy Selection: Problem-focused coping occurs when individuals feel they have control over the stressor, while emotion-focused coping is more likely when control is perceived as limited.

• Interplay Between Strategies: Both strategies influence each other; problem-focused coping can reduce unpleasant emotions, while emotion-focused coping may lead to more effective problem-solving in the long term.

Other Coping Approaches:

• Avoidance Coping: Emotion-focused coping aims to avoid negative feelings associated with the stressor (e.g., drowning sorrows in alcohol) but might lead to ineffective long-term outcomes like addiction.

• Proactive Coping: Intending to avoid a stressful experience (e.g., studying hard to avoid failing an exam).

Impact of Coping on Stress and Health:

• Active Coping Reduces Stress: People benefit positively and experience lower stress levels when actively engaging in stress-reducing activities.

• Belief in Stress Management: Belief in one's ability to manage stress reduces stress intensity and duration, potentially reducing risk factors in health (e.g., stress-related heart disease). Activities like yoga or spending time with friends can effectively reduce stress.

Social Support as a Coping Strategy

Significance of Social Support:

• Longevity and Social Contact: Regular personal and telephone contact with friends and family contributes to increased life expectancy (Gilles et al., 2005).

• Role in Stress Coping: Social support involves being part of a network with mutual assistance and care from partners, relatives, friends, or support groups. It can be emotional, informational, or practical and is crucial in coping with stress.

Gender Differences and Social Support:

• Taylor's Theory - Tend and Befriend: Women tend to provide and seek social support more consistently during stress, while men might exhibit fight-or-flight responses due to hormonal differences (Taylor, 2002).

• Women's Involvement in Social Support: Women are more engaged in giving and receiving social support, often mobilizing networks—particularly female friends and relatives—in times of stress (Thoits, 1995; Belle, 1987).

Cultural Variations in Social Support:

• Cultural Impact on Social Support: Cultural differences in perceptions of social support exist, influenced by the independence vs. interdependence dimension. Individualistic cultures emphasize self-independence, while collectivist cultures focus on interdependence (Taylor, 2008).

• Cultural Differences in Coping: Studies indicate variations in the use of social support as a coping strategy among different cultures (Taylor et al., 2004).

Social Support Groups and Online Support:

• Rise of Social Support Groups: Various support groups, including self-help groups for different conditions (HIV, cancer, obesity, alcoholism), have emerged to aid individuals in facing specific problems and stress (Evans, 1979; Kessler et al., 1997).

• Internet-Based Support Groups: Internet-based support groups are increasingly significant, offering additional support and information. They are efficient in providing a sense of proactive involvement (Klemm et al., 1999).

Efficacy of Web-Based Support Groups:

• Research on Web-Based Support: Studies have shown positive effects of web-based support groups on stress reduction and depression, especially in populations like breast cancer patients (Wenzelberg et al., 2003).

• Ethical Considerations: Despite benefits, ethical concerns about participant privacy and the role of facilitators need addressing in online support groups.

Mindfulness-Based Stress Reduction (MBSR) as a Coping Strategy

Understanding MBSR:

• Purpose of MBSR: MBSR, developed by Kabat-Zinn, aims to reduce stress by cultivating mindfulness—a present-moment awareness without judgment (Kabat-Zinn, 2003).

• Training Method: The program involves meditation training, teaching individuals to approach stress mindfully rather than react automatically, aiming to mitigate negative thought patterns.

Research Evidence on MBSR's Efficacy:

• Shapiro et al.'s Study on Medical Students: A controlled study showed that students who underwent MBSR reported less anxiety during exams and demonstrated higher empathy levels compared to the control group (Shapiro et al., 1998).

• Effectiveness in Stress Reduction: Results suggest MBSR's effectiveness in reducing anxiety, depression, and psychological distress during high-stress periods, as observed in medical students.

Generalization and Considerations:

• Applicability of Results: While the study showcased positive outcomes, its generalizability may be limited due to the sample being self-selected, comprised of medical students, and incentivized through course credits, affecting dropout rates.

