Week 1: Defining Health, Promoting Healthy Behaviour Change, and Evaluating Health Information

Study Questions:

1. What are the key characteristics of the medical model of health? - health defined as the opposite of illness, absence of disease and/or disability - when patient returns to neutral state, intervention is stopped - doctor is viewed as all-knowing; patient is dependent on doctor - focus on retroactive treatment 2. Compare and contrast the wellness model and the risk factor model of health. - risk factor model: mortality (& morbidity?) rates linked to various risk factors, variables that are associated with increased risk of developing a disease -> focus on proactive prevention - wellness (holistic) model: combine both treatment and prevention from medical and risk factor models, but also considers additional factors that affect health, such as social, mental, occupational, emotional , environmental, and spiritual health 3. Name and briefly describe the seven dimensions of health. - physical health: body functioning, susceptibility to disease or disorders, also ability for daily functioning (e.g. getting out of bed, off the toilet) - social health: capacity for satisfying interpersonal relationships, interacting with others and adapting to various social situations - mental health: capacity to think clearly, reason objectively, analyze critically and use brain to effectively meet challenges in life - occupational health: satisfaction from ones own career or stage of career development; as well, a balance between work and leisure - emotional health: ability to effectively and appropriately express emotions - environmental health: appreciation of the external environment and ones own role in preserving, protecting and improving it - spiritual health: health of the deepest or innermost part of you

4. Many different factors influence health. Brainstorm a list. Now group each of these based on the seven dimensions of wellness. Identify the ones that are within your control to change in order to improve your health. 5. Define mortality, morbidity, and preventable years of life lost. - mortality: death rate stats - morbidity: illness rates - life expectancy: number of years an individual is expected to live, calculated from a specific age (e.g. birth) - preventable years of life lost: life expectancy age at death = PYLL 6. Explain why cardiovascular disease accounts for a high percentage of premature deaths and a low percentage of PYLL, while the opposite is true for accidents. - consider that accidents is more preventable than cardiovascular disease, especially in premature deaths - the PYLL calculated for those killed by accidents is considerably higher (life expectancy is higher) than those who were killed by cardiovascular disease 7. What four supports are required for a successful health promotion program? Give practical and specific examples of each one. - educational supports: promote learning - organizational supports: programs and services that encourage participation - environmental supports: rules governing attitudes and behaviors and which also support decisions to change - financial supports: monetary incentives to motivate healthful decision making 8. Differentiate between primary, secondary, and tertiary prevention. Give a specific example of each type. - primary prevention: measures made to prevent health problems from occurring (e.g. engaging in regular physical activity) - secondary prevention: early recognition of a health problem and intervention to eliminate or reduce it before more serious illness occurs (e.g. modifying diet and physical activity levels in response to a bloodcholesterol or blood-glucose test) - tertiary prevention: treatment made after a person has become sick (misnomer, retroactive response) 9. Outline the health benefits to choosing healthy behaviours as listed by your text. - reduce risk for cardiovascular disease, cancer, major diseases; increase lifespan; improve quality of life; greater energy levels; stronger immune system; improved self-confidence, self-concept, self-esteem, selfefficacy; enhanced relationships due to better communications and quality time etc.

10. What health behaviours identified by your text show a significant relationship to increasing longevity? - getting goodnights sleep, maintaining healthy eating habits, maintaining weight, participating in regular physical activities, regular brushing of teeth, avoiding tobacco products 11. Differentiate between the concepts of "years added to life" and "life added to years". What behaviours are associated with the latter? 12. According to the article "Four Simple Habits add 14 Years to Life", what are the four habits? Briefly describe the studies that led to these conclusions. - Not smoking, Drinking moderately (1-14 drinks/week), Keeping physically active, Eating five servings of fruits and vegetables daily - longitudinal cohort studies: examine the risk of mortality in individuals with either none or combo of the 4 habits 13. Explain what predisposing, enabling, and reinforcing factors are. Give an example of each one and how it influences behaviour. - predisposing factors: factors that are likely to lead to a particular behavior (e.g. include age, sex, ethnicity, income, family, education) -> e.g. if your parents smoked, youre 90% more likely to start smoking - enabling factors: skills or abilities, physical, emotional and mental capabilities, and resources and accessible facilities that make health decisions more convenient or difficult (i.e. positive or negative enablers either encourage to carry through with your intentions or work against your intentions to change) -> e.g. membership fee of fitness centre is $1000, can be a negative enabler - reinforcing factors: refer to support and encouragement or discouragement that come from significant others or situations in your life that enable a particular behavior you have chosen -> e.g. you decide to stop smoking but your family and friends smoke in your presence 14. Explain the key principles of the Health Belief Model of behaviour change. What factors must support a belief in order for change to be likely? What factors are linked to the perceived risk of health problems? Use an example such as cessation of tobacco use or promotion of condom use to demonstrate how this model is used. You may find using the figure of the Health Belief Model provided by your text helpful in answering these questions. - In order for change to be likely, belief must be supports by the following factors: perceived seriousness of the health problem, perceived susceptibility to the health problem and cues to action (reminders or alerts about a potential health problem) - 3 factors linked to perceived risk for health problems are: demographic variables (e.g. age, sex, ethnicity), sociopsychological variables (e.g. personality traits, social class and pressure), structural variables (e.g. knowledge about or prior contact with the health problem) - Person positively affected by the 3 factors for perceived risk for health problems sees risk of seriousness