• Speca et al.'s Study on Cancer Patients: Another study involving cancer patients indicated significant reductions in mood disturbance and stress symptoms among the MBSR group compared to the control, suggesting therapeutic effects (Speca et al., 2000).

Further Research and Implications:

• Need for More Research: While promising, further research is necessary to ascertain the true extent of MBSR's efficacy, especially in diverse populations and settings.

• Cost and Time Efficiency: Group-based psychosocial interventions like MBSR show promise in aiding adaptation to stress due to chronic illness, offering cost- and time-efficient approaches for individuals.

7.2 Substance abuse, addictive behavior, and obesity

• Substance use for altering mood, cognition, or behavior has been common throughout history.

• Most substances, even seemingly harmless ones like coffee, can lead to dependence and withdrawal symptoms with prolonged use.

• Addiction is characterized by a compulsion to continuously use a substance to avoid discomfort and seek its effects.

• Addiction is not limited to drugs and can encompass behaviors like gambling, shopping, and internet use.

• The focus of the passage is primarily on nicotine addiction.

• Substance Use:

  • Involves the consumption or use of various substances, such as alcohol and nicotine.

• Substance Addiction:

  • Characterized by continued substance use despite awareness of associated problems.

  • Involves persistent desire and unsuccessful attempts to control substance use.

• Psychological Addiction:

  • Involves craving, a strong desire to use the substance.

  • Triggers for craving include situations associated with substance use, mood, and psychological state (e.g., after meals, during breaks, when feeling angry).

• Physiological Addiction:

  • Involves symptoms like tolerance (needing more of the substance for the same effect).

  • Withdrawal symptoms can occur if the substance is not taken, such as nausea, irritability, anxiety, difficulty concentrating, and increased appetite.

• Investigated Factors:

  • Biological Factors: Includes physiological aspects that might influence smoking behavior.

  • Psychological Factors: Involves mental and emotional aspects that drive smoking initiation, continuation, and cessation difficulties.

  • Social Factors: Pertains to the influence of the environment, society, and social circles on smoking habits.

Biological factors related to addictive behavior: smoking

• Nicotine's Effects:

  • The active ingredient in tobacco is a psychoactive drug.

  • Smokers intake around 1-2mg of nicotine per cigarette.

  • Effects include:

    • Stimulation of adrenaline release, increasing heart rate and blood pressure.

    • Stimulation of dopamine release in the brain's reward circuits leads to brief pleasure.

    • Acute effects wear off quickly, prompting smokers to continue for sustained pleasure and to prevent withdrawal symptoms.

    • Acts on acetylcholine receptors, prompting the brain to adapt by growing more receptors to maintain balance.

• Addictive Nature of Nicotine:

  • Research suggests nicotine is as addictive as heroin and cocaine.

  • Once addicted, smokers experience withdrawal symptoms without a consistent nicotine level in the body.

Cognitive and sociocultural factors related to addictive behavior: smoking

• Charlton's Study (1984): Found that young smokers associated smoking with fun and pleasure.

• Manipulation of Cognitions and Advertising:

  • Advertising agencies leverage cognition manipulation as a powerful tool.

  • People's self-image and beliefs are crucial; if one believes smoking is 'cool,' the likelihood of smoking increases.

• Social Learning Theory: Posts that smoking behavior is learned, influenced significantly by the social environment.

Prevention strategies

• WHO's Efforts:

  • On No Tobacco Day in 2008, WHO targeted children and adolescents to prevent smoking and raise awareness about the dangers of tobacco use.

  • WHO reports that two-thirds of countries lack sufficient information about the dangers of smoking, contributing to a lack of awareness.

• Impact of Advertising on Youth:

  • Consumer research indicates that tobacco advertising significantly influences young people's attitudes and behavior toward smoking.

  • Imagery, positive associations, and brand consciousness among youth contribute to the effectiveness of tobacco advertising.

  • Tobacco sponsorship, such as Formula One motor racing, has been linked to increased smoking initiation among boys (Charlton et al., 1997).

• Government Strategies:

  • Public health interventions and campaigns aim to prevent smoking and promote cessation among individuals.

  • Strategies include restricting or banning tobacco advertising, raising tobacco taxes, and implementing smoking bans in public places.

  • Various countries, including Scandinavian countries, the UK, Ireland, and the US, have adopted WHO's prevention strategies.

  • Research from Italy and Canada suggests that banning smoking in public places can motivate people to quit smoking and prevent relapse.

Treatments

• Nicotine Replacement Therapy (NRT):

  • NRT includes products like chewing gum, patches, and spray, which can help reduce nicotine dependence.

  • Nicotine gum, in particular, has been effective in preventing short-term relapse, serving as a valuable addition to treatment programs.

• Zyban (Bupropion):

  • Zyban, originally an antidepressant, emerged in the late 1990s as a smoking cessation aid.

  • It acts on brain receptors affected by nicotine, helping relieve withdrawal symptoms and blocking nicotine effects if smoking resumes.

• Tailored Treatment and Long-term Cessation Programs:

  • Research suggests that personalized treatments increase the chances of success in smoking cessation.

  • Long-term cessation programs have shown greater success in preventing relapse.

• Efficient Methods for Smoking Cessation:

  • Pisinger's (2008) research highlights that effective methods often involve consultations and participation in smoking cessation interventions, either individually or in groups.

  • Nicotine replacement therapies (like gum, patches, and spray) and Zyban are efficient, especially when combined with other interventions.

Factors related to overeating and the development of obesity

• Global Epidemic of Obesity:

  • WHO reports that obesity has become a worldwide epidemic, affecting over a billion overweight adults, with at least 300 million classified as clinically obese.

  • The prevalence of overweight individuals now surpasses malnutrition and hunger worldwide (WHO, 2004).

• Causes of Obesity:

  • Environmental factors, such as the availability of food, dietary fat intake, and lack of physical activity, are recognized as major contributors to the obesity epidemic.

  • Obesity stems from an imbalance between stored fat and energy expenditure used for physical activities and various bodily functions, including respiration and blood pressure regulation.

Physiological aspects of obesity

• Genetic Predisposition:

  • Body size tends to run in families, indicating a genetic link to obesity.

  • Having one obese parent increases the likelihood of obesity by 40% while having two obese parents raises it to 80%.

  • Research by Garn et al. (1981) suggested that thin parents have a lower chance (around 7%) of having an overweight child.

Sociocultural aspects of obesity

• Lack of Physical Activity:

  • Sedentary lifestyles with reduced physical activity, attributed to increased television viewing, use of computers, and decreased energy expenditure in work and transportation, have been linked to the rise in obesity.

• Caloric Intake and Decreased Physical Activity: Lakdawalla and Philipson (2002) estimated that 60% of weight gain was due to decreased physical activity, while 40% was attributed to increased calorie intake.

• Cultural Shifts and Dietary Changes: Traditional cultures, like Pacific Islanders, associated obesity with wealth historically but maintained traditional lifestyles, unlike modern sedentary patterns leading to obesity.

• Diet Composition: The fat proportion theory suggests that individuals consuming higher-fat diets are more likely to be obese due to the storage of fat rather than burning carbohydrates for energy.

• Socioeconomic Factors:

  • Socioeconomic status plays a role.

  • Individuals with higher education and wealth tend to eat healthier and exercise more, reducing the likelihood of obesity compared to those with lower socioeconomic status.

Cognitive factors related to obesity

• Dieting and Cognitive Restraint:

  • Dieting involves replacing physiological hunger with cognitive restraint and restricting food intake.

  • Cognitive restraint theory suggests that extreme dieting below hunger levels could lead to obesity as the body's hunger signals persist.

  • Chronic dieters, often obese, experience breaking their diets due to unrealistic goals, leading to feelings of loss of control and overeating.

• False Hope Syndrome and Unrealistic Expectations:

  • Obese dieters may set unrealistic goals and have overly optimistic expectations about rapid weight loss, expecting radical life changes.

  • The false hope syndrome explains how unrealistic expectations and unattainable criteria for success contribute to the lack of success in dieting and weight loss maintenance.