and susceptibility to lung cancer - cues from media campaigns also increase his perception that there is threat of lung cancer - there are few environmental barriers (his family/friends support the change) 15. Discuss the theory of reasoned action and how it relates to behaviour change. Use specific examples to support your explanation. - theory of reasoned action: behaviors result from our intentions to perform actions - the intentions are a result of our attitude toward a certain action and our beliefs about what others may want us to do; a behavioral intention is a stated commitment to perform an action - the more consistent and powerful your attitudes about an action and the more you are influenced by others to take that action, the greater will be your stated intention to do so (e.g. encouragement to get more active, from noticing that your body is weak and your friends advice) 16. Briefly describe each of the following behaviour change techniques: shaping, visualizing, modelling, controlling the situation, reinforcement, and self-talk. Provide a specific example of how each might be used to promote behaviour change related to health. - shaping: design a number of individual steps, where each addresses a change of one small part of overall behavior - visualizing: mental practice and rehearsal of a planned action ahead of time - modeling: learning behaviours by carefully observing other people - controlling the situation: putting yourself in the right setting or with the right group of people - reinforcement: reward yourself, include incentives (can also come from others) - self-talk: give self-instructions and positive affirmations to yourself rather than having negative self-talk 17. Describe the steps in analyzing a behaviour you wish to change. - examine that frequency of the behavior, the duration of the behavior, the seriousness of the behavior, the basis for the problem behavior and the antecedents or triggers to the behavior 18. What decision-making skills are described by the acronym DECIDE? Describe how these skills can be applied to changing alcohol use. - Decide in advance what the problem is (define the problem beforehand) (e.g. decide that drinking is not for you) - Explore the alternatives (drink a little or a lot? or drink something else) - Consider the consequences (e.g. positive and negative consequences for the alternatives) - Identify your values (base your decisions on your values) - Decide and take action - Evaluate the consequences, in retrospect 19. Describe the goal-setting method of SuPeR SMART. Describe how these skills can be applied to changing participation in physical activity.

- Self-controllable: goals my be within your control - Public: make your goal visible or known - Rewards: reward yourself for reaching short and long term goals (rewards should not contradict goal) - Specific: goals should be clear and precise (e.g. 15 min of high-intensity running, i.e. talk test) - Measurable: goals should be measureable; you know when u have achieved it - Adjustable: goals should be flexible (life can be unpredictable; you may fall behind because of some thing) - Realistic: goals must be realistic - Time-based: goals should be quantifiable and include a specific date or timeline for achievement 20. Outline the steps in the scientific method. - 1) Define the problem - 2) Formulate a hypothesis - 3) Test with experiments and data - 4) Interpret Data (*to further investigate, circle back to step 1) - 5) Develop theory based on duplicate results 21. What is an epidemiological study? Name the three different types of epidemiological studies and outline the strengths and weaknesses of each one. - epidemiological study: investigate the overall risk of a kind of disease within a specific population(s); there are three types - ecological study: study at the population level; can indicate direction for further in-depth studies; however, cannot prove cause & effect - cohort study: gather data on a large group of participants & follow the group over many years; can keep track of people (e.g. diets) and not have to wait for disease to appear first; to be effective, groups must be extremely large and follow-up must be a long period of time - case-control study: study group of people with disease and group without (control); can be costeffective way to study disease, with the proper controls; may depend of self-report, which can be fallible 22. What criteria are used to assess the potential for a causal relationship? - strength of association: stronger the association, the greater potential there may be for causality - dose response: examine relationship between increasing one variable and the change in the other variable (increase hot dog consumption more, leukemia risk also increase?) - consistency: repeated observation of the same result in varying conditions (e.g. different city population) - temporal correctness: one variable has to be within reasonable timeframe as other (e.g. eat hot dog within close enough time period to have effect) - specificity: there are many contributing factors so will removal of the factor of interest also remove the effect?

- biological plausibility: is there biological plausibility of a causal relationship between the two factors (esp. with disease)

23. What are laboratory studies? Describe the two types and the strengths and weaknesses of each. - lab studies: make small defined changes in test subjects and compare the various outcomes - in vitro: studies performed in test tube; are tightly focused and can have appropriate controls easily; however, not sure whether results are applicable in the real body - in vivo: test in living organisms; however, when using model organisms, do not know if results carry over to humans 24. What is a controlled trial? Define a blind and double blind study. What are the strengths and weaknesses of controlled trials? - controlled trial: dont just observe, also add small changes to two large groups (one is intervention group, other is control group) - Blind means that participants dont know if they are in the intervention or control group; double blind means experimenter and participants dont know if participants are in intervention or control group - avoid a lot of bias that can be found in other studies and allow scientists to keep tight control over other factors - Not sure if trials are done for long enough time; esp. with the development of disease - also may be difficult to keep the participants blind; people might be able to find out if they are in treatment group 25. What is a meta-analysis? - meta-analysis: combines findings of many different studies and examines the total results using statistical methods 26. Identify 10 characteristics that are signs of health fraud. - claims a quick cure-all or diagnostic tool for a wide variety of diseases - suggests that a product can treat or cure a disease - use words such as scientific breakthrough, miraculous cure, secret ingredient - use impressive-sounding words (e.g. hunger stimulation point, thermogenesis) - undocumented case histories by consumers or doctors claiming amazing results - limited availability and advance payment requirements - promises no-risk, money back guarantees - promises an easy-fix - claims that a product is natural or non-toxic 27. What questions should you consider when evaluating health information on the internet?

- Ask: who runs website? - what is purpose of website? - what is original source of info? - how is info documented on the website? - how is info reviewed before it is posted on the website? - is there contact info? 28. How does the US federal government protect consumers from false or misleading claims posted on the Internet? - FDA regulates drugs and medical devices to ensure they are safe and effective; also provides various resources