• All-or-nothing Thinking and the "What-the-Hell Effect":

  • Dieters guided by an all-or-nothing mindset tend to view minor slip-ups as major failures, leading to abandoning the diet and indulging in excessive eating.

  • The "what-the-hell effect" describes tendency for chronic dieters to overeat after a perceived failure, perpetuating a cycle of dieting and overindulgence.

Prevention strategies

• National programs focus on promoting healthy lifestyles, particularly regarding diet and physical activity.

• Prevention strategies emphasize healthy eating habits, requiring a balanced intake of macronutrients (fats, carbs, proteins) and micronutrients (vitamins, minerals).

• The key message is the importance of a varied and balanced diet for health.

Treatments

• Psychosocial Approach to Treatment: Treatment strategies integrate psychosocial elements such as diet modification, education on healthy living, exercise, cognitive restructuring, and relapse prevention.

• Components of Treatment Programmes:

  • Blair-West's treatment program in Australia involves:

    • 1. Realistic goal-setting aiming for gradual, long-term weight loss instead of rapid short-term results.

    • 2. A low-sacrifice diet emphasizing reduction without eliminating preferred foods. Individuals identify high and low-sacrifice foods, practice portion control, and eat high-sacrifice foods earlier in the day to prevent overeating.

    • 3. Incorporation of physical activity and exercise.

    • 4. Providing information on the health risks of being overweight and the benefits of weight loss.

Cognitive-behavioral therapy (CBT)

• Judith Beck's CBT-Based Programme:

  • Judith Beck developed a CBT-based weight loss program aiming to change thoughts and behaviors related to eating in obese women.

  • A pilot study conducted at the Beck Institute involved 10 obese women (weighing between 90-136 kilograms) who successfully lost weight and maintained it a year later.

  • Beck emphasizes targeting thoughts and beliefs contributing to overeating, focusing on "permission-giving beliefs" leading directly to excessive eating, such as eating when upset.

Drug treatments

• Weight-Loss Medication Overview:

  • Obesity is considered a chronic disease by the National Institute of Health in the US.

  • Weight-loss medication is recommended in combination with healthy eating and regular exercise programs.

  • Few studies have evaluated the long-term effectiveness and safety of these drugs, leading to concerns about potential overprescription.

  • Most drugs approved by the FDA are intended for short-term use but may be used for longer periods.

• Types of Weight-Loss Drugs:

  • Appetite Suppressants: These drugs reduce appetite or induce a feeling of fullness by increasing neurotransmitter levels affecting mood and appetite (e.g., serotonin and adrenaline).

    • They have shown some effectiveness but come with side effects such as nausea, constipation, and dry mouth.

  • Lipase Inhibitors: Act on the gastrointestinal system, reducing fat absorption and potentially causing unpleasant side effects, particularly after consuming high-fat meals, such as diarrhea. This could act as a deterrent to consuming high-fat foods.

• Study on Sibutramine (Appetite-Suppressant Drug):

  • Berkowitz et al. (2006) conducted a randomized trial involving obese adolescents (age range 12-16 years) to test sibutramine's weight reduction effects compared to a placebo.

  • 386 participants received sibutramine, and 130 received the placebo.

  • The study included counseling on dietary changes, increased physical activity, stress reduction, and monitoring food intake.

  • Participants on sibutramine typically lost weight (6.4kg), while those on the placebo usually gained weight (1.8kg).

  • Sibutramine users experienced rapid weight loss in the first eight months, maintaining weight thereafter. The main side effect reported was a rapid heart rate.

  • Approximately a quarter of the participants dropped out of the study, which lasted for one year only. There was no follow-up to assess the long-term benefits or potential harm of the drug, nor was weight change monitored post-study, making it challenging to determine if the weight loss was sustained.

Surgical treatments

• Surgical Options for Severe Obesity:

  • Gastric Bypass: Involves surgical reduction of the stomach size, limiting its capacity to absorb food. Typically performed through stapling or other methods.

  • Gastric Banding: This involves placing a band around the upper part of the stomach, restricting the amount of food the stomach can hold. This induces a feeling of fullness sooner.

• Effectiveness of Surgical Treatments (Meta-Analysis by Maggard et al., 2005):

  • Weight Loss: Surgical procedures resulted in substantial weight loss of approximately 20-30kg.

  • Long-Term Maintenance: Weight loss was sustained for up to 10 years after surgery.

  • Health Improvement: Patients experienced an overall improvement in health following surgery.

• Comparison between Gastric Bypass and Gastric Banding:

  • Maggard et al.'s meta-analysis indicated that gastric bypass surgery was more effective overall in achieving weight loss compared to gastric banding.

7.3 Health Promotion

Health Belief Model (HBM)

• Development and Purpose: Rosenstock (1974) developed the HBM to predict engagement in healthy behaviors aiming to prevent disease or its progression.

• Fundamental Predictions:

  • Perceived Threat: Individuals will act if they believe that a negative health issue (like lung cancer due to smoking or diabetes due to obesity) can be avoided by taking recommended action and if they perceive this health threat as serious but relevant.

  • Cost-Benefit Analysis: Engagement in healthy behavior depends on weighing perceived benefits against perceived barriers. These barriers may include financial, physical difficulty, or social impacts of behavior change.

• Key Factors Considered in the HBM:

  • Perceived Threat: Recognizing the seriousness of potential health issues.

  • Cost-Benefit Analysis: Weighing the pros and cons of behavior change.

  • Self-efficacy: Confidence in one's capability to perform a specific action. Self-efficacy influences motivation, perception, and performance.

• Influence on Health Behavior:

  • Perceived Threat's Role: Research supports that perceived threat influences health behavior. External cues, such as fear-arousing information, play a vital role (e.g., anti-smoking campaigns).

  • Self-Efficacy: Bandura (1977) highlighted the importance of self-efficacy beliefs as predictors of an individual's perceived capability. It's based on past achievements, observations of others, social persuasion, and emotional states monitoring.

Criticisms of the Health Belief Model (HBM):

• Focus on Individual Cognitions: The HBM primarily concentrates on individual cognitive factors, omitting emotional, social, and economic influences that significantly affect health behaviors.

• Measurement Challenges: Some concepts in the HBM, like perceived vulnerability, are challenging to measure or standardize.

• Assumption of Rationality: Criticized for assuming individuals always act rationally, disregarding instances where people are irrational in their health decisions.

• Unrealistic Optimism: People might be unrealistically optimistic about their health risks, leading to underestimation of personal susceptibility to health problems.

• Perception of Health Risks: Research suggests that even with awareness of health risks, individuals might still engage in risky behaviors due to a belief in personal invincibility.

Unrealistic Optimism and its Factors (Weinstein, 1987):

• Belief in Delayed Onset: If a problem has not occurred yet, individuals tend to believe it's unlikely to happen in the future.

• Belief in Preventative Action: People think their actions can prevent potential health problems.

• Belief in Rarity: Assuming that the problem is rare, leading to the belief that it's less likely to happen.

• Limited or No Personal Experience: Lack of direct experience with the health issue contributes to underestimating the risks associated with it.

Theory of Cognitive Dissonance (Festinger, 1975):

• Basic Assumption: People strive to maintain cognitive consistency and minimize psychological discomfort (dissonance) when faced with conflicting beliefs or behaviors.

• Attitude-Relevant Information: Dissonance theory predicts that individuals are motivated to:

  • Attend information supporting their existing beliefs.

  • Avoid or ignore information contradicting their beliefs to prevent cognitive dissonance.

Effects of Cognitive Dissonance:

• Selective Attention: People tend to focus on information aligning with their beliefs and avoid contradictory data. For instance, someone who enjoys smoking may overlook negative consequences and focus on the perceived positive aspects (like relaxation).

• Risk Perception: Studies, such as McMasters and Lee (1991), suggest that smokers, non-smokers, and ex-smokers have similar factual knowledge about smoking risks. However, smokers tend to underestimate their personal risk compared to the average smoker, possibly due to cognitive dissonance.

• Role in Attitude Change: Cognitive dissonance plays a role in altering attitudes, notably in anti-smoking campaigns. Strategies to manage dissonance involve discrediting the source of conflicting information, selective attention, or reinterpretation of information to reduce its impact.

Criticisms of Cognitive Dissonance Theory:

• Neglect of Emotional/Social Factors: Criticized for focusing solely on cognitive aspects and neglecting emotional or social influences in decision-making.

Stages of change model

Stages of Change Model (Prochaska et al., 1982):

• Precontemplation: Not actively considering quitting an unhealthy behavior.

• Contemplation: Aware of the issue but not committed to change.

• Preparation: Seriously considering change, making initial attempts or adjustments.

• Action: Taking steps to alter the behavior.

• Maintenance: Sustaining the new behavior and preventing relapse.

Insights from Studies Regarding Stages of Change:

• Smoking Cessation and Stages of Change (Prochaska et al., 1991):

  • Participants in the preparation stage smoked less, were less addicted, had higher self-efficacy, perceived higher costs of smoking, and had more quitting attempts.

  • Indicates that interventions targeting readiness to change can predict successful smoking cessation.

• Weight Loss in Women (Hawkins et al., 2001):

  • Women in the preparation stage viewed weight loss positively and were more likely to consider it.

  • Friends' opinions about weight and a positive attitude toward weight loss were important predictors of change.

• Challenges to Stages of Change Model (West and Sohal, 2006):

  • West and Sohal challenge the model by suggesting that many ex-smokers report quitting without prior planning.

  • Found unplanned attempts to quit were more successful for at least six months than planned attempts.

  • Propose a "catastrophe theory" suggesting smokers might react immediately to environmental cues, resulting in a more complete and sudden transformation compared to planned quitting.

Health promotion strategies - are they effective?

Health Promotion Strategies:

• Definition by WHO (1986): Health promotion involves empowering individuals to control and improve their health.

• Challenges in Behavior Change:

  • People often engage in conflicting behaviors (e.g., healthy eating and exercising while smoking to control weight).

  • Behavior change might be successful initially but relapse can occur.

  • Socioeconomic factors like education level impact behavior change likelihood.

Approaches in Modern Health Promotion Activities:

• Health Education Programs: Raise public awareness about health risks and encourage behavioral changes (e.g., media campaigns on obesity and smoking risks).

• Public Health Campaigns: Aim to alter beliefs, attitudes, and motivations (e.g., informing smokers about hazards and cessation methods).

• Changing Determinants of Health: Altering environmental factors to promote healthier choices (e.g., creating more exercise facilities, altering physical environments to encourage physical activity).

• Health Services: Providing services aiding behavior change (e.g., family doctors, smoking cessation clinics).

• Political Interventions: Implementing legislation (e.g., imposing bans on smoking, setting food standards in schools, altering taxes on unhealthy foods).

Health campaigns

Effectiveness of Health Campaigns:

• 1. Role of Health Campaigns: Health campaigns are seen as beneficial but should be a part of a holistic health promotion strategy.

• 2. Denmark's Campaigns on Food Habits:

  • Campaigns targeting food habits showed increased awareness and behavioral changes (e.g., reducing butter usage on Danish sandwiches).

  • Long-term campaigns contribute to enhanced knowledge and motivation for healthier habits.

• 3. Success Factors in Health Campaigns:

  • Effective campaigns address individual, community, and governmental levels for obesity prevention.

  • Media campaigns should be supported by local activities to facilitate habit changes.

• 4. The 'VERB' Campaign (US):

  • Aimed at children aged 9-13 for daily physical activity.

  • Survey showed increased awareness and physical activity among children aware of the campaign.

• 5. Anti-Tobacco Campaigns (Florida, US, and UK):

  • Strategies included confronting the tobacco industry and emphasizing a youth movement against smoking.

  • Surveys and follow-ups showed significant reductions in teen smoking and influenced non-smokers to remain smoke-free.

  • Similar successes were observed in anti-smoking TV advertisements in the UK.

Holistic Approach to Health Campaigns:

• Health campaigns are part of a broader health promotion project.

• They establish norms, create awareness, and contribute to behavioral change.

• Campaigns should align with daily life practices for effectiveness.